How Would Patients Prefer to Interact with Doctor's Online?

I am interested in how the public feels about the best way to interact with medical providers online. Some companies prefer a structured response with a "fill in the blanks" form according to the initial symptom (e.g. back pain). Some simply facilitate communication with one's own physician, whereas others, such as eDoc, use a "free form" communication style and have a group of physicians, psychologists, and pharmacists to answer general questions about health, behavior and medications.

What do you think is the likely future of On Line Health Care and how would you prefer to use an on line service like ours? Would you prefer to limit your correspondence to your own physician, or are you comfortable relating to a team of professionals such as the ones that eDoc has assembled? Would you prefer a more structured format to provide input to the online doc, or do you prefer a "blank tablet" on which you can simply describe your symptoms? What other services besides the ones we provide would you like to see?

What do you think? I'd love to hear from you...

For Drug Questions, Check Out our new ePharm

This week, eDocAmerica launched a new service, ePharm, in which patients can ask any question related to medication. In the past, patients often directed medication questions to our eDocs, and they are certainly still free to do that. In fact, in some circumstances, a medication question is much more appropriately directed to a doctor than to a pharmacist. However, in others, you may actually get more specific or better information from the pharmacist than you would from the doctor. Examples which might be better answered by pharmacists include differences between generics and brand name drugs, drug side effects, and drug-drug interaction questions. Questions related to the clinical effects and effectiveness of drugs are mostly, probably, still best directed toward the physician, although clinical pharmacists, such as the one on our team, can often provide valuable input on these issues as well.

If you are comfortable making this decision to whom to direct your question, just log directly onto "ePharm", using the new icon on our menu or just use "eDoc" like you have in the past. If you aren't sure, go ahead and direct your medication question to the eDoc and, if he feels that the pharmacist is better positioned to answer it, he/she will forward it to him.

Our ePharm professional is Eric Schneider, PharmD. I had the pleasure of working with Eric several years ago when he served on the faculty of the Department of Family Medicine at UAMS. Since then, he has spent time in South Carolina and recently returned to Fayetteville, when he now serves on the Northwest AHEC faculty of UAMS in Fayetteville.

I believe that this will be a great new addition to the robust menu of services we are able to offer to our clients. Please feel free to log on to eDoc and send Eric a medication question.

Your comments and opinions are always welcome...

Go Nuts

I saw a news spot about how a vegetarian diet is not only healthy for you, but makes you "greener", that is reducing your "carbon footprint". Nuts become a mainstay of a healthy vegetarian diet since they are a great source of protein and essestial vitamins and minerals. Nuts are one of the best examples of a meat substitute.

The University of California Berkeley Wellness Letter, May 2008, reviewed the health benefits of eating nuts. Here are some of the highlights:

• Even though nuts have a lot of calories, 160-200 an ounce, numerous studies show that people who eat nuts tend to weigh less than those who don't. Obviously, such people use nuts as a healthy snack or part of a meal, and control how much they take.
• The fiber and protein in nuts make you feel full or satisfied longer, helping you to eat less during the day.
• The unsaturated fats in nuts are "heart healthy" and can reduce cholesterol levels. One reputable study showed that nuts led to a reduced risk of developing type 2 diabetes.
• Nuts have B vitamins, potassium, copper, magnesium, vitamin E, fiber and a range of other healthy chemicals.
• Watch out for the salt (sodium) in many packaged nuts. Eat unsalted nuts.
• All nuts share most health benefits, but there are some differences. Almonds are the richest in vitamin E and calcium. Brazil nuts are rich in selenium. Cashews are richest in copper and zinc. Peanuts are actually legumes, but are classified as nuts because of their nutritional qualities, and are high in resveratrol and arginine (both heart healthy). Walnuts are richest in the omega-3 fatty acids.

With all of this, make nuts a bigger part of your nutrition in place of meats. You will help your body and the planet.

Using a Heart Rate Monitor

In my recent post "Younger Next Year", Crowley and Lodge recommend, among other things, that we all need to exercise 6 days a week for the rest of our life and, for at least four of those six days, we need to serious aerobic exercise. But, how does one do "serious" aerobic exercise and how does one discern the difference between serious exercise and something less than that? The authors of this wonderful book suggest that "serious" aerobic exercise consists of exercise in the "aerobic" zone for 45 minutes or more for each of those days. They recommend the use of a heart rate monitor to make sure that you stay in the "aerobic zone" for all, or most, of that 45 minute period.

Having exercised for many years, and having recently taken up their advice (again) and started using a heart rate monitor, I have some comments on this approach that I think are important observations for anyone who is serious about this aspect of their life.

When I am exercising without a monitor, I tend to use the "perceived exertion" scale. This is outlined as follows:

Healthy Heart Zone 50%-60% 2-5 (perceived exertion)

Temperate Zone 60%-70% 4-5 (perceived exertion)

Aerobic Zone 70%-80% 5-7 (perceived exertion)

Threshold Zone 80%-90% 7-9 (perceived exertion)

Redline Zone 90%-100% 9-10 (perceived exertion)

Since the goal is to stay in the "aerobic zone", I seek the perceived exertion scale of 5 to 7, which is described as moderately difficult, but not painful, able to continue to carry on a conversation but you know that you are working.

What most people who don't wear a heart monitor don't realize is that there is a significant difference in what you think your heart rate may be and what it actually is when you have a heart rate monitor on. Generally, I find that I need to "pick it up" frequently during my workouts to maintain my target rate of 130 beats per minute (this puts me in the 80% of maximum heart rate range). If I don't have a heart rate monitor on, I tend to think I'm exerting myself at a higher rate than I actually am. This is human nature at its best, the tendency to fantasize, dream, imagine, or wish that you are stronger, better, faster, or more fit than you really are.

But, having a heart rate monitor on allows you to make almost constant, subtle adjustments, whatever your exercise type, in order to keep your workout at a high quality level.

Make no mistake, without a heart rate monitor, and just using the perceived exertion method, you can get and stay close to your target and will be healthier for doing it. But, if you want to get "younger next year", you must stay after it, maximize your efforts to get and stay fit and, for that, you need a heart rate monitor.

Your comments are always appreciated.