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Tips for Reviewing a Website’s Usability

By Nathan Blake |2/15/17

Following up on our previous blog post, this week we will explore how usability reviewers analyze health websites while also providing some tips for becoming a more informed web user.

HealthWeb Navigator’s content reviews and usability reviews are distinct but complementary. Whereas a content review analyzes what information is provided (its accuracy, completeness, currency, depth, etc.), user-experience reviews are focused on how information is provided; that is, whether or not the presentation and organization of material, in your opinion, is easy to use and navigate, visually appealing, readable, widely understandable, speedy, and geared toward its audience appropriately.

Reviewers should always include direct evidence from the website to support any judgment made about a website’s usability.

Below you will find some specific tips for using your web experience as you review a health website’s usability. Due to time and space constraints, you won’t be able to touch on each one of these aspects in your review, but we hope that they can guide you to think more critically about a website so as to be a stronger resource for consumers.

Evaluating a Website’s Usability

A usability expert for HealthWeb Navigator should be prepared to:

Scan the pageReviews of usability should take visual appeal into account. Design is often unconsciously linked to credibility, and though a website’s credibility doesn’t necessarily hinge on its appearance, it does play a part. Let your eyes wander around the page; where’s the first place you look? What does your instinct prompt you to click on first? Do advertisement obstruct navigation, or is the focus directed toward content? Is the content well-organized? Do the colors or font make it difficult to read the type? How about pop-ups? Answering these questions will train your eye to slow down and analyze what it’s seeing. They will also help you determine whether or not the website is effectively designed, allowing you to articulate what could be done to create a more pleasant user-experience.

TIPPut down in writing or speak aloud your initial impressions about the layout of the page and what you think of the colors, graphics, photos, etc. Is it on par with other websites, or is it better or worse than you expected? What can the website do to catch the reader’s eye, and where does it excel at grabbing your attention?

Take the wheel. Think of each website as a vehicle for disseminating information. Each has a different design, yet there are widely shared features such as navigational schemes, search options, editorial disclaimers, etc. Some websites have site-wide search bars, while others only allow users to click links when searching for material. Usability reviewers should try to understand how the site functions and whether or not it’s easy to “drive,” testing out its various components before casting judgment. Is the website easy to use, and can you find what you are looking for? What’s the loading speed of individual pages? Are there any dead links? Can you get around the website intuitively, or does it have you spinning in circles?

TIP: An easy way to focus on a website’s functionality is to disregard the actual content on the page. Play with the website and test out as many of its features as you can, which often helps reviewers discover user-experience issues. It can also be helpful to search for a specific topic that falls under the website’s scope, testing out the various organizational schemes to determine if the site is user-friendly.

Identify the audience(s) and purpose. All texts presume an audience and a purpose, and it is the job of the reviewer to understand those potential audiences and purposes implied by a given web resource. Start with the idea that all writers, consciously or unconsciously, have an ideal audience in mind when they write, and with that knowledge they determine the shape, form, and scope of the ensuing content. The important concept to understand is that readers and listeners will vary in how much they know about the health information being offered, and websites will vary in what they want to accomplish. Some websites listed on HealthWeb Navigator have very little interest in providing medical content. Some are strictly focused on providing social media capabilities, others act as advocates on behalf of patients, and others simply list resources. Identifying these varying purposes can help you understand if the website successfully meets its goals or not.

TIP: Approach each website as an educator: If you had to give the website a grade, from A to F, what grade would you give it and why? What audiences does the website exclude and how? Is material offered in multiple languages, and it is accessible for people with disabilities? What’s the site’s purpose; is it to inform or persuade, describe or convince, define or influence, review or argue, notify or recommend, instruct or change, advise or advocate, illustrate or support?

Paraphrase information. A paraphrase is a restatement of an idea into your own words. Part of a usability reviewer’s duties involves assessing a site’s understandability, how easy it is to read and follow. One quick way to determine whether or not a website is easy to read is to try and summarize material after reading. Imagine teaching the content to someone else. Can you articulate the material’s substance, or are you floundering for meaning? If you find it easy to paraphrase a website’s content, especially as a layperson, then chances are the site is written clearly. If not, try to hone in on what makes the website difficult to understand and mention that in your review.

TIP: Think about how to articulate information in your own words. Of course some of the more clinical concepts will be difficult to summarize without using the resource’s exact language, but you should at least understand the gist of what is being said. Read over a page, look away from the website, and then write down or speak aloud the essential meaning. If you find this difficult, then the website may have a readability issue.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our usability review process. Check back to our previous blog post that focuses on how our volunteers conduct content reviews.

Finally, if you are a web user and are interested in a becoming a usability reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Usability Reviewer.

Tips for Reviewing a Website’s Content

By Nathan Blake |2/1/17

It is estimated that 40% of the global population uses the internet every day, including over 88% of the U.S. population. As healthcare costs continue to rise, more and more patients turn to the web for health information to learn about diseases and conditions, insurance costs, patient advocacy, and more.

But how can you be sure that the information you find online is credible, up-to-date, and easy to understand?

HealthWeb Navigator is a free online service that helps consumers make sense of the internet’s rapidly expanding collection of health-related websites. Our team continuously publishes reviews of online health resources. The idea is that these reviews will allow consumers to take control over their own health care by guiding them toward only those websites that are accurate, clear, and user-friendly.

Our credibility rests on the expertise of our volunteers, whom we group into two categories: content reviewers and usability reviewers. Medical authorities are tasked with evaluating a health website’s content, while our usability reviewers come from all walks of life and are responsible for reviewing a website’s user experience.

Whereas a usability review analyzes how information is provided (its organization, visual design, user-friendliness, speed, etc.), reviews of content are focused on what information is provided and whether or not that information can be trusted to be accurate, complete, up-to-date, and sufficiently explored.

Below you will find some tips that our health authorities keep in mind when judging a website. We hope that consumers can incorporate these tips into their web-browsing routine, helping them distinguish a reliable web resource from a misleading one.

