Advancements in Medical Diagnosis

http://video.msnbc.msn.com/rock-center/50582822#50582822

I found the above video fascinating and the doctor unusually candid.

WOW!!! CG, thank you so much for posting this. I think it deserves to be cross-posted to the tech or Mirador sections (or both) because everyone needs to see this. This is amazing and I guess the technology is here and all we have to do is embrace it. Oh yeah, and have a doctor hip enough to be able to do it too. woo hoo

Yesterday Dr. Ramon Garcia, the cardiologist, showed me an EKG machine the size of a pack of cigarettes that you simply point at your chest over your heart and touch the skin and it reads you heart and EKG and allows you to send, record, download to your computer from a chip, etc etc. He said he paid $400 US for it recently but it probably would be cheaper by now.

Now, just using you smart phone for labs, EKGs, skin signs, etc. . .I am really impressed!

Thanks again for posting.

Does anyone think insurance will pay for this?
It should be interesting to watch as this technology becomes more mainstream.

Wow, cool, however maybe we don't want to know everything. Both I and a former colleague are now refusing to even go to the doctor unless we have actual symptoms. It's working for her and for me. Neither of us have any chronic diseases which need monitoring. Every now and then I take my B.P. which is usually way on the low side unless I'm stressed out. Even in the emergency room when they were about to cut my leg open it was only 140 over 90.

What abut prescriptions you might ask. Well she writes her own, and I get my controlled substances from Dr. Lastra. The only show in town. They're just for pain, due to my neck problems.

E Raq quote - "I get my controlled substances from Dr. Lastra. The only show in town."

Do you mean he's the only qualified Dr. in town?

joec wrote:E Raq quote - "I get my controlled substances from Dr. Lastra. The only show in town."

Do you mean he's the only qualified Dr. in town?

No John, strike three, you're off the team. He's the only Doctor in town licensed to give prescriptions for codeine pills and the like. Whoa there dude, what are you on today? You been sneaking into my supply of Lertus with codeine or what?

E-raq wrote:

joec wrote:E Raq quote - "I get my controlled substances from Dr. Lastra. The only show in town."

Do you mean he's the only qualified Dr. in town?

No John, strike three, you're off the team. He's the only Doctor in town licensed to give prescriptions for codeine pills and the like. Whoa there dude, what are you on today? You been sneaking into my supply of Lertus with codeine or what?

So, what's tne big deal about codeine. There are many stronger drugs and Doctors at Lakeside write scrips for controlled substances all the time. I asked if you thought he was a qualified Doctor. maybe you do, but I know people who won't go to him anymore because of misdiagnosis.

IMHO, we have waaaaaay more misdiagnoses here than I've ever seen or heard of in my life. And the reason is that many of these docs just pull diagnoses out of the clear blue sky. Most do not request tests.

In the US, depending on your chief complaint, you are sent for appropriate labs, xrays, etc before you are given a diagnosis. Not here. Docs here just go. . . . . .hmmmmmmm and they pluck some magic thing out of the air and send you on your way with a prescription - which often doesn't work.

I've seen too many people here die before their time for 2 reasons: 1- they waited way too long to seek help and 2 - they were misdiagnosed at least once! Don't let that happen to you. Seek help as soon as you realize you are sicker than you should be, find a good diagnostician, and get some appropriate tests done first to take in with you. You don't need a prescription here to go to the labs or get xrays. Old people don't have the luxury of time while they plow through different docs and different diagnoses.

People complain about Juan Pablo because he orders too many tests. . .duh.

Simple, then go to JP. Or ask your doc which tests are needed to CONFIRM his/her diagnosis and go get those tests done before filling any prescriptions.

If you know what tests to get, do it first or ask your doc first what tests he/she recommends you get for a proper diagnosis. If not, do it after to confirm the diagnosis.

For most of us who have lived in our bodies for 50, 60, 70 years, we have a generally good idea what might be needed. If you have flank pain and are peeing a lot, get a urinalysis, if you think you have intestinal bugs, get a fecal exam, if you're hocking up green loogies take one to the lab and ask them to run a culture on it (that way you can get the appropriate antibiotic prescribed), if you twisted your ankle or fell and still have pain after there shouldn't be pain get an xray etc etc etc.

Good idea Ferret! Get labs done when you are healthy for a baseline.

