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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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Your Most Important Health Resolution for 2012

This column first appeared
in the Syracuse Post Standard
January 3, 2012

When considering health-related resolutions, you probably expect me to wax poetic on the virtue of losing weight or quitting smoking.  But no, this resolution actually trumps them both.

Perhaps the most important health resolution you can make for 2012 is to establish a strong relationship with a primary care provider (PCP). Even if you think you already have the best PCP in the world, you’ll want to read on – because that relationship could change.

There are three reasons you must establish or reinforce a primary care relationship in 2012.

1.    Fewer Doctors
The number of primary care doctors is dwindling and practices are changing.  Doctors are aging into retirement, or leaving their practices due to frustrations with the healthcare system. Because fewer medical students are choosing primary care, those vacancies aren’t being filled.  In addition, some doctors will stop accepting certain types of insurance, including Medicare and Medicaid. Others are joining forces to establish larger, less personal practices.

2.    Healthcare Reform
In 2014, when the biggest portion of the Affordable Care Act kicks in, there will be 32 million new Americans with insurance, and newfound access to healthcare. For some, it will be the first time in their adult lives they’ve been able to afford care.

3.    More Older Patients
As baby boomers age, they will need more care, more often than when they were younger. Further, they are living longer than previous generations, so they’ll need medical services longer, too.

Bottom line – a year or more from now, the competition will be fierce.  All those aging baby boomers, plus those 32 million new patients will need to be absorbed by a dwindling number of primary care doctors. After 2012, it may be impossible for you to find a PCP who is accepting new patients.

Thus – an important resolution!  As best you can, think beyond 2012 and what your medical needs may be. If you don’t have a primary care doctor, find one.  If you have one, but you haven’t seen her in more than a year, then visit her before she decides to drop you from her patient roster. If you have a PCP, but you aren’t happy with the relationship, then make a change in 2012, before it’s too late. If you like your doctor, then ask questions about insurance coverage or practice changes, and then make adjustments if necessary.

That’s a New Year Resolution worth keeping.

Here is more information about finding a primary care doctor:

The Shortage of Primary Care Doctors

Finding Dr. Right

How to Decide Whether to Change Doctors

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Healthy Travel Tips for the Holidays

This column first appeared
in the Syracuse Post Standard
November 22, 2011

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You may be among the millions of Americans who will travel during the upcoming holidays. Travel takes you out of your normal environment and disturbs your routine. If you have health issues, like a chronic disease, an injury, or even a short-term illness, it’s smart to prepare ahead of time for those changes and accommodate for them where possible.  You’ll want to be sure your travel doesn’t upset your health, and your health doesn’t upset your travel.

Drugs, supplements and supplies:  Pack enough to cover the days you’ll be away, plus extra, in case flights are delayed or a blizzard closes the roads. If you fly, remember that airlines can lose checked bags, so keep all medical supplies with you in your carry-on bag. Any time difference at your destination may require an adjustment of your drug routine. Make yourself a chart ahead of time to keep your regimen on schedule.

Airport security:  The TSA has strict rules about what can, or cannot go through security.  Medications, oxygen, inhalers and other medical items must be packed in certain ways, and will be screened through x-ray machines. Go online before you fly to learn to learn how to get your medical equipment or materials through security.  http://1.usa.gov/TSAMedical

Foods:  Alert your host ahead of time if you have special dietary requirements, or if certain foods upset your digestion. Mention any food allergies you have or conflicts with drugs you take. Plans can be made to accommodate your needs when they are discussed ahead of time.

Contagious diseases:  Of course, holiday time is often cold and flu time, too.  Get your flu shot prior to travel. Wash or sanitize your hands as often as possible, and keep them away from your mouth, nose or eyes. If you are highly susceptible or your immune system is compromised, consider wearing a face mask to protect yourself from others who might be contagious. If you have a cold, then cough or sneeze into your elbow, not your hands, to prevent infecting others.

Long Distance Travel:  If you’ll be sitting for great lengths of time in a car or plane, you risk potentially deadly blood clots in your legs called DVT (deep vein thrombosis.). Keep your blood circulating by taking hourly breaks to walk around and stretch.

These travel preparations will keep you healthier and will make your visit more enjoyable, too.

Here are some additional resources for
making sure you stay healthy while traveling:

•  Tips for Healthy Travel
Before You Go, As You Travel, and At Your Destination

•  Tips for Healthy International Travel

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A Dose of Reality – Today’s Doctor Appointment

Please note that this column first appeared in the Syracuse Post Standard
October 11, 2011

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In the “old” days, we could phone for a primary care doctor’s appointment in the morning, be seen right away, spend enough time with the doctor, leave with a treatment plan, and usually feel better within a day or two.

But no longer! Today it’s difficult to get an appointment, even within a few days. We sit in waiting rooms far longer than we expect. Then when we finally see the doctor, we often feel like we’re being rushed out the door.

We patients tend to blame our doctors and the way they run their practices. Why should we have to wait so long? Why won’t they spend more time with us?  What’s the big hurry?

The truth is, your doctor doesn’t like today’s limited time system either.  He would love nothing more than to be able to make immediate appointments, see you the moment you arrive in his office, and spend plenty of time with you, too.  But the insurance reimbursement system doesn’t make that possible.

Last week I had the opportunity to work with personnel at North and Northeast Medical Centers.  I was asked to help them help us patients manage this time-constrained reality we are all stuck with to improve patient satisfaction. I suggested some steps they can take to help their patients get the most from their appointments.

But the patient-provider relationship is two sided. We patients need to take our responsibilities in that relationship more seriously, too.

We can do so by preparing ahead of our appointments:

First – Write down anything that is new since your last appointment. New symptoms, new aches or pains, new supplements you’re talking, drugs another doctor has prescribed, or new triggers you’ve discovered that create problems for you. Record them along with the dates they started.

Second – Take a list of every drug and supplement you take, including brand names and dosages.  Note any that will need renewal within the next 90 days.  Or, instead of listing them, throw the containers into a bag and take them with you.

Third – Write down your questions. Prioritize them since you’ll only have time to ask two or three.  If you have more than one medical problem, and therefore extra questions, then make an additional appointment.

Being a prepared patient will make every interface with your doctor more effective and efficient. You’ll be more likely to get what you need – a collaboration that’s beneficial to you and your doctor.

……………… ADDITIONAL RESOURCES ON THIS TOPIC ………………

 Effective Patient-Doctor Communications

Why Do I Wait So Long for my Doctor Appointment?

Are You Prepared for Your Doctor Appointment?

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Want More Patient Empowerment?
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…and…
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