General

A Simplified Approach to Mental Illness From a Generalist’s Perspective

Crazy or Not? Real or Not? When it is all said and done, the simple distinction is PERCEPTION of REALITY, that which exits in space and time.

The individual mind or mental capacity adapts to reality that is shaped by “ID”; “SUPEREGO”; and “EGO,” which are in constant conflict.  “ID” implies a subconscious, basic instinct or will to survive.  The “SUPEREGO” implies a subconscious manifestation of established or acceptable morality (Right Versus Wrong) as the component of the individual’s development and social surrounding.  The “EGO” is the conscientious adaption of the individual to make or act on a choice between “ID” (will to survive) versus “SUPEREGO” (Morality).  This constant conflict that is manifested in the “EGO”  creates an environment for the mental health profession to assess and define levels of dysfunction based on a set of societal rules as defined by civilized principles which set humans apart from lower animals.

The dysfunctional qualities of the human mind are tiered by: 1) NEUROSIS, a form of defense mechanism in dealing with mental conflicts as either being mature or immature (which is highlighted by behavior or developmental disorder and mood/affect disorder, such as depression, obsession, anxiety, addiction, gender identity, eating disorder, etc); AND, 2) PSYCHOSIS, a form of defective defense mechanism with complete DISTORTION of REALITY (which is highlighted by anti-social disorder, schizophrenia, Major Depression with Suicidal Ideation, etc.).

The CLASSIFICATION of mental health disorders can be further defined through the Diagnostic  and Statistical Manual of Mental Disorders (DSM), and it is suggested for further reference.

The challenge for the healthcare professional is to appropriately assign the proper mental health diagnosis that is unbiased and representative of the INDIVIDUAL PATIENT’s NEED.  It is suggested that a team approach (to include family members, primary care physicians, psychologists/psychiatrists, sociologists, and theologists) is the best option for proper assignment of a LIFE LONG MENTAL  HEALTH DIAGNOSIS that will follow a patient for the rest of the individual’s life, and should never be haphazardly ASSESSED in isolation.

Medical Diagnostic Choices remains COMMITTED to informing patients for better quality, safe, and affordable health care.

 


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Dr Gates at the Microscope Desk Interpreting Diagnostic Pathology

Dr Gates at the Microscope Desk Interpreting Diagnostic Pathology


TOP TEN (10) Reasons to SEEK SECOND OPINION

Second Opinion Part ISecond Opinion Part II

“AN ESTIMATED FOUR HUNDRED THOUSAND (400.000) DEATHS ANNUALLY IN THE USA ARE DUE TO MEDICAL ERRORS”

 

In efforts to assure transparency and accountability in our health care system, here are the top  ten (10) reasons patients should consider a second opinion:

1. MISDIAGNOSIS:

A) False-Negative pap-smear in a patient with at least five consecutive years of cervical-vaginal pap smear reviews.

B) False-Negative and/or False Positive Diagnosis of CANCER, including NEUROLOGICAL CANCER, Breast, Prostate, Small Intestine, Stomach, Kidney, Pancreas, Colon,LUNG,  Melanoma, Leukemia/Lymphoma etc.

2. RARE, UNUSUAL AND/OR UNCLEAR, WRONGFULLY DELAYED DIAGNOSIS

3. UNCONTROLLED AND/OR INAPPROPRIATELY MANAGED CHRONIC DISEASES, Such as diabetes mellitus, high-blood pressure, HIV, Chronic Pain Syndrome, etc.

4. RARE INFECTIOUS DISEASES

5. RARE AUTOIMMUNE DISEASES

6. ADVANCED-STAGE, TERMINAL DIAGNOSIS

7. LACK OF EFFECTIVE COMMUNICATION REGARDING DIAGNOSIS BY HEALTH-CARE PROVIDER (Lack of Transparency and Accountability by Health Care Provider)

8. A HEALTH CARE PROVIDER WHO ADVISES AGAINST A SECOND OPINION

9. INABILITY TO MAINTAIN IMPROVEMENT IN HEALTH FROM A PREVIOUS DIAGNOSIS/POOR PROGNOSIS

10. ASSURANCE OF ACCURACY IN MEDICAL AND/OR PATHOLOGICAL DIAGNOSIS

 

 


Medical Release FORM For Medical Evaluation by Dr. Gates

CLICK ON THE ABOVE RELEASE FORM to PRINT COPY


Patients Should Not Be Required to Wait

Often times there is a delay in the transition of medical care. This delay is due in part to inefficient communication and operation by other medical office/hospital staff members outside of the control of MDC-Atlanta, and patients should not be held accountable for such actions. The delay in medical care transition can be potentially detrimental to patient care.

