I've found the most frustrating part of dealing with health care, is being treated like a number, not a person. It begins innocently enough - "here, fill out forms x, y & z, then take them to Window B." So, you do. Then Window B asks you to have a seat, "they'll call you, shortly." 20 minutes and two tattered magazines later, you get to show your identification and insurance card, sign some release papers, and then again are asked to wait. When you try to inquire as to how much longer it will be, you're met with sarcasm and disdain. "They'll check, but it looks as though they're a little behind, so it shouldn't be more than 20 minutes or so." It hasn't occurred to anyone yet that you've already been there waiting for an hour, and the appointment you scheduled was well over 30 minutes ago. Still they have no answers for the delay. It's always some vague reference to being behind schedule. Are they ever on schedule?
If I'm waiting patiently. That is without causing a scene, then don't I deserve the right to ask reasonable and legitimate questions? And, if so, then why does the staff look at me as though I'd grown horns or a third eye in the center of my forehead? If they don't want patients to ask questions or be vocal, then they should attempt to communicate with them. Offering an apology now and then doesn't hurt either. We are, after all, the paying customer. A fact they are often too quick to forget. If they were in any other business, the thought of any customer waiting for more than 20 minutes is simply unheard of -- especially without offering profuse apologies, detailed explanations and often associated with generous discounts and/or freebies. But the health care industry feels no such compunction. They regularly eat up hours of our personal time without thought or care. You truly begin to feel very invisible!
Don't allow yourself to be taken in by such bullying tactics. If you are made to wait beyond your appointment time, ask why? And keep asking why and how long you are expected to wait. Ask if you can reschedule when they're having a more productive day. Or, if you can just have them ring you on your cell when they're ready, so you can go take care of a few errands? While I GUARANTEE you'll get some of the worst responses to these suggestions, you're not being unreasonable! Stand up for yourself and be prepared to walk out. Now, I know this seems a bit extreme. But, if more people became proactive instead of reactive towards how health care treats us, and the tremendous amount of waiting we're forced to endure, we would have a more streamlined system. Did you know that the appointment that you scheduled was also given to at least 5-8 other patients? They call it patient loading. I call it something else, but that's another blog story. This way they figure all patients arrive at varying times before the scheduled appointment time, and can be dealt with in the order that they arrive. That is if everything goes according to plan, which rarely happens. So, while you've taken yet more time away from your job, family, and other priorities, they want to jam you into an impossible appointment schedule. Just the math boggles the mind. One doctor seeing 5-8 patients every 15 minutes? That's less than 2 minutes each. It doesn't work, which is why you're in this holding pattern for over an hour.
Stand up for yourself and your time. Become visible! Ask when you check in, how long the wait will be. If they say 10 minutes, add at least 15 more onto that. If you've been waiting longer than 20 minutes, ask why and if you can reschedule. Now most staff members can be rude, busk, unprofessional, and argumentative. You should generally expect some form of frost in their tone and manner. Unfortunately, the sorry truth is they are overworked, overburdened with paperwork, and you're probably the 20th person today to infer they're not doing their job. And, that 's exactly how they see it.
Most of the blame for all you're complaining about can be lain at the door of the insurance companies and physician's groups. They create the environment that causes doctors to overbook patients on a daily basis. Add to that, all the incentives they're given to limit care to just seeing your Primary Care Physician, and you have the current situation. A mess without end.
The key to becoming visible is to become known to your doctor's staff. Some people use bribery - cookies, candy, etc., others engage in personal conversations with staff members, creating a "friend" environment, while still others gain attention in all the wrong ways. Now while I recommend that you stand up for yourself, a little self restraint never hurt anyone and may be to your advantage later on.. Please do keep in mind that these are the few people whom can become your greatest ally and asset or your worst nightmare and adversary. If you can make your point without pissing off your allies, then please do so. You should be commended as truly gifted. But if you are like the other 99.9% of us, take time to consider life from their prospective. A never ending parade of impatient, rude, busk, and sarcastic patients. They have zero authority over who gets seen when, or whom waits longer or not. But.....if you can get them on your side, say as a friend or mutual acquaintance, they can be a wealth of information. Regarding the best days and times to schedule appointments, or even better, the worst possible times you should avoid at all costs. Some have even managed to squeeze me in a slot that didn't actually exist, just so I didn't have to wait.
Just counting to ten and calming your own temper can be the huge asset in gaining visibility. You can still ask to reschedule, but without the anger and defensive manner, you're more likely to get a better time slot and a lot less waiting. It doesn't always work, especially when visiting the radiological or speciality doctors that you see only rarely. But a few wise tips can help. Ask when the best time is for the least of amount of waiting. Also, go prepared to wait. Bring a book, magazines, that unfinished crossword puzzle, or whatever makes the time pass more quickly for you. Anything that distracts you from the amount of time you're wasting is great. So find something productive to do with your waiting time. With all these electronic gadgets in pocket size, I'd almost bet you could get the same amount of work done in the waiting room as you normally would at work.
Friday, May 28, 2010
Thursday, May 20, 2010
Trying to get in.
For most of us, finding the right doctor is a moot point. We already have one we're relatively satisfied with, and knows our medical history. So, we fortunate souls can skip the initial consultation preparedness speech, and move directly on to our problems.
Why is it that once you're in, you can never get in? Or, get an appointment, that is without what seems like an act of Congress? Now, not all doctor's operate this way, but enough do to warrant further investigation.
