Carlsbad Family Medicine, A Professional Corporation
2808 Roosevelt St., Ste 100
Carlsbad, CA 92008
760-688-0411
760-645-6385 FAX
www.medicine-in-motion.com

 

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Frequently Asked Questions (FAQ's)

What is sports medicine? What does "medicine in motion" refer to?

What does "Running water never freezes..." refer to?

What is an "industrial athlete?

What is a weekend warrior? Come observe their life cycle!

How was this website created?

What is our policy regarding specialty referrals?

How do HMO and PPO plans differ?

I_hate_magic! Do_I_have_to_be_subjected_to_tricks_and_jokes_when_I_visit_Dr._Pearson???

How can I get a copy of your mom's fabulous tabouli recipe?

I just hurt my (choose one or more: back, ribs, ankle, knee, toe, etc). Why didn't you perform an x-ray? (Don't you need the money?!)

***Important information for students***

What is sports medicine? What does "medicine in motion" refer to?

Sports medicine is probably best defined as medicine in motion, a term coined by Dr. Doug McKeag in the early 1990's. After all, the typical individual does not go through his/her life perched on top of a doctors’ examination table. Yet, this is how most physicians see their patients!

Sports medicine docs try to appreciate the human body for how it is in reality - active. Whether our patients are running marathons or walking the local shopping malls, lifting heavy barbells or pots and pans. Because sport docs tend to take a more aggressive approach to many conditions, particularly with regards to the musculoskeletal system, some of us proudly describe what we do as "medicine with attitude!"

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What does "Running water never freezes..." mean?

(Is it some sort of Zen philosophy or some long-forgotten geothermophysics thingy?)

Basically, "use it or lose it" sums it up. The Tin Man in the Wizard of Oz would not have frozen in place had he kept moving. Thus, another reason why we try to keep our patients  (particularly our seniors) active!

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What is an "industrial athlete?"

This concept originated somewhere in the late 1980's. Through it we apply the principles of sports medicine to the evaluation and treatment of injured workers.

A lot of time and money has been spent evaluating athletes to discover ways in which to help them perform better. They’ve been hooked up to all sorts of machines monitoring their hearts and lungs, strength/endurance, analyzing their diets and whatever supplements they might be taking, etc..powerlifter.jpg (63696 bytes)

Of course, this is all done with the best of intentions…….utilizing this information, the best athletes may look forward to winning Olympic gold. (Or perhaps lucrative careers earning obscenely high salaries, not to mention millions of dollars endorsing various advertising products...but I digress.)

Fortunately, the information gleaned from the athletic studies can easily be applied to the American work force. 

Treating these workers as "industrial athletes offers several advantages:

FIRST -faster return to participation: the typical athlete wants to get right back into the game ASAP. They generally won’t stand for a doctor who tells them to "stay in bed for 3 weeks so that back can heal." Furthermore, we know that activity promotes more rapid healing and restoration of performance. [And, while the "Michael Jordans" of the world probably wouldn’t miss a few weeks of income, not many of us regular folks can go too long, as a result of an injury, without a full paycheck.]

SECOND -self-esteem is improved: the sports medicine team serves as cheerleaders in a sense. We psych up our athletes every step of the way through their recovery, filling them with positive reinforcement. We do the same for our industrial athletes. ["Doc says he’s treating me just like Joe Montana!" In San Diego: cómo Péle!]

FINALLY -Team physicians are important. Not only does a good team doc cover events, but we truly become a part of the team. We know our players and coaches. We understand the personality dynamics around the workplace, as well, and how this may affect a worker’s recovery. [It’s well-recognized that an employee who likes their job will return to work faster than one who does not! Also, if the employees feel comfortable with us, they may start to trust us with such things as the truth of how or when an injury really occurred.]

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What is a "weekend warrior?" Come observe their life cycle!

Monday through Friday, our "desk jockeys" behave as mere mortals. Clark Kent.JPG (7315 bytes)
Come Saturday, watch out! superman.JPG (9924 bytes)
Sunday evening: paying the price... Magic Johnson post game; Picture by John Mendenhall published in A Day in the Life of California (1988)
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How was this website created?

Web Pages That Suck (by Flanders and Willis) was used to gain understanding for the basics of web design. After I planned out the site, I used Microsoft FrontPage 2000 to assist with the coding.  No "canned" themes were used in the creation of this site.  Buttons were created using Microsoft Image Composer  (part of MS FrontPage 2000), with clipart from Microsoft Publisher. The web site had been hosted by Hostway until March 2021 when we moved to GoDaddy for internet cybersecurity reasons. Currently, Adobe Dreamweaver is used to update the site.

