My practice philosophy

  ​I emphasize periodic health assessment and preventive health care, in accordance with currently accepted national guidelines. My goal is to detect and modify "risk factors" before they lead to serious illness such as heart attack and stroke, emphasize early detection of potentially curable disease such as breast, colon and prostate cancer, and provide individualized instruction and guidance in life-long health maintenance. In keeping with this philosophy, I will make every effort to promptly notify you of all diagnostic test results, and will personally address any questions and concerns you may have regarding your health. With my specialty training in Internal Medicine, I have the expertise to promptly diagnose and treat most acute medical illnesses, as well as manage chronic and often co-existent problems such as high blood pressure, diabetes and elevated cholesterol levels. The evaluation and treatment of more complex conditions such as asthma, emphysema, coronary artery disease, congestive heart failure and peptic ulcer disease are also well within the scope of my training. Should I diagnose a problem for which consultation with a specialist or sub-specialist (e.g. surgeon, cardiologist, gastroenterologist, or dermatologist) is indicated, I coordinate your referral and recommend consultants who have earned my confidence and trust throughout the years. By offering comprehensive medical services along with personal attention and care whenever the need arises, I hope to serve as your primary health care provider for many years to come.
 
What represents good communication?

•  You should have things explained to you in a way that is easy to understand.
• You should be listened to carefully
• You should be given clear instructions about what to do to take care of the health problems or symptoms that were bothering you
• You should be given clear instructions about what to do if your symptoms worsen or come back. 
• I believe that your health management is a shared responsibility
• You need to be a partner with me to get the care you need. Research shows that patients who are more involved in their care tend to get better results. Prepare for every visit and be clear about the reason for the visit. You should have as much information as possible about your condition, so that you have the confidence to share in the decisions that affect your health. The better prepared you are to ask informed questions, the better are your chances of receiving optimal medical care. Speak up if you have questions or concerns. You need to be sure you understand what you are being told. If you don't understand, ask to have it explained again. Bring a second person to help, especially if you are feeling sick, worried or English is not your first language.

How to Pick a Primary-Care Doctor

The best physicians are caring, competent and connected. Often patients choose and remain with a doctor because they are warm and engaging, an excellent diagnostician or highly accessible. The best PCPs are excellent in all three dimensions.

 Choose a physician who is caring.

A caring physician:

• Listens to patients’ concerns, makes eye contact, and asks and cares about patients’ personal stories.

• Discusses the plan for the visit and the future, offers a warm smile and empathizes.

• Avoids or explains unfamiliar medical terms.

 Choose a physician who is competent. 

A few ways for patients to evaluate a physician’s competency include:

• Look for information about the physician’s background and training online. For example, is he or she board-certified? You may also find patient reviews, which generally evaluate caring more than competency. It’s important to note that health care lacks standards for reporting physician or hospital performance, so the type and accuracy of information varies widely among sites.

• Ask the PCP what quality data they collect and how the data collection is performed. For example, how many of their patients with high blood pressure or diabetes has their disease controlled?

• Find out whether the physician—or more likely the practice—is part of a primary-care medical home, which provides coordinated care and monitors several measures of quality.

 Choose a physician who is connected.

With the significant changes in health-care markets, it’s important for patients to:

• Ask and understand how the physician schedules urgent appointments, who covers when they are away, and whom to call and what to do if help is needed in the middle of the night.

• Find out whether the physician uses email or provides online access to your medical record, and how available they are by phone.

• Ask what network of specialists the primary-care physician works with and how they choose those networks. What is known about their quality? What hospitals are they associated with, and do they have access to an academic medical center? Do any financial conflicts of interest exist with any of the networks? The same questions apply for lab testing sites, imaging centers and hospitals.

 

• You have the right to preventive medicine and I follow the American Cancer Society guidelines with regard to cancer screening.

• I try to keep abreast of the latest treatment protocols in the management of: osteoporosis, diabetes, hyperlipidemia, hypertension, coronary artery disease, congestive heart failure and chronic obstructive lung disease.         
  
  
• I believe in the value of getting an annual influenza vaccination in October or November and keeping up to date with appropriate immunizations ( e.g. tetanus boosters every 10 years; two doses of zoster vaccine (Shingrix) for adults >50 regardless of history of shingles; two doses of the pneumococcal pneumonia vaccines (Prevnar-13 and Pneumovax-23 at ages 64 and 65). It is advisable for college bound young people to receive the meningococcal meningitis vaccine. This is not part of the routine immunizations, so please ask about how to go about ordering this potentially life saving vaccine.  Three doses of the Gardasil vaccine are recommended for all adults aged <26 to protect against certain strains of  the human papillomavirus [HPV.] This virus is associated with a higher risk of cervical cancer, cervical dysplasia, genital warts, anal cancer and certain head and neck cancers.
•  In an attempt to reduce the development of resistant bacteria, I try my best to avoid the unnecessary and inappropriate use of antibiotics. Remember: antibiotics are ineffective against viral infections.  I have a link specifically devoted to this important problem.

Talking about tough topics:

• Give me a list of symptoms you’re experiencing. Do not be shy, ashamed or embarrassed about asking questions. Tell the truth. This is your health, and accuracy is important. List the most severe and most problematic symptoms first. Be specific. How long have you had them? When did they occur? What makes the symptoms better? Or worse?