What is the problem? The problem is that with the capitation HMO and PPO plans of insurance, most doctors are squeezed into a Physician's Group. Each step further down the ladder away from the insurance company your doctor is, well the fewer direct dealing they have with the actual insurance company. Therefore, your monthly premium gets hacked up into bits for each rung on that ladder: Step one - the insurance company; Step two - the Administrative costs; Step three - the Physician's Group; and steps four, five and six are juggled between the Doctor, the laboratory, and radiological groups. That's a mighty thin slice of the pie left to your Doctor. Plus, there are incentives to all to save money by restricting (denying) care. So, to make up for this thinning paycheck, the Doctor's do what any good business person does. Take on more clients (patients). On average, most Doctors see only 25-30% of the actual total patients that are assigned to their practice. Even that percentage is high volume, averaging 75-150 patients per week or more. It becomes somewhat like visiting Disneyland during the height of summer, Saturday afternoon. Chances are you'll be in for a lot of waiting. Same principles apply to getting that appointment. The more patients they have to see within only so many office hours, tends to strangle both the amount of time allotted for each patient, and the number of openings for future visits gets pushed further and further apart.
If you don't regularly see your Doctor, chances are excellent that when you call to schedule that appointment, they won't have any times available for 6-8 weeks, if you're lucky. Need to schedule on a certain day or between specific hours, add another 2-3 weeks onto your wait. It's a fact of our health care industry - fewer Doctors, being paid less per patient, to do twice the paperwork on top of treating numerous new ailments, illnesses, plus all those new drugs being pimped to you via television.
While you're waiting for that 6-8 weeks or more to pass, here are a few excerpts from my previous blog regarding the initial appointment, that may be helpful:
1. Ask if you need to complete any forms. If so, have them mailed, faxed, or go pick them up. Then you can fill them out and return them before the 6-8 weeks.
2. Ask if you should have any tests done. Usually the Doctor will want to assess your condition before any tests, but it can't hurt to ask. It may be that you're due to have blood work done or a mammogram, EKG, etc. This way you can be doing something productive while waiting for the appointment.
3. Always ask to be called if there is an opening &/or cancellation before your scheduled appointment. You never know when someone may be hospitalized or change their mind or have a conflicting schedule. Don't be afraid to ask, it happens more than you realize, but if you don't let them know you'd be willing to accept an alternate appointment time, then they assume you're content with the one you have.
4. Be prepared with a brief synopsis of your health ailments since last seen, anything new, including medications, emergency room or urgent care visits, etc. Also, include a list of questions you'd like to discuss with the Doctor.
5. Bring any recent lab work results, x-rays, etc., with you. If you are unable to hand carry these items, make a note as to the date and place any tests &/or x-rays, etc., were performed, so they can get the results efficiently.
6. Review your notes and make a plan. Most Doctors are so overwhelmed they have little time for each patient. Have a plan ready - the most important information relayed early, along with the most important questions. It may feel as thought you've entered a race against time while trying to jam everything into the conversation with your Doctor. That's why making those lists, notes, and having a plan of attach are so vital. Now, I don't recommend pouncing on the Doctor like some hyena, but try not to waste any time hemming and hawing about why you're there. Be direct, clear and concise. State your case. Ask your questions. But do allow the Doctor the courtesy to speak now and again. They may even want to see your list and reorder items to what they consider most important. So try to write as clearly as possible. Remember you only have a short amount of time to convey your health concerns and questions to a busy Doctor - you don't want to stumble over poor hand writing.
7. Take notes. Listen to what your Doctor is saying. After all, you've waited all this time for their advice, so listen up and write down the important points. It something isn't clear, ask for clarification. It's very important you fully understand your Doctors' actions, whether that's sending you for tests or to another Doctor or Specialist. Ask why and what they hope to accomplish with these actions and if you need to relay any information or do anything further.
8. Follow-up. If you're being treated in any manner - medications, tests, or referrals, always follow up with the Primary Care Physician.
9. Make the follow up appointment today. Don't wait to call in, ask when to follow up and make an appointment to do so today.
The truth is, Doctor's need to hold back some appointment times to see returning patients who need to be seen on a timely basis. For medication refills that are restricted, or cast or stitches that need timely attention, etc., They don't put you off just to piss you off, it's just part of they necessary plan in seeing patients in the order of medical urgency. Remember that when you call to make the appointment. Sometimes the key is to what you relay to the scheduling clerk, and how serious sounding it seems. Who knows, it could shorten your wait time down to 2-4 weeks or even less.
Why is it that once you're in, you can never get in? Or, get an appointment, that is without what seems like an act of Congress? Now, not all doctor's operate this way, but enough do to warrant further investigation.
What is the problem? The problem is that with the capitation HMO and PPO plans of insurance, most doctors are squeezed into a Physician's Group. Each step further down the ladder away from the insurance company your doctor is, well the fewer direct dealing they have with the actual insurance company. Therefore, your monthly premium gets hacked up into bits for each rung on that ladder: Step one - the insurance company; Step two - the Administrative costs; Step three - the Physician's Group; and steps four, five and six are juggled between the Doctor, the laboratory, and radiological groups. That's a mighty thin slice of the pie left to your Doctor. Plus, there are incentives to all to save money by restricting (denying) care. So, to make up for this thinning paycheck, the Doctor's do what any good business person does. Take on more clients (patients). On average, most Doctors see only 25-30% of the actual total patients that are assigned to their practice. Even that percentage is high volume, averaging 75-150 patients per week or more. It becomes somewhat like visiting Disneyland during the height of summer, Saturday afternoon. Chances are you'll be in for a lot of waiting. Same principles apply to getting that appointment. The more patients they have to see within only so many office hours, tends to strangle both the amount of time allotted for each patient, and the number of openings for future visits gets pushed further and further apart.
If you don't regularly see your Doctor, chances are excellent that when you call to schedule that appointment, they won't have any times available for 6-8 weeks, if you're lucky. Need to schedule on a certain day or between specific hours, add another 2-3 weeks onto your wait. It's a fact of our health care industry - fewer Doctors, being paid less per patient, to do twice the paperwork on top of treating numerous new ailments, illnesses, plus all those new drugs being pimped to you via television.
