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Archive for June, 2007

A Patient Advocate’s Reaction to Sicko

…. is that Michael Moore has only exposed the very tip of the dysfunctional American health care system’s iceberg.

As confessed in yesterday’s blog post, I’ve never been a fan of Michael Moore’s. I think his previous works have been inflammatory and one sided. Not that he doesn’t raise awareness of issues, and not that he doesn’t cause dialogue that is helpful, because he does. Rather, because he takes facts and bloats them, and his audience walks away believing partial truths.

But for Sicko? He is inflammatory, and if I worked for a health insurer, I’d want to hide. And if I were an executive for a health insurance company, especially the “medical director” of a health insurance company, I would be embarrassed beyond belief.

But as far as whether his presentation was balanced — well — his story was no more unbalanced than reality. The reality of what healthcare in the US has become is so lopsided, that it’s falling into the deep unknown. If it’s any indication? I’ve never attended a movie that elicited applause, not just at the end, but in reaction to statements made during the movie, too. And whereas many had told me I would laugh, and on occasion, I did — but — I left with tears in my eyes.

I learned a few things, which I will present to you, although I have not yet confirmed them to be absolutely true. The scary part is, even if they are only half true, then they are still worth noting.

For example: one woman who used to be a health insurance sales person spoke of a 37 page document of “pre-existing conditions” which would automatically cause denial of coverage to an applicant. Another woman described how executives in health insurance companies get paid: the higher the rate of denial of coverage (not just in policies, but in pre-approvals for treatment), the higher the bonus. “Payment of any claim,” she explained, “is defined as a medical loss.”

One gentleman explained his former job as a health record spy — in effect, if someone made a claim the insurance company didn’t want to pay, it was up to him to comb through the previous medical records of the patient and use anything at all — ANYTHING — to create a case for denying a claim. Of course, the insured has no recourse. None. (By the way — this is a perfect reason for making sure your medical records are always correct.)

I’ve often wondered if there was a watershed moment in American history that caused the previously considered “good” system of healthcare to go awry. Moore explains it as a Nixonian decision. In 1971, then president Richard Nixon and his buddy Edgar Kaiser (of Kaiser Permanente fame) created a new approach to healthcare where denial of service became a profit center.

And then there is Moore’s statement that there are 4 times as many health insurance lobbyists in Washington as there are congress members. Can you guess who is paying for those lobbyists?

The last example of what I learned (although there is really quite a big more) is that Moore visits Canada, Great Britain, France and even Cuba, and claims that in those countries, where healthcare is a given, paid for by taxes, then provided at no additional cost to its citizens, people live 3 or 4 years longer than Americans on average. Even the Journal of the American Medical Association cited those statistics. In England, doctors earn more by keeping their patients healthy, too. Amazing.

So here are a few comments from your friendly patient advocate — now that I’ve had a few hours to think it over:

1. While Moore did a good job pointing out the foibles of our system as they relate to how medical care is paid for, he didn’t even attempt to talk about medical errors, misdiagnosis, drug-related problems, etc (although he mentions pharma as being almost as evil as insurance.)

2. As long as Washington politicians are bought and paid for by health insurance, nothing will change. As long as health insurance companies continue rewarding their top echelons with huge paychecks and bonuses, nothing will change.

3. I whole heartedly agree with some of his statements as they regard the services we are all entitled to because we are citizens of America and our communities: police, firefighters, public education, inexpensive postal services, parks, libraries. Why isn’t healthcare on that list? Well — for seniors who use Medicare, it is. And what about the other 47 million of us?

For the first 50+ years of my life, I never would have believed I could even think this thought, much less type it…. and based on the research I have done, all of it prior to seeing Sicko today….. I do believe American needs to move to universal healthcare. Don’t forget — you’re hearing this from a woman who has owned businesses, and believed in private enterprise and profit all her life….. but LIFE is the keyword here…. and because health insurance and big pharma have become so greedy, because that greed is costing lives, because the need of the masses to access better care is more important than the need of individuals to control…. yes…. I believe we need to create a healthcare model similar to our public education model.

