Thursday, September 23, 2010

3.1 Using Doctors Well/University-HMO

Physician's Notebooks 3  - - See Homepage

Note that Chapter 1 "Using Doctors Well ..." with its descending table of content/topics is in the lower part of this section; just scroll down for it.

Physician’s Notebooks

Hyperlinked Table of Contents Physician's Notebooks 3. Click to Access Chapter

  • 3.1 Using Doctors Well/University-HMO
  • 3.2 Secrets of Urine Testing
  • 3.3a Secrets of Blood Testing - Introduction

  • 3.3b Red Blood Cells/Too Few or Too Many
  • 3.3c More on Too Many or Too Few RBC/Retics/Iron ...
  • 3.3d Oxygen and CO2 in blood/Measurements/Effects
  • 3.3e White Blood Cells, Types & Count & Percent i...
  • 3.3f Blood Clot, Platelets & Spleen

  • 3.3g Blood Testing Groups & Interpretation
  • 3.4 Secrets of Blood Test Reference

  • 3..5 Secrets of Body Imaging - X-ray & CT, MRI, Ul...
    (Note the new addition in 3.5 of electroencephalography, or EEG)

  • 3.6 Secrets of DNA to Help You Live Long
  • 3.7 The HLA System - Predictor of Disease

  •  Chapter 1: Using Doctors Well/Get the Best from the Medical System Update 25 November 2018. In the descending column are topics of this chapter in order as they appear in text. Use it for search & find or scrolling down.

    Purpose in visiting a doctor 
    Don’t give unasked-for information
    Over-Familiarity with Your Doctor
    Fallacy of Propinquity
    University-HMO is the Place to Go for Best Medical Care
    Frenzy for Surgery
    Fear of Illness - Excessive Tests
    Medical Costs
    Getting Low or No Cost Medical Care

    If your purpose in visiting a doctor is diagnosis, words are important. Patients mistake by using a diagnosis to describe a symptom. A woman who notes bloody urination may say “cystitis” in answer to “What is your symptom?” Or someone complaining of sore throat may say “strep throat.” Cystitis is a tissue diagnosis with causes ranging from infection to bubble bath, and a strep throat is a diagnosis that calls for antibiotic. Instead of giving a diagnosis for a symptom, tell how it feels or looks. If bloody urination, say “My urine looks bloody.” Or if sharply painful sore throat, say “Each time I swallow, my throat pains bad.”
       Write the day and time first noted and development in terms of worsening or getting better or spreading or having other symptom added on. Also give good description of quality and quantity of the symptom. If pain, Is it sharp or dull, was it continuous or intermittent, or made worse or better by what? 
       Don’t give unasked-for information: Do not assume the confidentiality of what you say about anything. Do not leave your test results lying about at home for your mother or husband or room mate to see and do not tell anyone about your doctor or hospital other than the minimum info.
    Over-Familiarity with Your Doctor: It is human when a doctor does well for you to make him your hero; most frequently, when a surgeon saves your life by surgery (See The Secret Life of Walter Mitty, 1947); but it is dangerous because it causes you to open yourself to bad use. If a doctor does well by you, thank him for good work but do not think What a great guy!  Just because he did you well once does not make him the Saint. Keep a cool distance from Doc no matter how well he did for you in order to prevent him from doing you.
       Socializing with any health worker who is caring for you asks for trouble. If you will make your doctor (or Nurse) a friend or lover, terminate the professional relationship before starting the social one. As in hero worship, the possibility of misuse is too two-ish to justify a close social relation. Avoid dining with your doctor or attending the same party.

    Fallacy of Propinquity: An attitude when seeking medical care I call the ‘bluebird of happiness complex’ is to limit treatment option to a doctor or hospital nearby. For everyday care this is sensible. You can’t be running to Mayo Clinic at each sniffle. But in dealing with major, potentially fatal, once-in-lifetime illness – cancer where you will have only one try for saving life or with a disease like multiple sclerosis or Parkinson disease where special expertise in diagnosis and treatment may be key to good survival, or lifetime medical condition like diabetes mellitus or hypertension where initial world class consultation can start one on road to healthy longevity – in each case a patient should set aside time for top opinion or expert team consultation even if it may involve traveling thousands of miles or using a hospital or doctor that one’s insurance won’t reimburse.

    University-HMO is the Place to Go for Best Medical CareHMO is Health Maintenance Org, (In U.S.A.; in other country, it is hospital outpatient clinic) a patient care place that includes outpatient clinics and attached hospital all in one place. The superiority of care in an HMO is based on its having all doctors on salary with lab and medication services included so no incentive to make money by ordering or doing unnecessary tests or medication or surgery or to hide mistakes. Specialist consultation should be rapidly available in same place and no extra fee. Basic decisions or major care - like surgery - are reviewed. And mistakes - especially at the operating table - are quickly discovered and can be quickly reversed because of the group care setting. The best HMOs are University. There are case variations but the superiority of the HMO system over the old, traditional solo fee for service is clear.

