Health Care Reform - A new idea

Do we really have a right to health coverage?

Think about it - why do people believe they have some right to free health care? No body else pays for our cars, our houses, or our groceries. Why is it any different when it comes to medical care? Maybe if we cared about the cost involved we as a society would actually care about what it all cost, maybe we would actually look into alternatives and conservative treatments for our problems rather than rushing into the most expensive tests possible at the slightest hint of a cough.

If we all paid for our health care and insurance didn't cover anything but emergency services, providers would have to lower prices and compete like any other business. This is one way to make sure that not only the prices are kept in check but also that the quality is also maintained.

As it stands today in America, no one ever really questions the prices of any medical care unless they are paying out of pocket with their own money. The mutual thought process among providers and patients alike is essentially -

'Why do I care - the insurance is picking up the tab?'

That kind of mentality is the reason we are in the situation we are in right now with health care. The insurance companies have tightened down on spending, increased premiums and run the system through the ringer because of the over spending on medical care that is not medically necessary and yet thousands of us throw caution to the wind on a daily basis because someone else is paying the bill.

That mentality hasn't gotten us anywhere so far...maybe that is what needs to change.

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Baritatric Surgery - Weighing the risks

Bariatric Surgery

- It's the newest craze in surgery today. Some surgeons net up to $16,000 each for the Lap Band procedure and other surgical weight loss options, most of which take only a few hours to complete. The staggering demand for these procedures has led to abuse of the system - patients eager to jump straight to surgery without going through the proper channels and greedy surgeons hounding after patients who are willing to pay cash like blood thirsty animals will tell them anything they want to hear if they think it will convince the patients to go under the knife.

If you or anyone you know is undergoing preparation for bariatric surgery - take a real look at the medical guideline criteria that is supposed to be met before surgical steps are taken. The reason the guidelines exist is to ensure that before a patient goes into any surgery that he or she has exhausted ALL other realistic options and the surgery is merely the final resort to achieve a healthy weight. By the way – weight watchers does NOT count!

1. The Risks -

The risks are one of the first things your surgeon should discuss with you, in fact if they were truly responsible – they wouldn’t even discuss bariatric surgery without discussing the risks first. As with any abdominal surgery the risk for post operative complications like incisional hernias, infection, or non-healing wounds is very high. Specific to bariatric surgery; other post-operative risks include:

• Peptic ulcer
• Esophageal stricture
• Kidney stones
• Anemia
• Chronic dehydration
• Gastric dumping syndrome
• Malabsorption of nutrients
• Severe depression
• Vitamin B12 deficiencies
• Neurologic complications
• Other personality disorders

The intra-operative risks are even more severe. Intra-operative risks in any abdominal surgery (whether laparoscopic or open) apply here.

• The surgeon could nick the intestine, then a bowel resection would be necessary possibly leaving the patient with a permanent colostomy.
• Open abdominal operations lead to a very high risk of leaving instruments or surgical sponges inside patients (forgotten instruments)
• Improper handling of laparoscopic instruments can damage any number of organs within the abdomen.

2. The Planning -

When going by clinic guidelines agreed upon by both the American Medical Association and The American Society for Metabolic and Bariatric Surgery your pre-operative workup would generally require at least 6 months of planning and that is a conservative figure, some patients need up to 1 year of pre-operative workups and dieting before they meet guidelines for bariatric surgery (if they meet the requirements at all).
The following is typically required pre-operatively of anyone below a Body-Mass Index (BMI) of 49.0:

• Psychiatric evaluation
• 6 months of physician supervised weight loss counseling/therapy
• Documented evidence of treatments tried/failed for any and all co-morbidities related to your planned surgery – meaning if you have arthritis due to morbid obesity you need documentation of failed treatments for the arthritis, if you have obstructive sleep apnea secondary to your obesity you need a documented sleep study and documentation of failed treatments for the sleep apnea.

Understand that bariatric surgery is not going to solve your weight problem in and of itself. The surgery is a pre-cursor to the extremely strict diet, and strictly controlled exercise program that is a necessity to maintain for up to 15 years after your surgery.  You will also be required to be closely followed by your psychiatrist to make certain you are not showing signs of suicidal thoughts or depression.

Your surgeon will (should) require regular follow ups at least once a year sometimes for the rest of your life to track and follow you progress, and if you have a Lap Band you will at some point require a saline injection or “fill” to make sure the band has not loosened up over time.

3. The Reasons -

With the heavy advertising done by up and coming bariatric surgery clinics and even the suppliers of the Lap Band system – it is of no surprise that a large portion of people suffering from obesity are clamoring into surgeons offices by the thousands to talk about bariatric surgery options. I would warn you that this is only good for the surgeons and not you as a patient. Your surgeon is sure to be a great talker – he could probably convince you of anything (as most doctors can after so many years) but you should do your homework before hand as regardless of what the surgeon said – you may need to try more conservative options before considering any surgery to help you lose weight!

