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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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: 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.

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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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)

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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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: I would like to know beforehand what I would have to pay for any procedure.
From: Esther S. of Saginaw, MI

Answer: This seems like a logical and reasonable request. You should also speak with the physician (s) providing the service and the facility where the procedure is to be performed. Remember that the facility, physician, and anesthesiologist will probably bill separately so you may have to make a few contacts. If you have insurance, contact the plan’s Customer Service Department and ask if this is a covered procedure and, if so, at what percentage. Also ask how each physician participating will be reimbursed. This should give you an estimate pending unforeseen issues.

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While you are the quarterback for your healthcare team, your primary care physician is your coach – without him or her – you wade aimlessly around the healthcare maze. Your primary care physician should work to keep you healthy, refer you to specialists and basically make sure nothing slips through the cracks.  Problem is, the number of medical school students going into primary care continues to decrease each year.  Worse yet, the number of primary care physicians leaving the practice of medicine is increasing.  The main reason for this defection is the reimbursement rates for primary care physicians compared to specialists. It could take decades before some of the government and medical school programs incentivizing more grads to enter primary care actually have an impact – if ever. In the meantime, what’s a patient to do?

Question: Why are we so rushed in doctors’ offices?
From: D.M. of Winchester, IN

Answer: In my book, 7 Steps to Your Best Possible Healthcare, I cite a study by The American Academy of Ophthalmology which indicates that patients find quality of their physician appointments to be more important than quantity. The study goes on to say that patients who were satisfied with their doctor visit tended to overestimate the time spent and those who were dissatisfied complained that the physician hurried, even if the visits were actually long. Patients have an average of 16 minutes with their physicians so it is important to be prepared when going into the visit. As I explain in the book, the preparation will reap benefits in the dialog you have. Important points are to organize your questions (write them down so you don’t forget), research the problem so you know what to ask, answer all the physician’s questions fully, listen carefully, repeat what you are told or instructed, ask for clarification if you don’t understand, ask for written instructions. You may want to take someone along if you are comfortable with that arrangement.

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After my daughter Emmalea had her first seizure and was diagnosed with epilepsy, she was treated by a neurologist at our local medical center, who I will call Dr. Smith. To be sure we were on the right path with such a serious diagnosis, we sought out a second opinion from Dr. Carl Bazil, a nationally known neurologist at Columbia Presbyterian Medical Center in New York City. Dr. Bazil, who agreed with the local neurologist’s treatment, sent Dr. Smith a letter describing his visit with Emmalea and documenting his suggestions.  This is standard practice, and basic etiquette, for consulting physicians to inform the primary physician about their visit with the patient.

After her second seizure, frantic, I called Dr. Smith.  When I asked him what we should do, he responded, “Why don’t you ask your fancy New York City doctor......”   I immediately hung up the phone and called Dr. Bazil who provided guidance and counseling to us immediately. Our next step was to find another primary neurologist.  

Question: What are dental care options on insurance?
From: Jane M. of Junction City, KS

Answer: Like healthcare benefits, dental benefits are often provided by an employer. Private coverage is also available but you want to research the premium cost, out of pocket responsibility, and the types of services covered and at what percent. There are truly many options out there (check the web) but be careful that you choose one that meets your needs. Your dentist’s office may or may not work with that plan so you want to check that point. Many dental providers know how plans work so ask your dentist’s office staff for their thoughts.

Question: Can I find out actions taken against doctors; complaints about doctors?
From: Mandy S. of Strasburg, PA

Answer: There are several websites available to check physician training. Some may offer information about disciplinary action taken against a physician but ease of access to the information may vary. Some state licensing boards may offer the information but getting it may be difficult. At a cost to the consumer, HealthGrades.com will indicate whether a physician has been disciplined but may not give specifics. The U.S. Office of the Inspector General administers two databanks that include disciplinary action against physicians but they are not available to the general public. They can be accessed by government agencies, credentialing organizations, and certain other parties. They are National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB). An on-line search will yield some sites such as Docinfo.org, a Web site operated by the Federation of State Medical Boards (FSMB). The public can access disciplinary, education, licensure and location information on U.S. licensed physicians and physician assistants. The consumer will pay a fee but can then receive credentialing and disciplinary information.

If you are comfortable communicating via e-mail with your physician, ask if this is an option for needs that arise between visits. More and more physicians are open to communicating via e-mail, especially if the patient initiates the communication.

