Why Choose Direct Primary Care?

There is a lot that can be said about Direct Primary Care (DPC). To keep it short and simple, we choose DPC because it is a solution. A solution to a problem that has been festering in healthcare for generations. Rampant and exorbitant costs, outrageous bills, overloaded providers, healthcare systems that take ages to get in to. The breakdown of the “doctor-patient relationship”. It’s a system that is headed towards collapse. In its current form, it’s unsustainable. Patients are unhappy, providers are unhappy, the whole system is a mess.

But why? How did we get this way? Surely, it wasn’t always like this, was it?

The truth is that over the last century a multitude of changes has occurred that has caused a constant evolution in the healthcare landscape for both good and ill. People will often state that a hundred years ago medicine didn’t cost what it does today. While that’s completely true, it’s not exactly the entire story. In the early 1900s, medicine was still kind of in its infancy. There weren’t standardized training programs, the skills of doctors varied wildly from physician to physician. Hospitals were in their infancy and sophisticated diagnostic imaging such as X-rays, CT scans, MRI’s, as well as the complex procedures that are available today just didn’t exist. The standard of care and technology in today’s medical landscape has advanced to levels that were unheard of a hundred years ago or even 50 years ago! Unfortunately with sophistication, comes the costs associated with it. In response to these changes, health insurance was developed in an attempt to make medicine more affordable. Hospitals began to contract with patients and employers to protect them from catastrophic illnesses and over time it became a normal benefit for employees across the nation. Over the years though, the original intentions of insurance have become obscured. The goal of protecting patients against catastrophic costs was so financially successful that other parties became involved and further profit-driven policies were developed to maximize revenue. Over time, Insurances enrolled physicians and hospitals to form networks that only their members could see. Insurances began creating their own system for how to manage patients that makes them the most money and pays out the least. Insurance became a business and along the way one of the most precious commodities, the doctor-patient relationship was lost. Today, many of the Fortune 500 most profitable companies are medical companies. It’s not just insurance companies however, price managers, distributors, and various other entities have gradually stuck their hand in the pot bloating the system little by little. Once lobbyists and politicians got involved with regulations and mandates we finally arrive at the mess we have created for ourselves today. At some point, the whole thing became rigged so that costs were so outrageously expensive and inconvenient that you just couldn’t get good care without health insurance.

As the insurance companies changed their billing practices to maximize profits they began developing what's known as “managed care”. They decided who and what they would pay for making the decisions of the providers and patients more and more irrelevant. After all, what good is it to have your doctor tell you that you need an MRI if your insurance won't approve it? Those providers who spent time with their patients, who got to know each person who walked through their door, who came to your home and who knew you and your family by name were either bought out or forced out. The practice of sitting down with a patient for an hour led to empty wallets and closing practices. Unable to keep up, they were replaced by those who could see more patients, faster, in the way the insurance companies demanded. The result is what has become the standard today: providers who don’t know you, whom it takes you weeks to get in to see, who you have to wait for an hour in the waiting room for, who you finally saw for 5 minutes before they rushed out the door and one who if you got a new job or new insurance you may lose and have to start over with someone else “in-network”. Honestly, this system is not why any of us got into medicine. None of us chose this profession so we could rush from room to room only to forget our patient’s names and come home after 16 hours exhausted. We didn’t get into medicine to memorize billing codes and watch the clock to know how much to charge you. We get into medicine to help and to heal, but the model of business thrust upon us to achieve that has become flawed and broken. There’s a reason burnout is rampant across medical providers (some studies estimate a nearly 30-50% burnout rate), suicide rates are way higher than the general population and it’s only getting worse. On average, each provider is having patient panel sizes that are orders of magnitude larger than any sane person could handle.

Now don’t get me wrong, health insurance serves a purpose. Innovation and evolution are a natural part of the history of healthcare and insurance is one of them. It is not inherently evil and despite all I’ve written so far I’m not against health insurance. Advances in medicine and specialist procedures ARE expensive. That MRI machine at your local hospital or brand new Da Vinci surgical robot that cost over 2 million dollars to acquire does not just pay for itself! Even I have my own insurance plan to protect me and I recommend everyone have something to protect them from catastrophic costs. The problem is how far the system has strayed from its purpose. It has migrated away from catastrophic costs into the arena of general everyday care and prices have skyrocketed because of it. Most homeowners have insurance to protect them against a fire, flood or other major damage to their home but most do not use their insurance to paint the walls and fix the toilet. The system has bloated so far today that the average person is paying more in health insurance than they do for actual health care. The average premium in the United States is $440 per month ($5,280 per year), with on average over $4500 deductible. Meaning on average, most Americans would need to pay nearly $10,000 PER YEAR before their health care costs are covered. Some may even have co-insurance beyond that. These costs drive many patients to forego insurance altogether and choosing to avoid visits to their providers, avoiding checkups and care regardless of their medical history. There is a way that we can co-exist but the current profit-driven system that dominates healthcare right now isn’t it.

