Some views of the current health care system from a Physician Assistant:

[Minimus]

I just got off the phone with my sister in TX. She recently went back to work as a PA for group of ENT doctors/surgeons and is quitting her job today. She has not worked in a patient care for several years (she was previously teaching) and has only been there 90 days. She is already fed-up with the healthcare system.

Following are a few examples of why:

- A patient came in last week with private insurance. He is on 3 medications for diabetes and 2 for high cholesterol. He came in to be evaluated for snoring surgery. He weighs over 300 pounds. My sister said she understands about being overweight because she herself needs to shed a few pounds and it is hard to do. What she doesn't understand is why this patient was not sent to a nutritionist. If he was to lose weight and eat properly then he could probably get off of many of his medicines and chances are he would not need snoring surgery. Her point is if she was overweight enough to have to take that many medicines and possibly have surgery, she would try do everything she could to lose the weight. She also does not feel that the physicians put enough emphasis on a healthy life style. They are content just prescribing more medications and doing surgery. It is also possible that his insurance does not cover nutrition counseling.


- When a Medicare patient comes in the physicians know they will not be paid as much and it is easier to just prescribe more medications. She said they recently had an elderly Medicare patient that was on 15 different medications. My sister was amazed that a patient would be given so many medicines.


- Since she works for an ENT they will often get referrals from dentists. Sometimes it is discovered that tooth pain is really related to sinus issues. Apparently many dentist's are now using CT scans in their practices. The CT scans are called mini CATS since they do not give very many views. These type of CT scans are not usable by the surgeons because they need several views of the sinuses. So a patient comes from the dentist with their useless mini CAT scan and is then sent for another CT scan.

One of her recent patients was already scheduled for a scan and just happen to have a dentist appointment before the scan occurred. When the dentist told him he wanted to do a CAT scan the patient told him he was already scheduled for one and couldn't the dentist just use the pictures from that one. The dentist's office called the doctor's office where my sister works and asked if they could just do the CAT scan there and have the surgeon use their scan. The answer was NO and the dental office got quite bent out of shape. The doctor told my sister "I am not going to justify that dentist owning that machine".


- Kind of a same as above but concerning an Asthma/Allergy physician right next door to them. This doctor also has one of those mini CATS and does one on EVERY patient. If a patient needs sinus surgery and is referred to the ENT, once again another CT scan has to be done. The ENT physicians are very frustrated with the use of the mini CATS followed by having to have a real CT scan because it is exposing the patients to unnecessary radiation. The consensus seems to be that the mini CATS are just a money maker for some dentists and doctors.


- She and I also discussed an issue that I have concerning my personal health care. I see a couple of different specialists for medical issues and they each have to order blood work for me every 3 months. I know that some of the tests are duplicated and posed the question as to why I couldn't just have one CBC for example and let both doctors see the results. She explained that was my insurance company's fault. Each time lab work is ordered it is given a CPT code the CPT code has to match the diagnosis code - ICD code - or it is rejected. So since one doctor is ordering blood work for my thyroid and the other doctor is ordering blood work for my Celiac it is two different codes. My sister said that one would think that the insurance company would want to save money by not having to pay out on two different claims for the same test but they are actually making money by doing it that way. They do not want it to be easier for the doctors or the patients.


I want to clarify that I know that not all physicians are content on just prescribing more medications or just doing surgery. Some doctors would probably order the 300 pound man to see a nutritionist and try to get patients off of so many medications. I also know that some dentists/doctors probably use the mini CAT in a necessary way. I just wanted to share this one view of the current system with DU.

BTW - my sister is going back to teaching.

[hedgehog]

1. I thought Obama was exagerating when he refers to patients

having the same test done over and over by different doctors. I guess I've just been lucky with my medical care.

[nightrain]

3. It's no joke. There's little time or reimbursement for coordination of care between

practitioners.

[silverweb]

5. No exaggeration at all.

I see it all the time in my transcribing of doctors' reports.

It's disgusting.

[cascadiance]

12. They tried to do X-Rays twice on me once...

This was quite a few years back. I was on some insurance plan that was pretty lame as a contractor then.

I had some growing numbness in my left pinky and in my wrist. I went to my primary care physician, and he said the wait time was at least a few months before I could be referred to a neurologist when I asked for it. He was saying it was likely just part of "getting old". They of course were trying to get me referred to someone within their health group.

I noticed in my health care plan that I did have the option to see a specialist that wasn't within the medical group of my primary care physician, and found a neurologist that was recommended from others that would see me sooner.

I went to him, and he did a number of neurological tests including X-rays, which he asked to be processed by the labs of the care facility where my primary care physician worked.

He then said I had ulnar nerve damage, and as it was in early enough stages, I might correct it by having an operation to move the nerves in my elbow to take away from the pressure causing the damage. But he suggested also that not just to take his word for it, but to get a second opinion, and secondly, if I do get referred by my doctor to get surgery, that I should make sure it is a neurosurgeon and not an orthopedic surgeon that I get referred to.

As an engineer I depend on my hands to type with, and I could ill afford to have my hands in worse condition than they were, and took his recommendations to heart, as he seemed to be a very straight forward guy, like the people who recommended him to me described him.

