A few more symptoms of a broken system

**Fern** · 02-13-2007, 11:26 AM

Re: A few more symptoms of a broken system

All of these examples just cement in my own mind the importance and need to be an educated consumer and your own advocate. In other words, don't rely on the health establishment to recognize that you don't need a pap spear if your cervix has been removed. Just like, if you're going in to have surgery on your left leg, don't assume they know it's not the right leg. Don't rely on the doctor to volunteer the percocet without seeing the patient.

Oh well. It's frustrating.

**Scanner** · 02-13-2007, 11:32 AM

Re: A few more symptoms of a broken system

I have found you have to directly engage the doctor on this subject and say,

"I know you are just being thorough and defensive but I just need a reasonable opinion on X, Y, Z." And then offer to sign any waivers that you are not following recommendations.

An example is my son's pediatrician - he likes to prescribe antibiotics for ear infections if there is slight fluid in there. Never mind the side effects of diarrhea he always gets - it's generally not recommended by the American Pediatric Assocation to do this for many reasons.

But old habits die hard.

I think there's psychology at play here. He gets into his routine and 97% of doctor visits end in a prescription. So, I have to break that routine by saying,

"You know, Dr. X, not every visit with me has to end in a prescription - I am just here to get your opinion if it's viral or bacterial. If it's viral, we'll try rest and nutrition and Tylenol. I wouldn't mind a follow-up either in 5 days to check him again."

But instead - it's "treat and street." No follow-up. Take this pill and call me if it hurts again.

But I guess I am weird - most people are there for drugs and feel gipped if they don't get some.

Unfortunately, I think they get into this psychology because of direct pharmaceutical advertising - everybody is lobbying for their doctors to prescribe them lipitor, viagra, Nasonex, mucinex etc, ad nauseum - 1 in 3 ads durinig prime time news are for drugs.

The amount Americans equate drugs with health is staggering - analyze the advertisements. The spokemen/spokewoman always looks healthy and beautiful and smart and informed and serious - this all comes from taking a pill, that's the subliminal message.

So, what's my point? We have to change the system. Doctor's aren't going to do it. Insurance companies aren't going to do it. THe gov't? Well, they can do it but you aren't going to like it any better when we all have a Blue Cross Hilliary in our wallets.

I think patients are going to have to change the doctor/patient relationships where they both become better stewards of the financial aspect of care and realize that a Blue Cross card is not a blank check.

Yes, going aggressive on 90 year old grandma deserves some thought.

**boefixepa** · 02-13-2007, 11:56 AM

Re: A few more symptoms of a broken system

PERSONAL RESPONSIBILTY!

It's no one's job to take care of you than you! I've not liked the answers my doctor's gave me quite a few times and came up with more informed information off of the internet. I go in and talk to them about what I have learned and they tell me what they think.

When I went in for my pre-marital visit I came away with a perscription for birth control, a sample moth of pills, and a tube of lubricant, and the advice to listent to my friend that willing to talk about sex?????

I talked to that friend and she referred me to a few books and gave me some sound advice. I should have saved my self the money (never filled the perscription thankfully saved that money) and just talked with my friend.

Educating yourself and knowing your body, as far as what is normal and what is different, is something they can not tell by looking at charts. I know I often feel frustrated by the service, (I really like my doctor and I think he is a great guy), but I know me and I know when I need help. Moms know their kids and can tell when they are 'off.'

Many of life's problems, not just medical, would better themselves if people just took the RESPONSIBILITY upon themselves to take care of themselves.

This is true of anything, health, finances, weight management, relationships, etc...etc.

**disneysteve** · 02-13-2007, 12:50 PM

Re: A few more symptoms of a broken system

Originally posted by Scanner

"You know, Dr. X, not every visit with me has to end in a prescription - I am just here to get your opinion if it's viral or bacterial. If it's viral, we'll try rest and nutrition and Tylenol. I wouldn't mind a follow-up either in 5 days to check him again."

