What is a Physician Assistant (PA)?

A PA is a nationally certified and state-licensed medical professional. PAs practice medicine on healthcare teams with physicians and other providers.

They practice and prescribe medication in all 50 states, the District of Columbia, the majority of the U.S. territories and the uniformed services.  Learn more about the value a PA brigs to a medical practice from the American Academy of PAs and New Jersey State Society of Physician Assistants.

What is Body Mass Index?
Body Mass Index (BMI) is a formula that uses height (stature) to correct body weight. BMI values between 18.5 and 25 are considered ideal. Individuals with BMI’s greater than 25 are at increased risk for hypertension, type 2 diabetes, and sleeping disorders. BMI is now considered an important component of a patient’s “vital signs” along with heart rate, temperature, respiration rate, and blood pressure.

What is a Calculator?
A calculator is a formula used to estimate the risk of developing a particular disease. See our Healthy Links page for several useful examples.

Dieting 101
Dieting doesn’t mean starvation or extreme hunger. It means paying careful attention to the amount and kinds of food you eat. Smaller portions rather than fewer meals preserve variety while simultaneously reducing caloric intake. Athletes often eat more than three meals a day while keeping the size of each meal relatively small. This approach tends to protect lean muscle mass, a critical element in exercise performance, while keeping BMI below 25. Avoidance of concentrated carbohydrates such as chips, soda, alcoholic beverages and fast foods is essential, especially for those with sedentary lifestyles. Get in the habit off reading the labels of the food items you buy and estimate the number of calories you consume every day. Remember the rhyme “Crudités and you are on your way!” and visit Choose My Plate for useful nutritional information.

Why is Exercise important?
Exercise is important because it helps keep BMI, blood glucose (blood sugar) and blood pressure in the healthful range and thereby reduces the risk of cardiovascular disease. Exercise along with diet and smoking cessation are the cornerstone of “Lifestyle Modification” and the foundation upon which medical treatment is built. Please see “What Kind of Exercise is Best?” as well as “What about Weight Lifting?”

What is an Electronic Medical Record?
Health care providers have been slow to capture the results of patient encounters in electronic form making it difficult to share information with other providers in your Medical Home and run quality reports. Healthcare legislation passed by Congress establishes “meaningful use” criteria for electronic medical records and provides strong incentives for their implementation, as well as agencies for their review and approval. Dr. Schmidt uses certified electronic medical record software in his practice.

What is an Electronic Prescription?
An electronic prescription (eRX) is a drug prescription that your doctor transmits to your pharmacist via the Internet so that your medications are usually ready for pick-up by the time you arrive. Pharmacists, doctors, and patients alike have embraced eRx’s because they eliminate errors due to illegible handwriting, misinterpretation, and faulty transcription. An Electronic Prescription feature is often built into electronic medical record software and allows your physician to work directly from your medication list when refills are due. Dr. Schmidt uses electronic prescriptions.

Are Generic Medicines OK?
When patents on drugs expire, they become “generic” medicines. Many important medicines have made this transition at which point they are manufactured not only by the pharma company that originally held the patent but also by one or more “generic drug manufacturers” often at substantially reduced prices. Generic drug manufacturers are required to show bioequivalence to the original branded medicine before FDA grants approval. Thus generic medicines are generally preferred, if available, because they offer the same efficacy at a more affordable price.

May I use Herbal Remedies?
While most of these preparations are harmless and have on occasion been the source of important medicines, there is generally limited evidence to support their use for the treatment of serious and life-threatening diseases. One of the issues surrounding their use is that they are invariably mixtures making it difficult to identify the active ingredients and their concentration. There is also the possibility of drug interactions with standard medications. Thus, if you choose to use such preparations, please report them in your medication list.

What is a History?
A History begins as a verbal account of the illness in the patient’s own words and remains the single most important guide in making an accurate diagnosis. It is also the starting point for the patient-physician encounter. While spontaneity is important in giving a history, it is also important to be a “good historian” meaning that the patient should reflect on the quality, timing, location, severity, provocation, and remedies for any complaint before the office visit. This helps the internist focus the physical examination and reduce the number of tests. Also included in the history is the Family History. If you are unfamiliar with your family’s medical history, talk to family members beforehand, if possible, to obtain it.

