Question: Why are so many doctors becoming plastic surgeons? Isn't this stupid, frivolous health care?
From: Valerie W. of Hesperia, CA

Answer: Plastic surgeons are often thought of as solely devoted to cosmetic alterations of the face and body. In fact, they deal with the repair, reconstruction, or replacement of physical defects or cosmetic enhancement of the skin, musculoskeletal system, face, hands, extremities, and breasts. In addition to residency, plastic surgeons undergo an additional 2 to 3 years of training. They are certified by the American Board of Plastic Surgery which also offers subspecialty certifications in plastic surgery of the head, neck, and hand. Some of the essential surgery they perform include breast reconstruction following mastectomy, post burn and trauma repair and reconstruction, and cleft palate repair. Their goal is to restore impaired function and physical appearance. Elective cosmetic surgery is a component of plastic surgery. Cosmetic surgery includes tummy tucks, facelifts, liposuction, dermabrasion, and rhinoplasty (reshaping of the nose).

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Question: What are the training requirements of mid level providers?
From: Andrew S. of Rochester, NY

Answer: Besides physicians, there are other members of the health care team who provide a certain level of care to patients. They are mid-level practitioners and include Nurse Practitioners and Physician Assistants. They are licensed and often provide more than a registered nurse can provide, but less than a physician provides. Mid-level practitioners also include certified registered nurse practitioners (CRNPs), nurse midwives, and nurse anesthetists. These professionals are all registered nurses, most with bachelor’s degrees or the equivalent, and additional training for certification. Physician assistants graduate from a 5 to 6 year program. All mid-level practitioners are licensed within the state where they practice. If permitted by the state, nurse midwives may treat patients independently. Most other mid-level practitioners work under the direct supervision of a physician. Federal law allows mid-level practitioners to treat patients for certain conditions without physician oversight if they work in a rural area that has a shortage of PCPs (primary care physicians).

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In his book, Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self, Peter Kramer, MD, refers to one component of the “medicalization” of mental health as “cosmetic psychopharmacology.” In particular, he addresses the ability of Prozac to alter patients’ personalities. Even when a patient is no longer depressed, he could use Prozac to sustain the personality change. Dr. Kramer describes the phenomenon as patients becoming “better than well. . . . patients acquiring extra energy and becoming socially attractive, through the continued use of Prozac when they may no longer have needed it to treat depression.”

Medicalization speaks to an issue of fear—fear that society continues to “lower the bar” in defining what is a disease in need of medical treatment. The following are some common conditions that may be life consequences and may receive treatment as medical diagnoses:

• Menopause
• Mood disorder
• Dyslexia
• Attention deficit hyperactivity disorder (ADHD)
• Hair loss
• Insomnia
• Obesity
• Restless leg syndrome
• Acne
• Sleep disorder
• Wrinkles
• Depression
• Yellow teeth
• Anxiety
• Headaches
• Sexual dysfunction
• Everyday unhappiness

This video produced by AHIMA provides a good overview of your health information and personal health records.

Just a quick note to let you all know that I will be a guest on WSPL 1250 AM on May 16th at 11:15ET. If you are located in the greater Chicago area I hope you can tune in.

I recently had the pleasure of being a guest on Jumping Monkeys, a parenting podcast for the digital age, hosted by Megan Morrone and Leo Laporte.   

You can listen to us discuss things such as online health records, how the internet has changed healthcare and using the internet to communicate with your doctor online at www.twit.tv/jm45.

If you are in the position of shopping for a private health plan the options may seem overwhelming. To get you started, you first have to decide what is most important to you. Factors to consider include services, choice, location, and costs. All plans have tradeoffs. Here is place where you need to apply your individual goals and values for your personal healthcare plan. You may want to ask yourself the following questions in deciding what plan is best for you and your family.

Services

• How comprehensive do you want coverage of healthcare services to be?
• What services are limited or not covered?
• Is there a good match between what the plan provides and what you think you will need? For example, if you have a chronic disease, is there a special program for that illness?
• Will the plan provide the medication and equipment you need?
• Does the plan pay for preventive care?
• If alternative or holistic treatment options are important to you, does your plan cover them?

Question: I would like to know more about alternative health
From: Alla R. of Cordova, MD

Answer: Conventional medicine (allopathic medicine) is medicine as practiced by MDs or Dos and their allied health professionals. Complementary and Alternative Medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not currently considered part of conventional medicine. Complementary medicine blends conventional and alternative treatments. For example, aromatherapy may be used to alleviate a patient’s discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of alternative medicine is using a special diet to treat cancer instead of surgery, chemotherapy, or radiation. Some examples of current mainstream practices that began as CAM are acupuncture for headache pain, glucosamine to assist in treating arthritis, and fish oil to help treat heart disease. The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government’s lead agency for scientific research on CAM and has been moved within the National Institutes of Health. You can explore CAM further by going to the NCCAM’s website, www.nccam.nih.gov. In my book 7 Steps to Your Best Possible Healthcare, I describe the approaches, publications, and teachings of several physicians.

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A review of practitioners’ Web sites and naturopathic medical schools provides information about the types of conditions that NDs commonly treat. According to the Association of Accredited Naturopathic Medical Colleges (www.aanmc.org), the top 10 conditions that NDs treat are:

1. Fatigue
2. Menstruation/hormonal issues
3. Allergies
4. Depression/insomnia
5. Thyroid disorders
6. Weight/appetite problems
7. High Cholesterol
8. Headaches/migraines
9. High blood pressure
10. Fibromyalgia (pain of the connective tissues and muscles)

Please join me in congratulating Barb Knobloch of East Moline, IL who has been selected as the Grand Prize Winner in the 6 Days at Disney contest from Happy Times in Healthcare and www.7stepshealth.com.

