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Archive for the 'General Commentary' Category

Top Doctors and Best Hospitals – for a Price

You mostly see them in airline magazines. But sometimes I see a banner or badge on a doctor’s website, or even a hospital’s billboard.

Big proclamations they are!  Dr. Horatio P. Speshultee is a TOP DOCTOR as ranked by some organization or another.  Or ST. HARELDA’S HOSPITAL has been ranked #1!

Oh really?  Says who?

And, fellow patients, THAT is the key.  WHO SAYS and HOW MUCH THEY PAID FOR THE RANKING is the most important part of all of this.  Because if you are choosing hospitals or doctors based on such labels, the label originator and its purpose will have a huge impact on your ability to get the care you need.  Making bad choices based on the wrong assumptions can only be trouble.

I raise this today after reading this piece in the New York Times, Top Doctors, Dead or Alive.

The author, Abigail Zuger, MD reviews an invitation to her 16-years-long-dead uncle to be considered a TOP DOCTOR ranking.  Maybe he was a good doctor when he will still alive, but… ?  A little suspect at the least.

I’ve seen these sorts of invitations before. I get them from some company called “Who’s Who” – I can be a Who’s Who in all kinds of great things – from business to marketing and maybe even patient empowerment (although I haven’t seen that one.)  It’s a company that produces directories for those with an ego.  If you fill out the paperwork, and pay a sum of money (not usually more than $79 or $89) then you TOO may be listed in that directory and get your very own copy of it!

Please note – no one is vetting this list. No one is looking to see if any real accomplishment is tied to it.  You pay your money, you show up in the book.  And you get to list all your accomplishments, dubious or not, true or not. These companies have been in business for decades, hawking their flattery and reeling in the profits. I can only think that it’s intent is solely to stroke egos.  But hey – if it pays the bills…  who am I to ask questions?

Well – maybe I’m exactly the one to ask… because when it comes to proclaiming these doctors are any good…. well then….

Therein lies the rub. With no actual vetting taking place, and without knowing who WE are and what WE need, how can anyone claim these doctors to be at the top? And, frankly, at the top of WHAT?  The top of the list of doctors who make the most money?  Or have the biggest egos?  Or do the most facelifts?  or?  TOP doesn’t tell me a darn thing.

And yet, there are patients who fall for the hype every day.

Now, we Who’s-Not-Whos don’t usually see those directories (they look impressive on the doctor’s bookshelf), but we actually do see the results of similar efforts in magazines. TOP DOCTORS, TOP PLASTIC SURGEONS, TOP STEAKHOUSES… we’re impressed, right?

Don’t be too impressed. At least not until you figure out how the rankings were done, and what the standard for “top” is, and maybe even most important, whether that “top” designation was simply based on whether or not a check was written. You’ll need to check out the fine print to see who sponsored the ranking, and what had to happen for that label to be publicized.  Then decide whether or not you want to believe it.  You might be surprised to know that some of the biggest names in websites and magazines that provide these TOP designations display their choices based on advertising dollars paid.

For me – I see egos all over those faces. I don’t see excellence, and I don’t see anyone who is focused on his/her patients or their outcomes. I just see someone who wrote a check to someone else who would promote the label on their behalf.

And I’m not buyin’ it.

Here is more information on researching the best doctors for you.  (And note, no TOP designation is required.)

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The Cost of a Doctor Visit – Where is the Value?

Man Holding Money in Doctor Outfit with Smirk ExpressionThis post at Kevin MD made the rounds again last week. Written by Mary Pat Whaley, and entitled , “Your 10 minute office visit needs 8 people and 45 minutes of work” it describes all the background work that takes place before, during and after a doctor visit so that patients won’t be so surprised that their visit costs so much money.

It’s an important perspective for patients to understand, certainly.  While most of us realize that there is much more that takes place behind the scenes than we are aware of, we really have no idea what it takes to support just one 10 or 15 minute appointment. This is a good overview, even if three years after it was first published, most of us experience it differently due to the shift to electronic records.