What is an Internist?
An internist is a physician who evaluates a symptom not in isolation but in the context of the whole patient. As an internist, Dr. Schmidt received training in all of the organ systems of the body and will therefore always conduct a “review of systems” when meeting a patient for the first time or evaluating a new complaint.

What Kind of Exercise is Best?
Current data suggests that aerobic exercise such as walking, jogging, cycling, dancing, swimming, and rowing are best. 20-30 minutes a day for at least five days per week is the recommended amount. Machines such as stationery cycles, elipticals, and treadmills provide a convenient way to perform graded aerobic exercise indoors while watching television, listening to music, or engaging in reflection or prayer. Aerobic exercise is serious business because it forces the heart to work harder and faster. Dr. Schmidt recommends that all patients serious about exercise invest in a cardiac monitor available for purchase online and in most sporting good stores. Such monitors allow persons to monitor their heart rate, as well as estimate the number of calories burned, during an exercise session. Having first consulted your doctor to make sure that you have no contraindications, a gradual increase in heart rate and exercise duration can be an excellent approach to cardiovascular fitness, weight reduction, and reduced cardiovascular risk. Plus you will be amazed at how much better you feel and look!

What is meant by Lifestyle Modification?
Lifestyle modification means getting into and maintaining a healthful routine consisting of regular aerobic exercise, eating healthful foods in the right quantity, and stopping unhealthful practices such as smoking and excessive drinking.

What is a Medical Home?
Most patients ultimately require a team of healthcare providers including but not limited to an internist, one or more specialists, gynecologists, nutritionists, podiatrists, opthalmologists, surgeons, chiropractors, and/or nurse-practicioners. When the patient’s provider team is linked by a secure, HIPAA-compliant, Internet-based data-sharing tool, it constitutes a Medical Home. Because of his broad training, Dr. Schmidt is ideally suited to coordinate patient services within his patients’ Medical Homes. Dr. Schmidt is actively in the process of setting up technology that will facilitate this role.

What is a Medicine?
Modern medicines, with few exceptions, are single chemical entities (compounds) resulting from years of painstaking and expensive research by scientists and physicians working in research universities, pharmaceutical companies, biotechnology companies, and government laboratories such as the National Institutes of Health. Most drugs are therefore the result of public-private partnerships culminating in a New Drug Application (NDA) to the Food and Drug Administration (FDA). The FDA is empowered to ascertain whether the drug is safe and effective and must approve the NDA before the drug can be prescribed and sold. Pharma companies are obligated to report the incidence of side effects and complications to the FDA on a quarterly basis. Most of the drugs used today are the result of this complex and elaborate process.

Dr. Schmidt worked in the pharmaceutical industry for twenty-five years and has first-hand knowledge of the advantages, disadvantages, and complexities of modern medicines. Working closely with each patient and your pharmacist, Dr. Schmidt will customize a medical treatment regimen that has the greatest likelihood of treating your condition while minimizing side effects and avoiding complications.

What is the Follow My Health Patient Portal?
The Follow My Health Patient Portal is an Internet-based user-friendly tool for patient access to Dr. Schmidt’s office and his/her medical records and lab results, as well as useful links to health resources. Patients can make appointments, complete forms, and access links and their medical records. Dr. Schmidt’s patients can access his Follow My Health Patient Portal on this website with a secure user id and password. Contact our office to access your electronic medical records on the Follow My Health Patient Portal.

Is the Physical Examination Still Important?
Much has been written about the replacement of the physical examination with expensive imaging tests and the loss of physical examination skills by physicians young and old. Dr. Schmidt believes that a careful and thorough physical exam guided by the patient’s medical history remains an absolutely critical, safe and cost-effective initial step in assessing his patients’ health issues. Incidental physical findings can also be an important clue to an early diagnosis.