Our Policy at MDC-Atlanta regarding  New Patient Review/Medical Care Evaluation is REVISED to reflect the following:

1) Patient must show valid identification card and/or document.

2) Patient must be 21 years or older for general medical care.

3) Patient must seek due diligence in obtaining medical records from previous health care provider and/or hospital as requested

4) Patient must complete registration and other appropriate agreement forms for medical care by MDC-Atlanta

5) Patient must abide by rules and practice policy as established by MDC-Atlanta

6) Patient must communicate directly with our practice in a timely fashion regarding medical office/home visits and/or any other medical emergency 24/7.

7) Patient must accept our physician as apart of their overall medical management team.

Medical Diagnostic Choices, MDC-Atlanta

CLICK HERE TO CONTACT DR. GATES NOW


Policy for Patient Care at MDC-Atlanta

Often times there is a delay in the transition of medical care. This delay is due in part to inefficient communication and operation by other medical office/hospital staff members outside of the control of MDC-Atlanta, and patients should not be held accountable for such actions. The delay in medical care transition can be potentially detrimental to patient care.

Our Policy at MDC-Atlanta regarding New Patient Review/Medical Care Evaluation is REVISED to reflect the following:

1) Patient must show valid identification card and/or document.

2) Patient must be 21 years or older for general medical care.

3) Patient must seek due diligence in obtaining medical records from previous health care provider and/or hospital as requested; The requested medical records should be faxed to: 888-349-7125

4) Patient must complete registration and other appropriate agreement forms for medical care by MDC-Atlanta

5) Patient must abide by rules and practice policy as established by MDC-Atlanta

6) Patient must communicate directly with our practice in a timely fashion regarding medical office/home visits and/or any other medical emergency 24/7.

7) Patient must accept our physician, DR. JACKSON GATES,  as apart of their overall medical management team.

Medical Diagnostic Choices, MDC-Atlanta


Transition of Medical Care

There are many reasons why patients choose to transfer or transition their medical care from one doctor to another.

We at MDC-Atlanta suggest the following steps to take in the transition of medical care:.

-Notify your current doctor or health care provider regarding your intent to discontinue medical services with that provider, and transfer medical care to a different provider.  Notify the hospital medical records department if you were discharged from a hospital so that your outpatient-based doctor or health care provider may receive pertinent medical records for appropriate continuity of care.

-Notify your new doctor or health care provider regarding your intent to form a new patient-physician relationship.

-Complete an appropriate HIPAA release form, an example of which can be viewed by clicking on the two images below:

 

HIPAA Page 1HIPAA page 2

When you have been discharged from a hospital, certain basic medical records are essential for communication as well as for continuity of appropriate medical care.

Medical documents from a hospital admission should include for instance:

The Hospital Discharge Summary, as it is called, which should include hospital admission/attending physician, detailed history and physical, imaging studies, labs/tests ordered, working diagnosis, treatment, surgery, and course of hospitalization including specialist referrals, as well as discharge diagnoses and recommendations for social work or home care.

-The above fore-mention completed document with HIPAA compliance to release medical records from previous provider should be sent to the doctor or health care provider with whom you will be discontinuing medical services, or hospital medical records department from the hospital facility where you were discharged.  According to standards, your medical records from your previous provider should be available to your new physician within two(2) weeks; or if discharged from a hospital, then your medical records from the hospital should be available to your new out-patient base doctor or health care provider within thirty (30) days after the date of hospital discharge.

-Schedule an appropriate face to face visit with your new doctor or health care provider.

Here at MDC-Atlanta, we strongly recommend direct, oral communication between your previous health care provider and Dr. Gates for safety of continuity of medical care, but it is not absolutely required.

Medical Diagnostic Choices, MDC-Atlanta

CLICK HERE, TO CONTACT DR. GATES, NOW


The Brain, Spinal Cord, Peripheral Nerves, and The Autonomic Nervous System-A Practical Explanation

Putting it all together to help patients understand how they could potentially be in a position to detect the earliest signs of  illnesses, retarding advanced stages of diseases, and to partner with a health care provider—-

In fact, the medical interview starts by assessing the Brain’s function through: Alertness and Orientation to Person, Place, Time, and Situation.

Proper alertness and orientation allow the health-care provider to assess symptoms and signs through direct-communication with the patient.

What CONTROLS our action, reaction, behavior, MEMORY, ability to speak and interpret WORDS/LANGUAGE,write/draw, ability to hear, see, taste, feel pain/soft touch/pressure/position in space/balance, ability to respond, move, emotion, sleep/wake cycle, AND ABILITY TO THINK or REASON or do other COMPLEX task, i.e.higher cortical functions which separate human beings from other lower intelligent or intelligible ANIMALS—–

The Central and Peripheral NERVOUS SYSTEM!!!!