While you're waiting for that 6-8 weeks or more to pass, here are a few excerpts from my previous blog regarding the initial appointment, that may be helpful:
1. Ask if you need to complete any forms. If so, have them mailed, faxed, or go pick them up. Then you can fill them out and return them before the 6-8 weeks.
2. Ask if you should have any tests done. Usually the Doctor will want to assess your condition before any tests, but it can't hurt to ask. It may be that you're due to have blood work done or a mammogram, EKG, etc. This way you can be doing something productive while waiting for the appointment.
3. Always ask to be called if there is an opening &/or cancellation before your scheduled appointment. You never know when someone may be hospitalized or change their mind or have a conflicting schedule. Don't be afraid to ask, it happens more than you realize, but if you don't let them know you'd be willing to accept an alternate appointment time, then they assume you're content with the one you have.
4. Be prepared with a brief synopsis of your health ailments since last seen, anything new, including medications, emergency room or urgent care visits, etc. Also, include a list of questions you'd like to discuss with the Doctor.
5. Bring any recent lab work results, x-rays, etc., with you. If you are unable to hand carry these items, make a note as to the date and place any tests &/or x-rays, etc., were performed, so they can get the results efficiently.
6. Review your notes and make a plan. Most Doctors are so overwhelmed they have little time for each patient. Have a plan ready - the most important information relayed early, along with the most important questions. It may feel as thought you've entered a race against time while trying to jam everything into the conversation with your Doctor. That's why making those lists, notes, and having a plan of attach are so vital. Now, I don't recommend pouncing on the Doctor like some hyena, but try not to waste any time hemming and hawing about why you're there. Be direct, clear and concise. State your case. Ask your questions. But do allow the Doctor the courtesy to speak now and again. They may even want to see your list and reorder items to what they consider most important. So try to write as clearly as possible. Remember you only have a short amount of time to convey your health concerns and questions to a busy Doctor - you don't want to stumble over poor hand writing.
7. Take notes. Listen to what your Doctor is saying. After all, you've waited all this time for their advice, so listen up and write down the important points. It something isn't clear, ask for clarification. It's very important you fully understand your Doctors' actions, whether that's sending you for tests or to another Doctor or Specialist. Ask why and what they hope to accomplish with these actions and if you need to relay any information or do anything further.
8. Follow-up. If you're being treated in any manner - medications, tests, or referrals, always follow up with the Primary Care Physician.
9. Make the follow up appointment today. Don't wait to call in, ask when to follow up and make an appointment to do so today.
The truth is, Doctor's need to hold back some appointment times to see returning patients who need to be seen on a timely basis. For medication refills that are restricted, or cast or stitches that need timely attention, etc., They don't put you off just to piss you off, it's just part of they necessary plan in seeing patients in the order of medical urgency. Remember that when you call to make the appointment. Sometimes the key is to what you relay to the scheduling clerk, and how serious sounding it seems. Who knows, it could shorten your wait time down to 2-4 weeks or even less.
Tuesday, May 11, 2010
Talk to the Doctor
It does matter what you say and how you say it.
Now while most doctor visits seem cruel and unnecessary punishment for most, there are ways to get though it all and still get the most out of each visit.
1. Be clear. Be clear as to why you came to the doctor's office today. Make a list of any symptoms you have, your general health since the last visit, along with any questions you specifically want to discuss with the doctor.
2. Present your case. Present your health case as if you literally were at a trial and are only allowed 60 seconds to make an opening statement. Focus on the most important items first. Be brief, yet concise. For example: I had a stomach ache with diarrhea 3 days ago, for 24 hours, off and on. I ate sushi about 3 hours before it started, etc. I took Imodium 2 times and drank Gatorade for 2 days. Today I'm feeling better, still weak, shaky, and my stomach is still feeling irritated and sore, etc.
3. Give a brief family history. Briefly add any pertinent information about the history of any family members health, as it pertains to your current conditions. i.e., My mom and brother have acid reflux disease, my Aunt has a Heyerdahl hernia, and my dad has a stomach ulcer. These are important pieces of a health care puzzle that the doctor is trying to piece back together.
4. Don't assume anything. Don't assume that just because you remember discussing possible medical conditions or treatment with the doctor 2 months ago, that the doctor will remember the conversation, much less any important factors. Also, don't assume the doctor remembers this is the 4th time you've had similar symptoms. There are many possibilities, remember each piece of information is like another puzzle piece. It makes the whole picture become more clear.
5. Keep things in prospective. Just because you're in pain, don't be too impatient. Most pain medications take away pain, but they also tend to make you sluggish and uncooperative. Also, they don't want any pain medications to mask any symptoms you're experiencing. That's why you'll feel as though you're being grilled by the police instead of the family doctor. They need to get as much useful information from you before any medication takes effect. So, refer back to Item #2, Present your case as clearly and concise as possible in the fewest words. When the doctor becomes satisfied they only need to treat the pain, and not send you elsewhere for more extensive testing, and the doctor is relatively certain as to what is happening to you physically, they probably won't give you anything to take away the pain. They may, however, if it's an extended time period needed to complete all tests, give you a small dose of some medications to ease the severity of your pain. Try to understand that they're trying to do their job effectively and aren't personally satisfied to see any patient in pain.
6. Keep your cool. While being sick and/or in pain is terrible itself, getting upset and angry doesn't help. It only make you feel worse, and makes those around you feel less like helping. No one wants to deal with anyone yelling or screaming at them. I know how difficult this can be, but trust me, you're doing yourself no favors by being grouchy and/or mean. If you are experiencing what you'd consider less than quality or prompt care, then ask someone with you to inquire as to the problem and/or delay. Their patience has not been compromised by pain and illness, so they are likely to approach the problem in a more dignified and tactful manner. Plus, the staff can hardly blame the patient if they're not the one complaining. It's important not to be labeled as being uncooperative or aggressive while being treated. Those two words can mean the difference of a 2 hour wait versus a 6+ hour wait. And, don't think that paperwork just magically becomes misplaced.