What is a Risk Factor?
A risk factor increases the likelihood of developing a particular disease. Some are avoidable and some are not. For example, smoking is a major avoidable risk factor for lung, throat, and bladder cancer, as well as for emphysema, chronic bronchitis, aortic aneurysm, stroke, and coronary artery disease. Other risk factors for coronary artery disease are diabetes mellitus, hypertension, hypercholesterolemia, and positive family history. “Family history” is an unavoidable risk factor that nevertheless must be confronted. The higher the risk, the more aggressive patients and physicians need to be in devising risk-factor mitigation strategies. For example, target cholesterol levels should be lower in diabetics than in non-diabetics. Likewise, the greater the risk, the more vigilant patients and physicians need to be in conducting screening tests. For example, the threshold PSA level for biopsy of the prostate should be lower in men with a strong family history of prostate cancer.

What is a Screening Test?
Screening tests are performed to detect medical problems early so that they can be managed more safely and effectively. Papanicolou smears (Pap smears) and screening mammograms are among the best known and validated by clinical studies. Other screening tests such as annual chest Xrays have proven not to be useful. All screening tests can be “false positive” and “false negative”. A “false positive” occurs when the test suggests a diagnosis that is simply not true. This was one of the major problems with regular chest Xrays. Patients were subjected to additional tests, some of which were invasive, only to find out that the “spot on their lung” was benign. A “false negative” occurs when the test misses a diagnosis, typically because it lacks sufficient sensitivity. The U.S. Preventive Services Task Force (USPSTF), the Center for Disease Control and Prevention, and various non-profit organizations such as the American Diabetes Association periodically issue and revise guidelines for screening tests based on the latest medical evidence. Some of these guidances have been controversial. Dr. Schmidt generally follows the latest guidance but also customizes his recommendation based on each patient’s personal, family medical history and personal preference.

Can I Stop Smoking?
While difficult, everyone knows persons who have successfully stopped smoking. The great thing about stopping is that the risk of heart attack, lung cancer and emphysema begin to decline right away even in people who have smoked for years. Studies also show that people who wish to stop smoking shouldn’t give up trying. If at first you don’t succeed, try again! Dr. Schmidt can help you stop smoking with medications provided you are adequately motivated to stop. The highly motivated quitter will also plan ahead and avoid weight gain by implementing an exercise and diet routine. Can you stop smoking? Yes you can! Visit our Healthy Links page to get started.

What is a Vaccine?
A vaccine is a preparation used to generate a protective immune response to a bacterium, virus or parasite. Everyone knows how the Salk and Sabin vaccines, funded by the March of Dimes, sharply reduced the incidence of crippling polio making the “iron lung” a museum piece. Many people believe that vaccines are only for children when in fact vaccines can also significantly improve the health of adults. The annual seasonal flu vaccine is a well-known example but there are others such as vaccines for herpes zoster and pneumococcal infections that should be given to adults once they reach a certain age. Fortunately, our bodies generally retain the ability to respond to vaccines as we age. Vaccine development remains an important area of biomedical research and we all look forward to the day when vaccines for HIV and malaria will eliminate these dreaded diseases just as the Vaccinia vaccine completely eradicated small pox. Everyone should keep a record of their vaccinations. Dr. Schmidt will advise you as to which vaccines are appropriate for you and whether its time for a “booster” shot.

What about Weight Lifting?
The goal of weight lifting, very simply, is to increase muscular strength and mass. The benefits of weight lifting are indirect because stronger muscles allow one to perform aerobic exercises at higher resistance levels for longer periods of time. Thus it is reasonable to supplement an aerobic program with weight lifting always making sure to start well below your weight goal, working in sets of ten, incrementally increasing the weight after each set and incorporating rest periods between sets. This approach helps to avoid injury and will ultimately lead to the achievement of higher levels of performance. Machines available in gyms help one to work on strengthening different muscle groups. This allows one to rotate among muscle groups thereby leading to greater overall strength while minimizing the risk of overusing any particular muscle group. A personal trainer for relatively little money can help you get the hang of it as well as teach you how to stretch your muscles in preparation for strenuous workouts.