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What is our policy regarding specialty referrals?

We often field requests for referrals to specialists, e.g. dermatologists to look at acne or remove a skin cancer.

First, it is important to understand that family medicine is a specialty itself. The vast majority of family physicians are capable of taking care of a wide range of medical and minor surgical conditions without a need to refer out to a specialist.

Every physician should know his/her limitations. I, for example, have not delivered a baby in over 15 years. I gladly refer these cases to the local obstetricians. I do, however, perform well-woman exams, so these do not have to be referred out unless a patient truly prefers a particular gynecologist.

We have the capability to perform minor office surgical procedures such as biopsies and excisions of many skin lesions, as well as cryosurgery ("freezing" of pre-malignant and other benign skin lesions). We treat most types of common dermatitis and other skin conditions, as well. However, should a patient not observe appropriate improvement with my treatment, I would not hesitate to make a referral to one of our fine local dermatologists.  These are but just a few common examples.

We do not make any referral decisions based upon insurance type or lack thereof! We simply try to do "what is the right thing" for our patient. If a specialty opinion is appropriate, I will make an appropriate referral regardless of coverage. When I ws part of the managed care system, I would never consider withholding or delaying a referral simply because someone had HMO coverage (this would be stupid, as well as unethical).

Incidentally, I always try to send my patients to those physicians to whom I would send my own family members. Be aware, though, that insurance plans have their own preferred panels from whom you must choose, should you decide to remain "in network."

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How do HMO and PPO plans differ?

Preferred Provider Organization (PPO) plans provide freedom of choice with regards to your medical care. The costs of these plans has risen steadily over the years. In response to this fact, Health Maintenance Organizations (HMO) were created as an attempt to keep health care affordable for the average family. It accomplished this task, primarily through containment of costs and limiting panels of physicians.

A former associate of mine offered this excellent analogy: 

Suppose that you want to go the shopping mall. You have two options to get there from your home: you may drive directly or take public transportation.

If you drive directly, you pay for the costs of your vehicle, the fuel, maintenance and upkeep, but you have the freedom to travel at the time of your choosing, as well as the route. (PPO)

Public transportation, on the other hand, will still get you to the mall. The monetary cost of the trip will be cheaper, however, it might not be as convenient - you might have to walk a few blocks/miles to the bus stop and the bus may have to make several stops along a long circuitous route, but eventually you will find yourself at the mall. (HMO)

With a PPO plan, you can usually choose the physicians that you like without need of a long referral process, so you can be seen faster in many cases. With the typical HMO plan, your choice of physicians within a particular community will be limited. It's quite possible that the best docs in the community might not even belong to the HMO.

In short, we get what we pay for. Convenience and quality has it's price.

[By the way, another term - IPA - frequently comes up in these discussions. IPA stands for Independent Physician Association. This is a contracting organization that serves as the go-between for practicing physicians and individual insurance companies. For example, Sharp Community Medical Group (SCMG) contracts with several HMO insurance companies (e.g. Secure Horizons, HealthNet) upon the behalf of practicing physicians.]

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I hate magic!  Do I have to be subjected to tricks and jokes when I visit Dr. Pearson?

Of course not! We recognize that some patients might not be in the mood, nor have the time, to be entertained during their visit. Simply tell the medical assistant that you'd like to politely decline any magic/joking/clowning at the time of your visit and we'll respect your wishes.

That being said, Dr. Pearson's philosophy closely correlates with that of Dr. Patch Adams' Gezundheit Institute.  Most people do not like to go to the doctor's office. Good studies have documented the stresses and shame that is often associated with admitting a weakness (e.g. illness), especially men. After all, John Wayne wouldn't have gone to a doctor. He would have chomped on a silver bullet instead!

It's been oft quoted that "Laughter is the best medicine."  Dr. Pearson uses humor in the form of jokes, improv, clowning, magic, etc to relax his patients and help them to forget that they're visiting a doctor. He is definitely NOT the stereotypical physician wearing a suit/tie who spends just 8 minutes with each patient. Rather, he cares enough to try and make his patients feel better spiritually, as well. Things can get silly at times (no matter what your age!)  and you probably won't find worse puns than this office, but he really does listen to what patients tell him and the vast majority appreciate his efforts and feel better afterwards.  [All in all, this practice is probably not a good one for patients without a sense of humor. There are plenty of other good docs in the area from whom to choose and we make appropriate recommendations if requested.]

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How can I get a copy of your mom's fabulous tabouli recipe?

Click here!

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I just hurt my (choose one or more: back, ribs, ankle, knee, toe, etc). Why didn't you perform an x-ray? (Don't you need the money?!)

