Thanks to Dr Minda Gold for covering during my appendectomy

As some of you are aware, I wasn't available suddenly yesterday. Thanks to the wonderful nursing staff at the PenBay ED and surgery department and Drs. Campa and O'Brien, I'm now very happily without an appendix after it started causing trouble late Sunday.

While I'm on strict orders to stay home this morning, I expect to be back at the office very soon. Thanks also to Doctor Gold of Full Circle DPC who was as kind enough to cover urgent issues yesterday.

Jen Overlock is covering our phones as usual and I'll be available via her or directly by portal message today.

Posted on August 15, 2017 .

We have a medical student with us for three days this week

We're very excited to have a first year medical student from Tufts University School of Medicine joining us today for a three day clerkship where she gets to see family medicine first hand.  Tufts has a program in which students from Maine spend a lot of time studying medicine at locations here in Maine.  Hopefully this will provide Maine with a steady supply of new physicians in the years to come.

Allowing the medical student to sit in on your appointment is optional for patients.  She's bound by the same privacy rules as Jen and me but you're under no obligation to have a student present during your visit.

Posted on July 31, 2017 .

Conference

Members Please Note:

Dr. Pierce will be out of the office June 15th & 16th (Thursday & Friday) to attend a conference in Washington D.C. Jen will be available by phone during our regular office hours for any questions and to help coordinate with our physician on call if you have urgent concerns and need to be seen. Dr. Pierce will be back in the office on Monday, June 19th. 

Posted on June 12, 2017 .

Some of you have wanted to call at night and just leave a message for Jen to hear in the morning.  We figured out how to add that.  You can also reach me for urgent issues like always.

During the day, the phone simply rings through to the office as before.

https://commons.wikimedia.org/wiki/File:Switchboard_Staff,_1979.jpg

Posted on March 22, 2017 .

Telephone Upgrade

I was going to post something this weekend about our new phone upgrade.  Our old phone system had some quirks that caused some annoyances for patients.  The new system has resolved these and adds some additional improvements. 

However, a minor glitch caused problems for folks trying to call us this morning.   Our new phone company fixed this quickly and the phones are ringing again.  If you had trouble reaching us this morning, we apologize but you can call us now.

Posted on August 18, 2016 .

Summer Heat Has Arrived - Prevention of Heat Stroke and Heat Exhaustion

The lazy, hazy days of summer are in short supply in Maine, but when they arrive, most of us break a sweat!  However, the heat can be too much for some and the Center for Disease Control and Prevention has helpful guidelines to keep us healthy until the leaves begin to color!  Stay hydrated and seek out shady locations for your outdoor activities.  Check out the CDC message here http://emergency.cdc.gov/disasters/extremeheat/faq.asp

Posted on July 13, 2016 .

Primary Care treatment of opiate addiction

As most of you know, we have a terrible addiction problem, both nationwide and especially here in Knox County where we have the second highest overdose rate in Maine.  

We've generally treated addiction as a moral failing or as a poor choice using abstinence only and twelve step type methods to combat it.  While this has helped a few patients, the data show this is rarely successful.  We have much better success at getting patients with addiction back to stable lives by controlling their cravings for opiates with regular controlled doses of clean prescribed opiates.  Combining this with counseling to work on changing harmful behaviors and rebuilding lives is helpful.

While methadone gets most of the press and political attention, buprenorphine (Suboxone) is a much better option for many patients.  Primary care physicians are allowed to prescribe this in their offices after taking a short course and getting special permission from the DEA.  Buprenorphine is an addictive opiate itself but has unique properties that make it much safer and very useful for this type of treatment.  

At Megunticook Family Medicine, we now offer a small addiction program with Amy Barnett, a Rockland substance abuse counselor with years of experience.  By combining individual and group counseling with frequent physician monitoring of buprenorphine to control cravings, we hope to taper most patients off opiates over two years.  

Like the rest of our Direct Primary Care practice, we've worked hard to make this affordable to most patients.  Addiction treatment requires far more labor and testing resources when done properly so we are offering this as a separate, additional service.  Since we don't have the costs and hassles of billing insurance companies, we can offer addiction treatment for a lower out of pocket cost to our high deductible policy and cash patients than insurance oriented practices.  For those with (non-HMO) insurance or Mainecare most prescriptions and out of office tests are usually covered but check with your insurer.

