Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 40 original podcasts with new episodes released every day.
Could arm chair detectives save our medical system?
I know a more robust system of advocates who were truly patient advocates would make a tremendous difference. The patient advocate who greets you or your loved one in the hospital to discuss your care is not working for you. She is working for the hospital to improve the profitability of the hospital and move you or your loved one to a secondary care facility as soon as possible to open up that bed for someone else while providing income to the other center which is part of the same organization.
Who in the system takes responsibility for making sure that you or your loved one is receiving optimal care? Not the doctor you have been seeing for years. He may not even have admitting privileges to the hospital he sends you to. You are at the mercy of the system and the basic sense of decency of their employees.
Arm chair detective is a genre of crime fiction where retired detectives solve crimes utilizing skills that are not being utilized by the system but (in fiction) manage to save the day.
I have become an unofficial (not entirely arm chair) patient advocate for friends and acquaintances who need help navigating our broken medical care system. I don’t have a structured way of choosing who I try to help. Because I am a retired physician, medical matters often come up in conversation with friends and even casual acquaintances. I ask a few questions to see what the situation is and what the person understands about that situation. If I think they may be having trouble understanding the situation or are facing inappropriate obstacles in their path, I offer to get involved. If they are interested, I ask for copies of all of their imaging studies and pertinent pathology reports and such. I review everything with them and reassess the medical situation as I learn more from them. Ultimately I have found that going with a patient to his or her doctor appointment has been universally productive. Trying to speak with another doctor by phone, unfortunately, is not possible. So I help the patient by being there and asking each doctor to explain what the plan is.
I have decided to take this need more seriously. I would like to develop an informal network of arm chair physicians who still have contacts within the system to offer assistance to each other in helping friends and family navigate medical issues. I already have a few fellow physician friends who share my concerns, and they have been helpful in brain-storming the problems that have arisen so far. I also share the confidence of a few local hospital nurses who are working within the system. They see the problem as well as anyone.
Any advice or help would be appreciated.
Published in General
I do this for a living. I’m a concierge doc.
So the system is working for you. I also go to a concierge doctor and the system is working for me. But that is not our nationalized conglomerate clustered system of healthcare. Do you ever try to help friends or acquaintances who are not paying you a monthly fee with their medical issues?
Let me know how that works.
I’m facing some upcoming surgeries. I sure would like to have an arm chair advocate.
I have a Medicare Advantage package from my retirement system. They changed from United to another provider this year. While we were with United, we were bombarded with offers of a “free home visit” from a nurse who would help us in terms of Medicare coverage. A little research on this revealed that the real intent of the visit is to allow them to re-classify us into higher risk categories so that our provider can get more from Medicare. Our new provider has not done this yet.
We also have long term care insurance (which, by the way, is jacking up the premium 56% over 3 years) and they have provided me an ally who wants to give me free stuff. The free stuff we’re getting is a shower chair and new shower nozzles/hoses and grab bars for our shower. Clearly they would like us to push out any need for their coverage farther into the future. But in this case, the insurer and I are aligned. We both want me to not need to start using the insurance sooner.
Our Social Security benefits rose, I think, 2% this year. My LTC bill has risen 17% so far and more to come, my car insurance has risen a lot more, and my home insurance has also been jacked up. Grocery and gas are way up. It takes a real genius to find a bundle of prices that only rose 2% this year.
Government Is How We Steal From Each Other™
I love this.
New guidelines for treatment of Heart Failure Reduced Ejection Patients (HFrEF) include medications that cost over $1800 for a three-month supply. They are said to be better than the old meds, but how much better is questionable. Ultimately, I think that government underwrites the cost depending upon the insurance plan.
This is an interesting video for heart patients. It’s long, and I had to slow it down to get all the details, but if you have need of this kind of medication you might find it worthwhile.
They shouldn’t be allowed to call them patient advocates.
A patient advocate that works for the hospital isn’t working for you, just as a real estate agent that is paid by the seller isn’t working for you. And any doctor that works for a health care system also isn’t working for you.
Follow the money!
Correct.
If someone isn’t working for you, then they’re working for somebody else.
This is one of many problems with third party payor systems.
Our system of medical care is not much of a party is it? Like John McLane said in Die Hard “Wellcome to the party, pal.”
When I chose to go to medical school, I never thought that DieHard would be a metaphor for medical care.