7. Be prepared. Like the boyscout motto, you should always go to the doctor prepared. Make certain you have a current insurance card and your personal identification with you. If you're dealing with medical care, be prepared to show both cards to almost everyone. Also, bring any reading glasses as you'll undoubtedly be handed several forms to complete and/or to read over and sign. Make sure you understand what it is you are signing. Also, if you have migraines, or regularly have nausea, then come prepared with an eye mask, ear plugs, ice packs, a wet wash cloth, a "barf" bag or bucket, tissues, or any thing else you can think of that you may need while you're waiting. Comfort items can make the difference between getting through the long wait or having to just grit your teeth and pull your hair out!
8. Try to relax. Conserving your energy whenever possible may be the only thing that will ultimately get you through until treatment arrives.
9. Ask questions. If you don't understand what someone is trying to explain to you about your health, the care you need, or the medications for you to take, then ask them to explain further. It serves no purpose if you don't comprehend the scope or magnitude of your care. You are the first line of defense for your body's ultimate healthy care, so make certain you know what that entails.
10. Follow-up. Always follow-up with your Primary Care Physician (PCP) after any illness, treatment , surgery, or testing. Even if you were seen elsewhere, such as an Emergency Room or Urgent Care facility, go see your personal physician to follow up afterwards. This is to make certain no other treatment, tests, or further care is necessary. Once a condition, illness, or surgery occurs, it can have long lasting effects on your overall health. So discuss what happened, what treatment was given, plus any medications prescribed, or any tests performed with your doctor. Keeping your Primary Care Physician in the loop is a vital part to keeping that puzzle whole and intact.
11. Listen to what your doctor says. Pay close attention to what your doctor says, especially if they are sending you for testing or to a Specialist. Make sure that you know what information is vital to relay to the testing facility and/or Specialist. Hemming and hawing about why you were sent there has negative effects on your health cause. "I don't know why my doctor sent me here.", will get you the least amount of care and/or concern from a Specialist. If they don't get the full story, including family history, the Specialist knows nothing except what they see before them. A person who's not certain why they're there, and who didn't bother to find out from their Primary Care. It you don't care, then why should the Specialist spend their precious time and resources to treat or aid someone who obviously doesn't participate in their own health care? It does matter what you say and how you say it. Most especially when relaying information between different doctors. You may not have all the answers, but what you do say can be the one factor that causes the Specialist or other doctor to pick up the phone and discuss your case with your Primary Care Physician, and/or other doctors. Withholding vital information irregardless of how embarrassing or personal can be the difference between care that's substantial versus minimal treatment that doesn't ultimately help you.
12. Make notes. Keep notes of important information from each Doctor you see. These will be very beneficial when seeking the help from a Specialist, or any health care facility, away from your Primary Care. Make a list of important points to discuss, pertinent information, tests, results, etc., to relay, plus any questions you may have.
Keep in mind, most doctors see on average 50 - 100 patients per week or more. After awhile they all begin to blur together, so forgive the doctor if they don't remember every detail of your health and care. You are your strongest and only advocate to enable you to receive the best care possible. Sitting silently, while waiting for the doctor to ask you questions won't get you much care. Be the patient, help your doctor to recall who you are, your current health concerns, plus any history you feel is necessary and important to bring to the doctor's attention. Then let them ask questions. Be your own ally. Help the doctor and their staff to help you by giving them what they need to provide you with the best care possible. Be vocal, but not aggressive. Be involved, but not in charge. Be aware, not taxing. Most of all, talk to your doctor and listen when they talk, too! Communication is the key to every great relationship. Remember you only get out what you put into it!
Now while most doctor visits seem cruel and unnecessary punishment for most, there are ways to get though it all and still get the most out of each visit.
1. Be clear. Be clear as to why you came to the doctor's office today. Make a list of any symptoms you have, your general health since the last visit, along with any questions you specifically want to discuss with the doctor.
2. Present your case. Present your health case as if you literally were at a trial and are only allowed 60 seconds to make an opening statement. Focus on the most important items first. Be brief, yet concise. For example: I had a stomach ache with diarrhea 3 days ago, for 24 hours, off and on. I ate sushi about 3 hours before it started, etc. I took Imodium 2 times and drank Gatorade for 2 days. Today I'm feeling better, still weak, shaky, and my stomach is still feeling irritated and sore, etc.
3. Give a brief family history. Briefly add any pertinent information about the history of any family members health, as it pertains to your current conditions. i.e., My mom and brother have acid reflux disease, my Aunt has a Heyerdahl hernia, and my dad has a stomach ulcer. These are important pieces of a health care puzzle that the doctor is trying to piece back together.
4. Don't assume anything. Don't assume that just because you remember discussing possible medical conditions or treatment with the doctor 2 months ago, that the doctor will remember the conversation, much less any important factors. Also, don't assume the doctor remembers this is the 4th time you've had similar symptoms. There are many possibilities, remember each piece of information is like another puzzle piece. It makes the whole picture become more clear.
5. Keep things in prospective. Just because you're in pain, don't be too impatient. Most pain medications take away pain, but they also tend to make you sluggish and uncooperative. Also, they don't want any pain medications to mask any symptoms you're experiencing. That's why you'll feel as though you're being grilled by the police instead of the family doctor. They need to get as much useful information from you before any medication takes effect. So, refer back to Item #2, Present your case as clearly and concise as possible in the fewest words. When the doctor becomes satisfied they only need to treat the pain, and not send you elsewhere for more extensive testing, and the doctor is relatively certain as to what is happening to you physically, they probably won't give you anything to take away the pain. They may, however, if it's an extended time period needed to complete all tests, give you a small dose of some medications to ease the severity of your pain. Try to understand that they're trying to do their job effectively and aren't personally satisfied to see any patient in pain.
