2010's Best Doctors

Whom would you send your family members to, or whom would you go to, if faced with a medical problem? These were the questions posed to physicians by Best Doctors, Inc., to determine who stands out in our community. Founded over 20 years ago by two physicians, Best Doctors, Inc. surveys doctors for their top recommendations; the answers account for approximately five percent of the specialists in the country. Physicians cannot pay to be on the list or to be surveyed. The results for Marin and San Francisco feature more than 500 of some of the area’s best physicians in numerous specialties (see the list here). Whether you are looking for a new doctor, are faced with a medical crisis, or just want to see if your own doctor made the list, the following article is a good place to start.

Healthy Living

Marin County is synonymous with healthy living: hot tubs to relieve stress, miles of trails to hike and bike and a bounty of fresh food grown (and raised) just miles from our dinner table. Within our Marin-grown kale, lettuce, heirloom tomatoes, and microgreens exists the ultimate magic pill for healthy living – antioxidants. These microscopic do-gooders not only offer a potent dose of nutrition but also protect the body from cancer- and disease-causing free radicals. “Along with good sleep, exercise and a positive attitude, good nutrition is the key building block of good cellular and tissue health,” says Dr. Elson Haas, best-selling author and founder and director of Preventative Medical Center of Marin. For optimal nutrition he suggests “choosing foods that are close to nature, less processed and in season.” In other words, grown nearby and recently harvested.

“Not only is eating this way best for our bodies,” Haas explains, but by forgoing that tomato from Mexico in January, “it’s best for the planet too,” considering that longer shipping adds to the carbon footprint of that food. February’s local crops include a few of the nutritional big hitters such as brussels sprouts and cauliflower. Packed with vitamins, these cruciferous vegetables are in the cabbage family and are known to contain cancer-preventing, sulfur-containing phytonutrients. Also in the same nutrient-dense family (leafy green division), chard and kale can be found in abundance this time of year. Need some fresh ideas for how to prepare these gems? Haas has recently authored a new cookbook: More Vegetables, Please! Santé!

 Trends in Hospital Room Design

Imagine feeling bleary-eyed and exhausted after a long day of travel. You check in to your hotel, are handed your key and make your way to the room—where the only thing on your mind is zoning out to the television or nodding off into deep slumber. But what if you opened the door to your room to see someone already there? You wouldn’t have it. You’d demand your own room, your own privacy. Yet still, in many hospitals today, when you’re sick and stressed and there for no other reason than to get healthy as quickly as possible and get out—you are given a roommate. Someone you don’t know and someone who is feeling as stressed and sick as you.

The benefit of a single-patient room has been one of the trends to emerge from evidence-based hospital design. According to the New York Times, “More than 1,500 studies have examined ways that design can reduce medical errors, infections and falls and relieve patient stress.” In 2006 the American Institute of Architects called for single rooms in all new hospital construction.

A decade ago, the Center for Health and Design in Concord, Ca., launched the Pebble Project, with the purpose of creating change in the health care industry by providing documented examples of how design has improved patient and staff experiences.

President and CEO Debra Levin says the move to single-patient rooms is catching on because not only has it led to a reduction in patients’ having to switch rooms due to roommate problems, or because a family visiting one patient could be distracting to the other, but it’s also reduced the number of infections from sharing a room or moving a patient.

Levin also observes a trend toward larger patient rooms with dedicated space for the patient, the family and the staff. “You have these rooms that have zones—a family zone with a comfortable bed area for a family member to sleep, a dedicated staff zone where all the equipment the staff needs is easily accessible and a dedicated patient space.”

The third trend Levin notes: variable acuity rooms, where the level of care can change depending on what the patients’ needs are at a given time. “Every time you move a patient you take the chance of medical error. Having a variable acuity room would allow the room to morph rather than the patient to move. All of this falls (under) the (category) of safety.”

Where to Go in Marin: Emergency Care

The backbone of Marin’s emergency medical services network is its field responders, who include firefighters, paramedics and emergency medical technicians as well as forestry and law enforcement agents, led by Marin Emergency Medical Services Agency Director Miles Julihn and Medical Director Dr. William Teufel. “We have a unique model, providing pre-hospital care through our fire departments,” Marin Health and Human Services Director Larry Meredith says, in that many agencies come together as first responders with the ability to channel patients to the appropriate trauma unit.

