Friday, July 6, 2018

Opuscula

Right diagnosis
Needs patient’s
Participation

EVERY SO OFTEN I get an email from the Silver Sneakers folks. Silver Sneakers is a program offered by many Medicare Advantage (and maybe Supplement) plans and it offers advice on many things to the geezer population. (I’m a geezer; it beats the alternative.

In the latest (e)mailing we are told, among other things, that patients (of all ages) should participate in their medical care – partner with the physicians treating this or than malady.


I was an military medic so I’m comfortable dealing with doctors and nurses.

To my Edward Bear mind, my doctors are consultants to the patient (me).

If I cannot work with a practitioner, I go elsewhere.

If a practitioner cannot work with me, I go elsewhere.

It is, after all, my health and my life.

Over my time with Medicare, I have had several Primary Care Physicians (PCPs).

My relationship with some ended after my first visit. (In one case, a PCP set aside afternoon hours to meet with prospective patients. That got the PCP a gold star.)

The same holds for specialists.

I have on more than one occasion walked out of a dentist’s office because the dentist and the patient were not copacetic. (I have an excellent dentist now, thank you very much.)

The Silver Sneakers advice1 to avoid a misdiagnosis – it turns out this is an all too common occurrence – is:

  • 1. Be an Active Participant in the Process
  • 2. Prepare for Your Appointments
  • 3. Trust Your Gut—and Get a Second Opinion
  • 4. Encourage Open Communication on Your Health Care Team

One thing I always do is make a list; sometimes I make a copy so the doctor can see my concerns as well as hear them from me. If your PCP says the specialist’s report never arrived, or was just note, contact the specialist and “prompt” the practitioner to get the information to your PCP . . . even if you have to hand-carry it to the PCP.

The complete Silver Sneakers article can be read online.

One thing not mentioned in the Silver Sneakers’ article – although I’m confident it was covered in another article – is to make certain all specialists send full follow-up reports to the PCP. It makes no difference if the PCP made a referral; the PCP must get the specialist’s report. The PCP is the health care coordinator.

Another person patients need to include in their health care is their pharmacist. While most medical practices have a copy of the Physician’s Desk Reference, the PDR, most physicians either don’t have time or don’t make time to look up a drug to see if it is compatible with other drugs that have been prescribed. This is especially important if the patient has multiple prescriptions from multiple doctors (e.g., the PCP and specialists). The pharmacist might warn against a medicine combination but the patient always should ask the pharmacist “Can I take this new Rx with the medicines already prescribed.” If the pharmacists recommends against the pharmaceutical “salad,” either ask the pharmacist to contact your PCP or do it yourself.

It is the patient’s responsibility to make sure the practitioner has all the information to make a diagnosis. It is the patient’s responsibility to challenge the practitioner; the practitioner is the patient’s consultant and while the doctor may be a “Subject Matter Expert,” the patient is the “customer.”

Never let a practitioner “stampede” a patient into something. Most Advantage and Supplement plans cover second opinions. If the patient and PCP come to a parting of the ways, most plans allow changing PCPs on the first of the following month (e.g., request new PCP two days before End of Month and on Day One of new month, you have a new PCP). Rapport with practitioners can play a major role in keeping geezers alive and well.


Sources

1. http://tinyurl.com/y7b3dh2u

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