Archive for the 'Health' Category



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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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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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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Health Insurance = Better Health (No kidding)

A report issued this week by JAMA, the Journal of the American Medical Association, reviews a study done by Harvard about the health of Americans and their access to health insurance.

More than 7,000 people ages 55 to 72 were studied. More than 2,200 of them had no health insurance to begin with, but were able to take advantage of Medicare once they turned 65.

Among those who had been uninsured and had cardiac or diabetes problems pre-Medicare coverage, 10 percent had fewer cardiac problems than would have been expected by age 72.

Bottom line, according to the researchers, is that health improves when we have access to health insurance.

Let’s put this one in the no-brainer category! Or — actually — let’s look at it another way:

Healthcare is way too expensive for too many (47 million Americans) to afford. Once you take away that money barrier, they will seek care — and they will be healthier.

My bottom line: This study wasn’t about insurance coverage’s affect on health. It was about removing a barrier.

Which then, of course, begs the question: If removing the barrier to seniors makes them healthier, what could it possibly do for those of us who are healthy to begin with? Maybe keep us healthier throughout our lives? And maybe cost the system less to keep us healthy?

And — doesn’t this make those who vote against SCHIP even bigger scrooges? What do you think about that, George Bush?

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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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