Sunday, September 30, 2012

Nurse Practitioners and Primary Care

Stephen L. Brotherton, MD
Fort Worth Orthopedic Surgeon

In a Sept. 14 guest editorial in the Fort Worth Star-Telegram, Sandy McCoy, a Plano nurse practitioner and president of the nurse practitioners’ state association, fashioned a plea for increased scope of practice for her profession. She made several correct statements that are worth repeating: Texas is low compared with other states in availability of primary care physicians, and it is undoubtedly going to get worse; there are not enough Texas medical residency slots to further the training of Texas medical school graduates; and, in her words, “nurses are crucial to the future of healthcare in our state.” She also quotes one of several economic models that show a positive economic impact to fully actuating primary care in the state.

However, she makes one statement that is arguable and leaves out two important factors. She asks for significantly increased ability to diagnose and prescribe — duties traditionally held by doctors — and states that such is “well within the bounds of (nurse practitioners’) education and training.” She is welcome to make that plea, but it is enough to say that not every stakeholder within health care would agree with her. She also fails to note that the shortage in access to health care is primarily rural, and that there is a chronic and recurring shortage of nurses functioning in their traditional role. Her solution would not address the first issue, and would tend to aggravate the second.

Nurses are an indispensable part of the health care team. Think about it — if you are a hospital inpatient, or in a post-anesthesia recovery room, or in an intensive care unit, you are there because you need access to a nurse. Health care as we know it today cannot exist without nurses. Further, nurse practitioners in their current role are a valuable part of the delivery of care, and I enjoy their input every day. However, converting our current advanced-practice registered nurses (i.e., nurse practitioners) to proto-physicians by allowing an expanded, unsupervised role in diagnosis and prescription is not the best solution to the problem Ms. McCoy describes.

We need enough funding for residency programs so that Texas medical graduates can stay here to train. We need loan repayment programs so that medical school graduates with six-figure education debts can get relief by practicing in rural areas (the 185 of 254 counties that Ms. McCoy mentions). We need to adequately pay for and respect nurses in their current role as members of the health care team. Anything else can compromise quality of care and patient safety.

Thursday, September 27, 2012

Three Steps for Tackling Cancer

This much is clear: Cancer is everywhere. Everyone knows someone who has been affected by cancer. The challenge is: How do we tackle this problem? Where is the best place to start?

Enter priority areas: specific steps we’ve identified that are proven to have a greater impact on a larger percentage of the population when addressing this worldwide problem.

Step 1: Quit the Habit
One of our biggest responsibilities in the medical community is to encourage people to stop using tobacco. Reducing tobacco usage and exposure to secondhand smoke has the potential to make a huge difference in the rate of cancer in Texas.

  • The Centers for Disease Control and Prevention states that tobacco use is the single most preventable cause of disease, disability, and death in the United States.
  • Almost one-third of all cancer deaths are related to tobacco.
  • Tobacco usage accounts for almost 90 percent of all deaths from lung cancer.
  • The estimated direct cost of cancer care for lung/bronchus cancer in Texas in 2007 was $1 billion.
It is essential to ensure that all Texans have an opportunity to learn about the dangers of tobacco use, and access to care when needed.

Step 2: Screen
A critical component in cancer care and prevention is early detection. Currently, cancers that go undetected can lead to tragic outcomes AND are more expensive. Screening the public for breast, cervical, and colorectal cancers will help alleviate the cancer burden for Texans.

