02 February 2010

Stayin' Alive : Picking a Health Care Provider

Stayin' Alive:
Tips on choosing your health care provider

By Mariann G. Wizard / The Rag Blog / February 2, 2010

[Stayin' Alive is a periodic column on Complementary and Alternative Medicine by Rag Blogger Mariann G. Wizard, a professional science writer with a wide-ranging knowledge of natural health therapies. Readers may suggest topics for future columns, within the restrictions suggested below, in the Comments section of The Rag Blog.]

If there is any advantage to paying my own medical bills, as I do with a so-called "Health Savings Account" and high-deductible insurance (the only real alternative for self-employed Americans), it is that I'm free to choose my own health care providers. No list of "in-network" doctors or HMO-approved dentists for me!

Having experienced "managed care" very briefly, I appreciate the choices I now have. Still, even for people whose choices are limited by geography or bureaucracy, there are ways to get a better "fit" with your partners in health.

Before meeting a prospective new health care provider, I like to refresh myself on the issues and questions that are important to me. For me, first and foremost, I want to be an equal partner in the health care decisions that affect my life. For you, it may be something entirely different. But make your priorities clear and ask the health care provider you're considering how they prefer to operate.

Admittedly I am an extremist in this regard. I adore my vehicle mechanics, in part, because they will show me, in however much detail I want, exactly what is going on with my car, what needs to be done, and how to avoid recurring problems. I want my doctor to do the same. Some people prefer to have an annual physical, and take whatever pills they're "given" for vague complaints, such as "my heart", or "sugar". Suit yourself, but this is a choice on your part; you need not be simply putty in Doctor's hands!

Ask questions. Always, unless you are meeting a provider for the first time in an emergency situation, schedule a first visit to get acquainted and to become an "established patient." Do you prefer a physician who is "hands-on" or one who allocates most routine tasks to a nurse or assistant? If a nurse or assistant is who you'll mostly interact with, meet that person as well as the primary provider.

I want to know where a provider studied and how long they've been in practice. I usually prefer someone who isn't brand new, but is also young enough (at least, when I establish myself as a patient) to know the latest information, and hopefully to be in business for a long time to come.

I like stability. I've seen a wonderful dentist, an eye doctor, and a chiropractor each for many years, and have been known to travel many miles to see them when needed. One good indicator of stability may be how long physicians or other professionals keep their staff. Frequent staff turnover, to me, warns of someone whose emotions may interfere with business; I don't want it to interfere with their analysis of my health status. Also, frequent staff turnover may, in a worst-case scenario, compromise the confidentiality of medical files or other personal information.

For your own part, be as honest as the law allows. Do you take dietary supplements? Drink a lot? Play contact sports? Have frequent black-outs? Tell the nice man or lady; they can't help you if you play coy. People with high blood pressure have been known to "fudge" results they report to their physicians; why do they even go??

Now, honesty can sometimes have unanticipated and even inconvenient results. In 1979, expecting my first and, as it would develop, only child, I had an obstetrician-gynecologist (OB-GYN) I liked, one of Austin's best baby-catchers who I had first seen a few years earlier and had seen annually in the interim. Everything was going swell, and I was a model patient until, at eight months gestation, I told him that my partner and I, in addition to Lamaze classes at his office, were taking home birth classes with the Austin Lay Midwives Association (ALMA) and were "considering" a home delivery.

At that time, midwives were not allowed to assist births at any Austin-area hospitals, and the first "birthing suites" had yet to be imagined. My doctor ordered me out of his office and said I couldn't come back until I in, effect, renounced heretical thought.

If you know me at all, you know how well that went over! Thanks to ALMA, and to Austin's best-beloved West Campus-area general practitioner (GP), Dr. Milton Railey of blessed memory, and to a truly dreadful emergency room butcher at the old Brackenridge Hospital, my son came into the world without my former OB-GYN's involvement. If I'd told him a few months earlier that my baby-daddy and I wanted a home birth, it might have gone a lot smoother, or we'd at least have been better prepared for what turned out to be the scary part!

Some part of me knew that my OB-GYN wasn't going to appreciate my "irresponsible" notions, and lacked the courage to tell him of them early on. Never again. Now, I try to think of issues that may arise and address them in advance, and strongly recommend that women of child-bearing age ask their regular doctor and/or gynecologist their professional and private opinions of matters such as birth control and abortion, and discuss whether those private opinions ever influence their professional actions.

In choosing any practitioner, whether dentist, dermatologist, or witch doctor, don't be shy. If you're uncomfortable with anything about a person, their practice, or their methods, speak up right away. I once changed dentists because the fellow who'd bought my former dentist's practice had lab coats that matched his garish, I'm not kidding you, office wallpaper, but was pinché with the nitrous oxide!

Some issues can be easily resolved with frank communication; if not, you're under no obligation to see a provider you don't trust, don't like, or about whom you have serious reservations. Yes, it may cost you some dinero to get established with a new provider. Suck it up; there is nothing worse for your health than a provider who distresses you!

Oh and hey, a little word to the wise? Health care providers sometimes forget to wash their hands between patients! I really prefer, if someone is going to put their hands professionally into any of my body cavities, to see them wash their mitts and put on new protective gloves beforehand. I will ask, in a hospital setting, anyone who comes near me to wash up where I can see it!

When it works

Physicians, naturopaths, acupuncturists, and other health care providers work hard to attain professional standing. Because their knowledge is specialized and important, they may expect, and usually receive, a great deal of respect from patients. For me, the best results come when that is a two-way street.

