I think that people with high deductible insurance plans, health savings accounts and the uninsured need to do some basic math before deciding where to go for their healthcare.
As a new calendar year approaches, everyone not on Medicaid (and not a county employee) has to know that their insurance likely does not pay a dime of their healthcare expenses until the deductible is met. For Medicare part B it is $147 for 2013 and for most private health insurance plans it is several thousand dollars.
As an example, let’s say that you are lucky enough to have a policy with only a $500 deductible. You could see a doctor on your plan (or more likely a nurse practitioner) 2-4 times during the year and be out the full $500 dollars. The good news is that each additional visit might only cost you $30-$50 out of your pocket.
Or, you could go to the Spiceland Pike Medical Center and see a licensed physician (even after work or on the weekend) for a basic problem up to 11 times during the year and still have some of your original $500 left over.
What I am saying is that it makes no financial sense to go to a doctor just because he is on your insurance plan if you have to meet a deductible before your insurance pays for part of your healthcare expenses.
You need to ask your doctor how much your visit will cost, how much the lab tests will cost and how much the x-rays will cost, especially while you are paying 100% of this cost during your deductible period.
12/28/12
11/5/12
HOWARD BEALE (GOOGLE IT) HAD THE RIGHT IDEA
I think that unless things change, I will be forced to stop taking care of my patients in the hospital by year’s end. Unfortunately, the hospital’s administration is making it impossible for me to do otherwise.
It used to be that I, as a solo practitioner, could call up any other primary care doctor and have them cover my hospital patients for me if I was going to be out of town. I would do likewise for them.
Now, I am the only primary care doctor in town who is not a hospital employee that cares for hospitalized patients. One would think that there would be no problem with getting coverage for the 2 weeks a year that I typically am out of town.
One would be wrong. Until recently, I would have a hospitalist (a former local internist) willingly cover for me. That doctor (who is now employed by St. Vincent’s) has since been forbidden from helping me.
I still have a group of three internists that provides coverage for me, but that will end soon. It will end because one of them is retiring, and the other two (who are employed by the hospital) are also being forced to abandon taking care of their own hospitalized patients.
To continue to provide care to my hospitalized patients beyond this year, I will have to never take a day off. The administration has made it clear that they are unwilling to make any accommodation to allow hospitalized Henry County citizens be cared for by their own doctor.
The hospital administration believes you won’t care that you no longer can choose which doctor takes care of you when you are hospitalized. They are probably right. But if you think they are wrong, call the CEO, Paul Janssen, at 521-1515 and let him know that your tax dollars support the hospital and pay his salary. You deserve a choice.
It used to be that I, as a solo practitioner, could call up any other primary care doctor and have them cover my hospital patients for me if I was going to be out of town. I would do likewise for them.
Now, I am the only primary care doctor in town who is not a hospital employee that cares for hospitalized patients. One would think that there would be no problem with getting coverage for the 2 weeks a year that I typically am out of town.
One would be wrong. Until recently, I would have a hospitalist (a former local internist) willingly cover for me. That doctor (who is now employed by St. Vincent’s) has since been forbidden from helping me.
I still have a group of three internists that provides coverage for me, but that will end soon. It will end because one of them is retiring, and the other two (who are employed by the hospital) are also being forced to abandon taking care of their own hospitalized patients.
To continue to provide care to my hospitalized patients beyond this year, I will have to never take a day off. The administration has made it clear that they are unwilling to make any accommodation to allow hospitalized Henry County citizens be cared for by their own doctor.
The hospital administration believes you won’t care that you no longer can choose which doctor takes care of you when you are hospitalized. They are probably right. But if you think they are wrong, call the CEO, Paul Janssen, at 521-1515 and let him know that your tax dollars support the hospital and pay his salary. You deserve a choice.
10/22/12
I JUST CAN'T "LET IT BE"
I think the local hospital has let down the citizens of Henry County. The administration and board of directors has chosen to transfer our hospital bit by bit to St. Vincent’s.
For years the hospital’s board of directors and administration has promised that this hospital will remain loyal to Henry County citizens and under local control. The recent facts paint quite a different picture.
First the administration took over the practices of primary care doctors. The FPs fell first, then the pediatricians and finally the internists at the Clinic. The few primary care physicians that remained independent were pushed out of hospital practice. All save yours truly (so far).
Next, the administration replaced these local doctors with hospitalists from St. Vincent’s. This decision prevents you from being cared for by your own doctor when you’re in the hospital. Instead your life is in the hands of nurse practitioners and doctors you have never met before.
Then, the administration contracted with St. Vincent’s to supply the emergency room doctors. This decision marginalized our local and longstanding ER physicians.
Most recently, the administration announced a “partnership” with St. Vincent’s to start a heart cath lab. It should come as no surprise now hat our hometown cardiologist is being replaced by cardiologists from our “partner”.
You don’t have to be a brain surgeon to know that it is just a matter of time before a statue of Mary is out front, welcoming patients to the latest hospital being incorporated into the St. Vincent’s network.
10/15/12
A HOSPITAL (NOT) OF THE PEOPLE, (NOT) FOR THE PEOPLE, AND (NOT) BY THE PEOPLE
I think that the citizens of Henry County have a right to know what is going on at their local hospital. I see changes being made that are not in the best interest of our community.
The hospital administration seems to be immune from public criticism. And indeed, who is willing to stand up and say what needs saying?
Is it the local doctors, who have the most intimate knowledge of the changes occurring? It should be, but it is hard to criticize your boss publically and all of the local doctors who have staff privileges at the hospital (save yours truly) are employees of the hospital.
Is it the hospital board of trustees which has the power and responsibility to oversee the administration and ensure that changes being made benefit the local citizens? It should be, but it has a long history of rubber-stamping any administration request.
Is it the Board of County Commissioners (appointers of the board of trustees) which allows the hospital CEO to continue in an ill-conceived and short-sighted direction? It should be, but these people are too busy devising boondoggles like the Health & Wellness Clinic.
The bottom line is that I am the only person not under anyone’s thumb with knowledge that the hospital’s current direction fails to best serve the citizens of Henry County. The next three weeks will outline the problem and how it affects my (and possible your doctor’s) ability to provide patients with the best healthcare locally.
7/16/12
IMAGIN(EIN)G: SAVING MONEY
I
think people can save a significant amount of money on their health
care even if they don't have health insurance. Imaging studies (CT
scans, ultrasounds, MRIs) can be one of the largest health care
expenses. This week I will tell you how to save money on them.
Independent
imaging centers such as Indianapolis based CDI (Center for Diagnostic
Imaging) charge on average 30% less than hospital-based radiology
departments. Free price quotes can be obtained by calling
1-800-537-0005. They provide the same high-quality studies and (in my
experience) often provide better and faster service.
The heart scan screens for coronary artery disease. The price of this can vary from $49 locally to $29 at Reid Hospital in Richmond. Your doctor can help you determine if this test would be beneficial to you versus a much more costly cardiac stress test.
A common expense can be a followup of an abnormal chest x-ray. A repeat exam in 3 months is much cheaper that an immediate CT scan and is often a reasonable alternative depending on the abnormality.
Mobile screening units offer a limited amount of low priced imaging studies (carotid artery ultrasounds and aortic aneurysm screens). I would caution you to discuss with your doctor which tests are appropriate for you rather than just doing all of the tests offered.
Screening mammograms are offered by many hospitals at a reduced rate around Mother's Day and during breast cancer awareness month in October. Certain patients can also qualify for free ones through a grant from ICAP at 765-529-4403.
Let your doctor know if an imaging study would be a significant financial burden to you so alternatives can be discussed. If you're willing and able to drive a little, you can save a lot.
The heart scan screens for coronary artery disease. The price of this can vary from $49 locally to $29 at Reid Hospital in Richmond. Your doctor can help you determine if this test would be beneficial to you versus a much more costly cardiac stress test.
A common expense can be a followup of an abnormal chest x-ray. A repeat exam in 3 months is much cheaper that an immediate CT scan and is often a reasonable alternative depending on the abnormality.
Mobile screening units offer a limited amount of low priced imaging studies (carotid artery ultrasounds and aortic aneurysm screens). I would caution you to discuss with your doctor which tests are appropriate for you rather than just doing all of the tests offered.
Screening mammograms are offered by many hospitals at a reduced rate around Mother's Day and during breast cancer awareness month in October. Certain patients can also qualify for free ones through a grant from ICAP at 765-529-4403.
Let your doctor know if an imaging study would be a significant financial burden to you so alternatives can be discussed. If you're willing and able to drive a little, you can save a lot.
7/9/12
ACCEPT NO (LESSER TRAINED) SUBSTITUTE
I
think that being cared for in the hospital by a nurse practitioner
instead of a doctor is unacceptable. The breath of depth of training
between physicians and nurse practitioners are immense.