  • Breast cancer:
    • Scope: It is estimated that in 2012, 16,000 women in Texas will be diagnosed with breast cancer and another 2,800 will die from the disease.
    • Cost: $923.7 million per year is the estimated direct cost of breast cancer to the state of Texas.
    • Power of early detection: Routine mammograms can significantly reduce deaths from breast cancer. A recent survey showed that 30 percent of women age 40 and older reported not having a screening in the last two years.
  • Cervical cancer:
    • Scope: In 2012, more than 1,200 women in Texas will be diagnosed with cervical cancer and another 400 will die.
    • Cost: In Texas, the cost of care for cervical cancer was $77.4 million in the last year.
    • Power of prevention: Cervical cancer is one of the most preventable and detectable cancers through screenings. Twenty-four percent of women age 18 and older reported not having a cervical cancer screening within the past three years.
  • Colorectal cancers:
    • Scope: Colorectal cancer is the third most commonly diagnosed cancer in men and women and the second leading cause of deaths overall. In 2012, more than 10,600 Texans will be diagnosed with colorectal cancer and another 3,700 will die from the disease.
    • Cost: In 2007, the direct cost of cancer care for colorectal cancer was over $1 billion dollars.
    • Power of prevention: If people age 50 and older have routine screenings, at least 60 percent of deaths could be avoided.
Step Three: Diagnose and Treat … but Most of All … Help People 
Cancer isn’t just about science. It is a disease that attacks people on the most human of levels: emotional, physical, practical, and spiritual. Effective diagnosis, treatment, and palliative care help ensure all patients receive timely and effective care and are equipped with what they need to fight cancer.

Palliative care is enormously helpful. Studies show this kind of care improves quality of life for patients and in some instances can prolong life. Unfortunately, Texas needs more. As of 2009 only 42 percent of Texas hospitals with at least 50 beds reported offering some type of palliative care program. The national average is much better at 63 percent. Our state needs more physicians who specialize in this kind of care. There are only 221 board certified palliative care physicians in Texas. It’s something to think about.

These are the first steps to take in the fight against cancer. For more information, and next steps, download your copy of The Texas Cancer Plan today:

Blog post contributed by the Cancer Prevention and Research Institute of Texas.

Wednesday, September 26, 2012

Q&A Health Care Reform: If You Are on Medicaid

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next eight years. Texas physicians carefully studied the law to help you understand what the changes mean to your health care.

Here are a few questions Texas patients asked their doctors. There are many more. Please feel free to submit your questions to Me&MyDoctor.

What If I'm on Medicaid?

Q. How can I find a doctor who takes Medicaid?

A. Health reform did little to increase the number of doctors who take Medicaid. State budget cuts in the past two years forced out even more doctors. Beginning in 2013, higher Medicaid payments to primary care doctors may help more participate in the program. Your doctors are working to find a solution.

Q. Can undocumented immigrants get Medicaid or CHIP?

A. The law has not changed. Medicaid coverage for undocumented immigrants is limited to emergency services. Under the Children's Health Insurance Program (CHIP), undocumented immigrant women can enroll in the CHIP Perinatal Program to receive basic prenatal care so they have healthier babies.

Q. How do I know if my children or I qualify for Medicaid?

A. Currently, low-income people may qualify for Texas Medicaid if they fit into certain eligibility categories and have low enough incomes. The chart below shows the rules based on the federal poverty level (FPL) for 2012, with income examples for a family of three:

Texas Medicaid Eligibility
Percent of FPL
Family of 3
Maximum Income
Allowed to Qualify
Child: 0-1 years 185% $35,316 
Child: 1-5 years 133% $25,390 
Child: 6-19 years 100% $19,090 
Working Parent  26% $4,963 
Pregnant woman 185% $35,316 
Adult with disability  77% $14,699 

If you think you are eligible and wish to enroll, you can find links to the application information at

Tuesday, September 25, 2012

Obesity: The Health Issue Eating Texas’ Economy

Commissioner of Agriculture Todd
Staples told participants, “Taxpayers
are picking up the tab for poor
eating choices.”
“At least 50 percent of health care expenditures are estimated to be lifestyle-related and preventable,” Texas Agriculture Commissioner Todd Staples said today at the Texas Public Health Coalition’s (TPHC's) University of Health forum. “We need to spend more time preventing disease so we can spend less money treating disease.”

Commissioner Staples spoke to dozens of legislative staff and community and health care leaders at TPHC’s third University of Health forum focusing on obesity and its impact on Texas’ physical and fiscal health. Joining Commissioner Staples were Eduardo Sanchez, MD, Dallas family physician, TMA member, and vice president and chief medical officer for Blue Cross and Blue Shield of Texas; and Michael Castellon, e-communications coordinator and editor at the Comptroller of Public Accounts.