One of the primary benefits of e-mail communication is that you, as the patient, receive a written, legible record of the information directly from your physician. Questions you may want to ask your physician regarding e-mail communication include:

• Do you communicate via e-mail with patients? May I e-mail you?
• Do you have a written policy regarding e-mail communication?
• Are there topics I should not address via e-mail?
• Is there a charge for e-mail communication? Will insurance cover it?

Naturopathy is a school of medical philosophy and practice that focuses on improving health and treating disease chiefly by assisting the body’s intrinsic ability to recuperate from illness and injury. Naturopathy practices the following six principles:

You may feel healthcare providers use medical terminology to put a barrier between you and them. Healthcare providers use medical terminology to be more efficient. Saving 30 seconds by using medical shorthand might make a difference between life and death in an emergency.

A good example is the term bacterial gastroenteritis. This term means “inflammation of the stomach and the intestines due to a bacterial infection.” Using two words versus 12 words is significant. String several terms together and you could save a minute or more. In the ER a physician could save a life in this amount of time.

Question: How to get inexpensive good insurance for elderly parents?
From: Steve of Ames, IA

Answer: You did not provide details about your parents” ages, whether or not they have Medicare and/or a supplement to Medicare. Since you use the term “elderly,” I will assume they are in the Medicare age group. Medicare is health insurance offered by the federal government for people 65 and older and to some younger people who have disabilities. Part A of Medicare is automatically available to people who paid social security taxes and it helps pay for hospital bills, nursing home care, hospice and home care. Medicare Part B is a supplemental insurance option for people who qualify for Medicare and covers outpatient doctor services and other medical services. Its purpose is to provide coverage for health care not covered under Part A. Part B provides coverage for doctors services, lab tests, physical, medical equipment, and some other medical services. There is a monthly premium and a co-pay. A fairly new part of Medicare is referred to as Plan C or Medicare Advantage Plans (like HMOs and PPOs). These private health plans have their own networks but do provide all Part A and Part B coverage and some offer drug coverage. The individual may have to see providers within their network. Out-of-pocket costs in these plans may be lower because of this. An excellent website www.medicare.com lists the options: Medicare Preferred Provider Organization (PPO) Plans, Medicare Health Maintenance Organization (HMO), Medicare Private Fee-For-Service (PFFS), Medicare Special Needs Plans (SNP), Medicare Medical Savings Account (MSA) Plans. People are generally eligible if they live in the service area of the plan, they have Medicare Part A and Part B coverage, and they don't have End-Stage Renal Disease. The newest part of Medicare is Part D prescription drug coverage. You must be enrolled in Medicare before you can apply for Part D coverage. It is offered by private companies and there is a monthly premium.

Question: Why insurance companies have the right to deny what the doctor deems necessary treatment?
From: Sylvia G.

Answer: It sounds like you have had encountered a denial or at least questions from your insurance company about a recommended treatment. An insurer may refuse to approve a test or treatment or it may refuse coverage of the test because you did not follow one or more of its rules. The important points are to know your insurance benefits and the rules, respond to requests within the specified timeframe, document information you are given by phone, give correct insurance information to the provider, and check whether the provider is within your health plan. If there is still an issue, your physician may need to write a justification and/or further explanation to the insurance company. An insurance company may approve payment of a generic, less expensive medication unless otherwise specified by the doctor. It may consider a treatment experimental. Know the reason for the denial and follow the insurance company’s appeal procedure.

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:

Ed on Selecting a Primary Care Practitioner - In an excerpt from her upcoming release of The Stories Behind the Steps, Dr. Russo is joined by Ed who discusses how he mapped out a strategy to research, interview and select a new doctor to serve as his primary care practitioner. For a free sample chapter of 7 Steps to Your Best Possible Healthcare or to purchase a copy of the book please visit http://www.7stepshealth.com.

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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:

A Health Advocate Helps With Billing - Dr Russo is joined by Natasha and Dave who discuss how they were able to work with their insurance company to avoid a potentially disastrous personal financial situation after receiving the diagnosis of a rare heart defect for their unborn child. For a free sample chapter of 7 Steps to Your Best Possible Healthcare or to purchase a copy of the book please visit http://www.7stepshealth.com.

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Question: Very often, doctors don’t give instructions on taking medicines-time, with other medicines, side effects. It gets very confusing when taking several medications, what can I do?
From: M.K of Bethlehem, PA

Answer: I have found myself in this situation also. I have called the pharmacist for instructions and/or read the leaflet that comes with the medicine. But even that does not always completely help if taking multiple medications. As I stress in my book, it is important to get clear and preferably written instructions from the physician. Make sure the doctor is aware of all medications you are currently taking. Take a list with you. Ask about side effects, best time of the day to take the medicine, with or without food, impact on or from other medicines you are currently taking..