Bariatric surgery is clinically indicated for the following situations:


Patients with a BMI >35 **

At least one of the following *

Type II diabetes

Dyslipidemia

Poorly controlled hypertension (must be documented)

Significant cardiopulmonary disorder (e.g. coronary artery disease, cardiomyopathy, pulmonary hypertension)

Obstructive sleep apnea (must be documented)

Severe arthropathy of weight-bearing joints (treatable but for the obesity)

Pseudotumor cerebri

Severe venous stasis disease (e.g. with lymphedema of morbid obesity)

Obesity related hypoventilation

Non-alcoholic liver disease or steatohepatitis

AND

• Attempted and failed at least 4-6 months of physician supervised weight loss counseling and therapy
• Been alcohol and drug free for at least 1 year

*Depending on your insurance you may need to have 2 or even 3 co-morbidities related to morbid obesity to qualify for coverage

**Some insurance will not cover bariatric surgery for patients with a BMI under 40.0

Note: Not all insurance companies cover bariatric surgery

I urge you – take a step back and look at the situation objectively (for real). Bariatric surgery is a relatively new concept and as such it should be utilized only in severe cases where patients have put forth a very determined and focused effort to lose weight and it truly has failed. If one is considering bariatric surgery – do your research first and be honest about it’s applicability to yourself – and do not take it lightly!

4. The after care -

As previously stated – surgery is not the end of your journey. There is extensive aftercare and follow up needed if you actually expect bariatric surgery to help you lose that weight.

Post-operative Diet


Nothing about your diet after surgery will be pleasant, flexible, or negotiable! You will fail in every aspect if you do not follow the diet assigned to you after surgery.

You will be eating nothing solid for upwards of 4-6 weeks after your surgery. For the first 4 weeks you will likely be gradually moving from clear liquids only to light juices and protein drinks.

You will more than likely be slowly moved to semi-solid foods like apple-sauce etc. and then you will be eating blenderized foods almost exclusively for a period of time. Some doctors standard post-op diet plans even include blenderized fish, pizza, and hot dogs! You honestly NEED to be prepared for this – it is not pleasant at first (if at all) almost anyone who has at any point in life needed to eat blenderized fish or meat will tell you so.

You will be moved to solid foods (obviously in small portions) eventually.

It is typical for your dietician or nutritionist to recommend that you eat very very small portions every hour or two as opposed to the normal 3 meal a day diet most of us are used to. Fluid intake is recommended in small portions – in some cases, every 30 minutes.

Your diet will almost always include a set minimum amount of protein (your choice of powders, drinks etc.) that you must intake every day.


Follow Up visits

Every member of your bariatric team needs to be someone you are comfortable with because you are going to be following up regularly with all of them – in many cases you will for the rest of your life.

Your psychiatric follow ups in some cases are not necessary after a few years, however in the case that you develop depression or other psychiatric problems after your surgery – the follow ups will continue until you are cured of them.

5. The Doctor -

As I have stated in previous posts – there are a lot of doctors out there so hell bent on getting patients to agree to surgery that they will tell them whatever sounds good. NOT ALL DOCTORS but there are many of them out there. If after considering and discussing the options and risks you decide to not jump to surgery right away – do not let them try and convince you other wise. In fact if they do continue to try and cite reasons you should go ahead with it after you stated you did not want to – I would recommend you not go with that doctor at all. It may be a hassle to find another doctor, it may have cost you a co-pay but do you really think a doctor who wants to operate on you after you said “no” is worthy of your trust?

I really hate to stereotype anyone however there is a big trend among the newest generation of surgeons (like the ones who just got out of residency and are really energetic and enthusiastic) to be way too quick to jump straight to surgery. A lot of them tend to boast about how they were trained on robotic surgery and they love the latest technology and so on, or how many hundreds of surgeries they did in their residency etc. As a general rule I would recommend you lean away from any surgeon who brags about anything – most of the truly skilled surgeons (or any doctor really) won’t feel a need to brag about anything. If you specifically asked them about their previous experience they would usually offer up the information gladly.

Doctors in general and surgeons in particular are as human as everyone else. As such they are subject to the same mental tendencies as the rest of us. For example when it comes to bariatric surgery – many surgeons who are not directly involved in the field of surgical weight loss will recommend against it at all costs because of the risks involved. Whereas many who specialize in bariatric surgery exclusively will recommend it to (literally) 9/10 patients they see. Some have even falsified their own records in order to facilitate payment for surgery where the patient did not actually meet the criteria.

In short – be aware that some doctors become better at making money than making medical recommendations after awhile. Read between the lines on that one!

The doctor you chose may also have influence over whether or not your insurance company will pay on your surgeons claim. Almost all insurance companies base their policies on Medicare Guidelines, the fair majority use parts of it word for word. Medicare guidelines state: “Coverage is provided only if the bariatric surgery is performed at a medical center designated a Center of Excellence by the American Society for Bariatric Surgery (ASBS) or certified a Level 1 Bariatric Surgery Center by the American College of Surgeons.”

If the surgeon who is to perform your bariatric surgery is not affiliated with such a facility then obviously he or she won’t be performing the surgery at an approved facility – which in turn will most likely end up in the claim being denied leaving you stuck with the bill; and it will be a very large bill.



You can to some degree avoid this by making sure you are going to a Medicare approved bariatric facility. Even if your insurance is one that does not require that the facility meet those guidelines – it is still a good idea to go with with one anyways as they have gone through proper measures to prove that bariatric surgery was successfully preformed their before.

