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Archive for September, 2007

It’s YOUR Turn to Participate

I’ve been meaning to set this up for awhile — a Forum where readers of this blog, my columns, and others who are interested in asking questions or sharing their two cents would be able to do so.

The Every Patient’s Advocate Forum is now online — and waiting for you to join in the conversation!

Link here to get started.

Hope to see you there….

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Where Health Insurance Meets You-Tube

pirates.gifForwarded to me today by my security guru Bob — who understands the power of combining a sense of humor with a pointed message….

If you are a patient, and a health insurance consumer, I hope you can see the humor through your frustration.

If you work in health insurance, and you’re tired of the bashing — well — that’s the way it goes. Your best takeaway will be that it makes no difference whether this video reflects reality — it reflects consumer perception which is far more powerful.

Give it a look-see and form your own opinion:

Go Ahead And Die! (Pirates Of The Health Care-ibean)

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Doctor Hunt: Practicing What I Preach

I’m proud of my husband and the reason holds a good lesson for us all….

Over the past six months or so, our experiences with our family doctor’s practice have been less than acceptable. First, Hubby contacted their “prescription refill hotline” about three weeks before his arthritis prescription ran out. He needed a new prescription and knew it would take some time to get it….but…. two weeks later he had to call them again. Then the next day, then the next. He was told they had called in his prescription to our pharmacy but — no — the pharmacy had no record. Eventually, because he had run out and was in pain, he stood at the pharmacy counter while they called the doctor’s office. Not right.

Turns out that part of the problem was that his doctor had left the practice! Of course, no one bothered mentioning that, nor had they bothered to tell him he had been “reassigned” to a new doctor — a 30-something woman who I’m sure is a fine doctor — but not for my 50-something husband who would prefer a male doctor!

Hubby is not a happy camper.

I ran into my own problems. I go for an annual checkup each fall. I made my appointment a couple months ago and was told to go in a week or so ahead for a blood draw. OK. I asked whether I needed to fast for the blood draw. Nope, I was told. That’s not necessary.

So, Monday, I called the doctor’s office to make sure all the paperwork had been done so I could go to the lab for the blood draw on Tuesday. “It sure is,” I was told, “They are a part of our system, so they have all your paperwork in the computer.” I asked again — are you sure I don’t need to fast? No — no need.

So I headed to the lab about 3 PM Tuesday. You guessed it. Yes, they found my records — but — the labwork request had been cancelled. Huh? Long story short — not only did I have to go back to the doctor’s office to straighten it out, but it turns out that yes, I did need to fast for the blood draw!

My doctor happened to walk into the reception area of the office while I was there. She asked why I was there (knowing, I guess, that I had no appointment) — and I told her I was there to straighten out the blood work fiasco. I asked her– fast or no fast? “Of course you have to fast, unless you want to be unhappy with the results!” she replied flippantly as she turned around and marched out of the room.

OK — so now I’ve gone from annoyance to ticked-off.

So these are two VERY BASIC services that require no rocket science whatsoever to handle. If they can’t do any better than this with the basics, how can we be sure they will handle anything of any consequence correctly?

So Hubby and I decided together we would begin to look for a new practice to move to — and yesterday Hubby began checking with our insurer to see who else is on their list of providers.

He narrowed his search down to a half dozen doctors — and then — he started researching them. He didn’t ask me for advice, instead, he just started poking around the internet. Sure enough, he found information that one of the doctors on his list has been fined $2,500 for some kind of squirrely billing practices. (I translate that as the possibility of Medicare Fraud — but I don’t know that for sure.)

Our next steps are to begin asking others whether they know any of these doctors to see if we can find happy patients. We’re not really in any hurry — thankfully — because we are both healthy and we’ve had all the 50-something tests we’re supposed to have, etc.

I’ll keep you posted on the great doctor hunt. Just wanted you to know that it can be done, and will be done.

Gotta let you know that yes — in our home — we practice what I preach.

Paging Marcus Welby!

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CNN and Misdiagnosis: Part II

CNN’s Empowered Patient, Elizabeth Cohen, provided more tips this week about what to do if you think you’ve been misdiagnosed.

My own misdiagnosis speaks to four of her five points – and if you have just a seed of a doubt about whether your doctor has diagnosed you correctly, please take Elizabeth’s advice. Here are her points and my experiences:

1. Ask for more tests. The CNN article tells the story of Nancy Keelan whose diagnosis was missed five times until she finally asked for a test her doctor had not ordered. It turns out that after three years of missing the diagnosis, Nancy had endometrial and ovarian cancer.

In my case, two labs had “confirmed” that I had lymphoma based on a biopsy of a lump removed from my torso. Ensuing CT scans and blood tests showed no sign of the lymphoma, yet my doctor insisted I needed chemo. Only by studying my own test results, which were all written in med- and lab-speak which I didn’t understand (meaning I had to look them up), did I realize that another test result was missing. I asked for that test. It turned out to be the pivotal one — the one that proved I had no cancer. If necessary, I also could have asked for a PET scan which would also have revealed I had no cancer.

I need to point out here, too, that I firmly believe that the reason the doctor didn’t look into more tests is because he wanted me to undergo chemo. He is an oncologist. Oncologists make their big money from putting people into treatment. Oncologists are the only medical doctors who profit directly from selling drugs themselves. Read more here.

2. Ask : what else might my illness be? If you have a list of symptoms and you begin reciting them to the doctor, then before you ever get anywhere near the end of the list, the doctor has already figured out what he thinks you have. Never mind that it might be wrong!