Question: How can I decide what specialist I need for what without having to call my personal doctor for everything.
From: Jennifer B. of Hopkinsville, KY

Answer: The American Board of Medical Specialties (ABMS) lists 95 specialties and subspecialties. Additionally, some specialties overlap as they seem to care for the same types of problems. You need to check on the training of the specialist and on what types of medical or surgical problems they deal with. Chapter 13 of my book, 7 Steps to Your Best Possible Healthcare discusses how to choose a specialist and gives a description of the more common medical specialties and subspecialties, their training and the conditions they treat.

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:

Take Control of Your Specialists - Dr. Russo is joined by Jay and Christine who share their story of coordinating multiple specialists after Jay was hospitalized with a diabetic foot ulcer, and how as a patient they learned the important lesson that they need to take a greater role in managing there own health and providing a continuity of care between specialists.  For a free sample chapter of 7 Steps to Your Best Possible Healthcare or to purchase a copy of the book please visit http://www.7stepshealth.com.

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Question: Where can I find a directory of doctors?
From: Jessica S. of Tulsa, Oklahoma

Answer: So often, we look to family or friends to give us the name of a physician. You can certainly gain insight into that person’s experience and feelings about the physician. Other options are to check into your health insurance plan’s list of providers, contact your local medical association, check into the American Medical Association website, or check the local hospital physician directories. Most hospitals will list physicians by specialty as well. You may want to check whether the physician is board certified, years in practice, where the physician trained and you may consider visiting the doctor’s office to observe the environment and office operations. In my book, 7 Steps to Your Best Possible Healthcare, I provide some practical questions to ask of the staff and the physician and things to observe.

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: Stories Behind the Steps Excerpt, Vera & MaryAnn - In an excerpt from my upcoming release of The Stories Behind the Steps, I am joined by sisters Vera and MaryAnn who discuss how the concept of a Medical Mentor helped Vera overcome her battle with breast cancer. For a free sample chapter of 7 Steps to Your Best Possible Healthcare or to purchase a copy of the book please visit http://www.7stepshealth.com.

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NCCAM (National Center for Complementary and Alternative Medicine) describes the following five types of CAM:

1. Whole Medical Systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional U.S. medical approach. Examples of whole medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.
2. Mind-Body Medicine uses a variety of techniques to enhance the mind’s capacity to affect bodily functions and symptoms. Some techniques previously considered CAM are now mainstream treatments (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques still considered CAM include meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.
3. Biologically-Based Practices use substances found in nature, such as herbs, foods, and vitamins. These practices include dietary supplements, herbal products, and other so-called natural but scientifically unproven therapies (for example, using shark cartilage to treat cancer).
4. Manipulative and Body-Based Practices use manipulation and movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage.
5. Energy Medicine involves the use of energy fields. There are two types. Providers use biofield therapies to affect energy fields that purportedly surround and penetrate the human body. Scientists have yet to prove such fields exist. Some forms of energy therapy manipulate biofields by applying pressure to and manipulating the body by placing the hands in or through these fields. Examples include Qigong, Reiki, and therapeutic touch. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.

As Complimentary and Alternative Medicine (CAM) is becoming evermore mainstream many states are beginning to license naturopathic doctors (ND). Below is a listing of states that currently license NDs:

1. Alaska
2. Arizona
3. California
4. Connecticut
5. Hawaii
6. Idaho
7. Kansas
8. Maine
9. Montana
10. New Hampshire
11. Oregon
12. Utah
13. Vermont
14. Washington

In its most recent issue, the U.S. News & World Report addresses alternative medicine. The cover states, "Top hospitals are now embracing such unconventional techniques as acupuncture, homeopathy, and energy healing." The article reports that recognized leaders in medicine such as the Mayo Clinic, Duke University Medical Center and the University of California-San Francisco offer acupuncture, massage and other Complimentary and Alternative Medicine (CAM) services.

CAM continues to grow in popularity and as a long time proponent of getting the best care possible, whether it be traditional or alternative, I’ve include an entire chapter dedicated to CAM in my new book. In addition to an introduction to CAM I introduce readers to several well known and well respected mainstream physicians who support and practice CAM. Among them are Dr. Ronald Hoffman, Dr. Mehmet Oz, and Dr. Christiane Northrup.