For Patients & Families

Remote Medical Care at a Distance Through MDC-Atlanta

Combined with detailed Medical History and Laboratory Tests, an accurate diagnosis can be determined nearly 90%

Reference: Western Journal of Medicine, February 1992 (156)

We are excited to announce the newest component of our medical practice, TELEMEDICINE AND TELEPATHOLOGY.  We are accepting patients throughout the State of Georgia, including the Atlanta metropolis, Gainesville, Athens, Rome, Augusta, Columbus, Savannah, West Georgia, Macon, Brunswick, Albany, and Valdosta!

Modern Telemedicine allows patients to talk to a health care provider via Face-Time, for example, which is private, safe, convenient, and effective! Now just a phone call away, you can get an idea about your health status!!! TRY IT TODAY!! No transportation, no traveling to a doctor’s office, JUST SIMPLY CALL, and you will have direct access to an ONLINE DOCTOR at your fingertip!!

GET A BASIC HEALTH ASSESSMENT TODAY, without physically going to the doctor’s office.

 

Here are the steps you would need to take:

1) Complete our ONLINE Medical Survey-MDC-Atlanta, prior to contacting our office

     COMPLETE ONLINE MEDICAL SURVEY

2) For patients who are older than 40 years of age for general health, preventative care evaluation, we suggest that you make an appointment  with Dr. Gates to get basic labs done to assess RISK FACTORS::

a) Complete Metabolic Panel (CMP).  This will give the patient an idea about electrolytes, glucose level, kidney function, liver function, etc

b) Complete Blood Count Report (CBC) with differential.This will give the patient an idea about red blood cells, white blood cells (including the five different types), and platelets, including the specific numbers, and basic morphology with regards to anemia (low red blood cells), leukopenia (low white blood cells), and thrombocytopenia (low numbers of platelets), or other possibly acute and/or chronic hematological abnormalities.

c) Lipid Profile. This will give information about the patient’s total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides, to assess patient’s risk for coronary arterial heart disease, and/or other vascular diseases.

d) Men, Prostate Specific Antigen (PSA). This is typically indicated to assist with evaluating risk of prostate cancer, and/or inflamed prostate glands in men.

3) An automated home blood pressure monitor with pulse rate may be helpful, as well as a weight scale.

4) Contact Dr. Gates directly to discuss Patient-Consent and other related medical policy and procedures at MDC-Atlanta regarding Online Medical Care; Further instructions will be given to potential patient prior to initiating the ONLINE MEDICAL CARE.

5)  Schedule a time for Dr. Gates’ to contact you, the patient, directly to began the ONLINE medical interview and medical care.

We at MDC-Atlanta, believe that proactive preventative care and health maintenance are  the best steps to take to reduce inefficient and expensive SICK-Care. 

MDC-Atlanta remains committed to keeping our patients informed for Better Quality and Safe Medical Care!!


How is My Disease/Illness Diagnosed?

Often times, patients are confused as to how a health care provider may derive at an accurate diagnosis in order to render effective treatment, management, and give patients an idea regarding whether or not the patient will get better or not (prognosis).

Patients should remember this simple equation:

symptoms+/- risks +/- signs + evidential support (lab tests, imaging studies, etc)

= Wellness or Diagnosis of illness/disease

The principle goal of medical evaluation is to derive at an accurate diagnosis of disease and/or illness.
So, when a patient sits down to chat with the health care provider, an interview regarding the patient’s health ensues.

The History of Present Illness (Symptoms):

-The health care provider asks a series of questions pertaining to the present illness, often initiated by “Chief of Complaint,” ie. “what caused you to want to see the health care provider?”

-Time or sequence of events pertaining to the “chief complaint.” When did this problem start? Was there an initiating event that caused it? Do you think the problem is getting better or worse? What makes it better, or what makes it worse? Are there any other symptoms that you can associate with this problem, and if so, what makes those symptoms better or worse? Are you having any other conditions that may be associated with the symptoms? Are there other concerns regarding your health and your current condition that you would like to address?

Past Medical/Surgical History (Risks)):

-Previous Medical Evaluation/Diagnosis: Do you have any other medical conditions that have previously been diagnosed by a health care provider? What are they? Have you had any surgeries done before? What are those surgeries that you have had done in the past?

Medication List (Risks):

Are you currently taking medications for treatment of specific diseases? What are they?

Allergy List (Risks):

Are you allergic to certain medications? What are the names of those medications for which you are allergic? What sort of symptoms do you associate with the medication allergy?

Social History (Risks):

Do you smoke or use tobacco or alcohol, or any other illicit drugs? If so, how long have you used tobacco, or how much alcohol do you consume within a week, for example?

Family History (Risks):

Are your parents currently alive and well? Do they have any medical conditions for which they are being treated? If your parents are deceased, what was the cause of death?

Based on the answers to the above questions, the health care provider generally has an idea regarding potential diagnosis, or diagnoses, as this is known as “A differential Diagnosis.”  The next step is The Physical Examination.”

