tag:blogger.com,1999:blog-4968787219619380438.post3082990772552117067..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Readmissions: Sometimes it's the patientsSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger23125tag:blogger.com,1999:blog-4968787219619380438.post-65739777937387467252014-12-08T19:40:12.224-05:002014-12-08T19:40:12.224-05:00Thanks. Your comment is appreciated. Thanks. Your comment is appreciated. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-81883835631146516832014-12-08T15:20:24.160-05:002014-12-08T15:20:24.160-05:00Great read! We, as doctors can only do so much. I...Great read! We, as doctors can only do so much. It is a two way street that takes all parties to get the best results.Orthopaedic Associateshttp://upstateoa.comnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-67105658476669365492014-10-27T16:20:27.137-04:002014-10-27T16:20:27.137-04:00Erica, I can't deny that some doctors don'...Erica, I can't deny that some doctors don't listen. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-43205546260027610042014-10-25T13:46:30.792-04:002014-10-25T13:46:30.792-04:00As a patient with a complex and rare underlying ge...As a patient with a complex and rare underlying genetic (storage) disorder and thus many secondary issues for me to be perfectly honest sometimes not taking cardiac meds on occasion is simply b/c of the side effects.... While I completely trust my Cardiologist I do feel drs need to be more willing to take in to account what pts. say about med side effects and work with us to find things that not only help our issues/symptoms BUT don't impede quality of life!<br /><br />Doctors so frequently get on the 'You need to stay active, not let what you have stop you from living' bandwagon (thankfully not mine)<br />and yet often they do not really listen to what pts. say about med side effects....<br /><br />Erica<br />www.rarelydefined.blogspot.comErica J. Thielhttps://www.blogger.com/profile/03637159089571195980noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-89045443121333604072014-10-21T08:09:54.001-04:002014-10-21T08:09:54.001-04:00There is no shortage of stupid things people do. S...There is no shortage of stupid things people do. Some of them may be a reasons for readmissions. Lets say after having keyhole surgery you start working out two weeks later and cause injury to your self. <br /><br />If a case like this was to go to court all that would matter it what is written in the medical records. If it isn't stated to not start working out within a certain time then court may find Dr at fault. frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9168899763332159502014-10-20T12:41:00.957-04:002014-10-20T12:41:00.957-04:00The cut off income for a single person for most lo...The cut off income for a single person for most low income programs is less the $19000 a year. Not much income by todays cost of living.frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-2417279270916149332014-10-20T11:30:41.505-04:002014-10-20T11:30:41.505-04:00Walmart has many drugs that they only charge $4 pe...Walmart has many drugs that they only charge $4 per RX. This card may save you money on drugs But note can save up to 75%. So this could be any where from 0 to 75%. Saving something is better then nothing But still may not gets drug price down to where some can afford them. frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-18890857488320056562014-10-20T10:03:49.462-04:002014-10-20T10:03:49.462-04:00Sorry for the delayed response. I needed to get so...Sorry for the delayed response. I needed to get some information. <br /><br />Go to this website http://npsncard.com. It is not a scam. The discount is real and possible because the pharmacy makes it up on volume. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-59220266041280977722014-10-18T22:29:46.695-04:002014-10-18T22:29:46.695-04:00Hey Skep,
Just wanted to say that the couple of d...Hey Skep,<br /><br />Just wanted to say that the couple of drugs I had didn't get discounts. If you work, you can forget getting any discount, to be honest. <br /><br />RandyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-40361586348582195542014-10-17T11:14:32.309-04:002014-10-17T11:14:32.309-04:00The problem with the study is it is done on a very...The problem with the study is it is done on a very select group. They sate other reasons why study has several limitations. <br /><br />To get better result of treatment of hypertension both PCP and patients have to get better educated. Patients need to take there B/P at home daily if possible. This lets patients see if meds are working. <br /><br />frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-5221840026296119092014-10-16T22:26:21.398-04:002014-10-16T22:26:21.398-04:00Anons, your point about the cost of meds is well-t...Anons, your point about the cost of meds is well-taken. I did not get into that and maybe I should have. <br /><br />On the topic of hypertension as noted above, there are many effective drugs, some of which have been around for ages and are off patent. I realize some docs only want to prescribe the newest and most expensive drugs. But you need to make sure they are aware of your circumstances. <br /><br />Also there are many drug discount plans out there and they charge no fee to the patient. Have you explored that possibility? Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-29156187643569335362014-10-16T21:42:00.673-04:002014-10-16T21:42:00.673-04:00Thanks Anonymous,
I also had a hard time paying f...Thanks Anonymous,<br /><br />I also had a hard time paying for medications. Actually it and one other item has sent me into trying to pay for that medical issue and I've had financial issues ever since. No one bothered to ask me, they just blamed me. <br /><br />After being booted out and saying I needed to see some results because I couldn't pay for things that didn't help (and I had paid several hundred dollars for it), I now just straight up tell docs if I can't afford it, I can't. If they boot me they boot me but after a couple of years and still in the hole trying to pay off, I have had it. <br /><br />Yes, we do need to take our meds, but with a lack of trust, funds, side effects, we're getting tired of taking the blame. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-50552153295300487302014-10-16T19:13:07.878-04:002014-10-16T19:13:07.878-04:00what happens when patient can't afford medicat...what happens when patient can't afford medications and is making trade offs? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-21428603780622124012014-10-16T13:20:39.527-04:002014-10-16T13:20:39.527-04:00Moose, good points about diabetes. Thanks.
