What makes a good doctor?

We all have to seek professional healthcare sometime. But how do we find a healthcare provider we really like and trust?

Think about a good experience you’ve had at the doctor’s office, urgent care, or hospital. What stood out to you as a good quality for your healthcare provider?

Think of a bad experience. What did you find frustrating? What would you change, if you could?

Find some more ideas here – https://www.npr.org/sections/health-shots/2019/07/08/739039046/how-to-pick-a-doctor-or-break-up-with-one

Conventional medical care

Conventional medical and health care are also called allopathic or Western medicine. This is in contrast with complementary, alternative, or integrative health approaches. Most of the healthcare you have probably gotten in the United States is this type of care – the kind where doctors, nurses and other affiliated medical professionals provide the care.

This type of care generally concerns itself with diagnosing, preventing and treating disease. Disease or illness in this system of care is thought to stem from organic changes in the body, like atherosclerosis, or from exposure to pathogens like bacteria and viruses.

The people who provide conventional care are medical doctors who hold MD or DO degrees, nurses (who may have a bachelor’s or master’s degree and who are licensed as RNs or NPs), physical therapists, and various other allied medical professionals. Examples include emergency medical technicians (EMTs), respiratory therapists, dentists, podiatrists, optometrists, and others.

Most medical doctors hold the MD (medical doctor) degree, and some may also have a DO or Doctor of Osteopathy degree. They attend accredited medical schools for several years, then have periods of residency and internship, and some may choose to specialize further. Doctors who provide general every-day medical care are usually those who studied internal medicine or family medicine. They may be known as general practitioners or primary care providers. They can see people for common complaints like respiratory infections, and well-care (check-ups that may include blood laboratories, blood pressure screenings, vaccines, and other prevention and routine care). They can order screening tests, blood work, medical imaging like X-rays or MRIs, and other diagnostic tools, and can prescribe medications. Doctors offices may also have Nurse Practitioners (NP) or Physician Assistants (PA) provide this kind of care under the supervision of the doctor.

Doctors who choose to specialize spend several more years working in a particular area of medicine. This can be based on a particular body system, like cardiology or neurology, a kind of patient, like pediatrics or gynecology/obstetrics, or particular type of disease, like oncology (specializing in cancers). Usually, a primary care provider may refer their patient to a specialist if they require more than routine every-day care.

Conventional care is also found in hospitals, urgent care centers, and rehabilitation centers. Here, many allied health professionals may be present to help doctors provide care.

When should you seek emergency care and when should you go to an urgent care center? Generally, you should go to the emergency room a life-threatening condition (heart attack), sudden serious changes like shortness of breath, numbness or paralysis, or serious/severe conditions like trauma, severe cuts or burns, severe allergic reactions and so on. Urgent care is for times when you need care right away and may not be able to see your primary provider quickly – things like respiratory infections, earaches, etc.

Weight management

You can be active at any size – https://www.niddk.nih.gov/health-information/weight-management/staying-active-at-any-size. You can also find lists of resources and organizations that espouse a Healthy at Every Size philosophy here
https://haescommunity.com/find/ .

Obesity, defined as a Body Mass Index (BMI) of 30 or greater, and overweight, defined as a BMI of 25 to 29.9, have been on the rise in the United States for decades. Obesity is a risk factor for heart disease, some types of cancer, osteoarthritis, sleep apnea and several other health conditions. Overweight when present with other factors like high cholesterol, high blood pressure, family history, or cigarette smoking, is also considered to be a risk.

Image shows a human body and lists medical complications of obesity: sleep apnea, stroke, asthma, pulmonary blood clots, heart disease, diabetes, fatty liver, cancers, arthritis, gout.

Learn more about obesity by watching Part 1 of the documentary Weight of the Nation. All parts are available for free on Youtube.

