We will soon be offering telehealth appointments for existing patients. As soon as the last few technical details are completed you will be able to schedule an appointment for a face-to-face video-chat visit using HIPAA compliant software. This is perfect for any type of visit or followup that does not require a hands on exam. When you’re too sick to come in to the office, or too contagious, we can see you through eVisit, which you can use on a computer or through the app on your phone or tablet. We can help you out with mental health concerns, with the stomach bug or influenza, with a urinary infection, a rash, pink eye, an allergic reaction,back pain, and many other common illnesses or follow up appointments. If you need to call us after hours for an urgent medical need we can direct you to sign in if we feel a telehealth visit is needed to properly treat you. You can choose to pay through insurance with just a standard office copay or you can pay out of pocket. We will still submit your prescription to your pharmacy or submit a referral to a specialist- just like a standard office visit. Just make sure you are somewhere you can talk privately!
Click here to go to our telehealth page on our website to read more about it and watch a video. You can click on the link there to be directed to our eVisit site. I recommend signing up now so that all you have to do is sign in when you are sick.
We are so pleased to be offering this to our patients and continuing to be collaborative and efficient in our health care practice.
In honor of the end of Breast Cancer Awareness Month let’s talk about risks and screenings. When should you get a screening mammogram? At what age should you start? How often should you get one? Do you need an ultrasound or an MRI for further evaluation and how often?
These questions have different answers depending on whose advice you are looking for. All the groups that make official recommendations have their own particular guidelines for routine screening mammograms. They all agree on the risk factors though.
- Family history/ genetics
- Younger age for first period
- Older age for first childbirth
- Older age for menopause
- Breast density
- Use of birth control and/or hormone replacement
- Lack of exercise
- Alcohol use
- Radiation exposure
The most aggressive guidelines for screening are from the National Comprehensive Cancer Network. They recommend annual mammograms starting at age 40, and clinical breast exams. The most relaxed guidelines are from the US Preventive Services Task Force which does not even give recommendations for women with higher risk but only recommends screening mammograms every 2 years, beginning at age 50, and recommends against breast self-exam. The American Cancer Society recommends screening mammograms annually at 45 and decreasing to every other year at 55. The American Congress of Obstetricians & Gynecologists recommends annual screening mammos at age 40. All but the USPSTF recommend being aware of the feeling of your own normal breast tissue and having an annual MRI if the lifetime risk of breast cancer is calculated to be more than 20% based on family history.
How do you determine a woman’s lifetime risk of getting breast cancer? There are computer programs available that allow us to calculate that based on family history and the personal risk factors listed above. At your next physical exam we can determine if we need to calculate this risk, and at a followup appointment we can take the time to enter your personal and family data into a program that will give us a percentage chance that you could have breast cancer in the next 10 years and also the chances of developing breast cancer in your lifetime. These are sobering statistics (I have entered my own data and even with no family history of breast cancer my lifetime chances of developing it are 12%!). If your lifetime risk is 20% or higher you are entitled to see a genetic counselor and your insurance is obligated to pay for it, as well as an MRI (thank you Affordable Care Act).
Come in and let’s talk about your personal and family risk factors for developing breast cancer and make sure you are getting the appropriate screening to ensure your longest healthiest life.
In addition to its known benefits of improving bone and heart health, adding a natural supplement of Vitamin D may boost our immune system. So, we know that certain groups of people are deficient in D- like darker complexions, higher body fat, and indoorsy types. Fat cells absorb Vitamin D and keep it out of circulation so those of us who have any extra weight (and females have a higher body fat percentage anyways) are likely deficient. Also, if you have a darker complexion or use sunscreen outside it’s really difficult to absorb enough of the sunlight in our skin to make this vitamin. While we are still sorting out the ideal level of Vitamin D in our bodies, there is decades of evidence that this vitamin our bodies produce naturally is essential in achieving and keeping our optimum level of overall health. Our bodies make Vitamin D in our skin when we are exposed to sun. We’ve all been spending less time outside, and people who live in the northern half of the US (or similar latitudes around the world) don’t get enough sunlight.
You know how milk says “Vitamin D” on the label? Well, that’s because we can’t absorb calcium without Vitamin D so the milk producers add it to the milk. We have a tough time using that calcium to build bones without enough D. So while we all know calcium is essential to build and maintain bones and avoid osteoporosis in our later years, that calcium is not useful unless it has its helper- Vitamin D. This means people who follow a vegan diet are also at risk of low D (in addition to B12 and iron).
High blood pressure, heart attacks, strokes, and heart failure are all linked to low levels of Vitamin D as well. Huge clinical trials are being done right now so that we can determine how much of an impact supplementation has on improving heart health.
What we are also realizing is that we have Vitamin D receptors on our immune system cells. People with low D levels are more likely to have auto-immune disorders and increased risk of infection in general. Remember how people with Tuberculosis were sent to sanatoriums to go sit in the sun? And how cod liver oil has been used for centuries for general health? Well sitting in the sun and drinking cod liver oil both increase your Vitamin D level- they were on to something!
Come in and see us at any of our Kelly Goodman Group locations and we can check your Vitamin D level (our Nurse Practitioner draws your blood herself). Once we know your level we can advise you on how best to supplement this essential vitamin and prescribe a prescription strength Vitamin D if needed. Say no to colds and flu this fall and yes to bone and heart health!