Evaluating a Website’s Content

A content expert for HealthWeb Navigator should be prepared to:

Look for gaps: If you’re a mental health professional reviewing a website focused on teen mental health, and you notice that the website does not include information about self-harm, then clearly there is a gap in the site’s scope. Consulting a website’s site-map can give you an aerial view of what can or can’t be found on the site. Use your review to make note of any noticeable gaps you find. This is equally true for websites that feature a doctor/provider-finder tool; if, when searching a familiar ZIP code, you see that a specific doctor/provider is missing, then that too is appropriate to mention in your review in regards to completeness.

TIP: Gaps in content are often found simply by browsing a website, keeping an eye out for information that could be present but is in fact missing. You might also consult a site-map when available, allowing you to get a quick idea of those topics the website covers without having to browse every single page. A litmus test for a site’s content might be: On content alone, would you recommend this website to a patient? If “yes,” give examples of what you liked. If “no,” explain what is missing and why it concerns you.

Test the depths. Some websites cover the breadth of a particular subject, including numerous topics and subtopics for consumers to explore. But how useful is the breadth of a site’s material if individual articles are too shallow to gain anything substantive? Use your knowledge to determine if a website’s materials are sufficiently examined in enough depth to provide consumers with quality information. Some websites sacrifice depth for breadth, others go very deep into a limited amount of subjects, while still others manage to strike a balance between the two.

TIP: The key to fairly judging a site’s depth is using your medical expertise to determine whether or not the page with less detail offers enough information to be of use to the public. It may be shallow, but sometimes shallow is all that is necessary, depending on the topic. Consequently, too much depth can overwhelm some readers, especially if the tone is clinical in nature.

Verify the research. Suppose the website you’re reviewing makes a variety of claims but does not provide research or evidence to support those claims—would you trust that website more so than an organization that includes direct links to outside sources? Or what if the site in question relies on misleading or downright false information to prove its points? In both cases, it is the job of the content reviewer to look for and judge the research (or lack thereof) being used by a website to determine whether or not it is credible and accurate. Follow up on any research you see linked on a page, and make note if you see either a lack of verifiable research or an abundance of biased materials.

TIP: Always look for evidence. Remember that good science relies on data and statistics, although even the most objective data can be influenced by bias. Keep the phrase “prove it” in mind, then assess the quality of that proof. Websites that lack research or only reference internal research should be analyzed with caution.

Check the dates. Imagine how you would go about reviewing a website on heart surgery that cited research from 1983. Would you trust that the research holds up after all these years? Or what if a website publishes material on a rapidly-evolving subject like the Affordable Care Act, yet the material has not been reviewed or updated since 2012? Look for dates of both publication and revision to determine if the website is maintaining its currency; the same goes with any outside research or support a site relies upon.

TIP: When you’re looking for evidence, take publication and revision dates of individual articles into account. Usually these dates are found at the top or bottom of web pages. Using your expertise, you can determine whether or not the website maintains currency in a rapidly changing medical landscape.

Know Who’s Who. Everyone approaches the world with particular biases, and it’s important to recognize that occasionally these viewpoints are not necessarily rooted in observable fact. When it comes to website content, always look for names to which information can be attributed including parent and affiliate organizations, leadership, sponsors, advisors, editorial boards, writers, etc. Approach it from the angle of expertise: Would you be more willing to accept an article’s claims if they were written by a layperson or a trained medical authority? If information is generated by laypeople, then there should be some form of expert oversight to maintain quality.

TIP: If individual authors cannot be attributed, do some digging on the website to find out who is responsible for writing and editing content. If you can’t find this information, then that is an appropriate issue to raise in your review.

Follow the Money. Have you heard the phrase “follow the money”? A good tool for assessing the influence of bias and allegiance starts with recognizing the power of financial transaction—determining who’s being paid and who’s providing the money. Look for any products being sold and ask yourself if the website is unduly advertising those products over established medical knowledge (that is, a “cure all”). What organization or sponsors support the website? Who is responsible for generating content, and can you see any financial incentive for what content is generated and what stance the content promotes? You can learn more about how to find out who sponsors a website HERE.

TIP: If you don’t recognize the organization providing the information, some cursory digging can reveal who finances the operation. Most websites you encounter through HealthWeb Navigator will provide this information in an “About Us” or related section. You can also dig deeper into a charity or nonprofit by looking up their listing on Charity Navigator.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our content review process. Stay tuned for our next blog post, which will focus on how our volunteers conduct usability reviews.

Finally, if you have medical training of any kind and are interested in a becoming a content reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Medical Reviewer.

When Your Doctor Doesn’t Accept Your New Health Insurance Plan

By Nathan Blake |1/17/17

An estimated 20 million Americans have been insured under the Affordable Care Act. Though the Senate recently voted to begin the process of repealing President Obama’s health law, the effects of that decision won’t take place for some time. Meanwhile, consumers can still enroll in a Marketplace plan as usual, with the 2017 open enrollment period for Obamacare ending on January 31st.

If you recently changed health plans, or are planning to do so, there is a chance that your provider no longer accepts your new insurance. Some common reasons are that you may have chosen a less expensive insurance which the doctor doesn’t accept, or perhaps the doctor recently decided not to work with your new insurance plan. 

Losing access to a trusted doctor can not only be distressing, but also time-consuming, since finding a doctor you like requires considerable planning and a bit of trial-and-error. The effort, thankfully, pays off in the long run. Research shows that patient satisfaction is directly correlated to treatment outcomes; that is, the more satisfied a patient is with their care provider, the greater the odds that they will experience a successful treatment.

In short, it’s worth investing time and energy into finding a quality doctor who you enjoy consulting again and again.

But what happens when a good doctor-patient relationship is jeopardized because of health insurance issues? Before answering that question, it might help to understand the basic mechanics of health insurance, specifically how insurance plans pay doctors for their services.

Health Insurance in a Nutshell

Health insurance policies are contractual agreements between consumers and insurers—called “policies”—that stipulate how much money the insurer will pay for health expenses such as hospital visits, medical tests, surgeries, immunizations, etc. The amount that the insurer pays, or “coverage,” will vary among insurance companies as well as their individual policies. Ultimately, it is the insurance company that sets the rate of pay, not the doctor.

There are two scenarios:

The doctor is contracted with the insurer: The doctor can only charge what that insurer allows.

The doctor is not contracted with the insurer: The doctor can charge their “list price” for services, which is usually higher. The insurer may reimburse you for the amount they would usually allow, but you have to make up the difference.