BMI is one of measures of body composition, previously defined here. Body composition is defined as the relative proportion of fat mass to lean mass in the body. It is usually measured by percent body fat, but that can be hard to do day to day. So one approximate measure is BMI, which is a ratio of mass to height. You can calculate your BMI here – https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm. Another measure is waist circumference, because abdominal fat puts you at higher risk for health complications.

There are more accurate measures of body composition. Calipers can be used by fitness professionals to do a skin-fold measurement to determine body fat percentage with more precision. There are also scales and handheld tools that use bioelectrical impedence to estimate a percent body fat. Less accessible are things like full body tools like air pods, hydrostatic weighing (under water), or special X-rays.

Body fat consists of essential fat (what we need to function), and storage fat. There is a range of normal body fat – https://us.humankinetics.com/blogs/excerpt/normal-ranges-of-body-weight-and-body-fat.

In order to improve your body composition, consider these tips.

Improve your diet, but do it as a change to your habits. Usually when people think of diets, they think of short-term programs meant to lose pounds fast. However, while this can help people lose weight, most will not maintain that weight loss. Read the post titled How can you eat healthier? Take a look at some myths about weight management – https://www.niddk.nih.gov/health-information/weight-management/myths-nutrition-physical-activity.

Practice portion control. Portion sizes have increased in the last several decades. Looks at this Portion Distortion Quiz to see how much. Read about portion control here – https://www.niddk.nih.gov/health-information/weight-management/just-enough-food-portions.

Exercise safely

It is important to prevent injuries when you exercise. There are traumatic injuries that can happen suddenly and overuse injuries that happen from repetitive motions. As a first line of treatment for overuse injuries, you can try RICE – rest, ice, compression and elevation. However, it is important that you see a healthcare professional as well, to make sure nothing serious is going on.

Wear comfortable shoes – https://www.webmd.com/fitness-exercise/features/how-choose-athletic-shoes#1.

Learn how to exercise correctly – https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/weight-training/art-20045842?p=1 .

Wear a helmet or other protective gear when riding a bike, skateboard, roller blades and other activities that can result in injuries. Wear the safety clip attached to treadmills – they will stop the machine if you get too far from the safety bar.

Stay safe when exercising in hot weather – https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048167.

Make sure to drink enough water before, during, and after exercise. You probably don’t need to increase your protein intake unless you decide to become a body builder. However, eating or drinking a small amount of protein-rich foods can be helpful with muscle recovery. Make sure you are eating enough carbohydrates for energy.

If you decide to use dietary supplements to enhance performance, first read this https://ods.od.nih.gov/factsheets/ExerciseAndAthleticPerformance-HealthProfessional/. Know that dietary supplements may not always work as you expect, so consider carefully. Using medications like anabolic steroids or human growth hormone to enhance performance is unwise and may lead to health problems.

How to plan an exercise program – be FITT

If you haven’t done much exercising before, or if you’re getting back into it, there are a few things that can help you to plan an exercise program for yourself.

First, make sure to warm up! There are many benefits to warming up – it is a way to slowly increase your body temperature, limber up your muscles and joints, and heart rate. You can do some dynamic stretching or light aerobic activity.

Then, use the FITT principle to focus on either aerobic or strength training, or both. F for frequency – how many times per week will you do it, I for intensity – how hard you need to work, T for time – how long will you do it at one time, and T for type – what kind of activity will you do.

For aerobic or cardio activities, use the guidelines to plan for 150 minutes of moderate or 75 minutes of vigorous activity per week. That can be 5 times of 30 minutes each, or something else that works for you. Intensity can be measured by your heart rate, your breathing rate or METs (Metabolic Equivalents – read more here https://sites.google.com/site/compendiumofphysicalactivities/home). Some examples are here.

For strength training or resistance training, try to exercise all major muscle groups at least twice a week. Try to give your muscles a rest of 24-48 hours between bouts of exercise. Intensity can be measured by the amount of weight you are pushing against. Overload your muscles to the point where it would be hard to do more repetitions. Time is measured not with minutes but with repetitions and sets – a common thing is to repeat the movement 10-15 times, for 2-3 sets, with a rest break of 30 seconds or a minute. Read more here.

