Posts Tagged Medical Errors and Mistakes / Misdiagnosis

Dad — an Empowered Patient Sets a Fine Example

…. and today is his 81st birthday.

When people ask me how and why I began doing patient advocacy and empowerment work, I first tell them about my misdiagnosis, and then I tell them it’s because I learned how to be an empowered patient from my dad.

Since beginning his battle with cancer in 1986 — yes — more than 21 years ago — Dad has battled his illness every step of the way. From learning everything he could, first through the libraries, then through the Internet, to partnering with his doctors but retaining decision-making for himself, to second guessing problems with a drug he was taking, then figuring out he’d been given the wrong instructions, to doing all the same for my mom to help support her through her Alzheimer’s disease… yes… dad is the epitome of the empowered patient.

Learn more about the steps he has taken here….

Then join me in wishing him a Happy Birthday!

I’m proud of you, Dad…. with love…. from your eldest 🙂

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Posted in: Health /Medical Consumerism, Healthcare Quality, Media, Patient Advocacy, Patient Empowerment, Patient Tools, Pharmaceutical Drugs

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Doctors Work the System to Increase Income – at the Patient’s Expense

Found an interesting op-ed from the Dallas News online yesterday, written by Dr. Steve Cole entitled, Biggest factor in rising health costs are the doctors themselves.” Unfortunately, the title doesn’t even begin to touch the content, so many folks will miss this enlightening piece — a piece that should be read by everyone who has an interest in the costs of healthcare.

The article explains many of the reasons healthcare costs go up based on a doctor’s wants and needs and not necessarily on the best interests of the patient. There are a few statements that should make all of us pause — because they speak to the real problems of increased costs. I give Dr. Cole plenty of credit for citing these points — and no doubt he’s taking plenty of flak from his physician-colleagues for raising them.

Doctors don’t order tests, or refer their patients to other specialists because they are necessarily best for the patient. They do so because there is a financial incentive to do so. Such as:

  1. A doctor orders a medication for his patient because he gets a higher reimbursement for that patient’s visit. The patient is considered to have a “more complex” ailment.
  2. The same is true for ordering a diagnostic test. Diagnostic test = higher reimbursement for that particular visit.
  3. A doctor will refer his patient to an additional consultant / specialist for the same reason. Only this time there is an additional financial incentive. By making the referral, he becomes part of an inner circle of sorts — and eventually may be rewarded by those specialists for sending patients their way. Sort of a medical referral commission, in effect.
  4. Dr. Cole suggests that much of the test ordering is about staving off litigation, too. Honestly, however, I’m not so sure it’s a fear of litigation. Instead I think it’s CYA (cover your a**) — because, if a medical error or misdiagnosis results, then all the tests in the world won’t avoid litigation. Instead, I think it’s just about having all that data and evidence amassed just in case there IS litigation. (As in, “But your honor. I tried to do it right! Look! I ordered all these tests!”)

What’s the bottom line for us savvy patients? When we think as patients — people with symptoms who need a diagnosis — we want to be sure we are getting the RIGHT tests and visiting the RIGHT specialists. We can determine that, at least fairly closely, by asking our doctor some questions. Why are you ordering this test? What do you expect it will tell us? What if it doesn’t tell us that? Is there another test that will be required? — or — Why do you want me to visit that specialist? Is there any other specialty that might might address the symptoms I’m having? And why are you sending me to this particular doctor? (if you determine it’s because they are friends, or are in the same practice, or even down the hall, then you’ll want to assess whether that doctor truly is the best one for you to see.)

When we think as consumers, then we want to be sure we aren’t getting any more tests than necessary, and that the cost of the test is fair. The literature is rife with doctors ordering tests only because they own the testing equipment and can bill insurance for it! That doesn’t necessarily help the patient, but it most definitely helps the doctor’s bottom line.

Truth is — doctors deserve to make a living and they deserve to max it for themselves, too. I don’t think it’s the doctors who are at fault for taking advantage of this system that is set up, like so many others, to fail patients. It’s more a question of looking at how reimbursements are made, and whether they support a patient-centered model of care.

And that’s another blog post for another day.

……………………….. See Follow Up Post to this Discussion ………………….

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Posted in: Doctor Communication, Health /Medical Consumerism, Health Insurance, Healthcare Quality, Media, Patient Empowerment, Patient Tools

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From the desk of (12/1/07)…

Miscellany from the week, not requiring full posts on their own….fromthedeskof.gif

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My big news is ready to be sprung! Although, through today’s blog, I’ll announce it “softly” — a bigger announcement is in the works for this week.

You may be familiar with About.com — tens or hundreds of millions of visitors each month go there to learn about 600+ topics of interest ranging from Women’s Issues to Fishing to Poker to Fashion to Football — and now — patient empowerment!

Yes — as of yesterday afternoon, the new About.com Guide to Patient Empowerment was launched — and yours truly is the expert/guide. Take a stroll on over! Let me know what you think! Join the forum so we can chat! And if you ever want to touch base, just link on my name at the top — my email address is right there.

The web address is: http://patients.about.com Why not bookmark it or add it to your favorites?

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An interesting report on the Thursday evening NBC news about differences in the way African American women are diagnosed, treated, provided with preventive medicine, etc…. It actually strikes me as the next revelation in the fact that medical research just can’t be generalized. First we learn that women require different diagnosing and treatment from men for problems like heart disease. Then we’re told that children can’t take smaller doses of adult drugs because “children are not simply small adults.” And now we learn that genetic makeup related to skin color affects the success of diagnosis and treatment as well.

