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"How To Combat The 10 Most Common
Obstructions To Your Best Medical Care"
This information
should provide
you with the
ability to walk
into your
doctor's office
confident that you
are in complete
control of your
medical care.
There
aren't many
medical patients
who are honestly
able to say that.
by Curt Graham, M.D.
“Anyone can learn, it takes a fool to ignore what they learned.”
“How to Combat the 10 Most Common
Obstructions to Your Best Medical Care”
Discover the perfect strategies to use to convince your own
doctors to provide you with top health and medical care
without them even recognizing what you are doing.
The importance of what I’m about to tell you:
Medical patients want and deserve the best medical care their doctor can
provide. With the rapid pace you are being pushed past your doctor today, the
trend is for getting even less time with your doctor. As a consequence of the
8-minute medical office visit the quality of your medical care is predictably
going to decrease.
The quality of your medical care, you may have noticed, is also being reduced
by your being seen and treated by a midlevel provider instead of a doctor. The
time when that issue is important appears when your assumably simple medical
problem or illness turns out to be far more dangerous than they thought.
I once consulted on a case where the medical office RN determined the
diagnosis by herself. It wasn’t an allergy problem that the post-operative
patient complained about on the phone that was causing her to have severe
problems with “getting my breath”. It was a pulmonary embolism that resulted
in death of the patient 24 hours later.
The majority of the midlevel medical providers (PA, CNM, RN, NP) are very
knowledgeable and accurate with what they do to treat patients. They just
don’t have the knowledge, astuteness, or training to do all that a doctor does
and therefore the probability of error or mistake is higher.
Midlevel medical providers are excellent at providing medical care for simpler
medical problems and illnesses. That’s why they are being employed much more
often in healthcare today. In the future of healthcare, especially if Obamacare is
not repealed, you are likely to routinely be seen by a midlevel provider first.
They will do the screening of your medical problems and then decide if you need
to see the doctor. It is the way your medical care will be handled.
These are a few good reasons for you to gain more knowledge about your own
illnesses, see the doctor as often as you can for healthcare and be in control of
what happens in your healthcare all the time. You should follow-up on your own
lab test results, x-ray reports and consultant recommendations yourself.
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These 10 healthcare barriers and solutions are just
the start:
1. Make Your Doctor Visits Much More Productive
and Valuable:
(There are ways you can make your time with the doctor longer that
don’t involve wrestling.)
Are you ever aggravated about how you are treated? Are you just plain
tired of putting up with not having enough time with your doctor?
You may have had a dozen questions to ask the doctor and only four
of them got answered. Even following the doctor down the hall in your
exam gown yelling at the doctor that you have a few more medical
problems to discuss, would only embarrass you and mark you as a
belligerent patient. Oh, what the hell, do it anyway! Maybe it would work.
Yes, there are some unique and appropriate ways to meet your needs
without resorting to nasty phone calls to the doctor’s office. Aren’t you
relieved, even just a little bit, to hear those words? Now, can you believe
them? This advice is given freely. Take it for what it’s worth from a
physician who is a strong patient advocate.
The question is…have you been shortchanged because of such a short
visit? The 45-minute wait to see the doctor and 8 minutes with the doctor
doesn’t seem worth it at times.
If you are writhing in pain, a doctor has no alternative but to spend
extra time with you. When your problem is that severe, any good office
assistant would immediately have the doctor see you. Routine "too short"
doctor visits, for whatever medical reason, are at the root of the problem.
It takes a bit of understanding by you about how the “short” doctor visits
have come about in the practice of medicine. It may not excuse it but
knowing the reasons does make it easier to swallow. Can patients
change it? No.
As with many things, if you know why something is happening, it's more
acceptable and tolerable. For example, is the doctor ill? Was the doctor
suddenly called to the emergency room to see an injured patient?
Back office nurses and medical assistants worth their salt should be
right there to explain why your time with the doctor had to be cut short.
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Powerful medical office visit strategies you can do to save time that is
often wasted on issues that can be handled with a little preparation:
1. Put your doctor visit plan in writing. Start the visit with your
most important medical problem or question, and prioritize
the rest.
2. Make a list of all of the prescription medications, herbal
medicines, and nonprescription meds you take on a regular
basis. Have a copy in your purse or wallet and a copy to give to
the nurse.
The copy for the nurse has two purposes. First, the list saves
the time it would otherwise take the nurse or medical assistant
to copy them down or add them to the computer as you read
them off to her.
Second, the length of the list gives both the nurse and the
doctor a quick idea of how long they expect the visit to last.
Lastly, the nurse will only present the doctor with your one
main urgent medical complaint before the doctor enters the
exam room. However, you have liability leverage to use. It
may only be a subtle nudge to coerce more time with the
doctor, but the fact that the office now has a copy of your
medical complaints.
They can’t come back later, if a problem arises, and defensively
accuse you of not telling the medical office that you had these
problems. Doing it verbally leaves no paper trail for attorneys.
3. Fill out or update in detail your medical history form they hand
to you. Doctor's often review your chart info before they enter
the exam room.
Suddenly coming up with new “uncharted” medical problems in
the middle of the visit brings the whole visit to a halt, and often
never provides time to get back to the main medical problem
you came in with.
Avoid popping up with a new medical issue in the middle of
everything. Stick to your prioritized list of medical problems.
4. Prioritize your written “questions”. The top 3 usually get taken
care of. Those below often are left for a later visit. Plan on
having the top three medical complaints attended to for sure,
then push for the rest if time allows.
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5. Avoid small talk. The old days are gone. No longer are doctors
about to spend extra time explaining what he did on his
vacation. If you need to know---ask the office staff.
Studies have shown that the average actual time spent with the doctor
on an office visit is 8 minutes. A typical office visit with the doctor is
interrupted within the first 27 seconds of the doctor being in the room
with you. It may be the nurse has an urgent message for the doctor or
has to get a quick decision from the doctor about some urgent issue.
This tells you it would be wise to plan your time to be used efficiently or
be disappointed that you never got to the second question.
What can you do to plan your doctor appointments?
Use strategy in making your appointments.
Make notes of all your symptoms that you have described in good detail
to be handed to the nurse or medical assistant. In the exam room, it’s too
easy to forget certain bothersome symptoms.
Prioritize your questions as to importance to you on that sheet of paper.
If there is not time to get to them all, at least you will have covered the
critical ones. Remember that you can schedule another visit to complete
your list of questions later, if they are important enough.
Be sure to arrive “on time” or "early" for your appointment. If the patient
scheduled ahead of you cancelled, then you may be moved directly into
the exam room without having to wait. Very often you will have a form to
fill out so it’s always smart to arrive at the office at least 20 minutes
before your appointment time.
The conflicts and interactions of medications prescribed today are
immense. A detailed list of your prescription medications, pill size and
dosage, and how often you take them is critical. Most patients can’t
remember all this, especially if they are on many medications. Carry a
list with you at all times.
In an emergency you may not be conscious to tell the doctor or
paramedic anything about the meds you are taking. Your marital partner
and your children often do not know what you take. Hand the list to the
nurse in the exam room. It saves lots of time for her to record them
separately and you get more time with the doctor.
Be very detailed in the information you put on the chart history form.
Doctors often scan your medical record before entering the exam room.
Keep it updated for your doctor. You have no idea how important the
medical history is for doctors to evaluate a symptom, prescribe a
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medication (Are you allergic to the medication?), and make a correct
diagnosis on the spot.
Make a decision for yourself not to use up a large part of your time with
the doctor socializing. Make up your mind that medicine is not like the old
days where the old doctor and you were friends as well as being a patient.
To find a good doctor like that today is equivalent to finding a pot of gold
in your back yard. Other patients may have a very long wait in the
waiting room if you trivial talk about old times. These are the things I've
found to be true.
Techniques to easily manage your visit with the doctor in the
exam room:
The last thing you want to do is handicap the doctor in any way from
giving you 100% of his or her attention in the exam room. Other than the
many ways to get more time with the doctor mentioned previously,
there are several more important things you need to do to guarantee you
will get the best care possible.
A. The importance of good communication tactics.
B. The importance of educating yourself about your
own medical problems.
C. Importance of trusting your doctor.
D. Importance of follow-up visits.
Most important and absolutely necessary, is for you to completely inform
the doctor of all medical symptoms or unusual signs you’ve noticed, and
any history of having these problems prior. Your doctor formulates a
diagnosis based on everything you reveal. The findings on examination
reinforce your information and his or her diagnosis.
Often, patients neglect to mention mild or intermittent symptoms, which
they consider irrelevant to their present condition, and which the doctor
may find very relevant. It’s a good idea to lay them all out for the doctor
no matter how trivial.
Don’t be afraid you are wasting time or bothering your doctor with
garbage. You may have come in to have your bladder infection treated,
but the black mole on your arm that keeps itching and enlarging could be
early skin cancer…or worse.
The consequence of your holding back on your medical information may
result in the doctor being misled, making a wrong diagnosis, or
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prescribing medication that doesn’t work. Even that adds to the number
of extra lab tests that shouldn’t have to be done. Be honest.
Patients who search out and educate themselves about their own disease
or medical problems are able to explain to the doctor in clear
understandable terms more exactly and thoroughly what is bothering
them medically. It leads to better diagnosis and treatment of you by
your doctor.
Consider also, when you know more about your medical problems, you
are much more likely to know when a significant or bad symptom shows
up. You get it handled quicker and avoid letting it get worse. Sometimes a
symptom seems mild or not bothersome and can still be indicative of
a serious medical problem.
You’d be surprised how often doctors see patients who have had a
symptom or medical problem watch it to see if it will get worse over time.
Then wait to go to the doctor until it gets much worse because they
didn’t want to bother their doctor with minor medical problems. It all
leads to a much more difficult treatment process.
Why trusting your doctor is of great importance:
Trusting your doctor is important---actually very critical to your medical
treatment. Patients who don’t trust their doctor, or are at least skeptical
of his/her knowledge or skills, will not take the medication as prescribed
or not all of it. Additionally, patients won’t listen to or follow the doctor’s
medical advice.
If you don’t completely trust your doctor, go to another doctor.
Trusting also becomes a severe barrier in medical follow-up. Sure, you
thought the lab tests he ordered were unnecessary so you didn’t do them.
What about the consultation with another doctor your doctor ordered that
you skipped?
The belief that your doctor orders tests to be done just for your
reassurance or maybe the doctor has a part ownership in the lab with a
lust for money comes from the lack of trust.
You need to understand when a doctor orders a procedure or test to be
done on you, somewhere in the doctor’s mind is the true medical reason
for doing it—and may not be made known to you. It may be for reasons
about confirming a diagnosis the doctor already has made. Sometimes
it’s done just to be sure the tentative diagnosis is correct.
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Today in our medical world medical malpractice suits have become so
prevalent that it forces large numbers of medical doctors to double check
everything so as not to make a mistake and get into trouble.
Extra lab tests or consultations may be the one key to your real medical
problem when the diagnosis is tentative. The consult ordered may be
because your doctor may need to refer you to a doctor that can manage
you medical problem better.
Following through with your doctor’s advice and instructions whether you
agree or not is SMART---you don’t know what you don’t know and may
never find out. Of course there are many more such issues
to be considered.
The things that occur in the exam room with the doctor and nurse are for
your benefit. A secondary benefit applies to your family in keeping you
strong and healthy.
Exam Room Boogidy:
Are you intimidated by your doctor? Does he or she have an “attitude?”
Can you see by body language that there is a definite conflict happening
between you and the doctor? Can you handle it? These hints and bits of
advice will make your day.
Don’t you just love it when you discover secrets to avoiding problems, as
well as getting your money’s worth from the doctor?