Well, my original doctor and their powers that be talked about it for a few weeks and then he referred me to an orthopedic surgeon. I then said, "oh shit!". And not only that but when I went to visit this surgeon, he also wanted to put me through all of the tests (X-Rays and all) over again as if I hadn't even seen the neurologist. And it was evident that he hadn't seen the X-Rays that were already taken, even though his medical group was the one that did these X-rays. I decided at that point that trying to go through that sort of risky surgery with the way my insurance was referring me and covering me was too risky to do, so I didn't do it and I have to live with permanent numbness in my two left fingers a decade or so later.

That's the price we have to pay for this sort of health care where we have insurance companies that gouge people at the cost of better quality care. They duplicate tests and provide substandard care.

[nightrain]

2. knr. Thank you so much for posting this. We need to hear more

from the practitioner side of this health care debate. Many of us know professionally that the dys-system is wasteful of time and energy, duplicative, fragmented, and a royal PIA to work with.

The photos of the VA and LA Remote Medical Area mass provision of services brings home the point from the patient side. Both parts need to be considered.

FWIW, a single payer from the practitioner point of view would free up most of us to actually provide care, which is what we want to do.

Good for your sister to leave a untenable work situation!!!

[theoldman]

4. My doctor said that it is a waste of his time talking to obese people.

They feel insulted if you tell them that they need to lose weight. If he does not provide them with the drugs required to keep them alive they will go to another doctor. I know several obese people and that is exactly how they think. My suggestion is to raise their insurance rates until it hurts. Maybe then they will start to eat less.

[hedgehog]

8. Are you absolutely certain that every overweight person is a lazy slob?

Polychlorinated Biphenyl-77 Induces Adipocyte Differentiation and Proinflammatory Adipokines and Promotes Obesity and Atherosclerosis

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2430232

Polybrominated Diphenyl Ethers as Endocrine Disruptors of Adipocyte Metabolism

http://www.nature.com/oby/journal/v15/n12/full/oby2007351a.html



Potential Links to Obesity:
These mature female mice, both from the same strain, had the same diet and activity levels. The mouse on the right, however, was exposed to the endocrine disrupting compound DES. During neonatal development, the mouse was given a dose of DES at 0.001 mg/day for days 1-5 (Newbold et al., 2005). Exposure of mice to DES during critical windows of development is clearly linked to obesity later in life.
(Photo courtesy of R. Newbold)


Human health effects remain a major concern, but definitive cause and effect relationships have not been clearly established yet. While research on humans has been limited, results from current animal research suggest the potential for adverse outcomes, including altered ovarian and testicular development, male infertility, impaired cognitive development, cancers (non-Hodgkin’s lymphoma, leukemia in children, elevated prostate cancer risk), Type II diabetes, obesity and immunosystemic disorders (Myers).

http://www.mawaterquality.org/Publications/pdfs/EDC_Factsheet_3_2007.pdf

[liberal N proud]

6. If there were a national database for medical records

The cat scans could be available (the ones the doctor ordered, not the dentist).
Every doctor could see what other medications for other physicians were prescribed to the patient
Blood work could be done once and everyone could see the results.

And single payer would take the for profit question out of it and the doctor would be more likely to prescribe the treatment that is best for the patient and not the bottom line.

[Minimus]

10. I recently went to the doctor with my mother. She has had back pain

for many years and it has gotten worse. She wanted to find out what options, if any, were available. The physician she went to was actually able to pull up her last MRI from a database he can access through the radiology clinic. The MRI was done a through a pain clinic she was going to for physical therapy.

I thought it was so great that the physician could do that. If she had it a different clinic he would not have been able to see it.

The physician also asked my mother if he could send a copy of his report to her primary doctor and then he said "This is one of the many things that Obama is right about in fixing the health care system". He then went on to say that physicians need to communicate with each other and this help prevents ordering duplicate or unnecessary tests. He said many times patients do not properly communicate with their doctors to explain that a certain test was ordered by another doctor.

I immediately liked this man. He was knowledgeable and personable. He told my mother he did not want to do surgery unless he could specifically see a problem he could go in and fix. My mother has a very slight bulge and some arthritis. She is going to have some injections in her back this week.

Funny thing is the pain clinic had told her she had one herniated disk and on bulging disk. They referred her to their surgeon. This doctor did not see a herniated disk and read us the radiologist report that did not mention a herniated disk -just the slight bulge.

I am so glad that I researched back surgeons and suggested this new one to my mother. She likes him and hopes the injections give her some relief.

[Laelth]

7. k&r for reality. Spread it. n/t

:dem:

-Laelth

[hedgehog]

9. Obama keeps reminding us that providing helath insurance for everyone

is only one of many steps in health care reform. In many ways, we're still regulating health care as it was in 1950. Recently, the State of New York closed the small hospital in my town because there were too many beds in the area. There is a hospital 10 miles north and a group of teaching hospitals 20 miles south.

The commission just looked at hospitals as as they are used today. There was no consideration of the role of a hospital or consideration of what might be needed in the event of a repeat of the 1919 flu epidemic. But OK, let's say that closing the hospital was the best way to cut costs.

Here's what happened next: the hospital was re-opened as an urgent care center. My understanding is that this allows the hospital to skim off paying customers since urgent care centers can require payment or proof of insurance up front while ERs have to take all comers.

Meanwhile, another hospital installed a freestanding MRI center in town. Can that unit be justified? I have no idea since it is unregulated.

[quiet.american]

11. K&R nt