The Physical Examination (efforts to detect signs of disease):

A general physical examination would include an objective analysis of all the organ systems, starting from a general health assessment, i.e. age appearance, physical appearance, gait, presence or absence of acute distress, orientation to time, person, place or situation, etc.  This is followed by assessment of vital signs,i.e. weight, height, temperature, blood pressure, pulse rate, and respiration rate. A detailed physical evaluation of all organ systems is then initiated, starting from Head and Neck, to Chest, then Abdomen; then Pelvis, Extremities, and finally the Neurological Assessment (which is often included during the performance of other parts of the physical examination)

At this point, specific diagnosis or diagnoses can be determined preliminarily.  A plan of action is then discussed with the patient with regards to gathering supportive, confirmatory evidence for disease or illness based on the above clinical assessment.  This would include the following:

Clinical or Pathophysiological Evaluation (ASE) (Evidential Support for Illness/Disease):

collecting blood/body fluid/tissue/cellular samples for laboratory testing

Special Clinical Studies, i.e. cardiac stress, ECHO,  EKG, EMG, Pulmonary function test (PFT), Endoscopy/Colonoscopy, bronchoscopy, colposcopy, cystoscopy, etc

The Anatomic or Structural Evaluation for Disease (Evidential Support for Illness/Disease):

-ordering imaging studies like X-rays, CT scans, MRI, bone scans, Mammogram, Ultrasound, etc

-Procedures, such as skin biopsy, or Fine Needle Aspiration, or Pap smear, Peripheral Blood Smear Review, etc

Based on the findings from the above collective studies, A FINAL DIAGNOSIS AND/OR DIAGNOSES ARE DETERMINED, and the following takes place concluding the medical evaluation:

-Plan of care, i.e. medications or surgeries

-Instructions and recommendations for life-style changes as appropriate for healthy living, recovery from disease or illness, maintaining acceptable functional course with stable chronic disease/illness, or preparing the patient for end of life process.

-Instructions and reading materials for patients to become Informed about their diagnoses and CARE-PLAN (we recommend that our patients get information from websites such as: MayoClinic; WebMD; and Medscape, for example)

-Recommendation for referral regarding specialty medical care and SECOND OPINION.

-Opened Question/Answer Session between Patient and Doctor

Preventative Care and Healthy Care Maintenance:

Now imagine, if the patients come in already prepared to answer the above questions, then the medical interview could be as short as 10-15 minutes, and the patients could be on their way to an accurate diagnosis, treatment, and management.  More importantly, patients without symptoms, should seek medical diagnosis before symptoms develop, as in complications from diabetes, or high blood pressure, or heart disease, or stroke,or HIV, or cancer, etc.  Typically when a patient presents with symptoms, the diagnosis of certain types of diseases is usually  in the advanced stages and effective treatment becomes limited.  Thus, we at MDC stress PREVENTATIVE CARE AND MAINTENANCE HEALTHY CARE, to avoid expensive, typically ineffective/inefficient sick care.

Consider preventing diseases through routine healthy check, and not just through dieting and exercising which are helpful but at no means all inclusive in the PREVENTION of major diseases, particularly as it relates to genetic, congenital, infectious, and degenerative diseases, for example.

 

Empowering Patients for Better Health-Care!

The Pathologist, as the common expression among other physicians,  “The doctor that is knowledgeable about many diseases, performs many investigative diagnostic procedures, and a member of the treatment/management team, BUT TOO LATE.” We at MDC-Atlanta, are committed to performing the medical tasks BEFORE IT IS TOO LATE, by partnering and communicating with patients DIRECTLY, as well as providing treatment and management of certain illnesses and/or diseases!

 


Spinal Pain, The Real Truth

Millions of Americans suffer from Chronic Spinal Pain.  Many choose to accept the debilitating function that comes with this type of long lasting and consistent pain, often times interfering with daily functional activity and/or routine activity with family and friends.

The real question becomes what is spinal pain, and what is the accepted course to deal with it.

Our late, and beloved President John F. Kennedy is an example of an elite figure in our history who had to deal with chronic, debilitating spinal pain, choosing medication to do so, in order to carry out daily activity.

Spinal Pain, commonly known as chronic back and/or neck pain, is often caused by a degenerative process of the vertebral (spinal) bone.  The vertebral column, or spine, is comprised of thirty (30) bones located along the central, posterior portion of the neck, back, and tail. Often times due to trauma, as it relates to motor vehicle accident, traumatic fall, and/or injury on job, or simply due to the aging process due to shear weight-bearing stress on the spine, the bones of the spine or vertebrae become brittle and began to break down.  During the life-long, on-going repair of the degenerative bone, extra bone, known as osteophyte, as well as fibrous and obstructive connective tissue may replace the original boney matrix with entrapped nerves along the cortex of the bone causing intense and severe debilitating pain.  Imaging studies, such as CT-scan and MRI, are used to define the anatomy of the abnormal boney structures of the spine.  This allows the patient’s health care provider to define the patient’s illness as it relates to the cause of the chronic pain syndrome, as well as to make recommendation for therapy and/or management.  Although, many of the painful symptoms are caused by irritation of nerves along the cortex of the vertebral bone, as well as nerves encased in reparative connective tissues within the medullary matrix of the bone, there is also bone on bone articulation where the intervening cartilage becomes less functional or absent all-together, as in degenerative knee/hip pain (osteoarthritis).

Three options for medical care currently exist for patients who suffer from chronic debilitating pain syndrome.  Those options are surgery, nerve block (with injecting anesthetic agents), and oral medication.  Often times, patients find themselves limited to medication to treat ongoing chronic pain syndrome due to the expense or inconvenience and other limitations that come with surgery and/or nerve block. Certain types of oral medications used to treat pain are similar in action as to endorphins.

