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Archive for February, 2008

Forbes: Patients Lose Thru Lack of Hospital Competition

Forbes Magazine this month includes an exhaustive and question-inducing series of articles about hospitals and their ability to best take care of the patients who trust them.

And the picture isn’t pretty. Even the titles make us pay attention:

Bad Medicine

Dirty Tricks

Hospitals’ Nightmare

And the subtitle under Bad Medicine is — The heart of the health care industry has failed the consumer.

I’ll try to condense it here. It’s complicated and frankly, much of it is over my head. When they start talking about government regulations, like Certificates of Need, my eyes glaze over.

But there are aspects of the discussion that directly affect us as patients and consumers that we need to be aware of:

1. Hospitals seem to be divided into two, maybe three types: community-based, private hospitals — or — community-based public hospitals (including academic medical centers) — or — small, specialty hospitals that focus on one body system, one type of surgery (ex: eye surgeries, knee surgeries, etc)

2. Studies have shown that medical errors, infection rates and even death rates are much higher in larger, community type hospitals than in the smaller, specialized hospitals. Even Medicare’s studies have shown that patients fare FAR better when they have surgery in the specialty hospitals.

3. But now those specialty hospitals pretty much can’t be built. There are a number of reasons, all of them focused on special interests, all of them stemming from stymied competition. Hospital-employed lobbyists have made sure it can’t happen by using words like “doctor profits” — oooo! b-a-a-d! They lobby legislators to make it sound like doctors would only perform knee replacements because they can profit from them. (Well? it would not be out of the question, would it?)

4. The point to the articles is that competition has been legislated away. Large community hospitals, in many ways, have a free pass to continue conducting business as if they aren’t losing and infecting patients, because marketplace balances have been stripped.

By removing competition, patients lose. Why shouldn’t we patients have the option to choose the place that is the safest for us to get the surgery we need?

But here we have to add a dash of this and a dash of that. A dash of — only the rich, or those with great health insurance can afford the luxury of specialty hospitals. A dash of — it’s the poor and indigent who are treated in the big public hospitals, and they will by nature be a sicker group, which may mean the numbers are skewed. A dash of — if we are saying competition is a good thing, then how does that fit into healthcare reform where the majority of the conversation centers around “universal” healthcare?

You know — usually I try to stay out of the “big issue” fray unless I can boil it down to make a difference for patients today. In this case, I think it’s something we patients need to be aware of because yes, we are making choices about where we will have surgeries. If we know the specialty hospitals — today — are cleaner and safer, then by all means, they become a better choice.

But there is a part of me that is nagging… a part of me that says there should be a way to find a level here… a part of me that says “hey! if the smaller hospitals are doing so well, despite the fact that they are making that big, bad profit, they why don’t we make a trade? How about giving them a bit of freedom to be built in trade for some sharing of their secrets for staying cleaner and safer?”

Wouldn’t it be better to find a win-win than just a whine-whine?

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When the Psychiatrist is a Bully

(Find a follow up to this post, Lessons Learned)

What you are about to read is my own personal experience, having taken place over the past 10 days with a psychiatrist from Naples, Florida who works in addiction psychiatry through his “Healing Institute.”

Many of you regular readers know that my blog used to be located at WordPress. About six weeks ago, I moved it so I could have more flexibility with its look, etc. All the posts were moved from the old location to this new location, but many visitors continue to find the old location first because it is so accessible through the search engines. In fact, I still get many more visitors in the old location than here in the new.

Ten days ago, I went to check the statistics on the old blog location, and — the blog had disappeared! It had been pulled offline by WordPress, with only a page that said I was in violation of the Terms of Service. What?? I had no idea why or what I had done wrong!

A day later, I got an email from WordPress saying my blog had been pulled because they had received a complaint from a man who didn’t like a comment made to one of my blog posts. Mind you — not anything I had written, but what one of my readers had written. Here is a link to that comment.

In order to put my blog back online, I had to remove his name. So I removed it from the old blog — and WordPress put my old blog back online. Truth was, I don’t know the man, I don’t know the woman who wrote the comment, I don’t know who is telling the truth — in fact, I didn’t even know the comment was there!

Two days later, I got an email from the psychiatrist himself, demanding I remove his name from the new blog, too. He was clearly frustrated that there was no one else to complain to — God forbid — he had to ask me directly. He cited all kinds of trademark laws he thought I was breaking, cyberstalking laws, etc — bottom line, his email was quite threatening and indulgent.

But — I was mad. What right did this guy have to get my blog pulled offline? And if he could find my email address NOW to make his demands, then why didn’t he do that politely to begin with? (I ask you — don’t you see my email address, front and center at the top of this blog, easily found?)

If he had asked me first, I would have gladly removed his name — as I said — I don’t know who is right or wrong, he-said, she-said, and I didn’t even know his name was there.

So I replied to him with just that — that I thought he was a bully, and that he couldn’t simply demand I remove his name. That he should have contacted me before he contacted WordPress. Then I very clearly told him: if you apologize for contacting WordPress, and embarrassing me, I will remove your name.

He replied to me: no apology, of course — instead, how is he supposed to support his children? No recognition whatsoever that he had interfered in my work by pulling my blog.

