A few more symptoms of a broken system

[asmom]

Re: A few more symptoms of a broken system

In my experience, which is nearing 21 years since I entered medical school, you are far more unique than you may realize.

It is way more common for me to be trying to explain to a patient why the test or treatment they are demanding is unneccesary than it is for me to be trying to convince them to have a test that I'm recommending. It seems that everyone with back pain wants an MRI. Everyone with a headache wants a CT scan. Everyone wants blood drawn to find what blood type they are. And yes, hundreds of patients come to see me every year because they have colds. In fact, most of them come with symptoms present for less than 48 hours, often less than 12 hours - "Doc, I woke up today with a stuffy nose."

In fact, I have often found that the patients who are hesitant to get tests or take meds are often the very ones who most need them. The patient recently who fell and I had to force her to get an x-ray which revealed her wrist fracture. The woman who was positive she had indigestion until the heart bypass surgery was done the next day.

So you may not be unique, but you are a rare breed and we need more patients like you.

I haven't read all the posts on this topic but I MUST agree with DisneySteve. I am not a physician, I'm a registered nurse(clinical nurse specialist) and I have almost 20 years of experience. The majority of patients expect to be treated with some sort of pill, diagnosed with the aid of some sort of radiology test or a procedure. Many, many times patients vent to me if they are unhappy with the care or the recommendations they receive from their physician. I cannot tell you how many times someone has come to me angry when their physician suggested as part of their treatment plan for osteoarthritis that they lose weight. Or that their respiratory symptoms due to COPD might improve if they stopped smoking. Or that their blood sugars and/or blood pressure might improve if they exercised even a little. Occasionally I have a patient say to me, "I don't want another pill, just tell me what things I can do to help myself get better." Yes, I've heard that. But that patient is a minority to be sure.

I used to work in employee health for the federal government. On a regular basis, I had people coming to me wanting antibiotics and tetanus shots for paper cuts(I'm not kidding), antibiotics for colds or other viral infections, and narcotics for muscle aches. They used to leave the office grumbling about how the nurses won't help or can't do anything after I sent them on their way. YES, we need more patients like you Joan.

[MoneyHoney]

Re: A few more symptoms of a broken system

File under unncessary office visits -
My employer requires a doctor's note for any sick leave taken. This includes a day or two absence due/to colds or flu. This policy is supposed to deter employees from taking sick days when they're not truly sick. But the unintended onsequences are that 1) many people come to work coughing/sneezing/etc., infecting others because they don't have the time or money to see a Dr. for a sick note and 2) those employees who do see a Dr. for this reason are wasting the time and money of all concerned.

[disneysteve]

Re: A few more symptoms of a broken system

Occasionally I have a patient say to me, "I don't want another pill, just tell me what things I can do to help myself get better." Yes, I've heard that. But that patient is a minority to be sure.

Another huge problem is non-compliance. If I order a prescription, the patient doesn't take it. If I send them for a diagnostic test, they never get it done. If I refer them for a specialist evaluation, they don't bother to go. And still they come back complaining that their problem hasn't gone away. Some days, I really don't know what it is some people expect of their doctors.

[disneysteve]

Re: A few more symptoms of a broken system

File under unncessary office visits -
My employer requires a doctor's note for any sick leave taken. This includes a day or two absence due/to colds or flu. This policy is supposed to deter employees from taking sick days when they're not truly sick. But the unintended onsequences are that 1) many people come to work coughing/sneezing/etc., infecting others because they don't have the time or money to see a Dr. for a sick note and 2) those employees who do see a Dr. for this reason are wasting the time and money of all concerned.

Agreed. This is a problem around here, too. Not only that, but it puts the doctor in an awkward position because I end up seeing patients who look and feel perfectly well and I have to take their word for it that they were, in fact, too sick to go to work a couple of days earlier. Also, some employers have this odd point/incident system and only absences of 3 or more days are excusable, so patients request notes for 3 days out even though they were really only sick for a day.

And as you noted, it is a waste of time all around. I'm seeing healthy patients just because they need notes which takes time away from seeing patients who are truly in need of my services.

[jodi]

Re: A few more symptoms of a broken system

Some days, I really don't know what it is some people expect of their doctors.

Well, Steve, just wave your magic wand then and make them all better

This is a very interesting discussion. I don't have too much to add, although I agree with a lot of what has been said here. I have always had a bit of a internal conflict about insurance paying for the routine things that we probably should be covering ourselves, much like the oil change analogy stated earlier. However, I have it, so I use it...hypocritical as it may be. I don't know the answer...just that the system is terribly broken.