Don’t forget to cool down! Now is a good time to do some static stretching of your muscles, especially ones you used during your main exercise. Flexibility exercises can be done every day, but at minimum you should do them 2-3 times per week. Make sure you do not feel pain when stretching, feel the point of tension and stop there – this is the intensity of flexibility exercises.

What is physical fitness?

Can you complete all of your activities of daily life without too much exertion and fatigue? Then you may be physically fit!

We know that exercise and physical activity is important for health. But what kind of physical activity should you do? There are several types of exercise that help with the main components of physical fitness. They are endurance (or aerobic), muscle strengthening, flexibility, and balance. https://medlineplus.gov/exerciseandphysicalfitness.html

Endurance or aerobic exercise helps with cardiorespiratory fitness – this refers to how efficiently your heart pumps blood, how much oxygen your lungs take in, and how well your blood vessels transport oxygen and nutrients to body parts that need them. http://www.shapesense.com/fitness-exercise/articles/cardiorespiratory-fitness.shtml What are some examples of aerobic exercise? Comment below.

Strength or resistance training helps with muscular strength and endurance – this refers to how much weight different muscles group can push or pull. Read more about it here – https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670?p=1. In particular, one group of muscles that are very important are core muscles – pelvis, lower back, hips and abdomen. Including them in your exercise routine is very important – https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/core-exercises/art-20044751?p=1 .

Stretching, yoga and tai chi can help with flexibility – the ability of joints to reach their full range of motion. Read about the importance of stretching here – https://familydoctor.org/the-importance-of-stretching/?adfree=true. Some of these activities can also help with balance – this is very important for older adults.

Ugandan women and men during the Sukuma dance, a physical fitness exercise to fight cancer by Oketch Michael Eriya

Body composition is another component of physical fitness – read more about it in the post Weight Management. This refers to the relative proportion of fat and lean mass in the body.

How can we move more?

Many people in the United States are not getting the recommended amount of physical activity. Studies show that even small amounts of physical activity can increase people’s health. So why is it so hard to move more?

There are individual reasons and barriers to getting more exercise or physical activity. Schedules tend to be busy, people may not know how to exercise correctly and be intimidated, or your motivation may slack when there are other things to do. What other barriers stand in your way?

There are also structural reasons why exercising may not easy for people – no gyms or affordable places to exercise in the neighborhood, poor infrastructure with no parks or playgrounds, no bike lanes, and other environmental factors can impact our ability to exercise. Read more here – https://newsinhealth.nih.gov/2015/05/opportunities-abound-moving-around.

One way we can overcome our obstacles is by first understanding what they are, and then thinking of ways to overcome them. Comment below with ideas of how to increase your physical activity throughout the day that are realistic to your situation.

Here are some ideas to increasing your physical activity – listen here https://www.npr.org/2018/12/12/676129459/get-started-exercising. And some more ideas to make exercise into a habit, based on research – https://www.npr.org/2018/12/12/676142159/build-an-exercise-habit-that-sticks.

Image of BMCC community at the 5K walk/run event
BMCC 5K walk/run event

Physical activity and exercise

One of the major risk factors for health-problems like cardiovascular illness is a sedentary lifestyle. Any body movement is called physical activity, things like walking your dog, walking to work, cleaning your house, and so on. More physical activity is always better – https://www.cdc.gov/physicalactivity/basics/index.htm.

Exercise refers to a specific type of physical activity, one that is repetitive, structured, planned, and usually done for the purpose of improving health, increasing physical fitness, or looking and feeling better.

Regular physical activity and exercise reduce people’s risk for chronic health conditions like cardiovascular disease, type 2 diabetes, stroke, and several types of cancer – https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf#page=55.

