Behind the scenes…What goes into my appointment?

If you’ve ever been to a doctor’s office, you may have wondered at some point...What exactly are they doing??   At Lake Washington Sports & Spine, our new patient consultations range from 45-60 minutes while follow up appointments range between 15-30 minutes.  Follow-ups can include imaging/lab reviews, checking your response to a previously done procedure and/or following up after you’ve completed recommendations set forth by the doctor.  A lot of patients do not recognize the time and effort that is put into each appointment from start to finish.  We want to share with you a “look behind the scenes” at what we are doing to ensure YOU have the best experience and care with us!

Front Office…Our front office staff includes the patient care coordinator and billing manager.  They work together to make sure the appointments are scheduled correctly, any necessary insurance authorization or other provider chart notes have been obtained and direct calls to the appropriate staff.  Overall, they make sure that scheduling, check-in and check-out run smoothly. 

The patient care coordinator is the first face you see when you walk in.  They contact patients to make sure they arrive on time for their check-in time and organize patient paperwork all the while answering phones with great customer service.  They explain referrals/orders to patients upon check-out and work with the rest of the staff to make sure the patient has everything they need before they leave.  They work to send your medical records to the appropriate clinics and facilities. The coordinator also schedules your follow-up appointment as you check out, and works with you to find the best day and time available. 

The billing manager checks insurance eligibility for patients and contacts them prior to their appointment with any concerns.  They answer insurance-related questions in real-time that either the patients or doctors may have, as well as discuss balances due with the patients.  They work with the medical assistants and doctors during appointments especially before procedures are done and/or scheduled in order to ensure all aspects of the procedure billing goes well.  They code and bill claims that require immediate payment as you check-out so you leave with a zero balance.

Clinical Staff… Our clinical staff includes the medical assistants to both our fabulous doctors!  They arrive early to prepare the day for the doctors so when patients are ready to be roomed they have the full appointment time booked with the doctor.  That is why it is so important for our patients to arrive at their check-in time versus their appointment start time.

The medical assistants typically review the chart notes for upcoming patients a day or two ahead of time.  If a patient is scheduled for an imaging and/or lab review appointment, they double check with the other facilities to make sure the images and reports are completed.  If the patient has not completed the needed orders, they work with the patient care coordinator to contact the patient in order to reschedule their appointment and/or find out when the orders will be done.  For patients following up for an in-office procedure, the medical assistants set up the equipment needed ahead of time for the doctor and also make sure necessary injectables are ready to be used (like PRP kits, Euflexxa, steroids, ect). 

Throughout the day, the medical assistants are constantly prepping for the next appointment, while also answering and returning patient calls.  They clean and prepare exams rooms before each appointment and work with each other to ensure that each doctor has access to the room/equipment he needs.  The medical assistants also input data from new patient and follow-up paperwork and generate referrals your doctor may recommend.

This is just a small glimpse into the amount of work being done to make sure you have a 5 star experience at Lake Washington Sports & Spine.  Our team is dedicated to keeping you active and we will ALWAYS go above and beyond to ensure that you receive the best musculoskeletal care around!

Happiness Based Musculoskeletal Medicine: The Power of Woo

 Drs. Hyman & Chimes are the pioneers of Happiness-based Musculoskeletal Medicine. Our practice focuses on more than just injury treatment and prevention- we help you optimize your health!
Here's a fun clip to help improve your posture & boost your mood: THE POWER OF WOO!

https://www.youtube.com/watch?v=1hgzTI-N--8

Tips for Beating the Heat!

As a relatively recent transplant to the Pacific Northwest, I have quickly realized that summer in Seattle is a magical time.  All of a sudden the clouds float away and we are left with an array of outdoor activities at our finger tips.  As our excitement grows, however, it is also important to recognize the dangers of being out in the heat for too long and without the right precautions.  Below are a few tips that will allow you and your family to have the happiest and healthiest of PNW summers!

1.  Get a Big Gulp….of WATER!

                This one may seem obvious but it is absolutely critical that we all remain hydrated during these flaming hot days.  It is important to remember that the time to start drinking is NOT once you feel thirsty; by this point, you are already behind.  Make sure to drink plenty of water before starting your activity and then continue to sip water while exercising.  If you plan to do vigorous exercise, it may be wise to bring along a diluted sports drink to replace electrolytes that our lost when you perspire.  Always remember to drink plenty once you’ve completed the activity too!

2.  Temperature isn’t the only thing that matters!

                Most of us are in the habit of checking just the temperature before we head outside.  Although the temperature is indeed telling of how bearable exercising outside might be, humidity is also a critical factor.  One of the body’s main cooling systems is perspiration (sweating) and the sweat evaporating off of our skin is what cools us down.  Humidity, however, makes it much more difficult for sweat to evaporate and in turn, makes is much more difficult for us to regulate our internal temperature.

