Category Archives: Using Health Care

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Part 2 – When You Need Surgery – Be Proactive!

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As you seek treatment for your problem, you will need to advocate on behalf of yourself on several levels:

  1. Make sure you know and comply with your health insurance rules and procedures – Do you need to get tests, referrals or procedures (even if they are outpatient procedures) preauthorized or precertified?
  2. Make sure you see physicians and use facilities that are in your health insurance provider’s Preferred Network.  Otherwise, your share of payments may be larger than if you “stayed in network.”
  3. Try to move things along as quickly as possible.  The people scheduling the tests & appointments are going to try to fit you in to the schedule where space allows.  If the test can be done at more than one location, you may want to ask whether it can be done sooner at a different location.  Similarly, some doctors practice at more than one office.
  4. If the appointment gets scheduled further out than you’d like, ask to be put on a waiting list.  That’s how I was able to get my thyroid removed 3 months earlier than it was originally scheduled.  Someone canceled a week before their operation & the surgeon’s office called me to see if I would like to take their place.  I had to scramble to get a few tests done, but I was able to do it and forego three months of anxiety while waiting for the original date.  I can relax.

Another non-medical reason to try to move things along could have to do with where in your insurance policy year you are and where you stand in regard to your deductible.  If you have already met your deductible for the year, your insurer will usually be paying a greater share of your health care expenses for the balance of the year.  Therefore, it may be financially to your benefit to get your surgery within this year rather than waiting until the following year. A full explanation is beyond the scope of this blog and really depends upon individual circumstances and health insurance coverage.  Next time we’ll talk about planning ahead!

Happy New Year!!

For Your Health – Dr. Bob

Part 1 – Know When To Seek Care & Act!

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About two weeks ago on December 9, I had my thyroid removed because it had enlarged and was pressing on my windpipe.  Though I am still waiting for the final pathology report, the results of the outpatient biopsy and the surgeon’s impressions were that this is not a cancer.  I first noted symptoms at the end of September 2011 and the workup took a little over 2 months.  Over that period of time I had 12 appointments for either testing or physician consultations. I think some aspects of my experience may be useful to help people in similar circumstances understand how best to use the healthcare system.

1. Pay attention to your body.

My symptoms were quite mild actually.  I started feeling a pressure against my throat as if someone was lightly pushing against my windpipe.  It wasn’t painful.  It was just different. My voice was also a little bit hoarse.

2. Understand the potential urgency of certain symptoms

As a doctor I naturally thought of all the things it could be, going from bad to worse.  Because it could start to affect my breathing, I set up an appointment with my PCP early the next week.

As a medical student, I was taught that about 80% of the reasons a person visits a primary care physician get better on their own.  But when you are having symptoms that can affect your breathing, heart beat, consciousness, or are causing an excessive amount of pain or a loss in how your body functions, you need to see a physician sooner rather than later.  For more on this topic check out this previous post, When To Get Care.

3. Get beyond the fear of the worst

The sooner a potentially lethal condition such as a cancer is diagnosed, the better are your chances for remission and potentially cure.  Ignoring symptoms does not treat the condition.  If it is a cancer, the delay gives it a chance to grow locally and spread throughout the body.  I know that this seems to be a very cold, scientific response to a situation that can be filled with emotions.  Everyone needs to work through these issues on their own.  But at this point, where a diagnosis has yet to be made, let your good sense take the lead and get a diagnosis.

In the next post I’ll share more about my recent experience and give you some things to consider if you ever are faced with a similar situation.  Meanwhile, please add your comments and experiences!

For Your Health – Dr. Bob

When Things Go Wrong – You Can’t Get To Your Doctor’s Office

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(To view the case of the original post, go to Case 1.)