“Endorphins are among the brain chemicals known as neurotransmitters, which function to transmit electrical signals within the nervous system. At least 20 types of endorphins have been demonstrated in humans. Endorphins can be found in the pituitary gland, in other parts of the brain, or distributed throughout the nervous system.Stress and pain are the two most common factors leading to the release of endorphins. Endorphins interact with the opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine. “

Most, responsible patients who partner with their physicians to do the right thing in managing their chronic pain syndrome do quite well on oral medication, which tends to be effective in allowing the patient to carry on daily functional activity. Surely oral medication tends to be more readily affordable for most patients as compared to the other two options.

THE BRAIN AND CHRONIC PAIN, READ

Responsible management becomes the most prominent position to address. Nationally respected panels of pain medicine experts have created guidelines and recommendations for patients and physicians to follow, given the fact, that more than 80% of physicians who manage patients for chronic pain are general practitioners and family medicine practitioners.  And, studies have shown this to be safe and effective when done under appropriate guidelines and recommendations.

(The Journal of Pain Volume 10, Issue 2 , Pages 113-130.e22, February 2009)

It becomes the patient’s responsibility to partner with a physician in choosing which course of management will be most effective for the patient.

Every patient May NOT be a candidate for out-patient based pain management, and licensed physicians who treat patients with certain medications for chronic pain syndrome should be held responsible in making this life-altering decision for patients (in keeping with FIRST DO NO HARM).  Certain high-risk patients for outpatient pain management include those who: 1) require more than 200 mg of morphine-equivalent opiates per day; 2) have been previously discharged from pain management clinics due to overdose, diversion, abuse, and/or addictive behavior; 3) patients who do not have evidential, imaging support of disease indicative of pain management.  The idea is to treat debilitating pain, and NOT pleasurable behavior.  Thus, my recommendation to patients who suffer from chronic debilitating pain syndrome, is to choose your physician and/or health care provider wisely by doing due diligence in reading, asking questions, and making sure the patient understands risk versus benefit in  long-term, oral medicinal/therapeutic management for pain. Moreover, patients who chose to “doctor shop,” visiting multiple doctors simultaneously for certain medications,  or “pharmacy shop,” visiting multiple pharmacies simultaneously for medication fillings, place their own lives at risk for serious complications related to certain type of medications. Physicians or other health care providers who treat patients for chronic pain syndrome with certain medications have ethical and legal obligations to discontinue care of such patients in keeping with the platform, “first do no harm.”  Furthermore, combination therapy, such as xanax, Klonopin, somas, should not be used while taking certain oral medications because of the risk of seizure, coma, and/or death. In our practice, our strategy regarding managing patients with certain types of medication is to follow National Guidelines and Recommendations (refer to above reference article in The Journal of Pain) with respect to: a) retard the development of rapid, high-dose medication tolerance through appropriate dosing of medication; b) monitor for side effects with oral medication(s);c) monitor behavior for abuse, diversion, and/or addiction; and d) appropriately make recommendation for detoxification with withdrawal protocols, and referral to board-certified MD-psychiatrist and/or addictionologist as clinically indicated.  HIGH RISK PAIN MANAGEMENT-A DIRECTION FOR PATIENTS

We, at MDC-Atlanta, have found that the best course of therapy for our patients is to base treatment strategy on the degree of MRI or other imaging findings, i.e. severe degenerative changes with canal and/or foraminal stenosis, nerve/spinal cord impingement, with or without osteophyte formation and/or bone on bone articulation.  The level of pain also helps decide treatment strategy.  Thus, the idea is to “start low and go slow” with chronic opiate therapy for NON-cancer related pain (COT), to maintain low risk potential for addiction, diversion, and abuse.  With this, we suggest oral treatment should only be taken when pain level exceeds level 8 out of 10, and to resist the notion of around the clock COT usage.  Typically, there is a relief of debilitating pain during tolerable therapy for 5-6 hours or more. By  the patient supplementing pain therapy with anti-inflammatory or topical analgesic type medication in between high level pain, this may also delay rapid development of high risk potential. For example, during tolerable oral medication therapy, if a patient takes a pain (analgesic) medication, a tolerable pain level should be achieved for 5-6 hours or longer. As patient begins to experience an incline in intensity of pain, then the patient should take an anti-inflammatory-type medication (i.e. ibuprofen, motrin, advil, aleve, etc) to retard the need for another stronger analgesic medication.  Thus, the time for next dosage could be around 8-10 hours or longer.  Therefore, typically 2-3 tablets of select analgesics (pain medication) (less than 100 mg dosage equivalence/day), each tablet separated in time by at least 6-8 hours,  over an 18 hour day, per day, may be all that is needed.  Keep in mind,  the chronic pain patient should also get appropriate sleep for at least 5-7 hours per day, given a therapeutic cycle of 12-18 hours over a 24 hour period, under appropriate prudence of oral analgesic (pain) medication usage.

It requires law-enforcement, pharmacist, and health-care practitioner communicating with one the other to keep patients safe.  One missing link in this communication effort may bring harm to patient.

MDC-Atlanta remains committed to keeping patients informed for better quality and safe health care!

 


Who Interprets Your Cellular or Tissue Sample?

 

Diagnostic Medicine at A GlanceAffordable Care Act-ACT and the VALUE of Point of Care Laboratory Testing

It has been estimated that more than 50 million biopsies are sent to American Medical Laboratories for Diagnostic Interpretation each year. Let’s take a look at this for a moment.  When you factor in cost for patient to travel to physician’s office or hospital, time off from work, and the professional expense by clinicians/hospitals/laboratories/etc, the average cost to patient for the biopsy could be estimated as much as $1500-$2000 per biopsy, i.e. 50 x 10(6) x ($1500 or $2000)= $75 to $100 billion dollars or more perhaps annual cost for those biopsies to the patient-public. And, that’s just a low estimate!!

