Archive for the 'General Commentary' Category

Smoking and Botox — Wishful Thinking and Common Sense

The FDA came out with a report on the negatives of botox injections…

It’s like deja vu, isn’t it?  Where is common sense?

Read this post at About.com, Patient Empowerment.

Tax Rebates: Maybe Health Insurance Should Pay Attention!

[Note to my regular readers... starting today, I am beginning my migration to my new blog site:

will get you there. You'll find most of the post here, but you'll need to finish it at the new site -- so -- why not link to it right now? Oh -- and don't forget to change your feed address. New posts will no longer be found here after February 1, 2008]

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So hubby and I are excited about this tax rebate thing… looks like we fit in that middle class group that will get $1200 back from the federal government.

We reflected on the rebate for a few moments, and the thoughts by legislators and the president alike — why they voted “yes.” I share their thoughts with you:

  1. The economy is a mess. We need to make people spend more money to improve it.
  2. If we GIVE them money, they will have more to spend.
  3. We want voters to re-elect us in November , and if we give them money, they will like us and vote for us.

So here’s little old me, wondering the following:

  1. Mr. President and Ms/Mr Legislator — excuse me — but wasn’t that my money to begin with? I sent you a WHOLE lot more than that last year, and I’ll be sending you a WHOLE lot more this year. I don’t believe you are “giving” me anything!
  2. And one other question — where did all this extra money come from that you have to give back to me? All I hear about is the escalating costs of the war in Iraq and the hole that has put in the federal budget. So who exactly are you taking money away from so you can give it back to me?

Those thought processes would be enough to share in today’s post….but…. why stop now?

I got to thinking that health insurers should begin to take a page from the federal government’s book…

Find this entire post at my new blogsite: www.EveryPatientsAdvocate.com/blog

Why Does the US Have the Worst Rate of Preventable Deaths Among Industrialized Nations?

From 2002 to 2003, about 101,000 Americans died from preventable causes ranging from diabetes to bacterial infections and surgical complications, so says a study releases this week.

The reports are based on results from a study undertaken by the Commonwealth Fund, a private New York City based health policy foundation.  The study took place among 19 industrialized nations.  The results were published in the journal, Health Affairs.

The US ended up at the bottom of the preventable death barrel.  France, Japan and Australia were ranked at the top.

Researchers looked at deaths before age 75 from a variety of “amenable” causes which included heart disease, stroke, some cancers, diabetes, bacterial infections, surgical complications and others.  They arrived at a death rate and numbers of patients who died before they might have if they had received “timely and effective healthcare.”

Among the countries reviewed, 64.8 of 100,000 French people died from preventable causes.  And 109.7 of 100,00 Americans died from preventable causes during 2002 – 2003.

The same study was undertaken in 1997-1998, and the US came in 15th then — so it descended to the health system basement since then.  Between the first study and the second study, all of the countries improved their preventable death rates by an average of 16 percent.  Except the US — which improved by only 4 percent.  (That may not be as bad as it sounds since the US’s rate was at a higher level to begin with.)

Why is the US in such bad shape?  Those at the Commonwealth Fund blame access — the fact that 47 million Americans cannot afford insurance or healthcare.  I have no doubt access is a big part of it.  If you can’t afford healthcare, then you don’t seek it out.  Who wants to spend a lot of money on a doctor appointment, only to be told you are sick, when you don’t have the money to treat the sickness anyway.

But I add my own two cents worth of reasons:

First, I believe that part of the answer lies in the way access is handled among those who DO seek help.  We have symptoms, we go to the doctor, and the doctor spends so little time with us that too often, the problem assessment isn’t handled correctly to begin with.  It’s a problem of misdiagnosis and missed diagnosis.  I’d be curious about the correct diagnosis rates among those other industrialized countries.  It only makes sense that people will die if their preventable disease isn’t diagnosed correctly to be begin with — even if it is eventually discovered, it may be too late to treat effectively.  (Yes, I’ll admit, I’m not particularly objective about this part, based on my own experience.)

Second, I believe our American lifestyles lead to preventable death.  We overeat, smoke, drink too much alcohol, drive too fast, live like couch potatoes — and then if we do go to the doctor, we expect the doctor to give us a pill that will fix our bad behaviors.  Please!  One pill won’t fix a lifetime of unhealthy habits.  My curiosity expands to the lifestyles in the other countries that ranked higher than the US.

The Answers for Wise Patients:

A two-pronged attack.  First, begin examining some of your own lifestyle habits to see if you can step up to the health plate yourself.  Don’t blame your doctor or lack of access for your bad choices.

Second, knowing that your doctor will never (in our lifetime) have more time to spend with you, pick up the banner yourself, and begin empowering yourself.  Take responsibility for your own healthcare.  Seek out the doctor when you are prepared to do so.

The truth is — excellent care exists in the US for those who seek it out.  I know the payment system is a barrier.  There is no question about that.  But that’s not going to change anytime soon.  So we patients need to do what we can to improve our own chances.

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How Supermarket Purchases Violate Your Privacy and Increase the Cost of Insurance

It’s cold and wintery.  Time to hunker down with plenty of comfort food and a toddy or two…  and while we’re at the store, let’s pick up a bottle of aspirin, some stomach acid medicine, and maybe even plenty of dog food for the rottweiler….

A swipe of both your store’s loyalty card (gotta get those discounts!) and of course, your debit card to pay for your goods — and home you go to lay in for the weekend, read a good book, and max out on all that junk food and alcohol.

Come Monday, your purchases, aligned with your identity, will be sold to a health insurer, or life insurance company, perhaps an auto insurance group….  and they will have that information to review should you contact them to make an insurance purchase.