I see a lot of good points that were brought up under this topic.
With new technology and testing in general there are certain things to remember.

As a doctor we are taught that there are different diseases/conditions that are diagnosed in different manners. Some are diagnosed clinically(physical exam and history), others radiologically( X-Rays, CT scans), others with Labs(blood work, culture) and while others are diagnoses made by excluding all others possible diagnoses(i.e. FIBROMYALGIA).
Your doctor should be able to explain to you how and why a diagnosis has been made with whatever information he has.

Although getting "BASELINE" labs can be a good idea, it can be costly and most patients would have to pay OUT OF POCKET for it. If a patient's medical history merits some diagnostics (i.e. Diabetes) then I order them and explain why I did so and what I expect to find or rule out.

Now with any new technology or diagnostic tool, a well-trained healthcare provider will take into account the SPECIFICITY and SENSITIVITY or any particular exam. We have to take into account the statistical validity of a test or diagnostic tool when we use it. Let's just remember that there are always false positives and false negatives and the potential for human/lab error always exists. I particularly like to go into a Diagnostic clinic and see how they run the operation before I send my patients to an Lab to get diagnostic work done.

With the new technology, I will be very interested to see the statistical validity of what seems to be such a great tool for a very good price.
Seems almost too good to be true.

Really? Very interesting.

E-raq wrote:

joec wrote:E Raq quote - "I get my controlled substances from Dr. Lastra. The only show in town."

Do you mean he's the only qualified Dr. in town?

No John, strike three, you're off the team. He's the only Doctor in town licensed to give prescriptions for codeine pills and the like. Whoa there dude, what are you on today? You been sneaking into my supply of Lertus with codeine or what?

Raq, does Dr. Lastra tell you that he is the only doc that can prescribe Lertus )and the like) ?

Dr. Sam Thelin wrote:Really? Very interesting.

E-raq wrote:

joec wrote:E Raq quote - "I get my controlled substances from Dr. Lastra. The only show in town."

Do you mean he's the only qualified Dr. in town?

No John, strike three, you're off the team. He's the only Doctor in town licensed to give prescriptions for codeine pills and the like. Whoa there dude, what are you on today? You been sneaking into my supply of Lertus with codeine or what?

Dr. Thelin, do you believe this to be so?

It is not so. Where do people get this kind of idea?

Dr. Lastra has a licenciatura in medico cirujano, same as any other general practicioner.

You can check any doctors credentials here:

http://www.cedulaprofesional.sep.gob.mx/cedula/indexAvanzada.action

Lertus can be purchased over the counter without any prescription by anyone. Lertus is Diclofenaco.

Lertus CD can be prescribed by any doctor having a cedula and pre-printed prescriptions having the doctor's name, address, and cedula pre-printed on it. Lertus CD does not require the bar-coded prescriptions that would be needed for most other opiates because it is a mixed medication containing both codeine and diclofenaco (50mg and 50mg). There are also a few others that can be given without the bar-coded prescriptions such as buprenorfina.

The bar-coded prescriptions for more controlled medications are available to doctors willing to go to the trouble of obtaining them, keeping the records of them, and being responsible with them.

Ms.Thang wrote:It is not so. Where do people get this kind of idea?

This is a valid question, Raq, where did you get this idea? Did Dr. Lastra tell you this or did you pull it out of thin air?

Since I haven't met or looked-up any other local physician's credentials I can't comment on what each can or cannot prescribe. I will say this. I have training and experience both in the U.S. and in Mexico with pain management. There are quite a few other ways to manage pain other than by prescribing "PAIN" medications. Controlled PAIN MEDS, which are usually OPIOIDS(Morphine, Codeine, Vicodin), are only one of many options a doctor has to manage pain. For somebody to have a "Diploma or Certification" in such areas such as Toxicology, NUTRITION or PAIN MANAGEMENT, a doctor does not need to do a long Fellowship or Sub-specialty here in Mexico. Some physicians do have training that is more in depth and may have a sub-specialty.

Having training as a family physician in the U.S. I oversaw and managed pain for every type of patient. From simple leg fractures to patients with herniated disks to patients with Fibromyalgia. Most can be managed by a PCP but there are a few patients that may need to be evaluated and managed by an anesthesiologist/pain specialist.

I haven't encountered any problem with any of the medications that I have written for pain management thus far.
Although this is a good point I think that it merits another THREAD. This is way off course from the original post.