That said…  to Mary Pat and others who want to defend that $100 charge – we patients still don’t get it, no matter what explanation has been provided.

We’ll ask you instead to look at it from our perspectives:  We have just spent an hour in your office waiting for our drive-by visit with the only person we really came to see. Then you tell us it cost $100 for that 10-15 minutes, which we translate to $400 an hour for his or her time. Further, from our perspectives, all he did was ask a few questions, embarrass those of us with modesty issues, and then leave. We rarely feel any smarter.  Some of us feel belittled and unworthy.  And then we are expected to pay for the insult.

Suppose you were treated the same way by any other service you needed yourselves…  What if your car mechanic treated you like that? Or your hairdresser? Or your accountant or lawyer?  You know you would walk away, no matter how they justified those charges to you.

So – let’s look at this another way:

Continue reading ‘The Cost of a Doctor Visit – Where is the Value?’

Looking for Trisha Torrey, (former) About.com Patient Empowerment Expert?

messydesk

 

You found me!  Here I am!

And I’m moving back in, here to my personal blog. Home. Where I started writing about Patient Empowerment in 2005.

It’s been awhile since I’ve been “home.” Look around!  You can see how dusty it is. I’ve got to wash the curtains and get them back up. Clearly the place needs to be swept and vacuumed.  Those are all tasks I’ll get squared away in the next few days. Give me a week and I may even get some new paint on the walls.

Are you wondering why I’ve moved back home? 

Simple answer – it’s because I was sent packing.

Most of my regulars know about my work at About.com Patient Empowerment.  I started writing for About.com in late 2007 and in all, I published more than 800 articles on topics from how to be an empowered patient, to how to get your medical records, to how to look up CPT codes, to how to deal with an arrogant doctors and much, much more.  In addition to those 800 articles, I wrote more than 1000 blog posts!  And I would still be writing and publishing there today… except that….

I was terminated June 30.  Gone. Kaput. Right in the middle of my contract year.  They decided they didn’t want me anymore and cut me off. Chop chop.

If you want details, here they are.  But that’s not the point of this post.

This post is to tell you that I’m going to lead by example.  That is – throughout my patient empowerment work, the advice I always give to you is to stick up for yourself and to be sure to take responsibility for the situation you’ve been dealt.  Don’t take crap from anyone.  YOU are the most important stakeholder in your own care and to get what you need, you need to take the lead.

So that’s exactly what I’m doing here.  As much as I loved my work with About.com, it’s no longer an option.  So I’m moving back home, gonna spiff up the place, and will begin publishing again right here to keep my commitment to helping you, my readers, get what you need from the healthcare system.

Here are some of my plans:

  • I’ll be writing articles just like I was writing them before – so – what topics would you like to see?
  • One of the recent changes About.com had made was to take away YOUR opportunity to comment on articles and blog posts.  By publishing here, I’ll be restoring that capability.  So please do comment!  I learn from you every time.
  • In the past two years I was sending out only 5-6 newsletters a year from this personal site, but now that there will be no more newsletters coming from me at about.com* I’ll begin sending from here.  You can help too, by letting your friends know.  Here’s the link you need to get signed up.

Together we’ll weather the healthcare system together, whether About.com wants to help in that effort or not.  I’m still Every Patient’s Advocate. They can’t take that away from me.  And I’m here for you.

Are you with me?  Great!

(Now could one of you big strong guys help me move my desk over there – under the window?  It’s a beautiful day, and I don’t want to miss the sunshine.)

I’ll be back soon with some usable healthcare information.  All suggestions welcome :-)

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*about.com will likely continue to send patient empowerment newsletters, and for the foreseeable future, they will be my articles. But there will be nothing new that hasn’t been sent out in a newsletter previously. Feel free to unsubscribe if it gets to be redundant.

More:  At About.com, Experts Are Disposable

Time to Put a Stop to Drive-by-Doctoring

As many of my readers know, I speak at meetings and conferences fairly frequently, and most often to groups of patients and caregivers. The focus of the talks I give is usually on a patient empowerment topic – ranging from how to communicate with your doctor, to how to stay safe in the hospital, to a dozen other topics….