Key recommendations for health benefits are as follows:

Physical activity guidelines from CDC - at least 150 minutes of moderate or 75 of vigorous aerobic activity, muscle-strengthening activities for all muscle groups at least 2 days a week, and a total of 300 minutes of physical activity per week.
From CDC.gov

Organic? GMO? Local?

You may have heard people talk about organic food or GMO’s and wondered whether you should change your habits. To make sense of all the labels and controversies, we will define these terms.

Organically produced food has a legal meaning according to the United States Department of Agriculture (USDA). In general, that means fruits and vegetables that have been produced without the use of chemical fertilizers and pesticides, and meats, seafood and dairy produced with organic feed and without the use of hormones. In order to display the USDA certified organic logo, the company has to undergo a review by the USDA to ensure compliance with the rules.

Explanation of USDA organic labels - can only display the seal if 95-100% of ingredients are certified organic, no GMOS, ingredients comply with national list of allowed and prohibited substances.
From USDA.gov

For consumers, it is usually clear that organically produced food is more expensive. But is it better for our health? Organic foods do contain fewer pesticide residues when tested, but studies have found different results when it comes to nutrition – some studies have found no differences in nutrient levels, while others have found higher amounts of antioxidants and Omega-3 fatty acids – https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/organic-food/art-20043880. This question is yet to be resolved.

The acronym GMO stands for genetically modified organisms. Farmers have genetically modified many crops by the process of artificial selection for hundreds of years. However, science has now allowed faster genetic modification by allowing genes to be inserted or deleted in the lab. The purpose for this is usually to provide more yield, resist pests and common plant diseases and thus require less pesticide use, and boost nutritional value. A law passed in 2016 has made it mandatory to label products produced with GMO crops – in the US most corn, soybean and cotton crops are GMOs (many others may also be produced using GM seeds). All foods produced in this way have to pass Food and Drug Administration clearance in order to be sold. Research has not shown there to be any health issues from eating GMO foods – https://www.nytimes.com/2018/04/23/well/eat/are-gmo-foods-safe.html.

While GMO foods are widely considered to be safe, some controversies have arisen based on how the companies that own patents for GM seeds have chosen to enforce their intellectual property – through suing small farmers. Another concern about GMOs is that insertion of other genes into crops may cause allergies – this has yet to be seen in humans or animals.

Local food is generally food that has been produced or grown in close proximity to where people live, but definitions vary. The 2008 Farm Act defined it as being grown within 400 miles of your location, but many people consider 100 miles to make more sense. Local food is often sold in farmer’s markets, through community supported agriculture, or in small local stands and may be produced on urban farms. Some argue that because local food has to travel fewer miles during distribution, that this reduction in greenhouse gas emissions (CO2 and methane), can help slow climate change. While it’s true that emissions are reduced be eating more locally, a greater impact on climate change would be to switch to a vegetarian or semi-vegetarian diet. https://blogs.ei.columbia.edu/2012/09/04/how-green-is-local-food/

What about the word “natural”? Surely foods that are natural are going to be better for our health! In legal terms, the word natural does not have any definition, so any type of food, including highly processed junk food, can be labeled natural.

What have you heard about these types of food?

Food safety

In order to eat safely, practice the four principles: clean surfaces and fruits/vegetables, separate meats and seafood from other foods, cook to the right temperature, and cool or refrigerate food promptly – http://www.fightbac.org/food-safety-basics/the-core-four-practices/.

Food allergies happen when the immune system of the body reacts to the food as an antigen (something that’s not supposed to be there) and produces an allergic response. That response can be fairly mild, like itching, or severe, like anaphylaxis. If you know you are allergic to something, make sure to read warning labels, let a waiter know, read ingredients lists, and carry an epinephrine injector with you for emergencies.

Food intolerance, or food sensitivity, can happen when people have a difficult time digesting a certain food. Symptoms happen in the digestive system, not the immune system, and can be bloating, gas, and diarrhea. One common intolerance is lactose intolerance, when people can’t digest large amounts of lactose found in dairy products.