I go to the MD once every year or two for bloodwork (borderline high cholesterol, I try to control it through diet), and maybe once every 1-2 years for illness, so I would lump myself into the doctor avoidance category...like others, I can take care of a cold at home, and don't need a note to call in sick. I personally loathe taking medicine daily, but luckily, I don't have any conditions requiring it. I hate the fact that DH takes Lipitor at age 29, although he has a very serious history of early heart disease in his family (many died before 50), so his doctor put him on fairly early. I do find that I am regularly urged by others to see a doctor or take my kids in, even if it seems to be a routine illness. I guess we are of the "better safe than sorry" generation.

[cicy33]

Re: A few more symptoms of a broken system

Before that, you wrote:



Not to pick on you but that's exactly the mindset DisneySteve and I are talking about.

I probably see it more in my line of work.

Person-at-a-Party: "You're a chiropractor? Wow! I really need you. I have a really bad back. It really hurts when I exercise. Consequently, I haven't been to the gym in months. I've gained 20 pounds."

Scanner: "Why don't you come in and see me? I can probably knock it out quick and getcha back again."

Person-at-a-Party: "No, first, I got to go get on some insurance."

Translation: I don't want to pay for it myself. Somebody else should and I should just wait for that day.

Never mind, all total cost may be $300-500 by the time, I'm done - it's a virtually sin in America to not have Blue Cross or Medicare or Aetna pay your way.

While this probably flies at the Frugal Forum, skimping on seeing the doctor, I think this mindset, partially, is one of the problems with healthcare and why you have seen costs spiral out of control.

Let me contrast this with the Pennsylvania Amish. They have no insurance, but often, when one of their own is sick, they go into the local hospital and lay down cash, with discount for the services and paying for a procedure up front.

They don't see it as a sin to pay the doctor/hospital. In fact, the mindset is it is just expected.

Do you see what I am getting at?

Really, the mindset is so deeply entrenched in America, you probably all think I'm nuts.

I think you totally misread me. I don't go to the doctor often because I believe that most illnesses can be cured by time, rest and fluids. But if I am really sick I go to the doctor and I almost always need antibiotics when I do. Perhaps, once a year or maybe two years. By the way I do have a sinus infection. I already knew that though! Why do assume that people just don't want to pay for it themselves? Can you afford $300 - $500? Well, if you can more power to you but I can't! And amazingly enough a chiropractor is the last doctor I go to. Why? Because I don't feel except in extreme situations that they are necessary. I did have to go to one a few years ago for a hand and arm that went to sleep all the time, and guess what the doctor said, Here is that scenario:

Me: Doctor, I am having trouble, my arm and hand are going to sleep when I talk on the phone, on my computer, vacuum, everything, I think I might have pinched a nerve cuz I waitress and I had an extremely busy week. Can you treat that?

Doctor: Let's get some info first, have you been in a car accident recently?

Me: About 18 months ago, yes, my car was t-boned. But this didn't start until about a month ago.

Doctor: Oh, but it can be the cause of it. Lets take xrays. Yep, that is the cause, your car accident 18 months ago. Your will treatment for probably about 1 year to fully fix this and possible follow ups for your lifetime.

Me: I cannot afford that kind of care, I have no insurance. I can manage a few visits to try to fix this numbness.

Doctor: OH, don't worry about that, you can sue the other guy and make him pay. Here is a lawyer I know in town. 618-999-9999. Call him.

Now, this is a real situation. I truly believe that I did have a pinched nerve and he is saying that is due to the car accident. I was willing to pay for a few visits to fix this and he wants to get rich. He treated me for about 3 months. the numbness did go away to a degree. Not completely and I still have episodes from time to time. I paid for the first visit and then he didn't want money until the lawsuit settled. end result? lawsuit settled and he got about $300. I wasnt' willing to have a bunch more tests so the lawyers settled. So don't always blame the patient.