When I worked night shifts in a hospital clinical lab many years ago, we used to call the piles of slips with almost every test checked “pre-autopsy physicals” If one’s GP or primary care specialist was not somebody hospital staff (feared?) respected and if the diagnosis was mixed or unclear (seemingly almost the norm in the very elderly) then the staff seemingly went through the motions, did butt-covering stuff and looked for any opportunity to pawn off the patient onto some other unit.
There is a huge difference between explaining/justifying a course of action to a patient versus another doc, especially a doc with some standing.
I have friends/colleagues who have made very nice living explaining the results of ill-considered treatment to juries.
Well, ok.
But if the doctor is working for the hospital (which nearly all hospitalists do, in one way or another), then they must at least consider the interests of their employer. Or they won’t be employed for long.
And Medicare is giving the hospital bonuses if a certain percentage of patients with your diagnosis are discharged in less than 48 hours, then guess what’s about to happen?
This is what happens when government starts paying for health care.
The needs of the patient are a concern. But their far from the primary concern.
I’m blessed to work directly for my patients. I sleep better at night.
What a wonderful offer you’ve made to others! The whole medical system can be confusing, and the decision-making for a patient can be overwhelming. Thank you for doing this work.
When my husband was first diagnosed with prostate cancer, we went to the Lahey Clinic in Burlington, Massachusetts (just north of Boston). It was an amazing experience in terms of patient care.
The part that impressed us the most was that we had a doctor whose sole role in his care was to advise us of the various options and to help us when changes or decisions needed to be made. He was available by email twenty-four hours a day.
He had a whiteboard list of choices that he discussed with us. He was friendly and a real joy to work with. He took all the fear and uncertainty away.
That was five or six years ago, before Lahey merged with Beth Israel. I’m hoping it’s Beth Israel that changes, not Lahey.
We think it is the best hospital we’ve ever worked with as patients or caregivers.
Having though about this, I think I can summarize this post and thread into two statements. Firstly, wouldn’t it be good if MDs could provide an organized volunteer paramedical service in which doctors look after and intervene on behalf of the intellectual and medical (and presumably psychological and lifestyle) needs of patients; sort of, a systematized way of informally doing for other people, what doctors may already be doing for family and friends? And secondly, that there are currently doctors who do this, but they are paid privately in addition to, or instead of, any medical insurance.
And I keep wondering, isn’t looking after and coordinating the whole of treatment already supposed to be the job of every doctor, sort of like that having a good bedside manner is informal and casual, but considered to be essential?
I’m not ragging on doctors because the field has become so fragmented with specialties and subspecialties that everyone seems to focus on and stick closely to his specialty, but isn’t looking after the whole of a patients’ needs actually a part, a standard, of providing good medical care? It seems unfortunate that we need to be considering what could become essentially a new medical subspecialty of advocating for the overall wellbeing of patients.
When I was a kid, my parents paid cash for doctor visits and cash for prescriptions.
What we had was insurance for hospital care. Blue Cross paid (I think) the hospital room charges and Blue Shield paid hospital doctor fees.
But paying cash at the current rates for drugs and procedures would be disastrous for most people.
Nobody has any foresight. The best time to overhaul everything was 1946. The second best was the second the Soviet Union fell.
But they do pay cash. Or their employers pay cash that would otherwise be given directly to most people in higher wages. For insurance companies, if total cash in was less than total cash out (for legitimate medical expenses plus all the salaries for all the people employed to operate the insurance system) they wouldn’t exist.
Medical insurance is a good thing. But high premiums with high deductibles is not. Low premiums with high deductibles are good. High premiums with low deductibles are good. Insurance companies can market slightly lower prices to the young and healthy and slightly higher prices to the elderly and infirm might be good. But the more government subsidizes employer insurance payments the more medical insurance companies’ prices are affected. And the more that the government, through government programs, takes over the diagnosis system and the concomitant pricing of diagnoses that doctors can charge, the more the doctors’ ability to price services is infringed.
I would say, get the government (and thereby the lobbyists’ influence) entirely out of the medical profession. Then we’d probably see medical costs come down.
It makes me insane.
This all started in 1946. Zero foresight. Ever.
Government Is How We Steal From Each Other™
Have you taken the time to look into various vaccines that you have been offering that may not at all be what they seem?
It is one thing to offer a vaccine to one’s patients after reading only the CDC print out – often only one page long and with only those statements that promote the fabulous results.