But I guess I am weird - most people are there for drugs and feel gipped if they don't get some.

I wish I had a lot more patients like you. Sorry to say, but you are weird.

If a patient takes off from work to make an appointment and bring in their sick child (or themselves), they get quite angry if I don't prescribe anything. They think I'm not doing my job. There is also a cost issue. They don't want me to recommend an OTC product that they have to buy. They want a prescription that is covered by their plan.

Unfortunately, I think they get into this psychology because of direct pharmaceutical advertising - everybody is lobbying for their doctors to prescribe them lipitor, viagra, Nasonex, mucinex etc, ad nauseum - 1 in 3 ads durinig prime time news are for drugs.

I absolutely DESPISE DTC advertising of prescription medications. The 15 or 30 second commercial can't possibly give any useful information. Some of the commercials don't even say what the drug is for - just ask your doctor for it. And I especially hate the ones that say to ask your doctor for free samples. Then I get stuck explaining why I won't give a fully insured patient free samples since I reserve samples for the benefit of my uninsured patients.

**pearlieq** · 02-13-2007, 01:10 PM

Re: A few more symptoms of a broken system

Originally posted by disneysteve

I absolutely DESPISE DTC advertising of prescription medications. The 15 or 30 second commercial can't possibly give any useful information. Some of the commercials don't even say what the drug is for - just ask your doctor for it.

While there are potential pitfalls, I heartily support DTC advertising for 2 main reasons:

1.) They support the idea of people being in charge of their own care. It introduces the idea that medical care isn't something done TO you, but rather something in which you are an active participant and at which you should be at the helm.

We already get consumer goods, financial services, cars, entertainment and everything else under the sun marketed toward us. Why not medications? Most people aren't dumb. The ads say "talk to your doctor". I see nothing wrong with a patient mentioning they heard about a medication that sounds like it could help and wanting to know their doctor's thoughts on it.

If someone walks into their doctor's office and demands a medication, sight unseen, and gets bent out of shape when the doctor won't percribe it the problem isn't DTC advertising, it's that the patient is an idiot. And while I sympathize with doctors having to deal with them, we all encounter idiots at work.

2.) The other main benefit is that DTC advertising tends to de-stigmatize embarassing or "nuisance" problems like erectile disfunction or bladder control problems. Many people just suffer with these conditions because they don't know that treatment is available. DTC advertising may get a man with ED to come in an talk to his doctor and get treatment for a condition that significantly affects his quality of life. And it also gives the doctor the opportunity to counsel and treat the man for the high blood pressure which is helping cause the ED.

In my own personal experience, DTC advertising directly affected the quality of my life. I've suffered for years from facial hair due to a hormonal condition. When I was first diagnosed there wasn't really much they could do about the hair, so I suffered for years being horribly embarrassed and self conscious about. I never discussed it with my doctor because there didn't really seem to be a point.

Then one day I was reading a magazine and saw an ad for a cream called Vaniqa which treats the hair. I made an appointment to discuss it with my doctor, started using it, and it's added greatly to my confidence and quality of life. I'm very grateful to the giant drug conglomerate for advertising their product--I would never have known it existed otherwise!

**disneysteve** · 02-13-2007, 01:18 PM

Re: A few more symptoms of a broken system

pearlieq - I agree with you in theory, but not in practice. Way back in 1994 when DTC advertising was first permitted, the ads that aired were for disease states, not specific drugs. I think that is perfectly fine. Smith Kline ran the first ads. They were for Tagamet, but they never actually mentioned the drug name. They only talked about the condition. It let people know that if they had those symptoms, they should speak to their doctor as treatment is available.

Then, however, all hell broke loose. Now they advertise drugs by name. They even run ads for controlled substances, like diet pills, and for specific surgical procedures. Sorry, but I've got a real problem with that.