To illustrate, let’s say Doctor X charges $100 for a routine physical exam, but Insurance Company Y believes such an exam is worth only $40. Doctor X can either accept the price difference or attempt to negotiate a higher payment. If the two parties are unable to resolve the discrepancy, Doctor X can refuse to work with Insurance Company Y altogether, leaving consumers insured through Insurance Company Y to pay Doctor X’s charge out of their own pocket.

Insurance Company Z, on the other hand, may provide a higher payment for Doctor X’s services (for example, $80 for a routine physical). If Doctor X finds that payment attractive, they could begin accepting patients insured through Insurance Company Z.

This negotiation process, believe it or not, occurs every year for each medical service provided at all insurance-accepting medical practices across the nation. As you might imagine, it is quite normal for doctors to change which insurances they choose to accept over the course of time.

When You Just Can’t Stand to See Your Doctor Go

So you’ve discovered your doctor of choice no longer accepts your new health insurance, but you do not want to see another provider.

Your first step is to ask your doctor what insurance carriers they do accept. The easiest solution would be to then switch to a policy included among that list of accepted insurances.

Keep in mind that Marketplace plans can only be changed during certain times of the year or for specific “special enrollment” scenarios like having a baby, getting married, losing a job, etc. Before you choose to make a switch, check beforehand to determine whether or not you qualify.

There are other options for working with your preferred provider. You can:

See if your plan will work with out-of-network coverageConsider asking your insurer to include specialists that are technically out-of-network. Call the insurer directly to see if they would consider adding your doctor to their network of providers; if they refuse, always ask for specific reasons. Conversely, you may want to contact the doctor with specific reasons as to why they should join a particular network. Sometimes a vocal patient is enough to do the trick.

Pay out of pocket: If you have the finances to do so, you may choose to pay for services out of pocket and then submit insurance forms for reimbursement. It is important to note, however, that insurers often apply reimbursements to your deductible rather than give you the money outright, and there is a good chance that you will be reimbursed for only a portion of the original cost. Keep in touch with your insurer during this process to make sure your voice is heard.

Negotiate a price directly with your provider: As more doctors choose to not take contracts with insurance companies, patients insured with incompatible plans are forced to pay the market price for medical services and then submit a reimbursement form to defray medical costs. Some doctors are willing to negotiate prices with patients on an individual basis, especially if there is already a long-standing relationship at play. The key to navigating these negotiations is to know what the fair price would be for a given expense.

Use a flexible spending account: A flexible spending account allows consumers to pay for medical costs using personal savings or money provided by an employer (usually capped at a certain amount per year without annual rollover). Consult with your employer to see if they offer employee FSAs; if so, you can pay for medical costs using these tax-free dollars.

When You Have No Choice But to Move On

If you’re not particularly attached to your doctor, then it might be easier to simply move on and find another doctor who accepts your new insurance plan. Consult our previous blog post, “Choosing Your Primary Care Physician,” for tips on how to secure the services of a doctor who works best for you. Being informed and prepared is your best bet to making a smooth transition between providers.

What Winter Weather Means for Outdoor Exercise

By Nathan Blake |1/4/17

If your New Year’s resolution includes either a gym membership or a smaller waistline, you’re not alone. Last year, 37 percent of Americans claimed that “staying fit and healthy” was their top priority for the coming year, while an additional 32 percent specifically wanted to lose weight. But with the rising cost of gym membership fees, more and more consumers are developing routines with a small (or nonexistent) price tag like bodyweight exercises, yoga, dancing, or old standbys like jogging and cycling.

Few people realize, however, that cold-weather exercise can aggravate some pulmonary and cardiovascular problems, and studies show that heart attack rates tend to spike in the frosty months of December and January. For those who choose to brave the cold this winter, you may want to educate yourself about the potential benefits—and dangers—that lie ahead.

Benefits of Cold Weather Exercise

Although many people believe that chilly weather increases the amount of calories burned during a workout, the truth is actually a bit more complicated; unless the drop in body temperature causes you to noticeably shiver and expend more energy, you won’t burn more calories in cold weather compared to warmer temperatures.

That’s not to say athletes should hibernate until spring. In fact, there are other benefits to winter exercise that shouldn’t be overlooked.

For one, exercise helps mitigate the symptoms of seasonal affective disorder, a form of depression that affects an estimated 20 percent of Americans. The additional exposure to sunlight and subsequent production of endorphins both lead to elevated moods, as well as a boost in vitamin D levels. Some research even shows that 45 minutes of running in cold weather can reduce flu-risk during the winter months by as much as 20 to 30 percent.

Fitness buffs will be happy to hear, too, that it may be easier to increase the intensity of workouts in colder weather compared to hot weather, which has been shown to negatively impact physical performance. Factor in the lack of humidity and the invigorating wind chill, and you might find yourself actively seeking out colder climes for training.

Now for the Dangers (and How to Prevent Them)

Don’t assume that you are capable of performing the same summer activities in winter without a hitch. Although the average person will not experience major health problems associated with winter exercise, those with a history of cardiovascular, circulatory, or pulmonary disease should understand that cold weather puts them at greater risks for discomfort, injury, and death. Even those in perfect health need to recognize the risks associated with winter exposure.

Muscle Tears As temperatures drop, our bodies overcompensate to accomplish the same tasks that would be easier in milder weather. Our muscles and connective tissues lose more heat, tighten, and become less flexible, leading to increased soreness and muscle damage in the form of strains and tears.

PreventionTake the time to warm-up properly before physical activity. Ease into your workout with some light cardio like brisk walking to raise your core temperature and increase blood and oxygen circulation. Common areas in need of extra attention are the hamstrings, chest, shoulders, and quadriceps.

Asthma: Winter athletes often report symptoms of exercise-induced asthma—coughing, wheezing, chest-tightness, shortness of breath, and excessive fatigue—whereas in other seasons they may exhibit none of these problems. Individually, cold, dry air and exercise both can aggravate asthma, but combined they become downright dangerous.

PreventionCover your mouth with a mask or scarf to warm the air you breathe. Use your inhaler 15-30 minutes before exercise to open your airways, and carry it on your person at all times. Drink extra water as well, which thins the mucus in your lungs and helps your body move more efficiently.

