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A Doctors Oath

The physician patient relationship is one of the most sacred and special relationships that society holds. It is one of defined caring, compassion, and trust. The Hippocratic Oath states:

I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug.

This is a powerful statement. Nowhere are insurance companies, government agencies, or managed care organizations mentioned. This is the essence of medicine. The patient, The physician. Nothing else.

In this day of electronic medical records, vast insurance companies, governmental intrusion, company owned practices, there are many people that now stand between Physician and patient.

I entered this profession perhaps a bit naïve. My hero, as a youth is perhaps a bit strange to some. It was not a professional athlete, movie star or rock star. It was a simple country doctor in a small town set in early pioneer America, Doc Baker, the town physician in “Little House on The Prairie.” Whether at Doc’s office or the patient’s home, Doc Baker Empathetically plied his profession. His pay… an evening dinner with a family or a fresh pie from the kitchen. No prior authorization, insurance approval, attorneys. Today it takes an act of congress to ask your physician a simple question. There is voicemail, 30 different options on the telephone to route your call, and often a dozen intermediaries who intercept on behalf of the physician.

If the physician-patient relationship is to be preserved there must be direct access to the physician. The manner employed may be debatable- through cell phone, internet, texting or even Facebook. What is not debatable however is the uninterrupted connection between the patient and her physician.

Although perhaps controversial with a few of my colleagues, I regularly give my cell number to my patients. If they need me they simply call.

By and large my patients are very respectful and call only when they genuinely need advice or to be seen immediately. In this small way, I continually hope to take another step to emulating my childhood hero, Doc Baker.

Fibromyalgia

Fibromyalgia is a recognized condition that is often diagnosed clinically by both a thorough history and physical exam. The defining symptoms of fibromyalgia include chronic pain, sleep disorder, diffuse musculoskeletal pain, and often chronic fatigue. The typical Fibromyalgia patient has visited an average of 15 physicians without correct diagnosis over a course, again on average, of 5 years. Once the diagnosis is made consistent with the American College of Rheumatology guidelines, the patient is often placed on pharmaceutical treatments such as Savella, Lyrica or Cymbalta. In some cases these medications are effective in alleviating the symptoms of the disease. In others, side effects or lack of efficacy may be a barrier to therapy. In either situation as a provider I also recognize the relationship of hormonal imbalance to the Fibromyalgia state.

The advent of Bioidentical hormone therapy (BHRT) allows the correction of hormonal imbalances that contribute immensely to weight gain, musculoskeletal pain, fatigue, irritability and sleep disorder. It has been demonstrated that progesterone does enhance both neuronal health and viability. Interestingly as time progresses and estrogen/progesterone levels decrease, fibromyalgia symptoms in many patients worsen. This is likely due to poor neuronal function leading to a neurosensory disturbance that in turn causes severe and diffuse pain. It is the correction of hormonal imbalances that can restore adequate neuronal health and thereby help the diffuse pain syndrome associated with fibromyalgia.
Many patients with fibromyalgia respond dramatically to BHRT. In the past, I have actually discontinued medications from Fibromyalgia patients given marked clinical improvement with BHRT. Although this may vary from patient to patient, this is truly an exciting new and potentially restorative treatment that we at my-BIO provide to our patients.