No matter the outcome of the presidential election this year, it’s likely that Americans will be spending more of their money on healthcare going forward. Dr. Davis Liu, a family physician at the Permanente Medical Group in California (and a contributor to this blog), has written a primer on how to get the most bang for your healthcare buck. The Thrifty Patient: Vital Insider Tips For Saving Money And Staying Healthy is a helpful little book for those smart enough to read it.
The first step to becoming a “thrifty patient” is to reduce your need for professional healthcare services. This lesson is perhaps the most important of all: lifestyle choices are the largest controllable determinant of how much healthcare you will consume. Daily exercise, healthy eating, and preventive care services (such as vaccines and screening tests) are the most effective ways to avoid expensive healthcare.
Dr. Liu offers tips for selecting a doctor, questioning the necessity of tests and procedures, choosing less expensive treatments, getting a second opinion, and learning to get the most out of a short doctor visit. He explains why annual check ups may not be necessary, and lists all the preventive health screening tests you’ll need (according to age) to maximize your chance of avoiding many major diseases or their expensive outcomes.
According to Liu, an excellent primary care physician (PCP) can be the best ally in avoiding unnecessary medical costs. Without a PCP’s guidance, 60% of patients select the wrong specialist for their symptoms or concerns. This can trigger a costly cascade of extra testing and referrals. Liu recommends trustworthy websites that can aid in disease management and patient education – suggesting that “Dr. Google” may not be so bad after all, armed with a correct diagnosis from a healthcare professional and links to credible sources of information.
Being thrifty isn’t necessarily “sexy” – but practical tips for avoiding unnecessary and expensive interactions with the healthcare system could add up to some pretty amazing savings (both financially and emotionally). Anyone who takes Dr. Liu’s advice to heart is likely to live longer and better – I just hope that the people who could benefit most from these tips find their way to this book. Perhaps you know someone who needs an early Christmas gift? đ
When I was a teenager I did some stupid things, but looking back I think that the worst decision I made was to go to a tanning salon. At the time I remember tanning salon staff assuring me that it was “safer than the real sun” and the fastest way to get a healthy-looking glow. “You could bake in the sun all day, or spend 20 minutes in a tanning bed for the same effect” said the staff. So after trying several sunless tanners in varying shades of orange and having them slough off like patches of dirt, I decided to make my alabaster skin a nice, even shade of light caramel with months of tanning each year.
Fast forward twenty some-odd years and I’m in the surgeon’s office having a wide-margin re-excision of a melanoma on my back. I’d been wearing sunscreen since my early twenties, carefully protecting myself from UV radiation. I had realized the error of my ways after a serious conversation with a dermatologist, but I had “gotten religion” about skin protection too late. My fate was already set from the tanning bed exposure.
A new study in the British Medical Journal (BMJ)estimates that tanning beds may be responsible for hundreds of thousands of non-melanoma skin cancers per year in the United States. As for melanoma (the deadliest kind of skin cancer), the World Health Organization has determined that the risk of melanoma is increased by 75% when the use of tanning devices starts before age 30. In fact, they classify tanning bed exposure as a “group 1 carcinogen” – in the same class of human toxicity as asbestos, tobacco, and mustard gas.
I was surprised to learn how common tanning bed use is, especially in Europe. According to the BMJ study, 10.6-35% of people in Germany, France, Denmark, and Sweden have used a tanning bed at some point in their lifetimes. The global nature of this problem is daunting – and with research suggesting that tanning has addictive properties, it may be as difficult to get people to avoid tanning salons as it is to have them quit smoking.
As for me, I learned my lesson and I have the scars to prove it. I was lucky that a dermatologist caught my melanoma before it spread, but now I need to be on the look-out for more of them and redouble my efforts to stay out of the sun. If you’ve ever used a tanning bed and have fair skin and freckles, you should probably keep your dermatologist on speed dial. That temporary “sun-kissed glow” can easily turn into wrinkles and Frankenstein scars in the not too distant future – along with a potentially fatal cancer diagnosis. Trust me, it’s not worth it.
I have been wearing contact lenses for about twenty five years. Overall, I’ve been very happy with them, and have found that they have improved my vision as well as my self-esteem. As a very nearsighted person, my glasses have the proverbial âCoke bottleâ lenses. Even though I’ve chosen âultra-thinâ lenses, the refractory nature of the plastic causes my eyes to appear unusually small, giving me the appearance of a juvenile badger (they have pretty small eyes for the size of their heads â check out the photo).