6. Keep your cool. While being sick and/or in pain is terrible itself, getting upset and angry doesn't help. It only make you feel worse, and makes those around you feel less like helping. No one wants to deal with anyone yelling or screaming at them. I know how difficult this can be, but trust me, you're doing yourself no favors by being grouchy and/or mean. If you are experiencing what you'd consider less than quality or prompt care, then ask someone with you to inquire as to the problem and/or delay. Their patience has not been compromised by pain and illness, so they are likely to approach the problem in a more dignified and tactful manner. Plus, the staff can hardly blame the patient if they're not the one complaining. It's important not to be labeled as being uncooperative or aggressive while being treated. Those two words can mean the difference of a 2 hour wait versus a 6+ hour wait. And, don't think that paperwork just magically becomes misplaced.
7. Be prepared. Like the boyscout motto, you should always go to the doctor prepared. Make certain you have a current insurance card and your personal identification with you. If you're dealing with medical care, be prepared to show both cards to almost everyone. Also, bring any reading glasses as you'll undoubtedly be handed several forms to complete and/or to read over and sign. Make sure you understand what it is you are signing. Also, if you have migraines, or regularly have nausea, then come prepared with an eye mask, ear plugs, ice packs, a wet wash cloth, a "barf" bag or bucket, tissues, or any thing else you can think of that you may need while you're waiting. Comfort items can make the difference between getting through the long wait or having to just grit your teeth and pull your hair out!
8. Try to relax. Conserving your energy whenever possible may be the only thing that will ultimately get you through until treatment arrives.
9. Ask questions. If you don't understand what someone is trying to explain to you about your health, the care you need, or the medications for you to take, then ask them to explain further. It serves no purpose if you don't comprehend the scope or magnitude of your care. You are the first line of defense for your body's ultimate healthy care, so make certain you know what that entails.
10. Follow-up. Always follow-up with your Primary Care Physician (PCP) after any illness, treatment , surgery, or testing. Even if you were seen elsewhere, such as an Emergency Room or Urgent Care facility, go see your personal physician to follow up afterwards. This is to make certain no other treatment, tests, or further care is necessary. Once a condition, illness, or surgery occurs, it can have long lasting effects on your overall health. So discuss what happened, what treatment was given, plus any medications prescribed, or any tests performed with your doctor. Keeping your Primary Care Physician in the loop is a vital part to keeping that puzzle whole and intact.
11. Listen to what your doctor says. Pay close attention to what your doctor says, especially if they are sending you for testing or to a Specialist. Make sure that you know what information is vital to relay to the testing facility and/or Specialist. Hemming and hawing about why you were sent there has negative effects on your health cause. "I don't know why my doctor sent me here.", will get you the least amount of care and/or concern from a Specialist. If they don't get the full story, including family history, the Specialist knows nothing except what they see before them. A person who's not certain why they're there, and who didn't bother to find out from their Primary Care. It you don't care, then why should the Specialist spend their precious time and resources to treat or aid someone who obviously doesn't participate in their own health care? It does matter what you say and how you say it. Most especially when relaying information between different doctors. You may not have all the answers, but what you do say can be the one factor that causes the Specialist or other doctor to pick up the phone and discuss your case with your Primary Care Physician, and/or other doctors. Withholding vital information irregardless of how embarrassing or personal can be the difference between care that's substantial versus minimal treatment that doesn't ultimately help you.
12. Make notes. Keep notes of important information from each Doctor you see. These will be very beneficial when seeking the help from a Specialist, or any health care facility, away from your Primary Care. Make a list of important points to discuss, pertinent information, tests, results, etc., to relay, plus any questions you may have.
Keep in mind, most doctors see on average 50 - 100 patients per week or more. After awhile they all begin to blur together, so forgive the doctor if they don't remember every detail of your health and care. You are your strongest and only advocate to enable you to receive the best care possible. Sitting silently, while waiting for the doctor to ask you questions won't get you much care. Be the patient, help your doctor to recall who you are, your current health concerns, plus any history you feel is necessary and important to bring to the doctor's attention. Then let them ask questions. Be your own ally. Help the doctor and their staff to help you by giving them what they need to provide you with the best care possible. Be vocal, but not aggressive. Be involved, but not in charge. Be aware, not taxing. Most of all, talk to your doctor and listen when they talk, too! Communication is the key to every great relationship. Remember you only get out what you put into it!
Thursday, May 6, 2010
The Prescription Dilemna
It seems everyone, at sometime will need to fill a prescription of some type. Whether for your child's cold, your migraine headaches, or for your husband's thinning hair -- we all live with and by prescription medications. So much so that many are converted to OTC (over the counter) and no longer require a written prescription from the Doctor.
While we all use these medications occasionally or regularly, we all experience the same problems in getting them filled. First, no one can read them except for the Doctors and Pharmacists. Who's to say they're not just passing lurid jokes back and forth? It would seem they're worthless, anyway.
After that, finding a Pharmacy has become easier than finding a convenience store or gas station. There are several on every other corner, so that's not part of the problem. Those begin when you actually get up to the counter to request that your prescription be filled. Most Pharmacies are overwhelmed during particular hours: upon first opening, although this is usually only on Saturday's and Monday's, or following a holiday; next is between the hours of 10:30 am until 1:00 pm, due most in part to patients who've just seen their Doctor and received a new prescription or a newly written prescription order; then again, between 2:00 pm and 6:00 pm or later is extremely busy. Again, due to afternoon appointment patients, and those patients requesting refills that morning or the day before; The busiest days are Monday, Tuesday, Wednesday, some Thursdays, and always on Fridays. -- If you know or have a Pharmacy that is open on Saturdays, use that day, you'll save yourself a lot of time and frustrations.