The most severe trauma cases go to Marin General Hospital, the only hospital to receive a rating by the American College of Surgeons, which ranks hospitals nationwide. MGH is rated a Level III trauma center (Level I is the highest rating) and can handle most trauma cases but functions as a Level II, as neurosurgery is also available there.

The Kaiser Permanente San Rafael Medical Center can also handle trauma cases and has received a special designation from the county as an Emergency Department Approved for Trauma (EDAT).

“It is a system we are all proud of,” Meredith says. “It serves well the residents of Marin.”

CENTRAL MARIN
Marin General Hospital
The designated trauma center for the county treats patients 24 hours a day, seven days a week. The hospital also offers express treatment for those with non-life- threatening conditions such as earaches, coughs and sprains and sends most patients home within an hour. Express service is offered seven days a week, 10:30 a.m.–8:30 p.m.
250 Bon Air Road, Greenbrae | 415.925.7000, maringeneral.org

Kaiser Permanente San Rafael Medical Center Dept. of Emergency Medicine
Board-certified emergency physicians are available 24 hours a day, seven days a week, to address emergency health care needs. The team also includes registered nurses, emergency technicians, orthopedic technicians and receptionists.
99 Montecillo Road, San Rafael | 415.444.2940, kaisersanrafael.org

Sutter Terra Linda Urgent Care provides medical services for minor illness or injury including colds, coughs, infections, rashes, headaches, sprains, burns and eye problems. No appointment is necessary. Open 11 a.m.–7 p.m. weekdays and 9 a.m.–5 p.m. weekends.
Sutter Terra Linda Health Plaza, 4000 Civic Center Drive, San Rafael | 415.492.4700, novatocommunity.sutterhealth.org

NORTH MARIN
Novato Community Hospital
The emergency department treats patients 24 hours a day, seven days a week and has two trauma beds, three minor treatment beds, a women’s examination room, an isolation room and two private procedure rooms.
180 Rowland Way, Novato | 415.209.1300, novatocommunity.sutterhealth.org

WEST MARIN 
Coastal Health Alliance

The CHA was founded by a group of residents and practitioners to provide primary care to all West Marin residents, including traditionally underserved members of the community. The CHA operates three community health centers in West Marin. Call or visit the website for hours and exact locations.
Point Reyes Station (415.663.8666), Bolinas (415.868.0124) and Stinson Beach (415.868.9656). coastalhealth.net

 Sports: Train Hard But Not Too Hard

Your neighbor Joe did it, and he’s no Lance Armstrong. As with the marathon craze of the 1980s, it seems everyone is either signing up for his or her first triathlon or retelling and reliving the finish weeks, months and even full seasons after crossing the finish line. Not that competing, let alone finishing the grueling .9 miles of swimming, 24.8 miles of biking and 6.2 miles of running involved in an international distance triathlon doesn’t deserve praise.

The intense training that comes along with being competitive doesn’t seem to deter newcomers to the sport. In fact, USA Triathlon, one of the main organizing bodies for the events in the United States, currently reports 130,000 members, almost 10 times more than in 2000.

Most casual athletes who enter the sport know they’ll have to put in long hours training, but training too hard too soon can cause injuries. Many newcomers who move from a single sport to triathlons assume they will be less prone to getting hurt because they are adding variety to their exercise regimen, thus putting less -strain on any single muscle set. In practice, though, people who take up triathlons tend to train harder than they did while working out in a single sport. Dr. David Goltz of Mt. Tam Orthopedics, the official medical provider for the U.S. ski team and the U.S. snowboarding team, says signing up for a triathlon entails a large commitment. “The overall amount of training really increases with triathlon training compared to simply cross-training.”

The most common injuries among triathletes include running-related injuries like IT band syndrome, which causes pain in the thigh or knee region, foot stress fractures and tendonitis, says Goltz. “Swimming has the occasional shoulder problem, but less so. Biking is pretty safe except for accidents and the ever-present danger of sharing the road with cars.”

Goltz advises that anyone new to a sport invest in rest when injured. “The healthy, slightly less trained athlete beats the injured superstar every time!”

Finding the Right Pediatrician

Having a child in 2010 seems complicated. Every aspect of parenting is flooded with decisions that contain a huge potential for right and wrong. For instance, will the baby be breastfed? According to the Marin Breastfeeding Coalition, in Marin County only 42 percent of babies were breastfed at six months and 19 percent at 11 months, a number the coalition finds way too low. And then there is the question of vaccinations. Or is there a question? Dr. Fred Schwartz, a public health officer for Marin County, would argue they are necessary for public safety; however, parents need to do their own research to make their own decisions.

