House Calls

A house call, or Physician house call, is an act of customer service where the doctors goes to the consumers home, rather than the consumer visiting the suppliers place of business. House calls are most often associated with doctor house calls. There are still doctors making house calls. The physician-led multidisciplinary team provides comprehensive, patient-centered care for any condition, from the simple problems to the very complex, in the patient’s own environment. Thanks to modern technology and our sophisticated, multi-faceted delivery system, we can do more tests and procedures in our patient’s home or place of business than other primary care physicians do in their office. House call doctors are equipped to perform most procedures normally performed in a medical office. House call doctors utilize electronic medical records and will coordinate home health and hospice services, mobile imaging services, durable medical equipment services, laboratory services, and specialist referral services. House call doctors acts as the primary care physician or as augmentation to or as an interim physician to the patients’ present medial team. Doctor’s House calls provide post hospital stabilization service to physicians, insurance plans, and hospitals to mitigate hospital re-admissions.

Direct Primary Care

Direct primary care is primary care offered direct to the consumer, without insurance intervention. It incorporates various health care delivery systems that involve direct financial relationships between patients and health care providers. One niche variant of direct primary care is concierge medicine. Direct primary care can remove many of the financial barriers to accessing care when needed. Often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers. Under this model, patients may pay a combination of visit fees and/or fixed monthly fees, which grant them access to a set of medical services, including same and next-day appointments, both in the form of house calls and office visits. A direct primary care arrangement benefits from pairing with either: a high-deductible health plan, as direct primary care alone will not cover catastrophic health care such as most surgeries, a health savings account, or health reimbursement account as the associated tax-benefits can generally be applied to direct primary care and other medical expenses. Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent. Direct primary care payments are over time, rather than in return for specific services, the economic incentives are such that the long-term health of the patient is the most lucrative situation for the doctor. Preventative care gains greater emphasis under direct primary care. Because the primary care physician compensation is better than it would be under insurance billing, doctors can afford to spend more time with the patient, rather than simply referring them to a highly paid specialist after a short consultation. Boutique medicine is a type of medical practice now found in many metropolitan areas across the country. Also known as, concierge health care, concierge medicine, or retainer medicine, the concept has come to represent a higher level of healthcare for those who want a more personalized relationship with their physician. This model has proven successful for those physicians who want to see a fewer number of patients on a day to day basis, thus allowing them to spend more time nourishing individual patient relationships.

Breast Engorgement

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. Engorgement usually happens when the breasts switch from colostrum to mature milk often referred to as when the milk comes in. However, engorgement can also happen later if lactating women miss several nursings and not enough milk is expressed from the breasts. It can be exacerbated by insufficient breastfeeding and/or blocked milk ducts. When engorged the breasts may swell, throb, and cause mild to extreme pain. Engorgement may lead to mastitis inflammation of the breast and untreated engorgement puts pressure on the milk ducts, often causing a plugged duct. The woman will often feel a lump in one part of the breast, and the skin in that area may be red and/or warm. If it continues unchecked, the plugged duct can become a breast infection, at which point she may have fever or flu-like symptoms. Breast engorgement is caused by an imbalance between milk supply and infant demand. This condition is a common reason that mothers stop breast-feeding sooner than they had planned. Breast engorgement can occur due to four main factors such as a suddenly increased milk production that is common during the first days after the baby is delivered or when the baby suddenly stops breastfeeding either because it is starting to eat solid foods or it is ill and has a poor appetite. Breast engorgement may also be caused when the mother does not nurse or pump the breast as much as usual. After the first 3 to 4 postpartum days, the quantity of colostrum is quickly replaced by an increased milk production.
When milk production increases rapidly, the volume of milk in the breast can exceed the capacity of the alveoli to store it and if the milk is not removed, the alveoli become over-distended which can lead to the rupture of the milk-secreting cells  Accumulation of milk and the resulting engorgement are a major trigger of apoptosis, or programmed cell death, that causes involution of the milk-secreting gland, milk resorption, collapse of the alveolar structures, and the cessation of milk production. Severe breast engorgement can lead to the flattening of the nipples or, it can result in inverted nipples which make it impossible for the baby to suck out all the milk from the breast. This is one of the common causes of the stagnation of milk in the breast. Not all women experience breast engorgement after they give birth and some degree of engorgement of the breast is however normal within the few postpartum days. Women with mild to moderate hypo plastic breasts with a wide intramammary space >1 inch and a tubular shape are at particular risk for producing less than 50 percent of the milk necessary for the first week. More concerning are the moderate to severe degrees of breast engorgement. In these cases, the condition can continue for up to ten days or more even though the patients will experience serious symptoms only during the first six days. Overfilled breasts can lead to severe engorgement due to waiting too long to begin breastfeeding the baby, not feeding often enough or due to small feedings that do not empty the breast, very common in cases when the baby is fed formula or water. As women are naturally prone to suffer from some degree of breast engorgement, the main part of treatment is prevention. This means breastfeeding the baby whenever he or she seems hungry and making sure that the baby is latching on and feeding well. In cases when the baby is not hungry enough to empty the breasts, the breast should be nursed or pumped. Avoiding caffeine and chocolate as well as wearing a well fitting maternity bra with wide straps that do not scratch and with a cup that comfortably holds the entire breast usually help in easing the discomfort and other symptoms. As women are naturally prone to suffer from some degree of breast engorgement, the main part of treatment is prevention. This means breastfeeding the baby whenever he or she seems hungry and making sure that the baby is latching on and feeding well. In cases when the baby is not hungry enough to empty the breasts, the breast should be nursed or pumped. Avoiding caffeine and chocolate as well as wearing a well fitting maternity bra with wide straps that do not scratch and with a cup that comfortably holds the entire breast usually help in easing the discomfort and other symptoms.

Gastric Band Revision

After gastric band surgery, patients may need gastric band revision surgery for a number of reasons. A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device that a surgeon wraps around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. The lap band could slip down, leading to a slow chronic condition or an acute condition requiring emergency surgery. Both circumstances ultimately lead to the gastric band not functioning the way it should. While each circumstance is different, treating these issues may require removing the lap band, repositioning the lap band or replacing the lap band all together. Removing the lap band obviously opens the door for potential weight regain. Gastric band erosion is another possible complication of lap band surgery. Lap band erosion occurs when the lap band burns a hole in the stomach, rendering the lap band ineffective. Patients may vomit blood as the first signal of lap band erosion. The most frequent symptom of lap band erosion is an infection around the site of the port. Due to erosion caused by the lap band, saliva leaks through the hole in the stomach and flows along the lap band tubing, causing the tissue under the skin of the lap band port to become infected. Gastric band revision treatment requires removing the lap band, resulting in no further weight loss surgery and a high likelihood of weight regain. The lap band may simply fail to produce the desired results and require revision bariatric surgery. Lap band is a restrictive weight loss surgery and some patients may not have the metabolism needed to lose weight with the lap band. Other patients may not be able to eat in the new prescribed way to achieve success after lap band placement. Gastric banding is the least invasive surgery of the bariatric kind. A gastric band surgical procedure using laparoscopic methods results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. The patient can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they are able to remain in the body without causing harm. However, not all patients are suitable for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery, or have complicating medical problems may require the open approach.