A board-certified Family Physician will have up to 1700 more lecture hours, 1500 more study hours and 10,000 more residency hours than a nurse practitioner. Advance clinical care constitutes only 33% of the curriculum for nurse practitioners.
Family physicians complete training for complex differential diagnoses and medical treatments. A nurse practitioner is trained to recognize and treat common conditions.
You know what you are getting with a board-certified Family Practice doctor since they must complete an accredited training program and pass a standardized exam to become board-certified. The requirements are the same in all 50s states.
A nurse practitioner must complete a training program that varies from state to state without any nationwide standardization. Only 38 states require them to hold a masters degree and those states grandfathered in those who called themselves nurse practitioners prior to 2008 whether or not a Masters degree was ever completed.
Physicians are taught by other physicians to learn what is needed to provide quality care to a hospitalized patient. Nurse practitioners or taught by nurses to attempt to learn what is needed to provide quality care to hospitalized patients.
That is like having a flight attendant train another flight attendant to act as a pilot. I am sure they are intelligent, hard-working and kind but I don't want them to fly my plane and I don't want a nurse practitioner taking care of me in the hospital.
A board-certified Family Physician will have up to 1700 more lecture hours, 1500 more study hours and 10,000 more residency hours than a nurse practitioner. Advance clinical care constitutes only 33% of the curriculum for nurse practitioners.
Family physicians complete training for complex differential diagnoses and medical treatments. A nurse practitioner is trained to recognize and treat common conditions.
You know what you are getting with a board-certified Family Practice doctor since they must complete an accredited training program and pass a standardized exam to become board-certified. The requirements are the same in all 50s states.
A nurse practitioner must complete a training program that varies from state to state without any nationwide standardization. Only 38 states require them to hold a masters degree and those states grandfathered in those who called themselves nurse practitioners prior to 2008 whether or not a Masters degree was ever completed.
Physicians are taught by other physicians to learn what is needed to provide quality care to a hospitalized patient. Nurse practitioners or taught by nurses to attempt to learn what is needed to provide quality care to hospitalized patients.
That is like having a flight attendant train another flight attendant to act as a pilot. I am sure they are intelligent, hard-working and kind but I don't want them to fly my plane and I don't want a nurse practitioner taking care of me in the hospital.
7/2/12
WHY YOU SHOULD CHOOSE A HOPITA(LAST)
I
think when people are at their sickness (in the hospital) they want
to be cared for by the doctor who knows them best. This is becoming
an option available for fewer and fewer people nowadays both locally
and nationally.
The concept of the hospitalist specialty is to have a doctor who only takes care of patients in the hospital. No care is provided in an office setting and no long-term doctor/patient relationship exists.
The theoretic advantages include having a doctor always available on site to immediately address test results and changes in the patient's condition. This arrangement should be able to save money by allowing patients to be discharged to home sooner.
The disadvantages include having a doctor who doesn't know the full, often complex, history of the patient including prior evaluations and treatment. Upon the patient's release, the family doctor often does not know what transpired during the hospitalization and what followup is needed.
Not surprisingly, the theoretic advantages have not materialized. Recent studies show that any cost savings from an earlier release from the hospital in patient's cared for by hospitalists are more than offset by the expense of additional ER visits and readmissions to the hospital in the month following discharge.
It seems to me that under the guise of "focusing on outpatient care ", family practice doctors who choose not to care for their hospitalized patients are abdicating their professional responsibility. I would not choose a doctor that was only committed to my healthcare while they are in the office 6 hours a day, 4 days a week. But maybe that's just me.
The concept of the hospitalist specialty is to have a doctor who only takes care of patients in the hospital. No care is provided in an office setting and no long-term doctor/patient relationship exists.
The theoretic advantages include having a doctor always available on site to immediately address test results and changes in the patient's condition. This arrangement should be able to save money by allowing patients to be discharged to home sooner.
The disadvantages include having a doctor who doesn't know the full, often complex, history of the patient including prior evaluations and treatment. Upon the patient's release, the family doctor often does not know what transpired during the hospitalization and what followup is needed.
Not surprisingly, the theoretic advantages have not materialized. Recent studies show that any cost savings from an earlier release from the hospital in patient's cared for by hospitalists are more than offset by the expense of additional ER visits and readmissions to the hospital in the month following discharge.
It seems to me that under the guise of "focusing on outpatient care ", family practice doctors who choose not to care for their hospitalized patients are abdicating their professional responsibility. I would not choose a doctor that was only committed to my healthcare while they are in the office 6 hours a day, 4 days a week. But maybe that's just me.
6/25/12
HOW TO AVOID ER(RORS)
I
think that having local doctors running local emergency rooms is a
good idea. Problems occur when a local hospital contracts with a
large group of doctors that are not invested in the community and
that work in multiple larger hospitals.
Out of necessity those doctors are trained to do things the same way in every hospital's ER. They have no understanding or caring that what works well in a large, big city Hospital does not work well in a smaller community hospital.
In a large hospital, the ER doctor often serves as a glorified triage nurse, merely stabilizing patients and deciding whether they need to be admitted. They often don't address every significant medical problem, putting the patient at risk for an adverse outcome.
At large hospitals, attending doctors are available in the hospital at all times and patients are evaluated by them in the ER prior to admission . In a small hospital, a doctor may not see the patient for several hours after admission and depends on the ER doctor being skilled and competent enough to keep the patient stable until reevaluated.
Relationships with other local doctors are important to establish trust and confidence . A primary care doctor needs to know that a patient being admitted from the ER is going to have all important health care issues addressed at the time of admission and that all those issues have been discussed.
It is also important for ER doctors to know the strengths and limitations of the local health care system. Small towns do not have the same resources as larger cities. Not every patient is best served by being sent out of town for tests, procedures or referrals.
Small communities are best served by local institutions which are best run by local people. This is true of government, banks and healthcare, especially where the ER is concerned.
Out of necessity those doctors are trained to do things the same way in every hospital's ER. They have no understanding or caring that what works well in a large, big city Hospital does not work well in a smaller community hospital.
In a large hospital, the ER doctor often serves as a glorified triage nurse, merely stabilizing patients and deciding whether they need to be admitted. They often don't address every significant medical problem, putting the patient at risk for an adverse outcome.
At large hospitals, attending doctors are available in the hospital at all times and patients are evaluated by them in the ER prior to admission . In a small hospital, a doctor may not see the patient for several hours after admission and depends on the ER doctor being skilled and competent enough to keep the patient stable until reevaluated.
Relationships with other local doctors are important to establish trust and confidence . A primary care doctor needs to know that a patient being admitted from the ER is going to have all important health care issues addressed at the time of admission and that all those issues have been discussed.
It is also important for ER doctors to know the strengths and limitations of the local health care system. Small towns do not have the same resources as larger cities. Not every patient is best served by being sent out of town for tests, procedures or referrals.
Small communities are best served by local institutions which are best run by local people. This is true of government, banks and healthcare, especially where the ER is concerned.
6/5/12
THE BIGGER THEY ARE...
I
think that the disturbing trend of the government allowing businesses
to get too big by merging with and buying out competitors is now also
involving healthcare. Just as financial institutions are allowed to
merge and acquire smaller entities with little oversight, so too are
healthcare groups.
Banks promoted that by becoming larger, they would be more efficient and pass those cost savings on to their customers. I would argue that the end result has been more reckless behavior, less flexibility and higher customer fees.
I am concerned because a similar situation is happening in healthcare. Fewer and fewer entities (think IU Health and St. Vincents) are controlling more and more of Indiana's hospitals and doctors practices. This creates at least 3 potential problems.
The first is the adverse effect on costs to the patient. Plastic surgery and laser eye procedures have been the only things in healthcare that have decreased in price over the years. This is because insurance is generally not involved and there is great competition amongst many providers.
The second is that if these large institutions were to make bad financial decisions resulting in insolvency , the government would have to bail them out to prevent a catastrophic collapse of the healthcare system. This policy is bad for consumers and bad for America.
The third is the de facto creation of socialized medicine this causes. If there are only 2 or 3 providers of healthcare and they all have to follow the government's rules on Medicare and Medicaid, the government is effectively running our nation's healthcare system.
Competition is good and necessary for the healthcare (and every other) industry. The harm from bigger and fewer healthcare entities vastly outweighs the benefits.
Banks promoted that by becoming larger, they would be more efficient and pass those cost savings on to their customers. I would argue that the end result has been more reckless behavior, less flexibility and higher customer fees.
I am concerned because a similar situation is happening in healthcare. Fewer and fewer entities (think IU Health and St. Vincents) are controlling more and more of Indiana's hospitals and doctors practices. This creates at least 3 potential problems.