The question becomes:

-Are those biopsies absolutely necessary?

-Are the additional specialized tests on the biopsies absolutely necessary?

-Is there appropriate communication between the patient’s clinician and the laboratory medicine physician who interprets the test sample?

-Can the patient’s physician personally identify which laboratory physician provided the final interpretative diagnostic result?

-Does the patient’s physician know what diagnostic criteria were used and/or if a second opinion/review was rendered?

-What references are available for the patient’s doctor or the patient to review for more clarity regarding the specific final diagnostic report?

-Does the patient’s physician have a financial incentive to send biopsies to certain independent-referenced laboratories or hospital-based laboratories?

-How can the patient directly participate in selecting which laboratory physician provides diagnostic service to patient?

Remember, prior to CLIA’88, physicians routinely performed supportive medical testing on-site in the physician’s office.  With the advent of increasingly CLIA waived clinical laboratory analyzed-testing, more tests are being done at the physician’s office, where patients can ask questions about the futility of the testing as well as cost upfront for testing, thus decreasing the number of unnecessary, additional medical laboratory testing sent out to referenced medical laboratories.  We at MDC are making an attempt to bring real accountability in diagnostic laboratory medical testing back to the physician’s office through our unique medical practice.

 

At MDC-Atlanta, we answer the above questions for our patients with transparency and accountability.

 


Classifying Human Diseases

FUNDAMENTAL CLASSIFICATION OF HUMAN DISEASES:

1. Genetic/Inheritable/Congenital: Related to chromosomal abnormality by the transferring of genes from parents to child; or abnormality related to embryonic/fetal development and/ or surrounding birth.

2. Degenerative and/or Metabolic Disease: Related to the aging process or wear and tear

3. Inflammatory, Infectious: Related to pathogens such as Bacteria, Fungi, Viruses, Parasites, etc

4. Inflammatory, Non-infectious: Related to autoimmunity,allergens, environmental pollutants, etc.

5. Neoplastic, Benign or Cancerous: Related to abnormal growth or division of cells.

6. Trauma: Related to chemical and/or physical destruction of cells or tissue

7. Psychiatric: Related to the alteration in mental status and/or perception

Organic Disease Classification could be summarized as Follows:

GENETIC VERSUS ACQUIRED

ACQUIRED DISEASES CAN BE GENERALLY CATERGORIZED AS: CONGENITAL/DEVELOPMENTAL VERSUS REACTIVE VERSUS NEOPLASTIC

REACTIVE DISEASES INCLUDE: INFECTIOUS VERSUS NON-INFECTIOUS (Allergens, Autoimmune, and Degenerative-related to the aging process)

     NEOPLASTIC DISEASES INCLUDE: BENIGN OR CANCEROUS (MALIGNANT) TUMOR-GROWTH 

DIAGNOSTIC CRITERIA FOR SPECIFIC ETIOLOGY OF DISEASE

(Usually established by World Health Organization-WHO, or other International Authority)

This is typically based on:

a) Clinical Presentation and Physical Examination/Evidence

b) Laboratory tests

c) Imaging studies

d) Clinical Studies

e) Research/Investigation by Scientific Methods, Peer-reviewed

TREATMENT AND MANAGEMENT OF SPECIFIC DISEASE

Typically under the auspice of National Standards and Guidelines, as established by Panels of Experts within Selective Fields of Specialty

National Guideliness For Medical Therapy and Management

PREVENTATIVE CARE AND MAINTENANCE CARE

Typically under the auspice of National Standards and Guidelines, as established by Panels of Experts within Selective Fields of Specialty

At the end of our medical evaluation at MDC-Atlanta, we want our patients to understand how we derive at an accurate diagnosis, as well as make recommendation for treatment and/or management; and we welcome the patients to ask the following questions:

1) Which category is my disease classified?

2) What is the specific diagnosis of my disease and/or illness, and what diagnostic criteria were used, as well as which national or world standards were used to derive at the specific diagnosis?

3) What references are available for the patient to access with regards to getting more clarifications regarding specific diagnosis, treatment, management and prognosis?

Thanks for visiting Medical Diagnostic Choices, MDC-Atlanta, as we are committed to empowering our patients to being INFORMED FOR BETTER QUALITY AND SAFE MEDICAL CARE!


Assurance in Accuracy of Pap Smear and Diagnostic Laboratory Medicine at MDC

Carcinoma in-situ by Cytology of Cervix/Pap smearModerate to Severe Squamous Dysplasia (HSIL) of Cervical Tissue

Typically, when a patient visits a clinician for laboratory medicine evaluation, i.e. pap smear, cellular or tissue biopsy, blood or body fluid testing, the medical laboratory that receives the sample is relatively dependent on the clinical office staff, non-laboratory staff member at hospital, and/or physician for appropriate collection of test sample, accuracy of labeling  test sample as well as other  documentations regarding the test sample.  This level of dependency, which by the way loses credibility simply by being manipulated by multiple persons before testing, requires appropriate communication and documentation about the patient’s demographic, clinical information, and descriptive characteristics pertaining to the pap smear, cellular/tissue biopsy, or blood/body fluid sample submitted.  Often times this most important first-step in communication and documentation is compromised, leading to error and/or potentially harmful medical outcome for patients. Remember in general, “Quality and Accuracy in Laboratory Medicine Diagnosis” starts with appropriate communication and documentation before the sample reaches the medical laboratory for testing.

