conversation with a doctor today, with interpretation

[RB TexLa]

M = me
D = doctor
RM = what doctor really means

D It's been over two years since you saw your doctor
RM How can you not have given your doctor money for over two years, do you realize she might have had to use used golf balls at the hitting range.

M I haven't been sick or hurt enough to see her.
D You never know what could be going on with any illness or injury
RM Doesn't matter how insignificant your illness or injury is, we can upcode it to something more severe and just steal from the insurance companies.

D You really should go see your doctor
RM Your doctor wants to take money from your insurance company and unless you go in they will be charged with a crime if they steal it from the insurance company.
M I'm doing fine. And what I really meant is I'll keep my money for myself.

Conversation then changed to something else.

[taught_me_patience]

1. You have a pretty cynical outlook

I think most doctors have your best interests at heart. Just because you look healthy, doesn't necessarily mean it's true.

[Joe Chi Minh]

18. No. Good health is normal. Not bad. It also seems to be normal, rather

than cynical that many US physicians are venal beyond the call of duty.

[Lorien]

67. Do they? After watching Bill Moyers last week, I'm not so sure:

BILL MOYERS: One of the other issues we're going to be hearing a lot about in the next few months is the high cost of prescription drugs. Most of us can testify to the fact that drugs save lives. When I had heart surgery fourteen years ago, my own life was saved by a skilled surgical team, a caring wife, and some remarkable drugs. But drugs are costly -and it seems their price keeps rising. The sticker shock has sent many people -especially the elderly - across the border to Mexico and Canada in pursuit of affordable medicine. And a report this week says that because of the cost, many middle class baby boomers are trying to do without. The pharmaceutical companies say you get what you pay for, they say it's not cheap to develop new medicines. But in journalism as in medicine, it's always helpful to get a second opinion. So if the cost of your daily meds leaves you feeling sad and depressed, unable to sleep or eat, I have a prescription for you - a consultation with the journalist Melody Petersen, who has written a powerful new book about what ails us.

Once upon a time — she says — around 25 years ago, in fact — prescription drug ads were rare on television. Now you can't escape them.

AD #1: ...with one little pill taken just once a day...

AD#2: I feel anxious. Can't make any decisions...

AD#3: ...fortunately, there's Mirapex

AD#4: Paxil CR

AD#5: Zetia

AD#6: VIOXX is there to help

AD# 7: Viva VIAGRA

BILL MOYERS: In a single generation, ads like those have helped to make America the world's greatest medicine show. That's journalist Melody Petersen's term for it in her book, OUR DAILY MEDS.

As a reporter for THE NEW YORK TIMES Melody Petersen covered the drug industry for four years, winning one of the highest honors in business journalism - the Gerald Loeb Award. Then she spent another four years researching and writing this book. She concludes that selling prescription drugs - rather than discovering them - has become the industry's obsession.

She found companies pitching drugs with cartoon characters, popping up on email and websites, on buses and street corners, at NASCAR races and even at the world-famous state fair in Iowa where Melody Petersen grew up....

MELODY PETERSEN: It was like Disneyland - this little critter, which was the mascot for Lamisil, a pill for toenail fungus. He was out there doing a jig with the children - and I found these marketing tactics just about everywhere.

BILL MOYERS: Here you are possessed to stay with one subject for eight years. Most journalists I know who spend so much time, do so much research, so obsessed with one subject will tell me that they had an epiphany, they had a moment when they said, 'This is what I'm going to do -the big investment of my life." Was there a moment for you?

MELODY PETERSEN: It was actually gradual. When I started writing about the pharmaceutical companies for The Times I didn't know anything about the drug companies and I actually thought that they were a lot about science. That's what they tell the public. They are all about science and discovering new drugs. But as I started to follow their daily activities and talk to executives, I learned that really it was marketing that drove them.

BILL MOYERS: Was there something you saw that precipitated this choice?

MELODY PETERSEN: There's a study that the FDA often cites-

BILL MOYERS: Federal Drug Administration?

MELODY PETERSEN: Uh-huh. That a 100,000 Americans die every year from their prescription drugs - that they took just as the doctor directed. This isn't when a doctor or a pharmacist made a mistake or the patient accidentally took too much. This is when everything supposedly went right. So, that just shows you how dangerous these products are.

BILL MOYERS: Petersen reports that Americans spend more on medicines than do all the people of Japan, Germany, France, Italy, Spain, Great Britain, Australia, New Zealand, Canada, Mexico, Brazil and Argentina combined. The relentless marketing has enriched corporate executives and sent stock prices soaring.

BILL MOYERS: What's the most conspicuous example of the aggressive marketing?

MELODY PETERSEN: The obvious example is the television ads. Only those ads are only allowed in the United States and New Zealand. So those are pretty much an American creation.

BILL MOYERS: You mean drug companies can't advertise in other countries on television?

MELODY PETERSEN: No. They can't advertise anywhere directly to consumers. They can advertise to doctors in other countries but not to us.

BILL MOYERS: You write, "This book is about how America's for-profit medical system, filled with incentives to make money and disincentives for good care has failed. In too many cases, whether a medicine helps or harms a patient has become secondary to how much it will bring shareholders in profit. Why should the drug industry be an exception to what all corporations, all business does?

MELODY PETERSEN: With medicines we're talking about life and death. With Wall Street driving it, there's this constant pressure to exceed the level of revenues that you made the year before. The result of this push from Wall Street-executive stock options depend on it. If the drug companies don't do this, their stock price goes down. Executive salaries go down. It's just driven to get those profits up. I write about one study in Iowa. A group of researchers looked at Alzheimer's patients who had just been diagnosed to see what medicines they had been taking before this diagnosis, they found that 30 percent of these patients were taking medicines that could cause dementia. Rather than stopping those medicines, the doctors just added a prescription for Alzheimer's. And we just learned with the antidepressants like Zoloft and Paxil they found that in about half the studies dozens of studies that were done of these antidepressants, the sugar pill- the placebo worked just as well or better than the drug.

BILL MOYERS: What do you conclude from that?

MELODY PETERSEN: There's a lot of money to be made.

BILL MOYERS: From selling a drug that works no better than a placebo?

MELODY PETERSEN: Uh-huh. If it doesn't work, if the patient still has the problem, what happens in American medicine today? The doctor prescribes yet another pill. So there is a lot of money in selling drugs that don't work.

BILL MOYERS: Petersen reports that almost 65 percent of the nation now takes a drug available only by prescription. Aggressive marketing has turned what were once normal life events into maladies that can be treated with a pill. With our consumer-driven culture, she says, America was ripe to become "a perfect medicine market," where the power of marketing can take an obscure niche drug and turn it into a best seller.

DETROL AD: The worry that your problem is as obvious as if you'd announced it to the world. But the good news is that overactive bladder is a real medical condition the symptoms can be treated. And the great news...

BILL MOYERS: "It's a real medical condition" the announcer tells us, guessing few had heard of it.

DETROL AD: Gotta go, gotta go, gotta go...With just one pill...

BILL MOYERS: The existing condition was called incontinence, and only a small percentage of people suffered from it. But the makers of Detrol weren't satisfied with so tiny a market. They needed a best seller. So they funded seminars and wined and dined urologists to persuade them that, in fact, there could be a new medical condition...it's all part of a grand marketing strategy of which ads are only the most visible tip

MELODY PETERSEN: A very powerful technique that the drug companies spend millions and millions of dollars on is hiring physicians to give lectures to other physicians on their drugs. So, it looks like this physician is up there giving his independent opinion on this drug. But, he often, he's been trained by an advertising agency. His slide presentation has been created by an ad agency. It looks like independent science, but it's not.

BILL MOYERS: Writing a story about the pain killers VIOXX and CELEBREX, she made an interesting discovery.

MELODY PETERSEN: I wanted a rheumatologist to just give me his opinion about these drugs. So I called a leading society of rheumatologists in the country and told them I want an expert. But I don't want anyone who's being paid by either one of these companies. And they said, "Well, we have lots and lots of experts. But they're all being paid by one of these companies."

BILL MOYERS: The marketing techniques, she found, extend far beyond simply rewarding agreeable doctors and go to the science, itself.

MELODY PETERSEN: They have a technique, which they benignly call publications planning. And what this is they want to get as many articles published in our medical journals as they can that show their products in favorable lights, and will get physicians to prescribe them. So, they often hire a Madison Avenue ad agency to write up an article for them or a study and the name of the ad agency rarely appears in the published version. Instead, they hire doctors to put their names on as author.

BILL MOYERS: Boosted by medical experts, the makers of Detrol were able to convince millions they might have a new ailment...

DETROL AD: ...You've got better ways to spend your day then worrying about wetting accidents or rushing to the bathroom.

BILL MOYERS: Presto! A blockbuster drug exploded in the market. Companies had figured out how to create a billion dollar hit......no matter that later research revealed that Detrol also made it difficult for older people to walk or take a shower or even feed themselves. Encouraged by record-breaking, share-boosting profits, she writes, the companies have poured even more resources into their marketing efforts pushing the boundaries for what might be considered a disease.

PAXIL AD: I'm always thinking something terrible is going to happen, I can't handle it.