**Scanner** · 02-13-2007, 01:22 PM

Re: A few more symptoms of a broken system

DisneySteve,

You know why I am weird? Because I am a chiropractor (I"m a rad. tech too) for 10 years.

We're the weirdos of health care - the cukes, the looney-tunes, the quacks, LOL@ myself.

Seriously though, I work with medical physicians all the time and may be joining a radiology group serving as a radiology assistant (an honor for my career - will still use the chiro. credential/license) so I understand both sides of the fence - I am not an "anti-medicine" chiropractor even if my diatribe sounded like it (in fact, many of my colleagues would call me a medipractor, LOL) but if I can speak for all chiropractors for a moment - in America, lately we feel we have lost the battle for the hearts and souls of the public in that we feel the pharm. co.'s have beaten us. INsurance companies too - they have made people lazy in spending their own money for valuable services.

They think Blue Cross should pay for everything as if Allstate should pay for an oil change. Americans, plain and simple, are spoiled healthcare-wise.

I know you MD's are just as upset at the pharm co.'s as we are and I am glad to hear you repeat it. Perhaps a coalition is needed and could be a way of burying the hatchet between our two fields, if it hasn't been buried already.

These commercials influence people in insidious ways.

Anyway, if you want some free advice from a drugless provider, I think a mea culpa by your profession, if you will, would be good.

TEll all patients that you analyzed your practice from last year and you decided I prescribed way too many drugs and you apologize for that. Then explain. . .to combat that, if you expect every visit to end in a prescription, then I'm not the doctor for you, no hard feelings. Tell them every visit will end in an honest opinion instead (not that you were being dishonest - I hope you know what I mean - ok, the mea culpa needs polish

).

Maybe then, you would have a little bit in changing health care.

On my end, we need to standardize our profession - going to a chiropractor is like opening a box of chocolates. And we need to establish benchmarks to see if drugless, conservative care is impacting healthcare at all in a fiscal way or quality of life way.

Good political subject - one I have followed for 10 years.

**disneysteve** · 02-13-2007, 02:57 PM

Re: A few more symptoms of a broken system

I was on my way out the door when I posted my last post, so let me continue.

Another problem with DTC advertising is it sometimes backfires. Numerous times, I have had patients refuse to take cholesterol-lowering medications because "they cause liver damage." They know this, of course, because they heard it on a commercial. Nothing I say can change their minds.

Yet another problem with DTC ads is that they worsen the distrust of generic medications. It makes people expect and demand brand name products that they are familiar with. Those brand name products come with far higher price tags when very often a much less costly generic would be just as effective. It also affects the demands for a prescription vs. an OTC product. For example, a 1-month supply of Prilosec OTC is about $15. A 1-month supply of Nexium by prescription is about $150, 10 times more. The drugs are nearly identical versions of the same molecule made by the same company. But just try explaining that to the patient who has seen dozens of tv and print ads for Nexium and comes in carrying the free trial coupon she ripped out of Woman's Day magazine.

I encourage them to advertise erectile dysfunction, acid reflux, restless legs, unwanted facial hair and high cholesterol. Discuss the conditions. Let people know treatment exists. But please leave the prescribing decisions to those who are educated and trained to make those decisions. I would hope that I learned more in 4 years of college, 4 years of med school, 3 years of internship and residency and nearly 14 years of practice than the average patient learned watching a 30-second commercial during The Simpsons.

**disneysteve** · 02-13-2007, 03:06 PM

Re: A few more symptoms of a broken system

Originally posted by Scanner

You know why I am weird? Because I am a chiropractor (I"m a rad. tech too) for 10 years.

They think Blue Cross should pay for everything as if Allstate should pay for an oil change. Americans, plain and simple, are spoiled healthcare-wise.

That explains it. For the record, I am a DO, not an MD.