    Frenzy for Surgery: Too often, patient or family on discovering a surgical diagnosis develops a frenzy to get it operated, typically with discovery of hernia or gallstone or with any tumor. Everyone recognizes the emergency that needs quick care because of coma, hemorrhage, pain, but in 50+ years observing patient care I have seen many poor results because of patient impatience to be treated by the first surgeon they see. And I have not seen harm done– even in cancer – by taking a week or even a month to get a second, or even third opinion or more testing before deciding on non emergency surgery. “Go slow!” and “Delay!” is advice that ought to be written large over entrance to surgery suite.

    Fear of Illness - Excessive Tests: Emphasis on preventive health check has good point as we know but it also creates neurosis that can become expensive, wasteful and dangerous. How much money and effort have I wasted on excessive or unnecessary testing? The normal CT or MRI I got, worrying about brain tumor? The radiation I’ve been exposed to over years because of the “routine chest x-ray” carryover from day when TB was frequent? The too frequent blood testing repeated at too short interval because of worry about cholesterol? The GI endoscopy too frequently repeated after normal findings? Too, too much!
       In addition to being wasteful, a test may harm. Blood test done too often may cause anemia and iron deficiency with sudden faint leading to brain trauma from fall on head or it may also lead to transmission of infection like hepatitis, syphilis, malaria, HIV from unclean blood sampling technique; GI endoscope test has possibility of bowel perforation leading to major surgery or death; and x-ray especially CT adds radiation exposure increasing risk of leukemia.
       To prevent over-testing, find out what is appropriate interval for routine test and delay it. Check advised interval for normal endoscopy. And keep in mind that the risk of a positive finding for disease drops sharply after 2 consecutive negative screenings and the remaining lifetime risk changes with age.
       Also consider what a positive test may mean for your life and then weigh its risk/ benefit to decide whether or not it is worth it to you. At one swoop your mental happiness may be shattered by a test and you may be provoked into unnecessary, inconvenient behavior. Patients think the earlier they learn about having illness the better for curing it. Not always so. There is a correct time to test for a particular disease before seeking diagnosis. Usually, a test is more efficient after a sufficient time in the course of a disease for its diagnostic signs to develop than it is very early on. At times it is better to wait for more signs or symptoms. It is useful to know you have high cholesterol if you are prepared to do something with your life about it. Once you take test and confirm it, there is no need to incessantly retest. I deal with these questions in the chapters; now I plant seed for thought.

    Medical Costs: Important point is what one gets for the money? An MRI that stops a need for exploratory surgery is worth weight of its machine in radium but a CT scan done and redone because of fear is waste of time and a risk for leukemia from the excess x rays. One wants to make every test count by testing at right time not by repeating excessively.
       Much money is thrown away on vitamin and mineral pills. Also in buying drugs, eg, the expensive, unnecessary and dangerous Viagra or the useless antibiotics for viral colds or flu.
      Check your billing for medical service and complain if overcharge. With Medicare in USA, the double-billing goes on and the old age patient does not complain for fear he will be punished by the medical facility or he may have an attitude it’s OK to cheat. Not so! If your doctor is bold enough to cheat government, you can guess what he has in store for li’lle ole you once he sees you’re an uncomplaining boob.

    Let’s close this with the question of getting medical care when you cannot afford the cost.
    Getting Low or No Cost Medical Care: If you have an illness that needs immediate medical consultation and care but you do not have enough money or you lack the insurance to get it taken care of, go to the emergency room of the hospital you determine can best take care of your condition. I advise a university affiliated hospital and health maintenance org (HMO). If you have an emergency condition that needs hospitalization, the hospital must admit you and treat you for two reasons: 1) The Patient Bill of Rights (in USA) that should be posted on the walls of emergency rooms demands it and 2) They know that if they turn you away for a serious, life-threatening condition because you do not show money, you can sue the hospital and win big bucks. No hospital may refuse to take care of your important medical complaint because you lack the money, and if they think it is not an emergency you will be scheduled for outpatient. 
    Concerning payment of medical bill, be sure you do not have obvious assets like a home (You may still live in a home as long as you are not the owner), keep your financial matters from snoops, and do not show where you have your money. As long as you can keep your money and assets private by not blabbing about what you have and where, if you are obviously ill and need expensive medical care, you will qualify in the USA for Medicaid and SSI (supplementary security income). I am not suggesting not to show any money for reasonable initial costs you can afford; these you pay in cash. (Never pay in personal check since it shows your source)
     If you truly cannot afford the full care without bankrupting self and destroying your family, do not pay it.
      END OF CHAPTER. To read on now, click  2 Secrets of Urine Testing

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