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Dr. Chin on Swine flu and pregnancy

May 4th, 2009
Chief of Pediatrics, Assistant Medical Director

Chief of Pediatrics, Assistant Medical Director

As the epidemic is evolving, it appears that the H1N1 (swine flu) illness seems to be similar in severity to the seasonal flu. As the CDC has noted, pregnant women are more likely to get sick than others and have more serious consequences with the seasonal flu. These problems may include premature labor or pneumonia. Therefore, pregnant women should probably be extra cautious not to get this illness. If you do become ill with the flu (seasonal or swine), consult your doctor before taking Tamiflu or Relenza. No serious side effects have been reported but these drugs have not been evaluated in pregnant women so there is little data to go on. Please consult a physician if you are pregnant and become ill.

From the CDC: Pregnant Women and Swine Influenza Considerations for Clinicians

Dr. Yan Chin On NBC Local News Tonight at 6:30PM

April 30th, 2009

Tune in and get your answers to questions about swine flu.

Chief of Pediatrics, Assistant Medical Director

Chief of Pediatrics, Assistant Medical Director

Dr. Yan Chin specializes in pediatric care and has been with Current Health since 2004. As Chief of Pediatrics, he oversees pediatric care for the practice. He did his residency training at Children’s Hospital Oakland and has practiced in San Francisco since 1998.

Dr. Chin is also a medical consultant with the California Department of Public Health and has lectured at medical conferences throughout California, including the academic medical centers at Stanford and the University of California, San Francisco. He has a strong interest in pediatric environmental health and sits on the California chapter of the American Academy of Pediatrics’ Committee on Pediatric Environmental Health. He has done public health work in West Africa and Thailand and has contributed to multiple scientific and medical publications.

Dr. Chin received a BA in biochemistry from Swarthmore College, an MPH in epidemiology and biostatics from the University of California, Berkeley, and an MD from the University of California, Davis, School of Medicine. He is board-certified in pediatrics.

Preventive strategies for H1N1 (AKA “The Swine Flu”)

April 30th, 2009

The latest reporting reveals one case of H1N1 in San Francisco and 14 cases in the bay area.  We’ll know more in the next week regarding the scope of this problem, however, because the virus is spread via human to human contact it’s important to be proactive and aware of some strategies that can help prevent an infection for you and your loved ones:

  1. Wash your hands regularly with hot water and soap, especially after coughing or sneezing.  Carry alcohol-based hand cleaners with you to use when water and soap are unavailable.
  2. Avoid contact with sick individuals
  3. Avoid unnecessary travel in close quarters (bus, plane, etc) and wear a mask if travel is unavoidable- the n95 masks are the most effective See: Dr. Sewell
  4. Stay healthy- your best defense against getting sick is keeping your immune system healthy
    1. Get at least 8 hours sleep per night
    2. Eat 3 high protein meals per day
    3. Avoid unnecessary stress and exercise regularly
    4. Consider some immune support supplementation- A good over the counter formula for this is called “Anti-V” by Natural Partners which contains botanical medicine known to stimulate the immune system and have anti-viral activity.  However, if you end up getting sick I recommend discontinuing the Anti-V as it’s an overactive immune system that causes many of the problems associated with H1N1.

Most importantly, at the first sign of symptoms (fever, cough, runny nose, sore throat) call you doctor.  There are effective anti-viral drugs to treat H1N1 but they need to be started with in the first 24 to 48hrs of onset of symptoms.

Dr. Clifford Sewell: To Mask or Not to Mask

April 30th, 2009

The number of suspected and confirmed cases of swine flu is increasing daily, and the next week or two will likely determine the severity of the outbreak.

One of the most  common questions we are getting is “Do I need a facemask in public?”

Internal Medicine, Currenth Health Medical Group

Internal Medicine, Current Health Medical Group

The CDC reports 109 cases nationally, and 14 cases in California. CDC

We are at an early stage, and the risk of contracting swine flu is low at the moment, however, the potential for an epidemic of swine flu is high.  During this evolution of the swine flu outbreak, all precautions should be followed including hand washing, hygiene, and facemaks in crowded areas.  Public areas with higher risk include airline, bus, train, and any public commuter transport. When it is absolutely necessary to enter a crowded setting or to have close contact with persons who might be ill, the time spent in that setting should be as short as possible. If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene.   A respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time.

When crowded settings or close contact with others cannot be avoided, the use of facemasks or respirators in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

  1. Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.

  1. Facemasks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people’s coughs and to reduce the wearers’ likelihood of coughing on others; the time spent in crowded settings should be as short as possible.

  1. Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.

These recommendations will be revised as new information about the use of facemasks and respirators in the current setting becomes available.