 

When all is said and done, only about 10% of the human brain function-capability is known.  We know more about the peripheral nervous system, because it is simpler to study without causing significant and sustainable harm to the human being, as opposed to the single, most IMPORTANT ORGAN—-THE BRAIN.

Life can not be sustained without a HUMAN BRAIN!!

We suggest for further reading that one considers a simple anatomy and physiology textbook to learn about the Central and Peripheral Nervous System. But in simplest terms, consider the brain as a CENTRAL STATION for processing a variety of Information.  In this Central station, there are different types of departments known as, NUCLEI comprised of neurons, with specific locations in the brain that have been mapped out (see image above).  For further simplicity, consider the peripheral nerves as highways and byways transporting various information to the central station, where the SPINAL CORD is the MAIN Transportation HUB or thoroughfare.  And, Finally, for even more simplicity, consider the medulla, pons, and midbrain, basal ganglia, hypothalamus, thalamus, Cerebellum as special relay stations to route certain electrical traffic to its final destination, where also throughout this electrical highway/transmission, there are negative and positive relay stations that use certain neurotransmitters to either stop, slow down, or speed up the electrical signals.   Remember, the Peripheral and Central Nervous system FUNCTIONS by either converting light, sound, as well as chemical reactions into electrical impulses or simply allowing direct electrical impulse to flow to the CENTRAL PROCESSING STATION—- THE BRAIN.

  

The Autonomic Nervous System creates a direct rapid transit system for FIGHT OR FLIGHT response through the parasympathetic and sympathetic routes, as well as in regulating SENSATION, MOTOR and other RESPONSE ACTIVITIES at the Local Position for INTERNAL ORGANS.  The parasympathetic and sympathetic electrical transmissions are carried out under involuntary conditions through glanglia and nerve-root complexes located along the spine or near internal organs in chest, abdomen, and pelvis, as well as nuclei within the brain or ganglia for select cranial nerves (2,5,7,9,10).  The autonomic tracts, for example, are key components in the CHRONIC PAIN SYNDROME, and why often times certain centrally acting medication, surgery, and/or nerve block therapy may be REQUIRED to relieve intense, long-lasting and ongoing PAIN, that interferes with normal daily functional activity!

Let’s List the Diseases of the Central and Peripheral Nervous System, which often times ARE SECONDARY TO OTHER PROBLEMS,

and can be PREVENTED!

1. Cerebral Vascular Accident (STROKE) due to lack of flow of adequate blood to the brain as caused by arterial disease, high blood pressure, diabetes, etc, or Bleeding in Brain, due to Trauma or an abnormal clotting system

2. INFECTIONS such as bacterial meningitis, viral encephalitis, parasites, prion disease, etc

3. Tumors, often times are metastatic, i.e. spreading from other primary organs, with Primary Brain tumors representing less than 1% of all Tumors.

4. Dementia, related to primary degenerative changes of the brain, where electrical activities of dendrites, axons, and neurons are less effective in transmitting electrical impulses for needed communication, and active response, as due primarily to the aging phenomenon.

5. Delirium, related to chemical toxicity to the brain, often due to other failing systems not primary to the Nervous System.

6. NON-infectious, INFLAMMATORY diseases of the Nervous System, where often times the immune system develops inflammation to its own neural tissues, and causes severe destruction of neural tissues, such as in Multiple Sclerosis, Chronic Demyelinating Neuropathy, etc.

Simply observing warning signs of the brain’s activity, and seeking appropriate timely help, as well as maintaining acceptable control of Chronic Diseases such as CHRONIC PAIN SYNDROME,  High Blood Pressure, Diabetes, and other metabolic diseases

could drastically reduce Nervous System Diseases

Medication and It’s Effects on The Autonomic (Involuntary) Nervous System:

The Autonomic Nervous System essentially functions through the initiation of Alpha and Beta Receptors located in various parts of the body, and the principle activation of these receptors  is typically mediated by Norepinephrine and Epinephrine, which are hormones produced by cells of the adrenal glands.  These hormones cause the Alpha or Beta Receptors to be activated to generated nerve conduction, electrical impulse through the peripheral nerves regulated by the Autonomic Nervous system.  Such functions that are critical to this system include but not limited to diseases such as: Diabetes, High blood Pressure, certain endocrine diseases, and many others.  Certain or Select Chemical Medications are used to inhibit, stimulate, or simply modulate these diseases by regulating the autonomic response, that if went unchecked could lead to failing human organ systems, and in certain instances, depression and death.  Close monitoring of medications that alter the functions of the Autonomic Nervous System IS REQUIRED.