Did you see the hashtag #FatSideStories on Twitter last week? A very sad story about being treated cruelly by health care providers was quite common. This really broke my heart. As a health care provider, it can be tough to talk to patients about weight because it is a sensitive subject for so many people. It doesn’t have to be. Let me tell you- this is one reason I love being a Nurse Practitioner. I feel that we really approach healthcare from a team perspective and without judgement. While we have the “expert” opinion to share with patients, we still want to be on the same personal level with them in terms of mutual respect. So, if someone comes to me to with a desire to discuss weight loss, I want to sort out what their story is. What is their day to day lifestyle that is keeping them from losing weight? If they come in with diabetes or blood pressure that is out of control, and weight is a factor, we will be discussing weight and the positive effect of even mild weight loss on those disease states. But if someone comes in for a cough, or STD/STI testing, or anything else unrelated to weight, there will be no discussion of a patient’s weight. When it is appropriate to have a discussion about weight, there is no judgement. If someone needs to lose weight because it is contributing to a chronic condition, we will talk about it. But it is not from a place of lecturing or scorn. It is an opportunity to gather some information from both the patient and the provider, and together come up with some options for treatment that the patient feels will work with their lifestyle, their family, and their personal beliefs and culture. There is no room for judgement in an honest and open relationship between patient and provider. It serves no purpose- whether the touchy subject is weight, sex, drugs, self harm, or anything else that is sensitive to someone. Our goal is to help people achieve their best possible health. So please don’t put off healthcare because you don’t want to deal with the lectures. Come see us instead. No lectures, no judgement, just health.
Whoever your Primary Care Provider is, they essentially have one central goal: to have your back and ensure you are always getting the best available care. Primary Care providers are the only ones who look out for total physical and mental health, coordinate care with specialists, and keep records of all your medications, labs, and imaging. Sure, you know you want a Primary Care Provider in your life, but here’s why you should see us here at Promenade.
We are highly accessible. With our convenient location in L’Enfant Plaza, we are served by 5 different metro lines. Little known fact: we are also the only primary care office in the entire Southwest quadrant of the city. But even if we had some competition, we are confident we would still be the clear choice for your primary care needs.
As a private independent practice, we take the time to get to know our patients. We are a local, family practice and we like to keep it friendly, personal, and simple. We don’t employ medical assistants or techs, so you will only ever deal with two people at our office: our front desk assistant and your provider. Upon checking in for an appointment, your provider (one of our lovely NP’s) will escort you to the exam room, measure your vital signs, discuss your symptoms or concerns, examine you, and if necessary, draw your blood themselves. You will see 1 room and 1 person per visit. And since we draw your labs ourselves, you will never need to go to an outside lab and sit in another waiting room to see another stranger.
We know how much continuity of care matters to our patients, and since we are a private, locally owned practice you can expect to see the same provider for most, if not all of your visits. Unlike a visit to any walk-in clinic or urgent care center, here at Promenade, each patient establishes a real relationship with his/her provider, and this helps us ensure that your health concerns are never forgotten or overlooked from one visit to the next.
Promenade Primary Care and our other location, Kelly Goodman NP & Associates in Bethesda, have streamlined your healthcare experience because we know your time is valuable. Check out our graphic and see how we have engineered our appointments to be as personalized and efficient as possible compared to other doctor’s offices.
I’ve heard many people say that since they are healthy they don’t need a primary care provider. They are wrong. Primary care is not just for people with chronic health conditions, although everyone with a chronic concern like high blood pressure or asthma should definitely have a primary care provider. Let’s look at a fictional typical young and healthy patient and see how they are cared for with and without primary care.
Jessica is 28 years old. She is in good health overall and moved to Washington, DC two years ago for a job. Since arriving she has gone to an Urgent Care twice for a UTI (urinary tract infection) and once for a sinus infection. She knows she is allergic to penicillin but can’t recall the names of the antibiotics she has taken for these infections. She has also seen a dermatologist for a skin issue twice. She has not been to a gynecologist since she moved here. She does not have a primary care provider. She relies on Google and Yelp reviews to find healthcare and so far this approach is working for her as far as she is concerned. Her copays are 75$ for each Urgent Care visit and $40 for the dermatologist or other specialists.
Let’s imagine Jessica begins to see a primary care provider (PCP). She schedules a physical every one to two years with a copay of $0 (it’s fully covered by insurance). These visits focus on preventative health and in addition to the physical exam, screening lab tests, and review of vaccination status her provider collects a family history, list of allergies and medications, and social history that includes her lifestyle. Jessica discusses her recent fatigue and the dietary changes she is making as she trains for a team triathlon. Her PCP orders a B12 test and the results show a low level of B12 and with supplementation she notices a significant improvement. She tells her provider about her healthcare visits from the past two years and signs a release to have her records transferred to her primary care office. Now all of her records are in one place. The PCP recommends a “well woman exam” for Jessica so she also has the recommended Pap smear and STD screening as her PCP takes care of her GYN needs as well. Her primary care provider is looking out for her overall physical and mental health.
Now, when she needs refills of her dermatologic cream, she requests them from her primary care office, saving $40. When she awakens one morning with symptoms of another UTI she calls her PCP and gets a same day appointment where she is prescribed an appropriate antibiotic given her allergy and the medications and culture results of her past infections, paying only $20 instead of $75. Further, she is screened for STDs regularly, protecting her fertility for when is ready to start a family. When she plans a vacation to Asia with her friends she is able to get the vaccines she needs to travel safely, and medications including antibiotics and motion sickness prevention to bring with her just in case.
So again, why does Jessica need primary care if she is a healthy young person? A good primary care provider offers holistic and preventative healthcare for people of all ages and in all states of health. Having a primary care office is the healthiest, most efficient, and cost effective way to take care of your health. At Promenade Primary Care we will take all of your past and current health issues into consideration as well as your lifestyle and health goals to provide you with the best care possible. Since we are a small private practice, we can truly personalize your care and establish close provider/patient relationships. And we will make it easy.