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Posts Tagged ‘Physician’

Why I Talk To My Pharmacist More Than My Doctor(s)

In behavior, business, Health, Medicine on August 15, 2010 at 12:59 pm
The mortar and pestle, an internationally reco...
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Turns out I’m part of a larger trend. Reports The New York Times:

“We are not just going to dispense your drugs,” said David Pope, a pharmacist at Barney’s. “We are going to partner with you to improve your health as well.”

At independent drugstores and some national chains like Walgreens and the Medicine Shoppe and even supermarkets like Kroger, pharmacists work with doctors and nurses to care for people with long-term illnesses.

They are being enlisted by some health insurers and large employers to address one of the fundamental problems in health care: as many as half of the nation’s patients do not take their medications as prescribed, costing nearly $300 billion a year in emergency room visits, hospital stays and other medical expenditures, by some estimates.

The pharmacists represent the front line of detecting prescription overlap or dangerous interaction between drugs and for recommending cheaper options to expensive medicines. This evolving use of pharmacists also holds promise as a buffer against an anticipated shortage of primary care doctors.

“We’re going to need to get creative,” said Dr. Andrew Halpert, senior medical director for Blue Shield of California, which has just begun a pilot program with pharmacists at Raley’s, a local grocery store chain, to help some diabetic patients in Northern California insured through the California Public Employees’ Retirement System.

Like other health plans, Blue Shield views pharmacists as having the education, expertise, free time and plain-spoken approach to talk to patients at length about what medicines they are taking and to keep close tabs on their well-being. The pharmacists “could do as well and better than a physician” for less money, Dr. Halpert said.

I have spent an inordinate amount of time this year at my local pharmacy, run by a veteran named Aqeel, a warm, plain-spoken guy with three daughters. His store is tiny, two aisles wide, and sits two storefronts away from a CVS, an enormous chain of drugstores. But since January, having to take a variety of serious medications for the first time to manage my osteoarthritis — from steroids to Fosamax — I don’t have the time, patience or interest in running back to my doctors every time I have another question about my health.

I first spoke to him a few years ago, when I asked which vitamins to use, and why. He actually sat me down on one of his folding chairs and explained how they work and would affect me. Some people don’t want that much explanation or want to take the time. I loved it. Someone who spoke to me like a fellow adult!

His friendly, open manner, combined with decades of experience, makes me feel safe asking him questions. When I took one drug recently (all of them new to me),  I felt so incredibly lousy — disoriented and highly anxious, this on a weekend — I went back to ask him about it. That side effect was indeed unpleasant, but not unusual, he reassured me.

He’s one of three local merchants in my town I interviewed for my new book about working in retail, “Malled: My Unintentional Career in Retail” (Portfolio, April 14, 2011.)

Patients live a weird existence. Away from the few, hurried minutes with our busy physicians, some of whom are brusque and intimidating, we wander about in a fog of confusion. Yes, I read the accompanying literature so know what side effects to expect. But I didn’t know that, (hopefully) on the second dose of Fosamax, for example, a drug meant to build bone, I might not feel so dopey and tired.

Do you have a pharmacist you like and trust?

What's Next — Leeches?

In Health, Medicine on March 12, 2010 at 11:43 am
ER (TV series)

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What a few weeks it’s been.

The good news is that it’s “only” been an insanely painful bout of athritis in my left hip and a lower back spasm that sent me to the ER at midnight. Could be much worse.

And I am very, very grateful to have good health insurance, through my partner’s full-time job, that allows me to get the care I need.

I did something I have never done in my professional life — transposed the address of a crucial interview with a source for my book, so I kept looking in vain for 970 Broadway — when I needed 907. I was 30 minutes late, apologizing like mad, and told him “Pain meds will do that.” So will pain. It’s insanely distracting.

