Archive for the 'Medical Commentary' Category

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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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

MRSA: Patients Ignored, Left to Die

(Find an update to this post: MRSA, Victimization and Shooting the Messenger)

In the past two days, I have heard three stories, all related to MRSA and other hospital acquired staph infections, and all relating to heinous — even (in my not-so-humble-opinion) criminal acts on the parts of healthcare providers or politicos.

One story came from a colleague who visited a woman in the hospital. The woman contracted an infection after surgery almost a year ago. She is still in the hospital, on life support, not because of the surgery, but because the infection has just consumed her.

This post has been moved. Link here to find it in 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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Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips
………………………………………………………………..
Join Trisha in the Patient Empowerment Forum at About.com
………………………………………………………………..
Or link here to empower yourself at
EveryPatientsAdvocate.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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.

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