Strategies to make it work for you:
1. What silent signals tell you.
2. How to deflate the “attitude”.
3. How to control the factors that free up more time with the doctor.
Many patients find it very difficult to talk to a doctor. Things get
awkward. They just don’t want to bother the doctor because he is so darn
busy anyway. Wrong!
Your attitude must be, “I am here because I have a medical problem.
This whole office visit and time is mine to do with it as I please. The
purpose and goal is to use the doctor to get information, reassurance and
medical care. I am the important one here.”
You silently have sent your doctor a signal without speaking—by your
thoughts. No, you don’t say it out loud! The next step is to
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instantaneously evaluate the doctor’s attitude to see if the doctor got the
clue you sent without verbalizing it. Notice if the attitude changes.
Some physicians are not good communicators and cover it up using an
attitude of some type.
Does your doctor act like you don’t exist in the exam room? What! No
greeting, hello, or handshake? Is the doctor in a hurry, and it’s obvious?
The doctor’s attitude sets the pattern for the whole visit…… he thinks! Boy
is that doctor going to have a revelation after you read this.
Every doctor has his own unique personality. Each patient must seek out
a doctor that they feel comfortable with and trust. If you don’t feel
comfortable with him or her, you will not trust their advice or
treatment. In that case, change doctors quickly. I say that because
attitudes of doctors don’t vary much over the years.
Some doctors dictate to their patients, and if patients don’t like it, they
have to go elsewhere. Most doctors are gentle, conscientious and
thorough, and treat patients like friends.
Doctors are always in a hurry, whether they show it or not. Their medical
training teaches them to ignore that hurry impulse when they are with a
patient. Today you rarely will find that to be true.
Doctors are excellent at diagnosing and treating patients, but are
occasionally disconnected from a pleasant bedside manner. These are the
doctors you have to know how to handle. Good doctors respect your time.
Hurried and irritable doctors will not respect your time, especially in the
exam room. Let the doctor know that you see right through the attitude
and as a patient, you deserve better. Just be straight forward about it in a
gentle tone of voice.
It’s not uncommon for any person, business professional, or even your
mom to be so wrapped up in what’s on their mind bothering them that
their focus and responsibilities on the “present” is somewhat retarded.
However, when a patient speaks out about the attitude they notice
coming from the doctor, aimed directly at the doctor, the result actually
follows a well know communication principle.
The principle is derived from the natural function of the brain and can be
explained like this; Everyone’s mind is in continuous thought while we are
conscious and awake. Therefore, the second you start to talk to someone
else, the first words out of your mouth should have the purpose of getting
that person’s mind totally focused on what you say next.
Your words serve to cause the doctor’s mind, which at that moment is
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concentrating on several other things, to disconnect from that ongoing
activity and immediately become fully aware of you and what you say.
That’s why everyone is accustomed to starting a conversation or comment
using the other person’s name, like, “Kent, can you………” , or “Hey guys,
I have an idea………”. It works well if the other person isn’t deaf, isn’t in a
Rage or otherwise overcome with their turmoil in their mind.
The point is that you have to interrupt the conversation they are having
with themselves at the time so you can grab their full attention.
Once you have verbalized your disappointment in the doctor, almost
100% of doctors will suddenly change into a new more pleasant person,
believe it or not. The last hassle a doctor needs is a letter of complaint
from a patient against them that reaches the local Medical
Association Grievance Committee.
Here are the ways you can bring these doctors to
their knees, and have them begging for mercy:
1.Be aggressive but nice (intimidation format). Simply point out that
your health is very important, and he or she should listen to all your
questions, and provide adequate answers.
Remind the doctor that he has made a pledge to his profession to do
all he can to help patients. These comments make a person ashamed
of the way they are acting and they shape up immediately.
2.Be understanding (sympathy format). Explain that you understand
the stresses of being a doctor and that you are sympathetic about that
issue. This will chop him off at the knees. On occasion, some doctors
are so wrapped up mentally with some other issues that they do not
recognize how they are acting towards a patient.
They just need a “heads up” push. You have to do it, because the
nurse or other office personnel won’t. If you value your job, you
shouldn’t walk up to the boss and unload.
3.Be apologetic (transference format). It’s just another approach to
try, if the others aren’t working. You can pretend that the way the
doctor is acting is your fault entirely.
Talk about making them feel guilty! Try, “If I have done something
here to upset you, I apologize for my behavior”. What a great “wakeup” call it is for the doctor!
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4.Be clever (guilty trip format). As soon as you see the bad attitude,
verbalize this; “It probably would be better for me to reschedule my
appointment for a time when my visit won’t add to your distress”.
Canceling your appointment on the spot, will give the doctor some free
time to get them self together before seeing the next patient. See, you
have just helped another patient, and feel good about it.
5.Be cool (abandonment format). It is a last resort strategy. Very
silently, and quietly, without uttering a single word, get off the exam
table, get dressed and walk out of the exam room without a single
look at the doctor, or any eye contact.
When you get to the front desk, ask to see another doctor. If the
doctor then follows you out front – kick him in the shins and run. No,
don’t do that – just think it.
About 9 times out of 10 the doctor will immediately sense that they
have committed an unpardonable sin by doing something, or saying
something, that terribly offended you.
The response you should expect is one of apologies to you and making
amends before you have left the exam room. If you reach the front
desk without the doctor saying anything like an apology,
change doctors.
The greatest risk for running into an impossible doctor is on the very
first visit. You haven’t had a prior opportunity to check him out. A
referral from a friend and their comments about the doctor is usually
all you have to go on. Medical Societies will not give out that kind of
information. It only comes from word of mouth from other patients.
One thing for sure on your arrival, if the waiting room is full, you can
usually count on the doctor being a good one. Having to wait for your
doctor indicates that the doctor takes extra time with patients. The
quality of his treatment of his patients can be measured by the
number of patients that are willing to tolerate the wait to see him.
Little secrets like these add great value to your doctor visit.
Keys to making more exam room time with the doctor:
Fifty years ago the usual 45 minute doctor appointment enabled time to
undress and dress, go into the doctor’s office for a nice discussion about
your diagnosis and treatment, have him write out your prescriptions, and
even shoot the bull a little.
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Now, you barely have time with the doctor in the exam room. The nurse
writes out the prescriptions (which he is supposed to sign), and you are
lucky if the next patient isn’t already pounding on the exam room door to
come in. Am I exaggerating? Nope.
Please don’t give away these secrets: (Just kidding)
1. The disrobing dilemma.
2. Children in the exam room.
3. Timing of your discussion with the doctor.
4. Good intentions just don’t hack it.
Anticipate any disrobing that you may have to do and put on the exam
gown before the doctor comes into the room. Usually, the nurse will tell
you what disrobing is needed.
Maneuvering around by changing clothing when the doctor is in the exam
room will consume some of your discussion time. Can you be in the
middle of changing clothing and still hear and remember what you are
told by your doctor? Most patients can’t.
New patients frequently want to talk to the doctor before they disrobe.
Then, the doctor steps out of the room to let the patient get into an exam
gown or drape, which wastes even more time that could have been used
with the doctor. However, you gotta do what you gotta do! Just
understand the compromise of your time you have available
with your doctor.
Small children in the exam room are a profound distraction to you as well
as to the doctor and nurse. Tiny babies cry, older children interrupt the
conversation repeatedly, and usually do not mind parental instructions
anymore (no parental control). Some much younger children walk around
in the doctor’s way and refuse to be seated. The result is complete
distraction of your mind away from what the doctor is communicating.
These events are likely to create conditions where you don’t quite hear
what the doctor told you, or you misinterpret what the doctor said while
focusing on the child not behaving.
If you have a desire to get the most value out of their doctor visit, you
always have time after making your appointment, to get a babysitter.
Emergency visits are the exception. Nowadays, having small children in
the exam room seems to be the standard. A reasonable person
understands the trade-off they are making. If a doctor had a choice, and
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they don’t anymore, they would prefer not to have small children in the
exam room.
If I told you all the dilemmas and problems that I have had with small
children in the OBG exam room, you would either be sympathetic or fall
over backwards laughing. It’s no laughing matter, actually.
There’s a debate about whether it’s better to blast the doctor with your
questions as soon as he gets into the exam room, or to wait until near the
end of the visit. Questions and discussions are better left till the end of
the exam.
Since the symptoms and illness that you have are the source of your
questions, the doctor is much better prepared to give you complete and
more accurate answers after the doctor has already examined you. Makes
sense, right?
The doctor, by the time they enter the exam room, already knows your
main medical symptoms and problems. The nurse or medical assistant
has already told the doctor.
Your intention may be to try and avoid the social interaction with the
doctor and use that time to focus on your best medical care, but
somehow it may be an important process also for you to be friendly and
pleasant instead. Then do it.
You may lose in one way and gain in the other. That trade-off may be
worth it in the long run for you. If you can just keep the socializing to a
minimum, it certainly won’t offend the doctor. In addition, being pleasant
doesn’t mean asking the doctor all the things he did on his
vacation—a simple short sentence is all that’s needed, like, “How’s your
day going doctor?”
When you have a complex medical problem that you know will use up a
lot of the doctor’s time, it’s wise to make a longer appointment
for that visit.
Secrets that are valuable to know about whenever you go to
your doctor:
1. Medication samples.
2. Information handouts.
3. Checking what is in your medical chart.
4. Telephone use.
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5. Computer use.
There used to be a time when pharmaceutical representatives hounded
the doctor’s offices, and were very promotional oriented. They were
elated to be allowed to pack the office closet with dozens of prescription
medication samples. If the office personnel didn’t swipe them all, then
most were given out to patients for free.
It was a very decent thing to do for patients who have to pay for their
medications. Doctor’s offices still obtain samples of prescription
medications, but in limited supply. If you don’t ask for medication
samples, you won’t be told that they are available. It can save you a
bundle by simply asking for samples if they have them.
Patients have begun to believe that the only way to be satisfied about
their illness diagnosis, treatment and options is to educate themselves.
Doctors usually will not take much time to give you more than a
skimming of the important aspects of the subject matter. They now rely
on midlevel medical providers to do that job for them, like nurse
midwives, physician assistants, and other trained personnel.
If you notice the changes that have occurred in the last 10 years, doctor’s
offices are now overstocked with commercial brochures on various
medical topics and illnesses. These commercial printed medical pamphlets
are truly whitewashed of important information for liability reasons. Most
of the information contained in them you can find on TV or in magazines.
Patients now want more knowledge about every aspect of their afflictions.
No one is going out of their way to educate you---well, except me.
Thankfully, there are a few doctors left that do provide articles, written by
both other doctors and themselves on pertinent medical topics.
Unfortunately, no one will take the time to tell you that credible and
reliable medical information is available for patients as handouts. You’ll
want to ask for those that are written by your doctor on topics that are of
interest to you. Trash the commercial handouts.
If you haven’t already come to the conclusion that the more knowledge
you have of your own medical problems the better results you will have
from treatment and medical advice, you need to grab onto that idea.
Patients have a legal right to all the information in their medical records.
Ask for copies of your record from the doctor’s office or hospital. You may
be charged a small copying fee per page, but having your own records at
home is useful and valuable if the office records are lost. Do offices or
clinics ever lose records? Of course they do.
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Reading your medical record will give you great insight into why you are
being treated in a certain way or what the doctor’s real thoughts were
about your medical problems.
Doing that will often induce considerably more trust in your doctor than
you might have thought. In the old days doctors usually recorded their
personal thoughts in your medical chart about plans for their patient’s
future treatments, tests to do later, and maybe alternatives to treatments
in case the first one doesn’t do the job.
