JustCare

Tag: Preventive care

  • Why it’s so hard to find a primary care doctor?

    Why it’s so hard to find a primary care doctor?

    With the medical profession becoming increasingly corporatized and physicians burdened by administrative ordeals and unable to treat patients as they think appropriate, fewer people are becoming physicians, particularly primary care physicians. A new report on the situation in Massachusetts by the Massachusetts Health Policy Commission explains why it’s so hard to find a primary care doctor.

    These days, you can wait a long time to see a primary care doctor, and you are too often forced to switch from one to another. Insurers do not treat continuity of care as a value and limit your coverage to their ever-changing and often restricted network of providers. It’s hard to get an annual check up without a long wait.

    Massachusetts is looking into the shortage of primary care doctors with the goal of increasing their numbers. You need a primary care doctor. The shortage will continue unless government acts.

    Three key reasons for the shortage:

    1. The bulk of primary care doctors in the US are older, averaging 55 years old, and retiring by the time they are 65. Others are just exhausted by their workload and administrative demands on them.
    2. New physicians are less likely to go into primary care because insurers pay little for preventive services; the provider money is in procedures and tests to treat conditions. Moreover, medical school can be very expensive and becoming a specialist allows physicians to pay off their debt more quickly.
    3. Those primary care doctors who continue to practice either end up doing new services to make money or going into concierge medicine, which gives them more time with patients and less administrative hassle.

    What is the value of having a primary care physician? Preventive services help identify diseases early or stop them altogether.

    What is to be done? We need to pay higher rates to primary care physicians and reduce their administrative burdens. As a society, we need to be investing in primary care.

    Here’s more from Just Care:

  • Cancer screenings bring benefits at substantial cost

    Cancer screenings bring benefits at substantial cost

    We’ve come a long way in being able to screen for a variety of cancers and less far in curing people with mid- to late-stage cancer. We still need to make sure everyone takes advantage of these cancer screenings; they are important for ensuring survival from cancer. Fortunately, people with Medicare can get several cancer screenings at no cost.

    Many people with Medicare don’t yet benefit from these free cancer screenings. One recent study found that only about 50-60 percent of people with Medicare get breast and colorectal cancer screenings as recommended.

    The cost of screening Americans for five different types of cancer is now $43 billion a year, according to a new estimate published in the Annals of Internal Medicine, reports Gina Kolata for The New York Times. The researchers estimated the cost of breast, cervical, colorectal, lung and prostate cancer screenings.

    Of the $43 billion spent each year on cancer, more than $22 billion is to cover the cost of colonoscopies. But, colonoscopies can both detect and prevent cancer. Physicians can remove growths on the colon that can become cancer over time.

    How beneficial are screenings? The U.S. Preventive Services Task Force, an independent entity that grades the value of screenings, recommends lung, breast, cervical and colorectal screenings as a way to reduce the likelihood of death. It does not take a position on the value of prostate screenings.

    Cancer death rates have dropped significantly in the last 40 or so years, some say because many people have stopped smoking, improved their diets and otherwise take better care of themselves than in the past. The death rate from colon cancer has dropped by half. Today, about half of all eligible individuals are screened for colon cancer.

    One clinical trial found that screening possibly reduced the likelihood of death from colorectal cancer by one third over 30 years.  That sounds like a lot, and I don’t want to minimize it. Yet, it’s important to note that the overall risk fell to two percent from three percent.

    Here’s more from Just Care:

  • Free preventive care: New avenue for health care price gouging

    Free preventive care: New avenue for health care price gouging

    Watch out. Don’t assume that the free preventive care services to which you are entitled under the Affordable Care Act (ACA) will not cost you a bundle. Samantha Liss reports for KFFHealthNews on how a free colonoscopy service turned into a huge bill.

    One couple with coverage through the Illinois state health insurance exchange were charged $600 for their “free” preventive care colonoscopies. Of course, the health care facility did not bill them for their colonoscopies, since that would be illegal.