3.  Fashion police!

                I’ll be the first to admit that I don’t spend a lot of time choosing the perfect exercise gear.  However, on hot and humid days, the clothing you wear can really play a large role in how well you handle the heat.  Fabrics like cotton, although typically comfortable, are not very breathable and can make a hot, outside workout feel unbearable.  The better choice is to wear breathable, synthetic fabrics (polyester, nylon, etc) that will wick away your sweat.  It is also important to wear a hat or visor and, of course, apply plenty of sunscreen before heading outside.  

4. Know your limits        

                If this is your first outdoor workout this summer, try to go in the morning or the evening when temperatures are cooler.  Also, change your workout for different heat levels.  If it’s a scorching hot day, taking a bike ride may be healthier and safer than a long run in the sun.  Most importantly, LISTEN TO YOUR BODY.  If you start feeling dizzy, nauseous, or otherwise not 100%, STOP.  You are not doing yourself or your body any favors by pushing through a workout when you’re feeling sick. 

The main thing to remember during these last days of a beautiful Seattle summer is that there are myriad opportunities to play outside but just be sure to take care of your body so your workouts are both fun AND safe! 

                

How to choose the right bed: what we can learn from the Pepsi Challenge

One question patient's frequently ask me is "what is the right bed for me?"

Like many things in musculoskeletal medicine, the answer is "it depends."  There is no one best bed for everyone, and the best choice will depend on a few different factors

One thing to pay attention is your preferred position for sleeping.  As a general rule of thumb, the most important thing to pay attention to is the position you wake up in, rather than the position you try to fall asleep in.  I had a patient the other day who thought she was a back sleeper, but she always wake up on her right side, which tells her that her body wants to sleep on the right side.

A second factor is paying attention to placement of your hands.  One of the hardest parts of finding a good night's sleep is figuring out where to place your hands relative to your upper body.  This is especially true for side sleepers.   The constant tossing and turning to find the right hand position reminds me of the scene from the movie Talladega Nights, where Will Ferrell's Ricky Bobby character can't figure out what do with his hands during his first interview.

The same thing happens with me when I sleep, especially if I am in a bed with pillows I am not used to, or sleeping in a bed that is too small for me.

One inexpensive item that can make a huge difference is using a full-length body pillow.  You can do what I do, and get a cheap one for $15 at Costco, or you can certainly get a much nicer one at a store like Relax the Back.

A third factor to consider with sleeping is the appropriate level of firmness when you sleep.  There is no best level of firmness for everyone, but I do find that patients often sleep with a bed that is a bit softer than would be optimal for them.  I think the reason for this is that the level of firmness that is most comfortable when you first lay down on a bed is generally a bit softer than the preferred level of firmness for a good, restful night of sleep.

By way of analogy, Malcolm Gladwell had a great anecdote about the Pepsi Challenge from the 1980s in his wonderful book Blink.   For generations, Coca-Cola was a the clear #1 brand in cola sales, with Pepsi a very strong #2.  Pepsi would set up booths in public areas and ask consumers to try a sip of the two products, and then reveal the brand of the cola they preferred.  Based on this "sip test", consumers strongly preferred Pepsi.

This challenge started in 1975, but took traction in the 1980s, enough so that Coca-Cola started to see drops in sales.  It eventually led to Coca-Cola reformulating their market-leading product, and producing a newer version of Coca-Cola called "New Coke" in 1985, designed to be sweeter like Pepsi.

New Coke is one of the all-time great marketing disasters, and soon Coca-Cola brought back their original, less-sweet Classic version.  So what happened?

It turns out that the attribute that makes a cola tasty for a small sip is not the same thing that makes a cola tasty for drinking several large glasses.  When asked to drink a thimble-sized sip of a cola, tasters generally prefer whatever is sweeter.  When drinking an entire glass, however, most people prefer something less sweet, as excessive sweetness can be cloying and unpleasant.

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Getting back to beds: The quality that makes a mattress comfortable when you first lie is generally how soft it is.  However, the quality that makes for a good nights sleep is how supportive it is, which is a different quality.   Softness and support are not oppositional- a mattress can be both.  It's just important to recognize they are different qualities.

Some things I would consider when buying a bed:
1. Give yourself ample time to mattress shop.  Plan on a few hours
2. Before you go, figure out what position you wake up in, and test beds in that position
3. Give yourself at least 15-20 minutes on each mattress to determine if it is a comfortable fit for you

Some specific stores I would consider when mattress shopping:
1. The Relax the Back store.  We've had very good experiences with specific owners of the Bellevue store.  They have excellent customer service and spend a lot of time with customers.  In the past, I've had concerns about Tempur-Pedic beds because of heat retention, but the newer generation of Tempur-Pedic beds no longer have that issue (although some competing brands of memory foam do, so I'd only recommend the Tempur-Pedic brand).
2. Bedrooms & More.  Located in Seattle near I5, they offer high quality natural latex mattresses, and also have excellent customer service.
3. Sleep Number.  The sleep systems, using individual air chambers, can be nice for couples who desire a different level of firmness.  This is what I have used for myself for about 7 years, and I'm happy with it.  I can't speak to the customer service of stores in the Bellevue/ Seattle area.