The first is the adverse effect on costs to the patient. Plastic surgery and laser eye procedures have been the only things in healthcare that have decreased in price over the years. This is because insurance is generally not involved and there is great competition amongst many providers.
The second is that if these large institutions were to make bad financial decisions resulting in insolvency , the government would have to bail them out to prevent a catastrophic collapse of the healthcare system. This policy is bad for consumers and bad for America.
The third is the de facto creation of socialized medicine this causes. If there are only 2 or 3 providers of healthcare and they all have to follow the government's rules on Medicare and Medicaid, the government is effectively running our nation's healthcare system.
Competition is good and necessary for the healthcare (and every other) industry. The harm from bigger and fewer healthcare entities vastly outweighs the benefits.
5/31/12
YOU CAN'T (AND SHOULDN'T) ALWAYS GET WHAT YOU WANT
I
think too many people are on chronic narcotics. There is a reason
that prescription drug abuse and overdose deaths are at a record
high. The biggest reason is the over-prescribing of these
medications.
Narcotics are a godsend to people in pain from terminal diseases. Nobody would argue that doctors shouldn't prescribe whatever is necessary to ease the suffering of those at the end of life.
These drugs are also clearly beneficial in patients recovering from surgery and significant injuries. Studies demonstrate that uncontrolled pain causes a release of hormones that slows the healing process.
Narcotics are too often prescribed to young patients for long-term use by naïve, inexperienced, lazy or unethical doctors (or inadequately trained nurse practitioners). These patients often have vague or unsubstantiated diagnoses.
A doctor is not doing a patient who has chronic pain any favors by additionally burning them with a chronic dependence on narcotics. There are multiple nonnarcotic medication that can be used to ameliorate different types of chronic pain.
Once a patient who has chronic pain is provided a routine, ongoing prescription for narcotics, they are being committed to a lifetime of use by the prescriber. It is very difficult to convince the patient to switch to safer medications for long-term use. Long-term narcotic use is associated with depression and increased risks of falls and injuries.
It has been my experience that many patients who have a chronic, large supply of narcotics are more than willing to play the "good Samaritan" and offer their drugs to friends and relatives who are in pain. This is problematic for reasons both medical and legal.
Patients who have chronic pain need to be treated with medications that are safe and appropriate for long-term use. Narcotics are rarely the right choice.
Narcotics are a godsend to people in pain from terminal diseases. Nobody would argue that doctors shouldn't prescribe whatever is necessary to ease the suffering of those at the end of life.
These drugs are also clearly beneficial in patients recovering from surgery and significant injuries. Studies demonstrate that uncontrolled pain causes a release of hormones that slows the healing process.
Narcotics are too often prescribed to young patients for long-term use by naïve, inexperienced, lazy or unethical doctors (or inadequately trained nurse practitioners). These patients often have vague or unsubstantiated diagnoses.
A doctor is not doing a patient who has chronic pain any favors by additionally burning them with a chronic dependence on narcotics. There are multiple nonnarcotic medication that can be used to ameliorate different types of chronic pain.
Once a patient who has chronic pain is provided a routine, ongoing prescription for narcotics, they are being committed to a lifetime of use by the prescriber. It is very difficult to convince the patient to switch to safer medications for long-term use. Long-term narcotic use is associated with depression and increased risks of falls and injuries.
It has been my experience that many patients who have a chronic, large supply of narcotics are more than willing to play the "good Samaritan" and offer their drugs to friends and relatives who are in pain. This is problematic for reasons both medical and legal.
Patients who have chronic pain need to be treated with medications that are safe and appropriate for long-term use. Narcotics are rarely the right choice.
5/21/12
INSURANCE SHMINSURANCE
I
think that health insurance is not needed (and in my opinion should
not be used) to have affordable basic primary health care. Healthcare
reform is only needed in areas involving insurance for the expenses
associated with hospitalizations and procedures.
The average American spends $65 per month on a cell phone bill, $40 per month on Internet access and $70 per month on a cable/satellite TV bill. That is over $2000 per year on (what I would argue is) discretionary spending.
In my practice, the average person who has 2 or more chronic conditions will spend per year about $120 for 2 office visits, $100 on labs and $160 on prescribed medications. This averages out to a little over one dollar per day for their basic healthcare.
There are very few people who cannot afford that amount. It is about priorities. If your health is important enough you will use your discretionary spending money on that first even if that means cutting down on smoking, eating out, cell phone use, Internet access or cable TV.
If you're spending more than that on your primary healthcare, you need to ask yourself why. Is your doctor charging you too much? Can your medications be changed to cheaper ones? Are you provided with samples of medications you cannot afford? Are the prices being charged for lab tests too high? Are all the labs necessary?
I encourage you to compare prices. Call various doctor's offices and ask how much a visit is, ask if medicine samples are available and ask how much a lab test such as a cholesterol screen will cost you.
Don't assume that you can't afford to care for yourself just because you don't have health insurance or have a high deductible. Receiving healthcare now can save your money and health for the future.
The average American spends $65 per month on a cell phone bill, $40 per month on Internet access and $70 per month on a cable/satellite TV bill. That is over $2000 per year on (what I would argue is) discretionary spending.
In my practice, the average person who has 2 or more chronic conditions will spend per year about $120 for 2 office visits, $100 on labs and $160 on prescribed medications. This averages out to a little over one dollar per day for their basic healthcare.
There are very few people who cannot afford that amount. It is about priorities. If your health is important enough you will use your discretionary spending money on that first even if that means cutting down on smoking, eating out, cell phone use, Internet access or cable TV.
If you're spending more than that on your primary healthcare, you need to ask yourself why. Is your doctor charging you too much? Can your medications be changed to cheaper ones? Are you provided with samples of medications you cannot afford? Are the prices being charged for lab tests too high? Are all the labs necessary?
I encourage you to compare prices. Call various doctor's offices and ask how much a visit is, ask if medicine samples are available and ask how much a lab test such as a cholesterol screen will cost you.
Don't assume that you can't afford to care for yourself just because you don't have health insurance or have a high deductible. Receiving healthcare now can save your money and health for the future.
5/14/12
SPMC IS THE PLACE FOR ME (AND YOU)
I
think the reason that the Spiceland Pike Medical Center (SPMC) has
been successful for over 15 years is because of several factors. It
involves continuity of care, good employees, patient focused concepts
and comprehensive care.
A doctor/patient relationship is more valuable the longer it develops. Patient's don't like to see a new face when they are sick, especially when that new face belongs to the doctor or a lesser trained healthcare provider. At SPMC there has always been just one full-time doctor.
Employees are hard to find when expectations are uncompromising. I am criticized for being hard to work for her, but I make no apology for having high customer service and technical standards. Quite frankly, few people are excellent enough to be hired and stay hired at SPMC.
From day one, SPMC has focused on what I would want as a patient. I would want to be able to see my doctor when I want and at a price I could afford even if I didn't have health insurance. Having that doctor board-certified in the top 2% is a nice bonus.
Only at SPMC can patients see the same board-certified doctor at each visit and not someone else's doctor or a nurse practitioner. Only at SPMC can patients be seen without an appointment, after 5 PM and on the weekend. And only at SPMC can patients without insurance not be expected to pay more than patients with commercial insurance.
SPMC provides for patients to be cared for by the same doctor in the office, hospital and nursing home. This comprehensive care used to be the standard but is now a rarity as other practices have abandoned a patient centered focus in favor of having a better lifestyle.
I thank the people of New Castle, Hagerstown, Knightstown and other surrounding towns for entrusting their healthcare to SPMC. We will continue to provide you the healthcare you deserve.
A doctor/patient relationship is more valuable the longer it develops. Patient's don't like to see a new face when they are sick, especially when that new face belongs to the doctor or a lesser trained healthcare provider. At SPMC there has always been just one full-time doctor.
Employees are hard to find when expectations are uncompromising. I am criticized for being hard to work for her, but I make no apology for having high customer service and technical standards. Quite frankly, few people are excellent enough to be hired and stay hired at SPMC.
From day one, SPMC has focused on what I would want as a patient. I would want to be able to see my doctor when I want and at a price I could afford even if I didn't have health insurance. Having that doctor board-certified in the top 2% is a nice bonus.
Only at SPMC can patients see the same board-certified doctor at each visit and not someone else's doctor or a nurse practitioner. Only at SPMC can patients be seen without an appointment, after 5 PM and on the weekend. And only at SPMC can patients without insurance not be expected to pay more than patients with commercial insurance.
SPMC provides for patients to be cared for by the same doctor in the office, hospital and nursing home. This comprehensive care used to be the standard but is now a rarity as other practices have abandoned a patient centered focus in favor of having a better lifestyle.
I thank the people of New Castle, Hagerstown, Knightstown and other surrounding towns for entrusting their healthcare to SPMC. We will continue to provide you the healthcare you deserve.