    Rather the health care facility, seemingly in cahoots with the couple’s insurer, billed the couple for “supply trays.” The story exposes how providers and insurers game the system at the expense of patients in our current out-of-control health care system.

    Here’s what happened: At 45, the couple went to a facility for what they believed to be free colonoscopies. The bill for the two procedures was $4,068. The insurer discount brought the bill down to just under $800—the insurers’ cost.

    Afterwards, the couple were each billed $600 by the facility for “supply trays.”  Their insurer brought their charges down to $250 each. But, their bill still totaled $500 for the two “free” colonoscopies and the couple appealed.

    What happened? The story suggests that the gastroenterology practice, owned by a private equity company, did an end-run around the ACA. It does not make clear whether charging for supply trays is legal, although it’s hard to believe it is. It also appears that the couple’s insurer was in on the game since the gastroenterology practice had arranged this charge with the couple’s insurer. The more revenue the gastroenterology practice can get from patients, the less it needs to get from their insurers.

    The couple filed complaints. Federal law does not protect people in these cases, even though the ACA is federal law. States are in charge. The couple were at the mercy of their insurer.

    Here’s more from Just Care:

  • Will Medicare cover a new cancer screening test?

    Will Medicare cover a new cancer screening test?

    Word’s out. Medicare has a lot of money to spend on medical services, and every corporation with something to sell wants in. Jonathan Wosen reports for Stat News on the latest lobbying efforts by Grail to have Medicare pay for its blood-based cancer screening test. Grail sees the dollar signs from getting Medicare coverage of the test, while Medicare’s approval could drive up Medicare spending for a test that might offer only limited benefits.

    Grail’s cancer screening test allegedly can identify 50 different cancers in people with no symptoms. The test detects bits of DNA. But, how would that help people? How often would people need the test for it to be useful and what would happen after cancer DNA were detected?

    If approved by the Food and Drug Administration (FDA), Medicare might cover the Galleri test, which costs $949. The FDA has not yet approved it.  In the last quarter, with the hope of imminent FDA approval, Grail spent $1.07 million pushing members of Congress to support Medicare coverage of this test.

    Medicare is not required to cover all preventive care services, as these services are not considered “medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” However, the government has chosen to have Medicare cover a growing list of preventive care services, because preventive services could help bring down people’s  health care costs down the road and save lives.  If Medicare covered the Galleri test, it would be as a preventive care service.

    No one yet knows whether multi-cancer screening tests offer benefits to people without cancer symptoms. Sometimes, cancer lives in your body for decades doing no harm. And, sometimes cancer cells grow so quickly that they are not possible to treat effectively. Time will tell the benefits of the Galleri test and its costs.

    Here’s more from Just Care:

  • Six reasons you need a primary care doctor in this age of specialization

    Six reasons you need a primary care doctor in this age of specialization

    As we age, most of us develop health issues. Along the way we may visit a specialist to handle each of these issues: for example, a cardiologist to treat hypertension and a gastroenterologist to treat acid reflux. However, it has become increasingly clear that in today’s era of specialization, you need a primary care doctor more than ever to coordinate your care, give you treatment appropriate for your age and gender, and prevent future health problems for the fullest quality of life.

    You may be surprised at how much of your treatment a primary care doctor can provide. Primary care doctors know your whole story, while specialists may not be in communication with each other or understand the range of your health care needs. Medicine has become increasingly specialized, and specialists can provide much needed targeted treatments for specific ailments or organ dysfunctions. But fragmented, uncoordinated care is the handmaiden of specialization.

    What is a primary care doctor?

    This term is generally restricted to internists (who have completed a 3 year residency in internal medicine, and treat adults) and family physicians (who have completed a 3 year residency and treat patients of all ages). Geriatricians are internists or family physicians with additional training in caring for the elderly, often in primary care. Within the healthcare system, these types of physicians are often called “PMDs”, for primary medical doctor or “PCP” for primary care provider.