Mr. Castellon revealed the disturbing truth: The Texas comptroller’s office found that in 2009 obesity cost Texas businesses an estimated $9.5 billion due to higher employee insurance costs, absenteeism, and other effects. Left unchecked, he said, obesity could cost employers $32.5 billion annually by 2030.

To combat this trend, Commissioner Staples said the focus needs to be on lifestyle changes through education and improved nutrition standards. The Department of Agriculture developed the 3E's of Healthy Living in Texas to tackle obesity: Education, Exercise, and Eating Right.

“We’ve placed a lot of emphasis on nutrition — which is good; nutrition is part of the issue,” he said. “But we are still losing the battle. We have the lunch room, we have the class room, and we have the living room. We have to send the right message in all three of those rooms if we are going to change people’s lifestyles. The lunch room alone is not getting the job done.”

Commissioner Staples called for action in the upcoming legislative session. “Studying [obesity] is not necessarily the answer,” he said. “We have the resources, we have the science, we have the programs. We’ve got to go into the ‘doing’ and not the ‘talking’ stage. We can do something about [obesity] but it is going to take us all working together.”

Monday, September 24, 2012

Texas Licenses Record Number of New Doctors, Emerges from Liability Crisis

The Texas Medical Board licensed a record 3,630 new physicians in the fiscal year that ended last month. The record total is 70 percent more than the board issued in 2001 and 2002; the low water marks during Texas’s medical liability crisis. It’s also the fifth new record since passage of the 2003 reforms.

Texas has long been a net importer of physicians and this past year was no different. Seventy-three percent of the state’s newly-licensed physicians are graduates of medical schools outside of Texas.

In the nine years since the passage of reforms Texas has licensed an average of 3,135v new physicians each year. This is 772 more than the average of 2,363 in the nine years preceding reforms; a gain of 33%.

“All Texans can thank our 2003 liability reforms for a huge chunk of these new physicians who are caring for our sick and injured neighbors all over the state,” said Texas Medical Association President Michael E. Speer, M.D.

A just-released study by noted economics professor Stephen Magee of The University of Texas at Austin tracks both total new licensees as well as in-state active physicians before, during and after the state’s liability crisis.

Today, nine years after Texas lawmakers passed far-reaching medical lawsuit reforms, the per- capita number of Texas direct patient care physicians stands at an all-time high. Professor Magee’s research shows that the number of doctors that left active practice more than doubled from 2000 to 2005, the last year of the crisis. That number dropped dramatically after the crisis, he said.

“Essentially, the number of doctors that treat patients flattened during the crisis but then took an upward trajectory four years after the passage of reforms,” according to Magee. “The delayed physician growth response is consistent with what we see in other tort reform states.”

Other notable findings from the study:
  • The number of high-risk specialists practicing in Texas has grown nearly 18 percent faster than the state’s population from 2005-2011.
  • The ranks of pediatric sub-specialists, emergency care physicians, cardiologists, vascular surgeons and anesthesiologists have outpaced the state’s population growth.
  • As a whole, the state’s most medically underserved counties have shown greater physician growth than they saw during the crisis period.
For research purposes, Professor Magee arranged all Texas counties from the most medically underserved to the most served. He then bundled those counties into ten groupings, with each group accounting for about 25 counties.

Using those groupings, he found that the Texas medical liability crisis reduced direct patient care physician growth in the bottom 80 percent (the bottom eight of the ten groupings) of Texas’ most medically underserved counties. “Following the 2003 reforms, direct patient care physician growth improved in six of the eight underserved county groupings,” Professor Magee said.

Sunday, September 23, 2012

Family Planning: The Great Debate

Kimberly Carter, MD
In Texas, the majority of unanticipated pregnancies are among the 18–24-year-old, uninsured, low-income, minority population. “If we want healthy children, adults … healthy Texans, who are not going to continue to be a burden on the social welfare system, then we should champion ways to make individuals responsible for their contraception and personal health,” said Kimberly Carter, MD, an Austin obstetrician-gynecologist.

 Dr. Carter was one of four panelists on “Family Planning: The Great Debate,” one of many topics discussed during the 2012 Texas Tribune Festival in Austin. Other panelists included Rep. Donna Howard, (D-Austin), Rep. Bryan Hughes, (R-Mineola), and Joe Pojman, executive director of Texas Alliance for Life. The panelists discussed why the 2011 legislature cut funding for women’s health services and how these cuts are now playing out in Texas communities.

