This blog features information about the political campaign nationally and in the state of Pennsylvania. it will discuss congressional races western PA, but it won't restrict comments to those jurisdictions. On many occasions, it will feature humor, but its main purpose is to "cut the legs off" political jihad. This is a site for political grown-ups of all ages.

Location: Ambridge, Pennsylvania, United States

I have a Ph.D. from the University of Rochester (English and American Literature). I taught for 10 years at various educational institutions (Univ. of Rochester, my alma mater, College of William and Mary, and University of Georgia, where I was also Asst. Ed. of the Georgia Review. Later, I worked as a speechwriter and "thinker" at various large companies, including Phillips Petroleum, Gulf Oil, Aetna, Merck (consultant), and Eli Lilly (consultant), among many others. I'm a full-time writer and political commentator/analyst. Favorite company: AudioTech Business Books. Favorite female: my wife, Patricia Ann Maloney. Favorite politcal candidate: Diana Lynn Irey (PA's 12th congressional district)

Monday, March 26, 2007

Is Your Doctor Bad for Your Health? To Find Out, Answer Some Key Questions

I've had some pretty bad doctors over the years. I had one in Athens, Georgia, who wrestled for many years with drug and alcohol problems and, I learned from one of his associates, had spent a good chunk of time in rehab. That doctor told me that he'd been a "straight-C" student at the University of Tennessee Medical School. When I'd sit with him in his office, he'd light up one of his cigarettes as he discussed his problems with anxiety. I can't say anything about his nurse or receptionist, because he didn't seem to have either one. When you entered the office you signed in, and he called your name. If you wanted a prescription of just about any kind, including a nice big bottle of Valium, you got it.

In the integration-conscious 1970s, this doctor still retained TWO separate -- but mostly equal -- waiting rooms, one for us (Whites) and one for them (Blacks), even though no one demanded any longer that anyone sit anywhere in particular.

That doctor wasn't the worst one I've had -- not by a long shot. The worst one was in the Pittsburgh area. For a time, he also served as the physician for my brother, who basically had no money and lived with us for a year as he recovered from a stroke. My brother (Billy) qualified for free drugs under the Prescription Assistance Program (the one Montel Williams pitches on TV). The drug companies insist on sending the drugs directly to the physician, who should be the responsible one, right?

Wrong -- at least in this case. This doctor, actually there were two of them working together, had one receptionist working (perhaps a better word is present) in the office, and it was her task to do little things like answering the phone and receiving medications sent by drug makers.

On three occasions, this doctor's office LOST my brother's free drugs. All of them were branded pharmaceuticals (read, expensive) and came in three-month supplies. The drugs lost would have cost in total about $900 at retail, and of course since we didn't get them, we had to buy others. To get new supplies from the drug companies, we had to have the doctor re-order them, which he wasn't especially enthusiastic about doing.

After the third lost drug shipment, we finally changed doctors, long after we should have. Yes, they were nice enough people. Yes, they were convenient, no more than a two-minute walk from our home. Yes, they always seemed to have plenty of flu medicine in the fall. But were they good doctors? Nope.

How can you tell if your family doctor is is not exactly a candidate for ER or Gray's Anatomy? Take the following test.

(1) Does your doctor see patients (including you of course) for an average of 10 minutes or more, which is the national average? If your answer is no, you've got a problem. Your doctor may be patient-churning, racing people in-and-out to make more money. Figure it out: six patients an hour at approximately $75 per visit, the going rate in our area, generates hourly revenues of $450 . Getting one more patient per hour in raises that number to $525, which adds up to some big bucks rather quickly. For your $75 bucks, you deserve your ten minutes, trust me.

(2) Does your doctor write prescriptions for chronic illnesses (diabetes, high cholesterol, high blood pressure, depression, and the like) with five refills? If the answer is no, he's like the Pittsburgh-area doctor I described earlier. He wrote prescriptions with two -- or at most, three -- refills. Then, when you needed a refill, his "office" (consisting of the one lousy receptionist) insisted that you had to come in to "see the doctor." Essentially, this is another case of patient-churning, getting you to visit the office more often and to keep plunking down your $75. With the two refills, it's a case of doubling not your pleasure but your payments. (Yes, I realize that "insurance" may pay most or all of your $75, but insurance is not a philanthropic enterprise, and in fact you end up paying, directly or indirectly.) By the way, prescriptions for controlled substances, such as anti-anxiety drug Ativan (Lorazepam) many require a doctor's authorization to get a refill. In general, however, you can tell a whole lot about your doctor's motivations by how many refills he or she circles on your prescriptions.

(3) Does your doctor check regularly your blood pressure, cholesterol levels, and heart rhythms? If the answer is no, flee immediately to another caregiver. He or she should also remind you to get your flu shot and, when you start into your 60s, to get a pneumonia shot. Before then, as Katie Couric and I will insist, you should have a colonoscopy, a stress exam (bicycles are better than treadmills), and other basic tests.

(4) Does your doctor prescribe a medicine to treat an illness AND discuss lifestyle adjustments that will help in dealing with the condition? If your answer is no, he's not doing -- or she's not doing -- the job. Lifestyle adjustments, eating better or exercising more, might not lower your cholesterol or your elevated blood pressure substantially, but then again they just might. If you're a diabetic, as I am, medication will help keep your glucose levels down, but you also need to stop ("just say no!") scarfing down white bread, soda pop, ice cream, and alcohol. Otherwise, your habits will undermine the medicine.

(5) Does your doctor have a good awareness of what drugs cost? If the answer is no, the physician is not unusual, because (1) most of them have great health plans; and (2) they can get all the free samples they want from those well-dressed phamaceutical representatives. Two years ago, I didn't have any prescription drug coverage, and my Pittsburgh-area doctor decided I needed Avandia (R) for my adult onset diabetes. It cost about $160 per month. Later, my Ambridge-area doctor suggested I try a generic, Metformin. It worked just as well as the Avandia, and it costs me $4.00 per month -- about one-fortieth what I was paying for Avandia. A doctor who doesn't know what the meds prescribed cost is deficient in a key area of medicine. The fine Bridgeville doctors I saw briefly -- Nicolette Chiesa and Don McFarland -- had a generic drug facility next to their office.

(6) Does your doctor have enough staff to get the job done well? If the answer is no, you need to find another doctor. The Pittsburgh-area doctor I saw had one mediocre staff member. That meant the doctors had to do all their own poking and prodding, and sometimes they weren't very good at it. The doctors in Bridgeville and Ambridge have relatively big staffs, nurses, receptionists, and clerks. Doctors shouldn't be doing work -- like asking basic questions, taking temperatures, checking blood pressure, and drawing blood samples -- that are better left to others. They shouldn't be answering their own phones. They shouldn't be wandering around looking for shipments of free meds misplaced by incompetents.

There are a other questions -- not by any means an infinite number -- you need to ask about your physician. Sure, it helps if a doctor has a pleasant manner, but if you're really sick, medical amiability isn't going to help much. Also, make sure your doctor, amiable or otherwise, isn't ripping you off, something that seems to be going around a lot these days.


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