From there, he tries to fit what you have into his ideas, not fit his ideas to what you have. It’s backwards.

There is a process doctors use called differential diagnosis. Doctors consider a list of possible diagnoses, then hone in on the right one based on evidence from your symptoms to medical tests. What you want to know is what other possibilities are on that list.

In my case I was diagnosed with a disease called Subcutaneous Panniculitis-like T Cell Lymphoma. The other very obvious possibility was panniculitis — and it turns out that’s what it was. Benign. Goes away on its own. Certainly a better alternative than lymphoma.

But my oncologist was trying to start with the lymphoma and fit my symptoms to it. He asked whether I had hot flashes or night sweats — which I did — which he therefore insisted were signs I had cancer. But hey! I was 52 years old and I’m female. Hello? Geesh.

3. Don’t assume no news is good news. This is so true! Patients tell me frequently that they have been given a medical test, and since they didn’t hear back from the doctor, they assume that means there is no problem. Guess what? Results get lost all the time. The specimen or biopsy may never even make it to the lab for review to begin with. They might never be delivered back to the doctor’s office. They might get lost in the mail or emailed to a spam folder. They might fall to the floor or get filed in the circular file by accident. They might get left in the copy machine, ferheavensake.

Even if they do come back, if they seem unusual, there’s a chance they are wrong anyway! That happened to me.

And, my original biopsy results never came to me until two weeks after the biopsy. I did nag the doctors — but somehow the biopsy had gotten lost in the shuffle because it was the 4th of July holiday. (And don’t even get me started on medicine and the holidays!)

4. Assume your doctors don’t talk to one another. This is way too true. They don’t talk to each other. Period. They don’t WANT to talk to each other. Further, they avoid talking to each other – because — there is no way they can get paid for talking to each other. I do think that Elizabeth’s suggestion that you get them on the same conference call is unrealistic. First of all, most of us don’t have access to the technology. Secondly, because there is no reimbursement code for them to get paid for that kind of conversation, you need to set up a scenario so they WILL talk to each other.

Better to set up an appointments with both at the same time, then show up at one of the offices, and while you are in the doctor’s office with doctor #1, have him place the phone call to doctor #2. After the conversation, get over to doctor #2’s office so he can make a reimbursement claim for you, too. That way they might take the time to talk to each other because they can both get paid for it.

In my case, despite several requests, my oncologists never spoke to each other. Those were the days when I was innocently trying to find my way. Had I known then what I know now? I would have been far more insistent, and an even bigger thorn in the “bad guys” side than I was.

After all — it’s my body and my life, and I’ve simply hired them for their services. If they don’t do it right? Well then — I will do what it takes to make sure it’s right.

And THAT is what I call Patientude.

Thanks for the reminders, CNN.

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Oprah Takes on Health Insurance

Oprah took on healthcare, insurance and the lack thereof today. While I think she did an astounding job of moving the discussion forward, I think a major point was missed — and needs to be pointed out.

Joining Oprah were Michael Moore, the director and producer of Sicko, Karen Ignagni who is the top lobbyist for the association of health care insurers, and Uwe Reinhardt, a health economist. The debate was heated, hit many of the important points, and during the hour, Oprah asked several times, “What do we believe?”

Believe? Here’s how it was posed: “Do we believe the child of a gas station attendant and the child of a CEO deserve the same access to healthcare?”

How many answers can there be? Of COURSE that child should have the same access!

.. but guess what… they don’t.

This is not new to anyone. And then, of course, the question about the 47 million Americans who don’t have health insurance is imposed…. but then — Joe Average American retreats to this thought process, “well, at least I’m insured and my family is insured, and I’m only one person anyway, and there’s nothing I can do about it, because I am only one person.”

Here’s the point that was missing — The great majority of Americans think like Joe Average American — and that thinking is flawed! Joe Average American — you have missed the point! Joe — you have coverage that isn’t going to cover what you think it is! You have coverage that will pay far less than you think it will, despite the fact that it has already cost you hundreds if not a thousand dollars a month just to have that coverage to begin with!

Yes — Lisa Ling showed the stories of three people who had insurance, yet were denied care. Those are huge, and sad, stories.

But that’s not what I’m talking about. I’m talking about those people who need help with normal, every day care. Their child breaks a leg? It costs them hundreds or thousands of dollars in addition to their insurance coverage. Find out you’ve got allergies? It will be declared a pre-existing condition and it won’t be covered. You’ve got GERD? Even though your health is covered, you prescriptions may not be — it will cost you an additional $300 or $400 per year for the drug you need.

Michael Moore and Oprah reiterated a number of times that they don’t understand why anyone should profit from healthcare. And I do differ with them on that, at least to a degree. I think that profitability is a great motivator for innovation, and it’s profit that drives good research, new discoveries and treatments, and eventually, advanced care.

But I don’t believe that’s true for insurance. Profitability should not be allowed when it comes to human lives.

For those who have insurance and who think they have decent insurance (even though they are usually wrong) …. be advised that you are likely clueless about how little coverage you really have. Be advised that your healthcare dollar won’t go nearly so far as you think it will. And be advised that the health insurance lobby owns too many legislators who will make sure that doesn’t change anytime soon.

I don’t know how Karen Ignagni sleeps at night. Honestly. I’ve seen spin doctors, but hers spins only a much more tangled web.

And those tangles are costing more lives every day.

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Find more commentary on Sicko here.

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