The Women’s Health Program, which does not provide abortions, delivers cost-effective basic health care screenings — such as for cancer, high blood pressure, and diabetes — as well as birth control. This is the only source of such preventive care for many low-income women in Texas.

Outlined in Texas Medical Association's Healthy Vision 2020, more than 70 percent of pregnancies among single, young women in Texas are unplanned. Increasing the number of women who enroll in the Women’s Health Program after a Medicaid delivery is especially important. Women who have had a Medicaid-funded delivery are at particularly high risk for subsequent pregnancy, often so soon after the first delivery that they face much greater risks of having premature or low-birth-weight infants. Babies born too soon or too small often have significant health problems, such as breathing or developmental delays, contributing to higher medical costs at birth and as the child ages. In 2007, unplanned Medicaid births cost the state more than $1.2 billion.

Representative Howard and Dr. Carter said Texas must spend money to educate young people about contraception. Studies show educating teenagers about contraception actually delays sexual intercourse and decreases unintended pregnancies. By rebuilding Women’s Health Program, Texas can give young couples the tools to take responsibility for their future and protect their own health and their children’s.
Baylor medical student asks a question at Texas Tribune Festival


Thursday, September 20, 2012

Prevention: Saves Money. Improves Lives.

Dr. Bias
“Daily I manage diabetes, high cholesterol, and high blood pressure … I encourage weight loss and smoking cessation … I screen for cervical, colon, and breast cancer, all while giving regular vaccinations to continue to prevent communicable diseases,” Travis Bias, DO, a Pflugerville family physician told members of the Legislative Budget Board (LBB) today. “I see what is and what is not working with our public health system.”

Dr. Bias, representing the Texas Medical Association, Texas Pediatric Society, and Texas Association of Family Physicians asked LBB members to support the Texas Department of State Health Services proposed 2014-15 budget, including additional requests for funding to address costly and threatening public health concerns such as obesity and mental illness. He cautioned members that additional budget cuts could harm Texas’ already fragile public health infrastructure.

TMA outlines why investing in prevention saves money and lives in its legislative roadmap, Healthy Vision 2020: Caring for Patients in a Time of Change. The state must invest in its public health infrastructure, especially now. Public health in Texas is tied to the viability and stability of our state economy. If we do not protect our workforce from infectious and preventable disease, ultimately the state’s income will suffer. A strong public health system is insurance against the things we know destroy economic systems: instability, lost work time, and unnecessary expenditure of resources.

Wednesday, September 19, 2012

September is National Gynecologic Cancer Awareness month.

The American Cancer Society recommends that average-risk women get Pap smears every two years, which is key to detecting cervical cancer early and providing the highest survival rates. Unfortunately, there is no approved screening test for ovarian cancer. The symptoms are often vague and may seem to be more gastrointestinal than gynecologic. If there is a suspicion of ovarian cancer, it is critical to schedule an appointment with a gynecologic oncologist as quickly as possible.

Marci Santiago is an ovarian cancer survivor. In August, Marci’s Team, made up of her friends and family, raised the most money for the Austin Walk to Break the Silence on Ovarian Cancer sponsored by the National Ovarian Cancer Coalition. This is her story:

“At this point in my life, both of the doctors involved with my ovarian cancer diagnosis are lifesavers. Although I believe paying attention to my body was the catalyst to geting me into the doctor’s office, my gyno, Dr. Eldrid Kaplan, took me seriously, did an exam, and sent me for a CT scan. He believed I had a fibroid tumor and would have a simple hysterectomy. He called me 15 minutes after the CT to tell me what they really found. He sent me to a gynecologic oncologist, something I did not know even existed. Dr. Mark Crozier saw me two days later, due to the phone call from Dr. K.

“I am in awe of what it would take to be an oncologist. A very special kind of person has to deal with cancer every single day. Dr. Crozier was kind, but firm; informative, but not scary. As it turns out later, I hear from a lot of people that I am very lucky to have had him because he does more teaching then surgery these days. My surgery was very successful, and I had ZERO complications..