It’s not really my normal life to see the same Xray technician twice in three days and have him recognize me. He is a ggggggorgeous man (sexist, I know, but when everything hurts so much, anything pleasant is especially welcome) and gentle and kind. I tend to joke a lot when I am scared, and was cracking so many jokes during my back Xrays he finally said “You must stop this.”

Yesterday, it hurt so badly to simply lie flat on the table for my hip Xray I started to cry. I hate crying and know it can’t be fun for them to see. The technician was very sweet and said he could clearly see the arthritis on my Xray.

“But you’re so young!” he said, as surprised as I at what appalling condition I’m in; my 80-year-old Dad is exhaustingly, astonishingly healthy and unmedicated.

“You’re a sweetie,” I said. “But I really hope we don’t see one another for a long time.”

In the past two weeks, I’ve been to the ER, my GP, another physician, (with a neurologist’s visit for Tuesday and an MRI likely after that), had a massage, taken four kinds of medication (two of which wreaked total havoc on my system and the latest isn’t much fun either) and now await a needle full of steroids plunged deep into my hip joint next Wednesday.

I live in the New York suburbs and have spent hours driving, sitting, meeting doctors, arranging appointments — so serious, focused work on my book has halted for the moment. I actually had to pay to park at a hospital in one of the county’s wealthiest towns, Bronxville. Paying to park at a hospital?!

Chronic or acute pain, as some of you know, makes you so filthy-tempered. You are forced to be alone (can’t go out, see friends, exercise); in pain; tired. It takes a lot of strength to do stupid and crucial stuff like just go to the post office or bank, where even standing for five painful minutes feels like an eternity. You want to rip people’s heads off, which they likely do not appreciate.

The injection, veterans tell me, will make a huge difference. I may, like the Tin Man, seize up for a few days right after that, but I’ve seen this with cortisone shots to my knee, so I at least know what it’s like.

The challenge will be if a major magazine assignment comes through — which will put me on a plane to rural New Mexico next Friday. Walker, cane, wheelchair, whatever. I once covered an entire political campaign, in the winter’s ice and snow, on crutches — getting on and off of campaign buses.

I currently walk like a drunken sailor because every single step puts painful pressure on my left hip. I’m actually forbidden to walk or climb stairs; so much for my girls’ museum/lunch day tomorrow seeing the Jane Austen show at the Morgan Library I was so looking forward to. I’d go with my walker (!) but the doctor says rest.

As you can tell, that’s a four-letter word in my world.

The good news? Our local indie film theater has three films I am dying to see: Hurt Locker,  A Single Man and Crazy Heart. I can easily shuffle from one cinema seat to the next, eat some popcorn and rest my aching bones — while enjoying a bit of the world.

I am really not 103. I just feel like it.

What We Expect From Our Doctors: Compassion, Advocacy, Trust — Candor?

In Medicine on November 20, 2009 at 10:38 am
Rob looks like a doctor...

God? Not so much. Image by juhansonin via Flickr

As yet another set of recommendations — fewer Pap smears, fewer breast exams and mammos — hits already confused Americans, it sets our primary relationship(s), with our physicians, into ever-sharper relief. If you’re lucky enough to have health insurance and lucky enough again to have found physicians you like and trust, you’ve made a set of decisions, (within, of course, the framework of your provider), that can change, shorten or save your life.

Here’s a fascinating analysis in today’s New York Times why these issues resonate so deeply.

“It’s going to take time, there’s no doubt about it,” said Louise B. Russell, a research professor at the Rutgers University Institute of Health who has studied whether prevention necessarily saves money (and found it does not always do so). “It’s going to take time in part because too many people in this country have had a health insurer say no, and it’s not for a good reason. So they’re not used to having a group come out and say we ought to do less, and it’s because it’s best for you.”

