Back to school and sports physicals

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.

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.

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!

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.

Did you know we offer Commercial Driver's License (CDL) and U.S. Coast Guard Merchant Mariner medical evaluations?

While our focus is Direct Primary Care (DPC), we also offer Commercial Driver's License (CDL) exams and U.S. Coast Guard Merchant Mariner medical evaluations.  

For our own DPC patients, these are inexpensive visits costing only our $20 scheduling fee.  For non-patients, we offer these exams for a $200 fee which includes office testing such as urine dipstick testing and an EKG, if needed.  Urine drug testing for the Coast Guard exam, however, must be done at an approved drug testing facility.

With quick access, early morning and evening hours we can get your CDL or merchant mariner exam done promptly and conveniently.

It's tick season again

While it's great that winter has finally ended and flu season is winding down, it's already time to take steps to prevent Maine tickborne diseases such as Lyme Disease, anaplasmosis, ehrlichiosis and others.  The deer (Blacklegged), Dog and Lone Star ticks are already out there and the spring nymph form of the deer tick is quite small and easily missed.

Some simple precautions when outside in the yard or the woods can reduce your risk.  Check yourself, your children and pets for ticks daily.   Lyme Disease is not transmitted immediately so removing a deer tick within 24 hours greatly reduces that risk.  In some cases, a dose of antibiotic may be considered to prevent Lyme Disease if a deer tick has been attached for 24 hours or more.  Check with your physician promptly as this should be done within 72 hours of removing the tick to be effective.

Most people know about DEET for keeping ticks, black flies and mosquitoes from biting exposed skin but fewer are familiar with permethrin for treating clothing.  You can buy clothing pre-treated with permethrin or treat your own clothing (NOT skin) following the manufacturer's instructions.  This usually remains effective through several washings.  Here in Rockport, Maine Sport Outfitters has permethrin clothing spray in stock in the camping section but most of the other local outdoor sports stores also had it when I've checked in the past.

Patients often bring in ticks that they've removed.  While this can help us decide if it's a deer tick, testing the tick for Lyme Disease is not usually helpful.

Finally,  Lyme Disease and the other tickborne diseases in Maine can present with a wide variety of symptoms.  You should check with your physician if you or a family member have symptoms during tick season such as rash, fever, a flu like illness, new joint problems, severe headache or neurologic changes, enlarged lymph nodes or other unexplained symptoms.

Patient Surveys

Now that we've been open for three months, we feel it's time to start getting more formal feedback from patients.   While there are plenty of complex (and expensive) surveys used for this by hospitals and the insurers, we're keeping it simple for now.   Jen created our own anonymous survey asking the questions we're interested in as we continue to refine the practice.

We sent these out to those of you that have signed up for the patient portal (which I highly recommend you try) and we're also giving out paper surveys to those of you we see at the office this month.  If you haven't received a survey yet and would like one, let us know.

So far the results are reassuringly positive.  Patients like the direct primary care model once they understand how it works and try it out.  Even without the survey, we've noticed that new patients are referring others to our practice.

While this survey helps us plan how to improve our growing practice, eventually we'll also look at some survey tools that help patients review their health care such as Dartmouth College's How's Your Health.

Sinusitis treatment

NPR recently broadcast a story about sinusitis treatment.   Acute sinusitis or sinus infections are fairly common, but there are a lot of misconceptions about how to treat it.

The new treatment guidelines cited by NPR continue to downplay the role of antibiotics since most patients with sinusitis eventually get better without antibiotics and antibiotics don't seem to shorten the illness in many cases.  

As needed nasal saline flushes seem helpful for relieving sinus pressure due to poor drainage.  I learned this trick from a wonderful navy ENT (Ear Nose and Throat) surgeon in Japan where patients with chronic sinusitis would have to wait months for the ENT surgeon to visit our base.  There are not many studies on this for acute sinusitis treatment but it is commonly recommended and is an inexpensive, if somewhat annoying, treatment. Some very rare infections were reported from doing this with infected tap water recently so using sterile water to make the saline isn't unreasonable. 

Avoid using nasal decongestant sprays for more than three days as that can cause problems.

Some patients develop complications or have a different problem and not sinusitis.  NPR quickly added a clarification to their story that includes "Signs and symptoms such as worsening headaches, visual problems, changes in mental activity, facial swelling and progressive fever can indicate impending complications."    