It is another thing to look into the people who have actually been the original researcher(s) on a vaccine program who then complain that it turned out to be very risky – with the risks out weighing the benefits.
https://www.beasleyallen.com/article/hpv-vaccine-developer-speaks-out-against-gardasil-cervarix/
From the above article:
Dr. Diane Harper, the lead researcher in human papilloma virus (HPV) vaccine development and director of the University of Minnesota’s Gynecologic Cancer Prevention Research Group, was expected to promote the vaccines Gardasil and Cervarix at the 4th International Public Conference on Vaccination in Reston, Virginia, earlier this month.
Instead of promoting the vaccines, however, Dr. Harper the HPV vaccine developer pulled the covers off of what appears to be a highly bogus and ethically questionable scheme concocted by Merck to have young girls mandatorily vaccinated in public schools. When asked why she had spoken out against the vaccines, Dr Diane Harper said it was a matter of conscience. “I want to be able to sleep with myself when I go to bed at night,” she told The Bulletin, a Philadelphia newspaper.
Dr. Harper explained that 90 percent of HPV infections resolve themselves after 2 years, and that the vast majority of those cases (70 percent) actually resolve unaided in under one year’s time. Moreover, the number of cervical cancer cases in the United States is so low that vaccines and PAP screenings would not lower the cervical cancer rate unless 70 percent of the population was vaccinated. And even then, the cancer rate decrease would be minimal.
####
Of course when parents end up having their teenagers paralyzed by this vaccine, they are assured by the clinic where the offending vaccine was offered that “Only one injury for every 1 million who are vaccinated ever suffers in such a way.” But then when pushing their teen around inside their community of only 250,000, it alarms them that they encounter another 2 or 3 parents doing the same.
Of course this might still be no reason to question the huge campaign of pushing this on all teens and young people, except that as Dr Harper explains above, the risks that are being experienced are significantly greater than the risks of cancers coming about due to HPV infections.
This is rather a case of cutting off the lower leg due to a mole that might become cancerous in 30 years time rather than just waiting to see when the mole becomes precancerous. We already have the technology to determine if a genital wart is pre-cancerous or not.
I think this thread is dead even though I started it. But, with no malice or snark involved, I would like to ask CarolJoy, Not so easy to kill, if she considers herself a proud killjoy? I can’t tell.
Right now some polls show that as many as 70% of all Americans have lost faith in the medical profession.
Most of the public that is not part of the upper 10% has really really bad medical people in their lives.
Every so often either the hand of God or fate allows an average person to have a decent doctor.
But then there is a huge worry that the doctor will be overworked by whatever medical franchise the doctor is working at and he or she will take early retirement.
The handwriting was on the wall starting around the year 2000. It became more and more apparent that hospital and clinic administrators were like wolves whose focus was on the bottom line. It was especially bad here in California.
At the time my dad was almost 90, living in Illinois, and he complained that once in the hospital he often had to argue his way out of there. But in California, very few people are allowed to spend much time inside the hospital. I knew of several women who had the complete removal of their breasts and their lymph glands under their arms, and were sent home the next day. They would be sent home with a bag of gauze for their dressings and tubes of antiseptic products. As they were booted out the door, it was all “Honey it is easy to do and be sure to do it every four hours.”
Really? The type of pain a person has after the removal of both breasts and all the lymph gland material under the arms is extraordinary. Now imagine trying to even move your arms, let alone to attend to doing the intricate work of putting on one’s own dressings.
Doctors didn’t interfere with this type of situation, because the doctors no longer work for the patients – they work for the clinic admins. So they tell the patients or instruct the nurses to tell the patients what the admins tell them to offer as instructions.
It is now standard in Calif to wait six weeks for an appointment. And then to be told to arrive 7 minutes early for the appointment or you will be counted as late. Three lates and you have to choose a new clinic.
Once at the appointment, a nurse measures your height, weighs you, and takes the Blood Pressure. Then you wait – sometimes an hour – for the doctor to come in. There is usually no queries put to the patient, including such necessary queries of “Why did you think you needed to come here today?” It is an immediate launch into “I see you haven’t had your seasonal flu shot!” Followed by “With your cholesterol reading at 160, you should be on statins.” (No woman who has gone through menopause ever has a cholesterol reading of under 160. In Europe, no one gets put on statins unless their reading is over 200. But that doesn’t sell as much pharma product as the situation in the USA where we are constantly pushed into taking statins!)