Single-Limb Exercises

What’s an extremely easy way to burn more calories, improve your stability, and increase overall strength? Start doing your exercises on a single limb!

We’ve talked about single-limb exercises frequently on this blog, and that’s because we think they’re the bee’s knees, the cat’s meow, the duck’s quack … and just to keep the dated references going – well, we think they’re just swell.

Single limb exercises obviously challenge your balance, but they do much more than that. They can help eliminate any strength imbalances since you can’t rely on your stronger side to make up for your deficiencies. Also, single-leg exercises are similar to movements you do in everyday life or while playing sports, such as walking, running, or leaping.  In addition, they can help you burn more calories since it takes twice as long to complete a single exercise.

But you might be thinking: “I’m not Gaston!” And that’s right. You’re not Gaston. No-one’s as burly or brawny, or as slick or as quick. Then again, no-one eats five dozen eggs every day (think of the cholesterol!) But that doesn’t mean you can’t perform single-arm pushups or single-leg squats like Gaston (probably does). You’re just going to have to build up to it. The act of performing a single-limb exercise is going to be very difficult for most people. Not only will balance be an issue, strength will be as well. Ease into it! You can modify exercises to fit within your strength level. Here are a few examples.

-          Upper body push: Single-arm Pushups against a Wall. Face a wall or doorway, spread your legs about shoulder-width apart, and raise your arm until it’s about chest height. Perform a one-armed pushup, making sure to keep your elbow close to your body. These might seem too easy at first, but I think you might be singing a different tune after 20 or 30. Remember to keep your core tight before you start your pushups. An easy way to make sure your core is tight is to clench every muscle in your body (your legs, butt, abs, and even your hands). To up the intensity, bring your hand to a lower plane, like a heavy table, a kitchen counter, a chair pushed against a wall, and eventually, the floor!

                      



-          Upper body pull: Single-arm Door Pulls. Open a door and stand facing the edge of the door so the doorknobs are perpendicular to you (round ones help here). Grab one doorknob with one hand, the other knob with your other hand, then bend your knees until you’re in a half-squat. Lean back until your arms are straight. Then pull your body towards the door. If you can, perform the pull with just one arm. Remember to keep your back straight and your shoulder blades in a stable position. To make things easier, use both arms, or move your feet further away from the door so you’re standing more vertical. To make things more difficult, place your feet behind the doorknobs so they’re further away from you/you have to squat more; or simply hold the contraction longer.

                    

-          Lower body push: Single-leg squats. Start by holding onto a doorframe or other sturdy object (like a couch) to make sure you don’t fall over. Don’t worry about cheating with your arms; you’ll still feel a burn after doing 10+ single-leg squats even if you help yourself up. Lift one leg off the ground and hold it either in front of or behind you. Then, squat as deeply as you can on your standing leg. Suspension straps can help TREMENDOUSLY with this exercise, as seen here:

Two things to remember:

1) Make sure you keep your bending knee from leaning inward – this is called a valgus fault, and can lead to injury. Activate your gluteal muscles to remedy this, as well as keeping your knee steady/leaning out. 

2) Don’t let your knee go over your toes. You want to be sitting back and activating those glutes. Letting your knee go over your knees can lead to injury.

-          Lower body pull: Single-leg Romanian Deadlift. Stand on one leg.  Keep your leg straight but without your knee locked out. Hinge at the hips, and bend over while keeping your back straight. Maintain a controlled pace and movement – think more Drinking Bird toy, less stapler snapping closed.

      

             

If there’s a running theme throughout these exercises, it is that FORM MATTERS. If any of these exercises are too difficult to do with proper form, then you may need to modify them further.  Also, these exercises are only a guide, not a complete work-out plan. There are many resources (books, personal trainers, online forums, etc) to find more information on complete work-out plans. 

The Parable of an Insurance Company's Perfect Physician: Dr. Donoharm

The Parable of an Insurance Company's Perfect Physician

Megalopolis Health Insurance (MHI) was searching long and wide for the physician who met their platonic ideal of what a doctor should be.  They found just such a physician, named Doctor Donoharm.  Dr. Donoharm was perfect on all measures that insurance companies crave on their quality metrics in the past year.

MHI started using Patient Satisfaction surveys as a measure of quality.   Dr. Donoharm was a model of perfection- zero patient complaints for the entire year!