What others are we missing?

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Has anyone else noticed this? Everytime I turn around — for the past several weeks — there have been more ads for health insurance on the TV, in the newspaper. From those plans that “pay you back” to supplemental plans for Medicare…. they must be spending millions if not billions.

Wouldn’t our premiums be lower if they didn’t spend so much on advertising?

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Today is World AIDS Day and it seems there’s not much mention of it in the press. My cousin Tim has AIDS. Tim is in his 50s. As a younger man he was a vibrant and talented actor, appearing in everything from plays to a soap opera in England back in the 1970s. Now, in these later years, Tim is a slave to the medications that keep him alive and by his own estimation, he doesn’t feel like his life has much quality.

My thoughts and prayers are with Tim and others who suffer through such a horrible disease.

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Posted in: Health /Medical Consumerism, Health Insurance, Healthcare Quality, Media, Patient Advocacy, Patient Empowerment, Patient Tools

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MRSA: Those With Power Aren’t Paying Attention

Two reminders during the past week about MRSA and the real problems facing those who are infected by it — and those who aren’t.

The first was an email from Genevieve who told me about her husband’s experience after knee replacement surgery. Two days after being removed to a rehab center, he began running a fever, and his incision starting turning red — obviously the sign of an infection.

He was transported by ambulance to the hospital where he had the surgery, and the resident on call proceeded to examine his knee — with no gloves on! Genevieve objected — loudly she says — “wait! what if it’s MRSA?”

The doctor turned to her and in a loud voice, exclaimed that MRSA wasn’t the problem everyone thinks it is, and she shouldn’t get so upset! Genevieve, however, insisted he wash his hands and put on gloves before touching her husband again. (you, go, Genevieve!) Fortunately, while there was in infection at the site of the surgery, it was not MRSA.

The second reminder came in the form of an editorial included in Health Leader’s Media by Molly Rowe called MRSA, MRSA Me. She tells about her difficulties this past summer in getting her “spider bites” diagnosed as the MRSA they were, and the ensuing disinterest on the part of her family care doctor when she was later scheduled for knee surgery and they didn’t care about double checking that her infection had, in fact, been healed. You can just imagine what might have happened had the MRSA spread to her surgical site.

Clearly, despite the media attention, despite the 100,000 deaths each year, despite the cost to hospitals of taking care of those who get sick from it — the very people who can make a difference don’t seem to be paying attention! It’s as if they take the concept of transparency (recognizing the problem so they can do something about it) to mean invisibility (if we ignore it, it will go away.)

It’s time those leaders in hospitals, and their staff, became “infected” with whatever impetus is needed to take note and take these infections seriously. Sadly, it will likely require some horrible tragedy — like the loss of a hospital’s CEO or the CEO’s loved one to MRSA — before the people in a position to make a difference will do so.

For now, we patients need to do just what Genevieve did. She proclaimed her dissatisfaction loudly to take care of the present danger. THEN, she got in touch with the hospital’s administration afterwards to complain. She is truly an empowered advocate.

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Posted in: Healthcare Quality, Hospitals, Media, Patient Empowerment, Patient Safety, Patient Tools, Surgery

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From the Desk of (10/27/07)…

fromthedeskof.gif

Some miscellany from the week, not requiring entire blog posts of their own….

The fires in Southern California have kept many of us riveted to TV and internet news. As reported earlier this week, my daughter, Becca, lives in Carlsbad, just north and east of several of the fires we’ve followed. I’m relieved and happy to report that she and her sigO Ed were never told to evacuate, and it looks like their home will remain standing, as will their neighbors’. Now they must deal with fallout from the smoky air and the ash that has coated anything and everything.

Thanks to those of you who kept them in your prayers.

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My radio show this week features two interviews you might be interested in. Dr. Helen Barkan will discuss migraine headaches, and Dr. Amy Friedman will tell us about kidney and pancreas transplants. My patient tip of the week is “Follow the Money.” If you can’t wait for Sunday, listen to the show from your computer. Same show – no commercials 🙂

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Have enjoyed my week here in Sarasota, Florida with my patient empowerment students. Our sessions went quite well and as always happens, I learned from my students as well as vice-versa. Thanks to them for that!

I’ve been asked to return to teach again in early in 2008. Let me know if you’re in Sarasota and you’d like dates.

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Another great article for CNN’s Empowered Patient this week. Don’t Be a Victim of Pharmacy Errors. Some great tips — including some I’d not thought about before. Take a look. Stay Safe!

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For those of you who have followed my column series about Glen and his brain tumor, you’ll want to catch the last in the series this Tuesday. You might be surprised at the outcome — but then again — you might not.

While the series was intended to provide a process for keeping emotions out of medical decision-making, it seems to have stirred a hunger knowledge about Glen’s treatment progress, too.

Stay tuned! And if you want to be among the first to see the last chapter, then sign up for email notification.

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Tune in again next week for “From the desk of….” !

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Want more tools and commentary for sharp patients?
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Posted in: Health /Medical Consumerism, Healthcare Quality, Media, Patient Advocacy, Patient Empowerment, Patient Safety, Patient Tools, Pharmaceutical Drugs, Self Help

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