June ZoomNews
Your monthly dose of HealthCare on Demand
Greetings,
Phewww, now with our first b-day behind us, we can get on with the business of trying to take ZoomCare to the next level and to perfect health care on demand so we can live out our mission "to provide you with the highest quality and most convenient health care anywhere."
But what do these terms really mean? Healthcare on demand? Ultra-convenience? Quality Care? Are they hollow slogans or are there ways to drive toward these ideals and measure our progress?" Are we "big hat, no cattle" as they say out East (east of the Cascades)?
Take a look at the chart below. This shows your wait time calculated from the moment you check in to the moment you meet with your ZoomCare Doctor.
What does this mean to you? Well, it tells you that our customers waited about 11-12 minutes in January through December of last year but in February through April are waiting 6-8 minutes. The downward trend is good, but the results are not good enough. We'll review this with you again in several months to see if our improvement efforts are working for you.
Here's what we do know. Our customers who schedule online or call to schedule a same-day visit are more consistently experiencing waits of less than 5 minutes.
Unfortunately, now and then, our customers do wait for 15 minutes or more. Sometimes many people walk in at the same time without reservations, and sometimes our customers require a bit more time that we expect. That's why we keep a stack of Peet's Coffee & Tea cards on hand.
Are you wondering how we know about the length of your wait? It's pretty simple actually. ZoomCare is powered by ZoomWare, the powerful software we designed specifically to deliver healthcare on demand.
ZoomWare tracks all this for us. So yes, being on time is really important to us because we believe it's important to you. You want great care on your schedule — not ours.
Ok. Enough logistics for now. Let's step back and take a look at the bigger picture. We see ourselves as part of movement, a very important movement, that we call Open Health Care. This movement calls for a departure from physician-centric, facility-centric, and technology-centric health care and a thrust toward customer or patient driven care. We envision a health-care world that is more inviting, based on a human scale, in easy-to-access neighborhoods and retail oriented sites, that are staffed by small professional medical teams who are empowered with state-of-the-art tools — all organized around your schedule and your health. We believe that our prices and our performance should be public so that you can make informed choices about what's right for you. While this vision excites us and hopefully you, we remain a small band of revolutionaries. For example, some insurers seek to force you or coerce you to use certain doctors, laboratories, imaging centers and hospitals based on nothing other than financial relationships. And some doctors feel threatened by this Open Health Care Movement. For example, the following article "Physicians pushing state lawmakers to regulate burgeoning nurse practitioner retail clinics" describes how physicians are using regulation to restrict nurse practitioner-based clinics. Though ZoomCare relies on board-certified, experienced family physicians because we believe that the physician is best prepared to provide superior care for our customers, we are strongly opposed to using lobbying and regulation to restrict your health care choices.
Thank you again for relying on ZoomCare. It's a great privilege and honor to care for you.
Sincerely,
David Sanders, MD
dsanders@zoomcare.com
&
Albert DiPiero, MD, MPH
adipiero@zoomcare.com
Dr. Katz's Corner
What does it mean to be healthy?
When asked to write another awesome ZoomNews piece, I rejected the usual summer topics: sunscreen and insect bites. Writing articles about these are as boring as reading them — "wake me up when it's over" kind of thing. Not awesome.
But with the change in weather, we start thinking more about our bodies and over-all health. So that leads to this question: What does it mean to be healthy? And who am I to tell you if you're healthy or not? First, I'll answer the latter question. I am a ZCP (ZoomCare Physician). All ZCPs are carefully selected at birth and raised under strict conditions to become the elite medical team you've come to love and trust. We are all experts in things like this — it's our specialty.
So what is health? Everyone has a sense of what it means, but have you ever tried to define it? My concept of health is changing because of the responses I get with the question, "Do you have any medical problems?" I ask it at every ZoomVisit. The answer is often, "Nope. I'm healthy." But when I ask, "Okay, do you take any medicines?" "Oh yes, I take medicines for cholesterol, blood pressure, and diabetes." Either people forget these are medical problems, or don't what to think of them as such. Or, perhaps people don't see high blood pressure or high cholesterol as related to being "healthy" — probably because they feel fine. I've also come to learn that many feel pride about being healthy, or their "lack of disease." But the notion that "I'm healthy because I feel good" is flawed. One reason is that there can be disease present without you knowing, and without making you feel "sick". When disease does develop, we often don't let go of a healthy mindset. That's beautiful, but a healthy mindset is not enough to make us healthy, either. I see you raising an eyebrow in disbelief. Preposterous! People will say, "Healthy attitudes are critical to good health." Yes, I say, that's true... but that's not enough. So what is health? I believe there are three necessary components to being truly healthy: 1) attitude, 2) action, and 3) acceptance. I'll elucidate:
1) Feeling well — physically and mentally, and having a healthy attitude/ mindset.