Heart Attack: Cold temperatures outside can cause vasoconstriction, or a narrowing of the blood vessels. As these passageways constrict, blood pressure rises, oxygen supply and blood flow to the heart are diminished, and the heart works harder than it would under normal conditions. If you have a weakened heart, or are otherwise not conditioned to exercise in colder climates, additional cardiovascular strain may result in angina or, worse, a heart attack.

PreventionPeople with a history of high blood pressure and/or heart disease should consult a physician before starting a new exercise regimen. Begin physical activity slowly, and allow your body to recuperate every 15-20 minutes. If you begin to feel chest pain, or pain that radiates down the left arm, err on the side of caution and call 911 or visit the nearest emergency room.

FrostbiteFrostbite occurs when the body’s skin and underlying tissues begin to freeze. As blood flow slows, ice crystals form inside body cells, killing them in the process. Ninety percent of frostbite cases involve the hands and feet, and people with frostbite will immediately notice numbness and skin discoloration in localized area(s). Left untreated, permanent skin tissue death can result in gangrene and amputation.

Prevention: Limit your exposure to cold, windy, wet weather. Keep an eye out for signs of frostbite like red or pale prickling skin, and stay dry, since wet clothes increase heat loss. Dressing in layers is essential for protection; aim for clothing that is comfortable, loose, and light, and make sure your outer layer is both windproof and waterproof. If you do notice signs of frostbite, do not rub or aggravate the frostbitten area. Instead, find shelter as soon as possible, and warm the affected area using either warm (not hot) water or body heat.

HypothermiaProlonged exposure to cold weather causes the body to lose heat through the skin and lungs faster than it can be produced. A dramatic drop in body temperature (generally recognized when core temperature falls below 95 degrees Fahrenheit) can slow brain function, heart rate, and breathing, after which confusion, fatigue, and even organ failure sets in.

Prevention: Layer up, and wear a hat, scarf, and mittens to conserve body heat. Stay dry, being especially mindful of feet and hands. Avoid alcohol and caffeine, both of which stimulate heat loss. Seek medical attention immediately if you notice any symptoms of hypothermia; in the meantime, remove any wet clothing and wrap yourself warmly in a blanket or other covering. Do not, however, immerse yourself in hot water for warmth, as it can lead to shock.

Choosing Your Primary Care Physician

By Nathan Blake |12/19/16

The Affordable Care Act (commonly referred to as Obamacare) has allowed millions of Americans to access the health coverage they need. Since its passage five years ago, over 16 million uninsured consumers have gained coverage through Obamacare, and healthcare inflation is at its lowest rate in fifty years.

The open enrollment period for Obamacare ends on January 31, 2017, during which you can enroll in or change health plans for 2017. An important first step after securing the health insurance plan that works best for you is to plan for your well-being with regular checkups. But which doctor do you choose if you don’t already have one?

Types of Doctors

The two main types of doctors are primary care physicians (PCPs) and specialists.

A primary care doctor, also known as a general practitioner, is who you would visit for routine checkups and non-emergency care, especially when symptoms first appear.

Specialists, on the other hand, have a more narrow scope depending on a particular area of expertise; these would include allergists, anesthesiologists, neurologists, psychiatrists, surgeons, cardiologists, etc.

Many health insurance plans require patients to first visit a primary care physician before covering specialist costs. Consequently, the primary care physician serves an important role in the maintenance of a patient’s health and long-term welfare.

The Role of the Primary Care Physician

Primary care physicians provide general medical services to specific patient populations and specialize in one of the following areas:  

Pediatric medicine: Pediatricians manage the physical, mental, and behavioral health of infants and children.

Adolescent medicine: Adolescent specialists meet the health needs of young people roughly between the ages of 11 to 19.

Internal medicine: Internists provide care to adults, specifically the diagnosis and nonsurgical treatment of diseases.

Geriatric medicine: Geriatricians are specifically trained to evaluate and manage the unique health needs of elderly adults.

Family medicine: These physicians provide versatile care for patients of all ages and gender.

Gynecologists/Obstetricians: Gynecologists focus on women’s sexual health issues, while obstetricians deal specifically with pregnancy, childbirth, and the postpartum period.

PCPs, unlike many other health specialists, get to know their patients intimately over a continuous period of time and are better able to assess what constitutes an aberration from that patient’s norm. Instead of focusing solely on the treatment of a specific organ such as the brain or eye, primary care physicians consider the patient as a whole. Treatment plans are then tailored to meet the individual’s needs based on personal history and mutual understanding.

Benefits of Having a Primary Care Physician

The primary care physician often serves as a patient’s go-to medical resource. They seek to understand and evaluate any medical concerns the patient might have in order to provide the best mode of care, whether in-house or through referral to an outside specialist.

Over the course of time, primary care physicians and patients engage in what is called “continuity of care,” which means establishing a personal relationship that develops year after year. Tracking a patient’s health over time allows PCPs to make more informed treatment decisions and manage overall progress and goals.

Keeping a close watch over a patient’s health allows PCPs to better intervene with disease prevention, patient education, health maintenance, and the diagnosis and treatment of both acute and chronic illnesses.

Lastly, the ease of access and communication involved in visiting a primary care physician is unparalleled; the intimacy fostered in such a relationship gives patients the opportunity to better understand and participate in health decisions.

Choosing a Primary Care Physician

You will likely discover that the sheer number of PCPs makes the decision process difficult if not overwhelming. Luckily, there are several tips to keep in mind that will help you choose a doctor who best fits your personal needs.

Ask around: Consider asking for referrals from friends, family, and coworkers. Many patients feel more comfortable visiting doctors that are recommended by trusted sources. Additionally, other people (or websites) can help you pinpoint what you are looking for in a provider. The more you know about a doctor increases the likelihood that you will find the one that is right for you.

Know your insurance: Consult your health insurance benefits to determine which doctors are “in-network.” It is common for insurance plans to provide a directory of in-network providers whose discounted rates have been negotiated beforehand by your health plan. Often, out-of-network doctors require patients to pay for services in full, so do yourself a favor and make sure your PCP is willing to work with your health insurance.

Understand availability: Not all primary care physicians accept new patients, and even doctors with availability may have hours that conflict with your schedule. Additionally, some doctors are responsible for more patients and require longer wait times to schedule an appointment. Reach out to a doctor beforehand just in case.