Do I think it will be perfect? Heavens no. But if it parallels public education, then many MANY more will benefit, and for those who still believe private care is important — well — we have private schools, too, right?

Of all the statements that made me really think, and there were many, this is the one I will leave you with:

“You can judge a society by how it treats its worst…. and its best.”

Society, our politicians, and our American way of medical care is failing us. It’s time we patient stood up and made the noise necessary to invoke the change that’s needed.

………………………………………………………………

Read what others have said about Sicko:

R J Eskow in the Huffington Post

M Foust in Artvoice

The American Thinker

And to learn more about how those running for president have reacted: The LA Times

…. and see follow up blog posts from Every Patient’s Advocate,

What Sicko Doesn’t Tell Us and Why Sicko is Only the Tip of the Iceberg

………………
Want more tools for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………

A Patient Advocate’s Reaction to Sicko

…. is that Michael Moore has only exposed the very tip of the dysfunctional American health care system’s iceberg.

As confessed in yesterday’s blog post, I’ve never been a fan of Michael Moore’s. I think his previous works have been inflammatory and one sided. Not that he doesn’t raise awareness of issues, and not that he doesn’t cause dialogue that is helpful, because he does. Rather, because he takes facts and bloats them, and his audience walks away believing partial truths.

But for Sicko? He is inflammatory, and if I worked for a health insurer, I’d want to hide. And if I were an executive for a health insurance company, especially the “medical director” of a health insurance company, I would be embarrassed beyond belief.

But as far as whether his presentation was balanced — well — his story was no more unbalanced than reality. The reality of what healthcare in the US has become is so lopsided, that it’s falling into the deep unknown. If it’s any indication? I’ve never attended a movie that elicited applause, not just at the end, but in reaction to statements made during the movie, too. And whereas many had told me I would laugh, and on occasion, I did — but — I left with tears in my eyes.

I learned a few things, which I will present to you, although I have not yet confirmed them to be absolutely true. The scary part is, even if they are only half true, then they are still worth noting.

For example: one woman who used to be a health insurance sales person spoke of a 37 page document of “pre-existing conditions” which would automatically cause denial of coverage to an applicant. Another woman described how executives in health insurance companies get paid: the higher the rate of denial of coverage (not just in policies, but in pre-approvals for treatment), the higher the bonus. “Payment of any claim,” she explained, “is defined as a medical loss.”

One gentleman explained his former job as a health record spy — in effect, if someone made a claim the insurance company didn’t want to pay, it was up to him to comb through the previous medical records of the patient and use anything at all — ANYTHING — to create a case for denying a claim. Of course, the insured has no recourse. None. (By the way — this is a perfect reason for making sure your medical records are always correct.)

I’ve often wondered if there was a watershed moment in American history that caused the previously considered “good” system of healthcare to go awry. Moore explains it as a Nixonian decision. In 1971, then president Richard Nixon and his buddy Edgar Kaiser (of Kaiser Permanente fame) created a new approach to healthcare where denial of service became a profit center.

And then there is Moore’s statement that there are 4 times as many health insurance lobbyists in Washington as there are congress members. Can you guess who is paying for those lobbyists?

The last example of what I learned (although there is really quite a big more) is that Moore visits Canada, Great Britain, France and even Cuba, and claims that in those countries, where healthcare is a given, paid for by taxes, then provided at no additional cost to its citizens, people live 3 or 4 years longer than Americans on average. Even the Journal of the American Medical Association cited those statistics. In England, doctors earn more by keeping their patients healthy, too. Amazing.

So here are a few comments from your friendly patient advocate — now that I’ve had a few hours to think it over:

1. While Moore did a good job pointing out the foibles of our system as they relate to how medical care is paid for, he didn’t even attempt to talk about medical errors, misdiagnosis, drug-related problems, etc (although he mentions pharma as being almost as evil as insurance.)

2. As long as Washington politicians are bought and paid for by health insurance, nothing will change. As long as health insurance companies continue rewarding their top echelons with huge paychecks and bonuses, nothing will change.

