Doctors

Health goals, like all goals, should be set up in ways that ensure success. Goals should be:

1. small
2. incremental
3. reasonable
4. manageable
5. achievable

For examples, non-health:

1. A child got a D on a test. His parents react by grounding him and forcing him to study from the time he arrives home, until he goes to bed! But a more reasonable plan would be to help the child set up a plan for studying. Review today's material for 20 minutes. Answer the end of chapter questions, 20 minutes. Practice words and spelling, 20 minutes. Homework 20 minutes. Breaks every hour. A small reward for completing the tasks, such as 30 minutes of a favorite TV show. Begin the next set of studies.
2. A girl wants to win the 100 meter dash. She has only run shorter dashes. Rather than setting a 100 meter goal, she begins with a 20 meter goal, then 30, then 40, etc. When she can run without huffing for breath, she adds one meter to her goal.

Health goals:

1. A woman, age 50, has smoked since she was 11 years old. What began as one cigarette turned into 4 packs a day. She dearly wants to quit-- but failed when she tried "cold turkey". She decides to "Quit by the clock"-- she can have 1 cigarette every 10 minutes for the first 5 days. Then, she switches and makes it 20 minutes between smokes. In increments, she increases the time between lighting up.
2. A 300-pound teenage boy wants to weigh 190-200 pounds. But he wants this "in a month". That is not reasonable! His mother suggests cutting out 1 meal from fast food sources once a week for 3 weeks, then cutting out 2 of those meals every week. She also buys more fruit and vegetables. His mom begins a gym membership for herself; her son can attend for half price. In the evening, he walks to his friend's house rather than having dad drive him. Within 6 months, he has lost 45 pounds.
3. A teenage girl feels depressed. She hates being outside where people can see she's overweight. She wants to quit school but her mother forbids it. The girl decides to make changes and lose weight, but how? She and her mother decide to take walks in the evening when most families are inside. Mom buys a treadmill they can use in the basement. The girl decides to enter a summer camp to help overweight kids--where she will also get more exercise.
4. Many people think that people with diabetes cannot eat sweets. That is not true! But they should build a food plan that includes sugary foods and carbs into a better diet. A man who used to eat 4 donuts a day chooses to eat only 1 every Sunday, but none during the week. A woman switches from white bread to wheat, but at her son's house on Sunday's she enjoys a slice of white bread with dinner.

Keep in mind, a psychiatrist is a Medical Doctor who specializes in psychiatry.

Formal education and training requirements for physicians are among the most demanding of any occupation-4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on the specialty selected. A few medical schools offer combined undergraduate and medical school programs that last 6 rather than the customary 8 years.

Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and organic chemistry. Students also take courses in the humanities and the social sciences. Some students volunteer at local hospitals or clinics to gain practical experience in the health professions.

The minimum educational requirement for entry into a medical school is 3 years of college; most applicants, however, have at least a bachelor's degree, and many have advanced degrees. There are 146 medical schools in the United States-126 teach allopathic medicine and award a Doctor of Medicine (M.D.) degree; 20 teach osteopathic medicine and award the Doctor of Osteopathic Medicine (D.O.) degree. Acceptance to medical school is highly competitive. Applicants must submit transcripts, scores from the Medical College Admission Test, and letters of recommendation. Schools also consider an applicant's character, personality, leadership qualities, and participation in extracurricular activities. Most schools require an interview with members of the admissions committee.

Students spend most of the first 2 years of medical school in laboratories and classrooms, taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. They also learn to take medical histories, examine patients, and diagnose illnesses. During their last 2 years, students work with patients under the supervision of experienced physicians in hospitals and clinics, learning acute, chronic, preventive, and rehabilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness.

Following medical school, almost all M.D.s enter a residency-graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.s serve a 12-month rotating internship after graduation and before entering a residency, which may last 2 to 6 years.

All States, the District of Columbia, and U.S. territories license physicians. To be licensed, physicians must graduate from an accredited medical school, pass a licensing examination, and complete 1 to 7 years of graduate medical education. Although physicians licensed in one State usually can get a license to practice in another without further examination, some States limit reciprocity. Graduates of foreign medical schools generally can qualify for licensure after passing an examination and completing a U.S. residency.

M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years in residency training, depending on the specialty. A final examination immediately after residency or after 1 or 2 years of practice also is necessary for certification by a member board of the American Board of Medical Specialists (ABMS) or the American Osteopathic Association (AOA). The ABMS represents 24 specialty boards, ranging from allergy and immunology to urology. The AOA has approved 18 specialty boards, ranging from anesthesiology to surgery. For certification in a subspecialty, physicians usually need another 1 to 2 years of residency.

A physician's training is costly. According to the Association of American Medical Colleges, in 2004 more than 80 percent of medical school graduates were in debt for educational expenses.

People who wish to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education and practice. Physicians also must have a good bedside manner, emotional stability, and the ability to make decisions in emergencies. Prospective physicians must be willing to study throughout their career in order to keep up with medical advances.

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1. Diagnosis

• Ask patient for medical history
• Physical examine (look for swelling, warmth and redness)
• D-dimer test (reference: <250ng/mL)
• Ultrasound
• If ultrasound was inconclusive then venography
• If venography isn't possible MRI

2. Treatment

Drug administration:

• Unfractionated heparin
• Low molecular weight heparin (enoxaparin/Lovenox, dalteparin/Fragmin, or tinzaparin/Innohep)
• Fondaparinux (Arixtra)