Archive for the 'Doctor Communication' Category

MRSA: Victimization and Shooting the Messenger

Yesterday’s post, where I told the stories of three (+2) victims of MRSA infections, raised ire, blame and excuses from commentators and emailers alike.

Never mind that they were stories of five people who are infected with MRSA, one of whom has basically been left to die. Never mind that the frustration levels of these patients while trying to get treatment are over the top. Never mind that these people are victims of dirty medicine — the kind where guidelines and controls exist, but are ignored in too many places. The negative comments were aimed at me — it’s easier, after all, to shoot the messenger.

This post has been moved.  Find it by linking to its new location

Why Your Doctor Won’t Help You

Notice that the title doesn’t say “can’t Help You.”  It says “won’t.”  There’s a big difference.

CPT codes are the stuff a doctor’s practice is made from.  I know — you thought patients were the basis for a physician practice, but no, CPT codes are more important than patients — even though I can guarantee that most doctors wish that was not true.

CPT Codes, Current Procedural Terminology Codes, are all those little numbers that show up on the bill you are handed as you walk out of the doctor’s office.  They are supposed to represent every type of task performed in medicine — from a basic check-up, to diagnosis, to administering a shot, to giving a medical test, to the levels of that test, to surgeries, to anything at all.  They are developed by the AMA, the American Medical Association,  and are intended to be the standard by which all doctors get paid, and all insurance reimburses.  The codes are revised regularly, and new codes are developed by an editorial board that represents the membership of the AMA.

Among the most frustrated of patients I hear from are those who can’t get diagnosed.  There can be a number of reasons for not getting a diagnosis, but one of the big problems is that patients can’t find one central person to review all the evidence.  They are sent from specialist to specialist, each looks at his own tests and results, but they don’t look at results from other doctors, except maybe the one who referred the patient. 

I call this daisy-chaining.  Each doctor represents a link to the answer.  Each link might look at the information from the link it is connected to.  But none of those links review information from links they are not directly connected to.

So what does that have to do with CPT codes?  Plenty.  Because the reason they won’t look at the other records is because there is no code for doing so — therefore — there is no way they can get paid (reimbursed by Medicare or insurance) to look at the big picture for a patient.

Why not?  I have theories, and they all relate to money, of course.  The AMA represents the doctors.  One would think that if doctors wanted to do this kind of big picture diagnosing, or review of other’s notes and reports, then the AMA would develop a code for it, right?  So theory #1 is that doctors don’t want to be doing so.  They don’t want to be responsible for that particular task. 

Theory #2 is that why would the AMA waste its time if insurance won’t cover the cost anyway?  And that’s actually the root of today’s blog.  A review of the new codes for 2008 shows that codes have now been developed for doctors who take phone calls or email from patients.  However, the report includes a caveat that says Medicare and insurance companies won’t be reimbursing for them anyway.

So that explains why your doctor won’t do what you wish he would do — take a comprehensive look at all your health challenges, and help you get diagnosed even after seeing a slew of specialists.   They wish they could — but they can’t.  If they can’t get paid, they can’t stay in business.  If they aren’t in business, then what good does it do for anyone?

I do give a bit of credit to the AMA for at least giving their new codes a shot — it’s a start.  Many more are needed.

But what’s really needed is someone to kick the payers in the backside.  They work for US, afterall — we pay taxes and we pay premiums.  So why aren’t they held accountable to reimburse for all those codes? 

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When Your Doctor Fakes You Out

Empowered patients will be interested in a report today on the study results of a survey of Chicago area internists (family doctors). It seems that 45% of them see nothing wrong in prescribing placebos — fake sugar pills — for their patients.

The report actually tiptoes around what the results really mean. The spinmeisters had their say with phrases like, ” this study suggests that placebos themselves are viewed as therapeutic tools in medical practice” and “a growing number of physicians believe in mind-body connection.”

Yes — I do understand that sometimes the mind triumphs over matter — and I do understand the mind-body connection theories. I’m a believer.

I don’t bring this up because I think patients shouldn’t be given what works — and if a sugar pill will help the pain or symptoms go away — then OK. But that is NOT why doctors are giving their patients sugar pills.

Instead I see these results as proof that doctors don’t care to take the time to figure out what is really wrong with a patient and that, too often, a placebo is simply the answer to “there, there, little lady — it’s all in your head.” If you could read my email, you’d believe the same thing.