    The word ‘primary’ care may imply simple or elementary medicine, but primary care is a highly complex practice. PMDs are prepared to diagnose and treat all common diseases, and many, if not most, of the less common ones too. Additionally, they are uniquely qualified to provide comprehensive and holistic care to patients with multiple simultaneous diseases. PMDs also try to prevent future health problems-– they don’t just treat what you have. PMDs keep up to date on the frequently changing recommendations on preventive medicine (e.g., vaccines, mammograms, colonoscopies). In all of their functions, PMDs strive to give care tailored specifically to each patient.

    Why do you need a primary care doctor?

    Above all, primary care is good for your health and will help you live longer. Multiple studies have demonstrated this. Here are six important reasons you need a primary care doctor now more than ever:

    1. A PMD can coordinate and oversee your care. The more complex and varied your health conditions are, the more important a PMD becomes. A PMD will give you guidance on how to integrate varied, complex, and sometimes contradictory recommendations that you may receive from multiple specialists.
    2. A PMD can save you from unnecessary or harmful treatments by taking the time to understand you as a person and know your history. The PMD has a 30,000-foot view of all your health problems. The PMD considers your age, gender and other factors to ask “is this really the right treatment for you?”
    3. A PMD can ensure that your medications are not hurting you. Some medications can be dangerous in older patients. A PMD might replace or stop medications that may do you more harm than good and detect drug interactions. It has been estimated that 265,000 adults (age 65 and older) each year go to the emergency room or are hospitalized because of an adverse drug effect. A PMD also can almost always shorten your medication list if it is too long for you; so, the PMD can end up saving you money.
    4. A PMD can offer a second opinion on whether a treatment recommended by another doctor is likely to be beneficial. For example, many treatments have been proven effective only in patients under 65 years old, and older patients may not derive the same benefit from them.
    5. A PMD works to prevent possible problems by offering vaccinations, screening tests and discussing lifestyle changes like weight loss, exercise and quitting smoking.
    6. A PMD can help you realize you’re developing health problems you hadn’t noticed yet. Problems with vision, strength and fall risk, urinary incontinence, depression or anxiety, and memory can sneak up on you over time without detection—even by doctors who don’t ask. These are things that you may not report, but PMDs are trained to look for.

    Click on the link to read the follow-up post: How can you know if your primary care doctor meets your needs?

    [N.B. This post was originally published on June 17, 2019.}

    Here’s more from Just Care:

  • Four questions to ask yourself about your primary care doctor

    Four questions to ask yourself about your primary care doctor

    I’ve explained the many reasons it’s important to have a good primary care doctor (PMD). Once you have one the next question is, how can you know if your PMD meets your needs?

    Most of us trust our doctors and believe they meet our needs. And, without medical expertise, it’s hard to judge whether a doctor is good beyond the doctor’s bedside manners. Do you like the doctor, and feel comfortable with the doctor? Of course, these things matter. Research confirms that patient health improves with better doctor communication skills. A doctor’s reputation, training, and certification are also important to review. The office location, and how smoothly the office functions are important factors.. However, there are other questions you should ask yourself about whether your primary care doctor meets your needs that are more subtle.

    Here are four questions to ask yourself:

    1. Does your PMD listen to you, know you, and share important decisions with you? Does your PMD practice ‘the art of medicine’? A good PMD will ask you questions about your view of your health, and health priorities before giving recommendations on important testing or treatments. For example, continuing routine mammogram screenings after the age of 75 is something for women to discuss with their doctors; the U.S. Preventive Services Task Force does not recommend it. But, the right decision is whatever is best for you. This discussion can also be important if you are considering a new drug or surgery. Age, kidney disease, diabetes, heart disease and gender may reduce (or increase) the effectiveness of some treatments, and you should know these factors before making a decision.
    1. Is your PMD comfortable discussing all of your medical problems? A good PMD will address any and all medical problems you raise, and doesn’t constantly refer you to specialists for every symptom.
    1. Is your PMD prepared to ‘be the quarterback for’ or ‘orchestrate’ the care from all your other doctors? All PMDs do want to coordinate care with your other doctors, but realistically may not have the time or resources to do this effectively. At the very least, does your PMD attempt to know what the other doctors are recommending for you?
    1. Do you have a PMD who tries to prevent new problems and not just treat existing ones? A good PMD will keep a ‘health maintenance’ list on you, or some similar file, that records your needs for screening tests, vaccines, and other preventive medicine items.

