Mammography for breast cancer screening

Ok this is not an endorsement for or against screening mammograms. This is just some information that's important to consider before you decide if mammograms for screening is right for you.

Your risk factors may be high enough that mammography screening makes a lot of sense.

The decision should be based on a good understanding of the risks and benefits.

Here's a rough outline of those risks and benefits:

If 1000 women between the ages of 50-74 get mammograms yearly for 10 years

1 will have her life saved by mammography screening
between 2-10 will be diagnosed unnecessarily with breast cancer
between 10-15 will be diagnosed earlier but it won't affect the prognosis
100 to 500 will have at least one false positive test requiring more testing or biopsy

http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2587?q=w_latest_topic
the british medical journal saying is a little differently


http://www.insidermedicine.ca/archives/VIDEO_One_in_Three_Breast_Cancers_Found_by_Screening_Mammography_May_Be_Harmless_Interview_with_Dr_Karsten_Jorgensen_MD_Nordic_Cochrane_Centre_3638.aspx


http://www.bmj.com/cgi/content/abstract/312/7026/273
talks about false positives ; each mammography center has a "recall" rate. The % of mammograms that are followed by "let's repeat the Xray" results
Our local center in Yakima, Ohana has a recall rate. I don't know the % for sure, but i'm sure we could find out.

http://www.scientificamerican.com/article.cfm?id=knowing-your-chances
this talks about one of the books of required reading if you want to make informed decisions about cancer screening tests

Lame Duck Session

I can not do everything a "PCP" can do, so please go ahead and check out the newly assigned docs and I think you'll like them.

I can provide things the PCP won't have the time for but our common goal will be your health. And like many treatments, combination therapy is superior to monotherapy.

Thank you for your patience

In the News 9/11/9

ok this one is great http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_med_swine_flu

notice how the swine flu has hit and is the dominant strain of influenza already all over the country. Ok so that means we basically just vaccinated people all over the country. The outbreak has happened and it's not the end of the world afterall. Since most people are better in 3-4 days, this outbreak is like any unique viral plague with kids missing school and more visits to the doctor's office for reassurance. There are people who get really sick for sure, but this is kinda it. People are getting more and more immune as we speak yet the US government with the full backing of the CDC and major medical societies is the proud owner of 198 MILLION doses of the swine flu vaccine? Who is going to be left to vaccinate?

And notice who is reporting on safety and efficacy data, the companies making the vaccine. Wow sign me up for that shot!

It MIGHT prevent a 3 day illness

It might be safe

Oh and this is a great quote


"Chinese manufacturers gave the first hint a week ago that one dose could be enough. But different manufacturers make different formulations of the vaccine, so more evidence was needed."


Come on! The Chinese vaccine by the way has a different formulation! wonderful

so not only is the vaccine not made by the some people, but there's different stuff you can mix in the shot to make it work better or stay preserved longer

i don't quite remember but wasn't there a deal with chinese made stuff killing pets and poisoning babies?

sheesh

The local medical community should be signing petitions for a city counsel resolution reaffirming the citizen's right to choose and refuse medical treatments including this untested, largely irrelevant vaccine.

Sounds like a good use of the local farmer's market....

A work in progress

Since it's the most timely of the issues we face, I'll be working on influeza vaccinations, testing and treatment for the next few days and post more about the plans for the budding community later.

If anyone has expertise in making a forums, feel free to move the posts I have over and I'll work on further educational materials there.

Health care advice must be individualized, but there is a lot to be learned before getting into the room and making a decision. You are the best person to balance the risks and benefits ; medical professionals are simply here to interpret the language for you.

The information can be a little overwhelming until you get used to filtering out the advertisements from the data.

I'm here to supply information ahead of time so you can have a foundation to making an informed decision.

I welcome your questions and starting 10/1/09 I will be available most of the day to answer questions, provide advice and arange for free evals to help keep you away from the aspects of the medical system that do the least good.

doctorcrafts@yahoo.com to send emails, the same ID (doctorcrafts) will be my screen name for the free yahoo instant messenger service
sign up for yahoo instant messenger for online, instant access to your former PCP

I am resigning from the for profit medical system because it is bankrupting and sickening society. The practitioners within this corrupt system are good people who are fighting the good fight in an increasingly unmanageble financial/political landscape. I want to devote ALL of my time and energy toward helping patients separate the wheat from the chaff, the propaganda from reality. I have no financial incentives. My reward is reducing the harms and profits generated by a corrupt, mindless and heartless system. I am no longer your primary care physician (PCP); I am now your health care advocate (HCA). What I have to offer is free of charge.

PS the remainder of these posts probably make more sense if read from last to 1st...

The Future

http://singularityhub.com/2009/06/08/growing-organs-in-the-lab/

yeah they grow organs in the lab now 

http://www.physorg.com/news165512266.html

nano-tech

Health Care Reform

Here's a great summary of what has been labeled as health care reform which is actually health insurance reform 

http://www.slideshare.net/danroam/healthcare-napkins-all

a lot more to be added to this section later 

This looks interesting http://emptywheel.firedoglake.com/2009/09/08/liz-fowlers-plan/

of course a lot of the folks appointed to overhaul the health care payment systems have ties with the industry they are supposed to regulate 

http://www.nytimes.com/2009/07/28/health/views/28essa.html?_r=1

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Effective July 26, 2009, Washington state law requires that all fees and charges for health care services by health care providers and licensed facilities must be disclosed at the request of the patient. Providers and facilities may refer a patient to the patient’s insurer for specific information on the insurer’s charges and fees, any cost-sharing responsibilities required of the patient, and the network status of ancillary providers who may or may not share the same network as the provider or facility. Providers and facilities must post a sign in patient registration areas indicating that patients may ask about the estimated charges of the health services. This practice will comply with all applicable requirements.

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http://www.nytimes.com/2009/07/28/us/politics/28dodd.html?ref=us

Frequently Asked Questions

This list will constantly be changing as I figure out exactly what can and can't be done through this community.  Think of me as a free supplement to your health care;  sort of like supplemental insurance except without the paperwork.  Or think of me as an eccentric retired uncle physician who enjoys giving away his knowledge and skills to family members.  

I'm still not crystal clear on any limits to prescribing authority and ordering tests and labs,  but the goal will be avoid getting into writing a ton of prescriptions or ordering a lot of routine tests since the infrastructure to collect and store that data won't present.  

What can I do?

Provide advice,  answer questions,  do limited physical exams (check ups,  well child checks, sports physicals) 

Deal with acute problems like colds, flues, bronchitis, sinusitis

Help you manage your chronic medical problems such as diabetes,  high blood pressure (you'll still need to involve your primary care provider)

Home visits

Work visits

Group visits

Walk in the park visits

Hiking visits

Biking visits

Educational lectures to small groups, class rooms etc

Blood pressure checks

What can't I do?

Referrals to specialists (that requires dealing with insurance companies) 

Refills of chronic medicines (requires access to medical records and fax machines)

Prescribe pain medicines, benzodiazepines, stimulants or any other controlled substances (that's just asking for trouble)

DOT physicals or other work physicals that require lab work or other special testing 

Hospital care (requires insurance company credentialing) 

Fill out paperwork for your insurance company 

Deal with nursing home faxes or faxes of any sort

Nursing Home visits ( except to visit;  can't write orders there without insurance credentials )