Archive for the 'Self Help' 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.

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

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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Join Trisha in the Patient Empowerment Forum at About.com
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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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Patient Empowerment on About.com

This is the announcement I’ve been waiting to make to you, and it’s finally time to spring it….

I’m pleased to tell you that as of Friday, About.com has launched a new site for Patient Empowerment — and yours truly is the expert behind the scenes.

aboutlogo.gif

About.com is owned by the New York Times — and has some impressive credentials:

  • About.com is one of the 15 most visited Web sites in the US
  • About.com is a top-ten content site
  • Every month, 34 million unique visitors in the U.S. (average; Nielsen//NetRatings) and 51 million worldwide (average: About metrics)
  • About.com’s content is created by a network of more than 600 Guides. These people are passionate about their topic areas, and have deep expertise and credentials in their fields. Guides make sure our visitors find answers and advice that are personally relevant, credible, and useful – all delivered in a human, accessible voice.
  • About.com is a “companion to your news” site, providing depth and breadth behind current topics

A big benefit to those with interest is the fact that we will have an ongoing forum on any topic of interest related to healthcare delivery — the good and the ugly.

Yes, this personal blog will continue. This blog and the one at About.com will cover different topics on any given day, so you’ll want to check them both. Comment on them, too!

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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
~~~
Or link here to empower yourself at
EveryPatientsAdvocate.com
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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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Another PHR Program that Violates Your Privacy

I learned this week that a loved one who has been battling cancer for many years was encouraged to sign up for an online personal health record (PHR) called Caring 4 Cancer. It’s a perfect example of the kind of PHR that I think can be dangerous for patients because there is no privacy.

Even their privacy statement (a misnomer — it should be called a No Privacy Statement) tells you that they are not required to follow HIPAA regulations. And I love this: the mission statement is this: “increase efficiencies for Physicians, Patients, Pharmaceutical companies, and Payers.” Uh-huh. Exactly what efficiencies does this take care of for patients? The efficiency of stripping them of their privacy?

I actually spent quite a bit of time on their website. There is some excellent information there — and I don’t discourage anyone from using the website to find articles or to use the message boards. I DO discourage you from sharing any information that can identify you personally — so where they ask for your mailing address or phone number or — ? — don’t do it! Make up some bogus information and set up an email address through some other means beside your main email address.

Yes, there is plenty of advertising — to your best ability, ignore it if you can. That’s the price of a “free” online application.

Here’s the part that gets me. Evidently there was someone right there in the oncologist’s office to encourage my loved one to sign up for the program….

As you know well in every other aspect of your life, there is no such thing as a free lunch. And thus it is true here, too. Only in this case, it could come at the cost of purchasing health or life insurance in the future, spam in your email box, junk in your postal mail box, or — who knows what they’ll dream up next?

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Cancer, Chemo, Emotions: It’s OK Not to be SO OK

In the past few months, I’ve blogged a few times about my admiration for those strong women on TV who are in the process of, or have transitioned through, chemotherapy.

Yesterday Robin Roberts (ABC) shared her chemo hair loss story during Good Morning America. Once again, Robin rose to the occasion, showing incredible strength, and it seemed to me, almost afraid of her own emotions — as if she had put her emotions on a shelf, perhaps to be dealt with later.

That was in great contrast with Hoda Kotbe’s (NBC) sharing of several weeks ago. Hoda shared her experience, after it was all over, but was still incredibly emotional and, it seemed to me, very real.

Then later last night, a woman named Lynn posted a comment to one of my blog posts about Robin’s experience, saying she was diagnosed a week before Robin was, and has had difficulty watching Robin’s reports, because she just doesn’t feel so strong. Her challenge is not about putting on a very public positive appearance; rather, she is challenged by paying her bills. (Thanks for writing, Lynn.)

This morning, I went to the ABC website to see what kinds of comments had been added to the story Robin shared yesterday. There are well more than a thousand comments — I read only about a dozen. But they are overwhelmingly atta-girls, and written by other strong women like Robin. So where were the comments by someone like Lynn?

And then it struck me. There was no allowance for individual differences… the role model had become not just a role model; rather, now she has become the expectation.

I do think there is an incredible amount of power and confidence (and healing) to be gained by doing anything you can to control your situation when faced with adversity. Robin shared her mother’s wisdom which I loved, “Make your mess your message.”

It worked for me. Taking control of my own situation, tightening my grip — I steered my own course and as a result, avoided chemotherapy all together.

But some people choose not to do that, and I think it’s unfair of those who are more public in nature to create a new expectation level that is impossible, and not even necessary for someone’s health. Hoda’s example was probably the best. She showed us her true and difficult emotions. But her emotions did not make her weak; instead they made her very real.

So that’s my message for today. No matter who you are, no matter how public or private your health situation, no matter what disease or debilitation it is — don’t let these public figures set YOUR standard. Don’t wonder what is wrong with you if you can’t meet their levels.

Instead, find your own strength, and transition through your treatment in your own way. If dragging yourself to work is the best you can do — that’s still fantastic! If wrapping yourself in a blanket, lying on the couch, and sipping hot chocolate makes you feel better, then go for it! If putting on a smiley face and pretending you haven’t been affected actually makes you feel better — then more power to you.

But do NOT let anyone else’s managing of their disease and treatment become your own expectation for yourself. Lynn figured out what she can handle. I figured out what I could handle. Robin and Hoda figured theirs out, too. None of us let anyone else define our expectations of ourselves. We have all just met our own expectations.

It’s up to each of us — man or woman — to figure out what our own individual levels are, and then to rise to our individual levels of expectation for ourselves. That’s patientude, too.

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. . .This Blog Has Moved!. . .

Where did everything go?

Not far.
We just relocated, that's all.

You can find every post and comment from this blog
-- and plenty more --
at the new location of the
Every Patient's Advocate Blog.

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