2) Living a healthy lifestyle, and making daily choices and sacrifices that lead to health. It's interesting that most men define health as not needing to go to the doctor, whereas most women go to the doctor every year for pap smears and breast exams, and therefore have a different view of healthcare. As guys, we take our health for granted. It is easy to be "healthy" early in life when we're active — when the only reason to see a doctor is for a twisted ankle. But after the age of about 40, our health no longer comes to us for free. We start needing to earn it.
3) Reducing risks requires us to accept that we're human: Everybody has at least one medical problem or a risk factor for a medical problem (Have a family history of high cholesterol? Ever been out in the sun?) Here, screening for hidden problems is the key. Some people are in denial that they need to be screened for diseases when they feel well, eat well and exercise. But denial is a lousy self-defense mechanism — it is really a self-harm mechanism. The critical thing is that screening can lead to better health — not worse. For example, people might have diabetes for a while and have no idea it's there. But when motivated people discover it, they improve their lifestyle and become exercisers. So having a diagnosis by itself does not mean you're not healthy anymore — it depends on what you do with it. Another example: having colon cancer diagnosed and removed before it spreads (by getting a colonoscopy) is a wise decision that leads to better health. In other words, it's not enough to exercise and think happy. You have to illuminate the hidden problems and work on solving them.
One way to earn health is to exercise. Often. Another way is to eat well — lots of whole grains, veggies, berries. Not just once on a Tuesday. Eat 'em all the time. And another way to illuminate health and eliminate disease is to receive the recommended screening tests by a physician. Make sure everything under your hood is working right — get your 50,000 mile service with a 31 point inspection. Make sure you're as healthy as you think you are — ask your ZoomCare team how to do it.
In This Issue
Cellulitis:
Your largest organ's way of getting your attention
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Ask your ZCP: Cellulitis
Last week a 30-year-old woman came into ZoomCare with painful, red streaks spreading from her foot up to her mid shin. She had classic cellulitis, a very common infection of the skin. In fact, cellulitis is one of the most common infections seen in the clinic setting.
The patient we saw at ZoomCare had very typical story: she had noted an ingrown toenail and had started trimming it. In the process, she nicked her toe with the scissors. The next day she noted some redness and had some pain around the edge of her toenail. One day later, the redness had spread from her toe up the foot and onto her lower leg.
Cellulitis is an infection of the skin that extends a bit below the superficial skin into the next layer of tissue. The area of infection is usually red, warm, and painful. It can also spread rapidly. Most cases occur on the legs and feet, but cellulitis can occur on any area of skin, including the face, abdomen, arms and hands.
We don't fully know why some people get cellulitis and others do not. Some specific factors probably contribute to the development this infection, but cases are varied. The most important risk factors are conditions that break the natural protective barrier of the skin: leg wounds, leg ulcers, cuts or skin breakdown between the toes, and "tinea pedis" (athlete's foot).
Also people with poor circulation, diabetes, or previous episodes of cellulitis are also more likely to develop the condition.
Most patients with cellulitis develop redness, pain, and swelling of the infected area- but otherwise look and feel fine. Other people develop fever, weakness and feel very ill. What can be surprising is the speed at which the infection spreads up a limb.
Most cellulitis is caused by bacteria such as "staph" or "strep". Cellulitis caused by certain versions of these bacteria can cause a rapid, very dangerous version of the infection where the tissue is actually rapidly consumed by the infection (the so-called flesh eating bacteria). More common is the development of methicillin-resistant staph aureus cellulitis. This is a cellulitis caused by a version of the staph bacteria that is resistant to the usual antibiotics used to treat the condition. It is important to know the likelihood of methicillin-resistant staph aureus in a community in order to determine the best treatment.
Cellulitis can often be treated by oral antibiotics and keeping the infected area elevated. But if the patient is ill appearing, has rapidly spreading infection, or has possible infection with unusual organisms, then hospitalization may be required.
The woman who came to ZoomCare had the typical redness and pain, but otherwise she appeared well. She was started on Bactrim (trimethoprim-sulfamethaxozole), which is used to treat methicillin-resistant staph aureus. This was suspected because of the commonness of the condition in this community. Commonly we treat cellulitis with oral antibiotics for 10 days. The key is to check back frequently to make sure the infection is responding to treatment. If the oral medicines are not working, it may be necessary to place the patient in a hospital to receive intravenous antibiotics. It is also important to realize that sometimes it can take up to two weeks for the swelling and redness to complete resolve.
- Dr. Albert DiPiero MD, MPH
As part of our commitment to growing deeper roots in the communities we serve, each month, ZoomCare gives a ZoomGrant of $250 to a local area non-profit.
Congratulations to June's winner:
Oswego Playschool
If your organization would like to apply for a ZoomGrant, you can do so on our website. Or, click here.
