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Sometimes It’s Better to Just Say No

Story One: When I was a child (and we’re talking a lo-o-o-ng time ago – when doctors made house calls)… if I got an earache, I would suffer.  REALLY suffer. Mom would drip some warm oil into my ear, and then stuff some cotton in behind it. She’d give me an orange flavored baby aspirin or two.  And I would just lie in bed, or on the couch, miserable.  MISERABLE.  Seems like I would sleep a lot. Two days later, my earache would be gone, and because I was a kid, and resilient, I would be back on my feet.

Story Two: When I was a kid, I fell off my bike as I flew around a corner near my house.  My bike flew off in one direction and I flew in the other, and landed smack on my elbow.  OH THE PAIN!  I pulled the cinders out of my arm, and cried all the way home as I dragged my bike with me.  That evening my dad walked me across the street to see a doctor who lived in our neighborhood.  He felt along my arm, moved it around a little, declared that I had sprained it, then put my arm in a sling where I was expected to keep it for the next few weeks.

Perhaps it’s miraculous that I survived childhood!  But I don’t think so.  I think any of us over a “certain age” had very similar experiences as a child.  We all had sore throats and earaches, we all sprained and broke bones – and we didn’t have the miracles of modern medical care to help.

Fast forward to today.  Today when we go to the doctor, no matter what the complaint, we are met with a barrage of tests, procedures and treatments.  If I had a sore throat and an earache in 2012, I would likely be given a strep test (chi-ching!) and prescribed an antibiotic (chi-ching!)  If I fell off my bike in 2012, I would be given at least an X-ray (chi-ching!), but more likely a CT scan.  I’d be prescribed an antibiotic (chi-ching!) and maybe even a pain killer (chi-ching!)  I’d need follow up testing to see how well everything was healing (chi-ching!)…

Bottom line – healthcare is so much more expensive today because we do things that we don’t necessarily need to do.  We are herded into services that we don’t necessarily need.  And (shame on us) we ASK for things we don’t necessarily need and probably shouldn’t get.

Don’t need?  Shouldn’t get?

Antibiotics, the miracle drug of the 80s and 90s, were so overprescribed that today the bugs they were intended to kill have evolved into superbugs. People die from acquiring infections that didn’t become problematic until the overuse of antibiotics.  Yet – mom takes her child to the doctor with an earache and insists an antibiotic be prescribed for her child.  Two days later, the child is no longer in pain.  (But is that any improvement over the two days it took me to get past my earache 50+ years ago?)

The existence of CT scanners, MRI scanners and PET scanners, and the need to pay for them, compel doctors to order those tests, even in cases when they may not be necessary.  Of course there are times when they are very necessary – but not always, and not as often as they are used now.  When it comes to so much extra scanning, it can create big problems for our health (too much radiation exposure from x-rays or CTs) AND our wallets – imaging is expensive, even when we have insurance.

So how can we know the difference?  How can we be a bit more savvy when it comes to test and treatments, whether or not they are suggested by our doctors?

Last month, a consortium of nine different medical specialties – the very doctors who make money when we have tests and treatments – came out with their lists of tests, treatments and procedures we patients don’t need.  They listed them all on a website, called Choosing Wisely.

If these doctors don’t think we should take these tests, then why would we have them?

What we know is that this elite group has made these recommendations.  What we don’t know is that those recommendations will filter down to the doctors who order these tests, treatments and procedures – because that’s how they make their money, and (they think) that’s how they can defend against lawsuits.  (We can only imagine how unhappy that orthopedist who makes his living running CT scans is with his own peers that tell patients not to get so many CT scans.)

So, knowing that our doctors may not be aware of the lists, or may have chosen to ignore the lists, it’s up to us patients to ask questions.  “Doctor, If I take this antibiotic, how soon will I feel better?  How soon will I feel better if I don’t take it?”  — or — “Doctor, I know an X-ray is much less expensive than a CT scan.  What will a CT scan tell you that an x-ray won’t?  Can I have just the x-ray?”

So yes, fellow empowered patients, it’s time for us to begin making smarter choices, both for our wallets and for our health.  Make yourself generally aware of the new recommendations of tests, procedures and treatments you just don’t need.  Understand that leaders in healthcare who understand about reining in costs, even if they are the ones who lose income, are calling out to their peers to make changes in their recommendations….

Unfortunately, anything in medical care takes a LOT time to implement.  But this is something we patients can do – and do with no detriment to our health OR our wallets.
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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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