• Menopausal symptoms, loss of libido, erectile dysfunction, concern about sexually transmitted infections [STI], depression, alcohol and drug abuse are some subjects that patients are embarrassed to raise as issues. I hope that you will feel comfortable enough to bring these problems to my attention, as excellent help is available.

• I strongly believe in smoking cessation, but understand how difficult it is for some people to kick the habit. Feel free to ask me about different approaches to dealing with this.                      
•  I believe in death with dignity and  have found the Hospice organization to be most helpful and supportive. Ask me about the value of having a Health Care Proxy.

Staying on schedule:

•   I appreciate that we all have busy schedules and feel very strongly about not keeping you waiting for me. Please keep your scheduled appointments, arrive on time and I will try my best to see you on time. Appointments are at a premium and if you do not keep a scheduled appointment, patients who really need an appointment cannot be given one.
  
  As a courtesy we call and remind patients about their previously booked physical exams especially if made months ago, but if we leave you a message and if no confirmation is received from you, then we have to regretfully give away the appointment slot. If a message is left for you on your answering machine or with a family member, please acknowledge this by leaving us a voicemail at  617-497-1776 ext 238

 

• To gain the most out of your visit, it's best to try and focus on the problem that is bothering you most and tell me about it first rather than leaving it to the end of the visit. Trying to squeeze multiple problems into one visit often leaves both the patient and physician feeling frustrated.
  • Be specific regarding what is wrong.
  • Prepare a handwritten list or copy of your concerns and give it to me at the beginning of your visit.
  • Be brief - mention your "major" issue first.
  • Tell me what you have done to help your problem (home remedies, medication etc).
  • Don't wait until the end to bring up a new topic or concern. Let me know all of your issues up front.
• "Patients are big online research fans, with 61% saying they had turned to the internet for information on their medical care. Many doctors are not big fans of this kind of research, with nearly half saying it helps very little or not at all, and only 8% saying it was very helpful.
  With only 7 percent of doctors e-mailing their patients, let alone engaging them on blogs, Twitter or Facebook, the medical establishment needs to realize the influence of the Internet and social media on patients.
  Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites"  - Kevin Pho, MD

 

• Annual examinations are encouraged, but remember: they are "well patient visits" or more like a "maintenance" visit when we review your history and see whether any studies or immunizations are due based on your age and updated family history. Please try not to cram in a year's worth of questions and expect them all to be answered, especially all the "orthopedic aches and pains".
• We make every effort to give same day service to any patient who needs, or feels they need to be seen. If my schedule cannot accommodate you, then you will be seen by one of my associates. Elective annual exams and non-urgent problems should be scheduled accordingly. 

Lab Work:

•  We try to reserve early morning (8:00 to 10:00) appointments for patients who need to have fasting blood work checked, so if you want your glucose (sugar) or lipid profile (cholesterol breakdown) checked, then it is important to FAST for at least 10 hours prior to your blood test. Remember that it is fine to drink water and take your regular prescribed medications. I review lab results daily and my medical assistant informs my patients of the results usually by phone or mail, so please leave an up to date phone number or address with our office. If you want a hard copy of the results, please inform her at the time. If you do not hear from us within 14 days please call or request results via email. Obviously early morning appointments are limited, but my recommendation is to have your fasting lab work done a few days before your physical. If done this way, then you could see me at any time for the actual hands on part of the physical and with the added advantage of being able to discuss the results with me in real time during your physical.

Humor

• Even though I take my work seriously, I try not to take myself too seriously and believe in the value of a sense of humor. Laughter has been shown to be a marvelous stimulus to the immune system. So feel free to share a good joke, but PLEASE do not email me any jokes!

Knowing your limitations and realizing that you can't please everyone 

• After 40+ years I know my limitations and am not afraid to ask for another opinion. You should not be afraid to ask either. You have the right to a second opinion. There should be no ego involved in getting you the best care. When you are sick and scared, the last thing you should worry about is your doctor's feelings. If you are a member of a managed health care plan, it is very important to discuss any referral with me BEFORE you make an appointment with a sub specialist. It is your responsibility to notify me as your primary care physician PRIOR to seeking services with a specialist. It is the policy of our office that we will NOT generate backdated referrals for patients who refer themselves (without first consulting their primary care physician) to specialists. It is also important to understand the concept of choosing a sub specialist within the "circle" of your primary care physician (or "PCP"). Remember that if you select me as your PCP I am affiliated with the Mount Auburn Hospital . Referrals outside of this circle are difficult and not encouraged. Over the years I've gotten to know and trust the sub specialists in this circle. If you do not feel comfortable within this referral circle, it would be my recommendation to select a PCP within the circle of your choice.
• Over the same period I've come to realize that as much as I may try, I cannot please everyone. If you have a problem with our office or me, please discuss it with us immediately and don't suffer in silence. The longer you wait the bigger the problem may seem! You should feel comfortable with your choice of physician. I may not be the right person for you. There are a lot of other good docs out there and you have a right to select your own doctor.
• Some patients may have had "bad" experiences with previous encounters within the medical field. Some are fearful and mistrusting. I try my best to make patients feel comfortable. I try not to be judgmental........I may not always succeed. I do believe that we are "on the same team" and I do not have an "us" versus "them" mentality.

I will endeavor to work with you
 and look forward to a long and healthy relationship
 based on trust and mutual respect.

  My practice philosophy