Our intimacy with our physicians, even briefly once or twice a year, creates a relationship like no other. We place, as we must, tremendous trust in our doctors’ training, skill, continuing education, ethics, attentiveness and experience. It’s the invisible hand of the insurers we forever fear and hate, the denied or delayed treatment, the cut-off therapy, the medication or surgery deemed unnecessary. “I don’t get to have my patients get 3/4 better,” raged one of my docs after my post-surgical physical therapy was cut off sooner than we agreed was needed. But this decision was pulled from his hands, something no MD signs up for.

Yet we also all know doctors make mistakes. Which is where we, the patient, come in. It takes vigilance, attention and assertiveness, even with good insurance and docs, to get what we need. I’m a bossy old journo, unafraid — thanks perhaps to my ex, an MD, and covering medicine for years as a reporter, and a family with some serious cancer issues — to ask and ask and ask until I feel satisfied with what my physicians tell me. But, especially as a woman, I know how hard it can be to push your doctor. They’re confident, sometimes even arrogant, usually in a hurry, busy, use big words and may simply have a really lousy bedside manner.

I recently saw my long-time dermatologist, a guy my age I like and trust, about a tiny red patch on my face. “It’s nothing,” he reassured me. “It’s sensitive to the touch,” I replied — much preferring  his quick reassurance and my hasty exit.

He treated it topically, just to be on the safe side. What if I’d stayed quiet?

I’ve gotten to know one of my docs, an orthopedic surgeon, better than I ever expected, after three orthopedic surgeries in 8 years. Yesterday I met one of his colleagues, treating a stress fracture in my left foot. I like my usual orthopod, but our first encounter was instructive. He’s a big guy, built like a linebacker, Italian, talks loudly, expecting  — like most doctors — to be listened to obediently. I came in after my first knee surgery using a cane, taboo. He blew up and started yelling. I yelled back. We yelled at each other for a few minutes until I got why he was yelling — concern — and why I was yelling, the desire to have my pain level respected and my intimate knowledge of my own body accepted. We’ve gotten along great ever since.

I’m always surprised, gratefully so, by my relationship with my physicians here in the U.S. As American legislators grapple with health care policy, and every woman wonders what to do next with our scheduled mammos and Paps, those of us who grew up in other countries, many of them (if not most) with government-run/funded health care systems, know that how one experiences medicine and medical care and treatment is very much culturally based.

How we treat our doctor(s) and vice versa is a mix of economics, social policy, cultural mores and expectation. I grew up in Canada and doctors there, in a government-run system, often have a different relationship with their patients:

1) They generally graduate, thanks to Canada’s heavily subsidized educational system, with less medical school debt than American physicians, which

2) creates less pressure to make big bucks fast.

3) because Canadians can’t sue as easily, doctors wield more power and know it.

4) Because their constraints on tools and tests are mandated by the provincial government — some provinces have fewer MRI machines than the suburban New York county where I live — you can’t pressure them into tests, quickly, the way you can pressure American doctors. There, the next doctor will face the same constraints; here, your doctor may have more clout or you have better (or worse) insurance.

5) Because you can’t hop from one doc to the next, patients, even the most demanding in other areas of their lives, tend to be more passive and docile.

6) Because you have to wait longer for some tests and their results, you may take a different attitude toward your doctors and your health. What they say, goes. You can’t doctor or hospital or specialist-shop, except in rare instances and for which you may have to pay out of pocket.

I’ve been very struck, in the 20 years since I left Canada, how assertive, demanding and impatient — American — I’ve become as a medical consumer. It took four days to see the orthopedic surgeon and another three to get an MRI for my foot fracture. Lightning fast, really, for something non-urgent. But even that felt slow because I was tired and in pain and wanted answers and solutions. That’s a deeply American mindset! In the old days, I would have waited patiently for whatever I could get, accepting the diagnosis and treatment as offered without lots of questions or challenges, however polite.

When I was told my foot was fractured — being a Type-A gogogogogogoreallyfast type of person — I burst into tears of weariness and frustration.  Five minutes later, I caught up with my other doc in the hallway. It was 5:30, the end of his day, so he had time to chat. We were laughing and joking as his colleague walked by. “For me, you cry — for him, you laugh?” the other doc teased, perhaps a little hurt.