Selecting a trusted doctor or nurse to be a partner in your child’s health care can ease the anxiety. But with a phone book full of options, choosing the right doc can be overwhelming. The American Academy of Pediatriacs offers sound advice. First of all, a month or so before your due date, start asking around for a referral from family and friends. If you are set on a pediatrician, as opposed to a family doctor or pediatric nurse, for your primary care, check credentials. Appropriate training in pediatrics involves medical school and at least three years of residency in either pediatrics or family medicine. Websites for most insurance companies list the credentials of physicians in their plan. It’s also a good idea to call the Federation of State Medical Boards (FSMB) at 817.868.4000 to be sure no significant disciplinary actions have been initiated against the doctor by patients or peers. Once you have a few options, set up informational interviews and you are on your way.

Prenatal Priorities

Congratulations, you’re pregnant! Get ready for a 40-week journey of hormones, heartburn and hemorrhoids and, of course, bliss. And just to be safe, make your first doctor or midwife’s appointment right away. “I urge my clients and friends who are pregnant to make a prenatal care appointment as soon as possible,” says Kent Woodlands’s Kathleen Belzer, mother of three and certified midwife and nurse practitioner. “Not only is it important to ensure you are getting enough folic acid (found in prenatal vitamins) but also, some of the prenatal screening tests available are offered as early as 10 weeks.” According to the National Women’s Health Information Center, babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and suffer other complications than those born to
mothers who do get care.

While the first appointment is exciting, it’s also a crucial time to evaluate the road ahead. Your physician will ask about your health history and your family’s health history, and do a complete physical as well as calculate your due date. Now the waiting and wonder begin. Besides getting medical attention early to monitor development, milestones, Belzer suggests finding an athletic outlet. “One of the best things an expectant mom can do for herself and baby is to get involved in a physical activity like swimming or yoga to keep her active and help her relax.” She says while swimming is a low-impact aerobic activity known to help the mom-to-be’s physical and mental state, studies have found that yoga is that — and more. “In addition to the physical benefits, the practice of yoga can improve the expectant mom’s ability to relax and concentrate as well as teach her how to release tension by breathing out—a highly valuable skill when it comes to labor.”

Wash Your Hands

You’re at work, in a restaurant or even at home dishing out dinner for the kids when nature calls. You answer. Then, hurriedly, you rush back to your desk, your table or your family—hands unwashed.

In that single moment, perhaps from distraction, perhaps out of lifelong habit, when you didn’t stop at the sink on the way out of the restroom, you became a primary cause of infectious disease — someone with dirty hands.

Most likely you’re a guy, because studies show that at best only two thirds of men wash their hands after using the restroom. Other studies put the number as low as at one third.

Ladies, you’re not that much better. One in four of you skips the soap and water on the way out of the loo.
The result is lots of bacteria — on your hands, then on your phone, then on doorknobs everywhere —germy little vermin that are responsible for the common cold, the flu and many other nasty infectious maladies, about 80 percent of which are transmitted by touch, according to the Centers for Disease Control.

Flu-like illnesses kill 36,000 people every year, and another 5,000 die from food-borne diseases. Your best defense against being one of those stats, says the CDC, is to wash your hands — a lot— and with soap, not just a rinse and run.

Yet, despite the ubiquitous bottles of hand sanitizer in grocery stores, offices and other public places these days, we don’t—wash, that is.

We think we do. More than 90 percent of us say we wash after a restroom visit. But study after study proves that to be self-delusion. Even after changing a diaper, only 73 percent of us regularly wash our hands. Yeewww!

How do you make something that is common sense a common practice?

A recent study of 200,000 toilet-goers by a research team of the London School of Hygiene and Tropical Medicine found some solutions. In an effort to influence behavior, the researchers installed lighted messages at the door of a public restroom on a British highway.

The messages ranged from the subtle to the blunt, urging people to wash. The findings say a lot about human behavior, and the differences between men and women.

Both men and women responded to peer pressure and washed more when the message read “Is the person next to you washing with soap?”

Women responded most to an educational message: “Water doesn’t kill germs, soap does.”

Men, however, ignored educational entreaties. They washed the most when messages read like a line from a Judd Apatow movie: “Soap it off or eat it later.”

Got the message? Now, go wash your hands.