The fact that 45% of doctors would be willing to sacrifice their patients’ potential health by ignoring real symptoms or not treating them accurately is just one more reason why trust continues to erode between patients and their doctors.

And if they think the sugar pills can really help a patient? Then they should tell them that’s what it is. According to this report, that is most often obscured.

Check your medicine cabinet. If you find something labled Obecalp (which is placebo backwards) or Cepocab — which is a pill made of lactose, a natural sugar, and can be prescribed and filled at pharmacies everywhere — then your doctor has prescribed a placebo for you.

Ethical? Unethical? What do you call it when someone pulls the wool over your eyes?

If you’d like to read more, you can do so here.

Wise patients know that asking plenty of questions is the best approach to making sure they aren’t victims of a placebo prescription. When your doctor writes a prescription, there are definite steps that can be taken to verify that the prescription is bonafide, that it’s the right drug for the right problem, and what to expect when you take it.

Wise patients work to make sure they aren’t being fooled.

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Overcoming the Doctor-Patient War of Words

I seem to have hit a nerve with my post about Dr. Steve Cole’s editorial published a few days ago. Dr. Cole asserted that the reason healthcare costs are going up is because doctors have learned to milk the system in ways related to how they order tests, prescribe meds and other tasks which allow them to use billing codes that get reimbursed by insurance at a higher rate.

Wow! Here are a few of the post outcomes:

  • My blog hits doubled.
  • The number of comments to the post doubled over my highest day previously.
  • Several doctors — those who commented and those who emailed — were ready to shoot the messengers — both Dr. Cole and me!
  • Some doctors agreed with Dr. Cole.
  • Some doctors vehemently disagreed.
  • And patients — always the ones who find themselves at the bottom of the totem pole, once again feel victimized by the whole sorry situation, regardless of how it came about or how it’s being handled.

As your friendly — and peace loving — Every Patient’s Advocate — let me raise a few points and clarifications:

There are many reasons the costs of healthcare are increasing. Dr. Cole offered one set of reasons but certainly not all of them. Others include the wish for private insurance to profit more and more, the too-high costs of drugs, the bad habits of patients which require more care to “fix” them (like smoking, obesity and others), the increasing healthcare costs of an aging baby boomer population, the fact that people are living longer, meaning they need higher priced care longer, the higher costs of advanced technology, and others. One commenter to the blog (justordinaryjoe) took a stab at this master list and did a good job at it.

What truly upsets me — UPSETS ME — is that somehow this translates to a them-vs-us discussion. Doctors VERSUS patients or patients VERSUS doctors. We’ve lost the “and” — and that, to me, is frightening and dangerous. This is not about a conflict. But it is about a loss of trust.

But a patient’s loss of trust in his/her doctor is not the trust that should be lost. The patient AND the doctor should be focusing their lack of trust on the very system that has created it. That’s what is broken — the system of healthcare in America. And it won’t be doctors or patients who can fix it, even though it’s doctors and patients who pay the highest price.

Recognizing that it’s the system — and not the doctors and patients — then we patients must work harder to collaborate with our doctors, and doctors must work harder to collaborate — and respect — patients. Here are some of the ways that can happen:

1. Respect for TIME: Time is money. And the respect for time is one of the biggest violations.

Doctors — PLEASE respect the time of your patients. Give them your 100 percent attention during those brief six or eight minutes you will see them. And don’t make them wait in waiting rooms for more than 10 minutes. After 10 minutes, it is a violation of your patient’s time.

And patients — PLEASE respect your doctor’s time. He can’t make a living (and yes, I’m serious about that) if you impose on his time for more than you deserve. Granted, you are hiring him to do a job for you. But you aren’t paying him out of your pocket — and you just can’t have ALL the time you want — so be concise, be specific, ask targeted questions and move on.

2. Respect for KNOWLEDGE

Doctors — you don’t have a corner on all the knowledge. Please respect that patients know their own bodies better than you do. Don’t try to fit their square problems into your round holes. Understand that the internet does yield ideas for them and be willing to discuss them, even if they seem ludicrous to you.