I couldn't agree more about Americans being spoiled with healthcare. Patients have become more and more demanding over the 20 years I've been in the field. People expect their insurance to pick up every little thing. And I too have often used the auto insurance analogy. I tell them that their auto insur. doesn't cover new tires or oil changes or wiper blades or batteries or anything other than major damage. So why should your health insurance cover a bottle of cough syrup or some ibuprofen? If you need those things, go to the store and buy them. If you have an HSA, you can use that money to pay the bill.

I'm hoping that consumer-directed healthcare accounts will catch on eventually and solve some of the current problems by making people more responsible for what gets spent. Healthcare is one of the only areas where consumers pay virutally no attention to the cost of the goods and services they are demanding, requiring and receiving because they aren't the ones paying for it. "I don't care what it costs. I have insurance."

**Joan.of.the.Arch** · 02-13-2007, 04:33 PM

Re: A few more symptoms of a broken system

Scanner, what makes you think "everybody" expects a prescription for an office visit to the M.D.? That is not true. Not true! I am headed for 50 years old and have known since I was a child that antibiotics are for bacterial infections, not viral. (Yes there are antivirals, appropriate for a few viruses.) I have since I was a child understood the uselessness of taking an antibacterial for a viral illness, and the possibility of selecting for the growth of a population of antibiotic resistant bacteria within the body when using anti-biotics inapproriately. I never expect a viral illness (cold, viral pneumonia, chicken pox, viral throat infection, etc) to get me an antibiotic prescription. How anyone persuades a doctor to write a prescription for such I have never understood. And neither I nor my child have ever had a doctor who would do that. They are not wimps who would just give in like that.

I have asked for advice on over the counter meds from my doctor, knowing that I would pay out of pocket. Last time, for example, I asked if he knew of a OTC med for cold symptoms that would be appropriate for me. I had developed high blood pressure and was concerned about nudging that up should I take most OTC cold meds. I did not have a cold at the time; I was in there for something else, but wanted to have info for future colds. (And BTW, I have never gone to the doctor for a cold.) We talked about it and he helped me decide that when I feel I need something I will go ahead and use the med which had worked best for me over the years, despite the likihood that it would cause a small rise in BP. This was not something my doctor felt he needed to cover his butt on-- to warn me vehemently not to use any OTC med which has a known possibility to cause a rise in BP. And other than that I will use zinc gluconate which I have found surprisingly effective. Of course, I choose a zinc gluconate product that does not contain vitamin C (many do), as the zinc ion and the ascorbate ion associate in a manner which appears to prevent the zinc from interacting with mucosa surfaces. The label of the first big-on-the-market zinc gluconate product hints at this where it advises against citrus drinks or vitamin C supplements within a certain period of time of taking the lozenge. I'm familiar with some rudimentary bio-chemistry, so I looked up my suspicions....This is all to say that we are not all such dumb sheep that go to the doctor and bleat for prescription meds when we percieve we have a problem.

Let's see, I also have had some tennis elbow that I mentioned during an office visit for another issue. I did not demand a prescription to treat it. I wanted opinion about how to ACT with it, to encourage healing---what excercises to do or to avoid, whether I should consider immobilizing it, what kind of time frame to expect an improvemnt within, etc....I use office visits to get the expertise, experience and knowlege of my doctor, whom I truly respect and feel respected by. But I also think I am a good consumer of his services and often come already knowlegeable about the matter I am there for; I am certainly not just demanding some prescription fix nor do I think I am unique in that.

And as for 34saving's idea that doctors are making us do too many expensive tests, take too many expensive ambulance rides, or withholding narcotics unreasonably---well speak up! That too, is part of being a good consumer. Ask why the tests are being given and if you disagree with the need, just say "no, thank you," and explain yourself if you want your doctor to understand your reasons. If you do not understand the need, wait until you do understand or until your best confidants can understand and help you decide. I know sometimes when you are in the midst of a health problem, it can be hard to take in the info and make a decision you feel confidently rational about. Ask family or friends for help. If you don't want to take the ambulance, have someone drive you or take a taxi. If you think you have lived beyond the point in your life where you even want to treat certain aspects of your health, then say so. There is no need to feel like you are at the whim of your doctors and must just shell out for unwanted services, or force your insurance to shell out. Reasonably refuse when it seems appropriate.