5/6/12
2012 DINKTHINK ROUND 2
I think that it is again time for me to inform people about changes in healthcare that are occurring both locally and nationally. These are changes that are largely harmful to patients and their pocketbooks.
As you may remember, I ran a series of these educational advertisements several years ago. There were many people who appreciated hearing an honest viewpoint from an independent, self-employed physician who was not under anyone's thumb.
There was even one patient who offered me a check to fund additional newspaper ad space for me. I declined of course, but was taken aback by how he and others were longing to hear the truth about various healthcare issues.
Many things that need saying about the changes in healthcare are not being said. Since my last series of ads there are even fewer people with inside knowledge of the local and national healthcare situation that are are willing/able to speak their mind.
Just as my office has always provided flu shots at cost (charging about 50% of what Medicare allows), this is a service to the community that otherwise wouldn't get this candid information. Hopefully, this will spark dialogue and action to correct problems both locally and nationally.
Healthcare reform so far has been a pseudo-science at best. Changes such as mandatory electronic health records are being enacted at great expense in the name of progress, modernization and efficiency despite it never having been shown to improve the health of patients.
Over the next 11 weeks I will be enlightening many, shocking some and annoying a few (OK , maybe more than a few) by illuminating the problems with the present state of our local and national health care system. So buckle up, it could be a bumpy ride for some.
2/16/10
A CHANGE THAT MAKES (AND SAVES) CENTS, PART 1
I think we all know by now, the Obama health care overhaul went nowhere. Despite being well intentioned, it was ill conceived and overreaching.
The quality and innovation of the American health care system needs to stay intact. The cost to people to utilize the system needs to come down. This should be done through free market principles not socialist ones.
The government’s role should be that of an oversight agency to prevent the abuses that have been allowed to occur to the benefit of a few and the detriment of many. (Wall Street anyone?) The government should not be competing with private entities.
The three main sources of the health care problems are the malpractice lawyers, the doctors themselves and the insurance companies. The list is in ascending order of culpability with the first two causing <5%> 95%.
Over the next several weeks I will address what those three groups need to do to correct things. The motivation for this will not come from within, but must come from the government and the people who elect them.
The quality and innovation of the American health care system needs to stay intact. The cost to people to utilize the system needs to come down. This should be done through free market principles not socialist ones.
The government’s role should be that of an oversight agency to prevent the abuses that have been allowed to occur to the benefit of a few and the detriment of many. (Wall Street anyone?) The government should not be competing with private entities.
The three main sources of the health care problems are the malpractice lawyers, the doctors themselves and the insurance companies. The list is in ascending order of culpability with the first two causing <5%> 95%.
Over the next several weeks I will address what those three groups need to do to correct things. The motivation for this will not come from within, but must come from the government and the people who elect them.
9/27/07
RIGHT (NOT) TO WORK
I think that Indiana is making it hard to be a small business owner. Everyone is aware of the outrageous property taxes. These affect the business owner twice, as he is likely a homeowner also. Most people don't know how ridiculously the administrative law judge for the Indiana Department of Workforce Development for Henry County applies the law.
Indiana has an "at will" employment statute. This theoretically means that an employee can quit an employer at any time without penalty and an employer can hire and fire employees at any time. An exception exists that prevents the firing to be based on an act of discrimination such as for race, ethnicity, or religion.
Indiana has gone beyond that to allow unemployment benefits to be awarded to a worker who is not terminated for "just cause". To establish just cause the employer must prove: (1) there was a rule; (2) the rule was reasonable; (3) the rule was uniformly enforced; (4) the claimant knew of the rule; and (5) the claimant knowingly violated the rule.
This all seems very reasonable as it protects the employee from the financial difficulties from being arbitrarily fired without warning or reason. An employer can still terminate someone at will, but that person is entitled to unemployment benefits.
The problem arises when the people involved in this decision making process are biased towards one side or the other or interpret the law in a matter that defies logic or even common sense. Such is the situation for Henry County.
The administrative law judge, Ann Carnes, has taken a very biased and liberal view on who deserves unemployment benefits. The most egregious example of which is where a policeman in New Castle, who was terminated for and admitted to taking a bribe, was granted unemployment benefits. The reasoning was that since the city couldn't prove that every past and current policeman had never taken a bribe, the policy wasn't being uniformly enforced. It didn't matter that all policeman caught taking a bribe were fired.
My own experiences involved an employee being awarded benefits who admitted to having violated a company policy against using cell phones at work. There was one involving an employee who was proven to have violated a company policy against using work computers for personal e-mails. And there is a pending one involving an employee who was fired for being rude to patients and causing them to transfer care to other doctors.
I lost the first two cases. I also fully expect to lose the third as well despite overwhelming evidence in my favor.
The problem this poses for the employer are multi-fold. They involve direct and indirect effects.
Directly, when an ex-employee is granted unemployment benefits, the employers unemployment tax rate goes up. This adds another straw on the small business owner's back.
Indirectly, the employer is less likely to hire full-time employees. Indiana does not grant unemployment benefits to part-time workers. There are therefore less full-time jobs available and therefore less health care benefits available to workers.
Unemployment benefits were created by the federal government in 1935 to form as a social welfare benefit to assist employees who lost their jobs through no fault of their own, e.g. through lay-offs. The requirements were that the worker would continue to actively seek other employment during the 26 week benefit period.
The problem with Indiana's system is that the system permits basically a 26 week partially paid vacation. There is an inappropriate granting of benefits and an inadequate monitoring of people who are receiving unemployment benefits. Many times these people 1) do not report having obtained a job, 2) take a job while being paid under the table, or 3) do not bother to look for a job at all until the benefits period expires.
Indiana would do well to encourage small business owners in these difficult economic times. Those people who abuse the unemployment system as well as those who ignore the problem with it should be aware that if there are fewer employers left in Indiana, there will be fewer opportunities for Hoosiers to obtain full time jobs.
Indiana has an "at will" employment statute. This theoretically means that an employee can quit an employer at any time without penalty and an employer can hire and fire employees at any time. An exception exists that prevents the firing to be based on an act of discrimination such as for race, ethnicity, or religion.
Indiana has gone beyond that to allow unemployment benefits to be awarded to a worker who is not terminated for "just cause". To establish just cause the employer must prove: (1) there was a rule; (2) the rule was reasonable; (3) the rule was uniformly enforced; (4) the claimant knew of the rule; and (5) the claimant knowingly violated the rule.
This all seems very reasonable as it protects the employee from the financial difficulties from being arbitrarily fired without warning or reason. An employer can still terminate someone at will, but that person is entitled to unemployment benefits.
The problem arises when the people involved in this decision making process are biased towards one side or the other or interpret the law in a matter that defies logic or even common sense. Such is the situation for Henry County.
The administrative law judge, Ann Carnes, has taken a very biased and liberal view on who deserves unemployment benefits. The most egregious example of which is where a policeman in New Castle, who was terminated for and admitted to taking a bribe, was granted unemployment benefits. The reasoning was that since the city couldn't prove that every past and current policeman had never taken a bribe, the policy wasn't being uniformly enforced. It didn't matter that all policeman caught taking a bribe were fired.
My own experiences involved an employee being awarded benefits who admitted to having violated a company policy against using cell phones at work. There was one involving an employee who was proven to have violated a company policy against using work computers for personal e-mails. And there is a pending one involving an employee who was fired for being rude to patients and causing them to transfer care to other doctors.
I lost the first two cases. I also fully expect to lose the third as well despite overwhelming evidence in my favor.
The problem this poses for the employer are multi-fold. They involve direct and indirect effects.
Directly, when an ex-employee is granted unemployment benefits, the employers unemployment tax rate goes up. This adds another straw on the small business owner's back.
Indirectly, the employer is less likely to hire full-time employees. Indiana does not grant unemployment benefits to part-time workers. There are therefore less full-time jobs available and therefore less health care benefits available to workers.
Unemployment benefits were created by the federal government in 1935 to form as a social welfare benefit to assist employees who lost their jobs through no fault of their own, e.g. through lay-offs. The requirements were that the worker would continue to actively seek other employment during the 26 week benefit period.
The problem with Indiana's system is that the system permits basically a 26 week partially paid vacation. There is an inappropriate granting of benefits and an inadequate monitoring of people who are receiving unemployment benefits. Many times these people 1) do not report having obtained a job, 2) take a job while being paid under the table, or 3) do not bother to look for a job at all until the benefits period expires.
Indiana would do well to encourage small business owners in these difficult economic times. Those people who abuse the unemployment system as well as those who ignore the problem with it should be aware that if there are fewer employers left in Indiana, there will be fewer opportunities for Hoosiers to obtain full time jobs.
