"I can't afford that!"

Everyone is complaining about "Obama-Care".  I don't have any answers for you on that, but I can tell you that the system that we have today is very broken.  Just today I had a patient that would have had to pay $700 out of pocket for Physical therapy, but I know that if she had the Physical therapy, she would be better by now.  I had another patient that was unable to get an MRI because her deductible is $1500 and she was told that she needed to come up with every bit of it in cash before she could have the procedure done.  Another patient had to pay $800 up front before she could get her vascular studies.  And lastly, I had a patient that has MRSA, you know that awful, antibiotic resistant staph infection that we all hear about.  Two of the antibiotics that would cover this infection, she is allergic to.  One is Tetracycline, which is cheap, but they have pulled it off the market. Another one is not too inexpensive, but she would have to come in for shots everyday for two weeks and may lose her hearing.  The last one her infection is sensitive to and the pharmacist worked with me to get the co-pay down to $200, as the medication is $1500.  So the patient had to tell me "I can't afford it!"  I long for the day when I can provide treatment that is good for the patient that they can afford!  I don't know if I will every see it, but it is a good pipe dream for now!

Oh my aching feet

There are few things that can bring a person down as quickly as a problem with their foot can. What can you do to prevent this?
1. Wear shoes that fit well.  Before you go shopping for shoes, make a tracing of your foot, place that on each pair of shoes that you would like to try on.  If your foot is wider then the shoe, that is NOT the shoe for you!!
2. Shop for your shoes at the end of the day.  This is when your feet will be most swollen.
3. Get more then one pair of shoes.  This will allow your shoes dry out in-between wearing.
4. Check your feet daily, if you notice any rashes, red spots, swelling or other problems, get to your Podiatrist immediately.
5. Ingrown-toenails, warts, ulcers, infections and other problems, require immediate attention.

More about PA's "Prior Authorization"

For many patients and doctors offices this is a very difficult area!  Patients and doctors assume that if they A. Evaluated you  B. Come up with a diagnosis C. Come up with a treatment plan, then this will all occur.  This could not be further from the truth.  Every insurance company is different.  Even if you and another person have blue/cross or united health care.  They many have very different benefits.  Even if you work for the same company as another patient, they may have selected a "lesser" plan.  At times an MRI will be approved that day with no more then a list of diagnoses.  Other times they may want office notes.  Still others the doctor may need to have a physician to physician peer review.  This may all take a day or a week, depending upon schedules and when this can be accomplished between other patients.  Prior authorizations are required for some x-rays, MRI's, cat scans, durable medical equipment, medications and any other services that your insurance deems necessary.  It is important for each person to check their coverage and work with the doctors to get these approvals.   Although it may be very stressful for patients, remember that the doctor does want you to have this service and they are working on prior authorizations for other patients as well!

Prior Authorization is not a guarantee of payment!

If you work in a doctors office, these words can strike fear into the hearts of all personnel.  Whether it is for surgery, braces, newer medications, physical therapy, MRIs, CT scans and other medical tests, many require prior authorization.  This can cost the office staff an entire day in trying to track this down.  We as doctors are trained to know what is going on with our patients and what they need.  Unfortunately, we spend a large part of our day being told that we are not able to get what we feel is necessary for the best care of our patients.  This leads to a large amount of dissatisfaction among doctors.  There has to be a better way to treat our patients well and not spend time fighting with "Peggy" to get their treatment plan instituted!!

Cost for the doctor to see you!

Recently Shopdme posted a great article breaking down how much your doctor actually makes when you go in.
The approximate breakdown of a $100 new-patient appointment:
$9 for malpractice insurance
$4 for equipment and maintenance
$8 for supplies
$6 for rent and utilities
$10 for office expenses such as telephones, accounting fees, advertising, medical journals, licenses, and taxes
$28 for staff salaries and benefits
$35 for the doctor
This does not include billing costs, legal fees if needed, the cost of implementing electronic health records or the cost of new equipment to keep up with the changes in medicine.
Most doctors graduate with large student loans.
I personally pay $2400 a month in student loans and have been for over 11 years.  This means that I must see 69 patients a month just to cover my student loans.  Then I can start earning money to cover food, housing, clothing, car costs, health insurance, and other expenses.  If this cost $3000/month, it would take another 90 patients a month to see.  That's 159 total.  Reimbursement is lower for established patients.  This doesn't include day care if the doctor has children or the cost of repairing equipment or their car.
The next time that you come in to your doctor.  Please don't say, well, you're a doctor you can afford it.  They have sacrificed many years of their lives and are usually in serious debt, to take care of people!

Your Leg Is a Mirror Of Your Body - ModernGhana.com

Your Leg Is a Mirror Of Your Body - ModernGhana.com

This a very good article to discuss the many complications that may occur with diabetes.

The best way to deal with a diagnosis of diabetes is this:

1. Educate yourself. The more you know, the better you can protect yourself.

2. Check your feet every day!

3. If you have any small wounds or sores, contact your doctor immediately!

4. Educated yourself. Yes I am repeating myself!! Things change regularly in treatments and how to manage your diabetes, if you keep up to date, you won't miss anything.

5. Make sure to wear shoes with a wide toe box and good cushioning. If you draw a picture of your foot on a white piece of paper and put your shoe on top of it.... if the drawing is wider then your shoe. You need a new shoe! It will be much cheaper to throw away a shoe that is too small and rubs your foot, then to deal with the cost of an ulcer and possible amputation.

There will be more on foot care coming up.

Children's Feet

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