Author Archives: Trudy

Patient Advocacy Corner: Maryland’s ER Wait Times…Yikes!

By: ARIEL J. WARDEN-JARRETT, MD, FAAFP

Maryland continues to have one of the longest wait times for patients to be evaluated in the emergency department. At one point, wait times in some hospital systems were as long as 16-24+ hours. I think most of us can agree that this is ridiculous, but that does not change the reality.

Our hospital systems and state legislators are looking in depth as to why this is the case. In the meantime efforts were made to pass legislation that would allow qualified immigrants to apply for certain hospital positions in order to help decrease staffing shortages. Only time will tell if this proves to be an effective measure. I think the root of the problem exceeds hospital staffing issues. We need more access to primary care physicians.

As a board-certified family physician, I have some tips to share with you that may help you and your family avoid the emergency department in the first place. I believe one of the possible root causes of prolonged wait times is that individuals are not utilizing the primary care setting appropriately. Health issues that could be optimally addressed in this setting are getting pushed to the understaffed and overwhelmed emergency department settings. This won’t be solved overnight, but here are 10 things you can do to decrease your need for an emergency department visit, because we want to keep you out of the emergency departments, and utilize them for true emergencies…

  1. Establish a relationship with a primary care physician. Someone needs to know you and care about your specific needs. You are important and special!
  2. Schedule your annual physical. This gives you an opportunity to discuss your health, identify potential concerns and place a treatment/prevention plan in place. After all, healthy people tend to not need the emergency room on a regular basis, if at all.
  3. Schedule regular interval visits with your provider to maintain/control your chronic health conditions. For example, If you have asthma, COPD, diabetes, heart disease or other significant condition, you should have an action plan — this will help to decrease your chances of needing the ER.
  4. Do not wait until the last minute to call your doctor’s office when you have an urgent need. Yes, we have staffing issues too, but we are here to serve you. Let the trained staff help guide you to seeing an available provider who can evaluate you ASAP rather than “waiting” to see your preferred provider who may be booked up. At MPCP, we consider you our family. Yes, you have a preferred provider, but during an emergency, if your preferred provider is not available, it’s ok to see another provider in the office.
  5. Do not let your medications run out. If cost is a concern, let your provider know, as we have access to some programs that may be able to assist you. We do not want your health to deteriorate because you did not have access to your medication(s). We want to help you stay as healthy and robust as possible.
  6. When in doubt, call us. Our trained staff can triage your needs to guide you as to prioritizing the setting where your health concerns should be addressed (office, after-hours telemedicine, urgent care or the emergency department).
  7. Make your health a priority! Years ago, a patient told me that when they became sick at work, their employer refused to let them leave for a doctor’s visit and told them to go to the ER after work. Sadly, that is what happened, but it is wrong! You have employee and patient rights. Become familiar with them, exercise them and advocate for yourself.
  8. Ensure that you are building a robust immune system. Get adequate sleep (7-8 hours/night), exercise 45-60 min at least 3-5 days per week, avoid excessive caffeine, limit stress, eat balanced and healthy meals, limit alcohol intake, spend time outdoors (with sunscreen), spend time with family/friends.
  9. Know your medications and take them as prescribed. Review them at each visit with your provider. Let your provider know about supplements or other medications you may take. This will help to decrease medication-related emergencies.
  10. Read number 6 again.

At MPCP, we strive to create the best healthcare experience for you. Thank you for allowing us to be a part of your patient-centered medical homes.

Introducing Dr. Margaret Wang

People sometimes ask if I have always wanted to be a doctor. No, but it is certainly one of the top-rated dreams for an Asian immigrant.

Growing up in Beijing in the ‘80s, I rarely visited the pediatrician, and my family usually depended on traditional Chinese medicine. For example, whenever a runny nose and a fever set in, I would be given a sweetened herbal medication called Ban Lan Gen and be forced under a stack of blankets until my pajamas were soaked with sweat, which means that the fever had broken and I would soon recover.

When it comes to medicine, the average Chinese person seems quite torn between their traditional medicine and Western practices. Not many are well-versed in traditional medicine — featuring powerful potions and genuine side effects — but every Chinese person has been steeped in a unique mixture of culture, tradition filled with anecdotes and myths, and a dependence on nature and a distrust for the man-made.