These days, in our malpractice abuse society, medical record notes about
your medical care are much shorter, often abbreviated with medical
abbreviations. The medical records are now kept strictly to the findings
about your medical issues. Things like alternative methods of treatment,
medical opinions about whether a patient is following the doctor’s advice,
and opinions about a patient’s personal life and lifestyle are left out.
One of my medical school professors told me that nothing should be
written in a medical record that the doctor would be embarrassed to read
out loud in public. That came immediately after he discovered what I had
written in a male patients medical chart after I had examined the patient
and had done a rectal exam to check his prostate gland for enlargement.
My actual chart note made reference to the fact that this patient was the
“goosiest” patient I had ever encountered. It was an opinion and not a
medical fact and opinions don’t belong in patients charts.
Use the telephone to your advantage. Once you know how your doctor’s
office responds to your calls, and who it is that calls back, you have the
inside track for medical advice and information. It will give you the
opportunity to have medical questions answered that were avoided or
forgotten at the time of your appointment. Find out what part of the day
they commonly make callbacks, and be available at that time.
Computers and medical patient’s access to a wealth of medical
information online is a real blessing for patients. Gradually, most patients
are learning how to use them. In the near future, there will be no choice
but to become computer literate.
Not only does the Internet contain vast amounts of medical data and
information at your fingertips on every topic and illness imaginable, it also
has one more substantial advantage for patient’s communication with
their doctors.
E-mail messages aren’t just for social networking. Medical offices now
have found it expedient to implement email into their medical practice
activities. Medical practice websites have become a good marketing tool
for doctors. New patients can gather a good deal of information on a
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doctor from their websites before they make their first appointment. It
allows patients to be much more selective in their doctor hunting.
You can use e-mail to ask questions of the doctor, make appointments
with your doctor, and avoid the usual “can you hold for a minute, please”
response on the phone. The top benefit of using email in healthcare is
related to ease of communication anywhere in the world instantly.
The much more detailed version of this report can be found at
www.healthcaresecretsrevealed-finally.com
2. How To Manage Conflicts With Your Doctor Or The
Medical Office Staff:
Now that medical treatment has become hurried and impersonal, there is
a higher risk of conflicts with doctors and their office staffs. "My Doctor
Aggravates Me Every Time I Have An Appointment.”
You know it! I do too. Doctors can have a bad day also, act grumpy, snap
back at you and even intimidate you verbally. Nevertheless, it's doubtful
that one sudden burst of unacceptable attitude or verbal comments would
drive you away. Here we're discussing the repetitive occurrence of
offensive happenings in the doctor's office that do cause patients to
change doctors.
The critical issue here is one of are you receiving proper and good medical
care while these issues are going on? To be blunt...NO! You may notice
several subtle clues and some not so subtle, which tell you things aren't
going to get any better.
Some aggravation factors that drive patients away:
• If the doctor upsets you repeatedly, you’ll lose trust in
your doctor.
• If you don't trust your doctor, you won't follow their
medical advice.
• If you don't follow their advice and take the medications,
your health suffers.
• Someone in the office repeatedly treats you terrible, for
some unknown reasons.
• Office personnel commonly forget something you need to have
done or ordered.
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• Your doctor repeatedly cuts you off in the middle of
your comments.
• Lack of appropriate follow-up on your health problems by the
doctor or the medical office staff.
Doctor's are taught to treat patients with dignity, always be kind, remain
pleasant and avoid passing their personal problems on to the patient.
That's the foundation and essence of "rapport" with your doctor.
Solution:
Letting the problem continue, is never the answer. Direct confrontation of
the doctor or office person is how you find out whether you need to find
another doctor. Of course, if you have no motivation to stick with your
doctor and resolve things, you just change doctors quietly later.
Doctors have a professional obligation to you of bending over backwards
to insure that nothing in the medical practice occurs which will distract
from or interfere with providing the best medical care possible.
Almost 90% of the time that you have a confrontation with your doctor,
the issues can be corrected without much difficulty or hard feelings.
The dissatisfaction issues are brought out in the open and usually you will
see the doctor, or healthcare provider, quickly give in to your demands
and agree to do better. The reason for that is that doctors want all
their patients to like them for many very good reasons. Trouble is,
promises don’t last long.
You will often find as time passes and the doctor has seen a few hundred
patients since your last visit, old promises and agreements with you are
long forgotten and things drift back to the same old disturbing
problems again.
It’s always considerably easier to change to a new doctor when you
realize you have a bad first impression on your first visit. Trust your
instincts. Doctor's often get the same impressions about you. The
difficulty is, doctors assume they have the character and maturity to
overcome any bad impressions with time.
The doctor-patient relationship may not work out as expected. You,
however, have no obligation to adapt to the doctor's faults. Don't try.
When you just don't like the doctor...change to another right then for
your own peace of mind. Otherwise you will burn a lot of energy
continually forcing youself to overlook the aspects of your doctor’s
interactions with you.
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Another side to the problems:
Personality clashes are real. Doctors and patients become complacent
about how they interrelate with others. Once a person realizes that all the
solutions in the world will not bull-doze anyone out of a personality
pattern they have developed for years. It's smart to stay away from each
other. Call it..."It's just the way we are”.
Trying to hang in there and make such a relationship work well is a
complete waste of time and mental energy.
Looking at it from another point of view, there are a lot of doctors out
there who are easily compatible with your personality. Why not change
to a new doctor and enjoy better rapport with your new doctor without
having to constantly be aware that every time you have an office visit
you’re in for another personality battle?
The case of an office staffer harassing you:
I learned about this the hard way and nearly got kicked out of my
residency-training program. It went like this.
The secretary to the head of our department (who seemed to run the
residency program) was repeatedly giving me orders to do certain things
I felt sure the boss never told her to pass on to me.
It so happened that at this time I was now 18 months out of the Vietnam
combat still with an aggressive personality trait. Like so many combat
troops arriving home, I continued to manifest a high priority for survival
against threats.
The secretary one afternoon was particularly arrogant in her mannerism
and how she was treating me. Up to this time I had used a great deal of
restraint for many months putting up with this attitude of hers. I blew up
at her with both barrels that day. I think it was the first time she actually
saw me as a significant threat to her.
Of course she went directly to her boss who was my boss, and Chief of
the Department of Obstetrics and Gynecology, to report my action.
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The next day after letting my anger subside the Chief came to me and we
discussed the event in a professional manner. At the end of the
conversation he said to me, "Barb, the secretary, has been my employee
and personal secretary and office manager for 18 years and knows how to
take the work load off my shoulders. I want you to know that it is a lot
easier for me to replace you than it is for me to replace her."
You guessed it. I spent the next 2 years trying to be nice to the Chief’s
personal secretary so I could finish my training program. It wasn’t easy.
Solution:
The solution for your managing a bad acting medical office staff member
is to discuss the issues directly with the doctor first, because the doctor
usually is totally unaware of the problem. Doctor’s office staff members
hide a lot of issues from the doctor.
Depending on whether you like your doctor and prefer to continue under
his/her care or not, determines the next step.
You have leverage...be aggressive! Never-never leave notes to the
doctor concerning the issue. Never send an email, letter or email to the
doctor's office about the problem. It’s amazing and always an
unexplainable mystery how commonly those methods of communication
come up "lost" or "deleted" accidentally.
Do it all verbally, face to face with the doctor.
Once the doctor knows the situation, choices must be made. An employee
doesn't want to lose their job. Usually the doctor can talk to the employee
to dig deeper into why the problem exists, and then manage the problem
in a way that everybody wins.
If you are being too demanding about the conflict, the doctor will end up
keeping the employee and you may be asked to leave the practice.
Yes, your guessed it, it's easier to get a new patient than to get another
employee of the same quality.
To add another component to this situation, the doctor may find that this
is just the tip of the iceberg. This employee may have been doing the
same to many other patients without the doctor's knowledge---and is
terminated.
Be aware that in your doctor's office many things happen that the doctor
will never find out about. One employee will rarely blow the whistle on
another employee’s bad activities. This phenomenon must
be world-wide underground doctrine or tradition among office workers.
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An employee will only report the problem to the doctor if the actions of
the troublesome employee somehow put this staff member at risk for
losing their job as well.
If patients never report a problem directly to the doctor, and just go
home each time grumbling about it as they "accidentally" slam the
medical office door on the way out, the doctor will never know what
goes on.
Advice:
Keep changing medical doctors or healthcare providers until you find one
you like and feel good around. When mutual admiration exists, you will
always receive much better healthcare.
3. What To Do If You Don’t Trust Your Doctor?
Trust that is lost because you don’t like the doctor to begin with and
understandably goes along with the usual trend of what our emotional
reactions and intuition tell us.
However, the real difficulty with managing the issue of trust is when the
doctor is a delightful person. You like the doctor a lot, but there are
indications that he is not very trustworthy.
It’s understandable how any patient might not trust a doctor they detest,
or at the very least, don't like? When you really like the doctor, it’s a
whole different story.
You must have run into hundreds of traveling companions, friends,
neighbors, and casual acquaintances who have given you an earful of bad
medical treatment by doctors, including doctors they don't trust or like.
That will make you even more suspicious, especially if it involves
your doctor.
It sure makes you think about it! That earful immediately triggers a
mental comparison to your own medical doctor. Over time, story by story,
a subtle antagonism may develop towards all doctors. Can you trust "any"
of them? Maybe your doctor is the one exception? Medical patient
frustrations don't end there, unfortunately!
Some contributing factors that may have created this distrust are:
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• The increasingly litigious nature of our society today, and in the
past 30 years. If so many malpractice suits are being filed against
doctors, they must be making a lot of mistakes---right?
It has been reported that almost 30% of cases filed against medical
providers are frivolous cases and increase doctor’s defensiveness.
• Media publications, reporting, and investigations of the most
severe and intolerable physician's mistakes, complications, and
unintentional adverse happenings in patient care add fuel
to the fire.
• The public tendency is to project each bad result in medical care
to all the other good doctors who treat patients exceedingly well.
• Stories about personal experiences with bad results are spread to
hundreds or even thousands of others over time. Not the minor
unintentional ones, just the rare outrageous mistakes that are
made. Who hasn’t made unintentional mistakes in life?
• The advent of "quickie" office visits has promoted dissatisfaction
with care that is often perceived to be inadequate and superficial.
• The persistent and unfounded expectation that doctors are
supposed to be perfect and never make mistakes is a myth
perpetuated in our society.
• Physician mistakes (doctor errors) must be punished severely--no excuses! Being human and making mistakes is unacceptable,
and irrational……. so many patients feel.
Where lack of trust of doctors has brought us today:
If you can attest to any of the issues listed above, you may have your
own axe to grind. You will have to do it soon, in view of the increasing
decline in numbers of medical doctors practicing in the USA. Doctors are
quitting practice 20 years sooner than one would expect. Why is that?
As the population increases and the number of doctors decreases as is
happening today as a result of our government taking over your health
care, reliance on foreign doctors, mid-level providers (CNMs, NPs, PAs,
and CNAs), and outpatient homecare by nurses are what you are looking
at for much more of for medical care in the near future. They are
already here and spreading rapidly.
Most of these substitutes are now an integral part of medical care we
can't do without. You may have already noticed that some of your care is
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slowly being transferred over to non-physician health care providers. Can
you trust them more or less than a doctor?
With less knowledge, ability, and experience than doctors, common sense
says you probably will have less trust in your medical care from them---or
maybe not?
Your lack of trust in your doctor may create the following
consequences:
• It will take a long time after that experience for you to
trust any doctor.
• You won't believe what doctors tell you to some degree.
• You will be hesitant to follow any doctor's instructions.
• You will gradually move from distrust to full blown anger
with your doctor.