In our unique medical practice at MDC-Atlanta, we are able to essentially eliminate this potential compromise in patient care, because there is a direct complete medical evaluation/communication between the patient and the general practitioner/ laboratory medicine specialist at MDC, which assures accountability for appropriate therapy and management as well as  continuity of care.

For example during a pap smear evaluation, our physician directly interviews the patient regarding ALL pertinent clinical information.  This would include collecting information directly from the patient as it would relate to the patient’s gynecological history such as previous  pap smear result(s), previous or current gynecological diagnosis(es) and/or treatment(s), last menstrual period and its regularity or lack thereof, history of pregnancy, presence or absence of previous sexually transmitted diseases, other medical diagnoses,etc. Once a complete history is obtained, our physician provides a thorough clinical pelvic examination using standard medical procedures.  We also perform a bi-manual examination to palpate for abnormally enlarged ovary, uterus, or any other palpable abnormality. A swab sample of the vaginal canal, external and internal cervix is collected and appropriately smeared onto a glass slide, and prepared for immediate microscopic review of the cells collected for accurate diagnosis by our physician the same day while the patient wait. The most important component to this process, is that the physician collecting and reading the sample, can determine if the sample is adequate or representative of any abnormal changes during the clinical examination. We believe that a conventional pap smear is just as effective in detecting pertinent vaginal/cervical and even uterine lesions in some instances as the liquid-based pap examination; and this has been documented in the medical literature (JAMA. 2009;302(16):1757-1764).  Furthermore, a decision can be made along with the patient for further diagnostic testing as it relates to, for example, the necessity for Human Papilloma Virus (HPV) testing, or molecular testing or other diagnostic testing at the time of the initial clinical visit. Keep in mind if a Pap smear is within normal limits, then Human Papilloma Virus testing or any other additional tests may not be necessary.  In general, this process of having a laboratory medicine specialist directly evaluate the pap smear alone saves patients unnecessary expense as it relates to the pap testing and/or diagnosis.

Our physician routinely consults with associated, appropriately credentialed laboratory medicine physician consultant/specialist with respect to second review and/or second opinion to highlight our commitment to accuracy and quality diagnostic testing.

We are essentially able to minimize or eliminate false negative and/or false positive results from ANY CELLULAR OR TISSUE TESTING, through direct-patient care/evaluation by our physician.  This is the assurance that we give to our patients, and we provide immediate medical therapy and/or appropriately refer our patients in the proper direction for continuity of care as deemed necessary.

Saving patients hundreds of dollars as well as anxiety and frustration through direct-patient care by General Practitioner/ Laboratory Medicine Specialist!

Thanks for visiting Medical Diagnostic Choices.

 


Cytology: Doc, Just tell me, “Is This Lump Cancer or Not?”

Cytology in History

Much information can be gathered by observing the cell and/or its surroundings under a light microscope.

More than 170 years ago, scientists/pathologists recognized that accurate diagnosis of cancer could be determined by simply observing the structure of the cell under a light microscope.

A cytological diagnosis can be simple to perform, saves patients hundreds of dollars ( essentially pennies on a dollar as compared to tissue diagnosis), and typically is less painful than an open tissue biopsy; surely less scarring and debilitating. More importantly, Cytology creates practicality for mobile pathology and rapid diagnosis.  In fact, the only materials needed for a pathologist to make a definitive cytological diagnosis are a slide (generally less than $1), non-toxic stain/fixative (generally less than $5), and a light microscope.  So this gives you an idea just how inexpensive cytological diagnostic testing can be. For example, when you factor in the above expense and the professional services, the fee for cytological diagnosis could be as little as $50 dollars, depending on the type of cytological evaluation done.  Not bad, eh?

Dr. Gates demonstrates the simplicity and low expense to study cells for an accurate diagnosis

The Immediate Use of Cytology? To determine if a growth is cancerous or not (benign or reactive). And, it should be the mainstay in diagnostic pathology.  This is what I use in my practice to prioritize  further diagnostic study on cytological samples from my patients when assessing cancer diagnosis through Fine Needle Aspiration (FNA), or simple body fluid smears/touch imprints, as with pap smear, or blood smear for example.  And, I am literally able to save them frustration, anxiety, and expense, by giving my patient a cellular diagnosis on the spot.

Here are the criteria that are typically helpful when assessing cellular disease:

1) Reactive versus Neoplastic: Reactive implies benign appearing cells, i.e. having usual preservation of the cell’s normal shape and size, mixed with inflammatory cells, or showing degenerative changes with or without inflammatory cells.  Neoplastic implies loss of cellular maturation, as well as an abnormal growth pattern that is different from normal mature cells of the same origin.

2) Neoplasia: a) Benign Growth; or  b) Cancerous Growth

3) Benign Growth:

a) Low cellularity (low number of cells); tightly cohesive cells.

b) Maintain Cellular Polarity (i.e. usual structure of nuclear size, shape, and position in the cell with cytoplasm)

c) Demonstrate minimal maturation arrest.

4)  Cancerous Growth (May Not Apply to Hematological Cancers):

a) High Cellularity (increased number of cells); loosely cohesive cells,usually in various sized clusters or singly.

b) Loss of cellular polarity (i.e, cell nuclear size, shape, and position vary from one cell to the other with respect to cytoplasm.

c) Pleomorphism/Polymorphism: This means that cells of same origin, i.e. epithelial, or stromal, or neural, etc, have variation in nuclear membrane irregularity, often with the size of the nucleus being enlarged and distorting the cell cytosol/cytoplasm and cell membrane.

d) Proliferative index: Generally, normal cells are in resting phase of growth; so to see many cells, and/or evidence of cellular division is a sign of rapid, abnormal cell proliferation, i.e. mitotic index.

e) Cell growing within cell.  Normal cells (other than placental cells or certain types of hormonal cells and the likes) do not grow within other cells, ie. cup and saucer, cell nuclear fusion, etc.

f) Marked cell-maturation arrest (a cancer cell may not resemble the original cell, having features of embryonic cell, or undifferentiated cell)

5. Hematological Cancerous Growth:

a) Monoclonal, which means a proliferation of one cell type, i.e. myeloblast or lymphoblast, etc, which often times requires special studies as indicated below

b) Lack of appropriate maturation sequence of individual hematological cell when compared to other cells of same origin, often expressing genetic or chromosomal abnormality as in dysplastic changes.

Special cytochemistries, or cytogenetics or other molecular studies can now be performed on cellular samples to objectively and accurately confirm cellular abnormality/diagnosis, as needed.  This also essentially eliminates subjective interpretation of cytological results.

Cellular Images of Diagnostic Features Can be Provided Via DIGITAL DIAGNOSTIC REPORTS (for transparency and Evidence for Diagnosis).

We make every attempt to save our patients time and money by simply doing cellular procedures over open tissue biopsy.  Open tissue biopsy tends to be more painful, debilitating, risky and yes, “expensive.”

Thanks for reading.

Jackson L. Gates, MD, Medical Diagnostic Choices, MDC-Atlanta


We Welcome Our New Patients

Letter to New Patient of Medical Diagnostic Choices

Dear  Patient:

I would like to send my deepest regards and sincere appreciation to you for allowing me to be your primary care doctor and laboratory medicine specialist.  I consider it an honor and a privilege to do so.

As we establish hopefully a life-long patient-physician relationship, I hope that you will consider me as a partner in the overall management of your health care.  I believe this can be done by my honoring your dignity, creating a mutually respectful relationship, and showing compassion for your well-being.  It is a prudent decision to have ONE Primary Care Provider to help you manage your overall, general medical care.

Choosing or visiting multiple primary care providers and/or medical specialists who do not communicate one to the other could potentially bring serious harm to your health.

We reserve the right to discharge any patient from our medical practice who violates our medical practice policy, as our primary goal is to provide the highest quality of standard and safe medical care.

We would like to highlight a special feature of our practice at MDC-Atlanta to our new patients: ONLINE MEDICAL CARE, which is provided to our established patients after a face to face visit with Dr. Gates, or to those patients who have NON-emergency acute illness, or stable chronic disease. We believe that this provides convenience for our patients who are generally healthy or who have stable, non-emergency, chronic disease.

For us to establish a relationship that will assure the Highest Quality and Safe Health Care here is what I would suggest:

1.       Be compliant with your medication(s); that simply means take your medication(s) as prescribed by the doctor.  Also follow the doctor’s order to enhance your well-being, i.e. doing light exercise and managing a sensible nutritional diet as well as keeping your appointed and scheduled visits with the doctor. 

2.       Self-monitor your blood sugar and blood pressure when necessary if at all possible, and record each reading along with date and time in a notebook for the doctor to review on follow up visits

3.       Notify the doctor when you become ill, or if you notice that certain medications that you take cause you to become ill, or if you are seen in the emergency room, or if you are admitted to a hospital

4.       Notify the doctor when you have been evaluated by a different doctor who may be unfamiliar to me as your primary care doctor and laboratory medicine specialist

5.       Call to schedule follow up office and/or home visits by me.

I can be notified 24/7 by simply calling my office number at: 678-591-6509.  My medical practice is accessible 24/7 via the practice website at: http://www.medicaldiagnosticchoices.com, or by contacting the office number.  At times, you may be invited to participate in our live ONLINE community forums sponsored by me, refer to our link at:Gates’ Global Broadcasting Network, CLICK HERE. During these forums, Dr. Gates will provide an educational session for patients to learn about different types of diseases.  This will include a clinical presentation followed by discussion regarding basic human anatomy and physiology, pathophysiology (origin, development and manifestation of diseases), sharing digital diagnostic images via video or pictures,clinical studies, treatment and management, as well as discussion of select relevant, peer-reviewed reference articles from the medical literature.  We will also take questions from our patient-physician audience.

WE, AT MDC-ATLANTA HAVE FOUND  SOCIAL MEDIA (Instagram,com/pathologygram and facebook.com/jacksongates)  TO BE AN EFFECTIVE WAY TO GET PATIENTS TO DISCUSS CONFIDENTIAL ISSUES REGARDING HEALTH. Thus our shows on Gates’ Gobal Broadcasting Network (GGBN) are postponed at the current time, and you may JOIN DR GATES ON INSTAGRAM FOR UPDATES ON MEDICAL RELATED ISSUES:

I look forward to working with you as we work together to assure your quality and safe, affordable/convenient health care.

Sincerely,

Jackson L. Gates, MD, Chief Practitioner and Owner, Medical Diagnostic Choices, MDC-Atlanta


Why Choose Direct-Care by a General Practitioner-Laboratory Medicine Specialist

The first and foremost duty of a physician is to educate or inform his patients, while keeping the patient safe or doing no harm to the patient.

Dr. Jackson Gates, MD

Dr. Jackson Gates, MD, The General Practitioner and Laboratory Medicine Physician who is a MEDICAL CONSULTANT FOR PATIENTS, and who treats the whole patient, not being confined to a desk in a cubicle or laboratory.

The ‘Days of Old’ are long gone, when the laboratory medicine specialists are only called upon to diagnose cancer (by biopsy and/or removal of part or whole ORGAN) or determine the cause of death which can be morbid! Patients may not need that biopsy or removal of that organ which can not be replaced in its native state!

TRY PREVENTATIVE HEALTH-CARE Through MDC-ATLANTA

With the advent of the modern internet, social media, and rapidly and consistently rising health care costs, patients are taking on diligent efforts to become more informed about their health care, and having a willingness to partner with a provider who will help them manage their overall care. The model for this relationship is termed,

“Patient-Centered Medical Home-PCMH

Direct Patient Care.”

Patients who choose this type model of health-care generally have more direct communication, better rapport, and a mutually respectful interaction with their providers.  Patients have a number of choices of providers that they now can select with whom to form this patient-physician relationship.  About forty percent (40%) of patients nationwide are now receiving direct care by specialists who are also providers of general medical care (Primary Care Medicine).  Patients accept full financial responsibility in this regard, i.e. self-pay or pay out of pocket.  This type model also makes health-care more competitively affordable.

Many patients seek the advice of a medical provider when they are concerned about a disease or illness.  The medical provider uses clinical and laboratory diagnostic studies as well as other special clinical studies to confirm or reject disease or illness in accordance with National and International Standards and Guidelines. This is generally known as “Evidence-based Medicine.”This process takes place after the primary medical provider/laboratory medicine specialist has obtained a complete medical history and physical examination.  Remember, the patient has ALL the information that the medical provider needs in order to render efficient, effective, accurate diagnosis as well as high quality and safe medical care. We at MDC-Atlanta obtain this helpful information to guide diagnosis, therapy, and management by doing the following:

-Listening to patient;

-observing various signs of illness and/or disease;

-investigating and/or analyzing evidence for illness and/or disease; and

-correlating and collaborating a final conclusion for management with patient highlighted by evidential support through the current medical literature. 

(L-Listen; O-Observe; I-Investigate; A-Analyze; C-Collaborate, and C-Communicate)

In fact, the purpose of laboratory medicine is to provide guidance with respect to two clinical categories for therapeutic and prognostic management,  based on scientific, objective clinical laboratory testing: 1) Well-Patient; and 2) Patient with Illness or Disease.  Laboratory medicine physician generally specializes in the diagnosis of clinical and anatomic diseases, and  selects appropriate medical laboratory testing to enhance sensitivity and specificitySensitivity  is the ability of a test method to accurately detect disease/illness.  Specificity is the ability of a test method to accurately exclude disease/illness. These two methods, sensitivity and specificity are used together to heighten accurate diagnostic laboratory testing interpretation. We also consider PREVALENCE of DISEASE/ILLNESS  within a community, as well as PREDICTABILITY of a test method when selecting a SPECIFIC or SENSITIVE TEST METHOD which also HEIGHTENS ACCURACY of the FINAL RESULTS of TESTING.  So, when a patient is assessed both clinically and through laboratory evaluation for disease or illness by a laboratory medicine physician, this direct-patient care assures credibility of the final laboratory test results, as well as timely and proper communication for appropriate follow up of medical care and/or management.  Errors are essentially eliminated through this direct care relationship between patient and general practitioner/laboratory medicine specialist.  Often times physicians, and now prudent patients, request the direct services of the laboratory medicine physician in this regard.

Consulting the Laboratory Medicine ExpertSchemata for Solving The Unknown

Here are examples of benefits regarding evaluation by generalist/laboratory medicine specialist:

1. Same day, Reproducible, Accurate Diagnoses (This means the final diagnostic interpretation by Dr. Gates can withstand scrutiny by other laboratory medicine experts.  Another expression for this statement is reproducible accuracy of diagnostic results because it is based on established scientific criteria as promoted by National and International Authorities):

a) Fine-Needle Aspiration, Biopsy of Lumps: Breast, Thyroid, Lymph Node, and Soft Tissue

b) Pap-smear

c) Blood smear

d) Joint fluid, sputum, etc.

e) Shave biopsy of Skin tumor

2. Fast turn around time of most clinical laboratory results (most within 48-72 hours), followed by timely verbal communication between patient and doctor with regards to appropriate treatment and management, and/or referrals.

Fast, Accurate Diagnostic Result routes patients to the appropriate specialist for definitive medical treatment, surgery, and management, as well as saves patients unnecessary additional expense.

The Laboratory Medicine Physician undergoes many years of extensive clinical and laboratory medical training in understanding the origin, development and manifestation as well as treatment and management of many different types of diseases or illnesses.  This allows for appropriate management for the patient particularly as it relates to detecting disease/illness early and preventative care maintenance.  Typically known as the “Doctor’s Doctor,” modern laboratory medicine physician provides medical care and evaluation, as well as management directly to patient.  This direct relationship with the laboratory medicine physician allows patients to participate in managing their overall medical care through efficiency and reducing health care expense through unnecessary lab tests.

 

In our unique medical practice, we promote early detection of disease and preventative care through laboratory medicine because it assures better outcome for overall medical care. 