8/21/07
WORKING FOR A LIVING
I think that the system for medical disability is a mess. Too often I see patients who should be granted disability unable to get it and too often I see patients who should not have been granted disability get it.
A big part of the reason that the disability system is a mess is because it's run by lawyers and the government. Nothing good comes to mind when you mix the two together.
Disability is of course a legal term. It is determined by the court system. A doctor never determines if a patient is disabled or not. Disability is very subjective which explains why two patients with the same condition may have one labeled as disabled but not the other one.
The doctor determines a patient's impairment rating which is based upon objective exam findings. There exists a published guideline to allow a concise number to be obtained which is called an impairment rating. This rating is a percentage with the maximum being 100%, say if someone is completely impaired from quadriplegia, and can range to less than 1%, say in the case of the loss of a little toe.
While one could argue the validity of the relative percentages assigned to different physical limitations, the important point is that these numbers have great reliability amongst different examining physicians. Consistency is a hallmark in impairment ratings but not so in disability ratings.
The disability rating, which is determined by the legal/government system, takes into account the impairment rating along with the patient's age, education level, ability to continue in his chosen profession and other factors. For example, a construction worker and a computer programmer would have the same impairment rating from the loss of a leg, but the former would have a much greater disability based on their ongoing ability to perform their current jobs.
Unfortunately, anyone can apply for disability at anytime. This process sets off a time consuming and expensive cascade of events that may involve an application, a review of same, a request for medical records, a review of same, a physical examination by a physician, a referral for additional diagnostic tests, a referral to a specialist, and finally a review of all the preceding information. The taxpayer pays for all these services regardless of how legitimate the claim for disability is.
The government pays a pittance for the amount of work required by a physician to review the records and perform a history and physical examination on the patient who is applying for disability. Thus, these exams are often performed by under trained and underpaid physicians who don't have the ability or communication skills to provide better employment opportunities.
A good rule of thumb is that everyone gets denied disability when they first apply. I have personally never heard of anyone receiving disability without retaining the services of an attorney first. I suppose this deters to some degree the people who shouldn't be applying in the first place, but not until the previously listed process is gone through. It does however also deter many deserving patients of this determination.
There is a reason you see ads on television for lawyers who specialize in disability claims. There is money to be made from people that deserve disability but cannot get it without an attorney's intervention on their behalf.
Too often a patient will come in and request disability papers be filled out and not be interested in nor having had pursued any treatment for the perceived disability. These patients, much like those that are in the process of suing someone over an accident, are not motivated, some consciously some subconsciously, to get better.
The rare but unfortunate case is the patient who has a condition that can be successfully treated and wants to be treated, but cannot afford the care required to treat and sometimes cure their disability. Once disability benefits, including health insurance, are granted, this patient will aggressively pursue treatment. The more frequent case is that of the patient who would rather maintain the disability, receive benefits, and eschew treatment.
Just like the welfare system used to reward mothers for having children out of wedlock and penalize women who married, so too does the disability system reward people for not working and penalize those who do try to work.
We are all aware of the patient who is on disability for a physical condition, but can golf, Jet Ski, and do any number of physical activities except work for a living. I remember a fellow resident who talked to first grade class about careers. He asked the students what they wanted to do when they grow up and one child said he wanted to be on disability, just like his dad. Sad, but true.
People should not be able to self-refer for a disability evaluation. Only doctors should have that right. And once a patient is referred the process should be streamlined and not require the patient to hire a lawyer to get disability benefits. If the evaluating physician thinks that an impairment and subsequent disability exists, then a lawyer should not be necessary. If the evaluating physician thinks that an impairment doesn't exist or doesn't merit disability, then a lawyer and court should not be allowed to overrule.
Although certain conditions are diseases and are disabling, they are also completely preventable. No one should be permitted to receive disability payments for obesity, alcoholism, or drug abuse.
If disability is granted, it should be determined whether it will persist despite treatment, it will persist only if treatments are discontinued, or it will not persist once a finite treatment is provided. This triage system would allow an appropriate and cost effective approach.
An example of the first case would be a person with quadriplegia. Although treatment can prevent complications from developing, the underlying problem of paralysis will not change. This person would require medical benefits and living expenses. All patients in this class should be re-evaluated annually to determine if any new treatments are available that could improve their underlying disability.
A patient in the second group would include someone with seizures. This person would require medical treatment to control his disability and should be provided medical benefits only once the seizures are controlled to the point where employment would be viable. An annual re-evaluation would determine whether medical benefits needed to be continued, or if the patient could now coped with his ongoing medical expenses on his own or through private insurance.
The people in the last class would include someone with severe hip arthritis. This condition is curable through surgery and medical benefits should end once that person has fully recovered and is able to return to full active work activities.
If someone has an impairment that prevents certain work, then they should be expected to work at a job that can perform with their disability. If this causes an income discrepancy from their pre-morbid state, then the difference can be provided. This makes much more sense than not allowing a partially disabled person to work full time if able.
When it comes to determining medical disability, the lawyers should be removed from the process. The government's role should be limited in the process. Disability benefits should be available on an "as needed basis" for an "as long as needed basis" as determined by a physician.
A big part of the reason that the disability system is a mess is because it's run by lawyers and the government. Nothing good comes to mind when you mix the two together.
Disability is of course a legal term. It is determined by the court system. A doctor never determines if a patient is disabled or not. Disability is very subjective which explains why two patients with the same condition may have one labeled as disabled but not the other one.
The doctor determines a patient's impairment rating which is based upon objective exam findings. There exists a published guideline to allow a concise number to be obtained which is called an impairment rating. This rating is a percentage with the maximum being 100%, say if someone is completely impaired from quadriplegia, and can range to less than 1%, say in the case of the loss of a little toe.
While one could argue the validity of the relative percentages assigned to different physical limitations, the important point is that these numbers have great reliability amongst different examining physicians. Consistency is a hallmark in impairment ratings but not so in disability ratings.
The disability rating, which is determined by the legal/government system, takes into account the impairment rating along with the patient's age, education level, ability to continue in his chosen profession and other factors. For example, a construction worker and a computer programmer would have the same impairment rating from the loss of a leg, but the former would have a much greater disability based on their ongoing ability to perform their current jobs.
Unfortunately, anyone can apply for disability at anytime. This process sets off a time consuming and expensive cascade of events that may involve an application, a review of same, a request for medical records, a review of same, a physical examination by a physician, a referral for additional diagnostic tests, a referral to a specialist, and finally a review of all the preceding information. The taxpayer pays for all these services regardless of how legitimate the claim for disability is.
The government pays a pittance for the amount of work required by a physician to review the records and perform a history and physical examination on the patient who is applying for disability. Thus, these exams are often performed by under trained and underpaid physicians who don't have the ability or communication skills to provide better employment opportunities.
A good rule of thumb is that everyone gets denied disability when they first apply. I have personally never heard of anyone receiving disability without retaining the services of an attorney first. I suppose this deters to some degree the people who shouldn't be applying in the first place, but not until the previously listed process is gone through. It does however also deter many deserving patients of this determination.
There is a reason you see ads on television for lawyers who specialize in disability claims. There is money to be made from people that deserve disability but cannot get it without an attorney's intervention on their behalf.
Too often a patient will come in and request disability papers be filled out and not be interested in nor having had pursued any treatment for the perceived disability. These patients, much like those that are in the process of suing someone over an accident, are not motivated, some consciously some subconsciously, to get better.
The rare but unfortunate case is the patient who has a condition that can be successfully treated and wants to be treated, but cannot afford the care required to treat and sometimes cure their disability. Once disability benefits, including health insurance, are granted, this patient will aggressively pursue treatment. The more frequent case is that of the patient who would rather maintain the disability, receive benefits, and eschew treatment.
Just like the welfare system used to reward mothers for having children out of wedlock and penalize women who married, so too does the disability system reward people for not working and penalize those who do try to work.
We are all aware of the patient who is on disability for a physical condition, but can golf, Jet Ski, and do any number of physical activities except work for a living. I remember a fellow resident who talked to first grade class about careers. He asked the students what they wanted to do when they grow up and one child said he wanted to be on disability, just like his dad. Sad, but true.
People should not be able to self-refer for a disability evaluation. Only doctors should have that right. And once a patient is referred the process should be streamlined and not require the patient to hire a lawyer to get disability benefits. If the evaluating physician thinks that an impairment and subsequent disability exists, then a lawyer should not be necessary. If the evaluating physician thinks that an impairment doesn't exist or doesn't merit disability, then a lawyer and court should not be allowed to overrule.
Although certain conditions are diseases and are disabling, they are also completely preventable. No one should be permitted to receive disability payments for obesity, alcoholism, or drug abuse.
If disability is granted, it should be determined whether it will persist despite treatment, it will persist only if treatments are discontinued, or it will not persist once a finite treatment is provided. This triage system would allow an appropriate and cost effective approach.