• You'll find many reasons to skip appointments beyond
the usual ones.
• You feel that you are being overcharged for what you get.
• You will soon believe you are not receiving good care.
• You won't refer friends or associates to this doctor.
• Eventually, you will have to change doctors.
• You wonder why you put yourself through all this torment.
Your dislike for your doctor can't be hidden. You may cover it up with
pleasant conversation, compliments, or friendly smiles, but your body
language, voice pattern, speech mannerisms, and facial expressions will
tell a different story to the doctor, who is used to "reading" patient's nonverbal communications.
Because your doctor is no different from any of us, responses are similar
to what you would get when you are around someone who doesn't like
you. Of course, the doctor's reaction will be more subtle---even polite.
Think about these characteristic responses from the doctor that
you’ll notice when the doctor knows you dislike them:
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• You may get a floppy quick handshake when he/she enters the
room---and maybe a boring greeting---but both are not the kind
you give to a friend.
• Your visit with the doctor will be focused directly to the point of
your complaint, no social talk, no extended advice or instructions
that other patients are used to---and get.
• If you have several health issues nowadays, only one will be
handled at each medical office visit. The less time in the room with
someone who dislikes you, the better.
• Doctors do not cater to those patients who don't trust them or
dislike them. Doctors have enough stress without having to deal
with a distrustful patient. They don't need you!
• It’s well known throughout the medical profession that patients
who dislike their doctor, or don't trust their doctor, commonly are
the ones that eventually file malpractice suits. Think about it.
• Phone calls with medical questions are not returned, or one of the
office staff will respond sometimes. Every member of the office
staff knows what is going on between you and the doctor, and you
will get the cold shoulder from them as well--in a polite way,
of course.
• Doctors understand in these situations that whatever they do to
please a patient who doesn't like them, doesn't work. So why try?
They don't! If the situation becomes a significant problem for the
office, you will be told to find another doctor---sometimes even
before you have considered doing that. Would that surprise you?
Rarely does the dislike of a person disappear. It is an indescribable
phenomenon in many cases because it may be subconscious. No reason
for it at all, but it's there.
Most of us have met someone for the first time and had an instant dislike
for them. Why? One can relate it to a 6th sense. Our brain does its own
evaluations and judgments. Our mental computer puts every megabyte |
of information together in a millisecond and spits out to our conscious
mind a warning.
The computed information indicates that a continued interaction with this
person has a high probability of conflict. What you do with the warning is
up to you.
The other kind of dislike is one that develops over time. Usually, an
obvious reason for it floats to the surface. It rarely happens, but if you
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have the intestinal fortitude to confront the doctor face to face about what
is disturbing you, it can be resolved---maybe!
Resolution of the problem depends on the doctor's sensitivity to your plea.
You never know what response you'll get. It may be a condescending
attitude agreeing to your terms of surrender, or it may be a loud verbal
outburst heard at the other end of the office. Expect anything!
Most of the time the doctor will bend over backwards not to start conflict
and are reasonable. Since we all are creatures of habit, agreeing to your
terms of treatment is easy for the doctor at the time, but usually is
forgotten soon after---and everything resorts to the previous situation.
That's why even here, it doesn't work, and the old feelings of
dislike return.
For example, if the problem was that the doctor was always explaining
things rapidly or using big words you didn't understand, and you went
home every time confused about which medication to take, you would
constantly put yourself at risk if you guess about it.
The doctor then agrees to always speak to you in a slow manner using
everyday words you can understand. By the second visit after that, the
doctor is back to the old tactic. He had already forgotten about the issue
with this patient.
From a practical point of view, if a doctor has made 30 different
agreements with 30 different patients about 30 different issues, how can
he remember them? Yes, sometimes there are big red letters across the
front of your medical chart or on the computer medical record.
Doctors will not play this game!
It's a complete waste of time for a doctor to spend his time catering to
the whims of patients that are unhappy with his way of practicing. You
can't please everyone, but all doctors try.
Changing doctors comes down to one of three solutions:
1. Find another doctor as soon as a definite feeling of dislike for the
doctor or medical office environment begins! The doctor and office staff
may seem at the beginning to be perfect for you, but then it changes.
2. Find another doctor immediately in order to avoid the conflicts that will
later inevitably appear. In the first few doctor visits you will sense the
friction and discontent increasing.
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3. Find another doctor promptly, so you can leave the previous doctor
under pleasant conditions. Leaving under hostile conditions will harm you
in many ways—but not the doctor. You catch my drift? Patients that
display anger, quick to raise hell about dissatisfaction, and cause
disruption in a medical office are often well known in the medical
community, and avoided.
To answer the original question:
• If you dislike your doctor, then you don't trust the doctor either.
• If you dislike and don't trust your doctor, the doctor will know it.
However, the doctor can still be trusted to give you "appropriate”
medical care under those circumstances. Otherwise, they will suffer
the increased risks associated with bad medical practice.
• Appropriate medical care means here that the doctor who accepts
you into his practice has an obligation to diagnose and treat you in
a professional and proper way. But, there is no obligation to do any
more for you than is absolutely necessary.
• Any doctor's "passive resistance" approach to your medical care
becomes intolerable FAST!
“Joy, temperance and repose,
Slam the door on the doctor's nose.”
---Henry Wadsworth Longfellow
4. How To Handle Decision Making When You Are Skeptical
About A Recommended Serious Medical Procedure:
“Decisions To Incisions--Elective Surgery Is A High Octane Trip”
Of the two categories of medical decisions—elective and emergent—both
require deep thinking on the patient’s part. Some patients can make a
decision rapidly, sometimes instantly; while others must spend hours
considering options and take weeks to decide—even years on occasion.
The most acceptable decisions about surgery or other serious procedures
are made by rational considerations balancing benefits and risks. It starts
when the doctor explains the pros and cons of the procedure to the
patient and/or the immediate family.
Most patients approach decisions about having elective surgical
procedures quite differently than they do emergency procedures.
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Major surgical procedures create the most concern for patients, so I’ll
continue in that track.
Your decision to have surgery performed is unique to your own medical
decision-making process. What’s good for you may not be good for
anyone else.
Dictatorial attitudes of doctors that once prevailed throughout the medical
profession are for the most part gone. A century ago medical patients
knew very little about medical diagnosis and treatment. They had to rely
on doctors telling them what to do. Doctors at that time dictated to
patients almost everything necessary for good medical care.
The shift of medical care responsibility to patients themselves and
away from doctors makes you the decision maker, whether you prefer it
or not. That has been made possible only because medical patients today
know a lot about healthcare and medicine. Patients are exposed to
multiple medical resources for education and enlightenment about good
medical care—and bad.
Now that you know who’s in charge, it’s time to give you pointers that will
enable you to make your decisions easier and ones you feel you can live
with afterward—no matter what.
Your “Must have” requirements for making the best decisions:
• The decision to go ahead with the procedure(s) must be definite and
comfortable. No namby-pamby stuff.
• Must have full trust and confidence in the doctor who will do the surgery
or any other major procedure. Make sure it’s your doctor who will be
doing the procedure, not substitutes.
• You must have an understanding with yourself that the benefits you
expect in your own mind far outweigh the risks involved. Doctors are
expected to explain all the serious risks of a procedure. To explain all the
small risks of any procedure would take “hours” and you wouldn’t
remember them the next day anyway.
• Realization that what is being done will improve your physical and
mental wellbeing and health. Recognition that you would otherwise have
to live with the medical problem and the resultant health problems of not
having the procedure done.
• You must have a clear mental picture of exactly what is to be done, how
it is done, and what will happen during the recovery phase. The purpose
of a pre-operative visit is for the doctor to explain all those things to you.
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• You always need to be informed of the worst situation that could
possibly happen during or after the procedure. Surveys and studies done
on thousands of patients provide the most reliable probability for bad
results of any procedure and are available in the medical literature online.
In actuality, you have considerably more chances of being killed or
seriously injured driving you car than having a surgical
procedure performed.
Beyond these rules of engagement, are many more subtle and worrisome
aspects of the decision making process. Questions arise that haven’t been
answered. Fearful reminders of rare and serious complications may not
have been discussed (doctors are not required to tell you everything no
matter how rare or serious).
The worst possible risks and complications are mentioned by almost all
doctors purposely to avoid legal problems should those serious
complications happen unexpectedly.
You should prepare for the pre-operative appointment
needs:
1. Make a written list of questions to ask the doctor at your preop
appointment. Each question you had and forgot to ask at the preop
appointment will reduce your confidence in your decision another notch.
Over the last 50 years, a change in physician’s thinking and methods
relating to the preoperative management have come about. In my opinion
those standards of old have been corrupted completely.
In addition, the preop management has been moved from “intelligent
design” to “evolution theory” as so many other elements of our society
have suffered. I’m from the old school of medical thinking where medical
practice expediency did not exist.
The basic medical teaching I believe has remained unchanged, but has
been modified to conform to physician’s convenience, time management
and what our society demands. Let’s make that a bit clearer for you.
A surgeon’s responsibility for a surgical patient’s health includes:
* Appropriate knowledge and skills necessary to perform the
surgical procedure safely and efficiently.
* Knowledge of the medical history of the patient so as not to
allow any elements of the patients medical past to complicate,
or in any way add risk of any kind to the present intended surgery
in any fashion.
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* Responsibility to the patient begins when they walk into the
doctor’s office and ends when the patient is fully recovered from
the operative procedure—usually 6 weeks. That responsibility can
extend to many months because of post-operative complications or
the type of surgery or procedure performed.
What changes have been made and are now seemingly acceptable
to surgeons and other medical doctors in the USA?
Preop physical exams and a detailed medical history in the past were
the total responsibility of the operating surgeons or other specialists
themselves. The reasoning for that is the patient may have a physical
finding during the exam, which might be completely without symptoms at
the time, and yet cause an increased risk during or after surgery.
Examples of that might be such things as very
numerous and very large varicose veins in the legs
(post operative clots and pulmonary embolus) or a
loud noise heard over the neck arteries which
indicates a partially blocked artery leading to the
brain (not enough oxygen not getting to the brain
and a clot breaks off and causes a stroke).
The surgeon will always check for important physical
findings that he knows commonly cause problems
during and after surgery. He is quite alert to those
risks and then has solutions to reduce those risks
during the surgical procedure.
The two changes that may increase surgical risks is the fact that
many surgeons do not do their own preop exams on their
preop patients.
In many cases, the surgical patient is sent to an Internist specialist doctor
to do the preop physical exam for the surgeon. Internists do very good
exams to be sure the patient can tolerate the surgical procedure.
The problem with that is that the Internist does not look at the patient
as a surgeon does. Internists are not surgeons and are not aware of the
things a surgeon might consider a risk, and the Internist doesn’t.
The second issue is that often no preop exam or appointment is ever
scheduled. I had a large thyroid nodule removed by a reputable surgeon
and no preop appointment or exam was ever done. That is unacceptable
for good medical care, even though I am a physician.
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I practiced over 30 years in a different specialty that left me without
memory of thyroid surgery complications. That did not excuse the
surgeon from explaining those things to me, regardless.
From the time I met the surgeon the first time when he looked at
some of my thyroid scan photos, thyroid biopsy reports and felt the lump,
to the time I recovered from the surgery, absolutely no one put a
stethoscope on my chest or did any form of even a short physical exam.
Why did I not object? Because as a physician myself, I knew what
physical shape I was in already and it didn’t need to be re-verified by
the surgeon.
If I had been a regular patient, I certainly would have objected and
pointed out his deficiency. Patients should always question everything
that they expect to happen which wasn’t explained to you.
The question remains. Is this what he does with all his patients? I
don’t know what studies or surveys have been done to discover what is
considered now to be acceptable, relating to preop exams, but I would
predict the majority of surgeons do the same.