    You may be surprised to learn that some PMD behaviors may not reflect whether your PMD is meeting your needs:

    • A good PMD may often have a staff member relay his or her response to your phone calls. PMDs have to balance how to spend their time, and may decide that some of their responses can be safely and effectively delivered to you through their staff. This doesn’t mean they haven’t thought or care about you!
    • A good PMD might sometimes be rushed, and unable to discuss multiple concerns at every visit. A good doctor will always at a minimum identify and address your most urgent needs, acknowledge the others, and make a plan for additional visits.

    If you haven’t really thought about these questions, you’re not alone. It’s easier to assume your doctor is meeting your needs than to find another doctor. You might want to consider asking a family member or close friend to help you to answer these questions. If some of your answers are no, consider starting here at this Just Care link to find a new internist or family physician who better meets your needs.

    [This post was originally published on June 4, 2015.]

  • Five ways to ensure the people you love are safe and healthy 

    Five ways to ensure the people you love are safe and healthy 

    At least once a year, every caregiver should engage the older people they love in what can be difficult conversations. No child looks forward to being a parent to her mom or dad; no one wants to have to speak with a spouse about exercising more, rethinking a medication regimen or considering stopping driving.  But, that’s often what needs to happen. Here are five ways you can help ensure the people you love are safe and healthy.

    1. Make sure they get an annual flu shot.  This should be easy since often the local pharmacy will administer the shot.  The shot minimizes the risk that older adults will develop flu-related health problems, including pneumonia and worsening chronic conditions. [Editor’s note: Also make sure they get their Covid-19 vaccine and booster shots.]
    1. Check out what drugs they are taking.  And, make a list of them, along with the names and phone numbers of their doctors, both for yourself and for their wallets.  If they keep the list on them, and you have a backup copy, it will help ensure their doctors are best prepared to treat them.
    1. Ask them about painkiller prescriptions they take as well as over the counter drugs, like Tylenol.  Too much acetaminophen can be dangerous. Prescription painkillers, such as Percocet or Vicodin, can be even more dangerous, particularly if mixed with alcohol, tranquilizers or other drugs.
    1. Try to nudge them to exercise. A brisk walk can reduce the likelihood of stroke and help prolong their lives. If they are not inclined to move, ask them what might get them out of the house.  Sometimes, a companion can make all the difference.  Anything they can do to move their bodies is great, including in hospital. Sometimes, showing them some easy exercises can work.  You can find simple balance exercises that the National Institutes on Health recommends here. For information about free and low-cost exercise programs in your community, visit the eldercare locator.
    1. Talk to them about driving if they are still driving. Many people can drive all their lives.  But, both mental and physical reflexes can weaken as you age.  The National Institute on Aging offers great advice on when and how you can help someone you love decide to stop driving.

    And, if you need help motivating them to change an unhealthy behavior, here are six tips that could help.

    Of course, there’s more you can do, including making their homes easier and safer to live in: for example, make sure floor surfaces are smooth to reduce the likelihood of tripping, install ramps and  raise toilet seats. More on that in a separate post.

    (This post was originally published on April 10, 2015.)

