One way to improve health care and cut costs - teach people how to communicate

with doctors.

For example, a patient goes in for a routine exam, and it is only when the doctor is leaving that the patient mentions something that is bothersome (the doorknob question). Sometimes the concern is trivial, sometimes it is more important than anything found in the exam. (ex. By the way doctor, I have this funny mole on my elbow -it's probably nothing, but..)
People know their bodies better than anyone else and need to be able to present their concerns with confidence at the start of the exam.

Another example: a pre-schooler has a mild cold, and wakes up with a fever. The parent checks the temperature through the day as it goes up and down from 99 to 101. Finally, at midnight, the temperature goes to 101.2, the parent panics and takes the kid to the E.R. Patients need to know when to call their doctor. If something is of concern at 2 in the afternoon, it's still going to be of concern at 2 in the morning. The difference is that your doctor can give you advice at 2PM, maybe see the child and maybe call in a prescription or give you instructions. You'll get the same results at the ER at 2AM, but at about 10 times the cost!

no insurance.

More than 50 MILLION people in the US don't have any kind of health insurance. Do you understand that? What do THOSE people do when their kid has a 102 degree (F) fever, whether it's at 2:00 pm or 2:00 am makes no difference whatsoever.

for the people with coverage, costs are higher than for equal or better care in other industrialized countries.

My former doctor loved it when you brought a list. Since then, that's what I've done with all my doctors. I throw everything on there and we go through the questions. The list means I don't forget, or even chicken out of asking (oh, it can't be important, so I won't bother him/her with this).

And my pediatrician is particularly good about being available and will answer questions all through the day. So I have also made sure I take advantage of that, and don't wait until the wee hours.

But too many people don't have someone to call. Hmmm...I wonder how much money could be saved, from a public health POV, if nurse practitioners (why doesn't that look right? Forgive my spelling) were on call at a free number in each community for those questions? Even if it was mainly just to direct traffic, but could also deal with those panics that are always worse in the middle of the night?

I think a personal relationship is necessary to get advice over the phone. How can you judge what someone is reporting if you have no context regarding that person's general health and their history? For example, I called our family doctor when one of my kids had what might have been a minor ankle sprain. He knew me well enough to know that I wouldn't be calling unless there was a problem. It turned out my child was having the first symptoms of Juvenile Rheumatoid Arthritis. No one can say for sure, but I am convinced that she had a mild course of the disease because she was so promptly placed on high doses of aspirin.

I just wonder about people who don't have that... would calling that number at 2 am to ask: is this something to be really scared about? might help.

I'm always nervous with a new doctor until I know them well enough to really take a read on how they work.

They want you in and out ASAP. One item per customer.

They want you to tell it all to the nurse, who might or might not tell them.

I've met very few doctors who give any more of a shit about their patients than your average Taco Bell cashier cares about their customers at the drive-thru.

What is the effective difference between seeing a strange doctor at the ER, a random doctor at the HMO or a doctor who doesn't remember you from visit to visit?

My SO's grandFATHER keeps going to his doctor asking for the pill to help WOMEN who have a problem going to the bathroom too much.

invest some time in patient education. We treat a lot of problems today that went untreated in the past because there was no good treatment. I know an elderly gentleman who was extremely sleep deprived because he was getting up several times a night to go to the bathroom. He finally mentioned this to his doctor after he saw an ad on tv. Until then he hadn't realized that anything could be done! It's up to the doctor to decide what, if anything to prescribe and to explain to the patient what is going on. A doctor who prescribes something (especially antibiotics!) just because the patient asks for it is a fool.

that's why the Dr's go to school.

How many people out there live with depression because they assume everyoen else feels like they do?