“My relationship with Dr. Crozier, and his fabulous staff, has grown into something completely different. He is very funny and honest. He picks his words carefully, and deals with the fact that I always have an entourage with me. At my very first appointment, there were four of us in the room with him, and 7seven of my friends were in the waiting room. He was also open to a lot of things: Western and Eastern medicine, a second opinion at M.D. Anderson, and a change of protocol that I requested for my treatment. I am cancer-free and in the middle of a year-long trial with him. Obviously, he is my hero!”

TMA’s Physician Oncology Education Program offers a 30-minute video for physicians, Ovarian Cancer and the Health Care Provider, featuring ovarian cancer survivors and their stories. To view the video, please visit

Tuesday, September 18, 2012

AAFP: Nurse Practitioners Not the Answer to Physician Shortage

The nation’s primary care shortage is expected to worsen as more American’s acquire health insurance and become eligible for Medicare. But a report released today by the American Association of Family Practitioners (AAFP), “Primary Care for the 21st Century,” cautions against substituting nurse practitioners for doctors to alleviate this shortage.

“Wholesale substitution of non-physician health care providers for physicians is not the solution, especially at a time when primary care practices are being called upon to take on more complex care,” said Roland Goertz, MD, MBA, chair of the AAFP Board of Directors and Texas Medical Association (TMA) member. Nurse practitioners do not have the same education or clinical experience as a physician, he says. “Their levels of knowledge and skills are complementary, but they are not equivalent.”

Instead, the AAFP says the most effective care is provided by a primary care physician or a team of health care professionals led by a physician in a patient-centered medical home (PCMH). A PCMH ensures that patient care is accessible, coordinated, comprehensive, and culturally relevant. The physician or team directly provides, coordinates, or arranges health care or social support services as indicated by the patient’s individual medical needs and the best available medical evidence. The model uses a team-based approach with the patient’s primary care physician leading the overall coordination of care. Trained teams and well-constructed electronic health records are key to a successful PCMH

“Patients need access to every member of their health care team — starting with a primary care physician, nurse practitioners, physician assistants, and all the other professionals who provide health care. Creating a system in which some patients have access to only a nurse practitioner is endorsing two-tiered care. That doesn’t happen in the physician-led patient-centered medical home, and we believe all Americans should have access to this quality of care,” said Dr. Goertz.

TMA’s legislative roadmap, “Healthy Vision 2020: Caring for Patients in a Time of Change,” outlines how PCMH could help to reduce fragmented care, lower costs, avoid repetitive and costly procedures, and improve patient outcomes. Given the budget constraints that Texas faces and a growing population with unique health care needs, the PCMH offers the potential for Medicaid cost savings as well as improved patient outcomes and physician and provider satisfaction.

View the infographic below for more information.

(Click for larger image)

Monday, September 17, 2012

Combination of Cuts Squeezing Valley Physicians, Patients

Carlos Cardenas, MD, vice chair of the Texas Medical Association Board of Trustees and TMA’s Border Health Caucus, told House Committee on Human Services members today that physicians in the Texas border region cannot keep caring for patients without immediate action by lawmakers to lessen payment cuts that went into effect in January. Texas Medicaid implemented a new policy limiting what it pays physicians who treat dual-eligible patients. As a result, physicians across the state who care for these patients have been forced to absorb a cut of 20 percent, and in some cases, even more.

“Dual-eligible” patients are low-income seniors and people with disabilities who qualify for both Medicare and Medicaid. In Texas, there are almost 465,000 dual-eligible patients who are among the sickest and most vulnerable people in our state. Many reside in nursing homes.

“Without physicians in communities across this region providing the right care, at the right time, and in the right manner, border health disparities and long-term health cost will rise by an exponential factor,” said Dr. Cardenas, a practicing gastroenterologist in McAllen.

“Over the past year, South Texas physicians and providers have experienced one of the most challenging periods of change in modern time,” he said. The Texas Medicaid program expanded Medicaid managed care for women, children, and seniors into South Texas. Simultaneously, the state reduced payments for Medicaid-eligible, low-income seniors through revisions to its dual-eligible payment policy, while changes by the federal government to the Health Professional Shortage Area program went into effect and led to the loss of additional payments for most urban counties in South Texas. These factors contribute to the growing health care crisis in Texas’ border region — a region already burdened by high rates of chronic health conditions, illiteracy, and uninsured individuals.

