Website Update

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The website is coming together, hoping to get it done by the end of the month. I've been playing around with certain headlining photos such as the one above, that pic likely won't be the one i choose.  Thanks for being patient with me. 

Also, I did an impromptu poll on my Facebook page and looks like I am going to getting into FB live. The choices were between periscope, FB live, & Snapchat. Now for full disclosure I have accounts on all these services but I usually sign up for them to secure drpierre as a user name :-). 

And by this time if you haven't sign up below for my email list, I finally decided to write a book and you'll have access to early snippets as I go along.


Medical Spotlight: Panic Disorder

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Back with another week of the "Medical Spotlight" segment. We will continue from our previous story of Sam the teen who was headed to school and gets pulled over. 

Fortunately Sam leaves the encounter with nothing but a speeding ticket but it is definitely an experience that forever changes him. He continues on his way to school but he can't help to constantly look over his shoulder or in his rear view mirrors. It has gotten to the point that he can't even ride in the passenger seat without getting deathly afraid. Sam thinks he constantly hearing police sirens or seeing cop cars pull up behind him. It has been months since he was first pulled over but the fear still grips him. Since that time he has had to watched ten more people get killed during police stops and the fear that he is next has almost become paralyzing.  He becomes so fearful in leaving the house that he spends most of his free time home. Family & Friends have become concerned but really aren't sure what to do. 

Topic of day is Panic Disorder

Here we have Sam who has left what should have been a routine traffic stop but he came away with a problem that is much more severe. He has been struck with immense fear which that he may one day end up at the wrong end of a police stop. We can see that his normal activities of daily living are starting to become affected as well. 

To be continued next week. Lets talk about Panic Disorder

Panic Disorder

Unfortunately Panic Disorders are another common disorder I run into in my practice. Of course with our fictional character above the event that started it off was his run in with the police officer but I have had patients whose initial events ranged from : 
  • Being bit as a child by a pet
  • Abuse
  • Car accidents
  • Death in the family
  • Clowns

Clinical symptoms associated with Panic Disorder includes

  • spontaneous, discrete episodes of intense fear
  • significant changes in behavior associated with the attacks 
  • Many of these patients develop somatic dysfunctions (cardiorespiratory, neurological, gastrointestinal) which resulted in negative medical workups and repeatedly following up with medical care


  • recurrent or chronic disease
  • few experience complete resolution
  • reduces the quality of life in affected patients and their families

DSM5 Criteria - Panic Disorder

  1. Recurrent unexpected panic attacks
  2. At least one of the attacks has been followed by a month or more of one or both of the following:
    1. Persistent concern or worry about additional panic attacks or their consequences (eg, losing control, having a heart attack, "going crazy").
    2. A significant maladaptive change in behavior related to the attacks (eg, behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
  3. The disturbance is not attributable to the physiological effects of a substance (eg, medication or illicit drug) or another medical condition (eg, hyperthyroidism, cardiopulmonary disorders).
  4. The disturbance is not better explained by another mental disorder. As examples, the panic attacks do not occur only in response to:
    1. Feared social situations, as in social anxiety disorder
    2. Circumscribed phobic objects or situations, as in specific phobia
    3. Obsessions, as in obsessive-compulsive disorder
    4. Reminders of traumatic events, as in posttraumatic stress disorder
    5. Separation from attachment figures, as in separation anxiety disorder
Again as a clinician it is important to recognize these early symptoms in your patients and point them in the right direction for help there are lots of different ways to go about doing so.  You don't have to be a health professional to see how damaging this disorder can have on a loved one, encourage them that what they are feeling isn't "crazy" and get them the help that they need. 

If you're in the south florida area you can see my wife who is licensed mental health counselor.  Day by Day Therapy 


Bad For Business: The Story of a Bad Doctor

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To be continued from yesterday post-  Are you a bad customer? Here's Five Ways to Improve

So yesterday I discussed being a better customer to your physician [ Last Post] but I wouldn't be all the way truthful if I didn't act like there are a lot of bad businesses[Doctors/Doctor's offices] out there that is making it hard for you to be the most loyal customer.  As a physician here are some of the top reasons I find that we as the businesses are failing the customer.

  1. Be on time
    • I can't tell you just how many appointments that I have been to where the doctor wasn't even in the office before I was, many of our customers have to take time off from work[losing money] to  show up to their appointment. The least we can do is show up before them. 
  2. Be Firm
    • Many times your schedule is running behind because you let your customer with the 10am appointment take up more time than you should have. It's ok to listen to the customer's needs but you have to let them know that you're only going to take care of some of their needs[especially if they have a whole laundry lists] and schedule a follow up visit for the second half. 
  3. Be Sensitive
    • Understand that the customer is in a vulnerable position[being sick] so they may not act accordingly.
  4. Act in the interest of the customer
    • At the end of the day you have to let go any personal endeavors & understand what benefits the customer will always benefit you in the long run. 
  5. Recognize your customer
    • There are several types of customers so you have to be able to adjust to them and not the other way around. 

Have any of you had a bad experience with your business[doctor]? Let me know how you handled that. 


Are you a bad customer? Here's Five Ways to Improve

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Very early in my medical school training one my mentors referred to our mock patient as the customer of the moment.  This was the first time I ever heard that title used for a patient but it makes sense that person is there to purchase the goods that we are selling which in this case was health care. Unfortunately, in the office I have had a few bad customers in the past few weeks so I wanted to write out a plea to all the potential customers out there what we as health care workers would love to see. 

  1. Show up and on time
    • As a customer running late causes everyone to fall behind. Very often the day's scheduled gets pushed down because one appointment ran late in the morning.
  2. Be courteous to the office staff
    • I can tell you one thing the easiest way to get dismissed from a practice is being rude to all the ancillary staff. These are people that we work with on a daily basis to make sure our heads don't explode because of all the work that needs to be done so please don't upset them. 
  3. Have realistic expectations 
    • As a customer you should have different expectations when eating at Apple Bees than you do Ruth's Chris, the same should happen when going to see the doctor. You have to know that miracles may not happen in that brief time you see them so being patient and trusting the process will make both of our lives better.
  4. Be Critical but Vocal 
    • I think this is one of the biggest things any customer can do for a business is let them know when they aren't doing something right so they can fix it. As a physician I may not know that you have difficulty getting to speak to me but if you never tell me and just leave the practice then we both lose. I lose a customer and you lose the chance to be taken care of by the best Internist in South Florida. 
  5. Tell your neighbors 
    • If you are being treated by the best Internist in South Florida[myself], why not tell everyone you know? Customers these days spend so much time writing negative comments online that they forget to mention any of the good things they come into contact with. 
And don't worry I definitely plan on writing out what how bad the businesses (health care workers) have been & what we need to do to improve. 


Starting to come together

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So the website is coming along quite nicely, just finished taking some new overdue photos. Take a look at the new logo for the site. I hoping to have the website done in the next couple of weeks. 

thanks to everyone who has been reading,liking & sharing the news. If you haven't yet sign up to be on my email list, I will be having exclusive giveaways for my readers.