BILL MOYERS: People who worried too much were encouraged to believe they might be suffering from a condition known as "generalized anxiety disorder." Paxil, once prescribed as an anti-depressant could ease it.

PMDD AD: A week before my periods, I get super moody ...

BILL MOYERS: Even women suffering from PMS were told they could have premenstrual Dysphoric Disorder or PMDD.

PMDD AD: Sarafem...a distinct medical condition...

BILL MOYERS: Prozac, once an anti-depressant, was re-packaged and re-purposed as Sarafem.

PMDD AD: Only prescription medication for PMDD...

BILL MOYERS: What are the dangers as you see them from all this medication?

MELODY PETERSEN: First of all, that people are taking drugs they don't need. Because every drug is a balance between its potential benefits and its potential risks. If you take a drug you don't need, then you can only suffer the risks.

BILL MOYERS: Ads, by law, mention some of those risks-but on television they come in a fast-talking, easy-to-avoid package.

COMMERCIAL VOICEOVER: Side affects may include decreased appetite, dry mouth, sweating, nausea, constipation.

MIRAPEX AD: Or if you experience increased gambling, sexual or other intense urges...

COMMERCIAL VOICEOVER: Some risk of dependency. Side effects may include unpleasant taste, headache, drowsiness...

BILL MOYERS: Don't you think a lot of people are willing to take risks to have a better life? More joy? More life experiences as the ad says? More sleep?

MELODY PETERSEN: Uh-huh. We want to believe in this. We want to believe that we can just take a pill and life will be better, our problems will disappear.

BILL MOYERS: You say, "The medicine merchants have learned to sell us hopes and dreams. A pill for every desire. Too few of us realize the dangers. "

MELODY PETERSEN: All you have to do is watch television and you will see this. It'll show patients hiking through the woods. They're dancing on a dinner cruise. They're running on the beach. They look like they are having such a good time. So yes, they're selling you what you wish you could be or wish you could do.

COMMERCIAL VOICEOVER: Maybe you've tried medicine but you're still waiting to enjoy life again...

BILL MOYERS: In many cases, Petersen writes, it is the marketers and not the scientists who decide which drugs are right for the new you.

COMMERCIAL VOICEOVER: You're unable to feel. You get overly startled and may have trouble sleeping.

BILL MOYERS: To boost sales of the anti-depressant Zoloft, Pfizer sought to expand the potential market by commissioning studies that suggested that the disorder PTSD was not as rare as most believed.

ZOLOFT AD: These are some symptoms of Post Traumatic Stress Disorder. A serious medical condition affecting over thirteen million Americans. While the cause is unknown ...

MELODY PETERSEN: A few years back, I kept getting information from a group called the PTSD Alliance. PTSD is Post Traumatic Stress Disorder. And one of the main messages of this group was that five percent of the American public suffered from PTSD. And this is estimate was millions and millions more than the government actually said suffered from this illness.

And later, I learned that this group wasn't actually what I thought it was. It was the creation of a public relations firm working for Pfizer to sell more Zoloft. In fact, it was staffed by the public relations firm. Its offices were the same address of the public relations firm.

BILL MOYERS: She found example after example of science compromised by marketing.

MELODY PETERSEN: You know, it's gone so far that some independent scientists are starting to view our medical literature as propaganda. I've learned that there are so many different ways for a study to be designed to get the data that will help you sell your drug. If you want to make it look more powerful than an older drug on the market, you give the volunteers in your trial the older drug at a dose that is too low to really help them so your drug looks better. If you want your drug to look safer than an older drug you boost the dose up of the older drug in the volunteers so they have more side effects. If you have one study that showed it worked, and one study showed it didn't, you publish the first study over and over again with the help of your advertising agency. And you don't publish the second one.

BILL MOYERS: Are we being deliberately misled?

MELODY PETERSEN: Yes.

BILL MOYERS: Intentionally?

MELODY PETERSEN: Yes, looking at documents from inside the drug companies, yes. I would say we're being misled deliberately.

BILL MOYERS: I was fascinated to read an attack on your book. A seething review in THE NEW YORK POST right here in New York. "Hard Pill to Swallow." It's very critical of your book. By Robert Goldberg. It says nothing about who Robert Goldberg is. But when you do a little investigation he turns out to be vice president of a group that receives funding from the drug industry. But, he does not disclose this fact in this review in THE NEW YORK POST.

MELODY PETERSEN: Exactly.

BILL MOYERS: Now, what does that say?

MELODY PETERSEN: This is what they do over and over again. The drug companies are very good at putting their words in the mouth of someone who looks independent to get their message across.

BILL MOYERS:

MELODY PETERSEN: responded to Goldberg's attack in THE NEW YORK POST with a letter that alerted readers to the fact that Goldberg was not the objective reviewer they were led to believe. Her letter ends: "The drug companies learned from the tobacco industry that the public would believe their message if it came from someone who appeared independent. People need honest information about medicines, not propaganda."

BILL MOYERS: Doctors, themselves, she writes in her book, can be part of the propaganda machine

MELODY PETERSEN: Unfortunately physicians have lost their way. And I don't think the public really understands this. But, in 1951, Congress changed the law so that we would require prescription for certain drugs. Before, we could go into the drugstore and get whatever we wanted. And Congress wanted an educated physician who had the best interest of his patients at heart and was independent from the pharmacies and the drug companies to be the gatekeeper. But, now, a lot of the physicians in America take gifts or cash from the drug companies. Some physicians take hundreds of thousands of dollars a year.

BILL MOYERS: Congress, too, is in the grip of the industry. Petersen reports that in a recent six-year period Big Pharma spent more on lobbying than any other industry and now employs two lobbyists for every member of Congress. With doctors and congress compromised, what about that other gatekeeper, the Federal Drug Administration?

MELODY PETERSEN: Actually, the drug industry pays the FDA too. There was a change in the law in 1992. Before 1992, the FDA had one customer and that was us, the public. But, in '92, the drug companies started to pay fees to get their drugs reviewed and approved. And so, the FDA has another customer now, the drug companies. And you can talking to scientists inside the FDA, you learn that there's an awful lot of pressure for the FDA to do what the industry want them to do.

BILL MOYERS: So after her exhaustive diagnosis,

MELODY PETERSEN: has some prescriptions of her own.

MELODY PETERSEN: The system is so out of whack the way it is today, you really have to be careful. Don't take any drug without understanding the risks that it could have. Find the doctor who has thrown the sales reps out of his office, who has said 'I'm gonna do what's right for my patients'. And there's a growing number of doctors who feel that way and think the thing that could do the most good is to have a law that bans doctors from taking money from drug companies. We need our doctors to be our independent advocates again.

BILL MOYERS: The book is OUR DAILY MEDS: HOW THE PHARMACEUTICAL COMPANIES TRANSFORMED THEMSELVES INTO SLICK MARKETING MACHINES AND HOOKED THE NATION ON PRESCRIPTION DRUGS.

BILL MOYERS: Melody Petersen thank you for joining me on the JOURNAL.

MELODY PETERSEN: Thank you so much for having me.

http://www.pbs.org/moyers/journal/05162008/transcript4.html

[Ilsa]

2. They want us to be hypochondriacs about

every little twitch or pinch of nausea so they can find something wrong with us to scare into anxiety and then up the dx and crank up the insurance billing.

[knitter4democracy]

37. Nope. Most can't stand hypochondriacs.

They take up office time and actually result in not all that much billing. A patient sitting there for 15 minutes whining about nausea could never legitimately get billed at a level four, but the patient who needed that slot might have.

[DAGDA56]

3. I guess you're better off doing that than asking your doctor what

the commercial on TV told you to "ask your doctor about". I don't necessarily see your doctor using your insurance company as a cash cow...Big Pharma, on the other hand...

[EmperorHasNoClothes]

4. Find another doctor.

They're not all bad. I have a very good doctor who doesn't behave at all like that.

[RB TexLa]

6. This wasn't my personal doctor.

My doctor knows I will not give her money until I need to.

[Indenturedebtor]

46. For most doctors it's not just about money

My Sister could have made a hell of a lot more money with a hell of a lot less work as an investment banker for example. She's a doctor because she cares about people in general and likes to help people.

A small percentage of doctors get rich. Many of them make as little as a good car salesman.

A huge part of the problem with our healthcare system is lack of preventative care. Preventative care, like that doctor was advocating, is the biggest cost savings we would get from socialised medicine.

[Clear Blue Sky]

109. Most are in training until they are in their 30s...

Earning minimum wage, long hours, hard work during residency and fellowship.

[uppityperson]

5. That is pretty cynical, esp since their ins payments are getting pretty low.

Speaking from a health care provider status, catching stuff earlier is better than later, and keeping an eye on things is a good thing. Insurance companies do not pay doctors a whole lot for basic check ups. Have you ever looked at an explanation of benefits received from an ins co? The amount charged vs the amount paid is usually greatly different.

This is not to say that there are not unethical health care providers as there are unethical people in all professions, but no, they are not getting rich like they used to. Especially family practice or primary docs. Specialists still can make a lot, but even they are not making what they used to.

You are more cynical than I, and that's saying a lot.