“Old friend, new friend,” I said.

I wish all patients could enjoy knowing, even a little bit, who their doctors are as people and how they feel about all these major potential changes to how we will receive medical treatment. We talked for an hour and I learned a great deal about his perspective on these new policies that I haven’t read anywhere. He’s told me he writes off 2/3 of his bills. They simply never get paid. I asked him why we — the public don’t hear more from doctors themselves, speaking out as loudly and forcefully, as patients do. They’re too busy making money, he said. The current system divides and conquers.

I don’t know what the new system, if we get one, will look like. But I wish I knew a lot more about how my doctors feel as well, not just health insurance lobbyists.

Marrying For Money — Smart or Heartless?

In men, Money, women on October 11, 2009 at 9:32 am
Franklin Covey Task List Wallet (inside)

Image by Thirteen Of Clubs via Flickr

If there’s a woman out there  — and there are likely many — who got married with no idea of her husband’s ability to earn, save and invest his income, she’s probably been on a steep, and possibly painful, learning curve ever since. You really can be deeply in love and find out what you’re getting into financially.

You must. Today’s New York Post offers an excerpt from a new book “Smart Girls Marry Money”:

“On average, a woman earns just one-third of what the average working man makes over their lifetimes. So if you’re gonna get married, hold out for a guy who brings in some cash…Financial responsibility may say a lot more about a man’s character than his big blue eyes.”

Frank money talk can make some men grab for their…wallets…in dread. But many women really need to be a lot smarter about who they’re getting into bed with, fiscally speaking.

Who really wants to be the next Mrs. Madoff, sucking up a lifestyle you really know, or strongly suspect, is based on lies or hugely overstretched lines of credit? I’ve been with my sweetie for a decade and we discussed finances within the first few months of dating: what we earned, what we owed, what we were socking away for our retirements. Some men, and women, would have shriveled from and/or fled such frankness. Crass! Gross! Rude! We’ve both learned a lot, and we’re still learning. The best news he shared with me this year? His FICO score, like mine, is terrific, allowing us some decent choices about what we’ll do next. That’s my kind of pillow talk.

My first husband was a physician, earning more than $130,000 (as far I knew, back when I played fiscal ostrich) in 1994 — when he walked out of our apartment and our brief marriage. I fell far and fast, financially, protected only by a pre-nuptial agreement I’d insisted upon, whose payments allowed me the time I needed to regain my financial footing, find a well-paid, full-time job and meet all my commitments. But everyone was thrilled when I married a doctor — MD can indeed mean Multiple Dollars. His fiscal life since then has been a lot bumpier than mine, even while earning ten times my income.

Talking about money is rarely an easy conversation, but it’s crucial. If Prince Charming is secretly up to his ears in 25% APR credit card debt, do you really want your coach re-possessed?

How Universal Health Care Works. You Get Sick, You Get Care and You Don't Get a Bill

In Medicine, politics on July 12, 2009 at 12:06 pm

Fantasy?

Reality.

Not in the United States, where editorial and op-ed pages are currently bristling with competing ideas and fears. We’re facing more class warfare as the wealthy are asked to kick in more tax to pay for the rest of us. Those who have good health care benefits through their jobs don’t want those benefits taxed or messed with. Those who can’t even afford to see a doctor are desperate. The one-third of us who work freelance, temp, permalance or don’t have access to a subsidized group healthcare plan are paying through the nose for market-rate prices — one New Yorker I know is paying $1,200 a month for his family of four. He runs his own company in an industry that’s been hammered by the recession and has already had to lay off many of his long-time, full-time employees. Do you have a spare $1,200 a month right now? Who does?

In the current health care economy, it’s every man for himself. For many of us, it’s ugly and frightening and unworkable and it has to change. Read the rest of this entry »

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