Don't make medical decisions based on something you read on the internet, including this.   If you have questions about possible sinus symptoms, call your primary care physician or get examined.  If your physician won't answer your questions without an appointment or it's difficult to get a prompt appointment, consider Direct Primary Care.

Saving money on prescriptions

Prescription medications are a big part of many patients' health care costs.  In many cases, patients can reduce their out of pocket costs with some medication changes and some shopping around.

The Walmart $4 medication list and the  Hannaford Healthy Saver plus program are fairly well known.   Even if a particular medication is not on these lists, physicians can often substitute an equivalent generic medication and the savings can be considerable.  

For other medications, there are several other options.   Calling around to several local pharmacies usually finds lower prices.  Interestingly, more than a few patients have reported they get a lower price if they don't give their insurance information to the pharmacy; the cash price is lower than their insurance copay.

Several free discount cards are available that can help.  I've only had limited experience with these but a few of my patients have reported big savings on an expensive medication this way.  One of these patients used the Maine Rx card offered via the Maine Medical Association.  (Disclosure- I'm a director of the MMA.)

For the really expensive medications with no generic alternatives, the various drug companies offer some limited prescription assistance.  The Prescription Assistance Program at the Knox County Health Clinic in Rockland can help uninsured patients with limited financial needs navigate these complicated programs.

Finally, many Direct Primary Care practices have had success with getting wholesale medication pricing for patients.  We're looking into this to see how often and how much we can save for our patients this way.

Finding better prices for medical care

For high deductible and uninsured patients, the price of medical visits, tests or procedures has a huge impact on their family finances and their care. However, finding these prices is a problem despite state and federal efforts to improve cost transparency.

One of these efforts, the Maine Health Data Organization (MHDO), publishes average costs at big Maine facilities.  Per MHDO, "Research shows that there is no correlation between cost and the quality of the services provided, yet costs can vary widely across the state."

In our experience, the MHDO website is mainly useful to get a ballpark estimate prior to shopping around for care.  It omits many smaller facilities that offer competitive pricing and cash discounts for same-day payment.  Furthermore, MHDO doesn't list actual prices, only the average cost paid in the recent past. We've found the "sticker price" at many facilities to be far above the past average cost. 

As a Direct Primary Care practice, we work hard to make your care affordable.  We publish our prices, which are well below those of insurance oriented practices.   More importantly, we help our patients find better prices and cash discounts on care outside of our office, especially big ticket tests and procedures.  This can make the difference between timely care and care postponed.

Closed for Washington's Birthday

No routine appointments today but I'll be available if you have questions or an acute problem.

Closed for the blizzard tomorrow

I'll be available by phone (207-390-8570) and via the Elation EMR portal but, like most of Maine, our office will be closed Tuesday 1/27.

No routine appointments today (Wednesday 1/14)

Our exam room is getting new flooring so, while our office and phones are open, we won't be seeing routine appointments today.   

We'll be open tomorrow with a shiny new floor.

Sea Trials Underway

Megunticook Family Medicine "launched" just over a week ago.  We opened appointments for a few patients who needed care before we could fully equip the office.  This was a great opportunity to test our plans and we've made some adjustments from what we've learned.   We also simplified our membership plans, choosing to use the lower membership fee plan for all patients this year instead of our initial intention to offer two levels of membership. 

Without a rushed office schedule, we got a glimpse of the benefits of Direct Primary Care. Jen and I had time to phone consulting specialists and coordinate care for a patient, saving that patient a long drive out of town.  We also saved a patient with a high deductible insurance plan quite a bit on an expensive test by "shopping around".

While stocking the office continues this week, we are happy with our progress!  Patients who've expressed interest in joining the practice should expect to hear from us with registration information and materials.

Jennifer Overlock joins Megunticook Family Medicine

I'm thrilled to announce that Jennifer Overlock has joined Megunticook Family Medicine as practice manager, medical assistant and phlebotomist.   Jen will be familiar to patients from my former practice as she supervised medical assistants and managed the laboratory there for years.  Her knowledge of primary care, local medical resources and our patients will be valuable as we launch direct primary care in the midcoast.

We've been busy this week organizing the new office, ordering supplies, and testing phones as well as using our new software to manage referrals and order medical/lab tests.