Next, you'll need to present at pertinent insurance information, insurance I.D. card, plus your own personal identification, along with your date of birth, full address and telephone number. Now, don't relax just yet, the tough stuff is still to come. Two very important things, first. Different states have different rules regarding how long a prescription is accepted from the date on the prescription. So, if you aren't getting that prescription filled right away, be certain you know how long you can wait before you must fill the prescription or return to the Doctor for another one. Second, if you're concerned about the cost of your prescription, NOW is the time to ask the Pharmacist for an approximate pricing.
If for some unknown reason, your Doctor did not complete the prescription form correctly, well, just stop. Don't argue. It won't change anything. Take a deep breath and return immediately to your Doctor's office. I would even call ahead to alert them to the problem so they can write a correctly completed prescription by the time you arrive. Now, to be fair, the State and Government change the look and appearance of prescription pads regularly to decrease fraud. But, they also change the required information and where to put it on the form each time, also. So, take that few extra minutes while you're at the Doctor's office the first time, and read over every line and box of information required to make certain the Doctor didn't inadvertently miss a important requirement.
Once the prescription is deemed to have been completed properly, then you should expect a wait of at least 30 minutes, but more often 1 - 2 hours, for it to be filled. Consider using the Pharmacy at your local grocery or discount store that you frequent, that way you can do your shopping while you wait. Otherwise, if the wait is beyond 30 minutes, I would choose to run other errands and return at a later time.
Part of the delay is the Pharmacist generally has to contact the Doctor to verify the authenticity, the correct medication, dosage and frequency -- just to minimize fraud, again. They have found alot of patients change the number of pills, the number of refills, and sometimes the dosage or strength of the medications. Honesty is never just assumed, anymore. In fact, quite the opposite.
After that's verified, then they must verify your insurance coverage is valid and in effect, plus what medications are covered or not covered, and how much the insurance will pay toward each prescription medication. Some plans pay a flat rate for medications, while others have a tier-rate system. They pay so much for drugs from column A, a different amount for column B, different again for column C, and D, and so on. While others pay only for Generic medications, even when there is no Generic equivalent available. Some plans only discount a certain percentage off the cost of the medication, while others have an annual maximum they'll pay for all medications filled within the same calendar year. The manner that insurance companies pay towards prescription medications is as varied as the insurance companies, themselves. Even some plans within the same insurance company pay out benefits differently. Read you policy benefits or contact your insurance provider for full details as to how they calculate payment toward your prescription medications.
After all that, the Pharmacy may not have sufficient stock to fill every prescription right away. Most will offer to fill for less than the prescribed amount, temporarily, until they can restock the need medication. Of course, you'll need to return later to pick-up the remaining pills.
If you find a diligent Pharmacist, and most are, they usually try to shop around for the lowest price with their competitors, and will mostly match any lower price. If your Pharmacy doesn't offer this service, then you can call around to several drug stores and ask what their cash price is for your prescription. I would strongly advise calling Sam's Club and/or Costco, as they generally have the lowest prices. If you find a lower price, bring it to the attention of your Pharmacist. If they don't match the lower price, I'd look for a new Pharmacy.
Once all this extraneous stuff has been completed, then can your Pharmacy begin to fill your prescription. When completed, it is the Pharmacist's duty to offer you a consultation -- to discuss the medication, what it's for, whether it should be taken with food or not, and any possible side effects and so on. If you are taking any other medications, over the counter drugs, supplements, and/or vitamins, NOW is the time to have the Pharmacist check for possible drug interactions. These can be fatal. I strongly advise you NOT to wave off the Pharmacist's consultation. It could mean the difference between using the medication safely vs taking it incorrectly, leading to most side effects and possibly even death! Even if this is a drug you are familiar with, at least allow the Pharmacist to check for any drug interactions with your other medications. Also, always verify that you completely understand when to take the medication. Twice a day can mean several things: a) upon waking and at bedtime; b) between meals; c) a specified time, i.e., every 8 hours; or d) with meals; There are several ways to interpret twice a day, so ask the Pharmacist to clarify exactly when to take the medication, or if it makes any difference.
Finally, before you leave the Pharmacy counter, do two (2) things:
1) Count the number of pills in the bottle matches the number of pills prescribed on the bottle.
2) Verify that the pills inside the bottle are the correct medication.
Additionally, make certain that you receive all the bottles of medications prescribed and paid for. Once you get home, review all the literature from the Pharmacy about your medications, including all known side effects and what to do should you experience any of them.
Now, if you're they to pick-up a refilled prescription, well, the rules are a bit different. Most Doctors and insurance companies will only allow either 30 days or 90 days worth of medications, depending upon the specific drug. Which doesn't work out well for months with 31 days in them. Most insurance companies only allow you to request a refill no more than 25 days after your last prescription was filled. In some cases, this time is reduced to 72 hours before the 30th day after you last filled that prescription. For example, if I filled my prescription last month on the 15th, with the 25 day rule, I can begin to request refill on the 10th of the following month; with the 72 hour rule, I can begin to request on the 12th. Which appears to be sufficient time, except because last month was 31 days long, I'll completely run out on the 14th of the following month, so my 5 day grace period just became 4 days, and my 72 hours became 48 hours. Oh, and guess where the weekend falls? Bingo! So now, I've got no time and a very good chance of running out of my medications!