I replied once again — as clear as you see it here — “apologize to me, and I will remove your name.” I also asked him, “If you can’t own up to your own responsibility in this matter, how can you ever expect to teach your patients to own up to their responsibilities?”

As you can guess — no apology has been forthcoming — still. No — instead, he got in touch with my colleagues about About.com and demanded THEY get me to remove his name. Can you believe it? They thought it was as ridiculous as I do.

So — from the sublime to the ridiculous. This man has real problems, in my opinion, and based on my interface with him. Think of it this way. He can’t apologize for his rude and ridiculous behavior, he invokes his children in his plea (who even knows if he has kids?) — but they aren’t important enough for him to type two words — “I’m sorry.”

Oh — and one other thing. I got to thinking I might not be the only one he has bullied. So I did a little research and learned that I am not. In fact, there is quite a bit of evidence online that indicates he has problems, including the fact that he has only practiced in South Florida (Naples and Ft. Myers area) for a few years. He was in Indiana before that, and for some reason, his license is listed as “Expired. Non-renewable.” In checking with friends who are psychiatrists, that “non-renewable” thing may mean much more than that. It’s hard to tell for sure.

But you know what? I can’t be party to this anymore. No time. I need to spend my time helping patients.

A message to The Bully Psychiatrist from Naples, Florida: you have won!

Your name is removed from that comment. I hope people who find you at your Healing Institute move on. Nobody needs a bully for a doctor, especially when they have addiction problems.

Lessons learned for patients: Doctors are human beings, too — with all the foibles that go along with being human. A doctor who can’t apologize has no empathy — and if you have an emotional problem that needs addressing, if you are battling addiction in particular, you need someone with empathy.

And — if you are looking for a psychiatrist in Naples, Ft. Myers or South Florida, there are many others to choose from not located in a Healing Institute: http://www.ucomparehealthcare.com/drs/florida/psychiatry/Naples.html

I truly hope this is the end of this. As my grandmother used to say, I’ve got bigger fish to fry.

(Find a follow up to this post, Lessons Learned)

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Health Net Pays $9 Million for Canceling Patient’s Policy

Put yourself in Patsy Bates’ shoes. She is a hairdresser who had health insurance coverage with Health Net, a large insurer in California.

In 2004, Patsy was diagnosed with breast cancer, and part way through her chemotherapy treatments, Health Net decided to cancel her insurance. At the point where she owed almost $130 thousand for medical bills, her doctors stopped her treatment.

Can you imagine? It’s bad enough to be sick. At least you’re confident that your insurance is covering most of the bills… only to find out that it isn’t? And because it isn’t, you can’t finish being treated?

That was then. Patsy was able to find a state-funded program that helped her get the rest of her treatment and she considers herself healthy today. And now her wallet is healthier, too — to the tune of the $9 million (minus the attorney’s cut, of course) she was awarded by the courts in California — payable by Health Net for the entire insult.

As it should be. And this, one day after the Los Angeles city attorney filed suit against Health Net for canceling another 1,600 policies, too. There may be thousands more, because in 2002 and 2003, Health Net was rewarding its employees big bonuses for the policies they managed to cancel.

Doesn’t this all just turn your stomach? I want to know where else is this happening? In what states are health insurance companies still getting away with cancellations? What would have happened if this woman had died? How could those people who won bonuses for cancelling policies live with themselves?

And what makes any of the rest of us with health insurance think this won’t happen to us, too?

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Jarvik’s Lipitor Commercials – Was Any of It True?

Questions began circulating about the Pfizer TV and magazine commercials for Lipitor earlier this month. You’ve seen them — Robert Jarvik, the supposed “inventor of the artificial heart” touts his use of Lipitor as his way of controlling his cholesterol levels so he won’t have a heart attack like his father did.

He runs. He rows. He plays physician in his white doctor-coat. And it turns out, he (or actually, Pfizer) pulls the wool over our eyes.

Maybe he runs. But a body double rows. He’s not a practicing physician. And lo and behold, while he invented AN artificial heart, he didn’t invent the first one.

I’m feeling “took” — how about you?

Learn more about his ad, how we TVviewers and magazine readers “misinterpreted” and what’s going to happen next at my About.com blog…. and while you are there, take the poll, too!

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Three Cheers – Cardiology and Second Opinions

This New York Times letter to the editor caught my eye…

Second opinions are so very necessary in a case of a difficult diagnosis, or when treatment will be needed for chronic recurrences of a disease, or in particular when a patient needs surgery.

Patients are way too often intimidated at the thought of telling their doctors they think they should be a second opinion. They are afraid the doctor won’t approve.

Hey! Let me tell you — ANY doctor who is ANY good will encourage a second opinion (OK — in an emergency, this may not be true)…. if I had not insisted on a second opinion, I would have ended up getting chemo for cancer, when I didn’t really have cancer. (And by the way — that was after I was told by my oncologist that what I had was so rare, “No one will know anymore about it than I do!” Don’t get me started on what an egotistical SOB he really was.)

You can see why I was so excited, then, to find the editorial in the New York Times….

And my kudos to Bruce McAuley, M.D. the letter writer. He said what needed to be said by an MD. He’s done many patients a huge favor, and perhaps saved them from the wrong treatment or a misdiagnosis.

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