**Joan.of.the.Arch** · 02-13-2007, 04:51 PM

Re: A few more symptoms of a broken system

Back again to say something to disneysteve.Once again I want to say that I do not think I am unique in my thoughts regarding healthcare expenses and insurance.

Right now I am on two meds for Type 2 diabetes. I have made some really good changes in my lifestyle that have brought my blood glucose levels way down. I want to trial getting off one of the meds. The one I want to try to discontinue is the expensive one, even though my insurance pays for it. The less expensive one has a longer history so its long term effects are known, so that is a consideration. But I also see it as a matter of being a good neighbor and having good manners toward those who share the insurance plan. I think it would be _piggish_ of me to go with the more expensive medicine if the less expensive one is as helpful and adequate by itself. I know it is a drop in the bucket and that my discontinuing the medicine is not going to free up funds for someone who has exhausted their benefits. But it is the right thing to do. If a similar decision were made ten thousand times over by people in situations similar to mine, well then, maybe the insurance company could decide they really could pay for some more of the meds for my husband's colleague's child who exhasuted their family coverage with a serious illness. Of course, that is only a metaphor. A profit seeking insurance company is unlikely to be flexible enough to make such a change, even if they cared. But still, I try not to be a selfish pig in how I consume health care. I know I'm not the only one.

**disneysteve** · 02-13-2007, 05:11 PM

Re: A few more symptoms of a broken system

Originally posted by Joan.of.the.Arch

I do not think I am unique in my thoughts regarding healthcare expenses and insurance.

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.

**PrincessPerky** · 02-13-2007, 06:23 PM

Re: A few more symptoms of a broken system

I wonder if ther is a concentration of that 'rare breed' here...

I am anti doc..not that I dislike docs, just that I see no reason to see a dr to tell me my kid has a cold, or flu or something..the kid needs fluids sleep and time..not a dr..

Right now, I had a fight to get the dr to move my appointment to two weeks from now, right now the most they can tell me is yeah or neah...in 3 weeks I will know if I can finish on my own or not (my first MC I had to have help, since then I seem to be able to manage) They couldn't understand why I wouldn't go in. Maybe I have better things to do?

During all of my pregnancies I have fought over rediculous tests..I do not need a glucose test....I am hypo glycemic, not hyper...I do NOT want the headache that I WILL get from drinking sugar water! but no a pregnant woman has to be talked into the test, and you know I still have the same blood type as the last 3 times you checked, write it down on that chart thingie!

On comercials for drugs..if prompting treatment ok..but you have to state what on earth the drug is for!!!!!

Oh and I think the fact that allergy med commercials make allergies to be all about sniffles is misleading....though prolly statistically accurate...I was sure I had no allergies, because I do not get sniffles or any other irritating thing..I just can't breath, tightness in the chest..feels like an elephant is sitting on me..bit of a cough too......somehow I had no idea allergy meds could help, so I never bothered to try...untill it got really bad. trip to urgent care cured me though....

course I still don't take those allergy meds......

**tinapbeana** · 02-13-2007, 07:14 PM

Re: A few more symptoms of a broken system

just a side thought to the practioners in our midst: do you think it's possible the demand for 'name brand' tests such as CT scans, MRIs, etc had a rise in the mid 90s when ER hit full stride? kinda like the CSI "everyone's a cop nowadays" phenomenon?

with that, me and my had-mild-scarlet-fever-and-didn't-tell-my-mom-i-was-sick-so-i-could-get-perfect-attendance-at-school past will now bow out of the healthcare frucus

A few more symptoms of a broken system