Quite simply, a good doc does not order a test unless it's going to change his/her treatment. While this might not be such a big deal when ordering cheap tests (do these really exist?), it becomes a significant issue when it comes to the more expensive technologies such as magnetic resonance (MR) scanning (MRI scans may easily exceed $1000).

There are numerous studies demonstrating the extraordinary amounts of money wasted on unnecessary radiographic examinations. For example, physicians in Ottawa, Canada, looked at the vast numbers of plain x-rays that were ordered for typical  injuries to the knee, ankle, and foot. They observed that while most patients who arrive at emergency rooms with an ankle sprain are sent for an X-ray, less than 15% actually have a fracture. These physicians developed the Ottawa Ankle Rules, a set of guidelines that can help doctors avoid ordering unnecessary X-rays simply by observing how patients walk and by feeling their feet. These rules were recently validated, yet again, by a Swiss study that concluded that they "can rule out ankle fractures with almost 100% accuracy and cut down on thousands of needless X-rays every year." As a sports med doc, I've used these rules over the years and have yet to miss a clinically significant fracture.

There are occasions where the diagnosis of a fracture simply doesn't make any difference in the subsequent treatment. Fractures of the toes and ribs are probably the most common examples of these. All common toe injuries are treated by "buddy taping" the affected toe to the adjacent one, whether a sprain or simple fracture. In the case of ribs, they are composed of bone and cartilage, the latter of which cannot be visualized with routine x-rays. Rib studies are notorious for missing rib fractures. For example, I cared for a patient involved in a motor vehicle accident who complained of left rib and flank pain. Plain films obtained by the emergency room physician were interpreted as being negative for fracture. When I saw him, I was concerned for a possible spleen injury so I ordered a CT scan of the region which revealed the presence of 7 broken/fractured ribs!  Regarding their treatment, we do not apply casts to chests for rib fractures as this would compromise breathing (we even try to avoid rib belts, if possible, for this reason). Hence, painful ribs are treated with analgesics ("pain killers"), ice and then heat, etc - whether they are broken or merely contused (bruised). Bottom line: no need for rib x-rays unless we clinically suspect a more severe injury such as a pneumothorax (and then the radiographic study of choice is a chest x-ray looking at the lungs, rather than a rib series).

 I could go on forever on the subject of imaging the acute (fresh/new) low back injury. The fact is that out of 100 back injuries, less than 5 will ever require surgery, including many disc herniations. Plain x-rays cannot visualize muscles, discs, nerves, or ligaments, nor can they identify facet subluxations (the "kinks" that patients commonly present with in the office). MR imaging can identify the majority of disc herniations/protrusions, but we would only order MR examinations if surgery was being considered because, as just noted, the majority of patients with acute disc injuries get better without surgery.  The natural course of acute low back pain is well-recognized, as are the treatment options. Early imaging studies do not add anything to the management of the typical case of acute low back pain. Of course, exceptions may exist and there are some "red flags" in the patient's history that we look for in order to identify who might really have an underlying condition warranting further investigation. The National Guideline Clearinghouse (U.S. Government) has published it's guidelines for the evaluation/management of low back pain or sciatica in the primary care setting. (They may be found here.) Finally, a brief summary of the treatment of low back pain may also be found at the Quackwatch site here. [And don't forget to read my patient education handout on the treatment of acute injuries elsewhere on this site!]

Oh yeah, could we use the money? Sure, but we have to live with ourselves ethically and do what's right for our patients. Bummer.....

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Important information for students

Word on the street is that some students actually enjoy (and perhaps even learn some things) during their rotations with us. While that's news to us, here's what we CAN tell you:

Dr. Pearson has been training students and residents for over 35 years, averaging 8-10/year. Student who rotate with us come from several disciplines: medical students (D.O./Osteopathic and M.D./Allopathic), Nurse Practitioners, and Physician Assistants. They come from colleges and universities across the nation including several of the Osteopathic colleges, UCSD, Stanford, George Washington University, and many others.

You will NOT learn medicine here. OK, you probably will anyway, but the real strength of the rotation is how to be real i.e. be human and be able to communicate with patients, whilst at the same time putting them at ease. (There's an ever so slight chance that you may learn a bit about magic, improv, and clowning, as well.)

For the record, I do not "pimp" students with questions and I only give out one homework assignment: reading the very first of the short Sherlock Holmes stories by Sir Arthur Conan Doyle, and a brief essay about the medical influences on the stories. [Click on the hyperlinks to download them]

Finally, Laurie has put together a list of things that you need to know before you arrive for your rotation. Please download this and review in advance.

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