First, call in the refill the day before the 5 day grace or 72 hours. Next, contact your Doctor and explain that even though you are following the rules, you will run out if they don't approve a refill before the weekend. Then, keep call both the Pharmacy and the Doctor twice daily. You don't want to become a pest, just be persistent! If all else fails, ask if they will allow you enough pills to get you through until Monday. And finally, always make certain that the medication your Doctor calls into the Pharmacy to be refilled is the correct medication that you need filled!
This brings up a series of questions even I don't fully understand:
1. If I have a written prescription and the Pharmacy can call the Doctor, then why when I requesting a refill can they only send a fax to request an approval? For some strange Doctor/Pharmacist law, they can only communicate via fax with regards to refills. Who knew?
2. If the original prescription says to give me so many refills, then why are we doing any of this other stuff to begin with?
3. Why does the insurance company always get involved? Especially if they believe you want to get your prescription refilled one day early?
4. Why do Doctors post signs in their offices that state, "All refill requests will take a minimum of 72 hours to process." Do they mean 72 business hours or just 3 working days? I'm confused and I know the answer.
5. Why do I always have to remind everyone else, (the Pharmacy, the Doctor, and the insurance company) that a 30 day supply doesn't last as long during a 31 day month? Am I the only person who understands the math?
6. When it's down to the final few hours before I spend my weekend in pain, and the Doctor's office swears they sent a faxed approval to the Pharmacy hours ago, while at the very same time the Pharmacy swears they haven't received anything from the Doctor's office? How does passing the buck help? It doesn't. I don't care who did or didn't do what, I just want my refill to be approved and filled so I can come and pick it up!
7. Why do these rules exist? I can't go to visit my elderly parents for more than 3-1/2 weeks because I can't get more than 30 days supply of my medications. Not 31, 40, 45 , or 60, just 30 days exactly!
8. If you take more than one medication, this creates it's own ripple effect: drug A has to be filled on the 10th, drug B on the 12th, C on the 17th, D on the 23rd , and so on. That creates numerous phone calls each month, plus alot of wasted time with at least 3-5 separate trips to the Pharmacy, if all works out well. Which rarely happens. Usually I make one trip for each prescription. I once tried to ask my Doctor to write a partial prescription just to get all my medications to refill at the same time. You would have thought I was holding him at gunpoint!
The harsh reality is, there is no easy way to deal with getting your prescriptions. I've tried the Pharmacies with the automatic refills. It doesn't work any better than calling them in yourself, because, again, they fill based on the 30 day month, while 50% of our months during a calendar year are 31 days long. So, I either suffer through for a few days, or I keep banging my head against that stone wall. Either way, I still end up with one heck of a headache!
While we all use these medications occasionally or regularly, we all experience the same problems in getting them filled. First, no one can read them except for the Doctors and Pharmacists. Who's to say they're not just passing lurid jokes back and forth? It would seem they're worthless, anyway.
After that, finding a Pharmacy has become easier than finding a convenience store or gas station. There are several on every other corner, so that's not part of the problem. Those begin when you actually get up to the counter to request that your prescription be filled. Most Pharmacies are overwhelmed during particular hours: upon first opening, although this is usually only on Saturday's and Monday's, or following a holiday; next is between the hours of 10:30 am until 1:00 pm, due most in part to patients who've just seen their Doctor and received a new prescription or a newly written prescription order; then again, between 2:00 pm and 6:00 pm or later is extremely busy. Again, due to afternoon appointment patients, and those patients requesting refills that morning or the day before; The busiest days are Monday, Tuesday, Wednesday, some Thursdays, and always on Fridays. -- If you know or have a Pharmacy that is open on Saturdays, use that day, you'll save yourself a lot of time and frustrations.
Next, you'll need to present at pertinent insurance information, insurance I.D. card, plus your own personal identification, along with your date of birth, full address and telephone number. Now, don't relax just yet, the tough stuff is still to come. Two very important things, first. Different states have different rules regarding how long a prescription is accepted from the date on the prescription. So, if you aren't getting that prescription filled right away, be certain you know how long you can wait before you must fill the prescription or return to the Doctor for another one. Second, if you're concerned about the cost of your prescription, NOW is the time to ask the Pharmacist for an approximate pricing.
If for some unknown reason, your Doctor did not complete the prescription form correctly, well, just stop. Don't argue. It won't change anything. Take a deep breath and return immediately to your Doctor's office. I would even call ahead to alert them to the problem so they can write a correctly completed prescription by the time you arrive. Now, to be fair, the State and Government change the look and appearance of prescription pads regularly to decrease fraud. But, they also change the required information and where to put it on the form each time, also. So, take that few extra minutes while you're at the Doctor's office the first time, and read over every line and box of information required to make certain the Doctor didn't inadvertently miss a important requirement.
Once the prescription is deemed to have been completed properly, then you should expect a wait of at least 30 minutes, but more often 1 - 2 hours, for it to be filled. Consider using the Pharmacy at your local grocery or discount store that you frequent, that way you can do your shopping while you wait. Otherwise, if the wait is beyond 30 minutes, I would choose to run other errands and return at a later time.
Part of the delay is the Pharmacist generally has to contact the Doctor to verify the authenticity, the correct medication, dosage and frequency -- just to minimize fraud, again. They have found alot of patients change the number of pills, the number of refills, and sometimes the dosage or strength of the medications. Honesty is never just assumed, anymore. In fact, quite the opposite.
After that's verified, then they must verify your insurance coverage is valid and in effect, plus what medications are covered or not covered, and how much the insurance will pay toward each prescription medication. Some plans pay a flat rate for medications, while others have a tier-rate system. They pay so much for drugs from column A, a different amount for column B, different again for column C, and D, and so on. While others pay only for Generic medications, even when there is no Generic equivalent available. Some plans only discount a certain percentage off the cost of the medication, while others have an annual maximum they'll pay for all medications filled within the same calendar year. The manner that insurance companies pay towards prescription medications is as varied as the insurance companies, themselves. Even some plans within the same insurance company pay out benefits differently. Read you policy benefits or contact your insurance provider for full details as to how they calculate payment toward your prescription medications.