3. I whole heartedly agree with some of his statements as they regard the services we are all entitled to because we are citizens of America and our communities: police, firefighters, public education, inexpensive postal services, parks, libraries. Why isn’t healthcare on that list? Well — for seniors who use Medicare, it is. And what about the other 47 million of us?

For the first 50+ years of my life, I never would have believed I could even think this thought, much less type it…. and based on the research I have done, all of it prior to seeing Sicko today….. I do believe American needs to move to universal healthcare. Don’t forget — you’re hearing this from a woman who has owned businesses, and believed in private enterprise and profit all her life….. but LIFE is the keyword here…. and because health insurance and big pharma have become so greedy, because that greed is costing lives, because the need of the masses to access better care is more important than the need of individuals to control…. yes…. I believe we need to create a healthcare model similar to our public education model.

Do I think it will be perfect? Heavens no. But if it parallels public education, then many MANY more will benefit, and for those who still believe private care is important — well — we have private schools, too, right?

Of all the statements that made me really think, and there were many, this is the one I will leave you with:

“You can judge a society by how it treats its worst…. and its best.”

Society, our politicians, and our American way of medical care is failing us. It’s time we patient stood up and made the noise necessary to invoke the change that’s needed.

………………………………………………………………

Read what others have said about Sicko:

R J Eskow in the Huffington Post

M Foust in Artvoice

The American Thinker

And to learn more about how those running for president have reacted: The LA Times

…. and see follow up blog posts from Every Patient’s Advocate,

What Sicko Doesn’t Tell Us and Why Sicko is Only the Tip of the Iceberg

………………
Want more tools for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………

Marcus Welby: Did He Set Us Up?

If you are of a certain age or older, then you remember Marcus Welby on TV. I spoke to a 20-something man yesterday and described Marcus Welby to him as everyone’s perfect doctor. His early 1970′s TV show was always popular, and we all KNEW he was the perfect doctor.

Compounding his image was the fact that at that time, doctors were venerated, as if they all stood on pedestals. Becoming a doctor was the ultimate, because one was promised reverance and beaucoups bucks, too.

While I was a major fan of Marcus Welby, MD, I can’t help but think today that perhaps one reason our healthcare system in the US has failed, is because we all still believe Marcus Welby exists, and is reincarnated in today’s doctors, too.

We’re wrong. He’s not. And it has become downright dangerous. We’ve been set up.

Consider:

Marcus Welby (played by Robert Young) and his partner, Steve Kiley (played by James Brolin) were handsome, white, male, compassionate, paternalistic, and highly intelligent. They had perfected the concept of bedside manner, and they knew everything there was about every medical specialty. [Can you think of one single doctor who fits that profile today? There are many doctors who embody one aspect or another -- but I can't imagine there is a single one who embodies it all.]

Drs. Welby and Kiley were always right. [OK -- don't even get me started on this one!]

They took care of both physical and mental/emotional health issues. [Today, if you have a mental or emotional health issue, it's probably dangerous to be treated by a physical health physician. Make sure you see a mental health professional to avoid getting yourself into treatments that may not be the best for you.]

I don’t recall that any of their patients ever had to pay for their care. No one ever raised the question. No matter who the patient was, how much care was needed, how long they stayed in the hospital, how many times they stopped by Welby’s office — no one ever had to pay for care. Not surprisingly, their patients never seemed to file for bankruptcy either! [Again -- don't get me started!]

I could go on and on — but you get the picture.

And just so you know I’m providing a balanced view — I do give them credit for showcasing who may have been the very first Latina-American actress as the person who ran their office — and perfectly so! Consuelo. She was crackerjack.

The problem is — just like we little girls dreamed of becoming princesses, and little boys dreamed of becoming firemen (and nowadays? vice versa!) — so many also embraced the idea that Marcus Welby represented their doctors, too. And for whatever reason, too many of us over that certain age, just can’t let go of that concept.