Every time I speak to groups of patients, I ask the question, “Have any of you ever felt rushed during a doctor appointment?”

The overwhelming majority raise their hands, and nod, and often turn to the person sitting next to them, poised to share their latest horror story about being rushed, which is often the case after they’ve waited in the waiting room for way too long.  A double whammy.

Frustrating. Maddening. Unfair.  And now, statistically accurate, including its negative effect on both our health and our wallets.

Newsweek Magazine published an article this week called The Doctor Will See You – If You’re Quick.  Written by Shannon Brownlee (author of Overtreated), it quantifies the problem of, what I call, “drive by doctoring” – the concept that we barely see the doctor walk IN the exam room door, before the doctor has retreated back out that door, asking the empty hallway (because he’s no longer engaged with the patient at all), “Do you have any more questions?”

The point to the article (which is excellent – you really should take the time to read it in its entirety), is that over the past few decades, the trusting relationship that used to exist between patients and their doctors has eroded to almost non-existent, and has resulted in bigger problems for both parties.  And both parties are suffering.  Patients don’t like it, and their doctors don’t like it either.

Or (another one of my sayings) – American healthcare is not about health or care. It’s about sickness and money – using sickness to make money.

Here are some of the points that support that:

  • The ideal patient panel (number of patients) for primary care doctors should be fewer than 1,800 patients in order to provide the kind of care patients need.  Today, the average number of patients per PCP is 2,300. And for “Medicaid Mills”, the panel is more like 3,000.
  • To speed things along, doctors interrupt their patients an average of 23 seconds into the answer to the question, “Why are you here today?”
  • One study showed that the average amount of time spent providing “critical information” to patients is 1.3 minutes (yes – that’s MINUTES.)  Your quality or quantity of life only deserves 1.3 minutes?

To those of us who understand this madness, and attempt to be smart patients, there is nothing new here. But the information is beneficial to us for a few reasons:

First – because our world is being driven more and more by data, and not simply our observations and stories. With the quantification of these kinds of problems, the powers-that-be will have to look at solutions, because no nation can afford sicker and poorer people.

Second – because this kind of information is a good reminder to us all that it’s us SMART, EMPOWERED PATIENTS who will manage to get the best of a system that has the capability to be great, but is growing worse every day.

We can’t help those who won’t help themselves… but we can be the ones who will STOP this erosion, and help ourselves.

•  Helping ourselves will mean we find the right doctors - the ones who WILL communicate with us. (A reminder that no doctor is average – they are either better than, or worse than, whatever average is. As empowered patients, we search out the “better than”.)

•  Helping ourselves means we place ourselves squarely in the middle of our own medical decision-making - we don’t default to letting someone else make them for us.

•  Helping ourselves means we find information to support our decisions, making sure it’s credible and reliable.

•  Helping ourselves may mean that we try to manage our relationships with our doctors on our own, or it may mean we ask someone else to help us.

•  Helping ourselves will mean understanding the roll the pursuit of profit takes on our health – we will understand the concept of Follow the Money and why that makes us poorer and sicker.

It took decades for the healthcare system to devolve to what it is today (just in time for us baby boomers to utilize it in huge numbers with, in too many cases, horrible outcomes.) It will take decades more to fix it.

Most of us don’t have decades to wait – and for that reason alone, we must engage in our own care.  We can’t afford, for our health OR our wallets, to let drive-by-doctoring take its toll on us or our loved ones.

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Want more Patient Empowerment?
Find hundreds of articles at:

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About.com Patient Empowerment

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Who’s Really a Patient? Skewed Opinions Result from Inside Information

That seems like a fairly simple question, don’t you think?  Who really is a patient? But the answer is actually more complex than you might realize.

Among the possibilities:

1.  anyone who has ever accessed medical care is a patient – which includes everyone, no matter what their relationship is to the healthcare system (so, for example, doctors would also be considered patients, as would any other provider, or even payers like insurance company employees, or pharma employees, etc.)