Conclusion

As a patient you may be inclined to believe that you absolutely need bariatric surgery – but you need to take your time considering the real world risks and truly huge commitment necessary for a good result. If you have tried your hardest (and really REALLY tried) and have failed at losing weight, and it’s effecting your medical well being – then by all means, talk to your doctor and make sure you are choosing the right one.

DISCLAIMER

This article is not intended to be the only basis on which anyone bases a decision to have surgery. I am in no way saying you should or shouldn’t have or consider having surgery – I am merely warning of some of the risks you may or may not be taking. Some of the content within this article is based on my personal experience in working with doctors and surgeons.



References



ASMBS – Post-operative concerns

ASMBS – General guidelines for surgical weight loss

ASMBS – Patient Resources

Medicare – Bariatric surgery criteria

Medicare - Approved bariatric facility Search

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Vascular Surgery

Just finished the Vascular Surgery Knol 

Check it out and let me know what you think! Most especially if you just so happen to be a vascular surgeon reading this post...but then again I doubt that would happen.

Don't let him fool you

Don't let his teleprompter fool you, President Obama is spreading a very clear message in this video but in the end his actions were opposite his very own words. It's beginning to become clear what his push for health care reform is really all about - money, and not the kind he claims to want to save the patients either.



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Health Care Bill moves forward 60-39

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Republicans, eager to defeat Obama were handed a punishing defeat of their own last night. The health care bill was passed with a vote of 60 for the bill to 39 against. This has cleared the way for a monumental, full-scale debate set to begin after Thanksgiving on the legislation. The bill is designed to extend coverage to the 31 million Americans who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

Whether or not any of the goals are achieved if and when the bill passes legislation and takes effect is anyone's guess. In recent years the trend of inconsistencies and misjudgments on the governments behalf would point to a grim road lying ahead if in fact it does pass legislation.

I have said it before - I will say it yet again: Reform is absolutely essential - but this may not be the way to do it. Handing over control of anything to the government has not exactly turned out well in the past.


Video - Senator Reid's remarks shortly after the bill passed the vote.

Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote

Mitchell Bard of the Huffington Post shared these thoughts on health care

Mitchell Bard: It's Too Early to Celebrate the Senate Health Care Vote:

I swear, I find no no joy in being Debbie Downer. I really wish I could celebrate the Senate's 60-39 vote to begin the debate on health care legislation, narrowly holding off the blocking tactic of the Republicans. I am 100 percent in favor of health care reform (I'm a fan of Rep. Anthony Weiner's proposal to extend Medicare to everyone). But a realistic view of what happened (and what has happened leading up to the vote) reveals far more things to be concerned about than to cheer for.


For starters, to get to an up-or-down vote on the final bill in the Senate, this 60-vote procedural hurdle will have to be jumped over again to close debate, and Sen. Joe Lieberman has already promised to join the Republicans in filibustering any bill that contains a public option. There are also several other centrist Democrats in the Senate who may not vote for cloture if there is a public option in the bill. Since the Democrats were only able to secure the minimum 60 votes to get past the Republicans this time, without Lieberman's vote (and all of the centrists'), if no Republican jumps ship, a bill containing a public option cannot get to the floor.


Also, it is easy to forget that a health care bill only barely made it through the House (220-215), and did so only after Democrats agreed to pass the bill despite the inclusion of the anti-abortion Stupak Amendment, which wouldn't just prevent the government from funding abortions, but would actually have the effect of making it harder for many women to exercise their constitutional right to choose under health care reform than it is today. True, the Senate's version has a less onerous anti-abortion provision, but if the House anti-choice Democrats stand firm again, even if a bill gets through the Senate, when it comes out of conference, the House will have two options, neither of which is good: pass the bill with the odious Stupak Amendment intact, or watch the bill go down to defeat at the hands of the anti-choice Democrats.


So what am I supposed to celebrate, exactly? That a health care bill will be debated? Even though, to get past a 60-vote cloture motion, it will have to be gutted even beyond the shadow of a bill it is now (the current bill has a weak public option, no other mechanism to really cut costs, and hands billions of dollars to the insurance companies who are a big part of the original problem)? I'm not saying I don't support this weak bill (it's better than nothing), but if it gets any weaker and cuts into the constitutional right of women to choose, really, does the good still outweigh the bad?


And the whole notion that there will be a debate is really hard to take seriously. There has been no honest health care debate up to this point. There has be a flood of outright lies from the right (two words for you: 'death panels'), and if you think it's getting any better, as the vote neared, Sen. Kit Bond compared health care reform to one of the biggest Ponzi schemes ever: 'Move over, Bernie Madoff. Tip your hat to a trillion-dollar scheme.' This is the level of debate. Paranoid ramblings about government takeovers and hidden agendas of doing the bidding for insurance companies, hospitals and pharmaceutical companies that line the pockets of those opposing reform. The nonpartisan Congressional Budget Office can report that the Senate health care bill will cut the deficit by $130 billion over the next ten years without raising taxes on the middle class, but Republicans will still scream about expanding deficits and massive tax increases. Some debate.


You know, there is one thing I really like about the health care legislation that will now be debated in the Senate, and, oddly enough, it's something that most of my fellow progressives oppose: the ability of states to opt out of the public option. Honestly, I think this part of the bill is spectacularly brilliant. Why? It's simple, actually. It's democracy at work.


