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winter 2008 |
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P
E R S P E C T I V E S
Educational
opportunities in unlikely places
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Don Lane Photo |
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Dr. Susan King |
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Never a dull moment in
this business, hey? There’s always something new and different to bone
up on; keeping current is a challenge. More and more continuing
education is being referred to us as KT _ Knowledge
Transfer or Translation.
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By Dr. Susan King |
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Never a dull moment in this business,
hey? There’s always something new and different to bone up on;
keeping current is a challenge.
Speaking of that, having gone through the
term CME, then CPD, more and more continuing education is being referred
to us as KT – Knowledge Transfer or Translation. Lots of places to get
it, too: online, journals, seminars, even the lay press. I often see new
information in women’s magazines or Reader’s Digest, not that I get to
read them as much as I’d like. I never expected, though, to find
something useful watching television on a recent Air Canada flight.
After watching all that was of interest to
me, I clicked on the Health and Wellness icon. I was intrigued by one of
the topics, featuring a Dr. Carla Cupido, titled “Upper Cross Syndrome”.
Dubious though I was (and who wouldn’t be with a name like that and a
syndrome I had never heard of), curiosity got me. Turns out Dr. Cupido
is a chiropractor in Vancouver and gave a very interesting talk on the
topic. The disease process was certainly nothing new. What was new to me
was having it named and the etiology explained.
It has to do with recurrent neck pain, the
curse of the computer age. I see patients every day with neck pain,
often caused by muscle tightness. This is mostly caused by a bad
combination of stationary (usually computer related) job, sub-optimal
posture, inadequate exercise, nutrition shortcomings and even smoking.
Some patients can be quite worried about this, especially as there is
often no precipitating cause such as an injury, and it tends to be
recurrent, even chronic, and is difficult to alleviate. The cause is
basically tightness in the sub-occipital and the pertoralis muscles and
inhibition of the deep flexor and rhomboid and the middle and lower
trapesius muscles. She describes the etiology and pathophysiology and
demonstrates simple exercises that help on her
website.
Check it out!
Of course, the other thing is finding the
time, energy, inclination and opportunity to do the required exercises.
I got a tip from one of my other important source of CME: one of my
patients. Her physiotherapist advised her to do her neck exercises while
in the shower. Let the hot water run on the back of the neck and upper
spine for a few minutes then do range of motion exercises, other ones
prescribed by a qualified provider and of course, if appropriate, the
neck retractions and snow angels Dr Cupido describes. Thank you, Mrs. P.
Now if only I had one of my grade school teachers, all very good at
watching our posture, to give me the occasional poke as they did years
ago and remind me to sit up straight!
Forms, forms, forms
Thinking about neck pain reminds me of
neck injuries, which reminds me of motor vehicle accidents, which
reminds me of insurances, which reminds me of all insurance forms and
attending physician statements in particular. I had a run on them a
couple of weeks ago, with five of them arriving in the one day. I
thought I'd go out of my mind. After so many years in practice my charts
are so voluminous that it takes forever to review them.
The annoying thing is that most insurance
companies have an upper limit of what they will pay, and more and more I
find that what they offer does not cover the time it would take me to
read every clinic note, lab, X-ray and consult note. However, not
reviewing the chart thoroughly may result in an omission, for which the
insurance company may attempt to hold me accountable at some future
time. What I do in these situations is to write a statement indicating
what I actually reviewed in the course of generating the report. For
example: “This patient has been a patient of this clinic since 1984 and
as such his chart is extensive. This report is based on my knowledge of
this patient’s medical history, a thorough review of the past five years
of his chart and a cursory review of the documents related to prior
years. I am able to do a more detailed review of the entire chart, if
required. An additional invoice reflective of the time involved will
apply.”
Hope some of this is of value. Any tips of
your own? Send ’em in. Remember to look after yourself at least as well
as you look after others. Keep well.
Dr. Susan King is a family physician at
the Newfoundland Drive Medical Clinic in St. John’s. Tips and hints may
be emailed or faxed to (709)
726-7525.
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