To the one that posted most people have insurance. Well, out of 20 of my friends I would say that 3 have insurance. That is not a majority. and I know lots of other people that don't have insurance. Generally the reason people don't go to the doctor is cost. Who can afford an $80 doctor visit? That is two weeks worth of food, or half my light bill or other bills. I do also agree that some people do want the magic pill to cure it all but I think that is the case in all situations. there are always people that want the easy way out of everything. But perhaps, and just perhaps, doctors are so accustomed to people being that way they just assume all people are that way. and so have that mindset when a patient comes in. When I return for my follow up in a few weeks my doctor is going to run a few tests on me to test my thyroid. I have tried to tell doctors for years that I have fatigue, no energy at all, cannot lose weight unless I literally stop eating, and yet I have been blown off for years. finally I have a doctor that will at least check. My sister 10 years ago was diagnosed and treated for a thyroid problem. Since I exhibit the same symptoms and have always explained that you would think that a doctor would listen to me. but nope, they blow me off. I have tried every over the counter option only to find they make me sick (like throw up sick), so I work out and I have to be so careful what I eat to just not gain weight. forget about losing. But my point to that is don't assume that EVERY patient is looking for magic pill. Some of just want to feel better when we do get sick.

[disneysteve]

Re: A few more symptoms of a broken system

To the one that posted most people have insurance. Well, out of 20 of my friends I would say that 3 have insurance. That is not a majority. and I know lots of other people that don't have insurance.

That was me. Yes, there are lots of Americans without insurance - somewhere in the neighborhood of 44 million people. But there are 300 million people in this country, so that uninsured group represents only about 15% of the total. The other 85% are covered. It sounds like you just happen to have a lot of friends in that small minority.

[cicy33]

Re: A few more symptoms of a broken system

I think it is because I live in a low economy area!

[BCHGRL]

Re: A few more symptoms of a broken system

I try to stay away from Dr's , hospitals, or the health care system in general. On my maternal side, I had a hypochondriac grandmother. I loved her, but I believe many of her issues came from her obesity. I hate to say this, but her overmedication ultimately lead to her death. My mom has had Crohn's from a young age other health issues related to a car accident. On the other side of my family, my dad of 51yo and his mom of 76yo go to the doctor once a year for a check-up. I try to treat any ailment with over-the-counter medication. I am starting to realize that my approach doesn't not always fix the problem.

Last fall, I had a sinus infection for two weeks before I went to the doctor. OTC medications helped me to feel better temporarily, so I thought I was recovering. I only went to the dr. because my mom came to my house, made me take off work, and go to the dr (she can still pull her mama strings on me:-). I wanted to go back to work but she made me promise that I would stay home if the dr recommended that I stayed home. I tried to convince the dr. that I was much better, but he said "just in case, I recommend that you stay home for at least one more day." I trust drs, but I aspire to be like my dad's side of the family. My mom can't really help her situation with Crohn's or a car accident, I've just accompanied her to enough dr's visits to know that the healthcare system doesn't interest me. I would rather be on a beach somewhere.

[disneysteve]

Re: A few more symptoms of a broken system

I think it is because I live in a low economy area!

That's probably true. I work in a very poor area - the poorest city in America actually. Many of my patients are on Medicaid, but there are also many who earn a little too much to qualify for Medicaid, but not nearly enough to afford to pay for the insurance offered through their employers: the working poor. That's where a lot of that 44 million people come from.

[Scanner]

Re: A few more symptoms of a broken system

CICY,

First of all, let me acknowledge and validate your experience - many DC's would dismiss your experience and say, "Oh, it was an isolated experience. . ." but I feel the chiropractor/medical doctor/lawyer cartels in the health care system are a serious problem.

In that, I have been outspoken at the health care fraud in that arena. My profession has their fair share of that kind of nonsense. Ironically, he got what he deserved - $300, in the end.

So. . .health care providers have some responsibility in health care woes.

It's not a "correct reasoning" but many doctors "overbill" because they are underpaid. Then, they are underpaid some more and then they "overbill" - it's a terrible, wreckless spiral. Again, it's not right - but that's the "mindset" out there.

It would be much better if the patient just paid and then sent the bill into the insurance company. How we got in the middle of this - people handing me their Blue Cross card and saying, "Here. . .good luck.", I don't know.

As far as the self-medication and "doctor-avoidance", of course, I'd rather be on the beach too. Really, I wish there was no disease, injury, and illness in the world.

But one of the problems out there are OTC medications leading to GI problems - bleeds, ulcers, sometimes death. Sometimes, I'd rather my patients stop the self-medicating, go to their family doctor (not me), and get a prescription vs. taking all the OTC meds. out there.

As far as these questions, rhetorical or not:

Can you afford $300 - $500? Well, if you can more power to you but I can't!

and

Who can afford an $80 doctor visit?

Well, let me bounce it back in your lap. Let's say, you have escalating back pain over 6 months, not getting better, you've done the "self-medication" route - it's starting to interfere with your ability to work:

How much should it cost for me to fix it?

$50?

$10?

