macgyver - 28 May 2012 03:40 PM

Youre missing the point VYAZMA or more correctly you’ve missed several points.

There are several levels of triage. In most offices a secretary performs the initial triage which is to say she answers the call and has a simple set of instructions as to which types of complaints need to be seen immediately ( within an hour or less), which complaints need to be seen the same day but not…... have usually given both of those issues careful consideration before I recommend a test but if all patients had a financial interest (whether by way of an MSA type system or by copays )in these decisions I am fairly certain you would see less waste.

This bloated description of the lackaday experiences of a typical outpatient care center is really engrossing.
You complain about hypochondriacs and then proceed to explain how you are NOT willing or allowed to turn anyone away. And how secretaries are a major force in diagnosing patients.  This was the focal point in my commentary on reform, and how to appease the complaints of doctors.
People are campaigning for free-universal healthcare, like many others around the world have.(don’t lecture me on the definition of free) Save your campy recollections of Health Savings Accounts for others in your professional field.  You obviously can’t see the forest for the trees.

VYAZMA - 30 May 2012 10:21 AM

This bloated description of the lackaday experiences of a typical outpatient care center is really engrossing.
You complain about hypochondriacs and then proceed to explain how you are NOT willing or allowed to turn anyone away. And how secretaries are a major force in diagnosing patients.  This was the focal point in my commentary on reform, and how to appease the complaints of doctors.
People are campaigning for free-universal healthcare, like many others around the world have.(don’t lecture me on the definition of free) Save your campy recollections of Health Savings Accounts for others in your professional field.  You obviously can’t see the forest for the trees.

VYAZ you need to actually read what is written. I never complained about hypochondriacs. YOU were the one who said we need to keep them out of doctors offices and I simply tried to explain to you why that is not possible. The doctor has to see them in order to determine that they are a hypochondriac in the first place. I did not say that secretaries were diagnosing patients. What i said is that for your plan to work that is what would have to happen and obviously that would be a bad thing.

If you are going to get into a discussion about the economics of medicine in this country you can’t complain when i try to explain the economics of medicine. There is no free lunch and there will NEVER be free medical care. Its just a matter of who will pay and how. My example of MSA’s was an attempt to put the problem and an example of just one solution in perspective. Like any complex problem the devil is in the details. The difference between those who just want to complain and those who really want to find a solution is that the former rant about whats wrong and don’t want to know why, the latter try to figure out why because thats where the answers lie.

I tried to help you understand the why. If you don’t want to hear it than you aren’t really interested in a solution to the problem you just want to complain.

VYAZMA - 30 May 2012 10:21 AM

You complain about hypochondriacs and then proceed to explain how you are NOT willing or allowed to turn anyone away…..

You still have to examine someone you believe is a hypochondriac. Even hypochondriacs come down with serious illnesses.. and someone you feel may be a hypochondriac, may either be someone having difficulty articulating their problem, or have a difficult to diagnose disease. For example, Lupus is not called ‘The Great Imitator’ for nothing. Gilda Radner, Gene Wilder’s late wife, was labeled a hypochondriac, because she frequented the hospital with vague complaints. It turned out she had uterine cancer, and by the time it was diagnosed, she was at stage IV, and died soon after.

macgyver - 28 May 2012 03:40 PM

I can give you a personal anecdote that supports my opinion to some degree. Within my practice I have a number of patients who have a Medical Savings Account. The way an MSA works is that the employee has a high deductible ( About $3,000) health plan and along with that they have an employer funded MSA which is tax free money that is put in the account and can be used for any medical purpose. The amount of the MSA is usually enough to cover the deductible and it is funded each year even if the previous years contribution was not used. If it isnt used in a given .

Our company does that. Except what is not used each year is kept by the insurance company. A big rip off. At the end of the year, you are scrambling to find SOMETHING to use it for, even if it is not something you really need or would ordinarily do. I stopped using it, preferring to pay out of pocket as the bill comes. The minimum you can put in is $1000.00. I take 3 or 4 meds, go to the dentist 4 times a year, get a check up once a year, get an optical exam every two years, and replace my glasses then. I don’t have a thousand dollars in expenses per year. The system you describe is a much better one. I wish we could roll ours over and then I could keep it banked for a catastrophic illness.

asanta - 30 May 2012 09:55 PM

Our company does that. Except what is not used each year is kept by the insurance company. A big rip off. At the end of the year, you are scrambling to find SOMETHING to use it for, even if it is not something you really need or would ordinarily do. I stopped using it, preferring to pay out of pocket as the bill comes. The minimum you can put in is $1000.00. I take 3 or 4 meds, go to the dentist 4 times a year, get a check up once a year, get an optical exam every two years, and replace my glasses then. I don’t have a thousand dollars in expenses per year. The system you describe is a much better one. I wish we could roll ours over and then I could keep it banked for a catastrophic illness.

Right. Those are a little different. They are called a “Flexible Spending Accounts” and may go by other names as well. I suspect the are a little cheaper than MSA’s since the insurance company gets to keep the unused funds and perhaps that is why some employers choose to offer that instead of the MSA, but they are obviously not as beneficial to the patient.

Here’s an update:

http://www.nytimes.com/2012/07/31/business/medical-debt-collector-to-pay-2-5-million-settlement.html?hp

Take care,

Derek

harry canyon - 30 July 2012 04:16 PM

Here’s an update:

http://www.nytimes.com/2012/07/31/business/medical-debt-collector-to-pay-2-5-million-settlement.html?hp

Take care,

Derek

Thanks for the update. Glad they were stopped.