For more information about this new service or Direct Primary Care in general, call us at 207-390-8570 or email us at answers@megunticookfamilymedicine.com.

Posted on February 28, 2016 .

Health Care Sharing Ministries

I've been trying to find the time to thoroughly research these alternatives to health insurance but the end of the year is nearly here so posting some references and a brief introduction to these will have to suffice for now.   

While we don't require patients to have any insurance to join our practice, we recommend a high deductible policy or some other means to protect against large medical expenses as well as the ACA (Obamacare) tax penalty.   However, a large minority of our patients still find their insurance options too expensive and don't even have catastrophic coverage.  The Health Care Sharing ministries are a less expensive alternative to insurance that provides some cost protection and four of them are reported to meet the requirements for avoiding the ACA tax penalty.

So far, we have a handful of our patients who use these these ministries but our experience with them at this point is limited.   They are not insurance policies and differ from insurance in how they are regulated and how (and which) medical expenses are reimbursed.  They don't restrict patients to narrow provider networks like HMO insurance plans. Most of these seem to require members be Christian but one, Liberty Health Share, has liberalized its membership criteria to a broader set of beliefs and is not restricted to Christians.

Alaska Public Radio Nov. 2015

US News and World Report 2014 article

A 2013 NPR story about Medi-Share

 A Feb. 2015 progressive opinion from the NY Times

Wikipedia

An article about CMF Curo, a Catholic version of these

CMF Curo

A critical 2011 Consumer Reports article quoting former Maine Supt. of Insurance Mila Kofman

 

 

Posted on December 26, 2015 .

2015 Holiday Office Hours

We are taking some time off to spend with our families for Christmas and New Years. As always, Dr. Pierce is available by phone for urgent concerns after office hours. 

Have a Merry Christmas and a Happy New Year!

Posted on December 23, 2015 .

Our local physician shortage

Village Soup, our local online and print newspaper, has discovered that there is a local shortage of primary care physicians and contacted a hospital administrator and two state legislators in researching an article and editorial published this week.

Lest those of you that don't have a subscription to Village Soup miss out on my opinion, this is the text of my online comment about their editorial:

It's disappointing to see Village Soup investigating a local primary care physician shortage and publishing an article and an editorial without apparently contacting any physicians.

As a local family physician for over 13 years who has recruited several other physicians to the area, I have more recently both contributed to the local physician shortage and offer a likely solution with my recent change in practice.

The problems that have led to the primary care physician shortage have been affecting us local physicians for years.   Commercial and government third party payers talk about the importance of primary care while steadily increasing their demands and shifting payments towards procedures.  As a result, many primary care physicians have retired early, others have given up their practices and retreated to the apparent shelter of large hospital systems that can charge facility fees or shift money from profitable tests and procedures to primary care clinics.  The rest of us worked smarter, harder and longer to sustain our practices with varying success.  Medical students and resident (trainee) physicians are well aware of all this and most avoid primary care.

However, primary care is undergoing a growing renaissance in many parts of the country.  Direct Primary Care is an affordable version of the high priced concierge practices enjoyed by the wealthy.  Direct Primary Care cuts out the middlemen and greatly simplifies the business of primary care for physicians, allowing them to lower prices back to levels affordable by almost all patients while giving those patients great access to their own physician.  Most importantly for this discussion, Direct Primary Care sustains successful practices that are drawing young physicians back to primary care. While Maine lags behind other areas of the country in this, Maine will soon have its seventh independent, direct primary care practice this winter.

The prescription to solve the primary care shortage does not require new government programs or further expansion of large hospital networks but simply the two groups that have lost the most in the current primary care mess, Maine physicians and patients.

Brian Pierce MD

Megunticook Family Medicine

Rockport

Posted on December 4, 2015 .

Pill Splitting

The Skeptical Cardiologist blog recently posted a good discussion of this common tactic for cutting the cost of prescription medications.

I find patients don't need to do this as often as they did ten or twenty years ago, mainly because so many inexpensive generic medications are now available.  Also, some pills shouldn't be split because it disrupts a time release or protective coating or because their size or shape makes them difficult to split.  If in doubt, check with your pharmacist.