Patients – your doctor spent up to 12 years gaining the medical education needed to accurately diagnose and treat you. Don’t think that by spending an hour or two on the internet, or by talking to other people, that you can trump that education. Ask for help in translating new information you learn… and do so with….
3. Respect for the COLLABORATIVE PROCESS: Getting to WELL is not one sided.
Doctors — please don’t jump to conclusions. Doctors must work WITH their patients — not AT them. And never EVER (well, OK, hardly ever) tell any patient that a malady is all in her head! (see RESPECT below.)

And Patients — make sure you participate collaboratively, too. Ask questions that allow you to assess possibilities, ask more questions, and arrive at a decision WITH your doctor, not just because your doctor tells you that it’s the “best” answer for you. YOU are the only person who can determine the best answer for you.

4. Respect for DECISION-MAKING

Patients — YOU are the people with the responsibility for making decisions about your own bodies (and, in terms of advanced directives, your own demise.) You need to step up to that plate to do so. Don’t just default to what the doctor recommends. Ask instead for a good review of ALL your treatment options, the pros and cons of each, and then make as objective a decision possible based on that input.

Doctors — don’t abbreviate the list of options you give a patient just because you think others aren’t good options. (And a message to many — don’t try to tell me that doesn’t happen, because even if you don’t do it, you know it happens with your colleagues.)

5. Respect for…. RESPECT

Doctors — working with a patient does not allow you to judge him or her. I wish I had a nickel for every time a patient has said, “The doctor just laughed at me.” or “I was so insulted!” A patient comes to you for help and counsel — not for your judgment. You need to treat that patient respectfully.

Patients – and I’m serious about this — the only time you need to respect your doctor is if that doctor deserves respect. If your doctor laughs at you or insults you, or in some way makes you feel like less than the respect-deserving person you are — say something! And if you can’t muster the ability to say something, then send them a report card and tell them. And — if necessary — find yourself another doctor.

And the bottom line is:
Doctors: please make sure your patients understand and experience the respect they deserve. For most of you, this is a daily occurrence. But we all know that for many, it’s not even on their radar.

Patients: stop expecting your doctors to be gods who can overcome a broken system to help you get the medical attention you need. For most doctors are truly doing the best they can. And it’s up to you to weed out the ones who aren’t — and walk away.

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EveryPatientsAdvocate.com
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Doctors Work the System to Increase Income – at the Patient’s Expense

Found an interesting op-ed from the Dallas News online yesterday, written by Dr. Steve Cole entitled, Biggest factor in rising health costs are the doctors themselves.” Unfortunately, the title doesn’t even begin to touch the content, so many folks will miss this enlightening piece — a piece that should be read by everyone who has an interest in the costs of healthcare.

The article explains many of the reasons healthcare costs go up based on a doctor’s wants and needs and not necessarily on the best interests of the patient. There are a few statements that should make all of us pause — because they speak to the real problems of increased costs. I give Dr. Cole plenty of credit for citing these points — and no doubt he’s taking plenty of flak from his physician-colleagues for raising them.

Find the rest of this post at the new blog location.

10 Things Your Physician Won’t Tell You…

…. and I can’t take credit for them.

Check out this article in Smart Money magazine

You’ll learn from it, as scary as that is.

Then read my commentary here.

Doctors Protect Colleagues at Patient Expense

One of the questions I am asked frequently is about the best way to find the right doctor for a second opinion. That question — and its answer — have become among the most important answers I’ve ever provided, ever since the proof of my answer was provided in the results of a study last week by the Institute of Medicine as a Profession (IMAP.)

How many times have you heard that advice — get a second opinion! It’s important to do so if you will ever need any type of difficult or invasive treatment for your medical problem. Long term drugs, drugs with difficult side effects, any type of surgical procedure or any procedure which will have a long term effect on you — yes — you need a second opinion.

Why? Two reasons. First, to make sure your diagnosis is correct. Second, to make sure you know about all the treatment options, have someone to discuss them with, and can then choose the one you have the most confidence in according to your own goals for the treatment.

The advice I give? Never ever ever see a second opinion doctor who has any relationship to the first opinion doctor. Don’t see a second doctor from the same practice, from the same building, from the same hospital, from the same country club, from the same neighborhood, from the same bowling league — you get the idea. The idea is that they can’t be friends or close colleagues.