The term “facemasks” refers to disposable masks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks. Such facemasks have several designs. One type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the nose bridge, and may be flat/pleated or duck-billed in shape. Another type of facemask is pre-molded, adheres to the head with a single elastic band, and has a flexible adjustment for the nose bridge. A third type is flat/pleated and affixes to the head with ear loops. Facemasks cleared by the FDA for use as medical devices have been determined to have specific levels of protection from penetration of blood and body fluids.

“Respirator” refers to an N95 or higher filtering facepiece respirator certified by the U.S. National Institute for Occupational Safety and Health (NIOSH).

Three feet has often been used by infection control professionals to define close contact and is based on studies of respiratory infections; however, for practical purposes, this distance may range up to 6 feet. The World Health Organization uses “approximately 1 meter”; the U.S. Occupational Safety and Health Administration uses “within 6 feet.” For consistency with these estimates, this document defines close contact as a distance of up to 6 feet.

When to wear a facemask is a personal decision, and this information is a general guide and may be over or under protective and cautions depending on the situation presented

Dr. Clifford Sewell on Swine Flu

April 27th, 2009

Swine flu is a respiratory disease of pigs that can be transmitted to humans.  There are now  documented cases of  person to person transmission happening now in the U.S. and internationally.  Since 2005, only 12 confirmed cases of swine flu have occurred in the United States.   From March – April 26, 2009, there have been 20 confirmed cases of Swine Flu in the U.S. Swine flu is a strain of Influenza A and symptoms of swine flu are similar to standard flu, and include fever, cough, headache, muscle aches, and on occasion vomiting and diarrhea.   Swine flu is not transmitted in pork meat, so there is no risk regarding pork consumption.   In general, the symptoms of swine flu are much more severe, and although unlikely, death may occur. This year, the flu season came later than usual, and new cases are being reported even now.  Mediciation that is effective on standard flu is likely to be of benefit for swine flu and includes Relenza or Tamiflu, anti-viral medications that attack Influenza A.  In order to be effective, Relenza or Tamiflu must be started within 48hrs of onset of symptoms.  Early detection and treatment are essential, so a prompt visit to your doctor is mandatory.

As of 9:00 AM on April 26, CDC has confirmed 20 human cases of swine flu in the U.S.:

Finding the Right Primary Care Physican

April 17th, 2009

Finding the right primary care physician. What you need to know and what questions you need to ask when picking the right doctor for you and your family. Dr. Jordan Shlain, medical director of Current Health, helps explain. Read Article

Is some medicine better than no medicine?

April 16th, 2009

Dr. Skylar Ulrich on: Is some medicine better than no medicine?

This is the question that comes to mind after reading Christopher Lawton’s article on “telehealth”. Cough, Cough. Is There a Doctor in the Mouse? Web services that allow patients to communicate with health care providers via webcam should never be a substitute for an actual office visit. While it may be challenging for some people to access a primary care provider or specialist when an ailment arises or even worse, to treat a chronic medical condition, attention must be paid to the fact that providing healthcare without actually having an in-person meeting with the patient, could actually do more harm than good.

Doing a consult via online video makes the assumption of an underlying trust between doctor and patient. The patient must trust a doctor who is unknown to them, most likely has not been recommended to them, and whose credentials may not be verified. On the flip side, the doctor must trust the patient’s history as well as their description of physical symptoms without actually getting to examine the patient. As many doctors will tell you, the story often changes once the patient is sitting in the room with the doctor. In addition, medical practitioners can often get a sense of what is going on with a patient by sitting face to face with them. A webcam is no substitute for this, especially when it comes to psychiatric disorders as in the case of Leah Light who was mentioned in the article. Ms. Light contacted a doctor via SwiftMd’s website to obtain a prescription refill because she didn’t want to spend the usual $260.00 to see her regular doctor. There is a legitimate reason most doctors require office visits before prescribing or refilling medication for psychiatric disorders. The drugs commonly used to treat panic-attack disorders and other psychiatric diagnoses can have serious side effects.

To paraphrase, “telehealth” is equivalent to taking an unfamiliar, possibly dangerous, shortcut to get to your final destination which should ultimately be access to quality healthcare

Dr. Skylar Ulrich on Alternative Medicine becoming mainstream

April 16th, 2009

The recent article in the Wallstreet Journal ‘Alternative’ Medicine Is Mainstream on the mainstreaming of Alternative Medicine is an excellent summary of what the future of healthcare should look like. As primary care providers it is essential to view medicine as an integration between traditional “western medicine” and “alternative” medical practices such as Naturopathic medicine, Ayurvedic medicine and Chinese medicine. Most of these practices have been around a lot longer than western medical practices yet it has only been in the last decade that they have received any validity as part of routine medical care. Dr. Chopra et. Al., are exactly right: we need to focus on and really value both monetarily and in a practical sense the benefits of a healthy diet, reducing stress, exercising more, building strong relationships and social support systems. These elements are unquestionably an essential component of health. At the same time, we see daily in our practice, the ill effects of having too little sleep, too much stress, unhealthy eating habits and a sedentary lifestyle. It is essential that we start to take our health and wellness into our own hands by focusing on and adapting these elements of wellness which are controllable. This is the first step towards a better healthcare system. The next step is to create incentives for Americans to adapt healthy ways of living, and to strive for prevention of chronic illness instead of treatment of disease.