After the ten minutes of being with a person who thinks they are a doctor but they are only in reality a pharma shill, the visit is over.
I have put the above complaint up on various social media outlets and at first I was sure someone would say “But my son is a doctor and he works so hard.” But instead my comment would always get many upvotes and people explaining how awful their situation has been.
Their doctor pressured them into back surgery and now they are in continual pain, rather than occasional pain. The woman was told her heavy bleeding indicated she needed a hysterectomy, and the surgery was done improperly and no w she can’t pee normally, has a colostomy bag and is never able to consider having sex because it hurts so much.
With the majority of people saying that they just are ignored by the doctor after the shilling for pharma products is concluded because their ten minutes is up.
It wasn’t always like this. In the 1980’s, no doctors I saw ever cared whether I did or didn’t get this or that vaccine. I was always asked the medical issue that prompted my visit. Then that issue was dealt with. No doctor ever pushed a medicine on me, telling me my numbers were qualifying me for the drug. The few times I did need a pharmaceutical product for an infection or for pain, my doctor at me in a chair in his office, took out several refernce books and described the advantages of the product he was thinking of prescribing sand the risks.
That type of information exchange doesn’t happen any more. (Right now I am 74 years old and take the occasional benadryl and my daily baby aspirin.)
Dr Bastiat has been wise enough to get away from being worked to death while under the thumb of some clinic or HMO chain. He branched out on his own. The first rule for a doctor is “First do no harm” and good for him that he is taking care of his health. I lost my one decent doctor who saw me from 2009 to 2015 to early retirement as the clinic he practiced at kept upping his obligations.
But what troubles me about doctors in general is that they aren’t pushing back against the system. The doctors that work at clinics don’t care that they don’t ask the patients they see about the reason for the visit. Even more concerning, they also tend to get these advisory articles from pharma or from the CDC or from both that this vaccine and this new pharmaceutical product are now A-okay.
If the pharma rep and the CDC state that some new wonder vax or wonder drug will keep us all healthy, the doctors don’t research it at all. It’s all dealt with by the thinking of “Well that visit from the perky pharma rep sure convinced me.”
And of course if they don’t prescribe the new wonder drug of the month, there are those fabulous medical conferences held on cruise ships where the indoctrination for the wonder drug can take place.
It isn’t just about vaccines being pushed on us. Recently Ozempic came on the market. It was advertised as being a good thing for diabetics as the diabetic individual would only have to inject themself once a day instead of 7 to 14 times a week. Sounds terrific. Plus Ozempic also seemed to cause people to lose weight.
I know several diabetics and all of them had the doctor they see recommend the product. Several got immediately aboard.
However one family friend had problems with the insurance end of things. Since it is quite price-y, he kept working on getting the insurance to cover it. So he had two months to research Ozempic. What he found out dissuaded him from getting it prescribed for him. The drug seems to have a lot of problems. It has been discovered that if you take it, the food you eat today might not be fully digested for 5 days. (What does that do to a person’s health?)
Also according to what our friend found out: The long-term dangers of taking Ozempic are mostly unknown. Despite costing thousands of dollars and creating a co-dependency, you are at risk of allergic reactions, pancreatitis, thyroid cancer, and the newly discovered stomach paralysis. And if you stop taking it, you regain the weight and more.
These problems might have been good information for my acquaintances to have had explained to them. When the doctor was talking it up and before they began taking it.
But apparently that is no longer how our medical system works. And that could be why some 70% of us have a lot less trust in the medical profession as we had some years ago.
Well, CarolJoy, how many of those Californians make the connection between how they vote and what they get?
Of course, when they voted, they thought they voted for something else. All they have to do is keep voting for same people, who keep promising the golden egg and they never make the connection between that and the unintended consequences.
Then, when they’ve had enough, they move to another state and vote the same way, because maybe people in their new state will finally get it right, and they’ll live in Utopia ever after.
I don’t understand how or why anyone could trust the medical profession. But then again some people, even here on Ricochet, trust quack doctors, so who knows what else they could trust.
I trust a lot of doctors, medical practitioners, and medical information (in a “trust but verify” mode) but why anyone would trust the profession is beyond my understanding.
CarolJay, who only appears to be a KillJoy, we agree completely on the dimensions of the problem. I am doing what I can to try to fix it one person at a time.