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Archive for the 'Medical and Research Studies' Category

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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Check Out Those Health Charities Before You Donate

This column first appeared
in the Syracuse Post Standard
December 6, 2011

It’s that time of year again.  The holidays, of course. But also the end of the tax year, when charities, including groups like cancer societies or hospital foundations, are pleading for donations.

Each year in December my husband and I make contributions to the charities we think are important, many of which are health-related.  Last year money was tight, and we knew we would either have to cut back on how much we donated, or leave some organizations off our list.

To help us make those difficult decisions, I did some background research on each of the charities we ordinarily support. I was surprised at what I found!  And learned some tips to share with you, too.

First, I learned that when children need specialized cancer treatment, they will get the same treatment  whether they live in Paris, Tokyo, Sydney – or Syracuse. Pediatric oncologists worldwide share their research and successes to the benefit of children everywhere.

I had to ask myself – why would we send a contribution to a children’s hospital out of state?  Since children receive the same specialized treatments, doesn’t it make more sense to donate in our own backyards?  I’m sure those famous children’s hospitals provide excellent care.  But if my child was sick, and I had to stay with her in a city far away, how would I get to work?  Where would I stay?  Bottom line – we decided to donate to our local children’s hospital, knowing local kids would get the great care they need.

Next up – family interests. Within my husband’s family or mine, we have loved ones who have dealt with Alzheimer’s, diabetes, lymphoma and breast cancer.  We have always donated to those very large, national charitable foundations, thinking our money was going toward education, research, and of course, a cure.

Not so fast! It turns out that not all charitable foundations are equal – including those we’ve sent money to each year.  I discovered that some charities are actually quite questionable. For example, too much of their money goes toward “undetermined” administrative costs. Or worse, only a small percentage of their budget goes toward their stated goals of education, patient support or research.  One very well known charity is spending the bulk of its donations on legal fees, suing smaller charities!

Based on that information, we decided against supporting two of the organizations we’ve sent money to for years.

As a result of this process, I realized that if more of us were choosier about our donations, health-related or not, the most effective and efficient organizations would have more funds to really make progress with their missions – a benefit for everyone.

You may want to review your charity choices, too, to be sure your donations have the best chance of accomplishing the goals you think are important.

Here are some additional resources for
choosing the best charities for your donor dollars:

How to Donate Money to Health and Disease Charities

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Don’t Let Your Medical Test Results Fall Through the Cracks

(as published in the Syracuse Post Standard August 30, 2011)

A few years ago, I changed primary care doctors.

The one I left had good credentials. Over the span of a few years and several visits, she had seemed competent and was friendly.

But on my final visit, there had been a change that caused me to leave her practice. It came in the form of a sign which hung on the walls in all of her exam rooms.  It said, “Please do not phone us for your test results. We will call you if there is a problem.”

I was stunned; although I knew immediately why she imposed that policy.  It costs time and money to phone all those patients, make copies and mail them.  She decided the expense wasn’t worth the failsafe. As her patient, I found that to be dangerous and unacceptable.

A study published in 2008 illustrates why this is a problem. It focused on mistakes made during the ordering, administering and reporting processes of primary medical care tests.  The report showed that seven percent of results that went unreported to the patient resulted in additional problems for that patient including delays in treatment, further pain and suffering, and more out-of-pocket expense.

Evidently my former primary care doctor finds it acceptable to intentionally drop the ball on care for seven percent of her patients.  Those weren’t odds I was willing to accept.

Few of us visit our doctors anymore, primary care or specialists, without being tested for something.  Blood work, urine tests, a CT, MRI or any other test…. No matter whether the results are perfectly normal, or identify a problem, we need to know where we stand and what to change, if necessary.  Their results are always important, and we patients must always know what they are.

When you are given any sort of medical test, ask how and when the results will be reported to you.  Don’t accept a “don’t call us” reply.  When they phone you with results, ask for a follow-up copy by email or postal mail.  If you don’t hear back when they say you will, call the office of the doctor who ordered the test and bug them until they come through.