MHI took to heart the Institute of Medicine's  To Err is Human report that attributed between 44- 98,000 patient deaths to physician error.  MHI recognized that the best way to save lives was minimizing physician error!  What a scourge!  And lo and behold, Dr. Donoharm had the lowest rate of physician error of any contracted physician.  In fact, Dr. Donoharm had no physician errors for an entire year!

MHI also realized that they could help stamp out the cost of physician over-utilization of resources.  At MHI Headquarters, they lived by the mantra "the most expensive tool is a physician's pen", and they were going to create a series of incentive systems to prevent physicians from over-ordering expensive tests.  They would follow the recommendations of the American Board of Internal Medicine's Choosing Wisely campaign to prevent unneeded tests like MRIs and expensive lab tests.  And when MHI executives looked to see who their #1 physician in terms of avoid over-utilization was for the past year, it was yet again Dr. Donoharm.

It was clear to MHI executives they had finally found the perfect physician.  No complaints!  No deaths attributable to physician error!   No unneeded tests!

MHI decided to pay a visit to Dr. Donoharm to see how they could teach other doctors act to model themselves.  The secret?

Dr. Donoharm died a year earlier, and stopped seeing patients.

The morals of this tale:
1. From the standpoint of an insurance company, the best physician is a physician who doesn't actually see patients.  They don't actually have to be dead (although, from the insurance companies standpoint, that's also one less patient to treat)
2. When an insurance company uses the word quality, what they really mean is cost containment
3. When an insurance company says they are saving costs, what they really mean is that they are increasing their profits
4. If you want to know if a doctor is a good, the quality metrics used by insurance companies and central health systems will confusing at best.

The US Medical Soccer Team Surprises at the World Medical Football Championships

While I've been involved with the US Medical Soccer Team since June 2013, this was my first time at the World Medical Football Championships.  The tournament was a great experience.  Over 500 physicians from 18 different countries gathered in Long Beach, CA.  Most of us stayed at one hotel, the Hyatt Long Beach, and we travelled daily together via bus to the fields at Cal State Long Beach.  We had 4 adjoining fields so that once done with a game, teams could stay and watch/scout other matches.  Staying and playing in the same locations made it easy to get to know people.  Evenings 4:30-7:30p were spent (by some of us) at our concurrent medical conference, and this was another opportunity to become acquainted with our colleagues.

The competition on the pitch was fierce.  These docs came to play.  Fortunately, 

the USMST had a decent draw, and our first round group matches were against Lithuania, South Korea, and Australia.  We fought a fit and young Lithuania team to a 0-0 tie (I believe they beat us something like 8-0 last year in Brazil) on Sunday, then beat a smaller but faster South Korea team on Monday 2-0, and on Tuesday we outworked a very tall and strong Australian squad to win 3-2 to win our Group and move on to the Winner’s Bracket.  

We presented our Healthy, Fit and Smart Program to ~200 children from the Long Beach Boys and Girls Club with the help of our international physician colleagues on the Wednesday.  

Wednesday afternoon our USMST team served as ambassadors on a Hollywood bus tour for our international guests.  Fun stops included: Santa Monica pier, Rodeo Drive, and Grauman’s Chinese Theater.  While no one signed any movie contracts, the bus returned full of happy faces and many souvenirs.

Then on Thursday the competition resumed and we were pitted first against Venezuela, a newcomer to the tournament.  By this time, injuries were stacking up for both teams and we had to dig deep into our reserves.  Our energy made the difference and we finished 2-0.

Friday we took on the tournament favorites, Czech Republic.  The Czech doctors were all young, skilled, big and strong.  They were very organized and strong in the air.  Without Alan, our best defender, downed by a torn Achilles in the Australia match, we couldn’t stop their air attack.  We lost in this Semi-Final match 4-1 (the last two of their goals came late on counter-attacks after we reduced our defense).

So that placed us in the 3rd place match on Saturday against Ukraine.  They struck first in the 1st half, and we tied it up early in the 2nd half.  Then we went up 2-1 with ~5 mins remaining, and they tied the match with ~30 seconds left pushing us into PKs.  Our squad rallied, and our fabulous keeper came up big, and we beat them 5-3 in PKs.

The USMST finished in 3rd place — a great accomplishment given our squad’s best past performance has been ~10th.  The Czech Republic won the tournament, beating Hungary in the Final.

Our Master’s team (45 and over) was quite strong, and went undefeated, but due to goal differential went into the Consolation Bracket, ending up in 5th place overall.

Dr. Bert Mandelbaum, the lead sports medicine physician for US Soccer, presented a lecture at our conference, and indicated his interest in assisting our organization in making further inroads with FIFA given our common interests of physical activity promotion and injury prevention.

All in all, I’d say this was an enormously successful week for the USMST and a fabulous experience for me.  A wonderful example of physicians from around the world 'walking the talk' of physical activity and adult play for better health.