2007 February : Every Patient’s Advocate

Doctors Write “Information Prescriptions”

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This month’s AARP Magazine has a good article about finding trustworthy health and medical information online written by David Kushner. (I tried to find it on their website to provide you with a link, but it doesn’t seem to be there.)

There is some excellent advice — points I share with readers and workshop attendees on a regular basis. And there was one point in the article that was new to me! So I thought I would share it with you.

Turns out, the American College of Physicians and the National Library of Medicine have finally figured out that patients WILL look online for information, even if they prefer patients not do so. (surprise!) In their “if you can’t beat them, join them” approach, they have now developed a “process” to help physicians help their patients find trustworthy information. They call it an “Information Prescription” — and they sell doctors little prescription pads so they can write down a web address or two, plus some keywords for patients to use.

OK. I’ll buy that. Now the question is — how do you find a doctor who buys in to the approach? (I think there may be one in Texas :-) !) My experience is that most doctors either hate the fact that patients use the internet, or they suffer it, sometimes not so silently.

But it’s definitely a step in the right direction.

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Pay Cash for Your Health Care

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I like to poke around other’s blogs… so many excellent points can be made in this free flow of information.

Found a great case for paying cash when you visit your doctor from Dr. Tim. Check it out:

http://drtim.wordpress.com/2007/02/23/the-case-for-cash-when-health-insurance-isnt/

Thanks for the eye-opener, Dr. Tim.

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Health Insurance Misinformation Can Cost You!

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I received a letter from a young woman (Amanda) with two suggestions for columns. (And let me tell you how much I appreciate those suggestions!)…

The one suggestion that shouldn’t have surprised me, but really ticked me off, was based on her experience with her health insurance company. It’s a heads-up for us all.

Amanda’s doctor was having a problem diagnosing her, and decided to send Amanda for a particular, somewhat expensive, test. Amanda has health insurance through one of the largest insurers in her area, and the doctor’s insurance person called to get permission for Amanda to have the test. The insurance customer service person reported that no permission was needed; that Amanda’s policy covered the test.

Amanda had the test, the results were delivered to her doctor, and they proceded with the diagnosis process.

A few weeks later, Amanda received a bill from the testing center. It showed that they had tried to bill her insurance company, but the insurance company had not paid any of the expense. Amanda called the insurance company to find out why they hadn’t paid for it — and she was told that since she didn’t get permission ahead of time, they would not pay for the test.

She told them her doctor’s office had tried to arrange for permission but was told she did not need that permission. The insurance customer service person told her that was too bad, but in fact she DID need permission, and gee — they couldn’t help it if their people gave her the wrong information. They refused to pay for the test.

Amanda is stuck with the bill now. If she is pursuing it further, she didn’t say. She didn’t tell me what the cost of the test was, but some of them run into the thousands of dollars.

The cautionary tale for all of us, of course, is to double check all the permissions we need. If you think there is any possibility whatsoever that you will need permission for a test or another procedure, then you’ll want to pursue that until you have a piece of paper that says you do — or don’t — have or need that permission.

Understand that the insurance company is the LEAST trustworthy of all the players in your healthcare. One only needs to have the rug pulled out from under her once to know that you can’t trust anyone whose sole raison d’etre is to profit at its member’s expense. Better for us to learn from Amanda than learn the hard way ourselves.

I’ve said it before — follow the money. And make sure to take care of all those loose ends that can cost you out of your pocket, too, when you aren’t paying attention.

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Prostate Cancer Caveat Part II

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A few days ago, I wrote about Jane and Max, and Max’s diagnosis of prostate cancer. Max was told he needed a prostatectomy and was trying to decide between laparoscopic and robotic surgery.

A comment from “hERB” reminded us that Max might have other options, too — radiation, cryosurgery, hormone depletion and others. The point being — perhaps Max should be looking at options beyond surgery.

And hERB (is that really how you spell your name?!?) is absolutely right — and it’s worth writing about because smart patients realize there are often options beyond what their doctors tell them.

As I’ve reminded patients before — that sometimes, part of our decision-making requires us to follow the money. Whether we want to believe it or not, doctors will way-too-often make recommendations for us that line their pockets, too. A surgeon is trained to perform, and GETS PAID FOR, doing surgery. That’s true whether we are talking about prostate surgery or brain surgery.

About a year ago, I heard from another gentleman, Bob, who has a brain tumor and was told he needs surgery. His neurosurgeon wouldn’t discuss any other options with him but surgery. Bob asked me how he could get the neurosurgeon to discuss other alternatives with him — including nutrition and natural remedies. You already know what I told him! A surgeon, who only GETS PAID FOR surgery, isn’t going to discuss any other options with Bob. I suggested Bob find himself another doctor to discuss those options with. (And — I just heard from Bob again yesterday — he did find another doctor, and he continues to pursue natural remedies, a pursuit which empowers him in many ways.)

And it’s not just surgeons. Earlier this week, I also wrote about oncologists MAKING MONEY FROM the chemo they recommend for the “infusion centers” they own. Many other doctors are now setting up their own testing centers, or purchasing the testing machines for their own practices. They are consistently on the lookout for alternatives ways TO GET PAID.

Here’s the thing — in many cases, and because I was a business person long before I was an advocate — I understand exactly why doctors set themselves up to profit in all these other ways. It’s really just good business to create profit centers. Doctors spend a lot of time in school, they have education loans to pay off, they set up state-of-the-art practices which are very expensive to run, they hire educated staff who deserve decent pay checks. Most doctors deserve high incomes and as insurance companies continue to squeeze them, they seek alternative sources of income.

And we patients can certainly benefit from all this technology and profit-basing…. BUT…. we have to be smart about it. Once it’s in place, doctors will want to, and deserve to, profit by it. So — as sharp patients, we simply need to make sure we take all aspects of our treatment into account — making sure it’s the right treatment for US, and not simply extra profit for the doctor.

Getting the best treatment, and profit making, are not necessarily mutually exclusive. But they do necessarily require review and examination, and consideration about whether they pave the right road to the patient’s best outcome.

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