Consider that in the last months since the health care debate took off, we have been treated to the following:


- Rep. Joe Wilson of South Carolina screamed 'You lie!' during President Obama's health care address to a joint session of Congress.


- Sen. Mitch McConnell of Kentucky said that passing health care reform with a public option could 'cost you your life.'


- Rep. Paul Broun of Georgia, who, by the way, is a physician, said that health care reform with a public option 'is gonna kill people.'


- Sen. James Inhofe of Oklahoma said, regarding the health care bill: 'I don't have to read it or know what's in it. I'm going to oppose it anyways.'


- Sen. Richard Shelby wrote to one of his constituents that health care legislation would 'directly subsidize abortion-on-demand,' 'rations health care so that our citizens are withheld important and potentially life-saving treatments,' and 'requires taxpayer dollars to fund health benefits for illegal immigrants,' all scare tactics that he knew (or, as a U.S. senator, should have known) is patently false.


Unfortunately, I could go on a lot longer, but you get the point. All of these politicians have many things in common, but there are two I would like to point out here: 1) They represent states that would likely opt out of a public option, and 2) they were duly elected by their constituents to serve in Congress.


Item 2 is really something important to remember. These men did not stage coups d'etat. No, they were elected by the majority of the voters of their states or districts. They were chosen by their constituents in democratic elections. And now it's time for democracy to do its job, so that the citizens of these states get exactly what they voted for. Why should we, as a country, spend taxpayer money to improve the health care of citizens who would send to Congress men capable of uttering baldfaced lies, all in the name of politics (trying to prevent the president from getting a 'win') or protecting the special interests that fill their campaign accounts? And if they are telling their lies in defense of some kind of pure ideology that abhors the government's involvement in anything (except the bedrooms of its citizens, of course, but that's another issue for another day ...), well, then, let's give their constituents what they want. Hell, Shelby went after Medicare in his constituent letter, so I would be happy to let the states opt out of Medicare and Medicaid, too


In Shelby's state, Blue Cross Blue Shield controls 83 percent of the health insurance market, with more than 600,000 people living without health insurance and another more than 175,000 who cannot obtain group coverage and are forced to buy insurance on their own. Under health care reform, most would have access to health care, more than 400,000 Alabama residents would be eligible for government subsidies to help pay for health insurance, and the 175,000 plus not on group plans could get more affordable insurance. But these people also voted for Shelby. I respect the democratic process, and the people of the good state of Alabama should be free to get exactly what they voted for. I wouldn't dream of stjanding in their way. And the same can be said for the folks in South Carolina, Kentucky, Georgia, Oklahoma and all the other states who have sent representatives to Washington to obstruct health care reform.


This is the country in which we live now. This is what passes for debate. So you will forgive me if I am not optimistic that a worthwhile health care reform bill will make its way past another cloture vote in the Senate, past an up-down vote in Senate, through a post-conference vote in the House, through yet another cloture vote in the Senate, and finally through a final up-down vote in the Senate, all while the Stupaks, Liebermans, and Lincolns of the world are standing in the way, not to mention the stop-at-nothing lies and scare tactics employed by the right. I am sorry, but I am firmly in I'll-believe-it-when-I-see-it mode.


The bottom line is that I don't want to be the messenger of doom. I would love to celebrate a health care reform victory. And when a real one arrives, I will.

Swine flu clinic set for Simpson Center in Hemet

Swine flu clinic set for Simpson Center in Hemet:
An H1N1 flu vaccine clinic is scheduled from 2 to 7 p.m. Monday at the Simpson Center, 305 E. Devonshire Ave. in Hemet.
Riverside County Department of Public Health officials said the nasal spray and injections will be available to about 2,000 people in the following groups: children 6 months to 12 years, caregivers of infants, pregnant women, people who work in health care or emergency medical services and adults ages 25 to 64 with chronic medical conditions.

House Passes Bill To Create EHR Loan Program for Physicians

Yesterday - Wednesday the 18th of November, the House of Representatives approved HR 3014, a bill that was designed to help health care providers purchase electronic health record systems and other health information technology tools, the Rutherford Daily News Journal reports.

The Small Business Health IT Financing Act would authorize the Small Business Administration to oversee a loan program for health care providers seeking to purchase health information systems. However many electronic medical records vendors are using the bill as a marketing tool - boldly claiming to practices nation wide that the government will 'pay in full for your EMR' when in fact it is more of a loan than a blank check as they would have their customers believe.

Kathy Dahlkemper (D-Pa.), chair of the House Small Business Regulations and Healthcare Subcommittee, introduced the measure
http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.3014:

Medical Insurance Dictionary - what they really mean!

Health Insurance - What does it all mean? 

Have you ever called your insurance company to ask a question, and only ended up hanging up your phone feeling more confused than you were to begin with? Insurance companies love to use confusing and overlapping terms and jargon like; copay, coinsurance, preauthorization, predetermination, and the list continues indefinitely. Knowing what these terms means in essential in turning that confusion into an understanding of what they really mean.

Deductible  - A deductible is the amount of money you must pay into your own health care costs before your insurance will begin to pay their contracted rates. Say you have a plan that covers costs at 80% with a $400 deductible; your insurance will pay absolutely nothing until you have paid $400 out of your pocket. Deductibles can range from $0 (generally only applies to HMO or Medicare beneficiaries) Now depending on your particular deductible you may have to pay for a single doctors visit in full to meet it, or you may have to pay for several doctors visits before your insurance is going to pay their share.