San Francisco’s First Medical Home Charts a New Course for Patient Care

April 16th, 2009

Current Health, Formerly San Francisco On Call Medical Group,

Announces New Primary Care Membership Program

San Francisco’s First Medical Home Charts a New Course for Patient Care

SAN FRANCISCO, Calif. (May 1, 2009) – Current Health Medical Group, formally known as San Francisco On Call Medical Group, is announcing a primary care membership program that represents the 21st century model for the practice of medicine. The program addresses the rising cost of medical care and the shortage of primary care physicians by establishing a Medical Home that provides affordable access to high quality primary care services.

Getting an appointment with a primary care physician in San Francisco varies anywhere from two to four weeks. Further undermining access to quality care, national studies indicate the average face time a patient receives with a doctor is seven minutes. “What patients want is an attentive, responsive and trusted doctor who is available 24 hours a day, on email and on time,” said Jordan Shlain, Current Health’s CEO and founder. “Patients want the peace of mind that their doctor knows their history, and are focused on keeping them healthy and will help them navigate the healthcare system in crisis.” Current Health was founded on a ‘patient-centered’ approach to medicine, and the creation of a Medical Home extends the practice’s commitment to providing consistent access to quality care.

San Francisco’s First Medical Home

By building a Medical Home that responds to the immediate need for a personalized approach to medicine, Current Health is changing the way healthcare is delivered. “Current Health is the antidote to ‘fortress medicine’ that often leaves the patient confused and underserved,” said Shlain. In contrast to an impersonal experience that ultimately increases costs through a distorted relationship with time, Current Health offers an ‘always-on’ environment that reduces cost by offering a system of mutually aligned incentives. Regardless of time, place, and the impact of technological change, the ‘functional unit’ of medicine remains the quality of time that patients spend with their physician – the ‘healthcare minute’. Instead of undermining the doctor-patient relationship, Current Health reinforces the value of this ‘healthcare minute’ by providing reliable access to the best doctors at the best price. Current Health’s Medical Home means eliminating the cumbersome hurdles and putting doctors and patients on the same page – achieving better outcomes and focusing on staying healthy. Current’s Medical Home incorporates integrative and naturopathic medicine as well as pediatrics. By integrating the best practices in naturopathic and western medicine, the doctors place significant emphasis on wellness with a focus on long term outcomes.

In their pursuit of access, Current Health provides house calls to the San Francisco and Marin area performing many of the same services that are provided in a traditional medical office. Physicians usually arrive at house calls within an hour and generally spend 30 to 45 minutes with each patient, making follow up calls and visits as necessary. Current Health is actively involved, both as a medical provider and as an advocate, throughout the entire patient care process. That is, Current Health serves as the ‘lead navigator’, coordinating all the specialists for a single, comprehensive plan.

Current Health believes that an individual’s health is her greatest asset. Coupled with a high deductible insurance plan to insure against a catastrophic event, Current Health offers the most comprehensive program for the delivery of ‘always-on’ healthcare. For $50 per month, one is eligible to receive Current Health’s simple platform: online, on time, and on-call access to medical care 24 hours a day, seven days a week. “Our promise to the patient is to make healthcare straightforward, responsive and meaningful,” said Shlain. Current Health is a fee-for-service medical practice. Current Health delivers care based on patients’ needs rather than insurance company policies.

About Current Health

Current Health was founded by Dr. Jordan Shlain in 1997 under the name San Francisco On Call Medical Group Inc. He found his inspiration during a house call to an elderly woman during his residency. Focusing initially on providing services to top Bay Area hotels and to the maritime and airline industries, Current Health continues to set the standard in providing medical care to those constituencies as well as individuals in the area. A San Francisco Bay Area native, Shlain earned a B.A. from the University of California at Berkeley and his M.D. from Georgetown University Medical School. He is an assistant clinical professor at the U.C.S.F. Medical Center and a medical economics lecturer at U.C. Berkeley. He is also the Northern California medical director for Lufthansa Airlines, and is on the board of directors for the San Francisco Medical Society.

Current Health’s office can be reached at (415) 732-7029. San Francisco Current Health offices and clinic are located at 490 Post Street, Suite 710, San Francisco, CA 94102. Garage parking is available below the building at 520 Mason Street. Information about the practice and the member benefits can be found on the Web at www.currenthealth.md.

Doctors plan 24-hour house-call service for Marin

April 16th, 2009

Dr. Jordan Shlain is either a revolutionary or throwback, but either way he could be changing the way family medicine is practiced in Marin County.

read full article>>