Choosing Wisely: 5 Questions to ask your doctor

choosing wisely 5 questionsCutting the waste

I’ve posted several times about the Choosing Wisely campaign.

Developed by Consumer Reports and the American Board of Internal Medicine, Choosing Wisely hopes to educate both physicians and patients, and cut back or eliminate unnecessary medical tests, procedures and treatments.

Over-testing and over-treatment are estimated to cost about $200 billion every year. I think that’s a conservative figure, as the financial—not to mention emotional—consequences of too much medicine can be difficult to quantify.

Bringing about change in our behemoth, for-profit healthcare system is a daunting task, and I’m always happy to see signs that it’s catching Continue reading

Rudeness and patient safety

How rudeness affects your healthcare

I just read an article in the New York Times by Perri Klass, MD: Rude Doctors, Rude Nurses, Rude Patients.

Rudeness all around!

Dr. Klass, a pediatrician, refers to a recent study published in a pediatric medical journal. The study looked at how rude or disparaging comments (by an actor playing the part of an infant’s mother) affect the performance of doctors and nurses.

The study’s conclusion?

Rudeness has robust, deleterious effects on the performance of medical teams. Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and

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Active surveillance for thyroid cancer

Papillary thyroid cancers are overtreated

In 2010 my husband almost died while being treated for a small papillary thyroid cancer.

Papillary tumors are by far the most common type of thyroid cancer, and are typically very slow growing. Most doctors I know say that if you have to get cancer, papillary thyroid cancer is the one to pick!

My husband didn’t choose to get thyroid cancer, of course, but once his primary care physician found the lump during a routine physical, he was put on a fast track to being overtreated.

Back then, we just didn’t know any better.

I … Continue reading

Healthcare’s perverse financial incentives

A hospital puts profits over patient safety

First do no harm.

That’s part of every medical school graduate’s oath. It should be the motto of anyone working in healthcare.

But I just read a disheartening piece of investigative journalism in my local newspaper, the Seattle Times, about a hospital where I trained, worked, and received care. The story highlights how the perverse financial incentives in healthcare (do more, get paid more) undermine patient care and safety.

…the aggressive pursuit of more patients, more surgeries and more dollars has undermined Providence’s values — rooted in the nonprofit’s founding as a

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Don’t presume your provider’s office knows best

This guest post is from a good friend of mine. She’s not in the healthcare industry, but she is one of the most savvy healthcare consumers I know. When she was telling me about some of her recent dealings with providers and insurance, I immediately asked her to write up her experiences to share with my readers! 

I don’t willingly part with my money, especially when I see a healthcare provider.

I question unnecessary tests, and I don’t want the office staff to be cavalier about spending my money. I expect the office to be familiar with my insurance plan, … Continue reading

Annual exams vs. annual wellness visits

Happy New (Calendar) Year!

It’s the start of a new year or, in health insurance lingo, the start of a new calendar year deductible. I’m reposting this from last January, because this month is the best time to start trying to schedule that annual exam or annual wellness visit (it could take weeks, after all, to get an appointment!)

I usually advise people to get any screening tests or annual exams done early in the year, just in case an abnormality is found and more testing/treatment is necessary.

Especially with the current trend towards enormous deductibles (up to $14,300 for Continue reading

Choosing Wisely – Use less healthcare

My goal for 2017? Use as little healthcare as possible

How will healthcare change under a new president and political party?

That’s a question I can’t answer. As I wrote in my last post, both candidates had multiple-point plans to tweak/improve/repeal/replace the Affordable Care Act, aka the ACA or Obamacare.

But I don’t know what will change or when.

What I know for sure is that for 2017 my premiums will be 20% more expensive, my co-insurance and co-pays will be higher, and my current primary care doctor will no longer be in-network.

I can and will shop around … Continue reading

“Brain on Fire” – A diagnostic odyssey

brain-on-fireI just finished reading a really gripping and emotional story—Brain on Fire: My Month of Madness by journalist Susannah Cahalan. (Soon to be a movie!)