Find the rest of this post at its new location:

http://www.trishatorrey.com/2008/01/03/how-supermarket-purchases-violate-your-privacy-and-increase-the-cost-of-insurance/

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Want more tools and commentary for sharp patients?
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Join Trisha in the Patient Empowerment Forum at About.com
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Or link here to empower yourself at
EveryPatientsAdvocate.com
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Dad — an Empowered Patient Sets a Fine Example

…. and today is his 81st birthday.

When people ask me how and why I began doing patient advocacy and empowerment work, I first tell them about my misdiagnosis, and then I tell them it’s because I learned how to be an empowered patient from my dad.

Since beginning his battle with cancer in 1986 — yes — more than 21 years ago — Dad has battled his illness every step of the way. From learning everything he could, first through the libraries, then through the Internet, to partnering with his doctors but retaining decision-making for himself, to second guessing problems with a drug he was taking, then figuring out he’d been given the wrong instructions, to doing all the same for my mom to help support her through her Alzheimer’s disease… yes… dad is the epitome of the empowered patient.

Learn more about the steps he has taken here….

Then join me in wishing him a Happy Birthday!

I’m proud of you, Dad…. with love…. from your eldest :-)

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Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips
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Join Trisha in the Patient Empowerment Forum at About.com
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Or link here to empower yourself at
EveryPatientsAdvocate.com
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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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Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips
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Join Trisha in the Patient Empowerment Forum at About.com
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Or link here to empower yourself at
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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Want more tools and commentary for sharp patients?
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Join Trisha in the Patient Empowerment Forum at About.com
.
Or link here to empower yourself at
EveryPatientsAdvocate.com
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From the desk of (12/1/07)…

Miscellany from the week, not requiring full posts on their own….fromthedeskof.gif

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My big news is ready to be sprung! Although, through today’s blog, I’ll announce it “softly” — a bigger announcement is in the works for this week.

You may be familiar with About.com — tens or hundreds of millions of visitors each month go there to learn about 600+ topics of interest ranging from Women’s Issues to Fishing to Poker to Fashion to Football — and now — patient empowerment!

Yes — as of yesterday afternoon, the new About.com Guide to Patient Empowerment was launched — and yours truly is the expert/guide. Take a stroll on over! Let me know what you think! Join the forum so we can chat! And if you ever want to touch base, just link on my name at the top — my email address is right there.

The web address is: http://patients.about.com Why not bookmark it or add it to your favorites?

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An interesting report on the Thursday evening NBC news about differences in the way African American women are diagnosed, treated, provided with preventive medicine, etc…. It actually strikes me as the next revelation in the fact that medical research just can’t be generalized. First we learn that women require different diagnosing and treatment from men for problems like heart disease. Then we’re told that children can’t take smaller doses of adult drugs because “children are not simply small adults.” And now we learn that genetic makeup related to skin color affects the success of diagnosis and treatment as well.

What others are we missing?

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Has anyone else noticed this? Everytime I turn around — for the past several weeks — there have been more ads for health insurance on the TV, in the newspaper. From those plans that “pay you back” to supplemental plans for Medicare…. they must be spending millions if not billions.

Wouldn’t our premiums be lower if they didn’t spend so much on advertising?

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Today is World AIDS Day and it seems there’s not much mention of it in the press. My cousin Tim has AIDS. Tim is in his 50s. As a younger man he was a vibrant and talented actor, appearing in everything from plays to a soap opera in England back in the 1970s. Now, in these later years, Tim is a slave to the medications that keep him alive and by his own estimation, he doesn’t feel like his life has much quality.

My thoughts and prayers are with Tim and others who suffer through such a horrible disease.

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Or link here to empower yourself at
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Kickbacks: Doctors, Pharma, Insurance and Surprise! Patients Caught in the Middle

See if you can get your arms around the following conundrum, which is typical of our dysfunctional American Healthcare System — only this time with a twist. We’ll begin with point-of-view:

Consumers (that’s us patients!): When we need a prescription drug to improve our health, we want the best drug for what ails us, at the lowest price possible. We also want affordable health insurance, with fair co-pays for those drugs.

Physicians: When it comes time to prescribing a drug for a patient, the doctor wants to be sure it’s the right drug with the best chance of improving the patient’s health. Further, the physician is also on the constant lookout for ways to increase his/her income. They are offered money, support and/or other incentives from pharma manufacturers on a constant basis, but this practice has become a real point of contention because it creates a conflict of interest. Now, for many, a possible new income stream has been offered by insurance companies (see below.)

Pharma companies: Are interested in maximizing income. Period. And they will do whatever they can to protect that interest. Their real allegiance is to their stockholders who may also be any of the players mentioned here. The great majority of their income is derived from branded/innovator drugs and they take a huge hit when their patents run out and they begin to compete against generics. They look for ways to reward doctors for prescribing and using their drugs.

Insurance companies: Are interested in maximizing income. Period. And they will do whatever they can to protect that interest. Even the not-for-profits want to maximize their income so they can pay out bigger bonuses to their top people. They are constantly on the lookout for ways to reduce their costs so their profits are larger. When they can get doctors to switch patients to generic drugs, (or when they can get patients to ask their doctors about the possibility) then they can save costs.

Some background:

Read the rest of this post at its new location:

http://www.trishatorrey.com/2007/11/26/kickbacks-doctors-pharma-insurance-and-surprise-patients-caught-in-the-middle/

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Want more tools and commentary for sharp patients?
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EveryPatientsAdvocate.com
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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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