[Joe Chi Minh]

20. Their insurance payments getting pretty low, eh? I suppose they need

some industrial muscle. Pretty rare for physicians and lawyers not to be able to look out for themselves financially.

[uppityperson]

23. Not so much any more. Many are having financial difficulties due to ins crap.

They are charged high insurance rates (liability) and people's insurance co's don't pay enough. Many places like where I live (smal town) are having serious issues keeping doctors in business, being able to afford to pay them the decreasing amounts they need to live on.

It is not so rare any more. Insurance is a scam.

[Joe Chi Minh]

29. do you mean that the doctors become unemployed? or that they move

to pastures new?

[knitter4democracy]

33. That's exactly what's happening.

Read up on memag.com (Medical Economics, my fave of Hubby's med journals). Many are leaving the profession from getting squeezed on both ends by insurance companies.

[Joe Chi Minh]

45. Well, I certainly never doubted a syllable of what you said about the insurance

companies. Devils incarnate. You can only pity the decent souls at the lower levels who have to work for them or face a very uncertain (or should I say, "even more uncertain") future. Maybe some in middle management too.

[knitter4democracy]

57. I have some knitting friends who've worked there.

They said it was the worst job they'd ever had (both of them have since quit). They hated talking to hurting people and having to stick to the company line of denying them payment and/or care.

[uppityperson]

47. We've had several quit because of that. They are pushed to treat as fast as possible, that

they cannot take the time to actually treat the whole person, to determine what all is going on. They are very stressed at not being able to practice good medicine.

I had a visit for something, day before my visit (think it was for routine check in due to thyroid) I got a bad earache. As I'd blown out my eardrum twice in the last few yrs, I asked if the doc could take a quick look and see. I was told no, I'd have to make another appointment as they didn't have time to look, think, diagnose, then document it all. The doc was really pissed at being squeezed like this, felt really bad that I had to come back but was unable to just look and see. Seriously. Most of the local family practice people have had to go under our local "Name Healthcare" due to high insurance (for them), and now are employees of "name Healthcare" and it just sucks.

We've had several quit in protest since it is poor medicine, but for some reason a business necessity since insurance companies do not pay enough and patients cannot afford to pay enough, yet liability insurance rates are going up up upup up.

[knitter4democracy]

59. We've been really lucky so far.

Hubby's in a good practice. They know he spends more time with patients, and as long as he meets his minimum billing (and he has so far), they don't mind. He'd never turn anyone away with an earache, but it does cut into our bottom line (there's a bonus if he goes high enough above minimum, and he has yet to do it).

[Joe Chi Minh]

63. One day soon it will come to a stop, and sanity will return. The corportatist "wheels" are like

hyperactive and totally indisciplined children, and will continue to push, push, push, to see how far they can go; and - no, don't laugh - when it will all collapse! Even if they saw the whole system on the verge of collapse, they still couldn't stop themselves. Introspection is forever an exotic-seeming mystery to them, and hence modification of their behaviour, for ever out of reach.

[knitter4democracy]

66. Most doctors I know are waiting for it to all come crashing down.

They used to talk about it during residency at the dinners. Everyone just assumes that the entire system will entirely collapse soon. Like Hubby says, we won't get national health care until the rich start asking for it, and we're getting close to that now.

[uppityperson]

44. Yes. Having the responsibilities and stresses, and getting paid less than

they could be making as, say, a computer technician, why? It's difficult to get many to stay here when they feel they are not able to practice good medicine because they are pushed to get patients through as fast as possible and not actually be able to do more than basic bandaid medicine. And their wages have dropped to $40-50 thousand a yr, along with the liability stuff. Yes, many have quit because it isn't worth it, stress wise.

Specialists may make gobs, but a lot of family docs don't.

[Joe Chi Minh]

51. Well, your post and that of knitterfordemocracy make interesting reading.

However, utterly deplorable as it is that they should have been put in that situation, expecting the ordinary Joe and Jane to take some of the strain by having routine checks done, unless they, specifically ask for them, doesn't sound any more enlightened to me.

Of course, in those circumstances, whatever course is taken, it will be making the best of a bad job. Whether it's keeping a doctor viable, by having routine checks you can ill afford; or not having them until the need was fely, which imo would ordinarily be common sense. Most women in the UK, at least above the age of 40, have routine scans and smear tests for cancer under the NHS.

[uppityperson]

58. A couple yrs ago my pcp was moaning at me about it, how healthcare had peaked

and was heading down. I've seen it happening more and more and the providers I know are very much not happy. Their unhappiness is not that they can no longer expect to be Rich Gods, but that they cannot do what they think they should be able to do to provide decent care since it is now a Business rather than a Service industry. If that makes sense.

And yes, they now have to prescribe unneeded tests for liabilities sake and also to cover themselves since they aren't able to take the time to put it all together and maybe not need extra tests. If they don't have time to look at the whole person, to look at everything, sometimes just doing a fast test will give the answer in a faster amount of time and yes, top management will be happy because less time is wasted, more things can be billed for.

It's pretty sad.

[knitter4democracy]

60. That's why we need national health care.

If we take the profit motive out of the equation, it'll help medicine greatly.

My doctor and my husband don't expect patients to come more frequently, though, just for the billing. They want more frequent checkups to make sure patients are doing okay and to catch things early (and this is only for seriously ill or chronically ill patients to begin with).

[nolabels]

96. We need a comprehensive and holistic health care system

Treatment for people after they become ill is even oxymoronic to the concept of the word 'health' itself. Having corporations adulterate of foodstuff and fill peoples minds with unhealthy concepts about pharmaceuticals and lifestyle agendas needs to be addressed.

[knitter4democracy]

97. I entirely agree.

Dental and Podiatry and Naturapaths had better be on there, too, along with chiropractors and acupuncture and massage.

[gateley]

7. I STRONGLY take exception to your bullshit post.

My dad was a doctor and if you didn't have the money, you didn't get billed. Period.

He would take time to listen to pharmaceutical sales reps so he could get mountains of samples, and give them out to his patients so they didn't have to pay for prescriptions (and he himself had plenty of stock in pharmaceutical companies).

If you needed to see him, he would work you in, regardless of the inconvenience to his staff.

And he wasn't some small town country doctor - he was a prominent surgeon in a large city.

My current doctor doesn't play any such games, and I know I'm in excellent hands -- that his primary concern is for my health, not his income.

If you're relaying your experience with your doctor, and you're accurate, then I question why you haven't found someone else.

[Donnachaidh]

19. "if you didn't have the money, you didn't get billed"

Ahh -- THOSE were the days! Haven't seen THOSE in years.

Of course NOW, if you miss an appointment, there's a fee. If you want copies of your very own medical records, there is a per page charge AND a fee. If you have shot forms that must be signed for your children to take to school, there is a PER SHEET Charge for the signature - and THAT must be PAID UP FRONT. Not Cashee - no signee. :sarcasm:

And people wonder WHY patients get cynical.

[gateley]

26. Granted, it was many years ago,

but none of the things you cite are true of my current doctor. I've had medical records copied from OTHER physicians, too, but was never charged.

Can't speak to the forms for children, but I'm guessing my doctor wouldn't charge for those either.

Again, if I encountered someone like that, I'd find another doctor.

[Donnachaidh]

93. and if all the *GOOD* doctors in the area had those charges?

I guess we need to move, right?

And yes, I'm being sarcastic - but that is EXACTLY what is happening in my area. From the top down, so to speak. The *Good* guys are killing off their clientele with their added charges.

I was spoiled by a doctor just like your Dad. And he's still my brother's doctor in NY. People in the area want to canonize the man. He's closing in on 90 years old, and STILL making housecalls. He hasn't seen me in a couple of decades, but he still asks my brother about me.

But here? We are being nickled and dimed to DEATH by the medical community. Now some of the doctors are adding clauses in their bills that will force the patients who have to pay out of pocket an additional 18 per cent CHARGE, just like the credit card companies. THAT is the reality of medicine in my area.

[knitter4democracy]

38. Mine doesn't charge those fees.

Most in our area don't. They would lose business if they did.

[Donnachaidh]

94. ALL of the doctors in my area are doing it - I've been checking

And we're in an area where there is massive health facilities - all *for profit*. The local hospital has been adding wings for the last 5 or more years.

Believe me, if we could FIND a doctor that didn't charge those fees, we'd be patients.

[knitter4democracy]

98. No way! That's crazy!

Oh, maybe it's because we're in Michigan. Most people here couldn't afford those to begin with, and by our state constitution, all hospitals have to be non-profit and take in anyone.

[BigDaddy44]

82. My brother is a doctor

And regularly treats people who can't pay (and doesn't bill them)

[Clear Blue Sky]

111. Make a reservation at a nice restaurant and don't show...

You get billed. Many ask for your credit card at the time of reservation. Ditto hotels.

Call your doctor after hours and you won't be charged for a phone conversation. Try calling a lawyer, especially after hours. You will be charged for a 1 min conversation. Ditto lawyers and copying fees.

Doctors value their free time as well and should be compensated for their work.

[The2ndWheel]

8. "You never know what could be going on with any illness or injury"

Damn, to walk around all day with that type of fear gnawing on your brain, doctor or not, must suck.