I myself harbor a great interest in acupuncture and toxicology. While I studied at Georgetown University School of Medicine, I took a class on alternative and complementary medicine, which taught me traditional Chinese medicine is not to be trifled with, and that Asian people who are scared of strong Western medications should exercise equal caution over Chinese potions.

Although I share in this cultural understanding about the human body and health, my systematic training in Western medicine remains the pillar of my practice as an internist. This can sometimes be challenging with Asian patients. They often see little value in preventative care and regular checkups, which I appreciate as the basis of sound medical care. Patients can also give pushback about starting a medication, because they believe — and rightly so — that everything with an effect has a side effect.

In the end, it comes down to communicating outside of typical Western medical care — more in the realm of preference, philosophy, and faith. These human discussions provide an important context for medical care and is what makes primary care most interesting for me. Not all doctors share this view, but that is okay. I think it enhances my effectiveness and benefits my patients.

2024 marks my tenth year practicing as an internal medicine doctor. I first spent some time as a hospitalist and at an urgent care center, but I seem to have settled in the right spot at MPCP, for which I am truly thankful. And if you’ve read this article to the end, I wish you a blessed new year.

 

 

Dr. Wang is a Maryland Primary Care Physicians partner and is certified by the American Board of Internal Medicine. She received her medical degree from Georgetown University School of Medicine. She cares for patients in MPCP’s Columbia office.

Naloxone: A Powerful Tool to Fight Opioid Overdose

By: ANDREA C. CUNIFF, M.D.

The opioid crisis continues in Maryland and has gotten worse as the powerful drug fentanyl is increasingly mixed into illegal drugs. From 2022 to 2023, the state saw 2,583 fatal overdoses, and fentanyl was involved in about 81% of those deaths.

In response, there has been a growing use of naloxone (commonly known by the brand name NARCAN®), a medication approved by the Food and Drug Administration that rapidly reverses opioid overdose. It has been used to save lives in Maryland. Healthcare officials encourage its distribution and use by the public.

What is naloxone?

Naloxone is an opioid antagonist: it attaches to opioid receptors in the body, reversing and blocking the effects of opioids, including heroin, morphine and oxycodone. Naloxone can quickly restore normal breathing to a person whose breathing has slowed or stopped because of an opioid overdose. However, it only reverses opioids and will not work on other drugs like cocaine or methamphetamine.

How naloxone is given

Naloxone should be given to any person who shows signs of an opioid overdose. It can be administered as a nasal spray or an injection. Learn how to respond to an overdose with guidelines from the Maryland Department of Health.


Signs of opioid overdose

  • The person’s face is extremely pale and/or feels clammy to the touch
  • Their body goes limp
  • Their fingernails or lips have a purple or blue color
  • They start vomiting or making gurgling noises
  • They cannot be awakened or are unable to speak
  • Their breathing or heartbeat slows or stops

Source: Substance Abuse and Mental Health Administration


Who can give naloxone?

Naloxone is widely used by police officers, emergency medical technicians (EMTs) and non-emergency first responders. In Maryland, anyone can administer naloxone and training is not required, but your healthcare provider or pharmacist can advise you how to use it.

You can buy naloxone at a pharmacy without a prescription. Free naloxone may also be available from Overdose Re​sponse Programs located throughout the state.

What to keep in mind

Naloxone works for about 30 to 90 minutes, but many opioids remain in the body longer than that, so a person can still experience the effects of an overdose after naloxone wears off. If you administer naloxone to an overdose victim, you should still call 911 as soon as possible for immediate medical attention.

Side effects from naloxone are rare, but some people might have allergic reactions to it. Overall, naloxone is a safe medicine and has the potential to save many lives.

In the state of Maryland you are protected under the Good Samaritan Law. This means you will not be arrested or prosecuted if you administer naloxone while you are under the influence of alcohol or illicit drugs, or are in possession of illicit drugs at the time of administration.

More about naloxone

 

Dr. Cuniff treats patients in the Annapolis office. She is certified by the American Board of Family Medicine and earned her medical degree from the University of Maryland School of Medicine.

MPCP Columbia Welcomes Lalitha Tadikonda, M.D.

Dr. Tadikonda is certified by the American Board of Internal Medicine. She received her medical degree from the University College Dublin Ireland School of Medicine in Dublin, Ireland. Dr. Tadikonda completed her residency in 2000 at the Cleveland Clinic Foundation in Cleveland, Ohio. We welcome this bright, enthusiastic provider to our practice!