2.  anyone who has accessed medical care, but doesn’t have inside knowledge of the healthcare system, is a patient

By dictionary definition, the answer is #1: that anyone who ever accesses medical care is a patient.

But when it comes to defining a patient’s perspective, his or her point of view, then the answer is not so cut and dried.  In my (not so) humble opinion, a medical insider cannot possibly truly understand a non-insider patient’s point of view about their healthcare experience.

Here are some examples:

  • When a doctor, nurse or other provider finds troubling symptoms,  s/he doesn’t just make an appointment, then wait for days or weeks like the rest of us do before we see a doctor.  S/he calls a friend and gets in to see him or her right away.  So – what is that patient’s perspective?  Is the point of view going to be the same? No.
  • When an insurance company employee needs a medical test or payment for a claim, s/he knows from the inside how to get it taken care of.  Is that the same perspective as someone who struggles to get those services?  Is the point of view the same? No.
  • When an insider, who is getting paid under the table for prescribing certain medications or is rewarded by a medical device manufacturer for using that company’s devices (think artificial hips and knees, or spinal fusion material, etc), is asked about the cost of care, they can’t see it the same way as the patient who needs that new hip and doesn’t have insurance.  Do they have the same point of view about their needs?  No.
  • When a popular doctor has surgery in his own hospital, in a private room, where the nurses respond quickly to the call button (because he IS one of their favorite doctors!), and is then discharged with no infection, do you think his perspective can be nearly the same as a Medicaid patient treated in that same hospital?  Yet – they are both patients in that hospital.
  • When the director of the “National Cancer Awareness and Prevention” charitable organization, the majority of whose budget is underwritten by a handful of pharmaceutical companies, is asked to represent patients on a conference panel to discuss the development and cost of cancer drugs, how objective can her opinions be?  Does she dare step on those pharma company toes by saying what a ‘real’ patient might say?

The subject came up most recently when yet another large, influential healthcare organization decided to hold a “patient and caregiver” forum to discuss “patient-centeredness” – and yet, once again, there were no non-medical-care-industry patients included as expert speakers.  Seriously.

It also reminds me of the many times I have approached healthcare conference planners, offering my speaking abilities, representative of that important patient point of view… and they were not interested.

Their response?  “We are all patients.”  (See #1 above.)  But if what they are trying to do is help patients – well – wouldn’t it be a good idea to ask a patient who isn’t an insider to chime in? Evidently not. They only wanted speakers who were from their industries.

Put another way:  it would be like GM or Honda designing cars without ever asking the opinions of car buyers, or JCPenney only selling size 4 dresses because they never assessed gender or the sizes of their shoppers.  They would swiftly go out of business….  which, of course, doesn’t happen in healthcare because we “consumers” (I hate that word in healthcare) don’t vote with our feet.

I think we need a way to make the distinction. If we are all patients – then what can we do to distinguish between those who do, or don’t, have a “real” patient’s point of view?  Are we, as non-insiders, “pure” patients?  Or are we “unencumbered patients?”

Or, maybe we do the opposite, and use a term to describe those patients who are insiders.  Maybe we call them “industry patients” or “insider patients.”

Or – maybe I’m missing the boat entirely….

This matters. It matters because when non-industry-insider patients are expected to be the representatives of a non-medical-industry-insider’s point of view, that point of view, and the results, get skewed.

And for us patients who don’t live inside the medical industry:
Skewed = Screwed …  In more ways than we can count.

What do you think?  Do you see the distinction?  While we may all access medical care, do you agree that our points of view are different?  What do you suggest we do to help the medical care industry understand and embrace the difference?

Please provide your 2 cents below.

…MORE…

Patients – The Invisible Stakeholders

The Myth of “Doctors Are Patients, Too”

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Want More Patient Empowerment?
Find Hundreds of Articles at:

Every Patient’s Advocate

…and…
sign up for 2x per month newsletters of
Patient Empowerment Tips