Needless to say, I prefer wearing contact lenses â but I must confess that Iâve been somewhat non-compliant in wearing them according to my eye doctorâs instructions. Iâve learned a few things from my mistakes, and from interviewing optometrists Jason Pingel and Christi Clausson about other patients who have been naughty. I will summarize six of the most common mistakes that contact lens wearers make, and explain what the potential harms can be. You can listen to the full podcast of this interesting interview, here:
Wearing Your Contact Lenses For Too Long â this was my biggest personal mistake. Itâs tempting to wear your contact lenses beyond the recommended replacement schedule in order to save money, or for simple convenience. My contacts felt so comfortable that Iâd wear them (donât gasp in horror) for months at a time, even sleeping in them at night. But after a while my eyes started hurting when I took my contacts out, which just perpetuated the cycle of over-wear. In effect, I was depriving my corneas of oxygen for long enough to kill some of the superficial cells, so when I took my lenses out it was like removing a bandage from a wound. My corneas were sensitive to light, touch, and even the wind. This medical condition is called âsuperficial punctate keratitisâ and although itâs reversible with eye rest, it is quite uncomfortable. If you wear your contacts for too long, this could happen to you.
Using Tap Water To Re-Wet Your Lenses â Sometimes when a piece of lint gets in your eye or your eyes are feeling dry you may be tempted to rinse your lenses with some tap water. Although that seems harmless enough, tap water is not safe for use with contact lenses. Tap water is not sterile, and it can contain bacteria or even protozoa that can cause serious damage to your eye. Just as you would never drink salt water, you should never expose your contacts to tap water. The risk of eye discomfort, alteration of the lens, pH imbalances, or even infection is not worth the risk.
Not Washing Your Contact Lens Case Regularly â At least a third of contact lens wearers report cleaning their cases monthly or less often. Obviously, mold spores and bacteria are not good for the eyes, so if you arenât cleaning your lens case frequently you are putting yourself at risk for eye infection and allergies. Lens cases should be rubbed and rinsed with sterile solution recommended by your eye care provider, dried with a lint free towel or and allowed to air dry with both the case and cap(s) down before re-use.
Not Changing your Contact Lens Solution â Dr. Pingel told me that many of his patients admit to âtopping offâ their contact lens solution or storing them in the same solution from the day prior. This increases the risk of bacterial growth in the solution and lens case. The way I think of it â itâs like having a surgeon simply wipe off her instruments on her gown between patients. Itâs much safer for her to dispose of the instruments or have them sterilized before the next use, right? The same goes for contact lenses and their solution.
Not Washing Your Hands Before Touching Your Eyes Or Lenses â Our hands are exposed to hundreds of different bacterial strains, molds, dirt, and chemicals every day. Not washing your hands with mild soap and water prior to touching your contacts is like touching your eyeball to a door knob. Why take the risk of introducing chemicals or bacteria into your delicate eye area? Itâs very important to wash your hands carefully before insertion and removal of contact lenses so as not to increase your risk of infection, allergy, or chemical burns of the eye.
Not Sharing Your Contact Lenses With Others (Or Buying Them Without A Prescription) â While that might sound like an uncommon practice, it actually becomes an issue around Halloween time. With cosmetic lenses that can make your eyes look like anything from a cat to a zombie, it is tempting to share lenses with friends. However, you should not purchase or wear cosmetic lenses without an examination by an eye doctor and a prescription to ensure they fit safely and comfortably. Delicate corneal skin can be scratched, irritated, or even infected by unclean or ill-fitting lenses. No one wants their real eyes to look scary, right? So please donât buy lenses without a prescription or share your lenses with others.
For more information about safe wear and care of contact lenses, I highly recommend that you check out the Healthy Vision & Contact Lenses e-brochure. It is a terrific summary of all the most important doâs and donâts of contact lens wear and care â perfect for double-checking on your safe use behaviors, or teaching your kids/teens about how to care for their lenses. Or you can use my blog post and podcast to badger them (pun intended), if thatâs more convenient.
Disclosure: Dr. Val Jones is a paid consultant for VISTAKONÂŽ Division of Johnson & Johnson Vision Care, Inc.