As a twenty-something cub reporter in New York, Ms. Cahalan began experiencing strange, seemingly unconnected symptoms, such as forgetfulness, paranoia and the sensation that bugs were crawling on one side of her body.

The details of her weeks’ long medical journey—which she had to piece together from medical records, her parents’ journals, and the recollections of friends, doctors and nurses because she couldn’t remember most of it—are a pretty frightening look at today’s fragmented … Continue reading

Drug commercials do more harm than good

I think it was a mistake to allow prescription drug commercials on TV. In my humble opinion, at least.

But I’m not alone in disliking these commercials, or direct-to-consumer (DTC) ads, as they’re called.

The news website Vox recently released a video that explains more about how DTC ads came to be ever present on our TVs. They attempt to be fair and present both sides of the debate, but it seems to me they lean negative. What do you think?

One of my objections to DTC ads is that these multi-billion dollar campaigns are … Continue reading

Doctors don’t know what healthcare costs

Heard on the golf course

I don’t want to reinforce the cliché that all doctors play golf, but my husband (not a doctor) plays with a lot of them.

Recently he shared with me a couple of conversations he’s had with his MD golf buddies about the cost of healthcare, specifically prescription medications.

A few weeks ago I posted about how much it costs to buy an EpiPen—over $700 for a pack of two, if you don’t have insurance. Even with insurance, it can cost well over $500.

My husband mentioned this to a friend, a urologist, during a … Continue reading

Skin cancer screening guidelines

skin cancer“Insufficient evidence”

Many years ago I had a primary care doctor who used to perform a total body skin examination (TBSE) on me every year as part of my annual exam.

Of course, those all-inclusive physicals are a thing of the past. I haven’t had a physician perform a TBSE for a long time.

I often wondered about that. A TBSE seems like a relatively easy and harmless way to quickly screen for skin cancer. The goal, of course, is to find a melanoma, the deadly skin cancer, when it’s small and possibly curable.

But the go-to source for screening … Continue reading

How to read your pathology report

Last week  I posted that you should always ask for a copy of your medical reports.

One of the downsides, of course, is that those reports are often written in medical language that can be confusing or alarming.

But in response to a more savvy patient population, the College of American Pathologists has made a video to explain how the system works and to encourage patients to be involved in obtaining and understanding their pathology reports.

You can watch the video here on the medical website KevinMD.

They also created a two-page educational brochure to guide a patient through … Continue reading

Always ask for your medical test results

An error of omission

A few weeks ago there was a lot of news about how medical mistakes are the third leading cause of death in the US, behind heart disease and cancer.

A medical error is defined as “an unintended act (either of omission or commission) or one that does not achieve its intended outcome.”

And now a Philadelphia paper is highlighting one very common mistake: when you and/or your doctor are not informed about a serious finding on a medical test.

The article explains that a well-known local musician (which is why this story is popular on … Continue reading

Why shared decision making matters

As a nurse who worked for a surgeon, I had to spend a lot of time talking to patients and educating them about their proposed surgeries.

The surgeon talked to them first, of course, but often patients don’t remember everything the surgeon said. Or they think of questions after the consult.

If I couldn’t answer a question, or if I thought the patient really didn’t understand what the surgery entailed—why it was being done, other options to surgery, recovery time, etc.—I would ask the surgeon to please speak with the patient again.

If I was going to sign my name … Continue reading

“End of the Line” for medical guidelines

Knowledge is king

That’s the take home message from Professor (of pharmacy) James McCormack’s latest parody video, End of the Line, which takes a whack at healthcare’s increasingly pervasive and rigid medical guidelines.

 

If followed to the letter, these guidelines (often based on research funded by drug companies) would have everyone diagnosed with a disease and taking one or more medications. Medical guidelines may be great for the drug business, but not so much for individualized, patient-centric care and shared decision-making.

Chronic disease state guidelines (blood pressure/lipids/glucose/bone density) do not provide clinicians with

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