But by all means, if something is gnawing on your brain...don't hesitate to see a doctor.

[RB TexLa]

10. Maybe he goes to his doctor every week, I don't know

[Radio_Lady]

9. I don't understand. You just don't want to go to a doctor with some regularity?

For blood pressure checks, tests, injections? Those are all routine -- and I feel they are quite necessary.

However, you may have come to a different opinion. Plenty of people can't afford or don't want to visit doctors.

If so, then just tell them you don't believe in medical treatment and you'd rather not go into it with them.

No need to progress to discussions of insurance money and how it is or is not appropriated. Are you on Medicare? Do you have an HMO?

Are you over 50? If so, I would strongly urge you to at least have a basic physical exam at least every couple of years.

Or not...

[RB TexLa]

11. I'm 39 with an HSA and that is where my money is staying.

If I have to pay one to do something I have to have I'll do that, but under normal circumstances I'm not going to give my or my insurance company's money to them.

[Joe Chi Minh]

28. "just tell them you don't believe in medical treatment ". I don't recall anyone

mking such a statement. With that single ludicrous "straw man", you vitiate the entire credibility of your post.

[Radio_Lady]

39. Why are you reaming me out? Some people just don't go to doctors.

They prefer to treat themselves through other means. I can respect that.

We have a tall, handsome, fifty-year-old plus man who has been doing housework for us once a month for the past four or five years. He is college educated and feels he is in excellent health. He takes many GRAMS of Vitamin C every day, and likes to quote Dr. Linus Pauling's work in decades past. He eats one meal a day consisting of nuts and fruit (no meat at all) and is in top physical health... AND he does NOT go to doctors. Doesn't believe in them, and doesn't believe in medical insurance.

Perhaps you mistook what I said. Perhaps I mistook what the OP said. He seemed to be locked in combat with some doctor who may just have wanted to catch up with his physical condition after two years. What's wrong with that? The OP just has to say "No. I don't need or want medical treatment."

Let's just leave it at that! I hate to be tangled in a web with someone in one of the most beautiful cities in the world -- Edinburgh, Scotland.
We love you guys, the most...

Cordially,

Radio Lady Ellen

[Joe Chi Minh]

55. Storm in a teacup with me, Ellen. It's easy to get worked up on here.

Take no notice.

[Radio_Lady]

68. (PHOTO) Next time we get there, I owe you a cup of tea! Cheerio, my friend...

[InvisibleTouch]

114. That would be me, pretty much...

...except of the opposite gender and somewhat younger. :) I can neither afford nor trust conventional medicine, for the most part, so I prefer to treat myself by whatever means I have available. If the time should come that I have a major illness, I prefer to die on my own terms. We all have to go sometime. To each their own.

[blondeatlast]

12. I'll comment when the doctor adds his editorial notes. nt

[TZ]

13. Thats pretty insulting

You do know one of the reason why health care is so expensive in this country don't you?. Its cause people like YOU don't go to the doctor on a regular basis and have your health checked. No the only time you go is if you have something catastrophic something you probably could have caught on an early basis!
My god, if I didn't go to the doctor on a routine basis, I may well have had a stroke by now from a condition I would NEVER have figured out except for blood tests.
There are all sorts of PSA's about this stuff and your paranoid, stereotyping of doctors does NOT help.
Geezus fucking christ. How did we get to be so damn DUMB in this country? People who really need doctors can't get them but people who have access WON'T because they fucking think its a scam.

:banghead:

[uppityperson]

14. k&r for an example of stereotyping and jumping to conclusions.

Why did you go to the doctor today?

[RB TexLa]

15. The doctor was in the same place I was, I didn't go to him or to my doctor today.

[uppityperson]

21. Ah, thank you for clarifying.

[silverweb]

16. Cynical, maybe. But there's also truth there.

I'm a medical transcriptionist and often see reports for high-priced consultations and diagnostic tests that even the referring doctors acknowledge are not really necessary and are unlikely to be helpful.

When my father, who is in his late 80s and has advanced dementia, was admitted to the hospital for a drug-resistant urinary tract infection, he was whisked off for a series of unrelated, unnecessary, and very expensive diagnostic tests. He was there for focused urinary tract cultures and administration of IV antibiotics, nothing else. We know perfectly well that the only reasons for a brain scan and nuclear heart scan, among other studies, were that he has excellent insurance coverage, a perfect credit rating, and a paid-for home. There was no other indication for those tests at all.

When my brother was finally asked to sign a consent form for an invasive study (cardiac catheterization) and refused -- saying that our father wasn't there for his heart, had never had any kind of heart disease in his life, and the family did not want invasive procedures -- the doctor got snippy and said, "Well, there's nothing more we can do for him here, then. He'll just have to go to a nursing home."

My brother then signed him out of the hospital AMA (against medical advice), took him home, and arranged with a home health service to administer the appropriate IV antibiotics at home. No one can tell us that the hospital was interested in anything but milking his insurance and assets to pad it's bottom line.

Even after payment to the hospital from what is considered "excellent" insurance coverage, my father's two-day hospital stay cost an additional several thousand dollars. That's not "health care" -- it's premeditated fraud and theft. Cynical? You bet -- and from an insider's perspective as well as from being on the receiving end.

There are dedicated, honest, caring physicians who do their best to provide excellent care without unnecessarily increasing financial stress on their patients. No one is denying that, least of all me. My family and I've have all personally received care from this kind of doctor and I have spent years transcribing their reports.

However, never deny that there are also the other kind -- in it purely for the money and willing pawns of the for-profit, milk-the-patient scam. More than we perhaps like to believe or acknowledge.

[Donnachaidh]

24. THANK YOU! n/t

[Joe Chi Minh]

25. It's not cynical for crying out loud. How can you swallow that! Those posters

who make that claim should be ashamed.

Admittedly, precisely because your ultra consumer society is built on infinite avarice, stress proves more of a maimer and killer than in the socially-advanced countries of Europe, for example, but at least until old age, good health should be the norm for most people. And knowing how strapped for cash most people are, after so many years of falling income, to suggest that even the elderly have regular check-ups seems insensitive, to say the least.

[silverweb]

27. I misread your post.

My apologies.

I do think some people have become too cynical, though, and give no credit at all to the many doctors and other professionals who are in health care professions for humanitarian rather than avaricious reasons.

[Joe Chi Minh]

30. No, I miswrote it - missing a negative! But I agree about your second point.

However, bad rulers brutalise people - and you know the saying... "No good deed goes unpunished." Never a truer word was spoken. But in the face of ingratitude, good people in every sphere try to understand, and persevere in doing good. Personally, I have good reason to be very grateful to a number of doctors.

[silverweb]

34. Oh, good! Whew!

I do worry about the hereditary aspects of dementia... nice to know I'm safe for a little while yet. :D

"But in the face of ingratitude, good people in every sphere try to understand, and persevere in doing good.

Beautifully stated!

[Joe Chi Minh]

42. Odd you should have said that. I'm very worried about my 92 year-old mother,

And here's me, at 57, sometimes starting a sentence and then forgetting what I was going to say!!!! Mind you, I reassure myself that I seem to have been "out to lunch" from the day I was born.

[silverweb]

50. Are we related?

"I reassure myself that I seem to have been 'out to lunch' from the day I was born."

I've been getting, "Oh, she'd forget her head if it wasn't attached" for as long as I can remember.

:rofl:

[Joe Chi Minh]

52. I suppose it could..... I was going to say something ....

[silverweb]

54. ...

LOL

:pals:

[knitter4democracy]

36. Sure, there are bad doctors.

I've had a few myself. It doesn't mean that I automatically assume all doctors are in it purely for the money. If I know that doctor and know that he is, I avoid him like the plague.

Btw, cardiac cath?! Were they thinking there was an infection in his heart? Cardiac cath wouldn't be needed for that, though, since it should show up on a regular (and cheaper) CT. We have a practice in town that covers a couple of the hospitals that's like that--they're awful, and people are starting to find that out and avoid them and ask for new doctors. You can always ask for a new doctor, if needed, even immediately.

[silverweb]

48. Yup, they wanted a cardiac cath with contrast dye.

Do you want to guess at how many reports for acute kidney injury requiring dialysis I've transcribed that were directly due to contrast dye?

If they were worried about heart vegetations or pericardial infection, a transthoracic echocardiogram or CT would have been appropriate, but not a cardiac cath. There was no indication for a cath... or the brain scan for that matter.

My brother did the right thing in getting him out of there. Our dad now has regular visits from a VA Hospital nurse practitioner who consults with the MD there*, and there's a local home health agency that can set up and monitor at-home IVs and other necessary therapies.

He won't be going back to that other hospital again.

* On edit: But my mother is still dead set against "socialized medicine" --- and she supposedly isn't demented! :D

[knitter4democracy]

61. *shudder* Bad practice, then.

It sounds like he was under a hospitalist or critical care practice. Some of those are so into billing to keep their practices going that they ultimately put patients at risk. Hubby ran into a couple of those in residency. He hates them, and now, as an attending, he keeps his patients away from them as best as he can.

[silverweb]

65. That was exactly it.

He went in via the emergency department and was admitted to the hospitalist's service for a resistant UTI. His PCP was at the VA, quite some distance away, and had recommended admission at the local hospital for this issue only.

