Lorraine Allegro-Skinner”™s medical degree is from Mount Sinai School of Medicine. She trained in the Brown Family Medicine Residency (Brown University). She is a board-certified family physician in practice for 13 years in a variety of practice types. She cares for a full-age spectrum of patients from infancy through elderly.
Her office ”“ Health Quest Medical Practice Hopewell Junction Primary Care ”“ includes Maura Sullivan, M.D. (family medicine) and Carolyn Schulhoff, FNP (family nurse practitioner), and is affiliated with LaGrangeville-based Health Quest, which runs Northen Dutchess, Putnam and Vassar Brothers hospitals. The office provides primary care exclusively and offers phlebotomy (blood drawing) and some basic lab services.
Why did you choose medicine? All those germs ”¦
“I love science, caring for people and the opportunity to be in a career that allows me to constantly be learning new things. I just always wanted to be a doctor, although I do remember a brief period around 9 years old when I wanted to be an astronaut.”
Family practice, general care, general practitioner, internal medicine, pediatrics, geriatrics ”¦ What do you call your practice and how do you define it?
“I am a family practitioner or family doctor. Family medicine is a specialty that requires residency training and allows board certification like other specialties. Our training includes the full lifespan, we can deliver babies, take care of children, their parents and grandparents. One of the greatest joys in my practice is seeing the husband, child or sister of a patient. This is an advantage of family medicine, we never have to stop seeing a patient because of their age or gender.”
We hear about “D.O.s” filling the gap of missing M.D.s in primary care. Who are they? What”™s different about their training, medical degree and options for treatment (such as drug prescriptions)?
“Doctors of Osteopathy or DOs go to Osteopathic medical school. DO”™s that have been board certified in their specialty need to meet the same residency training requirements and pass the same licensure and board exams as MDs. So in our current medical system there really is not much difference. I think more and more you will be hearing about “mid-level” providers, nurse practitioners and physician assistants, filling the need in primary care. I have worked with many smart and skilled mid-levels over the years and feel they can be a big asset, especially in a busy practice.”
What percent of your patients are then referred by you to specialists? Do you ever feel you are a screening service for more specialized physicians: the man with an odd mole to the dermatologist, the girl with a cranky appendix to the surgeon?
“I have worked in rural areas for most of my career so for the most part I can care for what walks in the door. Obviously, I am not performing surgery and I no longer deliver babies, but many medical issues can be addressed right in our office. I involve a specialist when medically it makes sense, when his expertise is required or if we hit a roadblock in a medical workup. Specialists are a wonderful resource for my patients and me. I never feel like a screening service, I”™m too busy taking care of sick patients.”
Autism is much in the news, often associated with the word “epidemic.” It”™s been said of autism: genetics are the gun, environment is the bullet. Agree or disagree and what chemicals, if any, do you recommend avoiding that are commonly available?
“I would agree. As to what chemicals, well I think it”™s a combination of all of them. We have gradually introduced more substances into our environment, each maybe with minimal effect to humans. But, I think there is a cumulative effect, plastic water bottles and preservatives and dyes and VOC”™s in the paint, etc. If it were easy to sort out I think there would already be a strong lead to the cause of autism.”
You are in a fairly rural region. Is there a medical problem that you have detected that”™s pronounced in your area? What about a benefit?
“I kind of laughed at this question because I worked in rural Montana for six years so I feel like I”™m in the city here. I have seen the same medical problems here as everywhere else I”™ve worked. I think the biggest problem people face is the issue of access to medical care. I haven”™t seen a doctor for years; I have no insurance; I can”™t afford my medications ”“ that sort of thing. A benefit of being in a rural area is the community. People know each other, they lend a hand. The staff in our office know our patients well (often prior to them being patients) and that is so beneficial for the patients and for me.”
How important is preventative medicine in your work week? Do you work on an outreach basis regarding preventive medicine?
“Preventative medicine is the bread and butter of primary care. If I can assist and educate a patient and that leads to her quitting smoking, I”™ve earned my keep for the day. Cancer screening, diet recommendations, exercise and cholesterol modification are constant topics in our office. In terms of outreach, I think there may be some outreach opportunities in the works, but since I”™m still fairly new to this practice and community I haven”™t been out there so much yet. Stay tuned, I”™m sure it will happen.”
In Columbia County, a famous study conducted by the University of Michigan linked violent behavior with violent TV as early as the 1960s. How much TV do you believe is appropriate for grade-school children?
“We need to limit TV, video and computer games to one to two hours per day. I”™d say one on school days and two on weekends. No TV with homework, no TV in the bedroom. In addition to the violence and excessive sexual content on TV, the time spent watching TV takes away from the other things your children should be doing. Playing with friends, riding a bike, making a mud pie; play is the work of children. Television should never replace simple playtime.”
Some rapid-fire TV images have been linked to seizures ”“ so-called photosensitive epilepsy. How early should a child begin watching TV?
“We recommend no TV for children under the age of 2. This has less to do with seizures and more to do with their rapidly developing brains. Infants require social interaction for language development and social skills. Again, it comes down to needing play.”
Organic or nonorganic on the plate ”“ is there any evidence it matters?
“The official jury is still out. Nutrient-wise, they are probably about the same. But here is where we are talking about those chemicals again. If you can afford to buy all organic produce and dairy, I think that”™s great. Most of us can”™t, so I”™d rather see you eating the nonorganic fruits and veggies; just be sure you peel or wash them well under running water to reduce bacteria and pesticides.”