The last major obstacle that Susan faced after her hospitalization was getting transportation to her doctor visits.  Follow-up care is essential to assure good outcomes, but for some people getting a ride to the doctor can be a problem.  So, put yourself in Susan’s shoes.  If you couldn’t drive yourself, what would you do?  Here are some options:

  • Ask a friend or relative.  Most would jump at the chance to be of help.  After all, some day you may be able to return the favor. 
  • If you are reluctant to ask someone to help you, you may need to use public transportation.  Depending on where you live that could be quite expensive or cumbersome. 
  • If you belong to a house of worship, they may have a ministry to help members of their congregation in these kinds of situations.  Contact them to find out.
  • If that isn’t an option you may want to contact the Social Services Department at the hospital from which you were just discharged.  The social workers there are aware of all sorts of programs in the community to help its citizens with a variety of needs, such as transportation. 
  • If these options all fail, you should contact your physician to let him know of your problem.  He may know of another way to address your transportation difficulty.

Over the last 2 months I talked about the importance of following your doctor’s discharge plans after you come home from the hospital.  I used Case 1 under Cases To Consider to describe an actual situation that a real person faced after she came home from the hospital.  I named her Susan and outlined the problems she encountered getting the care she was supposed to get along with how I would overcome those obstacles.   I hope you found these to be useful in understanding some of the important components of a hospital discharge and how to work within the healthcare system to stay your healthiest.  I welcome your comments and questions. 

For Your Health – Dr. Bob

When Things Go Wrong – Your Doctor Won’t Call You Back

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(To view the case of the original post, go to Case 1.)

One of Susan’s problems was that she wasn’t getting the home nursing visits she needed nor the physical therapy treatments.  After calling the home health agency, she learned that they hadn’t received the order from the physician.  When she tried to speak with physician she seemed to get nowhere and was waiting for a callback.  This raises the third issue – a practice that seems unresponsive.  You’ll notice I didn’t say a doctor who is unresponsive.  From the information we have, we don’t know that yet.  From my experience, patients often don’t know how to convey the most important information to enable the office receptionist to make the best decision.  The message sometimes lacks important information to convey the appropriate priority.  If Susan just said, “Hello, I’m Susan, Dr. Smith’s patient and I need to speak with him.  Please have him call me at XXX-XXXX,” that probably won’t rise to the top of the priority list. 

Let me give you a little background about how physician practices are run.  First of all the clinical training of the receptionist varies from practice to practice.  Usually it’s not a nurse who answers the phone, so in most instances their medical knowledge is limited.  In many practices there is a nurse who works with one or more of the physicians.  One of the responsibilities of this nurse is to handle many of her doctor’s patients’ issues.  This is the person you want to make sure gets an accurate message.  The receptionist who answers the phone will usually relay the information you have given to that nurse or the doctor. Sometimes the nurse can take care of some issues without the doctor having to call the patient back.  For instance, if Susan relayed all the necessary information, the nurse could have gotten her physician to complete the required paper work and forwarded it to the home health agency without the doctor calling Susan.  It’s critical that you communicate effectively.  Here are some suggestions:

  1. When calling ask to speak to the doctor’s nurse.  The nurse will have a better clinical understanding of the importance of your clinical issues.  If there is no nurse, the next steps are even more important.
  2. Tell them specifically what the issue is and why it’s important; not just that you want to be called back.  Be clear and direct.  If you need the doctor to make sure to sign orders with the home health company so you can get the care necessary for your recovery, say so.  Also state that you want to be notified once he has done that.  (You’ll see below why that’s important.)
  3. If you can’t speak with the nurse or doctor then, always get an estimate of the time when the physician or nurse will call you back.
  4. In Susan’s case, where she needs her doctor to authorize her visiting nurse visits, she has another option if her physician fails to help her.  But first she needs to call her doctor one more time to determine what, if anything, they have done.  (Sometimes the practice takes care of this kind of thing but doesn’t let the patient know.  In this way the doctor doesn’t even need to call the patient back.  But unless someone calls the patient, they are waiting for a call that may never come.)  If it hasn’t been taken care of yet, I would let the practice know that since I need the services, I’ll be calling my insurance to see what they recommend.  This may move your issue up in priority and get it resolved.  Otherwise, go ahead and call the Customer Service department of your health insurance to enlist their help.  They have a whole team of staff who work with physician practices who should be able to resolve this.  If you have to take this route, you probably need to find another more responsive practice, so see my last recommendation.
  5. If your experience trying to reach your doctor is disappointing, the next time you see him or her, ask how you can make sure you get a more desirable response in the future.  Most physicians take pride in being accessible to their patients.  Gauge your physician’s reply to your concern.  If it is unsatisfactory, you may want to consider my next suggestion without waiting for a recurrence.
  6. Consider changing physicians if you continue to have difficulty getting through to your doctor.  If your health plan requires you to use an in-network physician, call the Member Services number on the back of your health insurance card for help in identifying other suitable, in-network physicians in your area.  You may also want to mention to them your reason for changing doctors.