Co-payment (copay) - A copay is a set amount of money you pay each time you seek out certain services. Generally anyone with a copay in their insurance plan has a separate copay for each distinct type of service; for instance the copay may be $15 for a routine doctors visit, the copay for prescriptions may be $10, and more intense services such as a visit to the emergency room may require a copay of $100. Again some beneficiaries of Health Maintenance Organizations or Medicare do not have a copay depending on their plan. Co-payments are also typically waived if the Out-of-pocket maximum for the calender year has already been met. Failure to collect a co-payment on the providers behalf can be cause for payment reduction or even claims denial.

Co-insurance - Co-insurance is the amount of the total bill that the patient is responsible for paying. Although it is often confused with a copay it is in fact quite different. Co-insurance is never a set dollar amount but rather a percentage of the total bill for services rendered. It is a way to share cost between insurer and insured. Typically patient responsibility for higher end PPO plans is 10-20% in-network and 30-40% for out-of-network care. The cheaper PPO health plans sometimes have as high as 40% patient responsibility for in-network care and 50% for out-of-network care.

Out-of-pocket Maximum - Per calender year this is maximum amount of money a beneficiary can be required to pay out of his/her pocket. After they reach this limit typically all further co-payments or co-insurance (for the calender year) should be waived. Basically it is a spending cap on your own funds.Typically this is a few thousand dollars per calender year a common limit is $4000 per year. If you seek out health care on many instances in a year and reach your OOPM limit, your insurance plan should pay for services at their contracted rate and for the remainder of the year as long as you remain in-network you should not have to pay any further co-pays or co-insurance.

In-network/Out-of-network - These terms confuse most patients because they are generally only used by PPO/EPO type health plans. Even though PPO/EPO type plans that always claim to allow patients the choice of their provider - there are limits to those choices and thats where these terms are used. Any provider who signs with your specific insurance carrier/provider network is considered in-network and any provider who does not is out-of-network. Going to any provider that is out-of-network in any insurance plan is going to cost more and in fact many beneficiaries (especially those insured through smaller employers) do not even have out-of-network coverage; which leaves them stuck with 100% of the bill.

NOTE: Some groups/plans refer to the same principal in different terms such as; participating providers vs. non-participating, in-area vs out of area, or preferred vs. non-preferred providers.

Pre-authorization/Pre-certification - Pre-cert. or pre-auth (for short) are processes through which insurance plans review services on a case by case basis to determine medical necessity and issue approvals or denials. Most PPO/EPO plans have specified guidelines that state which services do and do not need pre-auth. or pre-cert. whereas with most HMO plans almost every service requires pre-authorization.

NOTE: All insurance plans will tell you very specifically that pre-auth and/or pre-cert are never a guarantee of any payment, but simply a determination (prior to any actual service is preformed) of whether or not the service(s) are deemed medically necessary by their guidelines.

Pre-determination - Often confused for pre-auth. or pre-cert., pre-determination is actually a process of determining the estimated pay out from the insurance company and the estimated financial responsibility of the patient. Again this process does not guarantee anything. The final pay out of the insurance company will never be given until after the claim is submitted, this is how they ensure that the insurance companies cannot be blamed for any physical damages suffered by the patient while awaiting insurance approval.

If the insurance companies did not use the infamous 'claims payment not determined until services rendered' clause hospitals and doctors could simply delay your care and blame the insurance company for not responding and all damages (or death) could be blamed upon them. Using this clause ensures that determination of 'necessity' in urgent situations is the responsibility of the provider.

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10 Tips that can help you at the doctors office

10 Tips that can help you at the doctors office

Health care is out of hand without a doubt but there are several ways you, as a patient - can improve the quality and efficiency of your care. Even if you are happy with the care you receive these tips can increase the efficiency of your doctors visit and even decrease the time you spend waiting around.

1. Communicate clearly - There are few things more challenging for medical office staff than patients who do not communicate what it is that they need. The reason you are in the office or calling on the telephone should be stated in as simple a manner as possible. Keep in mind that not all problems are simple and not every situation is the same and most of us do understand that - just be as clear and concise as you can. (ie. "hello my name is ________ I am calling for an appointment to be evaluated for _______ with Doctor _______")


2. Be aware of what you are there for - It is quite a burden to decipher your medical issues for you, especially if you are a new patient. Physicians' offices around the country waste enormous amounts of their time trying to track down information about patients that they really should have already known. If you are referred to a physician by your regular doctor do not call for an appointment if you do not understand why you are being referred there. This will smooth the appointment making process and help to avoid mistakes like being referred to the wrong doctor.

3. Be polite - Whether you are calling for the first time or calling for the 3rd time in a day you can almost certainly guarantee a better outcome by simply not being rude. You are seeking medical care so it is completely without doubt that at the very best you are not feeling well - that doesn't mean you need to treat the staff like idiots before they even attempt to help you. You don't need to act like their best friends at all, you don't need to suck up to them; in fact I would personally say you don't need to be much more than a civil human being and speak calmly to really help me solve your problems or answer your questions. It is not bias so much as it is simply easier to help someone who is not treating you in a rude or disrespectful manner. The office is getting calls from extremely hostile and rude individuals all day long - if you are the one who was easy to deal with or even a pleasant person to talk to, you have a good chance of smoothing your entire care process as people are more likely to go out of there way to just to talk to someone who is a decent person. .