As I said, he won't be going back there again unless it's a real emergency.

Your husband sounds to me like a very wise man. That being said, I have to get to work and see what kinds of doctors have reports for me today. :)

[bmbmd]

78. I don't know everything

but I do know not to question another's judgement by something I read on the internet. If I had a high functioning OBS patient with an ischemic looking pattern and elevated enzymes, I would not hesitate to recommend a cath. There is a very real possiblity that this was not just a routine urinary tract infection, and I give credit to his care-giving team for being thorough. I surely would not admit a patient just for specific IV antibiotics based on the recommendations from the VA-I would do my own evaluation. Refusing to offer life-saving technology is *shudder* bad practice, in my view.

[silverweb]

91. "high functioning" ??

"If I had a high functioning OBS patient with an ischemic looking pattern and elevated enzymes, I would not hesitate to recommend a cath."

Where in my description of my father did I say that he was high functioning, had an ischemic-looking pattern, or elevated enzymes? I said that he is 85+ years of age and has advanced dementia, but no history whatsoever of heart disease (or elevated cardiac enzymes).

He has a history of recurrent UTIs, partly because he refuses adequate oral fluid intake. He needed appropriate labs for persistent/resistant UTI, IV antibiotics, and IV hydration. This needed to be done in the hospital because he rips out IV lines and even ripped out an IJ cath once. Therefore he needs sedation, soft restraints, and very close monitoring when any kind of lines are in.

My family's objections stemmed from the fact that the minute the hospital got their mitts on my father, they sent him for a battery of unrelated imaging studies with NO explanation, and only asked for consent for the cardiac catheterization because they had to. The moment my family balked at an unnecessary invasive procedure, the hospital was ready to dump him in the nearest nursing home -- and the doctor never did explain the rationale for wanting the cardiac cath, but got snippy when challenged.

This was not defensive medicine. This was not "life-saving" medicine for a DNR patient. This was for billing.

[knitter4democracy]

99. Maybe I was approaching it from my own experience, then.

We have a critical care group in our area that bills up for everything, does all sorts of stuff that's barely explainable, and provides crappy care. If they were my loved one's doctor, I'd sure as heck question everything until I was satisfied with the level of care and the explanations.

[bmbmd]

106. Our hospitalists are outstanding, and after twenty-five years

in practice,they have given me my life back. I still make social visits on my hospital patients, but I consider the hospitalist to be the attending. They are another physician extender. The guys in the upstream post were just doing their jobs-it's what they are trained to do. The VA is notorious about dumping patients, and the attending usually has to start de novo with the case. If the poster didn't want aggressive care, hospice might have been a consideration. Saying that doctors do procedures "just for the billing" is tantamount to saying that families sometimes withdraw medical care "just to hasten their inheritance". I can smell an inheritance a mile away-whenever little sister or big brother show up and start raising cain about daddy's treatment, acting righteously indignant-it's a fair bet that there is money to be had. That is a horrible thing to say-but it is not any worse than impugning the integrity of a dedicated, hard-working and highly-trained professional. *shudder* bad practice, indeed.

[knitter4democracy]

107. You're lucky, then.

Our small community hospital that Hubby covers doesn't have a hospitalist practice, and there are two critical care practices in town (one of which is the bad one--the other's really good, and I'd trust them with anything). So, Hubby has them cover anyone in the unit, but he covers everyone else. If he has a patient admitted to the bad critical care practice, he watches them like a hawk to make sure they don't kill his patient (it's happened before) or do unnecessary stuff that Hubby's often already done (not that they'd call and ask).

There's a big difference between a doctor as dedicated and awesome as you are and the guys in the practice I'm referring to. When I read her post about her dad and all, it sure sounded a lot like the bad critical care practice in our town, but you're right--I jumped to conclusions on that one. Maybe if the doctors had done a family conference (like Hubby does all the time) to answer questions and explain what they wanted to do and why, all of that might have been avoided.

[silverweb]

108. Thank you so much for addressing me directly.

Talking about me instead of to me tells me a great deal about you, all of it unflattering. Besides that, every single presumptive statement you've made about my father's case has been 100% wrong.

The VA physician did not "dump" my father. Distance was the deciding factor and he felt that brief in-house treatment at the local hospital would be the best course.

I also heartily resent your statement that this was about a supposed "inheritance." You have no idea how completely wrong you are and you have absolutely no right to assume such a thing.

This was about providing appropriate clinical care and comfort to preserve the quality of life of this patient. That's why he's cared for at home by family and excellent visiting health care professionals. As I stated, the fact that he has ripped out IV lines and even an IJ cath in the past was the primary reason for admission.

Even assuming the hospitalist is the "attending" on an admission, the family should be completely involved in any testing or plan of care -- especially in a situation like this, where the patient is not critically ill and the family is present.

My mother and brother were both present, but NO ONE told them about the brain scan and heart scan until they'd been done. They thought he'd merely been taken for routine chest x-ray and labs. Furthermore, NO ONE ever provided a rationale for wanting the cardiac cath. If you really consider this "good practice," there's something seriously wrong with you.

The assumption that ALL medical professionals are good is as blind and stupid as the assumption that ALL of them are bad. I was very careful to make that distinction, yet you continue to impugn my integrity without knowing me or my family.

[nadinbrzezinski]

81. What you are also describing is a CLASSIC case of defensive care

also an insider... or at least used to be

They were covering their assess.. MAJOR time

And when you said no... they went... this could be trouble


Not that milking the system does not go on... but there is also quite a bit of defensive, we really don't need this test, but... medical care

Thank your ambulance chaser you see him for that....

And boy I could tell stories and they are the minority, but boy they are also leeches

[silverweb]

92. See my post #91.

n/t

[raebrek]

17. I'm not going to the doctor until I have a reason.

I think I should at least be sick. I would allow that something might not seem right and then I would go to the
Doctor. It just seems to me that they are scheduling regular visits just to see how well you are doing. I'll gladly take my chances at home.

I can give you a for instance. I had a physical a little while back (prep work for adoption. The doctor says I have high blood pressure. Two visits to his office and two times I have high blood pressure. I don't have high blood pressure. I think he has poorly trained office workers that take my blood pressure. How do I know I don't have high blood pressure? Each time that their office said I had high blood pressure I went directly to my wifes office and had my blood pressure taken by two different nurses using two different cuffs. Pressure was perfect each time. I think he just wanted me to come visit more times and prescribe medicine. My pressure is also fine at home where I take it daily. funny thing that.

Raebrek!!!

[uppityperson]

22. High bp @ dr's is not uncommon. IF it happens again, wait a while, rest quietly, then recheck

People should not get their bp taken right after they walk into the office as it is not uncommon for it to be highest then. IF it is high, sit a while, then have it taken again since it often goes down.

Speaking from experience. Some of the reason behind doing well people check ups is liability, along with catching things before they get bad and getting a baseline to compare to later to see what has changed.

[Radio_Lady]

32. Raebrek, you have what is commonly known as "white coat syndrome."

I get the same condition and doctors know about it. Your BP might be elevated due to the stress of being in a doctor's office. I've had abnormal tests followed by normal tests, and back again. In my case, I elected to try two drugs for HBP. They are cheap and they work -- combination of Atenolol and hydrochlorothiazide (a diuretic).

There are many other tests that MAY BE necessary on a regular basis. If you are a woman, then mammograms are good to have. If you are a woman, then PAP tests are good to have. If you are a man, then prostate blood work and a digital rectal exam is good to have. I believe in full colonoscopies after age 50, and earlier if you have a history of colon cancer in your family.

Blood tests are important, too, as are thyroid tests. Certain drugs also require follow-on blood tests. Believe me, I hate blood draws and I bring along soothing music and play it in my ears in the waiting room. I also do breathing exercises to keep me calm. I go very early in the morning to be SURE I don't have to wait.

Over 50, I believe in checking your body out completely if you can afford it. These are PREVENTIVE medicine options, in my opinion. I've had good medical and dental care all my life, and I feel I am going into my 70th year in good health. I wish it were excellent, but I'm still working on that level.

Everything about lifestyle comes down to choices. I have doctors whom I trust. I did stay with one doctor (not on this plan) too long, because he was always shuffling through my paperwork when I came for an exam and he terrified me with his weird opinions. Luckily, he moved his office and was no longer convenient. Then, we switched to an HMO and I carefully chose a primary doctor for myself and my husband.

Good luck and good health to you and yours.

Thanks for listening.

Radio Lady Ellen Kimball

[knitter4democracy]

31. What my husband, the internist, would really mean:

Hubby: "It's been over two years since you've seen a doctor."
RM: "The last patient I had who didn't see a doctor for a really long time died of advanced lung cancer. I don't want to go through that again. I did everything I could, but it was too late, and he was only in his 60s."

Hubby: "You never know what could be going on with any illness or injury."
RM: "Like the time the patient had mild dementia that turned out to be syphilis or my wife who had just some mild abdominal pain and off-and-on low-grade fever who had a huge kidney tumor that was trying to spread to her liver."

Hubby: "You really should go see your doctor."
RM: "So you don't come in with something so advanced that I lose you before getting a chance to know you."