    Here’s more from Just Care:

  • Roundup: Your doctors and your health

    Roundup: Your doctors and your health

    Some doctors are a lot better than other doctors. As you get older, it’s especially important that you and your loved ones have doctors who listen to you, who do not undertreat or overtreat you, and who work with you to think through your health care wishes and your treatment options. These days, many doctors are looking at their computers and their watches during the patient’s visit, and those doctors should be avoided at all costs. Here’s a bunch of things to think about as a caregiver and as a patient:

    Take care of your health:

    Choose your doctors carefully:

    Make the most of your doctor’s visit:

    Speeding your recovery:

  • Kidney stones and five tips to prevent them

    Kidney stones and five tips to prevent them

    The National Kidney Foundation estimates that one in ten people will develop a kidney stone sometime in their lives. Kidney stones are lumps that seem like stones in the kidneys, which can cause serious pain. Men are more prone to them than women, and they are most common among 30-60 year olds.

    You can get kidney stones and not know it if they are small enough to pass out of you in your urine. Often, they are painful because they get stuck in the urinary system and block the tube connecting the kidney to the bladder or the tube urine passes through out of your body. Or, they can cause an infection.

    Symptoms: You might feel an ache in your lower back, groin, or abdomen. You may also feel nauseous. Or, you may need to urinate often and feel pain when you do; there might also be blood in your urine.

    Often the stones will pass out of you in your urine. But, you may need to take medications or have them broken up with X-rays or ultrasound in hospital or even taken out through surgery.

    Most of us will never get kidney stones. But, if you do, you’re likely to get them again. To avoid them, drink a lot of water and eat a healthy diet. Here are five tips from the U.K’s national health service:

    1. Drink lots of water, especially if you sweat a lot. The best way to prevent kidney stones from developing is to make sure you drink a lot of liquids every day, so that minerals that make kidney stones do not settle in the kidneys and urinary tract. Water is good, as is coffee, tea and wine. We’re talking 81 ounces a day, a lot, a lot!!!! But stay away from sugary drinks, which increase your risk of getting kidney stones.
    2. Eat and drink foods with calcium and oxalate together. Oxalate-foods, such as nuts and fruits and chocolate are less likely to form kidney stones when you eat them with calcium-rich foods. Low-fat dairy products, whole grains and vegetables are also good. But, avoid beef and processed meats.
    3. Eat less food with sodium. Do not eat more than 2,300 milligrams of salt a day.
    4. Drink juices high in citrate, like lemons and limes and low in sugar.
    5. Eat calcium-rich foods. This might sound counter-intuitive as almost all kidney stones contain calcium.  But, as it turns out, eating a lot of foods with calcium reduces your likelihood of getting kidney stones, especially for men under 60 years old. It also might help you to eat foods rich in magnesium and potassium. Eat foods with 1,000 to 1,200 milligrams of calcium a day.

    [Editor’s note: This post was originally published on November 11, 2015 and has been updated.]

    Here’s more from Just Care:

  • Coronavirus: Have you gotten your cancer screenings?

    Coronavirus: Have you gotten your cancer screenings?

    During this novel coronavirus pandemic, most of us have opted against visiting a doctor’s office or going to the hospital when we had the choice. Fortunately, now that we appear to be coming out of the pandemic, many people recognize the importance of cancer screenings. Health Care Dive reports that people are once against getting breast and colon cancer screenings as well as other important preventive care services.

    COVID-19 led millions of Americans to delay care. Preventive care was put on a back burner. The data show drops in cancer screenings of 95 percent or more.  And, many hospitals and outpatient clinics lost billions of dollars in  revenue.

    But, preventive care is important for detecting diseases early on and promoting good health outcomes. Time will tell the consequences for people of skipping cancer screenings and other important services. No one knows yet how many patients will find themselves with later-stage cancers that might have been avoided.

    If you haven’t yet scheduled cancer screenings, talk to your doctor about doing so. Medicare pays for an array of preventive care services in full, including:

    Medicare also covers 80 percent of the cost of screenings for glaucoma, trainings for diabetes self-management, barium enemas to detect colon cancer, and digital rectal exams to detect prostate cancer.

    Here’s more from Just Care: