FAQ Category: General

Capitation means that you or your employer pays a set dollar amount to a health maintenance organization (HMO). It doesn’t matter how much you use (or don’t use) the health services offered.

An HMO is always a “pre-paid” or “capitated” insurance plan. Either the worker or the employers pays the fixed monthly fee for services. There isn’t a separate charge for each visit or service. The monthly fees remain the same each month whether or not you see a
doctor, nurse, or other health care provider in the plan.

Services are provided by doctors and other providers who are employed by or under contract with the HMO. HMOs vary in design. Depending on the type of the HMO, services may be provided in a central facility or in a physician’s own office.

When shopping for a health care plan, consumers must be able to understand the terms and phrases used by insurance agents, companies, and providers. There is a ealth insurance resource center with glossary of terms to explain unknown words or phrases. Check it out
at
http://www.healthinsurance.org/insterms.html.

The number of doctors per person in the United States has evened out for major urban areas. However, rural communities are still often without specialists. Many of these patients travel hundreds of miles to a major health center.

There are reasons for this. Many doctors don’t want to practice alone without other doctors to talk or trade call with. Likewise, major hospitals can offer the most up-to-date equipment and technology.

The type of practice and location you desire may influence your decision. Start looking in orthopedic journals for job listings and pay attention to the location, starting salary, and type of practice available. This may help you in making your final decision.

Many researchers are studying this question. Physical therapists, athletic trainers, and athletes are very interested in the answer. From studies published so far, the following
guidelines are suggested:

Hamstring injuries are very common in sports. They occur most often in high-speed or high-intensity activities like football and soccer. The chances of reinjury are high among athletes in these sports.

There are ways to protect yourself from reinjury. Stretching before an activity is very important. In fact studies show stretching to increase flexibility also improves muscle performance. Factors known to put athletes at risk of injury include improper warm-up, fatigue, and poor body posture during running.

Paying attention to all these areas is a good idea, but stretching is number one. Tight hamstrings is the most important factor in hamstring injuries among athletes.

Many studies have shown the importance of stretching. Improving muscle flexibility is thought to decrease muscle and tendon injuries. It also improves muscle function and,
therefore, athletic performance.

There are some muscles at greater risk for injury without stretching. The hamstrings on the back of the thigh is one. Studies show a lack of hamstring length is the most common cause of leg injury in athletes.

It’s best to take the time to begin a workout with some stretching exercises. The three to five minutes it takes to stretch your muscles is a good investment of time. It’s like
money in the back when it comes to preventing problems later.

Ossification is the formation of bone. Heterotopic means something shows up in a different or wrong place. Put the two together and we are describing the growth of
bone where it doesn’t belong, which is usually in the nearby soft tissues, such as the muscles.

Heterotopic ossification (HO) is often seen after trauma to the hip. Hip surgery of any kind, especially hip replacement is linked with HO. This overgrowth of bone isn’t malignant, but it can cause pain, stiffness, and disability.

It’s not clear what causes HO. There are some risk factors such as a condition called ankylosing spondylitis and another one called diffuse idiopathic skeletal hyperostosis or DISH. Some people get HO without having any risk factors.

Patients who seek other health care services after seeing their own doctors are said to be “doctor shopping.” Some are looking for a “quick fix” or “miracle cure.” Others may be
trying to get more drugs.

Research shows this type of patient is more likely to end up having surgery even though other doctors advise against it.

There’s also a certain group of patients looking for a financial payback. They hope to get a cash settlement. Some studies show “doctor-shopping patients” have a chronic illness. They seem unable or unwilling to accept what the doctor tells them. The reasons for this are unclear and may differ from patient to patient.

Unfortunately not. It sounds like you had an ideal situation. Studies show a
multidisciplinary approach often works best to get workers back on the job and avoid long-term chronic problems.

Exercise, counseling, stress management, education and training, and a fitness program give workers a well-rounded approach to rehab and recovery. Some patients also need help
with drug and alcohol problems. Concerns about finances are also addressed in some programs as these increase worker’s stress and may slow recovery.

Programs vary around the country. Even programs with all the services may offer them differently. In some places, treatment is two or three times each week during recovery (about six weeks). If the patient has already gone back to work, the program may be shorter. In other places, the program is almost nonexistent. Program delivery is based on funding, which varies from state to state.

There is some general confusion about breathing when lifting weights. The American College of Sports Medicine says:

The issue of breathing while lifting is important. Studies show lifting increases the pressure inside the stomach. This is called the intra-abdominal pressure (IAP).
Increased IAP puts pressure on the discs in the spine. Activity in the muscles of the back also increases.

Some researchers think the increased IAP supports and stabilizes the spine. They view the pressure like a rigid cylinder around the body. It’s not clear if the increased stability comes from the increased IAP or from the effect of increased IAP on the back muscles.

A recent study from the Division of Physical Therapy at Mount Sinai Hospital in New York looked at the effect of breath control on IAP. They found that inhaling and holding the breath increases the IAP the most. The type of breathing used doesn’t seem to affect when the IAP goes up, just how much it increases.

Other types of breathing (natural, inhale/exhale, and exhale/hold) all had the same effect on IAP. Until more information is available, use one of these methods instead of the inhalation before/hold while lifting method.