All of those are real, and that's why a good doctor worries about not seeing a patient in a long time. Remember, doctors deal with death on a far more frequent basis than most of the rest of us. When they see someone who hasn't been in for a long time (for whatever reason--Hubby always assumes it's lack of insurance/money unless told otherwise), they start worrying about all of the things that could kill the patient that they have to check for. Part of it is CYA (if you don't test for it and it's there, you can get sued), but a lot of it is trying to cheat Death out of one more patient.

[Book Lover]

41. Post rec!

Someday we'll be able to nominate individual posts. Until that time, I'm giving you a "post rec!"

[knitter4democracy]

43. Thanks for the smile.

:)

I can totally understand why many people are disgusted with doctors. There are too many bad ones out there. Just because some are bad, though, doesn't mean they all are. I personally know many great doctors who are doing everything they can for their patients.

[RB TexLa]

71. So I should be concerned with what a doctor does and doesn't "want to go through"?

when choosing how often to give my money to them? No, what the doctor doesn't "want to go through again" doesn't factor into it.

[knitter4democracy]

74. No, but it might help you understand that money rarely enters their minds.

Good doctors, anyway, don't think of the billing or the money when they're talking with a patient. Good ones run through algorhythms and lists in their heads as you talk and as they go through the chart, ticking off possibilities and things to listen and watch for to head off anything serious. They never think about money until they get their paycheck or when they have to sit down and do bills. When they talk with you, they're adding up symptoms and listening for key words and figuring out what you're going to die from (it's a bad habit many of them have) and what they have to work on to keep you alive.

Doctors who are in it purely for the money don't last. They start writing books and doing talk shows, go back to law school, start up some biotech company, or go to work for Pharma. They don't stay in primary care--the money's not there. Studies in recent years show their salaries are just as stagnant as anyone else's, and for some primary care docs (especially FPs and Peds), the salaries are actually going down. No one in it for the money stays in it--too many hours of hard work when they could make more money much more easily elsewhere.

[nadinbrzezinski]

84. My brother is a good example

he is a gastro... his pay is not stellar... and he works 120 hours a week

I am sure our OP has no clue about that

And if you needed a Gastro... I know, not because he is my brother, but because he's got the recognition in the field, he is one of the top gastros in the country.

I at times fear that he will pay a price, as in heavy price, for the time he spends at clinic with the wife

[RB TexLa]

88. I understand how hard doctors work.

I have two in my immediate family, both work long hours. One is now part owner of her specialty hospital and puts in many hours beyond what she has to do working cases.

[knitter4democracy]

100. 120 hours a week suck.

Been there during Hubby's residency. I decided I was a single mom with the occasional live-in husband at that point. It helped me feel better.

GI guys who know their stuff are worth their weight in gold, in my opinion. There's a lot of wiggle room on what to treat when, and the good ones know exactly what to do exactly when. Give him a hug from me. :hug:

[Hekate]

35. Lucky you. You can just stay away until that lump in your lungs makes you cough blood...

...then the doc will have something to work with.

Likewise you can stay away until your rising blood pressure causes a stroke...and then the doctor will have something to work with.

Or maybe, unlike the rest of us, you really are Superman. So just stay away.

As for me, I will continue to use the system I have -- getting gouged by Blue Cross -- and see good doctors for the (very real) ailments I have.

Sadly, my doctors are also getting gouged by Blue Cross, and some have stopped taking it. I have recently lost both my gynecologist and the radiologist who reads my mammograms.

True story about Blue Cross and my family. When my son was 16 he had a devastating facial injury requiring a couple of weeks in the hospital and extensive plastic surgery. There was a lot of follow-up surgery, too -- "revisions" the surgeon called them. He kept at it until my son said that was enough -- he's now 30 and his lip droops a little on one side, and his nose looks like maybe a boxer had a go at him, but yeah, he looks good. That surgeon worked a miracle.

And Blue Cross wanted to reimburse this man the same amount as for a boob-reduction. While Blue Cross had their clerks phoning us to question my son's treatments needs they also had their clerks deciding the doctor wasn't worth whatever it took.

I hope to God our next president can get us all into a single-payer health plan.

Because most of us really need it.

Hekate

[knitter4democracy]

40. National health care. Amen.

If I'd ignored my pain, based on what other doctors had told me years before, I'd have died from the appendicitis. Thank goodness I took my health into my own hands and did everything it took to get the surgery I needed (including survive a sexual assault by the damn radiology tech). No one knew it was appendicitis, and that could've killed me. Those darn doctors, trying to help me with my pain and finally figuring that it was time for an expensive surgery to save my life. :eyes:

[Radio_Lady]

49. Knitter, all of your posts here are very helpful and exceedingly intelligent.

Thanks for your story.

Many of us yuppy elderly folks (ages 65 to 74 is the definition) have had relationships with one "family" doctor for long periods of time.
Al and I went to one internist in private practice for more than 27 years! I could call him in the middle of the night (and did, once during a traumatic period after my husband fell off a ladder, lost half of his blood through a compound fracture, and almost died). Mostly, this doctor helped me a couple of times with his knowledge, as well as free samples when my insurance was delayed. He also returned my telephone calls promptly. We discussed many things, and he treated me like an individual adult. Then, he joined a group in the 1980s, but was still available pretty much all the time if I needed him.

Frankly, it's been a shock getting adjusted to an HMO (supposedly one of the best, Kaiser Permanente) where the doctors see massive numbers of people and probably are completely cross-eyed at the end of the day due to patient load. Communications by telephone are improving due to the number of complaints they received.

I'm managing to get through the system by being a smart consumer. I get the treatment I feel I need because I ask for it. My records are on the Internet and I can email my doctor anytime I want, and call in to his nurse practitioners or admins as necessary.

Right now, this male primary doctor is ON MATERNITY LEAVE until July, and expecting his second child. I thought that was pretty neat! It's his second baby in a short period of time. I'm sure he and his wife will be quite busy with two little ones.

It is a time of great pressure in the medical field. However, I agree that the government could follow other industrialized countries into some better kind of a health care system. I've heard both the pros and cons of the single payer systems.

Again, thanks for posting. You're to be commended for "listening to your body" and getting help when you needed it. As for the sexual assault, I hope you dealt with that in swift fashion with upper management. That kind of thing should never be swept under the rug.

Peace, love and happiness,

Radio Lady Ellen

[knitter4democracy]

62. It's hard these days, that's for sure.

As for the sexual assault, nothing happened. I called everyone I could possibly think of, put in an incident report with the police, and not a damn thing happened. What she did to me fell through the cracks in the law. It took a lot of therapy to be able to have medical procedures again.

My husband just wants to be that kind of doctor. He does home visits for his sickest patients, family meetings at all hours, and gets phone calls at home from trusted patients (he has one in particular who can't ever get our phone number, but that's another story), and he just wants to treat people. Billing requirements are getting tougher, but he's in a solid practice, and they understand him there. Since he's good at the more complicated patients, they look the other way for the most part.

[warren pease]

87. But when he starts coughing blood...

... he'll have a PRE-EXISTING CONDITION, which guarantees that nobody will insure him and that, therefore, he'll die because, unless he's seriously rich, there's no HSA in the world with enough of a balance to cover a proper course of treatment for lung cancer.

My mom actually survived it in the late '90s. But not without around $45K worth of surgery to remove the diseased part of her left lung, chemo and radiation treatments costing many thousands of dollars, a week in the ICU and another in the less acute care wing, a nurse to visit her daily for a month because she lives alone and a bunch of prescription drugs which probably cost a ton just because the scurvy bastards in Big Pharma product marketing decided that a 7000 percent return on investment for each little fucking pill isn't even near good enough.

Happy trails. If you actually resent the idea of preventive care, you'll REALLY resent the instantaneous removal of all your money from that HSA if anything serious happens because you decided you know better than the docs and waited until your disease reached critical mass.

And when they're done emptying out your HSA, they'll line up to see who has first dibs on your house, your car, your bank accounts, your IRAs and 401Ks, your furniture, your knick-knacks... even the food in your refrigerator isn't safe from these predatory bastards. I'd be inclined to invest in a few burglar-proof locks and two mean Alsatian - timber wolf cross breeds.


wp

[RB TexLa]

89. You do understand that with a HSA you also have a high deductible insurance policy in place?

And within the rules of HSAs you can also have supplemental insurance in place to pay on cancer and or specific events such as heart attacks and strokes.

[warren pease]

90. To be honest...

I don't really give much of a fuck about the details of HSAs. I'm more than familiar with the for-profit medical system and its unfortunate propensity to kill its customers.

I'm also more than familiar with the absolute obscenity of paying some CEO who's not even running a successful company a cool $50 mil plus options at 10 cents just because he's a well-connected, glad-handing white boy from a good family who looks good in Brioni suits.

More important, he's got the requisite bullshitting skills necessary to con an entire room of shareholders at the annual meeting into believing that the $3 billion loss he just caused by embezzling half the quarterly profits and laundering them through a couple of Colombian drug transactions is just the invisible hand of the market working overtime.