One final comment. One of the special advantages of having a preop
appointment with the surgeon is the opportunity to ask more questions
about the surgery, the risks, your concerns, and making your requests, if
any. If the preop exam is with an Internist, these opportunities don’t
exist. Is the Internist qualified and knowledgeable enough to answer
you surgical questions? Probably not.
Certainly the one minute the surgeon appears at your bedside in the
preop room immediately prior to the surgery, after you have already
received your preop meds, is a time when voicing your concerns to the
surgeon often will go unanswered. Substituted for you concerns are a few
words of reassurance from the surgeon.
2. Organize family, job and other work schedules to avoid demands on
you during this surgical time in your life.
3. Always expect more hospital and recovery time than is estimated. This
has the purpose of preventing disappointment of your being kept in the
hospital longer than expected. This extension has the effect of making
you feel that you aren’t recovering from the surgery in the normal length
of time, when it may be totally normal for most patients.
4. Don’t try to alter your weight, readjust your nutrition patterns or read
a bunch of medical articles about the procedure you are having done. It
leads to interference with the body’s metabolism and healing functions.
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Articles tend to lead to more confusion about your situation and
your decision.
Factors worth considering about your upcoming surgery or
procedure scheduled:
1. Doctor’s experience: How many of these procedures has this
doctor done, and what is his complication rate?
2. Delay surgery: Maybe it would be better to wait to have the
procedure done until you have more symptoms, or are mentally
ready to go through all this.
3. Wrong advice: Do you need a second opinion about this
procedure and the need for it? Maybe your doctor is one of those
rare doctors that are knife happy and need the income. Don’t be
afraid to ask for a second opinion.
4. Wrong reasons: Are you being pushed or intimidated into
having surgery? If so, cancel the surgery. Alternatively, have the
surgeon schedule it at a time that you want the surgery done for
your own personal reasons.
5. Unreasonable expectations: If you wind up among those few
patients that expected perfection with and after the procedure, and
the results were poor because of complications, it’s wiser to
understand that your surgical results will rarely meet what your
mind had envisioned as perfect results.
Know that any surgery has risks and unforeseen complications can occur.
Take a few minutes to ponder the differences in your thinking between
elective and emergency surgeries. Since “elective” surgery means the
problem is not life threatening, not causing significant intolerable
symptoms, and is a matter of personal choice, any rush to final
medical decision making is unnecessary.
Emergency medical problems implies that there is a significant medical
problem present which is commonly treated by surgical or medical
measures. It may not be life threatening, but may cause considerable
pain or distress.
Decisions about your elective surgical procedures:
Struggling with your medical doctor’s advice that elective surgery would
benefit you, isn’t nearly as difficult as making your final decision to have it
done. It’s a fact. Very few patients let logic, risk of complications, or
friendly advice stand in the way of the emotional vision of their
expectations from the procedure.
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The perception of the value and benefits takes on a life of its own.
You may find that your mind is made up for your having surgery before
ever going to a doctor for evaluation. It’s just the opposite of how your
mind works when major surgery is involved.
Elective surgery is always a positive venture for you. The decision is very
easy to make and the complications that might arise is disregarded. Your
emotions are the fuel that drives the decision, not logic.
Maxwell Maltz, M.D. wrote a book in the 1960s, Psycho-Cybernetics,
in which he defined the relationship between logical thought and
emotions. In his work as a plastic surgeon, he became aware of how
powerful the emotions are in overcoming what the patient perceives as
their being ugly looking.
Dr. Maltz found that patients who arrived in his office strongly believed
they looked ugly and needed surgery. He would sent them home after
giving them his view on why they are not ugly. They were asked to do
some mental exercises that would help them to see the truth about
themselves. After a few weeks, most returned and cancelled
their surgery.
Fifty years later his book and ideas remain unchallenged.
Decisions you make concerning major surgery:
When you start thinking about how you would
make medical decisions, if you should need to
have major surgery, the first emotion you feel is
immediate confusion. Your decision about
agreeing to the recommended surgery is made
only at the end of your investigation once you
understand all the risks, benefits, and reasoning
related to the surgery.
Contrary to the motivation to have elective
surgery, which benefits a person emotionally,
decisions about agreeing to major surgery is like
staring down the barrel of a make-or-break
moment where your decision stems from your
unconscious survival mode.
It’s not a decision made for health reasons only, but is also made out of
one’s personal devotion to family, commitment to continuing life, and a
profound realization that one has not finished their real purpose in life.
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The complexity includes elements of religious belief, the desire to remain
productive in life and not a burden to others, and the peace of mind that
comes with finally making a decision about surgery being done.
“I think we should follow a simple rule: if we
can take the worst, take the risk.”
---Dr. Joyce Brothers
5. Health education barriers that keep you from
receiving top medical care:
A commonly held belief about educating yourself about medical issues is
that even if you have read all the healthcare and medical books in the
world, when you get sick you still have to see a doctor for diagnosis
and treatment.
The huge number of benefits that result from your being knowledgeable
about medical problems is always underestimated. The smarter you are
about medical care and about how the healthcare system works, the
faster you discover how to get the best medical care from any doctor.
By learning how to use the many simple strategies for manipulating the
medical care process for your benefit, the more ability you will have to
easily and quickly propel your healthcare to top.
This article tells you how to do that in abbreviated terms. How much
importance you assign to maintaining your health defines your
responsibilities for improving it.
Obesity is an example of those who consider their health secondary in
importance to other things—namely eating. The decision about dieting is
difficult and often never made. People accept the consequences of obesity
on their health like increased risk or hypertension, cancer of the uterus,
heart attacks, diabetes, among others.
Medical doctors, in a sense, are moving from a position of directing your
medical care to a position of assisting you in your health care.
What does that mean to you?
Perhaps you know it already. Nothing is more important in your life than
the status of your health. From brain function to trimming your toe nails
requires every function in your body be purring in unison.
The more enlightened you are about medical care and health problems,
the more value you are to yourself and to others.
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Good health isn’t automatic. Your personal responsibilities for maintaining
and improving your health are a lifelong obligation—not a privilege. If you
don’t comply with what health care providers including home health care
nurses are telling you to do, you are choosing to suffer the consequences.
Just to give you a few examples why self-educating yourself about health
care and medical diagnosis and treatment will always be of extreme value
to you:
A. During your life you will be in places where doctors are not available,
or are hundreds of miles away. Many people walk wilderness trails,
mountain climb, hike into dangerous terrain, and put themselves in
situations where accidents happen.
A few years ago a young man hiking alone fell into a rocky crevasse. A
large boulder pinned his arm down and he couldn’t free himself. He
understood after about three days he would soon die without water.
Rescue was out of the question in his circumstance and would be too late.
He used his knife to cut off his arm and escape. He knew enough about
medical care to save his own life.(Real event and story)
Many true life stories circulate about life saving events where someone
has medical knowledge enough to know what to do and not to do to
save a life.
B. More important is the intentional decision to learn about your own
medical problems.
It means if you are a diabetic and control it with insulin you can keep
yourself functional by learning everything you can about diabetes. That
way you know what’s happening to you based on certain symptoms and
make your own adjustments of insulin to compensate.
You can’t have a physician follow you around 24/7 to do it for you.
For diseases that are not curable and are not fatal, patients learn
continually how to treat their symptoms, what treatment does the best
job at relieving those symptoms, and what doesn’t work at all.
Diseases like Lupus, rheumatoid arthritis, chronic pain syndrome,
fibromyalgia, tinnitus, interstitial cystitis, and migraine headaches make
your life miserable. Doctors don’t have cures for these diseases plus
many others. At least some medications reduce some of the symptoms.
Doctors prescribe the usual recommended medications, try new drugs,
use combinations of drugs and end up giving up on being able to help
patients. Doctors then refer those patients to the large medical centers,
such as the Mayo Clinic, for evaluation and help.
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The miracle is that some of those patients themselves find out more
about their medical problems and their treatments than the doctor knows.
It’s a fact. During their intense search for relief of their symptoms,
patients may even find their overlooked diagnosis for their medical
problem. Their search may lead patients to treatments that no doctor had
thought of. Their symptoms drive them to continue learning.
For these patients who suffer so much and their doctor has given up on
them, patients either seek other alternative therapeutic methods, move
from one doctor to another hoping the next one will have an answer
(some find that doctor).
C. The greatest value of your medically educating yourself has two sides.
First, it’s widespread knowledge among physicians that the easiest
patients to treat are the ones who have the most medical knowledge
already. When patients don’t have a grasp on what is happening to them,
they must be educated by the medical team. Meaning more time and
effort required for their medical care.
Second, patients who are savvy about health and medical treatment often
have the advantage of diagnosing their own medical illness even before
they get to the doctor. Additionally, they are quick to recognize the
difference between a serious symptom or sign and one that is minor and
can be watched for a while.
These patients get to the doctors sooner, are more easily cured before
the illness has led to other serious medical problems, and often will start
treatment on themselves promptly. On occasion they even treat the
head cold and prevent a secondary pneumonia. Not that any patient
would ever think of using those left over antibiotics remaining that they
never used up the last time…..right?
Probably the tools that have made the world knowledge of health and
medical issues so readily available to patients are computers and the
Internet. Most people now know how to operate computers and use the
Internet to find things. The wonderful aspect of these tools is that
patients need only walk across the room at home and punch in
their computer password to get rolling on their search.
One other important objective for health education is to have
enough medical knowledge to use to help others involved in sudden
medical emergencies. How many times have you witnessed someone
having a seizure and wondered what to do to help?
Have you any knowledge about performing CPR resuscitation on a person
who isn’t breathing? What about knowing how to perform the Heimlich
maneuver to save the life of a person who is choking with an airway
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blockage? Hundreds of lives are saved each year because of someone in a
restaurant who happens to know how to use Heimlich maneuver to
unblock the airway of person with a trachea blocked by food aspiration.
Those people who have spent their lives never learning medical things
have a number of significant disadvantages as pointed out above. Being
able to judge if a symptom indicates a serious problem or not, would be a
good start.
Mothers with small children seem to have a special intuition about the
seriousness of their child’s illness immediately.
How health care works today:
• You are now offered “choices” instead of “being told” what is
going to be done. You must be medically knowledgeable enough to
make the right decision/choice for yourself. Health
education is key.
• Your time with any healthcare provider is so limited that you are
now being forced to resolve your healthcare questions another way.
• Your resources for health information have changed from a
quickie office visit with the healthcare provider. Doctors used to
provide medical information handouts for patients. They now leave
the medical information for you to discover.
• Your ability to speak directly with healthcare providers for
medical information has become severely restricted. Now, you
must rely on second-guessing whether the office staffer’s answers
are correct, complete, and reliable.
Suspicion may arise about whether the information comes from the
office employee or from the doctor, and then transmitted to you.
I once consulted on a case where the office nurse responded to a
phone call from a patient 3 weeks post major surgery complaining
of great difficulty “getting her breath”. The doctor was unreachable
at the time. Because of the patient’s prior history of pollen allergies
the nurse advised the patient to call back in the AM if her
symptoms continued or worsened.
The patient expired in the hospital emergency room several hours
later as the result of a pulmonary embolus—blood clot that moved
from her leg to her lungs causing difficulty breathing. The patient
should have been sent to the emergency room immediately at the
time of her phone call to the nurse. A pulmonary embolus is a well
known often fatal post operative complication after major surgery.
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• Second hand medical information is well known to be
unreliable….even dangerous on occasion.
For these and many other reasons you will increasingly need outside
resources for reliable healthcare information which will at least help you
to maintain adequate healthcare, if not improve it.