Lifting can raise the blood pressure in the veins of the head and eyes. This causes the pressure inside the eye to go up. This pressure is called the intra-ocular pressure (IOP). Glaucoma patients should also avoid any exercise with the head-down position for the same reason.

This guideline is really for lifting heavy weights after surgery for glaucoma. Patients are advised to avoid contact sports, heavy yard work, housework, and swimming. Lifting objects heavier than five pounds isn’t allowed for at least one to two weeks after the
surgery.

Any activity that bumps or jostles the eye needs to be avoided after surgery. Patients are usually told to avoid bending, lifting, or straining for several weeks after the operation.

Ask your doctor to tell you what you can and can’t do. There is some variation from patient to patient. It’s best to find out from the one who knows your eyes and the specifics of the operation that was done.

Obesity is an example of a comorbidity. Comorbidities are diseases, illnesses, and conditions present in someone with another problem as well. For example, say a patient
has a torn rotator cuff of the shoulder. The same patient also has a peptic ulcer, asthma, and heartburn. These extra problems are comorbidities.

Many aging adults have two or more comorbidities. They are said to have “multiple comorbidities.” Some of the most common are arthritis, low back pain, high blood pressure, diabetes, heart disease, depression, and cancer.

In the most simple terms, they are the same thing. An embolism is the sudden blocking of a blood vessel. It can be caused by a bubble of air, blood clot, or piece of fat.

Pulmonary embolism is blockage of an artery to the lungs. It can be a blood clot that has broken off from the leg and traveled to the lungs. A blood clot that forms in the arms ar legs is called a deep venous thrombosis (DVT).

Doctors try to anticipate blood clots. Prevention and early detection are the keys to avoiding death from pulmonary embolism.

Low back and wrist injuries are the most common in professional golfers. Amateur golfers are more likely to suffer low back and elbow problems. Poor swing mechanics is most often
the cause of golf injuries.

Like many other sports, the swing is a repetitive motion that impacts the body. The lead hip is a main pivot point around which the body rotates. There’s quite a bit of torque or twist during the pivoting action. The lead hip takes most of the repetitive force. This is very similar to baseball pitchers or professional tennis players who have shoulder problems.

There is a danger in relying on a patient’s own report of his or her abilities. Patients may not recognize a decline in physical function. Or if they see the change, they may not
think it’s a problem. Tests to measure performance and physical function are available. Such tests may help identify problems earlier and more often than self-report by the patient.

A physical therapist can carry out tests of strength, balance, motion, and coordination. Finding out what changes have occurred in the patient’s daily activities will help guide the therapist. A program to regain lost skills or prevent decline of current skills is important for all aging adults.

Measuring indirect costs of injury or illness is often difficult. How do we put a dollar number to the possible production lost? How do you account for the first day a worker returns to the job if he or she isn’t working up to full capacity yet?

There are several accounting methods used to make these calculations. The first is the Human Capital Approach. This method gives a dollar value to the knowledge, experience, and wisdom of workers. This method may overestimate the actual loss because substitutes
are used to replace the missing employee.

Another method is called the Friction Costs Approach. This was first used in 1993 and assumes that losses occur only when the work isn’t being done. This takes into account both the time needed to replace the absent worker and/or to reorganize the way the job is done (if that’s needed). You’ll probably want to use this method. (For more details, see: Koopmanschap MA, Rutten FF. Indirect costs in economic studies: confronting the confusion. Pharmaco Econ 1993;4:446–54.)

Researchers count on the law of probabilities in studies like this. Most of the people keep a diary that reflects most of their costs most of the time. There’s probably someone else in the study with high costs who stopped spending money when the study started. That person would say the study doesn’t reflect his or her spending at all.

Asking people to keep track for longer periods of time (up to one-year) would probably be more precise. However studies of cost diaries actually show a record for three months is a good sample of what really happens over a full year.

Any drug that can affect your brain or your mind can cause problems with balance. For example, the class of drugs called psychotropics puts older people at risk for falls. These are used most often to treat depression, anxiety, or fibromyalgia.

Some (but not all) include:

Standing on one leg requires coordination between the eyes, the inner ear, the brain, and the muscles. This is called the postural control system.

The slightest thing can throw you off balance, even something as simple as too much wax in the ears or allergic reactions to foods and chemicals. Studies show our standing balance decreases with age. It’s definitely a skill that can improve with practice. Why some people have better standing balance than others is a mystery.

When our balance is challenged while in the standing position, the ankles keep the body from swaying too far in one direction. If the body sees that a loss of balance is likely, then the hips get into the action as well. If control at the ankle or hip doesn’t work,
then you will likely take a step to start a new, more stable posture.

If you aren’t losing your balance or falling outside of the yoga class, then you are likely very normal. Keep practicing! If you are experiencing these problems at other times, then a medical exam may be needed.

There is some definite truth to this observation. Some of the organs are made from the same tissue as the brain during embryologic development. The brain may perceive the pain signals from these organs more intensely than signals from other organs.

Scientists have also shown the importance of how each person perceives pain. That’s why pain from fibromyalgia, cancer, and headaches may be rated equally disabling by different
people. Mood, beliefs, and other psychologic factors may be the real key to how pain is perceived.