It's amazing that the shareholders haven't memorized them by now and consigned them to the ever growing mountain of VSOP corporate bullshit that pollutes newspapers, magazines, TV, radio and the Intertubes.

I do know that HSAs seem to be the usual republican free-market solution to a problem that around 50 million Americans suffer from that nobody living anywhere else in the advanced world ever even has to think about.

That being: they don't have enough money to pay premiums, fund HSAs, pay docs out of pocket or buy the prescription drugs that are also nearly free to the citizens of the rest of these advanced countries but because congress has been bribed for decades to the tune of several billion dollars, they see absolutely nothing wrong with fucking their constituents over 12 ways from Sunday while rewarding their corporate employers.

Nowhere else except the usual shitholes of the planet are medical services triaged on bank account. Nowhere else among advanced countries do about 22,000 people die each year for the sole reason that they lack medical insurance. Nowhere else among those countries is poverty the single greatest health risk, superseding all other factors: poor diet, dangerous job, tobacco addiction, chronic alcoholism or drug abuse, living in a violent part of town...

Sick and disgusting: poverty as the leading US heath risk -- another only in the US phenomenon that has people in Europe and Canada scratching their heads and wondering what the hell we're thinking.

Now you can squirrel away all you want and pay those premiums so the people who are paid to deny claims get a Christmas bonus. But the day I begin to think that's fair and equitable, and a function of a society that's built on decency and fairness, I'll probably be found to have a brain tumor and my thoughts will never again be even remotely tied to reality.

Let us know as soon as your accounts run dry and those premiums finally rise beyond your ability to pay them. Then you'll be joining the other 50 million or so who already understand that the American way of for-profit medicine, depending as it does on the non-existent altruism of some of the most rapacious and soulless entities on the planet, may not be the best way to deliver health care after all.

And one last point about corporate benevolence, as if anyone is actually gullible enough to believe in such a thing:

Under US law and SEC regulations, the only responsibility of a publicly owned, for-profit US corporation is maximizing shareholder equity. Anything that bumps the stock price is good, and anything that lowers it is bad.

Paying claims is bad because it sucks money from the bottom line. Denying claims is great because it saves money that then contributes to corporate profitability which, when repeated hundreds of thousands of times each year, helps raise the price of the stock, makes the investors a little less dour and keeps the SEC off the CFO's back for another quarter.

In short, it's literally impossible for a US for-profit publicly held medical insurer or medical facility or hospital chain to live up to its opposing obligations to its subscribers and shareholders. And, as noted above, when somebody has to get screwed, by law it's going to be the peasantry.

I doubt you're convinced, but as things plunge to an even deeper layer of shit and economic stability is the stuff of wistful daydreams, it's not unlikely that you'll eventually learn how the other half lives. And if not, there's always some stray dog to kick, which is the perfect metaphor for the way free-market medicine treats its clients.


wp

[Beaverhausen]

53. Gee- haven't been hit by any trucks lately, have you?

:eyes:

[treestar]

56. There are certain basic check-ups that are wise

And the preventative aspect can save you money in the long run.

I'm not real resentful about doctors making $$. They have a big responsibility. It takes a lot of education to get there. And they have to do some pretty icky sorts of work. Think of doing gyn exams and looking at people's rashes and looking down their throats.

As a lawyer I can tell you that when you wait until things are messed up, it takes a lot more work and that costs the client a lot more. People who resent having to pay doctors and lawyers end up paying them the most, because their troubles eventually hit the fan and by then, things have gotten screwed up to an unnecessary degree.

[knitter4democracy]

64. That's really true.

Doctors, some specialties more than others, deal with death on a constant basis, not to mention every kind of bodily fluid there is (I've heard more pus stories than I'd care to count). They all have at least seven years of training, and most have massive debt from that time (I think we're finally down to around $145K after starting with $175K after residency). If they'd gone into law with their pre-med degrees, they'd probably make more in fewer hours and no bodily fluids.

Good lawyers and doctors are worth every penny. Their expertise at the right time can save tons of money and help out during really hard times. I'm all for that.

[warren pease]

69. Resisting the urge to light the flame thrower and start incinerating...

You seem to be telling us that doctors, particularly those who think it's a good idea for you to be examined once a year if you're over a certain age, are frauds and charlatans just trying to drum up business so they can upgrade their bucket of range balls.

And the way they drum up business is by selling you -- and all of us -- on the idea that preventive medicine makes great sense because catching a disease or escalating condition early is almost always more effective and far less expensive over the course of treatment. And this is apparently nonsensical to you, since you resent the doc's pitch to get checked out every now and then.

My heart bleeds for the underappreciated American for-profit medical industry, which struggles along by skimming between 25 and 40 percent off the top of a $2.2 TRILLION business (2006 figures) and is at the mercy of these corrupt money grubbing docs who are lying about the effectiveness of preventative medicine.

Pity also the poor pharmaceutical companies who are barely surviving these days. The ones that charge insane amounts of money for drugs without a large market, many thousands of dollars per year in some cases. But they're also sitting ducks for some unscrupulous doc who's trying to treat a patient by prescribing generics and therefore cutting into these altruistic drug companies' well-deserved profit margins.

Here's the thing. In the real world most of us inhabit, if you see your doc for a checkup at regular intervals and something serious shows up, like some form of cancer or high blood pressure that could lead to a stroke, your chances of beating it are greatly improved by catching it at an early and more treatable stage, and before it can metastasize.

If you don't, you could wind up like my late girlfriend who I wrote about here.

And if you do share her fate, you can thank the American way of profit-based medicine and the harsh reality that about 22,000 people die each year because they lack medical insurance. This is murder, pure and simple, and it happens because we let these heartless bastards decide who lives and who dies based solely on the ability to pay.

Finally, who do you think deserves to be paid for their services? The docs and other medical professionals who collaborate to try and keep you healthy or to cure some deadly disease?

Or the parasites who skim between 25 and 40 percent of the money they extort from their subscribers -- which translated into between $550 billion and $880 billion in 2006 -- and then squander it on exec salaries, paper shuffling, well-paid investigators whose entire job is finding a pretense to deny a claim, and of course share holder return -- which has absolutely nothing to do with performing their alleged fucking jobs, which is covering medical expenses for the people who give them all this money.

I'll gladly pay the medical professionals for keeping me in one piece. I'll gladly eliminate every single one of these predatory for-profit vultures who insert themselves between docs and patients and steal both sides blind.


wp

[knitter4democracy]

70. Bravo!!

:applause:

[Canuckistanian]

83. Recommended for an in-thread award

I always look at these threads and shake my head in wonder.

I have NONE of these financial worries with regard to my health.

All this talk of "insurance companies" and "pre-existing conditions" make me angry.

Your situation is so bad that after I watched "Sicko" I wanted to write my Congressman and DEMAND a solution. But I have no Congressman, do I?

I'm Canadian. I can walk into ANY hospital or medical clinic or doctor's office and request treatment for ANY ailment and KNOW that I can walk out without seeing a bill.

The, I don't know what to call it, perhaps "capitulation" of the American people to this outrageous situation is just baffling.

Where are the activist groups? Why aren't they gaining any traction? Doesn't EVERYONE know someone who has been screwed by the system?

I heard of several ad hoc groups forming after "Sicko", but I haven't heard a peep from them since.

And the current presidential candidates have avoided the subject like the plague.

I ask you, what in FSM's name is holding you all back?

[warren pease]

85. '...what in FSM's name is holding you all back?"

Short answer: We're either too stupid, too co-opted, too undereducated, too afraid to make waves, too propagandized (which goes back to the "too stupid" problem), too complacent, too responsive to code phrases like "socialized medicine," too incapable of reasoning our way out of wet paper bags, too numb, too lazy, too narcotized by TV, too reliant on leaders and experts, too gullible, too ready to swallow the big lies, too easily manipulated, too invested in the inherent righteousness of America without any reason for it, too busy being wage and debt slaves to give a shit, too selfish to want to pool resources for the good of the whole...

You name it, we're too shitty at it.

Know what we do best these days? Shoot our feet so full of holes it's amazing the entire country isn't wheelchair bound.

Here's an article I did a while back on you guys, comparing the procedures involved in getting a simple set of blood tests through the American medical disaster with the complete lack of anything remotely irritating Canadians experience getting the same set of tests under various provincial health care systems.

Just reading through it makes my blood boil all over again. And because outrage loves company, here's another one that tries to illustrate how completely fucked up the for-profit mess is, particularly compared with single-payer, universal-access systems.

Honestly, the above list of serious American flaws notwithstanding, I really don't know what the hell's wrong with us anymore. This country used to idolize bravery and our heroes were always these kick-ass rugged individualists who triumph against ridiculous odds and there's never even a hair out of place.

This whole devolution into a country of fraudulent, strutting jerk-offs posing as hard-asses, and then caving at the slightest hint of opposition, began long before Bush.

But since the election theft in 2000, I think there's been a kind of learned powerlessness that's just removed most Americans' hearts and souls, leaving behind these empty stick figures who don't know what the fuck they're doing most of the time and just aren't serious people you have to be concerned about any longer.

So maybe it's learned powerlessness, which I just made up but kind of like already. Or maybe it's just part of the script when an empire declines and collapses of its own combined weight and over-blown sense of self-importance.