Currently, one of the few tablets that my patients split is chlorthalidone.  This is a less well known but often very effective thiazide diuretic usually used to treat hypertension.  Generic chlorthalidone is quite inexpensive but doesn't come in a small dose tablet and many patients only need a half tablet daily for good blood pressure control.

 

Picture by Steven Fruitsmaak   dual licence GFDL and cc-by-sa-2.5 and earlier

Posted on August 11, 2015 .

Back to school and sports physicals

Children waiting for smallpox vaccinations and pre-school examinations (Virginia 1943).

Children waiting for smallpox vaccinations and pre-school examinations (Virginia 1943).

Time to think about scheduling physicals!  Area public schools require students to have a an up-to-date physical on file with the nurse, dated no earlier than one year prior to beginning at that school. Schools with athletics programs require that athletes have an up-to-date physical on file with the school nurse before they can participate in any sport.  Every August, as sports schedules and tryouts are announced, and 6th and 9th graders enter new schools, families scramble for appointments and endure weeks-long waits for a physical with their primary caregiver.  At Megunticook Family Medicine, our Direct Care practice has appointments available now!  Patients who enroll at Megunticook Family Medicine have an annual physical included with their membership fee, and our convenient office hours ensure our patient athletes will not miss a minute on the pitch, course or playing field.

Links for school requirements or forms:

Camden Hill Regional High School

MSAD 28 (Camden and Rockport)

Union 69 (Hope, Appleton and Lincolnville)

RSU 13 schools

MSAD 40 schools

 

This is also time for children with asthma to review their asthma action plan with their physician.  Children who will need asthma medication available during the school day should discuss their action plan with their primary caregiver and provide that plan, with any medications, to the school nurse.   Scheduling an appointment and preparing the plan before school begins will provide a smooth transition and familiarize the student with their nursing office, particularly if they are new to the school.

Posted on August 9, 2015 .

It's not just Lyme Disease

Lyme Disease continues to be very common in the Midcoast Maine area but we're seeing anaplasmosis and other tick-borne diseases more frequently.  Knowing how to prevent tick bites and considering tick-borne diseases when symptoms occur continues to be important.  The CDC has useful information on its web site and even an iPhone, iPad and Android app for this.

Concierge practices, MDVIP and Direct Primary Care

A local TV station reported recently on several Maine physicians who joined Florida's MDVIP franchise. A lot of people get concierge medicine practices such as MDVIP confused with Direct Primary Care.  Both give patients great access to their own physician and unhurried appointments.  Concierge practices tend to be more expensive and many charge insurance copays and deductibles on top of their membership fee.  Direct Primary Care is simpler and less expensive because it removes the insurance middlemen, often saving money, especially for those on high deductible plans and the uninsured.

Posted on July 26, 2015 .

Coffee

I often get asked about the risks or benefits of coffee.  In some patients, caffeine can worsen heartburn, anxiety, palpitations, insomnia, seizure risk or tremor.  For most of us though, studies show marginal effects on health with moderate consumption.  As they say on the TV ads for expensive medications, ask your physician.

Health News Review explains how coffee studies are common examples of how the media frequently misreport observational studies and hype insignificant findings.

 

 

 

 

Posted on July 2, 2015 .

Closed for Memorial Day

The office will be closed on Monday for Memorial Day, but Dr. Pierce will be available by phone for any questions or acute problems. 

Have a great weekend!

Posted on May 22, 2015 .

A working vacation

I've been moonlighting as a hospital physician at two Maine hospitals while we get Megunticook Family Medicine established.  One of them is having a bit of a manpower shortage right now and I'll be busier than usual there for the next week.  This will not be a recurring issue as I've already made some significant adjustments to my schedules after this month.

I'm going to take the next week as a working vacation.  What that means is I will be available by phone but we'll schedule any routine follow up, new patient and physical exam appointments after next Wednesday 5/12.  We'll handle urgent issues on a case by case basis as always.  Jen Overlock will be here and available to help as usual.

I'm grateful to be able to work as a hospital physician while getting the practice off the ground and to help the hospitalists by filling in when needed.  However, my priority continues to be Megunticook Family Medicine and my patients.

Posted on May 7, 2015 .