Evaluate qualifications: Like all professionals, you want your doctor to be an authority in their field with an education and background that reflects competency. Check online or through the doctor’s office to see if the doctor is board-certified in the field(s) that you are visiting them for. You may also want to consider hospital affiliation if you already have a trusted provider.

Plan logistically: If you have a specific condition like diabetes, you may want to choose a PCP who has specialized training or experience in endocrinology. Spend some time contemplating the distance required to travel to the doctor’s office, if the office hours are convenient for you, whether or not the doctor can understand you preferred language, if gender and age matter to you, etc.

Look for compatibility: Many patients schedule preliminary interviews with potential doctors to determine compatibility. Try to see the first visit as a trial run, and do not underestimate the power of gut-feeling. Does the doctor explain things clearly and listen without interrupting? Is the doctor relatable or more formal than your liking? Can you tell if the doctor prefers aggressive treatment or a more prolonged wait-and-see approach? Is the doctor quick to refer patients to outside specialists, or do they prefer to handle care in-office? All of these questions and more will help prepare you to best weigh your options when choosing a primary care physician.

Crohn’s and Colitis – Common but Misunderstood

By Nathan Blake |12/7/16

The first week of December marks the fifth annual Crohn’s and Colitis Awareness Week. These two conditions affect the digestive tracts of nearly 1.6 million Americans each year, although many more remain undiagnosed and deal with persistent pain and discomfort on a daily basis.

If you or a loved one has been diagnosed with either of these conditions, it is important to educate yourself about them in order to best manage the symptoms and reclaim a sense of normalcy.

What are Crohn’s and Colitis?

Crohn’s and colitis are among the most common forms of inflammatory bowel disease (IBD). IBD refers to a family of conditions that causes prolonged inflammation of parts or all of the intestinal tract. IBD and its various forms are known as invisible illnesses, referring to chronic conditions that impair a patient’s day-to-day activities yet show no outward signs.

Crohn’s disease is an inflammatory condition that can affect any part of the digestive tract from mouth to anus. The lining of the digestive tract becomes swollen and develops deep, open sores called ulcers, which can manifest in multiple areas including the esophagus, stomach, small intestine, colon, appendix, and in rare cases the skin and joints. Commonly, there are healthy portions of the intestine between inflamed areas that remain unaffected.

Ulcerative colitis is also an inflammatory disease, although its effects are specific to the superficial tissues of the colon and anus. With ulcerative colitis, ulcers develop on the inner lining on the large intestine. These ulcers may bleed and/or produce pus. Ulcerative colitis generally begins in the rectum and spreads upward to the first part of the colon.

Both diseases often appear gradually and then worsen with time, though many patients report periods of remission during which symptoms disappear for weeks or months. Periods of painful inflammation, on the other hand, are called flare-ups.

Common Symptoms of IBD

Because Crohn’s and colitis affect similar parts of the body, diagnosing these two diseases can be difficult. Their symptoms are often indistinguishable and can vary from person to person. Inflammation of the gastrointestinal tract often leads to the following symptoms, many of which are common for people dealing with Crohn’s or colitis.

• Diarrhea

• Rectal bleeding

• Urgent bowel movements

• Constipation

• Abdominal cramps/pains

• Fatigue

• Unintended weight loss

• Fever

• Night sweats

• Loss of appetite

What Causes Crohn’s and Colitis?

The intestine’s absorptive area spans over 4,300 square feet, making it the single largest surface in the human body, including the skin. Previously, diet and stress levels were implicated as the main determinants of IBD, but today they are seen as aggravating factors and not the actual cause.

While researchers are still unclear as to the exact causes of Crohn’s and colitis, many agree that they likely originate from a combination of factors.

Individual genes: People with a family history of IBD are 10 times more likely to develop the condition than those with no history.

Immune system: It is possible that Crohn’s and colitis appear in response to a viral, bacterial, or fungal infection of the intestinal tract, where the immune system produces an inflammatory response in the intestines to fight off the foreign agent(s). However, people with IBD often have inflammation even when no infection is present, leading researchers to believe that the patient’s immune system may be attacking the body itself. This phenomenon is known as an autoimmune response.

Environmental factors: Clinical and experimental evidence indicates that IBD may be associated with a range of seemingly unrelated environmental influences including cigarette smoking, diet, stress, use of hormones, vitamin D levels, and geographic/social status, among others.

Complications in IBD

Though these two diseases are rarely life-threatening, if left untreated, Crohn’s disease and ulcerative colitis can result in several serious complications deserving of immediate medical attention.

Fistulae: When ulcers extend completely through the intestinal wall, they create fistulae, or abnormal fusions between different parts of the body. The most common site for IBD fistula formation is the tissue surrounding the anus, where the fistula creates a connection between the rectum and the skin. Fistulae can occasionally become infected and form a life-threatening abscess—a localized pocket of pus—if left untreated.

Bleeding: Blood often appears in the stool of people with IBD, caused by inflammation, ulcer formation, and anal fissures. Some even pass blood alone in the absence of stool. Bleeding in the rectum is more common in ulcerative colitis than Crohn’s, but will vary depending on the area(s) affected.

Anemia: People with IBD have difficulties absorbing important nutrients from food, especially iron, which is absorbed in the small intestine (an area commonly affected by IBD). As a result, nearly half of people affected by Crohn’s or colitis do not receive adequate levels of vitamin B12, iron, and folic acid, all of which are necessary for the creation of new red blood cells. Patients with low levels of red blood cells develop anemia, resulting in headache, fatigue, chest pain, and weakness.

Treatment and Management

The goal in treating Crohn’s and colitis is to achieve and maintain remission, and mostly involves drug therapy to reduce the inflammation that causes IBD’s signs and symptoms. Immunosuppressants and anti-inflammatory drugs called aminosalicylates and corticosteroids have proven to be helpful in improving or completely stopping the symptoms of IBD. Biologics are a more recently developed therapy, created out of biological antibodies rather than chemical medications. Biologics also suppress the immune system but offer a distinct advantage in that they target specific proteins in the IBD patient rather than affecting the whole body.

However, there is currently no cure for Crohn’s disease, and ulcerative colitis can only be cured in the most severe cases when the entire large intestine is surgically removed.