I know you'll be much better off once we're a second rate power with no aspirations to empire or world conquest. So will I, once the harsh period of adjustment ends and we decide that we'll somehow muddle on without a Lexus SUV and a 54" plasma TV.

But it's going to be a painful and protracted transition, I'm afraid, and many won't get through it at all. Many more will be warped for life. Personally, I intend to be happy as a pig in shit when the empire finally breathes its last.

Until then, it's pre-existing conditions, co-pays, $50 million salaries for lard-assed CEOs and fuck all for everybody else.

Until then, do you happen to have a spare bedroom or couch? Even a warm spot on the enclosed porch with the dogs for company doesn't seem so bad, considering that to deal properly with Amerika v2.0, it's best to be a canine rather than a human.


wp

[warren pease]

86. "...what in FSM's name is holding you all back?" -- Take two, please ignore post # 85

Short answer: We're either too stupid, too co-opted, too undereducated, too afraid to make waves, too propagandized (which goes back to the "too stupid" problem), too complacent, too responsive to code phrases like "socialized medicine," too incapable of reasoning our way out of wet paper bags, too numb, too lazy, too narcotized by TV, too reliant on leaders and experts, too gullible, too ready to swallow the big lies, too easily manipulated, too invested in the inherent righteousness of America without any reason for it, too busy being wage and debt slaves to give a shit, too selfish to want to pool resources for the good of the whole...

You name it, we're too shitty at it.

Know what we do best these days? Shoot our feet so full of holes it's amazing the entire country isn't wheelchair bound.

Here's an article I did a while back on you guys, comparing the procedures involved in getting a simple set of blood tests through the American medical disaster with the complete lack of anything remotely irritating Canadians experience getting the same set of tests under various provincial health care systems.

Just reading through it makes my blood boil all over again. And because outrage loves company, here's another one that tries to illustrate how completely fucked up the for-profit mess is, particularly compared with single-payer, universal-access systems.

Honestly, the above list of serious American flaws notwithstanding, I really don't know what the hell's wrong with us anymore. This country used to idolize bravery and our heroes were always these kick-ass rugged individualists who triumph against ridiculous odds and there's never even a hair out of place.

This whole devolution into a country of fraudulent, strutting jerk-offs posing as hard-asses, and then caving at the slightest hint of opposition, began long before Bush.

But since the election theft in 2000, I think there's been a kind of learned powerlessness that's just removed most Americans' hearts and souls, leaving behind these empty stick figures who don't know what the fuck they're doing most of the time and just aren't the kind of serious people you have to be concerned about any longer.

"The events of 9/11" (tm) pretty much sealed the deal. It scared people so badly that many still haven't recovered. And because we're such self-absorbed, arrogant assholes by and large, we demanded the sympathy of the entire world as if we were the only country to ever experience such an event. So we started whining and sniveling about how our whole comfy little insular world was turned upside down and how we could never feel safe again.

Never mind that the entire Middle East, most of Europe, Central and South America and a good chunk of Asia has been dealing with this stuff for decades -- much of it instigated by good ol' us. Nah... Screw them. We're the only ones who count and we absolute require that the rest of the world share our terror and our pain.

Incredibly, the world was actually going for this national garment rending, queen for a day charade. But because the Bushies are peerless at fucking up a good thing, they used this outpouring of sympathy and solidarity as cover to bomb the little bit of Afghanistan that hadn't already been flattened, and then run a "shock and awe" drill on Iraq that amounted to mass murder of as many as 500,000 non-combatants in less than three days.

Predictably, the world had had just about enough of our self-serving bullshit by then and resumed its customary relationship with the US empire -- one of dread mixed with loathing, along with a snarky laughter at what abysmally ignorant rubes we really are. Bush is actually the perfect iconic American these days, given that huge segments of the population are at least that dumb but lack the silver spoon and manic lust for power that's elevated him above the standard American imbecile and into the ignorant sociopaths hall of fame.

So maybe it's learned powerlessness, which I just made up but kind of like already. Or maybe it's just part of the script when an empire declines and collapses of its own morbid obesity and unjustifiable sense of self-importance.

I know you'll be much better off once we're a second rate power with no aspirations to empire or world conquest. So will I, once the harsh period of adjustment ends and we realize that we can somehow muddle on without a Lexus SUV and a 54" plasma TV.

But it's going to be a painful and protracted transition, I'm afraid, and many won't get through it at all. Many more will be warped for life. Personally, I intend to be happy as a pig in shit when the empire finally breathes its last.

Until then, it's pre-existing conditions, co-pays, $50 million salaries for lard-assed CEOs and fuck all for everybody else.

Btw, do you happen to have a spare bedroom or couch? Even a warm spot on the enclosed porch with the dogs for company doesn't seem so bad, considering that to handle Amerika v2.0, it's best to be a dog instead of a human.


wp

on edit: too many notes and a kupple to menie tpyoes two

[Aragorn]

72. ethics

Most doctors in this area (small town East Texas) are employed by a hospital system - illegal under the Medical Practice Act but widely ignored by the Medical Board. If they could do well enough to have their own independent practice, they would not be in that position. Think about that, first.

The "not-for-profit" hospital conglomerate tells them what to order - they make their money on testing - and if the doc won't comply they are fired. No balls, most of them.

Patients often understand the issues in this post, and tell me about them. That's why I have been unlisted for 15 years, and still get too many referrals.

Most kickbacks are in the form above, not from Big Pharma, as far as I have seen. But some of the area pharmacies hate my guts because I changed patients to generics (before Medicare Part D came along) and hurt their bottom line big-time. Thing is, the patients love me. These are folks on fixed income, and NOT stupid.

I have a website with health info, for 15 years. So articles like this post DO make a difference.

[raccoon]

73. Wonder what s/he would've said if you didn't have insurance? nt

[knitter4democracy]

75. Probably the same thing.

Doctors don't like losing patients. Period. If it were up to my hubby (and since he's an employee and not a partner, it's not), he'd take anyone and everyone, damn the bills. Since the practice has paychecks to write and bills to pay, though, they have limits on how many Medicare and uninsured patients they take. For the uninsured, they have a payment system, and no, they don't charge them the full rate or make them pay a flat fee just to get seen by someone, like I've heard about some other places (which makes Hubby see red, but that's another thread).

[Evoman]

76. Huh? I'm a young 28 year old male, almost a superman like you.

I'm barely ever sick. But I still go to the doctor for a routine check-up. A couple of years ago they find I have non-alcholic fatty liver. I'm not overweight or sick, but I have a condition that can get worse. If I don't keep an eye on it (I'm on a healthier diet), it could have progressed to steatitis and even fibrosis. I've got some appointments coming up with a specialist to futher pinpoint the cause. I never would have known I was less than healthy if I hadn't gone for a check-up.

Hell, a lot of conditions are painless..including cancer and high cholesterol. It doesn't mean you have to be afraid for your health every second or go to the doctor everyday. But as you get older, it's important to keep an eye on your health, and that includes visiting the doctor for check-ups. Most doctors are genuine human beings that want to help you, and not just take your money.

[RB TexLa]

77. Not any kind of superman here.

[MonkeyFunk]

79. And people here always talk

about preventative care, and how it can save lives and money. Everyone agrees that's one of the best ways to keep health costs down and improve our quality of life.

But when a doctor suggests that very thing, he's a money-grubbing bastard. :shrug:

It's not unreasonable for a doctor to suggest annual checkups.

[nadinbrzezinski]

80. This is prima fasciae evidence of the kind of reeducation we will need

once we finally get NATIONAL HEALTH CARE

and yes the system as it exist right now will collapse, my brother gives it ten years, I give it less

By the way PREVENTIVE medicine is THAT critical to keep costs down

[dysfunctional press]

95. what a major league asshole that "M" person seems to be...

in this day and age, two years IS too long to go without seeing a doctor...and YES, they have YOUR best interests at heart, NOT their wallets.

[cosmik debris]

101. You're a potential Darwin Award Winner

We will miss you.

[RB TexLa]

102. Right, because if I gave my money to doctors often enough I'd live forever.

[cosmik debris]

103. No, because you seem to believe

That you are smart enough to diagnose prostate cancer by yourself. Or maybe colon cancer, or high blood pressure, or diabetes.

Yep, with your medical knowledge there is no reason for you to ever pay a doctor.

:rofl:

[RB TexLa]

104. I belive no such thing. You must have made that lie up yourself.

[cosmik debris]

105. Just be sure to tell them where to send the award.

[LostinVA]

112. He doesn't drink with you

Or doctors.

[RB TexLa]

115. I was having a drink with the doctor during the discussion, hardly relevant.

[cynatnite]

110. Have you ever heard of preventative medicine?

That's what your doctor was talking about. Physicals, colonoscopies, etc is preventative medicine. If there is something wrong these types of visits will pick it up before it gets out of hand.

It's not your doctor that's the problem...it's the insurance companies.

My Dad was doing fine, too. He's been gone for over ten years now. :(

[fed_up_mother]

113. GEESH Preventive care is very important in all countries with single payer health care

because it's important for your own well being and for keeping medical costs down.

Period.

Sometimes, that's all your physician is telling you.