Are doctors hurting for money???

[miradoblackwarrior]

Hi, all-
I just got a peculiar phone call from my doctor's office, asking me to set up a pap smear appointment.

Now, I've never discussed a pap smear with my doctor, and the call particularly surprised me, because we are in the middle of (yet another) snow storm, here in the Boston area. The thing is, I'm not that close to my doctor, but I'm wondering if she is either incredibly proactive (I haven't seen her in over a year), doesn't have enough to do that she has to drum up business when the whole state is shut down, or it is some new way to steal identity with fraudulent phone calls. The call confused me. I declined the offer, but I wondered what other people's experiences were.
Many thanks!
Susan

[CathyA]

Was it a robo-call or an live office person? Is this a doc who has done your pap tests in the past?

[goldensmom]

My brother is a physician and he is not hurting for money. I would appreciate such a call because I don't keep track of what I need done. If the call is from your own doctor I would think it is legitimate but I would return the call to the doctor's office number and not some number I got from a phone call.

[kib]

When DH went to the doctor for one of his many diabetes checkups, his physician said that his insurance company had asked her why he wasn't on a statin, because his cholesterol is slightly high. Yeah, Push those dangerous and unnecessary pills, someone has to make a profit here! (The Dr. herself doesn't like to prescribe statins, and we are a passionately anti-statin family, and his cholesterol is only slightly above their new "ok point", that's why; I have no idea what she told them, though.) Perhaps your doctor's pap push was initiated by your insurance, too.

[JaneV2.0]

It's my impression that they're increasingly using coercion and intimidation to drum up business. If you decline drugs, they write "non-compliant" in your file and may threaten to "fire" you. They--or their surrogates--hound you at home (I just had yet another call from my stalker insurance company). They pressure you to undergo unnecessary tests in the hopes that they might find some condition or indicator they can throw drugs at. For-profit medical care has been a disaster, IMO.

[kib]

It's my impression that they're increasingly using coercion and intimidation to drum up business. If you decline drugs, they write "non-compliant" in your file and may threaten to "fire" you. They--or their surrogates--hound you at home (I just had yet another call from my stalker insurance company). They pressure you to undergo unnecessary tests in the hopes that they might find some condition or indicator they can throw drugs at. For-profit medical care has been a disaster, IMO. +1. I just think it may be the ins cos and pharmas more than the drs themselves driving this. It's become my goal to avoid having a checkup as long as possible, because I'm sure I'll be found "rebellious" "uncooperative" or just plain "naughty" in some area where I'm perfectly comfortable with my shortcoming.

[catherine]

kib and Jane, it doesn't make sense for the insurance company to push drugs or tests--they're trying to *prevent* healthcare costs--they only make money if they collect the premiums and don't have to pay out.

So the perception on the part of the insurance companies in your two cases would be that they feel (rightly or wrongly) that statins are going to have a health economic benefit down the road in the way of reduced hospitalizations or other comorbidities.

However, that's not to say that drugs aren't being pushed! The other main reason for over prescribing tests (other than the fact that no ONE person is pulling the money out of their own pockets) is liability. If a doctor doesn't perform a test and someone winds up having something that could have been caught, the doctor might wind up in court.

[kib]

Warning: curmudgeonly gripe ahead.

Every bit of in-depth reading I've done about statins comes to the same result: Statins given indiscriminately to people with high cholesterol do not save lives, they simply steer people toward different, equally fatal illnesses. However, it's necessary to actually analyze multiple-source meta data and remove unrelated causality assumptions and not just read the summary written by the pharmaceutical company to get to this POV, and apparently no one has time for such things.

So to my way of thinking, just as with the low fat nonsense that's STILL being pushed around as good health advice, the ins co is relying on rose-colored summaries on which to base its advice, and, in my not at all humble opinion, that shouldn't be my problem. Even if I'm wrong and not taking statins will kill me, the perhaps well meant but by definition profit-driven demands of my insurance company shouldn't be my problem.

ETA: Catherine, I realize you are somehow in this business, not sure precisely what you do. Please know that I respect you and always appreciate reading your posts and POV, my frustration here is not meant to aim itself at you.