4. Have your questions written down before your visit - Take a few minutes; whether it be a day or two before your appointment or in the waiting for before your appointment, and write down what specifically you want to discuss with the doctor. If you leave your appointment with the doctor and think of more questions it is usually going to be a hassle for both yourself as well as the doctors staff and the doctor as he/she has certainly moved on to the next patient. This is not to say it is frowned upon, it is perfectly acceptable if you remember a question the next day or something of the sort, and the doctor may be very easily reached depending on your scenario and how busy the doctor is. However if you just walked out of the room, got the front desk and saying 'oh wait i forgot...' you are not going to help the doctor patient relationship because you are interrupting the flow of the office for something you very well should have asked moments before when you were face to face with the doctor.
NOTE: Try not to go overboard with it as I have personally witnessed a doctor walk into - and then immediately out of a room because the patient had a 6 page list of questions to ask before he even walked in, the doctor spent another 30 minutes printing out every piece of material on the patients diagnosis he could find to hand to them personally.

5. Know your facts - It should go without saying that it is your responsibility alone to know the facts about yourself, such as - what kind of insurance you carry, what tests you have had done, your prior medical history, and your allergies. Whether you think so or not - no one besides yourself is responsible for keeping track of the simple information. If you do not give the staff the correct insurance information or you change your insurance without informing them - you can absolutely be held responsible for 100% of your bill, read the contract you signed at the front desk; in my office it is in bold! If you don't mention a previous treatment, surgery or sever allergic reaction; you could suffer extreme complications or even die to not fault but your own. It's simple: you are the only one who is responsible for knowing the simple facts about yourself and omitting them is not hurting anyone but you.


6. Remember the doctor-patient relationship -This is an idea that has been mentioned less and less over the years however the fact is that the doctor-patient relationship will always be just that - a relationship. You have a role to play in the relationship as does the doctor. As with any other relationship, treating the other party poorly or communicating poorly is only harming the relationship: and since you (the patient) are the one who needs the help of the doctor, you are not helping yourself any by harming that relationship. Again as with the staff - you do not need to kiss up to the doctor. Rather you need to treat them as intelligent, decent people as most of them are when dealing with patients. The exception here is if the doctor is treating you poorly or not being respectful and polite to you - even then I would suggest you refrain from reciprocating the poor behavior and find a different doctor.
 

7. Follow directions -  It's quite sad that this is a tip but the fact is that the vast majority of the delays in patient care we deal with most frequently are caused by the patients themselves. Almost without exception anytime a patient is scheduled for any type of test or procedure, they are given both verbal instructions and written instructions. You need to understand them completely and follow them for your test or procedure to be preformed in any type of timely fashion. If you didn't do what you were instructed to how can you expect that your test or procedure will still be done? My office in particular mails them certified to every patient we schedule and yet 90% do not follow them. If you are one of the few patients who follows directions - you are a shoe in for fit-in appointments - this makes you and your care easier to deal with.

8. ASAP does not mean at your earliest convenience - Without exception, every patient believes that their treatment should be scheduled as soon as possible (ASAP)! Hearing this a few hundred times a day takes a toll on medical staff because it frankly gets old, as most patients do not understand that ASAP means next available and that's not always convenient for them. If you are telling the office to do something ASAP and they get you the next available appointment then you as a patient need to do what needs to be done to make that appointment work, ASAP DOES NOT mean that you get the next appointment that fits your schedule! If you request ASAP you are basically saying "I will do what needs to be done to get this done soon." Now if you just so happen to have something extremely important (ie. not- your family is in town, you are going to disneyland, or you have tickets to a show you want to see) and it truly takes precedence over your own health - you would be best advised to very sincerely apologize, explain yourself, and give the office the next time(s) that you are available and hope that they are able to match your schedule.

9. Anticipate delays - It sucks but all over the world doctors are outnumbered by a huge margin, this is what almost guarantees a wait at almost any doctors office. It is typical for a doctors schedule to be booked with two patients per every fifteen minutes, in my office it is actually scheduled four patients per every fifteen minutes for every clinic we have scheduled. Why? you ask - because for a doctor (the kind who treat patients, not work administrative jobs) to be successful he or she must make the best use of nearly every minute of every day literally if they are waiting around for a patient because the last one did not show up - they are wasting their time and could be on their way to a hospital to save a life. Try to understand if they staff is telling you the doctor is delayed - if you were lying in a hospital bed in unbelievable pain, would you want them to up and leave because they had patients in their clinic?