“Physicians already have begun exiting the South Texas community,” Dr. Cardenas warned lawmakers. “Relief for these physicians and their patients cannot happen too soon.”

Saturday, September 15, 2012

PAs Making Up for MD Shortage

The physician might still be captain of the health care ship, but the expected increase of insured Americans (due to aging boomers eligible for Medicare and the new health law expanding health insurance coverage) requires all hands on deck to prevent catastrophe, reports the Wall Street Journal’s MarketWatch.

Enter the physician assistant (PA).

The WSJ describes this highly competitive health care field as willing and ready to make up for the shortage of doctors. According to the article, “authors say [PAs] can fill about eighty percent of a doctor’s role. They can prescribe medication in all 50 states, run medical practices when the supervising doctor is in another part of the country, and even help perform endoscopies and heart procedures.”

The Texas Medical Association believes the solution to high quality patient care is to use a "team approach," where each member of the health care team provides their important skill set and training. Physicians will continue to provide patient care services, but they also will be called upon to manage the care provided by the entire team.

It essential patients receive the right care, at the right time, by the right professional, in the right venue. The association outlines this solution and many others in TMA's Healthy Vision 2020: Caring for Patients in a Time of Change.

Friday, September 14, 2012

Juice: Soda’s Evil Twin?

America is a country obsessed with consuming liquid calories. Numerous articles and infographics have been published on the health dangers of soda. But what about juice? For many, “juice” implies drinks full of fruit, vitamin C, iron, and other healthy nutrients. So why should it be a concern? A infographic questions the health benefits of many popular “fruit drinks,” and exposes the amount of sugar and calories hiding in these beverages frequently marketed to children.

Soda's Evil Twin

Thursday, September 13, 2012

Infographic: Obesity Is Complex but Conquerable

The solution to obesity might seem simple: exercise more, eat less. But it’s much more complex than that. Today’s culture of fast food, sedentary jobs, and shrinking physical education time in schools helps contribute to the nation’s obesity epidemic. It’s a tough problem to fix, but it’s not impossible, says the Institute of Medicine (IOM). IOM put together an infographic detailing the factors affecting today’s obesity crisis as well as solutions.

Click on image for larger view.

Wednesday, September 12, 2012

The Healthy Benefits of Texas Medical Liability Reform

By Michael E. Speer, MD
President, Texas Medical Association

Originally published in D Magazine Healthcare Daily

It’s clockwork. Nine years ago this week, Texas voters approved our desperately needed medical liability reforms. Just like every other year at this time, the trial lawyers’ propaganda machine is once again trying to convince Texans to ignore the improvements they’re seeing all around them.

I’m pleased to report on some new research that soundly contradicts the naysayers’ rhetoric.

In 2003, the Texas Legislature passed sweeping liability reforms to combat health care lawsuit abuse, reverse physicians’ skyrocketing professional liability insurance premiums, and help ensure sick and injured Texans can see a doctor when they need one. The centerpiece of those reforms was a $750,000 stacked cap on noneconomic damages assessed against physicians and health care facilities (hospital systems, nursing homes, and such) in a liability judgment. There is no cap on economic damages.

On Sept. 12, 2003, Texas voters approved Proposition 12, a constitutional amendment that ratified the legislature’s authority to establish these important reforms.

The reforms have worked. They’ve lived up to their promise. Texans today have more physicians to deliver the care they need, particularly in high-risk specialties like emergency medicine, obstetrics, neurosurgery, and pediatric intensive care.

Just ask George Rodriguez of Corpus Christi, who walks today thanks to tort reform. Newly established Corpus Christi neurosurgeon Matthew Alexander, MD, urgently operated on Mr. Rodriguez’ spinal abscess, relieving the pressure on his spinal cord and sparing him life in a wheelchair. Without the state’s lawsuit reforms, Dr. Alexander wouldn’t have relocated to Texas, and Mr. Rodriguez would not have found a doctor to perform the emergency neurosurgery in Corpus Christi.

