House Call MD

A house call MD, or Physician house call, is an act of customer service where the doctors goes to the consumers home, rather than the consumer visiting the suppliers place of business. House calls are most often associated with doctor house calls. There are still doctors making house calls. A physician-led multidisciplinary team provides comprehensive, patient-centered care for any condition, from the simple problems to the very complex, in the patient’s own environment. Thanks to modern technology and our sophisticated, multi-faceted delivery system, we can do more tests and procedures in our patient’s home or place of business than other primary care physicians do in their office. House call MDs are equipped to perform most procedures normally performed in a medical office. House call doctors utilize electronic medical records and will coordinate home health and hospice services, mobile imaging services, durable medical equipment services, laboratory services, and specialist referral services. House call doctors acts as the primary care physician or as augmentation to or as an interim physician to the patients’ present medial team. Doctor’s House calls provide post hospital stabilization service to physicians, insurance plans, and hospitals to mitigate hospital re-admissions. Some concierge practices do not accept insurance of any kind. These are as cash-only or direct primary care practices. By refusing to deal with insurance companies, these practices can keep overhead and administrative costs low, thereby providing affordable healthcare to patients. They become concierge only if the practice assesses an annual or monthly fee instead of or in addition to a fee for each medical service. Other concierge practices do take insurance, even Medicare, but ask for an annual fee for additional services exclusive of insurance plans. This annual fee is not a substitute for medical insurance, and generally does not cover consultations outside the practice, laboratory procedures, medicines, hospitalizations, or emergency care from other providers.

Gastric Bypass

Gastric bypass procedures are any of a group of similar operations used to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations. A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower remnant pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different bypass names. Any bypass leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has reduction of up to 40 percent. The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. An increasing number of these operations are by limited access techniques, termed laparoscopy. Laparoscopic surgery uses several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise. The gastric bypass reduces the size of the stomach by well over 90 percent. A normal stomach can stretch, sometimes to over 1000 ml, while the pouch of the gastric bypass may be 15 ml in size. The gastric bypass pouch is formed from the part of the stomach, which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between stomach and bowel, and the ability of the small bowel to hold a greater volume of food. Over time, the functional capacity of the pouch increases, and by that time, weight loss has occurred, and the increased capacity serves to allow maintenance of a lower body weight. When the patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves, which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if they had just eaten a large meal—but with just a thumbful of food.

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Isotretinoin

A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Amnesteem, Sotret, Claravis, Clarus) over a period of four to six months can cause long-term resolution or reduction of acne. Doctors believe that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin research shows it to be very effective in treating severe acne and can either improve or clear well over 80 percent of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). About 25 percent of patients may relapse after one treatment. In those cases, patients require a second treatment for another four to six months to obtain desired results. Doctors recommend that one allow a few months pass between the two treatments, because acne can actually improve somewhat over time. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. The most common side effects are dry skin and occasional nosebleeds (secondary to dry nasal mucosa). Oral retinoids also often cause an initial flare up of acne within a month or so, which can be severe. There are reports that the drug has damaged the liver of patients. For this reason, doctors recommend that patients have blood samples taken and examined before and during treatment. In some cases, doctors terminate or reduce treatment due to elevated liver enzymes in the blood of the patient, which suggest a link to liver damage. Other dermatologists claim that the reports of permanent damage to the liver are unsubstantiated, and deem routine testing unnecessary. A doctor must also monitor the blood triglycerides. However, routine testing is part of the official guidelines for the use of the drug in many countries. Some press reports suggest that isotretinoin may cause depression but as of September 2005, there is no agreement in the medical literature as to this risk. The drug also causes birth defects if a woman becomes pregnant while taking it or takes it while pregnant. For this reason, female patients are required to use two separate forms of birth control or vow abstinence while on the drug. Many doctors only supply isotretinoin to women as a last resort after milder treatments have proven insufficient. The USA put into effect restrictive usage rules (see iPledge program) beginning in March 2006 to prevent misuse, causing occasioned widespread editorial comment.