Fortunately there are several ways that people with IBD can manage their symptoms. If you or a loved one has been diagnosed with IBD, consider the following strategies in conjunction with a physician’s oversight to help alleviate symptoms of the disease.

Manage stress: Many patients report an intensification of symptoms in times of stress. Consider adopting a meditation, yoga, or acupuncture routine to reduce symptoms, and get plenty of exercise, preferably daily.

Stay hydrated: Inflamed colons do not absorb water and electrolytes properly, resulting in diarrhea, increased bowel movements, and dehydration. Keep yourself hydrated with distilled water in order to combat this increased fluid loss, and monitor your urine to determine whether or not you are drinking enough liquids.

Limit “trigger” foods: Foods that cause flare-ups depend on the individual, but some are more commonly associated with intensified symptoms than others. They include fatty, spicy, and high-fiber foods; alcohol; coffee; carbonated drinks, nuts and seeds; raw fruits and vegetables; and red meat.

Get your vitamins: IBD flare-ups can negatively impact nutrition due to the increased bowel movements, loss in appetite, fatigue, etc. When the small intestine becomes inflamed, the body is unable to absorb nutrients from food. Coupled with a reduced appetite, IBD can easily lead to malnutrition. Patients can avoid malnutrition by eating smaller, well-balanced meals throughout the day. Your doctor may also recommend vitamin supplements as well.

What Does Medical Science Say About Fish Oil Supplements?

By Nathan Blake |11/23/16

A recent survey of over 11,000 consumers revealed that fish oil is currently the second most popular nutritional supplement on the American market today, with annual spending exceeding $1.2 billion for over-the-counter fish oil pills and related supplements.

Fish oil has long been touted for its supposedly positive effects on a variety of bodily functions including lowering blood pressure, triglycerides, and cholesterol levels; preventing heart disease; inhibiting the formation of cancer cells; combatting depression and mood disorders; reversing the effects of macular degeneration; and countless others.

But what does medical science have to say about these claims? Is fish oil the cure-all it’s advertised to be, or would consumers be better off spending their money elsewhere?

Fish Oil’s (Not So) Secret Ingredient

Fish oil capsules contain concentrated amounts of omega-3 polyunsaturated fatty acids. Omega-3 fatty acids are necessary for human health, playing a crucial role in brain health and the regulation of inflammatory responses. There are three main types of omega-3 fatty acids, two of which can be found in fish oil capsules.

Eicosapentaenoic acid (EPA) is absorbed into the body by eating oily, coldwater fish like salmon, menhaden, sardines, mackerel, albacore tuna, halibut, and herring. EPA is also found in edible strains of seaweed as well as human breast milk.

Docosahexaenoic acid (DHA) is an important structural component of the human brain and is essential for its proper functioning. It also plays a primary role in maintaining the health of the eye, cerebral cortex, skin, sperm, and testicles. The human body can produce a small amount of DHA on its own, but like EPA, we get the majority of our DHA from cold-water ocean foods. DHA can also be found in organ meat, poultry, and egg yolks, though in small amounts.

Cardiovascular Health

The positive effects of fish oil on the human cardiovascular system have well been established, but that’s not to say no controversy exists. After evaluating the potential benefits of fish oil supplements for patients with multiple pre-existing cardiovascular disease factors, scientists concluded that DHA and EPA had neither a positive nor a negative effect on cardiovascular health. However, an early meta-analysis of fish oil studies revealed a possible correlation between fish oil supplementation and lower blood pressure. Further, scientific data indicates that fish oil consumption can reduce the risk of coronary heart disease, decrease mild hypertension, and prevent certain cardiac arrhythmias. Other studies show that fish oil capsules can be effective in the prevention of primary and secondary cardiovascular disease. In multiple clinical trials, fish oil supplements have been linked to the suppression of major coronary events. The most conclusive benefit of fish oil supplements seems to be that fish oil capsules are effective in lowering triglycerides in the blood. One study found that a prescription dose of EPA + DHA (2x the normal amount) lowered patients’ triglycerides by 27%.

Mood Disorders

Fish oil is not considered to be an effective replacement for mental health treatments, but when used in conjunction with other therapies, fish oil seems to provide beneficial effects to patients diagnosed with borderline personality disorder, unresponsive depression, and schizophrenia. EPA in particular has been studied for its possible use in regulating mood disorders, and researchers found that EPA-heavy omega-3 supplements appear to be effective against primary depression when used alongside prescription medications and other treatment. There is some evidence, however, that fish oil supplementation does not improve mood when tested against a placebo.

Alzheimer’s Disease

In a double-blind study spanning 26 weeks, researchers found that neither high nor low doses of fish oil had an observable effect on cognitive performance in patients age 65 and older. A much longer study, however, found that fish oil intake is associated with lower rates of Alzheimer’s disease. That being said, in a study of 174 Alzheimer’s patients, fish oil supplementation was not shown to reduce cognitive decline in patients with mild or moderate Alzheimer’s disease, though some positive effects were shown in a small group of patients with very mild Alzheimer’s. Other trials confirmed these finding that omega-3 supplementation is beneficial only for patients with mild cognitive impairment. While it’s still too early to make firm recommendations regarding the potential benefits of fish oil intake, daily DHA supplementation in excess of 180 mg is associated with a 50% decrease in dementia risk.

Eye Health

Regular consumption of EPA and DHA fatty acids significantly reduces the risk of developing age-related macular degeneration in women. Other findings suggest that increased omega-3 intake via fish oil capsules can prevent age-related macular degeneration in all subjects, sometimes by an estimated 22%. While the precise role of omega-3 fatty acids in eye health is unclear, there is some evidence that suggests DHA supplements can prevent cell damage and eye stroke injury in the retina.

Inflammation

A study of 250 patients with neck or back pain revealed that fish oil supplements are an equally effective but safer treatment for reducing arthritic pain compared to NSAIDs like ibuprofen and aspirin. Some studies suggest that EPA, independent from DHA, is a potential therapeutic treatment for arthritis-related inflammation in mice, and that EPA has a stronger anti-inflammatory effect than DHA. While another study’s findings suggest that fish oil supplements are not as effective in reducing chronic low-grade inflammation in obese men compared to weight reduction, multiple studies seem to suggest that omega-3 fatty acid supplements can decrease inflammation in patients, particularly those diagnosed with rheumatoid arthritis or ulcerative colitis.