In another example of government over-reach, the NYT describes how the Obama administration is enlisting the help of patients to report physicians (whom they believe may have made a medical error), directly to the federal government. While there are systems already in place for such reports at the local hospital level, apparently the “under reporting of medical errors” has triggered AHRQ to pilot a program in which questionnaires are sent to patients to ferret out potential examples of errors caused by the following:
* âA doctor, nurse or other health care provider did not communicate well with the patient or the patientâs family.â
* âA health care provider didnât respect the patientâs race, language or culture.â
* âA health care provider didnât seem to care about the patient.â
* âA health care provider was too busy.â
* âA health care provider didnât spend enough time with the patient.â
* âHealth care providers failed to work together.â
* âHealth care providers were not aware of care received someplace else.â
So if a patient determines, for example, that a physician did not spend enough time with them, and they believe that resulted in a medical error (whatever that might be), they can/should report the physician to the federal government. Wow. One physician explains the potential hazards of such a process:
Dr. Kevin J. Bozic, the chairman of the Council on Research and Quality at the American Academy of Orthopaedic Surgeons, said it was important to match the patientsâ reports with information in medical records.
âPatientsâ perceptions and experience of care are very important in assessing the overall success of medical treatments,â Dr. Bozic said. âHowever, patients may mischaracterize an outcome as an adverse event or complication because they lack specific medical knowledge.
âFor instance, a patient may say, âI had an infection after surgeryâ because the wound was red. But most red wounds are not infected. Or a patient says, âMy hip dislocatedâ because it made a popping sound. But thatâs a normal sensation after hip replacement surgery.â
I believe that reporting medical errors is critical in the process of quality improvement, but that is most efficiently handled at the hospital level. There is no need to involve the federal government at the earliest stages of investigation, and the amount of bureaucracy required to support such an effort boggles the mind.
In the past when I encountered medical errors in the hospital setting, I found successful ways to report the incidents to the local administration. The result was a rapid correction of the problems and new processes put in place to ensure that it didn’t happen again. This is how medical errors should be reported and resolved. Soliciting patients for accounts of subtle lapses in social graces by their healthcare providers, and then reporting them to the government for it, is nothing short of Big-Brother creepy.
One of my dear friends just came down with influenza, and she asked me for some advice. Top of mind questions included – When can I go back to work? And when will I get better? So in a nutshell, here’s what I told her (borrowing heavily from the CDC website):
The most common flu symptoms are: Fever or feeling feverish/chills; Cough; Sore throat; Runny or stuffy nose; Muscle or body aches; Headaches; Fatigue (feeling very tired)
Adults shed influenza virus from the day before symptoms begin through 5â10 days after illness onset. However, the amount of virus shed, and presumably infectivity, decreases rapidly by 3â5 days after onset.
Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.
Uncomplicated influenza illness typically resolves after 3â7 days for the majority of persons, although cough and malaise can persist for >2 weeks.
The 2011–12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010–11 vaccine. Annual vaccination is recommended even for those who received the vaccine for the previous season. Vaccination is the most effective prevention strategy available to reduce your risk of catching the flu.
My suggestions: Don’t go in to work (if you have the option) until 5 days after illness onset. If you go in earlier, you can wear a little face mask (and use Purell or other alcohol-based hand sanitizer) to prevent spread of the virus. Next year, get your flu shot early in the season.
As far as treatment is concerned, the Mayo Clinic recommends: LIQUIDS, REST, and TYLENOL or IBUPROFEN for pain. No vitamins or supplements have been shown to shorten the course of the flu.
P.S. My suggestions are relevant for “garden variety” flu sufferers. If you are immuno-compromised, elderly, or otherwise in a high risk category, please check out the CDC website for more information.
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No matter the outcome of the presidential election this year, it’s likely that Americans will be spending more of their money on healthcare going forward. Dr. Davis Liu, a family physician at the Permanente Medical Group in California (and a contributor to this blog), has written a primer on how to get the most bang for your healthcare buck. The Thrifty Patient: Vital Insider Tips For Saving Money And Staying Healthy is a helpful little book for those smart enough to read it.
When I was a teenager I did some stupid things, but looking back I think that the worst decision I made was to go to a tanning salon. At the time I remember tanning salon staff assuring me that it was “safer than the real sun” and the fastest way to get a healthy-looking glow. “You could bake in the sun all day, or spend 20 minutes in a tanning bed for the same effect” said the staff. So after trying several sunless tanners in varying shades of orange and having them slough off like patches of dirt, I decided to make 
In another example of government over-reach, the 
One of my dear friends just came down with influenza, and she asked me for some advice. Top of mind questions included – When can I go back to work? And when will I get better? So in a nutshell, here’s what I told her (borrowing heavily from the 