10. Understand a doctors limits - Doctors who save lives posses a skill set that is in high demand and as such, medicine is all doctors really get to live - and that is ok because it helps them stay focused. Aside from diagnosing illness and treating their patients, doctors knowledge of things like insurance procedures and even their own schedule - is minimal at best. They are specifically taught not to worry about these things because they are nothing but clutter in the brilliant mind trying to save lives - that's why they hire staff to handle these things. However you will be reluctant to find a doctor who will admit when he does not know (for example) when his next appointment to have your surgery done is. They probably have no idea what your co-pay will be and so on. So do yourself a favor and be aware of what questions should really be directed at the staff. If you ask a doctor anything that is not directly linked to your diagnosis or treatment (ie. insurance procedures, scheduling, disability papers etc) they will more than likely give you an answer reluctantly off the top of their head, that is worth almost nothing. My doctor will tell patients he can fit in their surgery 'next week' when in fact he is double booked in the O.R. and the office for the next two weeks. Why? Because it is not his job to worry about his schedule that's why he pays a scheduler. If you ask him how to get insurance approval he will tell you he'll take care of everything. Why? Because he has no idea and he knows it will put your mind at ease and you will walk away feeling happy and informed. The fact is - medical questions go to doctors: anything else goes to the staff - if you want an accurate answer that is.


Conclusion  - If you read these and thought that it was all common sense, you are right. However there is not one patient my doctors have ever treated that was actually able to use said common sense behaviors - people tend to get very emotional and lose their sense of rationale when dealing with doctors because the doctor has hundreds of people to worry about but every single patient doesn't care about anyone but themselves. Keep these in mind and you will make a positive impact in your own life. If nothing else - you will find that medical staff will treat you like their best friends if you simply a pleasant person.

Health Care bill HR-3962 passes house vote

The House floor erupted in one of the loudest cheers the chamber has heard in years when Rep. Maxine Waters (D-Calif.), an hour before midnight, cast the 218th and deciding vote on landmark health care reform.

There were still six minutes and fifty-two seconds on the clock and the chair made a move to gavel the vote closed.

Democrats waived their opposition, keeping the vote open.

Almost every eye in the chamber darted to the far end of the GOP side, where the last possibility for a bipartisan bill sat wedged between Minority Whip Eric Cantor (R-Va.) and Rep. Don Young (R-Alaska), both of whom were leaning on him, both literally and figuratively.

The White House, two sources told HuffPost, had been working hard to win the vote of Rep. Joseph Cao (R-La.), a freshman in a strongly Democratic district. The pro-life Cao's vote came into play when an amendment from Rep. Bart Stupak (D-Mich.) passed overwhelmingly, greatly restricting reproductive rights.
After several minutes, Cao cast a yes vote from his seat, making the bill bipartisan. Reps. Jim Oberstar (D-Minn.) and Mike Honda (D-Calif.) waded into the Republican side of the aisle to get to Cao, rub his shoulders and slap him on the back.

Cantor stormed out as the Democrats applauded their defector.
The majority party had seen plenty of defections earlier. A stunning sixty-four Democrats joined with the GOP to pass Stupak's amendment, 240-194.
Stupak, during the vote on the final bill, didn't stick around long. He cast his vote quickly and shook the hand of Majority Leader Steny Hoyer (D-Md.), then headed over to the GOP side, where he was warmly welcomed.

Rep. Patrick McHenry (R-N.C.), a strident partisan, was the first to greet him, shaking his hand and slapping him on the back. Stupak then found Cantor and Young, shook their hands, and retired from the floor to the Republican cloakroom.
Cao's vote was a mere bonus for Democrats, whose spontaneous floor celebration radically outdid the reaction of the Yankees to winning the World Series recently. The normally stoic Pelosi had tears streaming down her cheek. Rep. Rosa DeLauro (D-Conn.) bent over and vigorously pumped her fist. Arms were thrown in the air; hugs all around.

As the clock hit ten seconds, Democrats counted down the time, finishing with an even louder cheer as Pelosi read out the tally: 220-215.
Not even the extreme pro-life amendment could dampen enthusiasm. "We'll live to fight that battle," said Rep. Louise Slaughter (D-N.Y.), a passionate supporter of reproductive freedom. "It took a hundred years to do health care. Nothing can dim that."

Majority Whip Jim Clyburn (D-S.C.) said it was the hardest vote he'd ever whipped. "We crossed a threshold tonight," he said. "This was a tough deal."
Rep. Keith Ellison (D-Minn.), who'd fought for a stronger public option, was fired up, too. "I'm ecstatic. I think it was great," he said, before adding that he wasn't happy with the Stupak amendment or the weaker public option.
As he spoke, Rep. Dennis Kucinich (D-Ohio) walked by, handing reporters a statement explaining why he'd been the only liberal to oppose the bill.
Would you have changed your vote if yours was the deciding tally?
"No," said Kucinich. He then added cryptically: "I could've been, but that would've been up to the White House." Kucinich is pushing for inclusion of an amendment that would allow individual states to implement single-payer health care without being sued by insurance companies.

His measure and others, as well as the surprisingly strong showing by pro-life Democrats and the ever-looming immigration issue, threaten the fragility of the bloc of 220. But for now, Democrats were basking in the moment. As Speaker Pelosi walked with her leadership team to a press conference, a reporter asked her how she felt as she passed by. Her eyes filling with tears, she turned and slowed her walk. "I feel great," she said.
 

Medical decision making

All patients deserves to know exactly what goes into the decision making process when their lives are in the hands of physicians. Sad but true is the fact that it rarely is a transparent process. You see if physicians simply went by medical guidelines and ordered treatment based on what was best for the patient, their profits would soon begin to decline and for doctors all over the country money is why they got into the health care business. For those of you who think it was to help people - think again.