Frankb...Moose, good points about diabetes. Thanks.<br /><br />Frankbill, I agree there are a lot of choices. I still would not advise unilaterally stopping a drug. I agree with others who have observed that mild hypertension is over treated.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-69906985110501030672014-10-16T09:58:05.298-04:002014-10-16T09:58:05.298-04:00I think there are two problems here. One is commun...I think there are two problems here. One is communication the other is trust.<br /><br />Both the Dr and patient have be able to communicate with each other. This seem like it should be easy to do but if one reads what is put in there medical record they may get a surprise. What they said and what the Dr writes about he thinks you said are not always the same. <br /> <br />The trust part depends on many things. Today it is very hard to build trust in a 15 min. visit. would you trust a Dr that can't remember the name of one 4 meds you are on even though this is the med you are talking about? frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-5382002262181242372014-10-16T08:51:22.246-04:002014-10-16T08:51:22.246-04:00The JNC 8 guidelines Now says that in some can sto...The JNC 8 guidelines Now says that in some can stop or reduce med if over 60 as B/P goal is now 150/90 up from 140/90. frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-55813379649321867242014-10-16T08:16:19.815-04:002014-10-16T08:16:19.815-04:00Most internists have limited knowledge on treatin...Most internists have limited knowledge on treating hypertension. <br />Since I use the VA for health care Dr Grim came up with this example as to what it can take to get the right drugs that may work for treating and having side effects one can live with. <br /><br />we know there are several classes of drugs used to treat HTN. And each class has several variations.<br />So lets say the VA limits the choices.<br /><br />1. Diuretics: 4 choices<br />2. BB: 2 choices<br />3. ACEs: 2 choices <br />4. ARBs: 2 choices<br />5. CCBs: 2 choices<br />6. Central agents: 2 choices<br />7. MCBs: 2 choices. <br /><br />So how many different possible combinations to try to find the right one that works for you.<br /><br />Thus the first choice is 1 of 7. Then if single therapy does not work you have a permutation and combination problem.<br />As I recall the number of combinations you can make of these 7 is calculated by the following<br />Number of choices of one from each group = 7<br />Number of choices of two from the group of 7 = 42<br />Number of choices of 3 from the group of 7 = 210<br />Number of choices of 4 from group of 7 = 840. <br /><br />So we sum these a and get 1549 different combinations and permutations we would have to go thru before deciding you are a treatment failure. frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-68323068255490831842014-10-16T05:19:54.344-04:002014-10-16T05:19:54.344-04:00Argh. As a type II insulin-dependent diabetic, not...Argh. As a type II insulin-dependent diabetic, nothing drives me further up the wall than diabetics who somehow think that the disease means giving everything up. However, the medical professionals are sometimes to blame for this. So is the mass-media. <br /><br />Both continue the ancient beliefs: You must lose weight. You must diet obsessively. You must give up all sugars. I heard all of this when I was diagnosed, plus that if I didn't do these things I would be blind, have amputations, and be dead within 10 years. That was 22 years ago.<br /><br />You do not have to lose weight, although if you can it will improve insulin resistance. However, you MUST exercise, which will also improve insulin resistance as well as improve overall cardiovascular health. <br /><br />You do not have to obsessively diet. You DO need to learn to eat in a healthy manner. You DO need to learn the difference in carbs, and how each carb affects you (which is different for every person). You DO need to spend time learning how to juggle foods in your diet, but you do not have to give up anything. Everything in moderation.<br /><br />The American DIabetes Association, at some point, woke up and realized that telling people "never eat this!" not only makes foods forbidden fruit, but is bad for mental health. Even folks strictly following the ADA diet are encouraged to occasionally have a treat. Want some ice cream with dinner? Do your carb & fat exchanges and have at! A high-protein, low-carb salad and some chocolate chip ice cream is a wonderful meal.<br /><br />As far as testing -- one of the things I've found over the years, talking to other diabetics, is that the best way to encourage more testing is to use something that juvenile diabetics are taught: There Are No Bad Numbers. You test to see how a combination of foods affect you. You test to see if your medications are working or need to be adjusted. You test to see what needs to be modified, not to see if you're "bad" or "good." Unfortunately, too many medical professionals see high numbers and blurt out "This is bad!" (Worse, I've seen some more concerned over a 500 than a 50.) To get patients to test more we need to get rid of the guilt and encourage it as a pro-active behaviour.Moosehttps://www.blogger.com/profile/10397412122635951126noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-67141001131311844282014-10-15T22:55:07.926-04:002014-10-15T22:55:07.926-04:00I do agree should try to work with prescribing Dr ...I do agree should try to work with prescribing Dr but many Dr are slow to change ones meds. frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-77741457673978661152014-10-15T17:39:08.710-04:002014-10-15T17:39:08.710-04:00Frankbill, I am not an internist and never treated...Frankbill, I am not an internist and never treated hypertension, but I would say that if a patient is having intolerable side effects from a drug, it would be best to discuss the problem with the prescribing doctor instead of simply stopping it.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-42085371459219822392014-10-15T17:34:43.451-04:002014-10-15T17:34:43.451-04:00One reason may be side effects of B/P meds. If you...One reason may be side effects of B/P meds. If your choice is to have slow heart rate or shortness of breath on meds. Can tell you this is no fun. One may find they get to the point where they stop taking meds just to feel better. <br />frankbillhttps://www.blogger.com/profile/05592389641852861124noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-90283429853946975062014-10-15T17:32:57.766-04:002014-10-15T17:32:57.766-04:00Isn't that how you are supposed to use it? I&#...Isn't that how you are supposed to use it? I'm glad I wasn't eating or drinking when I read your comment. I would have aspirated for sure.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-12355426740951284562014-10-15T17:30:51.780-04:002014-10-15T17:30:51.780-04:00OB hotline where I did my rotation claimed a patie...OB hotline where I did my rotation claimed a patient called, surprised with a pregnancy. She'd been using spermicidal jelly routinely - on her morning toast.Anonymousnoreply@blogger.com