 AN EXAMPLE OF A CASE THAT OCCURS FREQUENTLY AND OFTEN TIMES CAN BE PREVENTED:

A 63 year old patient, obese, with chronic diseases including uncontrolled high blood pressure and diabetes, suffered a cerebral vascular accident (CVA-stroke), 12 years ago, which caused deficit of movement on one part of the patient’s body.  The Patient was placed on “blood thinning medication,” and while on this medication, suffered a seizure.  The patient was subsequently placed on ventilator because of difficult to sustain adequate oxygenation, and breathing drive, and now is bed confined.  Let’s choose to PREVENT Cerebral Vascular accident through appropriately controlling chronic diseases such as diabetes (HbA!c needs to be less than 6) and high blood pressure (Systolic pressure less than 160, and diastolic pressure less than 90), which has proven to drastically reduce CVA.

MDC remains committed to keeping our patients informed for better quality and safe preventable medical care!

 

 


The 40-years and Older Patient

Most of us tend to be healthy or at least without any significant medical issues prior to the age of Forty (40) Years, other than some minor illnesses here and there for which often times we are able to recover without further sequela..  While it remains a mystery why the human body begins to develop major illnesses or diseases after the age of forty,  we know that there are multifactorial issues that predispose the human being to developing illness or diseases,

Here are two clinical scenarios that one can use as a paradigm for making sure they are getting the maximum benefit through the health care process:

WELL-Patient   Versus   Patient with Illness or Disease

THE WELL, 40-Year old Patient Visit:

Doctor: What would you like to see the doctor about?

Patient: Well, I feel otherwise healthy without any symptoms, but I would like to have a general health-evaluation.

Doctor: Is this your first visit to a health care provider or doctor?

Patient: No, I have gone to visit a health care provider in the past for minor illnesses such as a cold, or flu, or minor trauma, but nothing really major or long lasting that would cause me to be concerned about my health. And, I am generally very aware and health conscious about being sick.  So, I exercise and promote good nutritional balance and dieting.

Doctor:  Great! So, what I understand is that you have not been diagnosed with any major illnesses in the past such as high blood pressure, or diabetes, or cancer, or any other major diseases, or have undergone any major or minor surgeries in the past and that you otherwise DO NOT have any current symptoms? Furthermore, I understand that you have not been on any short term or long term medications, or that you are not aware that you have allergies to certain foods or medications, or that you do not smoke cigarettes, drink alcohol daily, or use illicit drugs, and that you are employed or have your own business?  Furthermore, I understand that your parents are alive and well as elderly above the age of 75, and that there is NO genetic patterns of disease within your family tree that you are aware of.

PATIENT: Doctor, as I stated to you before, I feel as though I am completely healthy.

Doctor: I recommend that we obtain vital signs, and complete a physical examination, just to confirm your apparent healthiness.  Your Physical Examination is WITHIN NORMAL LIMITS.  Therefore, my impression is that you are a healthy 40-year old patient, and I recommend that you continue your habits for healthy living.  Now, there are some screening exams that are recommended including, but not limited to: Mammogram (for women); Prostate Specific Antigen/digital rectal exam (for men), among others.  I also recommend that you follow up with me within 1-3 years, or sooner if you become ill.

Patient: Thank you, Doctor/Health-care provider, I COMPLETELY understand your assessment and plan for my health-care, and will participate in partnership with you regarding my medical care!

DOCTOR: You are very welcome, and I applaud you on your efforts to remain healthy-conscious, and for participating in proper communication and partnership  for SAFE-MEDICAL CARE!

VERSUS

THE 40 YEAR-OLD PATIENT WHO IS SICK or HAVE KNOWN CHRONIC DISEASES OR HIGH RISK FACTOR FOR DISEASE/ILLNESS?

                              THE SCENARIO?

              IT’S COMPLICATED

START HERE WITH COMPLETE EFFECTIVE COMMUNICATION

CHOOSE WISELY, CLICK HERE

MEDICAL DIAGNOSTIC CHOICES-WELCOME LETTER TO OUR NEW PATIENT


The Simplified Pathology Report for Patient at MDC-Atlanta

OUR NEW PATHOLOGY REPORTING SYSTEM FOR PATIENT:

The Clinical Image:

Clinical Image of Keratoacanthoma, as viewed while on patient's body

The Diagnostic Pathology Image:

Pathology Image of Keratoacanthoma

Additional Information about Keratoacanthoma and Prognosis

Keratoacanthoma (KA) is a special lesion, a pseudocancer, occurring as an isolated nodule, usually on the face, and mimicking squamous cell carcinoma (SCC). Unique features are its rapid growth rate, much faster than that of an SCC, and also its spontaneous remission over a period of several months.


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