[catherine]

So to my way of thinking, just as with the low fat nonsense that's STILL being pushed around as good health advice, the ins co is relying on rose-colored summaries on which to base its advice, and, in my not at all humble opinion, that shouldn't be my problem. Even if I'm wrong and not taking statins will kill me, the perhaps well meant but by definition profit-driven desires of my insurance company shouldn't be my problem.

ETA: Catherine, I realize you are somehow in this business, not sure precisely what you do. Please know that I respect you and always appreciate reading your posts and POV, my frustration here is not meant to aim itself at you.

I totally get it, and I agree with you. I AM in the business and am personally very Rx-averse. I've seen both sides, however. My PCP has drunk the Kool-Aid and keeps telling me that I should take statins (I have very high HDL and slightly high LDL). I've refused. But I have spoken to many cardiologists [I do qualitative market research studies in the pharmaceutical industry and as such have interviewed thousands of healthcare professionals and health insurance executives and pharmacists and patients) and have gone to congresses where the glories of statins as a panacea for everything have been touted. So the doctors have been "educated" by the pharmaceutical companies.

I just wanted to point out that it's the pharma companies that push the drugs as well as the doctors who have been convinced, and OTOH, the bean-counting by insurance companies has made life very difficult for doctors, pharma companies and patients.

[bae]

I have noticed that most of my health care providers have installed new office software over the past several years, probably to comply with all the new patient record-keeping/management requirements. Shortly after each has installed their cool new software, I've started getting courtesy calls from them reminding me of appointments, or the need to make one, or whatnot.

Progress perhaps?

[catherine]

I have noticed that most of my health care providers have installed new office software over the past several years, probably to comply with all the new patient record-keeping/management requirements. Shortly after each has installed their cool new software, I've started getting courtesy calls from them reminding me of appointments, or the need to make one, or whatnot.

Progress perhaps?

Yup--EMR (Electronic Medical Records). Eventually they hope to expand the possibilities of this kind of data collection in order to figure out the best, least expensive way to treat people and optimize good outcomes. And then the next wave will be putting technology in the hands of the patients--there are already apps available that allow you to do your own EKG and then email it to your doctor. There will be tons of things like that available. That I definitely see as progress. (bae, didn't you already mention in another thread some really cool EMT applications of technology?)

[JaneV2.0]

The various entities involved are all trying to maximize profits; I imagine they're at odds much of the time. But with the incredible proliferation of drugs, tests, appointments, consultations, immunizations, etc. we're expected to participate in now, it's no wonder we have the most expensive system in the world. Outcomes? Average. But at least investors benefit.

ETA: Re statins, I came across the following quote. It's apt, I think:

"Drug companies are a bit like high-school boyfriends. They're much more concerned with getting inside you than being effective once they're in there." --John Oliver

[pinkytoe]

We have a new medical school forming here and I enjoyed reading the new director's thoughts on how to improve healthcare:
http://alcalde.texasexes.org/healthcare/

[ApatheticNoMore]

When DH went to the doctor for one of his many diabetes checkups, his physician said that his insurance company had asked her why he wasn't on a statin, because his cholesterol is slightly high.

statins and diabetes now that seems like a bad combo. I mean yes diabetes can increase heart disease risk, but also statins make blood sugar much harder to control.

[kib]

My thoughts: Progress, an expanding knowledge base and increased communication and connectivity should be a great thing. In reality, it doesn't usually work out that way.

What I have seen in my lifetime is that whenever computerization comes into play, a certain percentage of people are "sorted" incorrectly. You're sent a flier saying you can save 15% with Geico, when in fact you already have a Geico policy. You're sent a notice that it's time for another perm, when in fact you got one a week ago. These are silly and annoying and you just use your own judgement, ignore them and move on.

What I feel is dangerous is when this inaccurate sorting process becomes coercive or, in some cases, outright blackmail, when a suggestion becomes an order, and when disregarding it in and of itself becomes enough evidence for the computer to take action against you, action that is difficult, expensive and sometimes impossible to reverse. Have an oil change even though it's only been 2 weeks, or we will void your warranty. Buy these pills, or we will cut off your insurance. Rather than innocent until proven guilty, you are guilty by proxy unless you engage yourself as a secretary or even a lawyer.