Have you had difficulties with accessibility to your doctors?  Please share some of your experiences.

On the next post I’ll talk about Susan’s transportation problems.

For Your Health – Dr. Bob

When Plans Go Wrong – Visiting Nurse Visits Aren’t Happening

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(To view the case of the original post, go to Case 1.)

Some strategies at the time of discharge can help prevent the missed visiting nurse visits that Susan experienced.  The discharge plan is usually at the very least verbally explained to the patient by the attending physician.  (Attending physician is the term to describe the doctor who actually admitted the person to the hospital and writes most of the orders for the patient during her stay.  Orders include diet, activity level, medications, testing, consultations with other specialist physicians and therapies.)  Often a nurse will give the patient their discharge instructions (plan) and go over it with them in more detail before they leave the hospital.  It is then that such issues, as whether the visiting nurse visits have been arranged or not & how to contact them should be clarified.  If there are questions, it is a lot easier for the nurse to resolve the issue than it will be for the patient to take care of them once they are home.  Bottom line – you as the patient need to know exactly what the plan is for your continued recovery and when various visits are to take place and by whom with contact information for those other care providers.  In certain instances you may need to schedule some of these and you need to know which and get them scheduled ASAP after you return home. 

I would also emphasize that after discharge a patient should set up a post-hospitalization visit with their physician as instructed in the discharge instructions.  In most instances that should be within 2 weeks, but depending on the reason for the hospitalization and the treatment, it could be a lot sooner.  Also, you should not hesitate to call your physician if you notice new or worsening symptoms.  Sometimes an evaluation of these can wait until your scheduled appointment, sometimes not.  Sometimes, these symptoms can be due to a life threatening complication so time is of the essence.  That’s why a call to your doctor can be so important.

So, what should you as a patient being discharged from the hospital do to assure a smooth transition home?

  • If possible, have a reliable relative or friend with you when you get your discharge instructions.  For most hospitalizations you will not be able to drive home by yourself, so the person picking you up can help with this.
  • Ask for a copy of your discharge instructions so you can look at them while they are being read to you.  Follow along and make notes on the paper.
  • Make sure that any questions you have get answered before you leave.
  • Make sure you understand what are your responsibilities once you get home, for example, when does the doctor want you to make an appointment to be seen in the office?
  • Make sure you know what other components of care you will be receiving and whether you need to contact anyone before those appointments begin.
  • Always get contact information for any of the other care providers who will be working with you.
  • VIP!  Make sure you know what medications you should be taking and whether the medications you were taking before admission should be stopped or continued.  I have heard of instances where a person was taking a brand name medication before admission and was discharged on the same drug but the hospital staff referred to it by its generic name.  When they got home the patient took both medications and had significant side effects from the double dose that required an emergency hospitalization.  Such mistakes can be fatal.

So with some preparation this issue Susan encountered might have been avoided.  In the next post I’ll discuss what to do to make sure your doctor calls you back.

For Your Health – Dr. Bob