Why? Because two friends won’t contradict each other. Your number two will rarely give you different answers from your number one doctor if they know each other and respect each other. Knowing that, then you also understand that your number two won’t be as objective as necessary and if you need anything at all when you are being diagnosed and decisions are being made for treatment, then you know you need objectivity!

The study done by IMAP proves this point. Without going into all the details, the bottom line is that too many doctors talk out of both sides of their mouths. While, on the one hand, 98 percent of them say that medical errors should most definitely be reported, 46 percent said they had witnessed an error and had not reported it.

Why didn’t they report those errors?  Because they were committed by a friend, or close colleague, or a business partner or even just the guy down the hall.

Hmmm… a major ethical disconnect if you ask me.

You’ve seen me type it before: trust, but verify. A second opinion is absolutely necessary. We want to believe that our doctors are not the ones who do these unethical, and possibly dangerous things. But it turns out that about half talk out of both sides of their mouths. That means if you have seen two doctors, then one of them fit that unethical profile. If you’ve seen 10 doctors, then five of them do.

A second opinion from someone with no relationship to your first opinion doctor may be lifesaving in its objectivity.

Read more, and get more details on my About.com blog.

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…..
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EveryPatientsAdvocate.com
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Is Your Doctor the Right Religion?

Or the right gender?

Or the right color?

Or does s/he have the right sexual preference?

Or any of a number of other attributes that make your doctor the right doctor for you?

Wait a minute — are these attributes relevant?

This question came to mind today after a conversation with a friend who is gay. He told me about an experience when he went for a checkup that just blew his mind…. a discussion of relevance ensued.

Read about the conversation — and then join the discussion!

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.
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From the Desk of (11/24/07)…

Some miscellany from the week, not requiring blog posts on their own….fromthedeskof.gif

Hope you all had a delightful Thanksgiving and that your leftovers are no longer left over.

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Another quiet week with the arrival of the holiday. I did hear from some folks I’ve not heard from in awhile, with atta-girls for my mention in the Wall Street Journal article this week. Among them, Dr. Allan Showalter who runs a very comprehensive and thought provoking website and blog about medical compliance. He says he’s looking forward to when I finally appear on the cover of Rolling Stone. (hey! me too! isn’t that every boomer’s fantasy? !!) Thanks, my Ozark-bound friend.

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Looks like Dr. Scott Haig has really riled some feathers — both patient-side and physician-side — with his Time/CNN articles about patients who google. Included is my soon-to-be About.com colleague (there’s a hint!) Mary Shoman whose blog was even cited in the New York Times. I posted about the article a week or so ago, and Mary and I see his post differently — but there are a couple of bottom lines to the question. The first one is that if we are to communicate well — patients and doctors — then we need to be able to understand the other’s point of view. And second, that I still believe Dr. Haig misdiagnosed himself. In fact, I don’t think it was so much the fact that his patient had used google to get information about her knee problem; instead, I think she was just obnoxious and honestly, I don’t blame him for not wanting to treat an obnoxious patient.

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My big news? Still on hold for the moment…. fully expect to announce it this week…. and I did give a hint above :-)

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WSJ Interviews Every Patient’s Advocate

Not only was I privileged to contribute to an article in today’s Wall Street Journal (You Doctor’s Business Ties are Your Business, Too ) — but I actually learned even more than I knew before from the article!

The question asked by the author, David Armstrong, was whether patients have a right to know about any financial ties doctors have to the treatments they recommend. We discussed that topic last week while he was researching for his story. I told him absolutely I believe patients have a right to know, but it’s not so easy as just asking the question.

What I learned from his column is that there is a proposal in Congress called the Physician Payments Sunshine Act of 2007 that will require companies to publicly disclose any payments of $25 or more to doctors. I also didn’t know that the American Academy of Orthopaedic surgeons has mandated, beginning in January, disclosure of any arrangements made between a surgeon and a company which will relate to treatment. So, for example, if you need your knee replaced, and the surgeon stands to profit from the new knee parts — s/he will need to disclose that to you.

Love it! Both are grand steps forward toward transparency and disclosure…

My contribution to the article was a response to the question whether patients should ask their doctors about financial relationships that might affect their treatment …. my answer might surprise you…. (and you’ll have to read the article to find out why!)

Then, when you’re finished, you’ll be interested in this post, too.

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. . .This Blog Has Moved!. . .

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We just relocated, that's all.

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