Your health responsibilities, however, go well beyond becoming an expert
about your own medical disease problems. Your family will expect you to
be their healthcare advocate as well.
Once you discover where you can find reliable healthcare information,
whether it’s online at Cullmanchat Medical Forum, from a home health
care nurse, or by reading articles about health, you become a highly
regarded asset to your family and friends.
Talk about a way to improve your self-esteem! Wow!
So where are those reliable sources for health education
you need?
1. Physicians— online doctors or in the medical office.
2. Internet— trusted medical websites or websites publishing
peer reviewed info.
3. Healthcare Institutions— hospitals, clinics, and doctor offices.
4. Medical Educational Facilities— medical schools, local
community colleges, medical teaching hospitals.
5. Internet Article Directories— where medical information is
peer reviewed, meaning it’s more reliable information.
WebMD.com online is a great one.
6. Public Libraries where health education and information are
often provided in many formats, such as CDs, MP3 audios,
downloaded/printed from Internet sites, medical newsletters,
email advice or recommendations, articles about health,
and others.
There’s another responsibility you have beyond all those mentioned
above. Want to take a guess what that is?
Applying your health education and medical information
aggressively…… is the answer.
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Just learning all you need is not enough. You have to use it in
a beneficial way both for yourself and others.
As an example, weight loss is a hot topic in the media today along with
dieting and special diet programs. If you’re depressed about your weight
problem, seek immediate mental health services for help.
Why do most people know what to do, but never do it? The answer to
that question is multi-faceted and quietly resides inside each person’s
mind. A common reason for procrastination and inertia is way beyond
problems with motivation, desire, goal setting, self-intimidation
and distractions.
No one takes time to tell you exactly how to lose weight effectively.
It’s a fact that has long been neglected in the medical community.
How many times have you been told, “Lose some weight, get yourself
together, or forget all that dieting crap.” How often does anyone then go
on to tell you the best, fastest, safest, and proper way to go about it?
Nobody! Doesn’t that fry your oysters?
If anyone has an impulse to do something and doesn’t know how, how do
you think most people react to that? You bet—put it off for a better time
(which never comes), find something easier to do, find someone to do it
for you. Unfortunately, it’s exactly the way people react to healthcare
problems and issues.
If you know and understand the what, how, why, and when about some
area in healthcare you want take action on, you are much more likely to
go at it.
Ask yourself these questions:
1. If I knew exactly how to improve my health, would I likely
go ahead and do it?
2. If I knew where I could find legitimate reliable healthcare
information, would I feel more secure about how I am
being treated medically by my doctor?
3. If I have a place that explains healthcare issues in an
understandable way, wouldn’t I be able to get much more
out of my visit with my doctor?
4. If my medical and healthcare is worsening, wouldn’t it be
smart to dig into the health education information available
to me and benefit from it?
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Comment:
Eventually everyone will be taking on all these responsibilities. The
problems with our health care system being taken over by Obamacare
and our government will require it—unless you have no plans to live
long enough to ever enjoy your grandchildren.
The solution to better healthcare is knowing what to do and how to do it
by diving into every source of health information available. Health
education materials are available nearly everywhere…..grab ‘em!
My personal recommendation is to subscribe to a few of the elite medical
center healthcare newsletters that contain a variety of medical topics and
articles written on a level you can easily understand.
Many other large medical centers across the nation publish a medical
newsletter besides this list. On the computer, type in the search line the
name of the medical center. Google will give you a list of websites about
those keywords. You will find out what newsletters they publish, what the
newsletter is focused on medical wise and how to subscribe.
Harvard Health Letter,
Mount Sinai School of Medicine Focus,
Duke Medicine Health News,
Massachusetts General Hospital Mind Mood Memory,
Weill Cornell Medical College Women’s Health Advisor,
Mayo Clinic Health Letter,
Cleveland Clinic Health Advisor.
6.
Barriers To Healthcare Caused By Not Knowing
How To Navigate The Health Care System:
Medical care dead ends should never happen—but do, for some patients.
Learning how the system of healthcare works, how to use it to your
advantage and how to avoid the pitfalls of the system is important.
If you choose not to pay attention to how healthcare is managed, you will
continue to be frustrated every time you engage the healthcare system.
First, you need to understand human behavior enough to know the
frailties of people who work in the system. Once you are aware of those,
you can anticipate the problems that arise from those factors and learn
how to avoid them, bypass them, or overcome them.
Human frailties that dominate our society today
(to name a few):
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_
_
_
_
_
_
_
_
Incompetence
Poor work ethic
Avoid responsibility
Promises never kept
Common courtesy lacking
Appeasing people with lies or B.S.
Selfishness
Procrastination
It has been estimated that every person who works in the healthcare
system has some degree of each one, the same as everyone else today.
One would think that a person employed by the healthcare system (any
medical facility), would be a notch or two above the usual caliber of
employees in any business. They aren’t, excluding the medical providers.
When you encounter any person anywhere, be aware of their frailties and
expect the best from them. Then, plan for the worst from them.
One of the most common examples is, “I’ll call you back.” You know from
your own experience that there’s a 95% probability they won’t call you
back. When you call into the doctor’s office, you know that there’s a high
probability you will be put on hold or disconnected somehow.
What’s the best time of day to call the doctor’s office?
Answer = mornings. Why?
a. Because employees are more alert in the morning.
b. The usual pile of problems has not yet advanced to chaos.
c. 10 AM is when they get caught up on morning chores and
have more time to answer the phone without rushing you.
Call between 10:00 and Noon and you will connect with
office staff that are much more courteous and helpful.
Hardly anyone sticks to her or his word. Your approach should be to
remind them repeatedly to do what they promised. There are two good
reasons to do that.
1. Your gentle reminder said directly to a medical office staff
member is intimidating, makes them feel incompetent or like
someone who BS’s patients. No one wants to be recognized
like that so they will likely do what they said they’d do, at
least in your case.
2. Patients are the only ones to point out frailties. No other staff
member is aware of another staff member getting away with
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manipulation of patients, by not keeping their word to
patients. You become the watchdog here.
The best time to make your doctor appointment for is mid morning or
mid afternoon. That portion of the appointment schedule is when the
office normally functions more efficiently, and you won’t be sitting in the
waiting room so long.
At that time the office staff has caught up for that half of the day and the
doctor has reached a point when they are now seeing patients right at
their appointment times. The second reason is that the staff members are
more efficient because they are anxious to get a full 60 minute lunch time
or go home at the end of office hours for the day. They don’t like to run
overtime nor does the doctor.
At those times the doctor becomes more efficient with the patient
schedule because there is always a committee meeting, educational
lecture, or other business that needs attended to at the hospital at noon.
Being late to meetings frustrates most doctors who are conscientious.
Besides, the hospital often furnishes lunch for them when they
attend meetings. Just don’t tell anyone that I told you that!!
Walk-in lab tests to be done, are best done in late afternoon if possible.
Consults ordered by your doctor for you should be done within 3 days.
If not, there’s a problem and you need to call the consulting doctor and
ask why.
Fit-in appointments--Should you need to see the doctor right away and
you have not made an appointment, you can usually walk-in and be seen
by waiting and being fit into the appointment schedule. When patients are
friendly and known by the office staff as being a pleasant person, it
creates an environment that caters to your needs. You earn special
treatment and get it. Others will usually be put off until the next day.
Inpatient hospital problems--If you are an inpatient in a hospital and
you are fed up with the way you are treated, you should ask to speak
with the nurse supervisor first. When your complaints are not
resolved, you have the right to sign yourself out of the facility.
Some patient’s don’t know that. They believe their doctor has to
discharge them. The release papers you sign to leave the hospital against
medical advice say that the hospital will not be responsible for what
happens to you medically after you leave. That’s not a problem for you,
because your attorney can get around that issue if needed later.
Medical records---Copies of your medical records are available to you
legally. Go to medical records department and pay the fee required for
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copying the records, confirm your identity, and keep those records in your
home files permanently. Not very many patients take advantage of this
opportunity, but it’s smart to do.
Years later, you won’t remember much of the real details of your hospital
stay. When you have the copies of your records, you can copy them for
any medical doctor or medical use and save the cost of obtaining them
from the hospital over and over again for future needs.
The average patient should know the details of their hospital stay for
many reasons. The pathology report on the tissues removed, the
medications you received, progress notes made by the doctors, and other
parts of the records are important, and you need to know. Occasionally,
those notes and information reveal disturbing information you wouldn’t
find out otherwise.
As a patient, you also have the right to speak to the top hospital officers if
you choose. Never use threats to get people to respond to you because
two things usually happen if you do.
Nurses will avoid you as much as possible and provide you only basic
required medical care—just enough to get by with.
Also, threats immediately create a permanent barrier to any form of
communication with the hospital personnel. If being nice to start doesn’t
work, then all other options are open. Let the hell-fire roll.
Changing Doctors---If you choose to leave your doctor’s practice and
change doctors, never leave in a hostile manner, swear, make a scene
in front of all the other patients or threaten anyone, even if you have a
great urge to punch someone in the mouth. Flood them with compliments
as you leave, even if the door happens to slam shut on your way out.
Any hostile actions on your part somehow magically get over to the new
doctor’s office staff and your reputation as a troublemaker spreads. Many
offices will not accept such a patient into their practice.
Because patients have reached the level of dominating their own medical
care in one way or another, life as usual in the doctor’s office has also
changed considerably, and maybe not so pleasant for patients.
Patients are much more selective of who cares for them in today’s world.
They also are making more demands on their doctor to comply with their
needs. Medication ads on TV drive patients to insist on prescriptions they
heard about and want to try. Patients push doctors to do medical testing
that isn’t really medically indicated at times.
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Doctors, on the other hand, have tightened their control of patient care to
the point that patient filtering is common. For example, about 30% of
medical doctors have stopped accepting Medicare patients for financial
reasons—government dictated fees aren’t high enough to cover the care
patients receive.
Doctors sometimes preselect new patients to fill their appointment slots
who have health insurance that does at least cover their overhead costs—
enough to be able to keep their office open. Many medical doctors have
incomes far less than yours, which is why so many are now quitting
medical practice.
Why medical doctors are quitting medical practice
in droves:
You may not believe the truth about what is happening in the medical
profession for the past decade—doctors are quitting medical practices
in droves.
All you hear about this unrelenting process are articles written now and
then about the problem with no real solutions—just nudges by
professional medical educators to show that at least some effort is being
made to relieve the attrition of doctors, which is like a frog trying to
swallow an elephant.
A while back AARP, American Association of Retired People, published an
article titled, “Where Have All The Doctors Gone.” The article gave a good
description of the problem and reported on some thoughts about solutions
for the crisis.
The biggest change in healthcare providers today:
This leads into the next major change doctors in private practice, as well
as managed care systems, have incorporated into their health care
structures. Now you are reading articles about midlevel medical care
providers who have stepped into the action thereby filling the void of
medical doctors.
These midlevel care providers are known by such names as Physician
Assistants (PA’s found in many medical specialties), Certified Nurse
Midwives (CNM’s handling OBGYN problems), Nurse Practitioners (NP’s
who work in many specialties of medicine), and Nurse Administrators
(NA’s who function in the administration of health care needs).
It’s appropriate now to state that all of these mid-level health care
providers are well trained and contribute reliably to patient care. You see
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them often in your contacts with medical care facilities, often mistaken for
physicians because they also wear long white coats and actually perform
many of the medical diagnostic and treatment functions that only doctors
performed in the past.
These mid-level providers are required to work under the supervision of
medical doctors. However, these supervisory rules are widely defined and
poorly regulated for the most part. Meaning, the mid-level providers are
given a wide array of medical responsibilities for medical care based on
their knowledge and abilities.