An example of the first case would be a person with quadriplegia. Although treatment can prevent complications from developing, the underlying problem of paralysis will not change. This person would require medical benefits and living expenses. All patients in this class should be re-evaluated annually to determine if any new treatments are available that could improve their underlying disability.
A patient in the second group would include someone with seizures. This person would require medical treatment to control his disability and should be provided medical benefits only once the seizures are controlled to the point where employment would be viable. An annual re-evaluation would determine whether medical benefits needed to be continued, or if the patient could now coped with his ongoing medical expenses on his own or through private insurance.
The people in the last class would include someone with severe hip arthritis. This condition is curable through surgery and medical benefits should end once that person has fully recovered and is able to return to full active work activities.
If someone has an impairment that prevents certain work, then they should be expected to work at a job that can perform with their disability. If this causes an income discrepancy from their pre-morbid state, then the difference can be provided. This makes much more sense than not allowing a partially disabled person to work full time if able.
When it comes to determining medical disability, the lawyers should be removed from the process. The government's role should be limited in the process. Disability benefits should be available on an "as needed basis" for an "as long as needed basis" as determined by a physician.
7/24/07
COLOSSIANS 3:16
I think that too many people today do not have any sense of gratitude. While certainly gratitude is not a trait that is promoted by the popular culture, it is one that any mature, responsible adult should exhibit. When one doesn't display gratitude, it raises serious questions about one's upbringing and suggests inadequate parenting.
Gratitude is an expression of thankfulness towards someone who has done you a favor especially when they were not obligated to do so and more so when it comes at some cost to the giver. In Christian terms, gratitude towards God is one of the central themes of the Bible.
Research shows that feelings of gratitude improve one's emotional well being. Studies show that people who are more grateful also are happier, more helpful and forgiving, and less depressed than those who profess lesser degrees of gratitude.
A lack of gratitude is not limited to patients and doctors. It is also evident in workers and bosses, children and parents, as well as Christians and God.
In medicine, as in other areas of life, gratitude is not due someone just because they are performing a service that they are being paid for. It should more correctly be considered thankfulness when a patient expresses their happiness to the doctor when receiving good care that they paid for.
Gratitude is due when the doctor goes beyond his obligation to the patient. Three areas in which a doctor, at an expense to him, may give the patient a free service includes providing medication samples, completing insurance and disability forms, and checking blood pressures.
When free samples of medicine are provided, the patient is getting something beyond what they are paying for and the doctor, who has no direct monetary cost for this service, is taking his and his staff's time to meet with the drug reps to receive the samples, using time and space to store the samples, taking time to prepare the samples, and spending time to answer phone calls for patients' who request them. When a patient receives them, gratitude is due.
Doctors often will fill out the cumbersome paperwork involved with insurance, work release forms, and patient assistance forms. The doctor is only obligated to complete insurance forms if they are a member of that particular plan. Filling out FMLA papers and other disability forms required by a patients' employer are not included in the office visit charge. The exception being with workers' compensation claims. The patient assistance forms required by drug companies to provide patients with free samples are especially burdensome and time consuming.
Many offices charge for these forms to be completed. Indeed the AMA and other professional organizations consider it acceptable and ethical to charge separately for this extra work. When it is done at no charge to the patient, gratitude is due.
Even blood pressure checks performed by an office nurse can ethically and legally be charged to the patient. The doctor is paying for his nurse's time and for the equipment and the facility with which and where the service is rendered. There exists an insurance code to charge for this service and many offices do so. When such a service is provided at no charge, gratitude is due.
Unfortunately it seems that the more gratitude that is due, the less that is shown.
Patients all too frequently stop in for their free samples only to complain when the staff doesn't stop every other task to immediately devote all their energy to getting the samples ready. And heaven help the poor receptionist who has to tell the irate patient that the office is out of the particular samples that he is requesting (demanding).
Multi-page forms are often expected to be completed on the spot despite a waiting room full of sick people who need cared for. At other times, a form is dropped off with the patient telling the receptionist that they need it completed that afternoon.
Having to wait too long for their free blood pressure check (often while getting their free blood pressure medicine) is a frequent complaint of some patients. It gets worse when they have to wait to for the doctor to review the result when it is too high.
By logical extension, the most grateful patient should be the one who is given the most services at the least cost. This includes patients who are provided free care and most Medicaid patients. The difference in the attitudes between these two groups is often quite dramatic.
The former group does not have a sense of entitlement. They realize that they are not due anything from the doctor. When a doctor chooses to see a patient pro bono, he does so out of generosity at a significant expense to himself. Because of this and knowing that this free service could be rightly revoked at any time, these patients tend to be very grateful.
The latter group will often display a sense of entitlement. That comes from an unfortunate system in which otherwise healthy people are only entitled to free medical care if they don't work or they work in a job with substandard pay and benefits. These patients don't realize that doctors who treat Medicaid patients do so out of a sense of obligation knowing that that the money they receive is less than the cost of providing the service.
Talk to your emergency room physicians about some of the Medicaid patients. You will here stories about ungrateful, impatient, entitled individuals who come in for chronic or trivial complaints because it is convenient for them without giving any thought to what it costs to the taxpayers to provide this service for them.
At its root is that sense of entitlement. If someone thinks that they deserve something, they will not be grateful, and usually not even thankful for it. Remember this when you hear a politician suggest that people should be "entitled" to free health care. Anything that is not paid for in some manner, not necessarily monetarily, is soon taken for granted, not valued, and therefore soon to be abused.
Gratitude is an expression of thankfulness towards someone who has done you a favor especially when they were not obligated to do so and more so when it comes at some cost to the giver. In Christian terms, gratitude towards God is one of the central themes of the Bible.
Research shows that feelings of gratitude improve one's emotional well being. Studies show that people who are more grateful also are happier, more helpful and forgiving, and less depressed than those who profess lesser degrees of gratitude.
A lack of gratitude is not limited to patients and doctors. It is also evident in workers and bosses, children and parents, as well as Christians and God.
In medicine, as in other areas of life, gratitude is not due someone just because they are performing a service that they are being paid for. It should more correctly be considered thankfulness when a patient expresses their happiness to the doctor when receiving good care that they paid for.
Gratitude is due when the doctor goes beyond his obligation to the patient. Three areas in which a doctor, at an expense to him, may give the patient a free service includes providing medication samples, completing insurance and disability forms, and checking blood pressures.
When free samples of medicine are provided, the patient is getting something beyond what they are paying for and the doctor, who has no direct monetary cost for this service, is taking his and his staff's time to meet with the drug reps to receive the samples, using time and space to store the samples, taking time to prepare the samples, and spending time to answer phone calls for patients' who request them. When a patient receives them, gratitude is due.
Doctors often will fill out the cumbersome paperwork involved with insurance, work release forms, and patient assistance forms. The doctor is only obligated to complete insurance forms if they are a member of that particular plan. Filling out FMLA papers and other disability forms required by a patients' employer are not included in the office visit charge. The exception being with workers' compensation claims. The patient assistance forms required by drug companies to provide patients with free samples are especially burdensome and time consuming.
Many offices charge for these forms to be completed. Indeed the AMA and other professional organizations consider it acceptable and ethical to charge separately for this extra work. When it is done at no charge to the patient, gratitude is due.
Even blood pressure checks performed by an office nurse can ethically and legally be charged to the patient. The doctor is paying for his nurse's time and for the equipment and the facility with which and where the service is rendered. There exists an insurance code to charge for this service and many offices do so. When such a service is provided at no charge, gratitude is due.
Unfortunately it seems that the more gratitude that is due, the less that is shown.
Patients all too frequently stop in for their free samples only to complain when the staff doesn't stop every other task to immediately devote all their energy to getting the samples ready. And heaven help the poor receptionist who has to tell the irate patient that the office is out of the particular samples that he is requesting (demanding).
Multi-page forms are often expected to be completed on the spot despite a waiting room full of sick people who need cared for. At other times, a form is dropped off with the patient telling the receptionist that they need it completed that afternoon.
Having to wait too long for their free blood pressure check (often while getting their free blood pressure medicine) is a frequent complaint of some patients. It gets worse when they have to wait to for the doctor to review the result when it is too high.
By logical extension, the most grateful patient should be the one who is given the most services at the least cost. This includes patients who are provided free care and most Medicaid patients. The difference in the attitudes between these two groups is often quite dramatic.
The former group does not have a sense of entitlement. They realize that they are not due anything from the doctor. When a doctor chooses to see a patient pro bono, he does so out of generosity at a significant expense to himself. Because of this and knowing that this free service could be rightly revoked at any time, these patients tend to be very grateful.