The plaintiffs bar’s assault tactics tend to rely on two faulty arguments:
  1. There was no crisis to begin with, and/or
  2. The reforms really haven’t worked.
A just-released study by noted economics professor Stephen Magee of The University of Texas at Austin refutes both those allegations.

Dallas Doctor’s West Nile Story on published an adapted version of our post detailing Don Read, MD’s first-hand experience with West Nile virus. What started out as a low-grade fever and muscle aches quickly turned into paralysis requiring months of recovery. To this day, Dr. Read says he cannot function in the same capacity, and has had to give up activities most people take for granted, like carrying his grandchildren.

Tuesday, September 11, 2012

Infographic: Exercise Is Good For the Brain

Texas’ Obesity Awareness Week (TOAW) runs Sept. 9-15. Created by the 80th Texas legislative session, TOAW raises awareness of the health risks associated with obesity and encourages Texans to maintain a healthy and active lifestyle. Texas currently weighs in as the 10th-fattest state in the nation.

A Harvard Medical School study reveals not only do overweight and obese students struggle with self-esteem, but also they may struggle academically. The study compared sixth-grade students’ level of fitness with their test scores and determined that the fittest students scored 30 percent higher than average students, while the least fit students scored 20 percent lower. The conclusion? Fitter body, fitter brain.

Monday, September 10, 2012

The Impact of TV on Children

The McCuistion Program is a Dallas-based educational television show about social, economic, public, and health care policy. Its most recent broadcast, “TV and its impact on our kids,” looks at the repercussions from watching too much television.

From McCuistion:
Television watching in the average American home has reached an all time high. Today the average 2-5 year old spends 32 hours a week in front of a TV set and 6-11 year olds spend an average of 28 hours. This program focuses on the influence of television, including both the pros and cons of television watching, and how it impacts kids, their reading ability, and school function.
Read more

Friday, September 7, 2012

Whooping Cough Kills Five Kids, Sickens 1,000 More in Texas

Texas Department of State Health Services Commissioner David Lakey, MD, issued an advisory yesterday urging Texans to protect themselves and their loved ones from pertussis (whooping cough) by getting vaccinated. An increase in cases this year claimed the lives of six children — two of whom were infants — and sickened more than 1,000. That’s the highest number of pertussis victims since 2005. Texas doctors urge families to avoid tragedy by vaccinating their children and themselves from this deadly disease.

Read More:

Thursday, September 6, 2012

HPV Vaccination: Why I Hesitated But Later Had My Daughter Vaccinated

By Lauren Schrader  
Lauren is a mother of three who lives in Austin

When I took my 11-year-old daughter to the pediatrician for her yearly check-up, he recommended the HPV (human papillomavirus) vaccination. My response: I didn’t want to introduce ideas about sexual activity when I knew she wasn’t sexually active yet. So I decided to put off the shot and the discussion about it.

Professionally, I work on a vaccination program, so I’m a vaccine believer. And my kids were up to date on all their other vaccines. So why my hesitation?

I know HPV vaccine (three shots required for full protection, by the way) works better if given before an adolescent becomes sexually active. I am confident in its safety. In fact, several physicians assured me of its safety. I guess I really just didn’t want to think about my daughter being involved in the kinds of behavior that lead to this disease.

So for the next year, I deliberated over the decision. I talked with friends and family, who were on both sides of the fence.

At some point along the way, my thinking started to change. What if a future sexual partner exposed her to the disease? By no fault of her own, she could get HPV.

And then I started to think about cancer. I was seeing articles talking about the cancers that can be caused by HPV – cervical, head and neck, oral, and the like. As a two-time cancer survivor myself, I knew I’d much rather prevent cancer than treat it. That saves time and money, and emotional toll.

When my daughter’s check-up rolled around the next year, I spoke privately with the doctor. Even though my husband and I had decided to have our daughter vaccinated, I wanted my doctor’s advice about how to explain the HPV vaccination. His response was simple: “It prevents cancer.” And that’s what we told her. No discussions about sex, just an attempt to prevent something for her that she’d watched me go through. She didn’t question.