Cancer

Some evidence points to the benefit of fish oil’s anti-inflammatory effects on reducing the overall number of cancer cells in the colon. Another investigation found that EPA + DHA are good candidates for primary and secondary breast cancer prevention due to their abilities to reduce inflammation. Strangely enough, one recent study has shown a correlation between elevated levels of omega-3 fatty acids and an increased risk for developing aggressive prostate cancer; men with the highest DHA levels were 2.5x more likely to develop high-risk prostate cancer, though similar studies proved inconclusive. Further, other studies revealed opposite findings, that fish oils are actually helpful in reducing the risk of prostate cancer in healthy individuals, as well as preventing colorectal and breast cancer formation.

The Last Word

Ultimately, the health benefits of fish oil supplements are still unclear. Studies surrounding omega-3 supplements, as we have seen, are conflicting at best, contradictory at worst. That being said, multiple organizations agree that the potential benefits of fish oil capsules outweigh the potential risks for generally healthy people, though more evidence is needed before making a definitive claim.

Continue taking fish oil capsules if they have been prescribed to you by a physician. If you are planning to begin a fish oil regimen, consult with your primary care physician beforehand to make sure you are healthy enough and that they will benefit you. General consumers should be aware that while many of the findings referenced above are interesting, it’s entirely possible you may not be receiving the benefits you’ve been paying for.

What Do You Know About Diabetes?

By Nathan Blake |11/9/16

November is designated National Diabetes Awareness Month.

In 2012, over 9% of the American population—roughly 29 million people—had some form of diabetes. Worse, one in four people with diabetes do not know they have the disease. With over 1.5 million new cases of diabetes being diagnosed every year, this disease is quickly becoming one of the nation’s fastest growing and most serious epidemics. In fact, diabetes was the seventh leading cause of death among Americans in 2010. That number, if current trends continue, is sure to rise.

What is Diabetes?

Diabetes is a group of health conditions that makes it difficult for the human body to properly control the level of sugar in the blood. When we eat, our bodies convert food into sugars, one of which is called glucose, which our cells rely on as a main source of energy to carry out the basic bodily functions of our muscles, brain, heart, liver, and more.

Because of the importance of glucose in everyday health, there are very intricate biological processes at play to regulate glucose in the blood. These processes ensure that our glucose level does not rise above or fall below a healthy range.

The Importance of Insulin

The cells in our body cannot use glucose directly and must rely on a hormone called insulin. After eating, insulin is released into the bloodstream by the pancreas. Insulin attaches to cells and prompts them to absorb glucose from the bloodstream. The cells then turn the glucose into energy.

When there is an overabundance of sugar in the blood—for instance, after a big meal—insulin stores this excess glucose in the liver to be used later when blood sugar levels drop, such as during the period between meals or while exercising. Normally, glucose is kept under tight control by the pancreas which uses insulin to regulate the blood levels. Diabetes occurs when this regulation system fails to control the levels of glucose.

Types of Diabetes

Type 1 diabetes (formerly called “juvenile-onset diabetes”) occurs when the body cannot create its own insulin. This is because the body’s immune system has destroyed the insulin–producing “beta cells” in the pancreas. Without insulin, glucose cannot enter cells. The cells must then use other inefficient sources of energy while glucose levels rise. This metabolic imbalance can be life–threatening. To prevent this problem, patients with Type 1 diabetes must receive insulin injections daily in order to regulate their blood sugar levels.

Type 2 diabetes (formerly called “adult-onset diabetes”) occurs when the body continues to create insulin but the cells have a sluggish response to its effects. The result of this “insulin resistance” is elevated levels of glucose in the bloodstream. Over time, the high glucose level can also affect the pancreas and reduce its production of insulin.

Gestational diabetes, occurring in roughly 4% of pregnancies, results from hormonal changes during pregnancy that inhibit insulin’s ability to regulate glucose levels.

Risk Factors

While the risk factors for developing type 1 diabetes are still being studied, research shows that having a family member with diabetes can increase your risk for developing the disease. Type 1 diabetes occurs most commonly in children and young adults, accounting for roughly 5% of all people diagnosed with diabetes.

More is known about what causes type 2 diabetes, as it is the disease’s most common form. Several risk factors include a family history of diabetes, being overweight, not getting enough regular physical activity, an unhealthy diet, high blood pressure, and increasing age.

Pregnant women at risk for developing gestational diabetes include those over the age of 25, people with a family history of diabetes, and women who are overweight. For reasons that are not fully understood, gestational diabetes occurs more frequently among black, Hispanic, Asian, and Native American populations.

Treatment

Many diabetics require treatment with insulin or other medications that help control glucose. Equally important are lifestyle habits that can be helpful in preventing diabetic complications. Diabetes can be managed by taking the following precautions:

• Eat meals balanced in starches, fruits and vegetables, proteins, and fats.

• Make physical activity a daily routine.

• Monitor blood sugar levels to be sure they are under control.

• Manage blood cholesterol and lipid levels by eating healthy and taking prescribed medications as recommended by a healthcare provider.

• Control blood pressure to a healthy range (below 130/80).

Prevention

Type 1 diabetes cannot be prevented, although many studies have shown that patients can take a few simple steps to drastically reduce their risk for developing type 2 diabetes.

The Diabetes Prevention Program was a federally-funded project that monitored over 3,000 individuals who were at risk for type 2 diabetes. Researchers discovered that adults at risk for the disease were able to reduce their susceptibility by half by following two practices: healthy eating and regular exercise.

Adhering to a low-calorie, low-fat diet and getting at least 30 minutes of physical activity for five days a week were shown to be effective markers for lowering the risk for diabetes.

To learn more about diabetes diagnosis, treatment, and prevention, visit the National Institute of Diabetes and Digestive and Kidney Diseases, supported in part by the National Institutes of Health.

Is Obamacare Affordable?

By Mark A. Kelley |10/13/16

The upcoming election has dominated the media lately. Health care is not far behind with reports about Obamacare, health insurance and drug costs.

What’s behind the headlines?

Obamacare—too expensive?