What do you think my fees should be? (Honest question)

You see, I guess my views have been slated by my area too - I live in the shadows of Atlantic City, casino capital on the East Coast here.

Amazingly, people can afford cigarettes, liquor, casino visits, Starbucks Coffee, yet, they boo-hoo to me when I tell them over 3 to 7 visits +/- x-rays, it will take $300-500 to fix their back up.

A bad weekend at the casinos, I guess. Health care is ailing. . .but yet, the casino industry is thriving. They're building monoliths there.

Can they really not afford it? Maybe, I think there's a few people in my Average Town, NJ that can't - but I think the vast majority "don't want to pay" vs. "can't pay."

Where you fit, I don't know - I'm not really talking about you - I'm talking more in generalities so don't take it personally.

I see it all the time - in fact, being kind of an ornery guy, I have these standing instructions to my front desk staff:

"Wendy, think of me as a prostitute. *laugh at me* When the patient comes in, you have to get their co-pay and get it before they leave. Why? Because 30 days later, after they are all better, and they get a bill for $150 balance, they will look at it very indignantly, as if 'Why is he charging me? It was a privledge to treat me - hey, he wasn't so great.' This is exactly how John's think after the "deed is done."

This collection policy and anaology has worked well for me over 10 years.

[Ima saver]

Re: A few more symptoms of a broken system

I have been very lucky all my life and have never been sick or in the hospital. For 15 years we had health insurance with a very high deductible. We paid out $90,000 in premimums and never collected a penny.
Finally the premiums got so high we dropped the insurance. When dh needs something medical done, we tell them we have no insurance and we pay up front. We find we actually get a break for paying the bill up front.
He got a shot in a pain clinic to help relieve a pinched nerve in his neck. The up front cost if we had insurance was $1350, they only charged us $950.
Was it worth it, you bet!! To go from two months of constant pain, to feeling good again was worth any price.

[cicy33]

Re: A few more symptoms of a broken system

I feel that a more proper cost for a doctor visit, just a visit, should be around $35.00. I really do. but the doctors around here charge as said before around $80 just for a visit. When I went to the doctor the other day I paid a $20 copay. (that was sooo nice!) The doctor was with me for less than 15 minutes. She was actually an assistant. I think they said a PA? anyways, she was very nice but I still don't think anything over $35 is necessary for the visit. Perhaps if they charge less people would be more willing to pay? And maybe they would go more often if they could afford it? you know, before it got really bad. Now, if you have to go to the hospital for tests that is totally different. Then of course there are additional charges, how about they inform the patient exactly what the cost will be? They know what it will be, then a patient could say yes or no or at least be aware of the cost. For the record, I don't smoke, I don't drink more than maybe once a month or less, (not morals, just don't like it!) I have been to the casino boat but we only go maybe twice a year and spend $50 each. It is apart of our weekend away. I don't really spend huge sums of money or even small that add up to huge. My worst vice is coke, and I don't drink much of that. I don't have any unpaid doctor bills cuz I don't go unless I am really sick and fortunately I am very healthy. but if I did I would try to pay as soon as possible. I just don't think that it is unreasonable to expect reasonable costs for health care.

[disneysteve]

Re: A few more symptoms of a broken system

I feel that a more proper cost for a doctor visit, just a visit, should be around $35.00.

That would be very nice if it were realistic, but it simply isn't. When you factor in office overhead like rent, utilities, staff salaries, supplies, business insurance, professional dues, licensing fees, malpractice insurance, taxes and more, your doctor would likely be earning less than the guy who mows your lawn. And that doesn't even account for student loans. When I was still repaying, I was sending about $1,200/month in loan payments.

[cicy33]

Re: A few more symptoms of a broken system

That would be very nice if it were realistic, but it simply isn't. When you factor in office overhead like rent, utilities, staff salaries, supplies, business insurance, professional dues, licensing fees, malpractice insurance, taxes and more, your doctor would likely be earning less than the guy who mows your lawn. And that doesn't even account for student loans. When I was still repaying, I was sending about $1,200/month in loan payments.

While I actually agree with what you say you have to agree that if the fee is $80 to go to see you and the patient does not have insurance then the patient most likely cannot afford 1/3 of their paycheck to go to the doctor. true it is sometimes cheaper than the alternative but for some people, $80 is a serious lot of money and can make difference between eating for the family or going to the doctor. and that doesn't include meds. there is usually another $50 or so. I know that earlier it has been reported that if you go to the hospital and pay cash for your visit they give you a discount. Do doctors do that? I am guessing no.