After all that, the Pharmacy may not have sufficient stock to fill every prescription right away. Most will offer to fill for less than the prescribed amount, temporarily, until they can restock the need medication. Of course, you'll need to return later to pick-up the remaining pills.
If you find a diligent Pharmacist, and most are, they usually try to shop around for the lowest price with their competitors, and will mostly match any lower price. If your Pharmacy doesn't offer this service, then you can call around to several drug stores and ask what their cash price is for your prescription. I would strongly advise calling Sam's Club and/or Costco, as they generally have the lowest prices. If you find a lower price, bring it to the attention of your Pharmacist. If they don't match the lower price, I'd look for a new Pharmacy.
Once all this extraneous stuff has been completed, then can your Pharmacy begin to fill your prescription. When completed, it is the Pharmacist's duty to offer you a consultation -- to discuss the medication, what it's for, whether it should be taken with food or not, and any possible side effects and so on. If you are taking any other medications, over the counter drugs, supplements, and/or vitamins, NOW is the time to have the Pharmacist check for possible drug interactions. These can be fatal. I strongly advise you NOT to wave off the Pharmacist's consultation. It could mean the difference between using the medication safely vs taking it incorrectly, leading to most side effects and possibly even death! Even if this is a drug you are familiar with, at least allow the Pharmacist to check for any drug interactions with your other medications. Also, always verify that you completely understand when to take the medication. Twice a day can mean several things: a) upon waking and at bedtime; b) between meals; c) a specified time, i.e., every 8 hours; or d) with meals; There are several ways to interpret twice a day, so ask the Pharmacist to clarify exactly when to take the medication, or if it makes any difference.
Finally, before you leave the Pharmacy counter, do two (2) things:
1) Count the number of pills in the bottle matches the number of pills prescribed on the bottle.
2) Verify that the pills inside the bottle are the correct medication.
Additionally, make certain that you receive all the bottles of medications prescribed and paid for. Once you get home, review all the literature from the Pharmacy about your medications, including all known side effects and what to do should you experience any of them.
Now, if you're they to pick-up a refilled prescription, well, the rules are a bit different. Most Doctors and insurance companies will only allow either 30 days or 90 days worth of medications, depending upon the specific drug. Which doesn't work out well for months with 31 days in them. Most insurance companies only allow you to request a refill no more than 25 days after your last prescription was filled. In some cases, this time is reduced to 72 hours before the 30th day after you last filled that prescription. For example, if I filled my prescription last month on the 15th, with the 25 day rule, I can begin to request refill on the 10th of the following month; with the 72 hour rule, I can begin to request on the 12th. Which appears to be sufficient time, except because last month was 31 days long, I'll completely run out on the 14th of the following month, so my 5 day grace period just became 4 days, and my 72 hours became 48 hours. Oh, and guess where the weekend falls? Bingo! So now, I've got no time and a very good chance of running out of my medications!
First, call in the refill the day before the 5 day grace or 72 hours. Next, contact your Doctor and explain that even though you are following the rules, you will run out if they don't approve a refill before the weekend. Then, keep call both the Pharmacy and the Doctor twice daily. You don't want to become a pest, just be persistent! If all else fails, ask if they will allow you enough pills to get you through until Monday. And finally, always make certain that the medication your Doctor calls into the Pharmacy to be refilled is the correct medication that you need filled!
This brings up a series of questions even I don't fully understand:
1. If I have a written prescription and the Pharmacy can call the Doctor, then why when I requesting a refill can they only send a fax to request an approval? For some strange Doctor/Pharmacist law, they can only communicate via fax with regards to refills. Who knew?
2. If the original prescription says to give me so many refills, then why are we doing any of this other stuff to begin with?
3. Why does the insurance company always get involved? Especially if they believe you want to get your prescription refilled one day early?
4. Why do Doctors post signs in their offices that state, "All refill requests will take a minimum of 72 hours to process." Do they mean 72 business hours or just 3 working days? I'm confused and I know the answer.
5. Why do I always have to remind everyone else, (the Pharmacy, the Doctor, and the insurance company) that a 30 day supply doesn't last as long during a 31 day month? Am I the only person who understands the math?
6. When it's down to the final few hours before I spend my weekend in pain, and the Doctor's office swears they sent a faxed approval to the Pharmacy hours ago, while at the very same time the Pharmacy swears they haven't received anything from the Doctor's office? How does passing the buck help? It doesn't. I don't care who did or didn't do what, I just want my refill to be approved and filled so I can come and pick it up!
7. Why do these rules exist? I can't go to visit my elderly parents for more than 3-1/2 weeks because I can't get more than 30 days supply of my medications. Not 31, 40, 45 , or 60, just 30 days exactly!
8. If you take more than one medication, this creates it's own ripple effect: drug A has to be filled on the 10th, drug B on the 12th, C on the 17th, D on the 23rd , and so on. That creates numerous phone calls each month, plus alot of wasted time with at least 3-5 separate trips to the Pharmacy, if all works out well. Which rarely happens. Usually I make one trip for each prescription. I once tried to ask my Doctor to write a partial prescription just to get all my medications to refill at the same time. You would have thought I was holding him at gunpoint!
The harsh reality is, there is no easy way to deal with getting your prescriptions. I've tried the Pharmacies with the automatic refills. It doesn't work any better than calling them in yourself, because, again, they fill based on the 30 day month, while 50% of our months during a calendar year are 31 days long. So, I either suffer through for a few days, or I keep banging my head against that stone wall. Either way, I still end up with one heck of a headache!
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