For example, if a health care provider calls me by my first name, I take that as an invitation to call them by theirs, and do so immediately. I'm totally cool with that. But if they need to be called "Dr.," they'd better be calling me "Ms."! I am a grown woman, as worthy of respect as anyone else, especially from someone who I am paying to treat me professionally. However you define it, you have a right to be treated with respect by your health care providers!

Of course, where respect has been earned, it flows freely. I may call my doctor by a nickname in private, but in the public front office, she is "Doctor" to me!

The relationship between patient and care provider, if successful, is multi-dimensional, with aspects that can hardly be quantified. There is a chemistry to it, a mutual trust that only develops over time. I know, for example, that my chiropractor gives me her best effort. She knows I'll work hard to use her recommendations. The more I understand why something is prescribed or recommended, the more likely and able I am to comply.

A word about specialists: Sometimes it is necessary to see a health care provider with specialized knowledge, usually on a short-term basis for some acute problem. In general, your best bet is to ask your regular care provider for a referral. The better your regular provider knows you, the more likely they may be to suggest someone with whom you'll also find a rapport, but your main goal in this situation should be to address the acute problem as effectively and appropriately as possible.

In other words, you don't have to like a specialist as much as you do your regular guy or gal! However, if you're not comfortable with anyone your regular provider sends you to, for any reason, don't hesitate to let them know about it, and to ask for other suggestions if the health issue that sent you to a specialist hasn't already resolved.

The money part

Part of the reason our national health care costs have skyrocketed is that we've been lousy consumers, abrogating our choice and discretion and comparative shopping skills to insurance companies, happy to pay 20% of outrageous fees for medical goods and services.

So, part of my establishing a good rapport with a health care provider is financial. Especially for those of us toting our own health care freight, it's best to know in advance the usual cost of an office visit or annual physical. Discuss your own financial and insurance situation frankly with the provider and the business office. Some providers offer a sliding scale or discount when they understand that a giant insurance company isn't going to automatically pay 80% of your bill. It never hurts to ask.

In seeking any complementary or alternative treatment, investigate first how much, if any part of the cost, will be borne by any insurance you carry. Consumers must each do their own cost-benefit analysis of un-reimbursed CAM therapies.

If you're getting a new prescription, ask about its cost, and if it's available in a less expensive generic version. If the doctor's clinic has an on-site lab, don't assume costs will be lower than costs at a specialized laboratory elsewhere. Along the same lines, check all bills and statements for accuracy.

This is, perhaps, especially important with any hospital bills, where many billable treatment codes may be entered by many individuals. A month after my son was born, in addition to a bill for the surgeon's services, I received a bill from the hospital's resident pediatrician. However, we had arranged for a pediatrician before the baby was born (Rag Blog shout-out to Dr. Jimmy Justice and Nurse Gloria, wherever you are!), who saw our son daily while he and I lay up in Brackenridge and I tried to heal.

I called the hospital billing office to let them know I'd received their pediatrician's bill in apparent error. A nice lady explained to me that the doctor's education was very expensive, and so the parents of all babies who used the hospital nursery (for which we'd also been billed) paid for his services whether he ever saw them or not.

I replied that my education had also been expensive, but that I did not bill people for work I didn't do, and if that was their practice, they should institute legal proceedings to repossess the baby. That was the end of the matter.

Ask about what-if's as well as likely's. Once, I became established with a GP in a shared practice, who seemed very nice. I always prefer shared practices, so if I get sick and my primary care provider is unavailable, someone with ready access to my chart will be there.

Unfortunately, between the time of my initial physical exam and a scheduled follow-up visit, a family emergency forced him to resign and move away. The business office told me there would be another $80 fee to "re-establish" myself before I could see another of their physicians! For me personally, this was a deal-breaker. I would prefer to establish myself elsewhere, and not be nickle-and-dimed to death, especially when I'd seen the departing guy exactly once!

Self-Health Tip:
Use Your Brain to Protect Your Body!

In selecting a complementary and alternative medicine (CAM) product or therapy, use independent sources to learn about uses, dosage, side effects, and possible interactions with medicines, foods, or herbs you use. The American Botanical Council, a non-profit educational organization headquartered in Austin, Texas, is one such source; there are many others, including CAM professionals.

A website selling a "miracle" product isn’t the best information source! Third party verifications of good manufacturing practices, or that a product contains what the label says it does, are also available from several reputable sources.

For safety’s sake, TELL your doctor about your CAM practices. Chances are s/he didn’t learn much about them in med school, and may think CAM is useless. So how is s/he ever gonna learn differently unless you speak up?

Seriously, keeping use of herbs or supplements secret for fear of Doctor's disapproval is not only dumb but dangerous! Some DSs and many HMs have effects that can interfere with other medicines. If you want to use CAM safely in your personal health continuum, bring your health care provider in on the discussion. Share information you find useful, and listen to them with care, even if they don't always say what you want to hear.

To be responsible for our own health, we must weigh all the evidence. For me, if a health care professional won’t discuss CAM as well as conventional care, we may not get along!

Of course, one must make an exception to this disclosure rule in the 36 medical cannabis-prohibiting states, so as not to leave a paper trail for insurance companies who can cancel coverage in a heartbeat. In any event, do not use cannabis for 24 hours before any scheduled medical exam, including -- with great emphasis! -- eye exams!

Marijuana has been used to treat glaucoma since Queen Victoria’s day. A vasodilator (blood vessel relaxer), it temporarily lowers blood pressure as well as interocular pressure. If you have high "hydraulic pressure" going on anywhere, you and your physician and/or eye doctor need accurate information.

-- mgw
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