The latter group will often display a sense of entitlement. That comes from an unfortunate system in which otherwise healthy people are only entitled to free medical care if they don't work or they work in a job with substandard pay and benefits. These patients don't realize that doctors who treat Medicaid patients do so out of a sense of obligation knowing that that the money they receive is less than the cost of providing the service.
Talk to your emergency room physicians about some of the Medicaid patients. You will here stories about ungrateful, impatient, entitled individuals who come in for chronic or trivial complaints because it is convenient for them without giving any thought to what it costs to the taxpayers to provide this service for them.
At its root is that sense of entitlement. If someone thinks that they deserve something, they will not be grateful, and usually not even thankful for it. Remember this when you hear a politician suggest that people should be "entitled" to free health care. Anything that is not paid for in some manner, not necessarily monetarily, is soon taken for granted, not valued, and therefore soon to be abused.
7/3/07
WHO'S YOUR DADDY?
I think too many people in health care are paternalistic when it comes to providing information to patients. This group includes many, if not most, doctors and hospital administrators both locally and nationally.
There exists an inevitable movement to provide people information on doctors and hospitals. The information includes prices as well as quality measures. Having previously discussed prices on my blog, I will now focus on the effort to make quality information available to patients.
In the past, patients had to assume doctors and hospital were qualified based on third party reports. There was no direct to consumer information readily available to the average patient. There was no way to determine which doctor or hospital provided a higher quality of service.
It was assumed that if a doctor was board certified, he must have received the appropriate training in his specialty and passed an examination. Nowadays, to remain board certified, a physician must maintain continuing medical education credits through seminars or self-study courses and possibly, depending on the specialty, be required to pass the accreditation exam every few years. A failure would result in a loss of board certification, but not of the license to practice medicine.
Medicare would require hospitals to pay a third party to audit themselves every few years to assure the quality of care, and more importantly to the inspectors, and that the paperwork was up to date. Again, no information was available to patients other than whether the hospital passed or failed an inspection. A failure would result in the hospital no longer being allowed to bill for Medicare services. This would effectively shut a hospital down.
As patients are becoming much more sophisticated about their own health and the health care system in general, a demand has developed for more information. People want to be able to compare doctors and hospitals just like they compare car makes and models before making a decision on where to spend their health care dollars.
There are several inherent problems with trying to compare doctors or hospitals. A car make or model has a well defined service record and resale value. People don't. A patient might not get better compared to another one because of a multitude of reasons with the quality of the health care provided being merely one.
A doctor might have more elderly patients, more acutely ill or injured patients, or other demographic differences based on the location and type of practice, even within the same specialty. The socioeconomic condition of the patients might impact the compliance and ability to afford medications.
Comparing hospitals will have similar problems. Even after accounting for the difference in the size and location, considerable, confounding variables will exist making it difficult to fairly compare one hospital against another.
Another difficulty to be overcome will be the motivation of the reviewing organization. Unfortunately there is no Consumer Reports for health care. Health care quality cannot be tested in a controlled laboratory setting. Some groups do not divulge what information the assessment is derived from, but will provide that, for a nice fee, to the doctor or hospital so they can work on "improving" their rank with that specific group.
Who will be watching the watchmen is a question that should be asked of these self-appointed raters. There is tremendous opportunity to slant results for political or financial gain.
The upside will be that too much and conflicting information is better than the current situation of too little information. Most people will be able to sort out and compare information from different organizations to draw their own conclusions on the quality of different doctors and hospitals. Indeed they do so now based on a far lower quality and quantity of information, largely word of mouth.
Certainly some people will draw the wrong conclusions from the information given, but the American Way has always been for people to have the right to make poor choices. And a poor choice is less likely if it is also an informed choice.
There exists an inevitable movement to provide people information on doctors and hospitals. The information includes prices as well as quality measures. Having previously discussed prices on my blog, I will now focus on the effort to make quality information available to patients.
In the past, patients had to assume doctors and hospital were qualified based on third party reports. There was no direct to consumer information readily available to the average patient. There was no way to determine which doctor or hospital provided a higher quality of service.
It was assumed that if a doctor was board certified, he must have received the appropriate training in his specialty and passed an examination. Nowadays, to remain board certified, a physician must maintain continuing medical education credits through seminars or self-study courses and possibly, depending on the specialty, be required to pass the accreditation exam every few years. A failure would result in a loss of board certification, but not of the license to practice medicine.
Medicare would require hospitals to pay a third party to audit themselves every few years to assure the quality of care, and more importantly to the inspectors, and that the paperwork was up to date. Again, no information was available to patients other than whether the hospital passed or failed an inspection. A failure would result in the hospital no longer being allowed to bill for Medicare services. This would effectively shut a hospital down.
As patients are becoming much more sophisticated about their own health and the health care system in general, a demand has developed for more information. People want to be able to compare doctors and hospitals just like they compare car makes and models before making a decision on where to spend their health care dollars.
There are several inherent problems with trying to compare doctors or hospitals. A car make or model has a well defined service record and resale value. People don't. A patient might not get better compared to another one because of a multitude of reasons with the quality of the health care provided being merely one.
A doctor might have more elderly patients, more acutely ill or injured patients, or other demographic differences based on the location and type of practice, even within the same specialty. The socioeconomic condition of the patients might impact the compliance and ability to afford medications.
Comparing hospitals will have similar problems. Even after accounting for the difference in the size and location, considerable, confounding variables will exist making it difficult to fairly compare one hospital against another.
Another difficulty to be overcome will be the motivation of the reviewing organization. Unfortunately there is no Consumer Reports for health care. Health care quality cannot be tested in a controlled laboratory setting. Some groups do not divulge what information the assessment is derived from, but will provide that, for a nice fee, to the doctor or hospital so they can work on "improving" their rank with that specific group.
Who will be watching the watchmen is a question that should be asked of these self-appointed raters. There is tremendous opportunity to slant results for political or financial gain.
The upside will be that too much and conflicting information is better than the current situation of too little information. Most people will be able to sort out and compare information from different organizations to draw their own conclusions on the quality of different doctors and hospitals. Indeed they do so now based on a far lower quality and quantity of information, largely word of mouth.
Certainly some people will draw the wrong conclusions from the information given, but the American Way has always been for people to have the right to make poor choices. And a poor choice is less likely if it is also an informed choice.
6/27/07
NKDA Q.E.D.
I think that most patients do not understand medication allergies very well. Wrongly thinking that you are allergic to certain medications can limit the choices your doctor has in deciding which the best medicine for your current condition is. You could be given a costlier or less effective medication if you incorrectly state that you are allergic to a particular drug.
It is important to know the difference between an allergic reaction to a medicine and a side-effect from a medication. Some patients have been erroneously told by their doctors that a medicine caused an allergic rash when in reality the rash was caused by the underlying illness that the medication was prescribed for. Your doctor should know about any medicine that you have had an allergic reaction to or a side-effect from and should be able to differentiate between the two.
An allergic reaction to a medication occurs when your body's immune system reacts to a drug. The symptoms can include itching and a generalized rash. In severe cases an anaphylaxis allergic reaction occurs which can lead to life-threatening breathing and circulatory troubles.
The allergic reaction can occur even with medications that have been used without problems in the past. Once it occurs the medication will always cause reactions in the future, oftentimes escalating in the severity, unless an allergist desensitizes you to that particular drug by giving you tiny incremental amounts over several months. It will recur with medicines in the same class and sometimes with closely related medications. Just because a family member had an allergic reaction to a certain medication, doesn't mean that you will.
A side effect is not based on your immune system's response to a medication. It most commonly includes nausea, headaches, and drowsiness but can include many other symptoms such as dizziness and taste disturbance. These side-effects are annoying but seldom dangerous.
The side effect might improve with a dose adjustment or just over time with continued use of the same dose. It will usually recur if the same medicine is given in the future. It will sometimes occur with similar medicines but often is specific to a certain drug.
A common mistake a patient will make involves refusing to take a certain medication because of concerns of either allergic reactions or side effects. Unfortunately our pharmacist friends provide written handouts that are often misleading when it comes to warning patients against taking a particular drug if a prior reaction occurred with a similar but different medication. Three common situations are detailed below.
If you had an allergic reaction to penicillin in the past you are still able to safely take some, if not all, cephalosporins (Keflex, Ceclor, etc.). You and your doctor do need to be extra careful however if your allergic reaction to penicillin in the past was an anaphylactic one.
Many patients say they are allergic to codeine. That almost always means that they have a side effect of nausea and/or vomiting when they take codeine. That does not exclude you from taking hydrocodone for pain or a cough, if it is indicated. While you could coincidentally have a gastrointestinal side-effect from that, it is much less likely.
There is a difference between sulfa and sulfates/sulfites. The former is used as an antibiotic while the latter are included in many medications such as morphine and some diabetes pills. Many patients develop a rash with the antibiotic (much more so than with penicillin in my experience), but very few, if any, of them will have any reaction to the other medications.