The Affordable Care Act (ACA, Obamacare) was designed to expand health care coverage for those without insurance. Under the ACA, the federal government subsidizes the insurance for those who cannot afford it.

There have been a few surprises since the ACA was implemented. The newly insured folks have had more health problems than anticipated. This has driven up total heath care costs. Insurance companies had subsidies to cover these losses, but they will soon expire and the losses will increase. As a result, some major insurance companies, such as Aetna and United Health, have pulled out of the ACA.

Some policy experts think that the costs of ACA will go down. The theory is that as newly insured sick people receive medical care, their health will improve and they will need fewer services. No one knows if this will happen. Even President Obama admits that the ACA “has some problems”.

Rising Costs  

Aside from the ACA, other health care costs have been rising. A major driver has been the price of prescribed drugs. A second factor is the cost of expensive technologies especially electronic health records, mandated by federal law. These systems can improve communication but do not reduce costs.

These and other factors have created health care “sticker shock”. Employers are seeing their insurance costs accelerate. To reduce premiums, most employees have an annual insurance deductible, averaging over $1000. Prescribed medications often fall into the deductible. For example, someone who once paid a $20 co-pay for a drug must now, with a deductible plan, pay the insurer’s cost. The price can be ten times the cost of the co-pay. That can be an economic disaster for a patient on many medications.

Corporate Scandal

The recent uproar over the “Epipen” may be the last straw for the American public. The Epipen provides a life-saving injection for patients who suffer severe allergic reactions. The price of this product skyrocketed without any new enhancements. In effect, the company used its monopoly to extract extraordinary profits from families who need this “rescue drug”. This maneuver enraged the public and created distrust of the pharmaceutical industry.

The Flaws in the System  

These reports reflect significant flaws in our health system. Unlike most developed countries, we have few price controls for prescribed medications. We are also more liberal in approving new technologies and devices. Finally, in our private insurance system, insurers pass increased costs to employers and patients so there is no brake on inflation. This makes health care prices difficult to understand and to justify.

Employers are losing patience with rising costs of health care. One alternative is to providing employees with a “defined contribution” i.e. a fixed dollar amount for health insurance. This is how 401K-retirement plans work. Most employers can no longer afford pensions. Instead they provide a fixed amount for the employee to set aside for retirement. How the employee uses the money is up to them.

“Public Option” on the Horizon?

Many policy experts believe that we are headed for a “single payer” system. This means that health insurance would be provided and regulated by the federal government. We already have such a plan—it’s called Medicare.

Medicare controls prices, eligibility and coverage rules. It has kept medical inflation low for the past five years and its payment is accepted everywhere. Medicare is not free. It is supported by taxes and premiums and is very popular with its beneficiaries.

Will “Medicare for all” ever happen? The American public is becoming restless for such a change and politicians have noticed. For years, there have been political discussions about a “public option” similar to Medicare. Now, the federal government pays for almost 50% of our nation’s health care costs. That figure is rising as more “baby-boomers” enroll in Medicare. Some policy makers think that a national health insurance plan is inevitable.

They may be right. Studies and polls show that the majority of physicians and voters favor such a system.

That may be the most significant news of all.

Prostate Cancer – Does Everyone Need Treatment?

By Mark A. Kelley |09/20/16

Last week, the New England Journal of Medicine published an important study about prostate cancer. The research showed that men with early stage prostate cancer can safely choose “monitoring” instead of treatment.

This might seem like a strange recommendation for such a serious disease. However, prostate cancer is an unusual malignancy. It is more common as men age but it rarely causes death.

Prostate cancer can be detected very early with the simple blood test, the prostate-specific antigen (PSA). The treatment is either surgically removing the prostate gland or treating the prostate area with external radiation. Both treatments are effective but can cause impotence and incontinence.

This is an unusual paradox in cancer treatment. A very simple blood test can detect prostate cancer in its early stages but the cancer grows slowly and is rarely fatal. Furthermore, the treatments have important side effects. Should a patient undergo treatment for a cancer that is rarely causes death?

The new study helps to answer that question. The major goal was to determine if prostate-cancer survival is better with early treatment versus to a “watch and wait” strategy. The study recruited over 1600 men between 50-70 years old with localized, early stage prostate cancer. These volunteers were randomly assigned equally to one of three groups: immediate surgery; immediate radiation; or “active monitoring” of their cancer by a medical specialist. During that monitoring, patients whose cancer became more aggressive were offered treatment. All patients, on average, were followed for ten years.

The major results of this study are:

1.  For all patients with localized prostate cancer, the 10-year survival from the disease was 99%.

2. There was no survival advantage from early treatment or the type of treatment (surgery vs. radiation).

3. Progression of prostate cancer occurred in 20% of the “active monitoring group” and in less than 10% in the treatment groups. This difference did not have any affect on survival over the ten years of the study.

4. About 60% of the “active monitoring group” eventually had surgery or radiation during the follow-up period. However, the remaining 40% had no progression of their disease.

What did we learn from this study?

The study confirms that localized prostate cancer does not behave aggressively. Over ten years, survival is excellent. Nearly half of the patents assigned to follow-up had no progression of their disease. They were spared unnecessary procedures. This lends support to follow-up as an option for patients.

What still remains in question?

More of the “active monitoring” patients had progression of their cancer compared to early treatment patients. (20 % vs. 10 %). This difference did not affect mortality in this study. However, the significance of this finding is unknown and warrants further research.

What will physicians recommend now?

Before this study was published, most experts have been offering follow-up as an option for men with localized prostate cancer. This new study gives convincing evidence that follow-up, instead of immediate treatment, can be a safe choice for newly diagnosed prostate cancer patients. In 40% of such patients, the tumor remains stable over a decade and requires no treatment. If the tumor grows during that period, and treatment is needed, the survival rate is still 99%.

A warning: in this study, specialists carefully followed men with “active monitoring”. Men who do not have this follow-up may have less favorable results.

This study may be especially helpful for patients who are hesitant about treatment. Those concerns are often about the complications of treatment or the risks of co-existing medical conditions. For such men, this study confirms that monitoring is a reasonable choice. This information will make it easier for doctor and patient to plan the next steps.

This is a great example of how medical research can help patients make informed choices.

To read more about prostate cancer, see the American Cancer Society website.

 

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