Some treat patients for long periods of time with basically no supervision
on a day to day basis. Some doctors allow the trained and capable midlevel providers to do an extensive scope of medical care activities, while
the same mid-level provider working under a different doctor may be
quite restricted in their medical duties.
Medical doctor supervisors vary considerably in what they permit the
mid-level providers to do. The reason is that the physician is entirely
responsible for every medical care action a mid-level provider does,
advises, prescribes and teaches. All mistakes they make put the doctor
in jeopardy and legally subject to punishment for any offenses that arise.
In the future of medical care, there is very little doubt that the majority
of health care will be in the hands of mid-level providers. Only the
patients that can’t be safely managed will be referred to a doctor for care.
It’s logical because the dwindling supply of medical doctors will never
catch up with the population growth. It’s sensible because there are no
alternatives that can take the place of mid-level providers. It’s desirable
because it’s the only method of continuing to provide medical care in
adequate amounts to the rising population.
The efforts of the 142 or so medical schools in the USA and Canada to
provide more doctors fall well short of the need. About 10 new medical
schools are planned to be built, or have begun construction. Most medical
schools have agreed to increase the size of medical student classes by
about 15 new students each year (A laughable number).
Medical schools can’t begin to solve the real problem of
decreasing doctors.
Another problem with these feeble efforts is that about 50% of medical
students graduating are female doctors. It’s reported that about 50% of
female doctors practice only part time, thus decreasing the availability of
physicians to treat patients. What do you think that does to the
availability of medical doctors?
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Why are male college students choosing other professions instead of
medicine? The answer is not a secret. College students are smarter than
the medical recruiters are. College level students already know that they
can make a lot more money and live a happier life in a business
profession rather than practicing medicine.
The unplanned rise in foreign doctors treating patients in the USA seems
to be another way of satisfying our health care needs, but increases the
skepticism of patients regarding the quality of their medical care, which is
influenced by cultural beliefs inherent to foreign doctors.
7. Secondary barriers to your medical care you may
not have considered or realized:
What you need to know and understand about the causes of this medical
healthcare crisis will absolutely affect you and your family considerably.
You need to know because the causes are the formidable barriers to your
medical care that exist today and will increase in the future.
Additionally, barriers that even physicians face today in the practice
of medicine converge on the increasing difficulty you have in obtaining
your own medical care. As the restrictions on medical practice increase,
your medical care availability will be restricted as well.
The interference with the practice of medicine, especially involving private
medical practice outside of the managed medical care systems, can be
categorized here for better understanding. However, when these elements
are interfering all at the same time, doctors become exceedingly unhappy
with their profession, patients are disturbed and rightfully so, and all
health care is becomes ruthless.
Several obstructions physicians (and you) are facing now:
1. Governmental control of health care and restrictions
on doctor fees.
2. Medical malpractice effects on medical practice forces doctors
to do unnecessary lab tests, procedures that aren’t medically
necessary and makes doctors the scapegoat for
healthcare costs.
3. Legal solutions to medical malpractice are intentionally
prevented by trial attorneys in the legislatures of most of
the states by prevent “caps” on malpractice verdicts.
Who wants to give up their “cash cow”?
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4. Overwhelming educational debt doctors’ face when training
is complete. The average is about $150,000.
5. Complete neglect of medical educators to provide foundational
business education for doctors. Doctors enter medical practice
and run the small business without one lick of knowledge
of how to make a medical business profit, grow and survive.
It would take the contents of a full 1,000-page book to cover each
obstructive process above.
Here we must crunch it down to paragraphs, which will open your eyes to
the fact that we have an irresolvable and worsening situation that can’t be
fixed, at least in the next 100 years.
More detailed information about the worst barriers for
doctors:
1. Government control:
When doctors are asked to see and treat patients who are on government
run health programs like Medicare and Medicaid, doctors lose and quit.
What the government is really saying, “the fees we are allowing you to
charge us may not be sufficient to cover your office overhead, but we
expect you to care for these patients anyway, even if your practice fails.
You are being forced to survive in relative serfdom, and you can’t do
anything about it.”
Would you try and find another way to make a better living? Most of us
would and that’s exactly the issue tormenting all doctors today, even the
ones in an employed status. What’s happening today? Private physicians
stop seeing patients on Medicare and Medicaid.
Most doctors believe that the government will find some way to force all
doctors to see these patients regardless. When doctors do agree to see
Medicare patients, and are losing money, then they have no alternative
but to find ways to make up the income loses by dropping patients with
lousy paying health insurance and replace them with patients with good
paying insurance.
You can envision yourself being booted out of your favorite doctor’s
practice. Other doctors limit their practices to patients with the need for
high paying medical or surgical procedures, or even convert to a “cashonly medical practice” as many are doing today.
2. Medical Malpractice Risk:
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As a result of an increasingly litigious society, especially in the medical
care segment, all kinds of protective methods have been implemented in
virtually 100% of medical practices to reduce that risk.
That process of protection is exemplified by filtering patients a doctor is
willing to take care of, eliminating areas of their practices that are
not income producers (like stopping delivering babies), and ordering
many more tests and exams than is reasonably needed so that they can
be sure they haven’t made a rare medical mistake they could be sued for.
What happens in these circumstances?
• You may have to find another doctor.
• You may be seen more often in the practice.
• You may have to sign an arbitration agreement.
• You may develop a disease that necessitates your being
dropped as a patient.
• You may be blackballed from many medical practices when
you are known as a high-risk patient for suing doctors. Yes,
maybe it’s unethical to do that. But, refusal to take on a new
patient can be easily and ethically excused by saying it in
a different manner, “We are not accepting any new patients.”
• Malpractice cases can and do destroy a doctor’s profession, his or
her reputation, and destroy their lives. If that doctor remains in
practice afterwards, they change the way they practice and
increase their defensive measures to the hilt.
It only takes one mistake to do it, and their life profession
and income is destroyed. You as a patient can see the
barriers you will have finding the right doctor for you.
The average number of malpractice suits filed in California against
OB-GYN doctors reveals that about one medical malpractice case is
filed every three years in private OBG practice in California.
The other way to look at the rate, about one out of three doctors has a
suit filed against them every year. Would you take such a high
risk yourself?
3. Malpractice Law Reform:
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What most patients fail to understand about medical malpractice
litigation, is that the injured patient in every case always receives a fair
and substantial settlement to cover for the future medical care
necessitated by the medical damage.
The separate jury verdict issue regarding outrageous high jury verdicts
for settlement for “pain and suffering” continues to be the single
circumstance and issue that needs reformed legally. They are called “runaway verdicts.” Imagine yourself as a patient receiving eight million
dollars for pain and suffering as a result of a breast implant problem.
Mind you, this is $8,000,000 million dollars above the verdict amount to
pay for all future medical treatments of the problem. It’s just for “pain
and suffering” only.
Very competent plaintiff (patient) attorneys, who convince a very
sympathetic jury that an injured patient should be compensated at such
a high figure, earn a fortune off such verdicts. Who wouldn’t want that
kind of income—about 30% of the verdict?
About four or five states have resolved the issue by putting a monetary
cap on the “pain and suffering” part of malpractice verdicts. In those
states, doctor’s malpractice insurance premiums remain much lower and
reasonable compared to states that have no cap.
That’s the reason you often hear about in the media that doctors are
moving to a different state in large numbers. It has happened in
Pennsylvania, Massachusetts and Nevada in the near past.
Why haven’t the remaining states passed statutes to cap those
verdicts as well?
The answer is very clear. Since most legislators are attorneys, and the
trial attorneys lobby is so powerful, a cap will never be passed now
because attorneys refuse to destroy their “cash cow”. It is definitely
greed on their part.
Doctors practicing in those states continue to pay excessively high
medical malpractice insurance premiums causing large numbers to move
to other states. They can’t earn enough in practice to afford the
cost of malpractice insurance—up to $200,000 or more per year.
When doctors are forced to move, you lose your doctor. Is that physician
barrier one that is a barrier to your medical care as well? Absolutely.
4. Overwhelming Medical Education Debt:
Well, that’s the doctor’s problem, not mine…right? Wrong!
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Surveys have revealed that the average educational debt owed by a
doctor at the time of their graduation from medical school is $150,000.
That doesn’t include the additional costs of post graduate education for
becoming a specialist over the next 2 to 6 years. Unless they come
from a very wealthy family, a doctor is already in over his
head before he even starts his practice and makes some money.
Do you believe there might be a little financial stress on top of a
malpractice risk stress at the time they start practice? You bet.
How long does it take a doctor to pay-off such a large debt…5 or 10
years, or more? What do you think most of those doctors do to solve that
debt problem? If you’re penniless, you certainly would look for a job as
an employee. Doctors go to work for managed care hospitals and clinics
on salary.
If you don’t belong to an HMO or PPO managed care group, those doctors
are not available to you. You are left with a decreasing pool of private
doctors to choose from. Maybe you even might have to drive 100 miles to
the doctor’s office.
Does that create another problem for you? Can you see the step-by-step
evolution involving all these barriers doctors fight every day and how it all
relates to barriers you recognize obstructing your own medical care?
5. The impact of running a medical practice when you were
never taught how?
I’m quite sure you are familiar with the reputation of doctors being “lousy
business people”. There’s a reason why, and the truth to be told. Medical
educators hold on to the traditional dogma that all a doctor has to do to
be successful and make lots of money is graduate from medical school
and hang out his shingle. It’s the same story today.
Every entrepreneur and successful businessperson knows that businesses
only survive and become profitable when the business principles are
applied and business systems are in place. Over 90% of graduating
medical doctors neither understand nor were ever taught anything about
successfully running a small business (medical practice).
They are sent out to fight the battle with no weapons. This is also true for
other medical professionals, like dentists. Obviously, doctors are doomed
for failure in their business activities. The lack of business and marketing
knowledge cripples doctors for as long as they practice.
No one in the last hundred years has done a thing to improve medical
practice survival. Why?
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The top business and marketing experts in the world who have worked
with medical doctors recognize this business educational deficiency
repeatedly. Without the help of business experts doctors will never have
the opportunity to reach their maximum potential and income.
The result is that doctors achieve at best a mediocre medical practice,
surrender to having someone less knowledgeable run the business of
their medical practice, and may even leave a million dollars on the table
that they never recognized was there to be had.
Now, with these factors in mind, you can get an idea about why doctors
are disappearing into other occupations. You surely must see how much
of an impact this makes on your own medical care barriers. Imagine how
much better your doctor could be if they had enough money to expand
their talents, knowledge, and skills far beyond where they are now.
Bunching all five doctor-barriers together and envisioning what happens
when all these factors are affecting their medical practice business at the
same time, leaves a picture that is not pretty.
Doctors choose the career they want and are responsible for every
consequence that comes along. It doesn’t mean that your personal
understanding about their battles doctors are fighting can’t serve to
improve your rapport with your, which in turn will significantly improve
their care and treatment of you.
“We make a living by what we get,
we make a life by what we give.”
---Sir Winston Churchill
8. Money barriers to the best healthcare:
The huge tragedy created when all medical malpractice
insurers moved out of California.
One day every medical malpractice insurance carrier stopped covering
every physician in the state of California because of the cost to them of
“run-away jury verdicts” in medical malpractice cases—1970s.
Since most malpractice cases stemmed from the poor segment of the
population, most doctors began weeding out all the Medi-Cal welfare
patients from their practices to reduce malpractice risks. It was a
sensible decision considering they had no malpractice coverage anymore
and any case would put them out of business and possibly their career.
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I kept one or two Medi-Cal patients in my practice simply because I liked
them as people. This patient I’m talking about knew what was happening
and that I was one of the few doctors who kept a few Medi-Cal patients in
their practice.
