Rural Doc Alan

Obstetrician | 40 years of #medical practice, 6,000 #babies delivered, 0 #maternaldeaths. Sharing what I’ve learned with #mothers & #physicians is my goal.

[Rural Doc Alan @RuralDocAlan]

Pregnant women are usually told how many pounds they should gain during pregnancy but I suggest the nutritional needs of the baby may not by these weight recommendations for mothers in my latest Substack post.

https://t.co/W3eHYsjZLh

[Rural Doc Alan @RuralDocAlan]

Preeclampsia is considered a woman's disease, but little attention is paid to the evidence that fathers contribue to the risk for eclampsia, something I have posted about on Substack.

https://t.co/ZpOlmPgQq2

[Rural Doc Alan @RuralDocAlan]

I have added another new printable to my Etsy site:

Postpartum Depression Can Be Prevented. 

A new baby changes everything. In my experience, postpartum depression is reactive. In other words, it is a reaction to the many changes a new baby brings into a household when there hasn't been enough thought given in advance as to how to adapt to the inevitable changes.

https://t.co/xgm3xZ1Yg4

[Rural Doc Alan @RuralDocAlan]

I have added a new printable to my Etsy site: The Hormone Cascade in Labor and Delivery. Learn how your hormones in labor and delivery can vary depending upon whether or not you have an induction. Check it out!

https://t.co/A4VRh58SHY

[Rural Doc Alan @RuralDocAlan]

What is a Kick Test?
I have an Etsy page with a number of printables for pregnant women and their families. I just posted my latest printable on the importance of monitoring your baby's movements during your last trimester of pregnancy with a home kick test. Check it out!

https://t.co/bZgKDaFMRu

[Rural Doc Alan @RuralDocAlan]

Pregnancy Your Way Application Update
My “proof of concept” web site which provides a preview of the pregnancy application I am seeking funding to develop is now live. My Pregnancy Your Way application (an extension and expansion of the information in my book, Pregnancy Your Way) will contain my pregnancy advice gained from 50 years of experience. Please stop by and let me know what you think! #pregnancy #choices #healthare

https://t.co/VD7wvkU4HC

[Rural Doc Alan @RuralDocAlan]

Will No Longer Be Posting Weekly

Women can choose the kind of pregnancy they want 95 percent of the time, but most women do not know this. My pregnancy application will provide them with the information they need to make safe choices in their pregnancy and choices for the kind of pregnancy and delivery they would like. #pregnancy #access #choice

https://t.co/vUV1ji6NfF

[Rural Doc Alan @RuralDocAlan]

Penny Wise and Dollar Foolish

I have written ad nauseam about how to really decrease the healthcare budgetwithout hurting the average consumer or provider. In the first place, decisions about cutting the healthcare budget require looking at where the money in the healthcare budget currently goes. It strikes me that there are probably some really good reasons that nobody at the Centers for Medicare and Medicaid Services (CMS) wants the public to know that only 7 percent of the healthcare budget actually goes to direct patient care. In other words, CMS is directing 90 percent of their attempts at controlling the healthcare dollar at the 7 percent who actually provide the healthcare. #healthcare #Obamacare #insurance

https://t.co/3hm8F3uIWC

[Rural Doc Alan @RuralDocAlan]

Pregnant and Afraid

Postpartum depression and other mental health problems are recognized as the number one complication in having children, but our healthcare system fails miserably in addressing this problem. In fact, our healthcare system fails miserably in even looking for mental health problems in prenatal care, much less recognizing the problems after the birth of a baby.

Maternal mental health issues are now recognized as being central to the well-being of mothers and their families globally. The Centers for Disease Control and Prevention (CDC) notes that up to 20 percent of mothers experience postpartum mental health issues, the leading cause of maternal mortality. #postpartumdepression #fragmentation #healthcareaccess

https://t.co/IHvLDqNbXG

[Rural Doc Alan @RuralDocAlan]

Ineffective Fragmented Care Solutions

CMS recognizes the added costs of fragmented care but is unable to recognize why independent practices are more successful at reducing the costs of fragmented care. That would require recognition that independent physicians understand the inherent value of the patient-physician relationship and how that relationship plays a critical role in quality care.
Years ago, we physicians owned our care. Our patients were not considered our property—until corporate medicine began to consider patients property. #fragmentedcare #qualityhealthcare #CMS

https://t.co/ajP2sfPoCq

[Rural Doc Alan @RuralDocAlan]

Nursing Homes Old and New

Articles about long-term care will describe various kinds of regulations for assisted living. But I have never seen any articles about long-term care in an acute hospital. Long-term care in hospitals are essentially nursing homes but somehow have escaped nursing home regulations so they are monitored very differently. #nursinghomes #longtermcare #Medicine

https://t.co/AhXyCl7xqi

[Rural Doc Alan @RuralDocAlan]

The Ivory Tower and Poisoned Wells

The internet has made it possible for the Ivory Tower crowd to commune with the rest of us in the everyday world. So now every research paper in existence is blasted from the Ivory Tower as being the truth and everything else is misinformation. Doesn’t matter that the research studies may contradict each other. Yet we all know that research studies give various results for many reasons, and indeed, some research results relied upon for years are overturned by later studies. #science #research #medicine

https://t.co/uv4cGzcz6H

[Rural Doc Alan @RuralDocAlan]

The primary care physician is fast disappearing from our healthcare landscape. This Substack post by Paula Demasco does a wonderful job of describing what a primary care physician does and what we have lost. #primarycare #medicine #healthcare

https://t.co/1hV1nApGnB

[Rural Doc Alan @RuralDocAlan]

I will now be publishing a newsletter on Patreon about Pregnancy Your Way and how to choose the kind of pregnancy you want 95 percent of the time.

https://t.co/JtBkwqGjGr

[Rural Doc Alan @RuralDocAlan]

Due Process Here and There, by @RuralDocAlan

I’ve talked about the sacrificial lamb in medical practice many times, in particular, with regard to punishing one physician for the faults of many. As I have indicated many times previously, a problem like this does not arise suddenly from nothing. I have also discussed the public harm caused by the political nature of board decisions which protect their friends.

https://t.co/aqqqP591Le

[Rural Doc Alan @RuralDocAlan]

Tylenol Is In The News

Anapyrexia is the term for a very serious infection which has no fever. This is a condition commonly seen in the very vulnerable, which include the very young and the very old. Years ago, before we started taking Group B strep infections seriously, many newborns became ill with Group B. They do not get a fever. They simply become sluggish and unresponsive, and finally, they go to sleep and die. So, it is easy for nurses, doctors, and parents to think that their babies don’t cry much and are well behaved. These vulnerable patients with these conditions without fevers are extremely high risk and subsequently caretakers, including nurses, and doctors need to have a high index of suspicion, to recognize, treat and save those seriously ill patients without fevers. #acetaminophen #fevers #antiobioticresistance

https://t.co/fgdvftqhJl

[Rural Doc Alan @RuralDocAlan]

We All Need Access to Good Healthcare

Unfortunately, it is also true that healthcare financing is in an extreme crisis and there is absolutely nobody in our legislature looking realistically at the causes or genuinely exploring any kind of long-term solution.

https://t.co/zUIIyUXQ6Q