You should tell your doctor which medications have given you which symptoms and let him decide if it was an allergic reaction or a side-effect. Only by doing this can you assure yourself of allowing your doctor to choose the most beneficial and cost-effective treatment for your condition.
It is important to know the difference between an allergic reaction to a medicine and a side-effect from a medication. Some patients have been erroneously told by their doctors that a medicine caused an allergic rash when in reality the rash was caused by the underlying illness that the medication was prescribed for. Your doctor should know about any medicine that you have had an allergic reaction to or a side-effect from and should be able to differentiate between the two.
An allergic reaction to a medication occurs when your body's immune system reacts to a drug. The symptoms can include itching and a generalized rash. In severe cases an anaphylaxis allergic reaction occurs which can lead to life-threatening breathing and circulatory troubles.
The allergic reaction can occur even with medications that have been used without problems in the past. Once it occurs the medication will always cause reactions in the future, oftentimes escalating in the severity, unless an allergist desensitizes you to that particular drug by giving you tiny incremental amounts over several months. It will recur with medicines in the same class and sometimes with closely related medications. Just because a family member had an allergic reaction to a certain medication, doesn't mean that you will.
A side effect is not based on your immune system's response to a medication. It most commonly includes nausea, headaches, and drowsiness but can include many other symptoms such as dizziness and taste disturbance. These side-effects are annoying but seldom dangerous.
The side effect might improve with a dose adjustment or just over time with continued use of the same dose. It will usually recur if the same medicine is given in the future. It will sometimes occur with similar medicines but often is specific to a certain drug.
A common mistake a patient will make involves refusing to take a certain medication because of concerns of either allergic reactions or side effects. Unfortunately our pharmacist friends provide written handouts that are often misleading when it comes to warning patients against taking a particular drug if a prior reaction occurred with a similar but different medication. Three common situations are detailed below.
If you had an allergic reaction to penicillin in the past you are still able to safely take some, if not all, cephalosporins (Keflex, Ceclor, etc.). You and your doctor do need to be extra careful however if your allergic reaction to penicillin in the past was an anaphylactic one.
Many patients say they are allergic to codeine. That almost always means that they have a side effect of nausea and/or vomiting when they take codeine. That does not exclude you from taking hydrocodone for pain or a cough, if it is indicated. While you could coincidentally have a gastrointestinal side-effect from that, it is much less likely.
There is a difference between sulfa and sulfates/sulfites. The former is used as an antibiotic while the latter are included in many medications such as morphine and some diabetes pills. Many patients develop a rash with the antibiotic (much more so than with penicillin in my experience), but very few, if any, of them will have any reaction to the other medications.
You should tell your doctor which medications have given you which symptoms and let him decide if it was an allergic reaction or a side-effect. Only by doing this can you assure yourself of allowing your doctor to choose the most beneficial and cost-effective treatment for your condition.
6/19/07
THIS IS NOT BURGER KING
I think that some patients confuse a doctor's office with a supermarket. They come in with a written or mental list of what they want and are not happy unless they receive what's on that list. I will explain what a visit to a physician is and isn't.
A patient is paying for an evaluation and treatment of a medical condition. It would be a mistake to take your car to a mechanic and tell them you need a new water pump. If they replace it and the car still has the same problem, you would be upset. You should tell your mechanic that your car is overheating and let the expert determine if the problem is the water pump, the thermostat, the radiator or something altogether different. Certainly a car owner with a lot of knowledge about cars can provide thoughts as to what the problem is, but the diagnosis should be left up to the mechanic.
So too should the patient avoid going to the doctor and tell him that you need Nexium for your hiatal hernia. If you are just given the prescription without a proper evaluation and then have a heart attack, you would be upset. You should tell the doctor that you are having indigestion and let the expert determine if the problem is a hiatal hernia, ulcers, angina, or something altogether different. Certainly a patient with a lot of knowledge about health can provide thoughts as to what the problem is, but the diagnosis and treatment options should be left up to the doctor.
The above is not a perfect analogy as diagnosing medical conditions is often an art and not an exact science. If the diagnosis turns out to be incorrect or incomplete on several occasions, you should find a new expert.
The two areas that often bring out the worst in patients are for prescriptions of antibiotics and pain medications. These are the two most frequent situations in which some patients insist on particular medications and will refuse others.
With antibiotics some patients insist on getting one even if they have a condition in which there is no benefit from it. I do not know why someone would expose themselves to the risk of allergic reactions, unnecessary side-effects, and the build-up of resistant bacteria in their system if antibiotics are not going to help them recover from their illness faster.
Other patients insist that they are immune to certain ones. It is often difficult to convince these people that while some bacteria are resistant to certain antibiotics, people are not. An antibiotic that might not have worked for a particular infection in one instance may very well be the best choice for a different infection.
It can be helpful for a patient to notify the doctor if they have had side-effects, allergies, good success, or bad success with a certain antibiotic for a similar infection in the past. The ultimate choice however, should be left up to the expert.
With pain medication, it is one thing to let your doctor know your past experience and results with particular drugs. It is quite another to insist on only one particular medication for your pain. You run the risk of being thought of as a drug-seeker if you are unwilling to try any medication other than strong narcotics.
Just as there are many different types of pain so are there different types of pain medications. One kind may be good for one pain while another might be better for another pain. Your doctor is in the best position to diagnose the cause of your pain and offer the most effective and appropriate medications for the situation at hand.
With any medication that your doctor prescribes, there is a chance that it will cause side-effects or might not be fully effective. That does not mean that the wrong medication was chosen. But your physician needs to be available to adjust a dose or change a prescription if the results are not satisfactory.
While a doctor patient relationship is a partnership, it is not an equal one. They each have their roles and responsibilities to achieve optimal results. The doctor should listen, examine, and advise. The patient should ask questions, choose among reasonable treatment options, and comply with the recommendations. Patients receive better care when they work with instead of trying to be their doctor.
A patient is paying for an evaluation and treatment of a medical condition. It would be a mistake to take your car to a mechanic and tell them you need a new water pump. If they replace it and the car still has the same problem, you would be upset. You should tell your mechanic that your car is overheating and let the expert determine if the problem is the water pump, the thermostat, the radiator or something altogether different. Certainly a car owner with a lot of knowledge about cars can provide thoughts as to what the problem is, but the diagnosis should be left up to the mechanic.
So too should the patient avoid going to the doctor and tell him that you need Nexium for your hiatal hernia. If you are just given the prescription without a proper evaluation and then have a heart attack, you would be upset. You should tell the doctor that you are having indigestion and let the expert determine if the problem is a hiatal hernia, ulcers, angina, or something altogether different. Certainly a patient with a lot of knowledge about health can provide thoughts as to what the problem is, but the diagnosis and treatment options should be left up to the doctor.
The above is not a perfect analogy as diagnosing medical conditions is often an art and not an exact science. If the diagnosis turns out to be incorrect or incomplete on several occasions, you should find a new expert.
The two areas that often bring out the worst in patients are for prescriptions of antibiotics and pain medications. These are the two most frequent situations in which some patients insist on particular medications and will refuse others.
With antibiotics some patients insist on getting one even if they have a condition in which there is no benefit from it. I do not know why someone would expose themselves to the risk of allergic reactions, unnecessary side-effects, and the build-up of resistant bacteria in their system if antibiotics are not going to help them recover from their illness faster.
Other patients insist that they are immune to certain ones. It is often difficult to convince these people that while some bacteria are resistant to certain antibiotics, people are not. An antibiotic that might not have worked for a particular infection in one instance may very well be the best choice for a different infection.
It can be helpful for a patient to notify the doctor if they have had side-effects, allergies, good success, or bad success with a certain antibiotic for a similar infection in the past. The ultimate choice however, should be left up to the expert.
With pain medication, it is one thing to let your doctor know your past experience and results with particular drugs. It is quite another to insist on only one particular medication for your pain. You run the risk of being thought of as a drug-seeker if you are unwilling to try any medication other than strong narcotics.
Just as there are many different types of pain so are there different types of pain medications. One kind may be good for one pain while another might be better for another pain. Your doctor is in the best position to diagnose the cause of your pain and offer the most effective and appropriate medications for the situation at hand.
With any medication that your doctor prescribes, there is a chance that it will cause side-effects or might not be fully effective. That does not mean that the wrong medication was chosen. But your physician needs to be available to adjust a dose or change a prescription if the results are not satisfactory.
While a doctor patient relationship is a partnership, it is not an equal one. They each have their roles and responsibilities to achieve optimal results. The doctor should listen, examine, and advise. The patient should ask questions, choose among reasonable treatment options, and comply with the recommendations. Patients receive better care when they work with instead of trying to be their doctor.
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