Remembering one of my special patients always brings a smile to my
face. She wasn’t smart and never made it to high school. Although she
was far from pretty, her vibrant personality more than made up for her
rambling chatter, pudgy belly and welfare lifestyle.
There wasn’t a single time she came into my office and didn’t become
friends with everyone in the reception area. She usually began by telling
everyone about her dog named “Bingo”.
Medically, she had very few serious medical problems. I can’t remember
how she happened to enter my medical practice, but she remained our
patient until I left the area.
Being poor, living on their small farm with her one-armed husband, and
the enjoyment she radiated about her life was magnetic. From her first
visit to the last, beginning prior to the insurance crisis, she always
brought in various foods from her farm to share with us.
She brought in sometimes jars of canned vegetables she had canned.
Other times, she brought in cucumbers or small melons. It was something
any warmhearted person might do.
Another connection to poverty in my early upbringing from age 10 to 18
was living around poverty. As a teenager raised on my grandparent’s
small farm, I experienced many interactions with the other poor farmers
and their families up and down our narrow country blacktop road
in Pennsylvania.
Everyone found it necessary to share farm machinery, neighbor bulls for
breeding livestock, and several other necessary living requirements.
Living on the tightrope of poverty and the fragility of financial stability
impacted my mind with rather intense lessons.
It’s how people lived together in the 1940s to 1060s during and after
WWII. Bartering was part of life then. And if the present condition of our
country continues to decline, it will also be a way of life again.
Perhaps not yet, but soon, I believe there will come a time soon in
medical care where financial survival of both patients and doctors will
reach a critical level. That issue is well on the way presently.
It seems obvious to me there are lessons to be learned from the past that
may very well come full circle and become important soon. With millions
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of people in our country who have no health insurance and can’t afford to
see a doctor, how can medical care be made available to everyone?
You may be interested in one solution I came up with that could be an
answer. My calculations about how to do that are rough and may be well
off the mark, but the solution is reasonable.
If every medical doctor practicing medicine today, even those who are
employed, in the USA would be willing to see 5 non-paying (free)
patients each week in their medical practices, the government reported
30 million patients who can’t afford medical care would have it. Large
numbers of medical doctors certainly wouldn’t like this idea at all.
However, if patients were to barter for that free care, the doctors might
go for it to some degree. I would and I did in my practice.
Good examples of the bartering effects:
We all understand that every person born is gifted with certain talents
and skills in life. Most physicians, especially those who own homes, are
presently paying someone to do the many jobs around their home that
they don’t have time or ambition to do themselves.
It may be filing and paperwork. It might be landscaping and yard work. It
could be almost anything to do with fix-up. The fact that labor costs are
rising, the value of the dollar is decreasing, and 95% of doctors aren’t rich
anymore, as many are led to believe, would present an opportunity for a
win-win situation. A patient would get free medical care and the doctor
would save $150.00 per month, the normal yard maintenance cost in
our area.
Most doctors normally would be happy to have their lawn mowed (for
free) or their house cleaned (for free), in exchange for a free medical
office patient visit for the patient. A patient would also likely be thankful
to contribute their skills and time for free medical care by the doctor.
My feeble mind may be off cruising on the Titanic with such ideas, but
impossible wild ideas have solved problems throughout history, especially
before money had been invented.
When and if the world economy crashes, money will have no value. What
do we do when that happens in order to survive? Now you know at least
one method how you could receive medical care.
Back to my original idea to provide free medical care.
I believe that in our environment today, healthcare can be obtained from
doctors who donate their time for free to care for patients. One just has
to find a doctor who will do that. If a doctor refuses to accept and treat
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patients (for free), then a smart patient would be wise to offer any kind of
service to the doctor in exchange for the free care. It will be much less
costly for both in the long run.
If you as a patient have a skill for doing something that any doctor might
need eventually like painters, concrete masons, carpenters, roofers,
landscapers, tree trimming, plumbing, housecleaning, tailoring, ironing,
cooking, planting gardens, typing, computer research, etc.
All it takes is for you or any patient to approach any doctor about
this offer.
Just ask!!.......You’ve got nothing to lose.
It could result in an ongoing agreement between you and not just for one
office visit.
Everyone prefers to receive something for their labor or services. Most
people, even the poorest of the poor, prefer not to receive charity or
handouts unless there are no other options. Thinking about this approach,
both are in a sense paid for their actions, it becomes less difficult to break
the pride barrier and ask for the deal from the doctor.
The doctor is likely not to bring up the topic so patients must do it. You
may be pleasantly surprised at how often you will get a positive response.
I had my outdoor gas grill installed by a husband in return for a minor
surgery procedure on his wife. No cash changed hands, yet both of us
received what was needed. Be bold when it comes to your health
and wellbeing.
“A man’s gift maketh room for him,
and bringeth him before great men.”
---Proverbs 18:16
9. The barrier of the “white coat” intimidation:
Incredibly, intimidation is a factor in obstructing good health care in many
ways. On the one hand a patient is willing to tell everything to their
doctor that they will never reveal to anyone else on earth, yet feel
intimidated to some degree when a person in a white coat
approaches them.
This intimidation factor of the white coat is only a symbol. The fact that
there is a doctor, male or female, wearing it, is the basis of the emotion.
By the middle of my years in practice, I became quite aware of how much
a white coat triggered the emotion. I decided to not wear the white coat
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while seeing my patients to see if there was truly a definite barrier
between the coat and the patient, and not me and the patient.
I never liked wearing the white coat because it was uncomfortably warm.
This was quite evident during the 8 years I spent in Philadelphia, PA in
summers of high humidity.
A large part of the white coat issue is primarily a tradition of the
profession beginning centuries ago when doctors recognized that they
needed to protect themselves from catching the diseases they treated.
Bacteria, viruses, and sterilization were yet to be discovered. Finally, Dr.
Semmelweis proved a connection between fatal childbed fever and
infections could be reduced or prevented by frequent hand washing with
chlorine in water.
Ignaz Philipp Semmelweis (July 1, 1818 – August 13, 1865), also
Ignác Semmelweis (born Semmelweis Ignác Fülöp), was a
Hungarian physician called the “saviour of mothers” who
discovered, by 1847, that the incidence of puerperal fever, also
known as childbed fever could be drastically cut by use of hand
washing standards in obstetrical clinics.
You see, in those early days doctor’s used bare hands doing everything.
They would study dead bodies in the morgue while rolling their hands
around in the infections purulent fluids and then went to the delivery area
to deliver a baby without washing hands. After the deliver they would
then insert their purulent covered bare hands up into the uterus to be
sure no fragments of the placenta were left inside. With so many deaths
of women delivering babies in hospitals, pregnant women often chose to
deliver elsewhere than in the hospitals.
Semmelweis went all over Europe for several years trying to persuade all
the obstetric doctors and others to repeatedly wash their hands in the
chlorine water in order to have the fantastic results he proved to them.
No doctors would believe him or his results.
Extremely depressed about the rejection of his discovery and proof from
most all doctors, Semmelweis decided to prove what he was saying was
true. He went into the morgue, slashed his hands, dipped his hands in all
the puss and rotten body contents and died from the overwhelming
infection shortly after—proving that there was something in infected
tissues in dead bodies that is transmitted to obstetrical patients, which
killed thousands of women. After his death, most doctors started hand
washing with chlorine water routinely.
Now back to the “white coat syndrome”.
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The other aspect about wearing a white coat was that it represented
authority, great knowledge, a revered professional to be paid attention to.
For centuries doctors dictated to the patient what had to be done, and
patients knew better than to object. However, all that respect went out
the window after the 1960s.
It became quite evident to me that wearing a white coat made absolutely
no difference in my practice. At least, I never ever had a patient who
stood up in my presence out of respect when I walked into the exam
room wearing my white coat. Only those suffering with bad hemorrhoid
pain were standing when I entered.
On the contrary, I found patients communicating with me easier and more
extensively when I didn’t wear a white coat. It wasn’t surprising to me
because of the disintegration of rapport with patients in our profession
over the past 60 years I relate to our cultural casualness of dress.
What’s important about who doctors really are:
• Remember that doctors are regular people just like you. They catch
illnesses, put up with stressful problems, die of cancer, suffer through
family tragedies, grow old and feeble, and if you met them outside the
medical office and you didn’t know they were doctors, you would think
they were like your friendly neighbors.
• Doctors have already done what every person should do in life—carry
every talent and skill to their maximum potential.
• Whether you realize it or not, you have areas of expertise that these
highly educated doctors don’t have. Also, be aware that your doctor is
one friend you have that will not tell your secrets to others.
• Understand that there are famous and very successful uneducated
people out there who never got out of high school, yet are millionaires
and billionaires and have done more for the world than their doctors.
My recommendations for you to chew on:
o Approach your doctor with boldness and aggressiveness, but with
a pleasant manner. You are there to resolve your medical problems
and the doctor is there to see that it happens.
o Don’t judge your doctor before you have been treated by him at
least 6 times. Give him or her time to show their stuff.
o Never be reluctant or hesitant to ask medical questions in the
office or from home.
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o Show respect and recognition for your doctor’s efforts and say
the actual words, “thank you”. It’s uncommon for patients to say
those words to their doctors, at least in my experience.
o These bits of wisdom, when followed, will open doors to much
better medical care than given to those who don’t.
The same goes for the doctor’s office staff:
a. Your great relationships with the medical staff will spill
over into the arena of what is done for friends, as opposed
to unappreciative patients.
b. You will receive preference for appointments, extra time
with the doctor, questions answered, phone calls,
prescription refills without an appointment and help well
above the usual.
c. The subtle subconscious trigger for reciprocal activities is
manifested in many ways—including better medical care.
10. Other barriers to the best medical care:
Your best resource for finding ways to avoid the pitfalls in the healthcare
system, discover the best strategies for approaching your doctors and
enticing them to automatically feel obliged to provide you with
outstanding medical care, and increase your opportunities to improve
your medical care is the eBook I wrote recently.
During my many years in active medical practice, I learned of and
witnessed innumerable examples of not-so-good medical care—some
my own when I was in too much of a hurry or overly tired after being
awake all night—in many other medical offices.
It disturbed me to discover that patients were completely unaware of how
to deal with doctors and win every time. No one that I have found has
written about those factors. Healthcare articles rarely cover these issue as
they should.
I wrote the book specifically for medical patients with the idea that there
should be information patients can use to great advantage. This report
could not cover the many other obstructions to better health care, nor be
as detailed as the discussions on each topic in the eBook.
Most patients usually don’t want to hear, “go do this, or go do that,” and
then are never told where to look or how to do what needs to be done,
including how to use the information authors expound about.
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Please take the time to read this eBook about these important and helpful
loads of information unavailable anywhere else. I guarantee you will find
several strategies you can use to improve your medical care.
Curtis Graham, M.D., FACOG, FACS –This retired medical doctor
and author reveals strategies, tactics, and information which
enables patients to obtain top health care easily and quickly.
Avoiding healthcare obstacles and overcoming healthcare
barriers are simple if you know how.
Go there NOW: www.healthcaresecretsrevealed-finally.com
© 2004-2013 Curtis Graham, M.D., L & C Internet Enterprises,
Inc. All Rights Reserved.
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care, healthcare providers, medical articles, health articles.
Please Note:
Feel free to use this REPORT for the benefit of others
as long as it and the bio are left intact.
NOTE: Take advantage of the information contained in these and other
patient articles by this author. Many topics will soon be available to you,
like these, in the hopes of making your health care considerably better,
reduce your frustrations with the current medical system, and provide you
with the best way to avoid problems going through the medical
care process.
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Dr Graham
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