This overstepping is at best inconvenient and time consuming, but in the case of over-compliance with computerized medical advice, it could also be fatal.

[JaneV2.0]

Warning: curmudgeonly gripe ahead.

Every bit of in-depth reading I've done about statins comes to the same result: Statins given indiscriminately to people with high cholesterol do not save lives, they simply steer people toward different, equally fatal illnesses. However, it's necessary to actually analyze multiple-source meta data and remove unrelated causality assumptions and not just read the summary written by the pharmaceutical company to get to this POV, and apparently no one has time for such things. ...

Doctors are punished by Pharma, I understand, if they don't prescribe, or there are incentives they won't get. It's insidious. But there are studies out there, if you dig--like this one:

http://www.ncbi.nlm.nih.gov/pubmed/25655639

It seems statins are toxic to mitochondria and deplete a number of critical nutrients.

Sound mitochondria and a robust gut biome seem to be necessary for good health, and foreign chemicals appear to damage both.

[domestic goddess]

This is one reason why I don't have a dr. My brother recently got insurance, after years of having none. He has recently been diagnosed with COPD and type II diabetes. Neither surprises me; he was a smoker for many years, and diabetes runs in our family. While I think the COPD is the greater danger, he has really taken the diabetes thing to heart, although his blood sugar isn't all that high, and is driving everyone nuts. He refuses to talk about anything else, and you can't distract him for more than a few minutes. I think someone is really scaring him about how he could die from an elevated glucose; his blood glucose now is 80-90 most of the time. The highest ever recorded for him is is in the range of 120-140, yet he is convinced he is at death's door. It seems that insurance companies are pushing more and more tests, and there seem to be a lot of scare tactics. Or maybe I am just jaded, because my patients genuinely have so much that is seriously wrong with them that I minimize too much that isn't so serious or immediate. Anyway, with as lousy as I felt on anti-hypertensives, I'm not likely to sign up for another batch of meds.

[Lainey]

I got a note from Cigna that it's been 2 yrs since my last mammogram. I had the same reaction as others: this may be a combination friendly reminder/liability prevention notice.

I'm about to ask my Cigna doc for a shingles vaccine shot and I'm wondering if she's going to insist on me coming in for a check-up before she'll authorize it. That's what I think kib was talking about - the holding you hostage til you agree to do what they say.

[SteveinMN]

What I have seen in my lifetime is that whenever computerization comes into play, a certain percentage of people are "sorted" incorrectly. You're sent a flier saying you can save 15% with Geico, when in fact you already have a Geico policy. You're sent a notice that it's time for another perm, when in fact you got one a week ago. These are silly and annoying and you just use your own judgement, ignore them and move on.
The problem with computers is that they can pretty much do only what we tell them to do. There's an old saying in computer-dom: "Garbage in, garbage out." If no one codes that you were in last week for a perm, the computer doesn't know. So it sends you the notification. Very few people realize that maintaining the data a computer system uses is more work than implementing the system in the first place.


I'm about to ask my Cigna doc for a shingles vaccine shot and I'm wondering if she's going to insist on me coming in for a check-up before she'll authorize it.
DW and I wanted to get shingles vaccines (knowing the prevalence of it and knowing people who've had it) but our clinics would not even discuss it with us because we were not nearly old enough to have the vaccine covered by insurance. We went to Walgreen's and they gave us the injections. We paid for it out of health-care reimbursement funds we had left over. No hassle, few questions asked. Done deal.

[kib]

The problem with computers is that they can pretty much do only what we tell them to do. There's an old saying in computer-dom: "Garbage in, garbage out." If no one codes that you were in last week for a perm, the computer doesn't know. So it sends you the notification. Very few people realize that maintaining the data a computer system uses is more work than implementing the system in the first place. Yep. GIGO. The problems really come when the GO is not only incorrect, it's impactive on your life.