Direct Primary Care

Direct primary care is primary care offered direct to the consumer, without insurance intervention. It incorporates various health care delivery systems that involve direct financial relationships between patients and health care providers. One niche variant of direct primary care is concierge medicine. Direct primary care can remove many of the financial barriers to accessing care when needed. Often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers. Under this model, patients may pay a combination of visit fees and/or fixed monthly fees, which grant them access to a set of medical services, including same and next-day appointments, both in the form of house calls and office visits. A direct primary care arrangement benefits from pairing with either: a high-deductible health plan, as direct primary care alone will not cover catastrophic health care such as most surgeries, a health savings account, or health reimbursement account as the associated tax-benefits can generally be applied to direct primary care and other medical expenses. Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent. Direct primary care payments are over time, rather than in return for specific services, the economic incentives are such that the long-term health of the patient is the most lucrative situation for the doctor. Preventative care gains greater emphasis under direct primary care. Because the primary care physician compensation is better than it would be under insurance billing, doctors can afford to spend more time with the patient, rather than simply referring them to a highly paid specialist after a short consultation. Boutique medicine is a type of medical practice now found in many metropolitan areas across the country. Also known as, concierge health care, concierge medicine, or retainer medicine, the concept has come to represent a higher level of healthcare for those who want a more personalized relationship with their physician. This model has proven successful for those physicians who want to see a fewer number of patients on a day to day basis, thus allowing them to spend more time nourishing individual patient relationships.

Ophthalmology

Ophthalmology is the branch of medicine, which deals with the anatomy, physiology and diseases of the eye. The term ophthalmologist refers to a specialist in medical and surgical eye problems. Since ophthalmologists perform operations on eyes, they are both surgical and medical specialists. The eye is a fragile organ, requiring extreme care before, during, and after a surgical procedure. An expert eye surgeon must identify the need for specific procedure and be responsible for conducting the procedure safely. Anesthesia is essential for any eye surgery. Local anesthesia is most commonly used. Retrobulbar and peribulbar techniques for infiltrating the local area surrounding the eye muscle cone are to immobilize the extraocular muscles and eliminate pain sensation. Topical anesthesia using lidocaine topical gel is preferred for quick procedures. In topical anesthesia, patient cooperation is a must for a smooth procedure. General anesthesia is for children, traumatic eye injuries, major orbitotomies, and for apprehensive patients. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are used to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are necessary. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is used to keep the eyes wide open. Although the terms laser eye surgery and refractive surgery are used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions, while radial keratotomy is an example of refractive surgery without the use of a laser. A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the retina. If visual loss is significant, surgical removal of the lens with lost optical power is performed and it is usually replaced with a plastic intraocular lens. Due to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is necessary. LASIK is Laser-Assisted In Situ Keratomileusis. LASIK is a type of refractive surgery, performed by ophthalmologists using a laser. The operation is with the patient awake and mobile; however, the patient is sometimes given a mild sedative (such as Valium) and anesthetic eye drops. LASIK is in three steps. The first step is to create a flap of corneal tissue. The second step is remodeling of the cornea underneath the flap with the laser. Finally, the flap is repositioned.

Topical Bactericidals

Widely available over-the-counter (OTC) bactericidal products containing benzoyl peroxide treat mild to moderate acne. Other anti-bacterials are triclosan, or chlorhexidine gluconate, but these are often less effective despite having fewer side effects.