It's not just the crooked doctors you hear about in the news and on late night talk shows that are doing unnecessary surgeries and procedures on patients either - many of them are well respected and have well run practices. The clues are all in the framework of the doctors decision making. The thousands of cases of unnecessary appendicitis surgery can be easily explained by the vague and deceiving nature of this very common disease. Appendicitis is often diagnosed based upon unspecific symptoms which can be misleading in the process of deciding upon the correct diagnosis. Appendicitis is often mistaken for various other internal disorders that generate resembling symptoms.

There have been hundreds of cases if not thousands where patients have complained of abdominal pain alone and had an appendectomy through an emergency department only to recover with the same exact pain. Often this leas to more surgeries which is even more money for the doctor. Being that the appendix is seemingly benign and removal generally causes no 'harm' to the patient in the long term - it is usually never questioned by patients. In fact often doctors will remove a healthy appendix if a patient is having any other abdominal surgery for the bump in pay, claiming that it was a precautionary measure.

This is only one example of the many routinely preformed yet routinely unnecessary treatments that patients receive frequently. Some others include; removal of skin lesions that are non-symptomatic, the widespread misuse of ADHD/ADD medication, antidepressants, and antireflux medication.

The industry in America is overrun with reps from drug companies, medical suppliers, pharmacies, and even representatives from home health agencies - all trying to sell, sell, sell! They hand out vast amounts of sample medication, boxes of business cards, and all sorts of goodies for doctors to leave around their office. In turn the doctors will almost universally send large numbers of patients their way - and sometimes it's not even intentional: many times if the doctors wanted to prescribe say an anticoagulant (blood thinner) he would simply ask his nurse to prescribe a blood thinner, however if the doctor just met with a pharmaceutical rep who sells blood thinners he's quite likely to mention them by name simply because it's fresh in his mind.

On the other hand, there is quite a bit of intentional patient redirection - often at no benefit to the patient at all. Typical examples are: gynecologists who own ultrasound machines, surgeons who own surgery centers, and so on.

The government has picked up on this in recent years, Medicare and Medicaid have continuously decreased payments for most procedures due to the amount of unnecessary procedures and tests were being ordered on patients. By the time someone with the power to act upon this problem had put the pieces together - the problem was no longer manageable, it had spread throughout the entire health care system across the country.

The financial burden of this problem is bad enough, but worse yet is the damage to people that unnecessary treatment often causes. Perhaps the worst side of this story is the trust most of us tend to have with physicians. If we can't listen to our doctors what are we to do? My advice (for what it's worth) is to just be cautious. If a doctor is recommending treatment it is a good idea to read up as much as you can on the indications, contraindications, and alternatives that exist as well as the benefits and risks. Information is worth more than gold!

Good people are hard to come by

Good people - they are unfortunately a dying breed in this age. Common courtesy, decency and even common sense having taken a back seat to iPhones and the "I am better than everyone" mentality. I observe it on a daily basis and to be quite honest usually I observe this behavior from the patients I deal with on a daily basis, I do see it on occasion in my own coworkers and even some of the doctors I work with.

Today though, I came across a genuinely kind person - a patient who came into the office who almost saved my life, or at least my hand, from an uncertain fate.

Many people can be kind on the outside but quickly turn rotten without the slightest provocation - few are actually nice as this patient happened to be. It was her first visit and she was nervous but maintained a pleasant demeanor. The doctor talked with her for quite some time, then he decided to preform incision and drainage of an abscess in the office which she handled like a champ. After he walked out of the room I came in to clean up and before I could even put on gloves the patient very abruptly warned me of the uncovered - used #11 scalpel that the doctor had just carelessly thrown in the garbage can. She told me to be careful and then said goodbye and went on her way.

For those of you unfamiliar with surgical instruments a #11 scalpel blade is about the most dangerous piece of metal under 2 inches one could find in or around a medical office. They are pointy like an x-acto knife and add to that the tempered medical grade surgical edge sometimes down to half a micron thick - and you are dealing with something that could cut through the trashcan in an instant...never mind the trash bag or my hand for instance.

Now it may come as a shock to some of you but some doctors, when it comes to anything remotely unrelated to diagnosing illness - are about as dumb as rocks. Never mind the medical training during which I guarantee they received instruction on proper disposal of instruments - how about common sense?

Razor sharp blade + trash bag = bad?

The reason I find it worth mentioning that this lady happened to mention it to me and how wonderfully kind that is - is because it has happened before! The first time this particular doctor pulled this stunt I would have sliced my hand to bits if I had not been paying very close attention to what was at the time a half visible handle in the bag of trash. I came to find out later that the patient had actually been the one to throw the scalpel in the trashcan himself! Nonetheless the doctor was to blame on this occasion as well, as there is a sharps container attached to the wall next the door of every single exam room in the office.

When approached about it on both occasions not once did he look up from fidgeting with his iPhone when he laughed, shrugged it off, insincerely apologized and walked away. This kind of behavior is exactly why patients aren't the only ones who hate arrogant doctors, their staff do too!

There is light at the end of the tunnel however because I have now come across at least one - good, kind person and for that I am thankful if only she could teach the doctor to do the same.