Doctors’ practices are becoming busier than ever. It’s easy for test reporting efforts to drop through the cracks.  Don’t let your test results be among them.

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

How to Get your Medical Test Results

How Primary Care Doctors are Dropping the Ball on Medical Tests

How to Get your Medical Records

How to Correct Your Medical Records If There Are Mistakes

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Want More Patient Empowerment?
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About.com Patient Empowerment

…and…
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Patient Empowerment Tips

July – a Potentially Dangerous Time for Healthcare

(as published in the Syracuse Post Standard
July 5, 2011)

Seven years ago this week, I found a golf ball sized lump on my torso that changed the course of my life. After its removal, I was diagnosed with a rare, terminal form of lymphoma. Subsequently I determined I didn’t really have lymphoma.  That was eventually confirmed medically, and I have never had treatment.

The fact that my tumor appeared in the month of July played a prominent role in my misdiagnosis.

Why July?

When we need medical care, we need to receive the best care possible.  That best care requires a team of professionals playing different roles, depending on what ails us.  From doctors and surgeons, to nurses, lab specialists and others, the team must conduct itself in a highly coordinated and collaborative manner to be sure we get the right answers and care. They dance a well-coordinated healthcare tango because each knows the right steps.

But sometimes there’s someone new on the team who doesn’t know how to tango.  A new dancer can cause the entire team to stumble or fall. When that happens, we patients suffer.

July brings many new team members.

First, many of the “regular” professionals take vacations beginning with the July Fourth holiday, throughout the summer. That means new, sometimes temporary replacements must step in. They may only know how to waltz.

The second set of new members are recently graduated medical students. Having just completed their studies in May and June, they begin their residencies July 1. Not only don’t they know how to function within the team, but they have barely learned the two-step.  A study reported in 2010 showed that counties with academic medical hospitals showed a 10 percent increase in medical mistakes in in July.

So how can we patients protect ourselves?

If possible, avoid medical care in July.  In particular, any care that will require you to be hospitalized should be handled either before July 1, or postponed, if possible.

If you can’t avoid medical care in July, then be sure to verify every step with an advocate’s help.  This includes double checking any lab work that yields unusual results, which – yes – was the root of my misdiagnosis.

No doubt those professionals who care for us in July have the very best intentions.  But doing a tango with someone who only knows how to waltz results in toe-stepping and bad results.  If possible, it’s a dance we patients should just sit out.

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

 Your Annual July Warning – No Time to Seek Healthcare

How the Calendar and Time of Day Affect Your Hospital Care

and

What to Do If You Must be Admitted to the Hospital Anyway

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Want More Patient Empowerment?
Find Hundreds of Articles at:

Every Patient’s Advocate

About.com Patient Empowerment

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

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Uh-oh Video! (Can’t escape it…)

When it comes to TV and video, Al Roker provides one of my favorite quotations:

“They say the camera adds 10 pounds. OK. So I figure I must be standing in front of 10 cameras.”

Oh, yes, Al. I know how you feel….

However — I’ve decided to come out of my video-avoidance closet to share the following with you all.

First — my excitement at the invitation a week ago to appear on MSNBC to speak to a problem that I actually cited a few years ago – that July is the worst month of the year to be hospitalized. Why? Watch and see!

Visit msnbc.com for breaking news, world news, and news about the economy

(Even got my two cents in about hiring patient advocates!)

So that’s the first one.  But if I’m going to jump in to the world of video, I might as well do it with both feet.  Many of you know that I am brought in to speak at various conferences and meetings across the US and Canada.  I enjoy speaking!  So in my attempts to do even more of it, I’m told I need to have a professional video made.  So, yes, I finally bit that bullet, too, and have uploaded the online version of the opening here.

It’s not like I’ve never done TV before – I have done local TV on a number of occasions.  And broadcast isn’t the problem – ferheavensake, I have hosted a radio show for 4+ years!  But video, in general, has just always been a step I’ve avoided.

Until today.  So, OK, I feel better now.  [[gulp]]

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