And — what if you are a doctor today? Granted, there are many of them who think they are Marcus Welby, and would want you to believe such. And I suppose there are even a few Welby-wanna-bes out there, too — but most? naw. Who on earth would ever want to live up to that TV perfectionist hype? They don’t ask for it, they don’t want it, and it’s not appropriate.

It’s time for Welby Worshipers to let go. Time to face reality. Time to realize that doctors are people just like we are, who pull their pants on the same way and have the same human attributes — including failings — as we do. And once we embrace that attitude, it will be a whole lot easier to understand why we need to advocate for ourselves and continually question our doctors and our care.

No more abdication of healthcare decisions to the likes of a doctor who really is NOT Welby, or McDreamy or McSteamy — or even House.

It’s time to take responsibility for ourselves.

………………………………

On a very separate, but related, note: I’m headed out to see “Sicko” today. I’m no fan of Michael Moore as I believe he is inflammatory, but never offers positive alternatives. I hear this movie is bi-partisan — definitely a break with his tradition, but certainly appreciated. And, I suppose that he incites dialogue, too — in the case of healthcare, I see that as a plus.

So as much as possible, I promise to remain open-minded, and I’ll let you know just what I think.

………………
Want more tools for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
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………………

Yackety Yak: It’s all about the doctors

This post has been moved (along with the rest of this blog….)

Find it at its new location: http://trishatorrey.com/2007/06/28/yackety-yak-its-all-about-the-doctors/

Thanks for stopping by.

Yackety Yak: It’s all about the doctors

… so said the doctors in a study conducted in Rochester, NY and reported in the Archives of Internal Medicine ….

It seems that 100 doctors were studied over the span of a year to see how they communicated with patients. Mystery patients made appointments, visited the doctors, then recorded their conversations. Even though the doctors had given permission for that to happen, they didn’t know for sure which patients were the fake patients.

In one-third of the conversations, the doctors talked about themselves, likely in an effort to create a rapport with the patient.

But when that happened, 80% of the time the conversation never returned to where it began — meaning — the conversation never turned back to whatever the patient was saying or asking. Meaning — patients didn’t get their full service, nor did they have the opportunity to get answers to all their questions.

Here’s a link to the study:
http://archinte.ama-assn.org/cgi/content/abstract/167/12/1321

Read about it in the New York Times:

http://www.nytimes.com/2007/06/26/health/26doctors.html?_r=1&ref=health&oref=slogin

The interesting commentary shows that the doctors who did the research were, in a word, appalled at themselves. I give credit to Dr. Susan H. McDaniel and Dr. Howard Beckman, who led the research, for owning up to their own befuddlement at the results.

Hey — at least give them a pat on the back for trying! But, give them a swat for being clueless, too.

I see a few different aspects here for sharp patienting:

First — doctors hear that their patients want to establish a rapport, or that patients want a doctor with good “bedside” manner… BUT…. nobody teaches those doctors just how to accomplish that. So what happens? Because they don’t know any better, they talk about themselves.

Hey medical schools — do you hear that? There’s been a cry to teach doctors some bedside manner for years… do you hear this? What good is a doctor’s diagnosing and treatment ability if it can’t be well communicated?

Second — if doctors talk about themselves and still try to stick to their 6 or 7 insurance-alloted minutes? Well then — that’s definitely wrong! If they want to spend the patient’s precious time talking about themselves, so be it, but either discount the visit, or make sure the patient gets what s/he is paying for.

Third — we are empowered patients. We are free, intelligent and have questions. The tenets of smart patienting tell us to get the conversation back on track ourselves! We don’t have to converse at the doctor’s direction — we can direct the conversation ourselves, can’t we? Ask those questions. Don’t allow yourself to be derailed!

Kudos to the primary care doctors who were willing to be studied. Kudos to those doctors who analyzed and published the results. Kudos to the doctors who “get” the results and wish to move their patient interaction into a more positive direction.

And mega-kudos to those patients who can establish a rapport with their doctors, without allowing it to detract from their care.

………………
Want more tools for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………