Royal Rooters

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Good opinion pieces. Definitely illustrate one aspect of provider-patient contributions to rising health care costs as evidenced by the data in numerous journal articles.

If you have time, you may want to check out this 4 part series by Dr. Thomas Bodenheimer in a 2005 issue of Annals of Internal Medicine that I've attached.
 

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made it out alive
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I agree with almost all of what he says.

Telling someone they're too fat or that their smoking is killing them is a privilege that only ER docs are afforded. They don't have (and probably don't want) to ever see those people again. Family practitioners, podiatrists and anyone else who builds a practice has to tread lightly in order to make sure they don't get a reputation as a jerk so that they will continue to get referrals and current patients will speak highly of them to their peers.

We would all love to be like Dr. Cox on scrubs and tell people straight to their face that they're a fatty and that is what is hurting/killing them, but this isn't realistic. With the "obesity epidemic" in this country, that would lead to a lot of angry patients and a lot of empty waiting rooms. Most docs just aren't willing to risk their reputation. We still need to "encourage" them to lose weight and stop smoking which many do, but without being blunt and to the point, most patients disregard this advice and think that something else is the problem.

Has medicine become too "nice"?
 

215353

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Has medicine become too "nice"?
Yeah probably...

People are stubborn and most people ignore most doctor's orders if they are not life threatening. This is probably seen, to an even higher degree, in the fields of podiatry and dentistry. Both feet and teeth tend to be less of a priority for most people. Couple this mentality with tools such as WebMD and you have people who already "know" what they have before you even examine them.

I think the best way to deal with potential and current non-compliant patients is to keep on recommending they make lifestyle changes in a polite manner. Thats all you really can do. You give off the perception that you care (whether you truly do or don't) and they walk away not thinking you are a jerk. It's the most positive outcome.

Being blunt and brash accomplishes nothing. It only gives you a bad reputation and your patient keeps on leading his/her non-compliant lifestyle.
 
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Feli

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I think that a simple part of the answer is higher co-pays, especially for non-life threatening ER visits and prolonged geriatric/disability hospitalizations. If it's not immediately life threatening, they must pay cash or credit card upon ER triage... or alternatively provide SSN for authorization of their wage/tax garnishing to pay the hospital and care providers in that way. Similarly, families who want "everything possible" for a sick elderly family member who has no reasonable prognosis of ever leading a meaningful self sufficient life or contributing to society again should definitely have to fork up a hefty % of the gargantuan hospital bill they are generating by their decisions. People should be forced to actually think about how they utilize health care (aka the money of other taxpayers).

I hate anecdotal examples as much as anyone, but they do serve a purpose. I saw an ER patient tonight who was scheduled for our clinic in five days since we had a busy schedule. She just couldn't wait. It was a diagnosis of possible metatarsalgia or met stress fracture that wasn't visible on the XR yet (and that's being generous). She racked up a likely $1000 ER bill this evening for what could have been a $150 clinic bill in a few days. I have had other similar established or new patients call or page to describe a foot injury, and when I tell them I will schedule them to come to clinic since it's much cheaper than the ER, they respond "well I have a co-pay for the office but no co-pay if I just go to the ER." I don't even have to get started on how many inpatient consults I see for people who will never again walk, work, function, or sometimes even wouldn't survive a day at a care level outside the hospital or nursing home care. Yet we keep pumping them full of high cost antibiotics, nutrition, physician consults, medications, diagnostic tests, surgery, etc etc until the bitter end since the family won't give up or there is no family to even ask.

The entitled and arrogant "I'm might not be paying for it, but I deserve health care" attitude will only get worse with socialized medicine. I think it's a good idea to make patients to think about when, where, and how they utilize health care... and money talks a language they may listen to. Higher co-pays for patients/families and more health education would go a long way to not seeing the minor injury ER nonsense and ICU/hospice hopeless money pits that are all too common in America.