As the Grand Prize Winner Barb will be receiving a 6 day trip to Walt Disney World for 4 people including airfare, lodging and park passes.

Congratulations and thanks for your support!

For a complete list of winners please visit www.happytimesinhealthcare.com/contest

The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician, using healthcare quality rating tools, and understanding your medical record. In this episode:

Podcast: The Healthcare Paradox - Dr. Ruthann Russo discusses the healthcare paradox in the United States and also the individual consumer healthcare paradox..

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Dr. Ruthann Russo discusses the healthcare paradox in the United States and also the individual consumer healthcare paradox.

Question: I'd like to be able to learn more about the different doctors that are practicing in my area. I'd like their background information and it'd be nice if there was a way for former patients to rate them. That way I can get a doctor that is right for me.
From: Amy G. of Allendale, MI

Answer: This is an issue that I have addressed in recent presentations as well as in my book, 7 Steps to Your Best Possible Healthcare. When purchasing a new car, we will go to several auto dealers and check safety and price reports on the car we are interested in buying. We take the care for a test drive to make sure we like the way it runs and that we feel comfortable in it. And, yet, we often rely on family or friends to suggest a new physician. Good health is precious good healthcare is essential. A family or friend’s recommendation should be one part of our study. Your local medical association provides names and information of physicians in your area and local hospitals often list physician providers affiliated with the hospital. A rating agency, http://www.healthgrades.com, provides ratings based on outcomes. New legislation also requires that providers survey Medicare and Medicaid beneficiaries. Most health insurers are doing the same. Patients with health insurance may soon see surveys asking how they feel about their healthcare and their providers. Medicare will publish results to help improve the healthcare system, give patients information so they can choose their provider, and to measure the quality of care the patients received. Medicare will begin to reimburse providers, in part, based on the quality of care they provide. And just as you would test drive a car, try to meet with the doctor and talk with the office staff and observe office operations. But you will need to prepare ahead for this. Find out what is important to you and what you expect from the physician and staff and then organize your questions. I provide many helpful examples of questions and observations in my book.

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Question: How to find good health care in rural areas without having to drive hours to a big city?
From: Julie T. of Warner, OK

Answer: Access to healthcare for people living in rural areas is a major concern. I would like to share a few statistics with my readers. According to the American Hospital Association, 54 million Americans (including 9 million Medicare recipients) live in rural areas. For many, travel to community or urban hospitals is limiting. Additionally, rural hospitals face the pressure of decreased government payment and limited assets. Rural areas tend to have higher poverty rates and a higher percentage of elderly, that segment of the population which is in poorer health. Although approximately 20% of the U.S. population lives in rural areas, only 9% of the country’s physicians practice there (from U.S. Department of Health & Human Services Agency for Healthcare Research and Quality). The federal government is aware of this imbalance and has made efforts to improve the situation. Government designated Critical Access Hospitals (CAH) are often found in rural areas and are paid by the government on a cost basis rather than the prospective payment system (paid on cost rather than diagnosis basis). Some medical schools are trying to do more to rotate medical students into rural areas. Currently, the federal government reimburses Nurse Practitioners in Federally designated rural areas but legislation is pending for all areas. Nurse Practitioners are registered nurses with advanced degrees and can treat common ailments, do physical exams, prescribe medicine, manage chronic health problems, and do medical screenings.

If your values and your hospital’s values are aligned, you are more likely to be satisfied with your care. You can usually find a hospital’s values, vision, and mission statement in the “about us” tab on their Web site.

Below is a list of the top 10 values, compiled from a random sampling of hospitals. I list the values in order, from those most frequently mentioned to those least frequently mentioned.

Top 10 Values for Sample Hospitals (in Order by Most Common)
1. Quality of care
2. Compassion and respect for the patient
3. Cost effectiveness
4. Community service and community health
5. Caring for those who cannot afford care or are uninsured
6. Customer service
7. Stewardship
8. Ethical actions
9. Accountability and responsibility
10. Teamwork and collaboration

Question: Why do we have to wait so long in the emergency room before we receive treatment? The wait often seems so long and many of the patients don't look well. Why is there such a wait for treatment?
From: Jack M. of Pittsburgh, PA

Answer: I have heard this complaint from many people so it seems to be a rather common problem. According to the National Academy of Sciences’ Institute of Medicine, the U.S. population grew by 12% from 1993 to 2003. ER visits grew by 27% in the same time period. Furthermore, a 2004 study of university-based hospitals showed that ER beds were occupied 35% of time. Many hospitals have tried to decrease the wait and have critiqued their own ER procedures to find ways to more ways to efficiently serve their patients. Emergency room care is costly and overcrowding causes services to be slow. Seriously ill patients may wait hours to days in the ER before being admitted to an inpatient bed or ICU because of bed shortages. For those without health insurance coverage, the ER becomes their first option. Too often, people use the ER for non-emergency health concerns rather than call their physician or go to a health clinic or an urgent care center. Not every situation is an emergency but the dilemma is in knowing the difference. Emergent conditions include loss of consciousness, fractures, chest pain, head injury, seizures and should be addressed immediately. Conditions such as cold, flu, prenatal care, sore throat, and headache may be treated by a primary care physician or health clinic or urgent care. Federal law requires that ERs must evaluate anyone who requests help. Additionally, ER staff must treat the most serious injuries and illnesses first. Many ERs lose money and some have closed, further contributing to overcrowding.

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