Now my youngest daughter is about to turn 12. I won’t hesitate about getting her vaccinated at her well-check.

Tuesday, September 4, 2012

Physicians and Legislators Defend Doctor-Patient Relationship

Dr. Neavel
Yesterday’s public hearing on how the Texas Women’s Health Program (TWHP) will function without federal funding saw doctors and legislators speak up for the well-being of Texas women and the doctor-patient relationship.

Celia Neavel, MD, FSAHM, warned the Texas Department of State Health Services (DSHS) that its proposed rules, if implemented, would restrict a physician's ability to provide candid and confidential information about elective abortions to any woman seen in the practice, even if the physician felt this information was in the best clinical interest of the patient or if the patient asked about the procedure. "The rules set a dangerous precedent for future interference by lawmakers in patient-physician communication, based upon the political agenda of the day," Dr. Neavel said. Her clinic, People's Community Clinic in Austin, will reluctantly resign from the program if the rules are adopted.
Dr. Realini

"We are alarmed by the proposed Women's Health Program rules because they will discourage provider participation and limit women's access to care," said Janet Realini, MD, president of Healthy Futures Alliance (HFA), a coalition dedicated to reducing teen and unplanned pregancy. "Members of HFA are already seeing a real crisis in access to women's preventive care. Further loss of providers will only make things worse."

Dr. Realini outlined her concerns to DSHS officials:
  • TWHP is critically important to the health of Texas women and families. The program keeps women and babies healthy, and reduces Medicaid costs to taxpayers.
  • A recent two-thirds funding cut to TWHP has cut off at least 150,000 women from preventive care and is creating a crisis in Texas communities.
  • There are too few TWHP physicians to meet the current need, and the proposed rules will mean even fewer doctors. 
Dr. Realini urged DSHS to drop what Texas physician organizations call the “gag order” in the TWHP proposed rules to maximize the number of physicians who can provide care to low-income women in Texas.

Joining Drs. Neavel and Realini were Reps. Donna Howard (D-Austin) and Sarah Davis (R-Houston), and Sen. Kirk Watson (D-Austin). They told DSHS the rules will further erode physician participation in TWHP at a time when Texas already has too few doctors and clinics serving these patients. The legislators cited the Texas Medical Association’s letter to DSHS officials, which states: "Physicians will not sacrifice their medical ethics and professional standards to participate in a program that imposes such draconian restrictions.”

"Few relationships are as sacred as the doctor-patient relationship," Representative Davis wrote in the letter to Health and Human Services commissioner in August. "I have been an outspoken critic of any legislation that interferes with this relationship, and oppose any rules that are ambiguous enough to prevent a doctor from sharing his or her best medical advice with a patient."

Monday, September 3, 2012

Because Your Doctor Cares: What You Need to Know About Health Care Reform

During the health care debate, doctors worked to make sure nothing would come between you and your doctor. Now that Supreme Court has upheld most of the law, that is still our biggest priority.

The goal of health reform was to lower health care costs and cover millions of Americans with insurance. Your doctors are working to make sure that doesn't mean you get lower quality of care or less care.

We know health reform is big and confusing. Some parts of the law started in 2010. Other parts are rolling out over the next eight years. Texas physicians have carefully studied the law to help you understand what the changes mean to your health care.

What You Need to Know About Health Reform.
  • Most people must have health insurance beginning in 2014 or face a tax penalty.
  • People who cannot get affordable health coverage from their employer can buy it through a federal or state health insurance exchange. Starting in 2014, some people can get tax credits to reduce the cost of their premiums, copays, and deductibles.
  • Small businesses also can buy health coverage through an exchange.
  • Large employers (50-plus employees) who don't offer health coverage to their employees must pay a penalty for each employee who receives a tax credit to buy their health insurance through an exchange.
  • Health insurance companies must provide coverage to anyone, regardless of health status or a preexisting condition. People will not pay more because of their health status or sex.
  • There will be no lifetime or annual dollar limits on health insurance coverage.
  • Texas has an option to use federal funding to expand the Medicaid program to cover more low-income adults.

Here are a few questions Texas patients have asked their doctors. There are many more. Please feel free to submit your questions to Me&MyDoctor.
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