It is clear throughout the medical literature that more than 80% of medical decisions are based on laboratory medicine data. Dr Gates personally provides patients with complete medical care which includes not only a medical history and physical examination, but also fast, accurate, evidence-based laboratory medicine diagnoses, followed by treatment and management of many different types of diseases.  Such diseases and/or illnesses include sexually transmitted disease,urinary tract infection, bronchitis/pneumonia, skin rash, diabetes, arthritis, and degenerative bone/spine disease causing chronic neuropathic or nociceptive pain, for example.  We also refer patients to appropriate medical specialists when necessary only after we have given our patients working, complex diagnoses for continuity of their medical care.

Our mission is to guide our patients as partners in managing their care through the complexity of high quality, accurate, and safe medical care .

We at MDC, believe that the very premise of medical care provided by a responsible physician is to appropriately advise patients with regards to RISK versus Benefit for medical therapy.  In our practice, and as a general practitioner, if your risk to benefit ratio is greater than one (1),i.e. risks outweigh benefits for medical therapy, then we will either make a recommendation against medical therapy or refer our patients to the appropriate specialist for high risk therapy or further medical management. We, at MDC-Atlanta, are committed to “FIRST DOING NO HARM”, which is the mainstay of the Hippocratic Oath, and the far most responsible duty of a physician and/or medical practice, regardless of the physician’s designated medical specialty!

We welcome your partnership with our practice, as we offer our patients safe, CONVENIENT, affordable, accountable, and transparent patient-direct, high-quality general medical care as well as diagnostic laboratory medicine.

Thanks for visiting: Medical Diagnostic Choices-MDC-Atlanta

Logical Derivation of Accurate Diagnosis, Safe and Effective Medical Treatment and Management:

If you can solve this equation:
A + B = C

Then you should be able to solve this one:

Sx + Sn + evidence= Diagnosis of illness or disease.

AND

This One:

Ta -SE +SC + Le = Tx

Note:
Sx (symptoms); Sn (signs); Evidence (labs, imaging studies, clinical studies, etc)
(Ta-targeted Proven-EFFECTIVE agent/drug); SE (side effect of drug); SC (Supportive Care); Le (Least expense); Tx (therapy or treatment)

 

 


An Online Medical Survey, MDC-Atlanta

We, at MDC-Atlanta, believe that online, digital-based medicine is safe, effective, and saves patients time and money while providing convenience for patient.

Primary duty of online medical practice is to first provide a triage-consultation for patients to receive timely medical advice from a licensed physician.  While the goal is not to treat every patient’s  illness or disease via online communication without properly providing appropriate medical history and physical examination by way of face to face visit in our office or at the patient’s home, proper questioning could lead to patient getting appropriate medical advice  from a licensed physician. Online medical survey or consultation saves the patient money, time and route patient in the proper direction for either safe telemedicine/telepathology care/consultation  and/or appropriate face to face medical care and/or management.

Here is an online medical consultation/survey that you may complete  prior to contacting our office at MDC-Atlanta:

1. Are you currently under the care of a physician? Yes–Please contact your health care provider or have that provider contact Dr. Gates;

NO, then proceed to question #2

2. When was your last visit to a health care provider? Recently or within the past month, year or two years, i.e. days, weeks, months, etc–Please contact that provider or have that health care provider directly contact Dr. Gates

I have not seen a health care provider, and I am over 21 years old, then proceed to question #3.

3. Do you have any medical diagnosis, or are you currently or have you previously been treated for an acute, short-term or chronic, long-term medical condition(s), i.e. heart disease, lung disease, liver disease, kidney disease, diabetes, high blood pressure, stroke, aneurysm, HIV, cancer, connective tissue disease, chronic pain syndrome,etc: YES, Please contact the health care provider who diagnosed and/or treated you for your previous diagnosis(es) and/or illness(es) or have that health care provider directly contact Dr. Gates

NO, then proceed to question #4

4. What are your current symptoms? Do you feel like those symptoms have gotten worse over hours or days, and you are anxious about these symptoms regarding life emergency, and that you have never experienced these symptoms before? Yes, if possible, please go to an emergency room immediately or call 911.

No, then proceed to question #5

5. Have you experienced any other symptoms, i.e. recent cough, fever, night sweats, chest pain, shortness of breath, headaches, fainting, dizziness,  weakness, abnormal bleeding, chills, diarrhea, constipation, nausea, vomiting, itching skin, red, irritated or painful, abnormally colored skin lesions, discharge, painful/abnormally colored urination, bone or joint pain, etc, prior to becoming ill with current condition? Yes, Please explain?

No, then proceed to question #6

6. Would you like to schedule a telemedicine consultation with Dr. Gates or schedule a face to face visit with Dr. Gates for diagnostic evaluation, medical care and/or management? NO.  Please contact another health care provider to receive appropriate care.

YES, ( please call Dr. Gates to arrange for a direct telemedicine consultation or  face to face directed physical examination, medical treatment and/or management in our medical office or at the patient’s home)

Answering the above questions truthfully, could lead to shortened office or home visit, fast rapport, rapid, accurate diagnosis, treatment, and management by Dr. Gates, as well as heightened quality and safe medical care.

THIS IS MEDICINE NOW (CONVENIENT AND FAST MODERN DAY MEDICINE AT ITS BEST, 2013)!

Thank you for visiting Medical Diagnostic Choices-MDC-Atlanta
Jackson L. Gates, MD