So back to the original question, why choose Direct Primary Care? We choose DPC because it is a way that we can cut through the mess that healthcare has become. Simplifying care into something that makes sense and is more affordable. It’s not perfect and there are roadblocks at every step of the way... but we choose it anyway. We choose it because DPC is how patients get a provider in their lives that they can get to know and trust no matter which insurance they have. We choose it because DPC is how when you fall asleep tonight you can rest easy knowing that if your child wakes up with a fever in the morning your provider will be there to answer your call. We choose it because DPC is how when you go get your blood drawn this week you realize you can actually afford it. We choose it because DPC is how when you were sick with cancer and had to see the specialist, your provider went with you. We choose it because DPC is how we rebuild the provider-patient relationship.

In my own life, I wasn’t always in medicine. I grew up wanting to be an aerospace engineer and an astronaut. I wanted to build space shuttles and travel to the moon. I had a whole life plan on how I was going to do that too! But life it seems... had other plans for me. In college I got bounced from one doctor to the next for nearly a year, never spending more than 10 minutes with any of them. No one had the time to sit down and just listen to me until finally, one did. Early 2007 after being bounced to over 15 different doctors - one single provider, a physician assistant I’d been turfed to sat down and just listened to me. There were of course patients waiting behind me but she let them wait and took the time anyway to just listen to my story from start to finish. Concerned by what she heard she ordered an MRI and soon after a diagnosis was made and one final referral was in the works. Within a month I was scheduled for my first life-changing surgery and never looked back. All it took was one, one person that had made the time to sit and listen that changed my life. It doesn’t matter if it’s a doctor, a specialist, a physician assistant, a nurse practitioner, a counselor, a family member, or a friend. The ones who make the biggest impacts in our lives are the ones who actually care and listen. I choose DPC so I can be like that PA who listened to me. I choose DPC so the patients who now see me will always know I’m available to listen when they need it.

If you’re here reading this, chances are you know there is something seriously wrong with our healthcare system. It’s messy, it’s bloated, and there are uncountable entities all driving the system to become more and more expensive. If you’re reading this then you also know that to fix it, there’s so much more to it than just slapping a Medicare for all sticker on it and giving the same broken system to everyone. In life, it is often the case that the best solutions are the ones that are outside of the box. DPC offers a novel way to untangle at least some of the mess that healthcare has become. I choose DPC because I believe there is a better way to make a difference in the lives of my patients.

Direct Primary Care, Direct Care and Concierge Medicine Defined

What is does Direct Care Group do and how is it different from concierge medicine? Or, more generally, what is direct care/direct primary care and how is it different from concierge medicine?

We receive this question frequently. Since we are operating in a relatively new niche within a growing industry there are many terms used to reference our business. A century or so ago, the automotive industry was in a similar stage of development and their products carried many different names. Automobile. Wagon. Cab. Motorcar. Jalopy. It's generally understood that each of these terms is synonymous with "private, personal, internal combustion transportation machine."

In the medical industry, references to concierge medicine include: direct primary care, celebrity medicine, private doctors, personalized medicine, private medicine, elitist-sounding phrases, or direct care (as we prefer). Direct primary care (or simply direct care) is just another term for concierge medicine.

A broad definition of concierge medicine includes several key attributes. By any name, it is a format in which: doctors see fewer patients; patient access to a doctor in person, by phone or email is enhanced; an 'executive physical' is included; and patients are charged an annual or monthly fee. Benefits to patients consist of a better relationship with their doctor, more preventative medicine including wellness and nutrition, and overall enhanced wellbeing as demonstrated by fewer trips to the hospital. Physicians see an improved lifestyle, ability to focus on their craft, and stability of income.

Within the current discussion and nomenclature surrounding the product, there is little to no differentiation or coherent brand identity. There is no standard for a "premium" concierge offering nor is there a clear "entry level" version. In fact, there is little product development or marketing outside of broad, generic themes. As the industry grows, however, these types of distinctions will become more and more apparent and dichotomies will evolve.

At present, the most easily identifiable differentiator is price. Independent doctors charge from $1,000-$6,000 per year per patient, MDVIP doctors charge $1,500-$2,000, and at the high end, MD Squared charges about $50,000 per year per family. Features and benefits generally trend with the expenditure to some degree. But... these practices are indiscriminately referred to as concierge medicine, direct primary care, and etc. regardless of price or offering.

Upon close inspection two major distinctions emerge. Surprisingly (or not) they are rarely identified by how a practice is referenced and neither is clearly explained or promoted.

First: Hybrid vs. Pure (Patient Conversion)

In most cases, a doctor will complete a process whereby his patient base is solicited to join a new concierge arrangement. In a pure practice, patients' options are to either continue on with their current doctor in the new program with 24/7 access, same or next day scheduling, longer appointments, wellness and nutrition, and more or to find a new doctor. In the hybrid model, the doctor retains those patients which do not wish to convert to the new format. While the ratio of hybrid to pure concierge practices is unclear, the differences are not.

Consider a long, transoceanic flight with a hybrid passenger cabin. Coach passengers are directed past roomy, premier lounge chairs on their way to tight, upright seats. Imagine the same flight attendants prioritizing between serving champagne flutes in first class and stale peanuts in steerage. Hybrid concierge practices are the healthcare embodiment of this system. In these practices, doctors are awkwardly juggling two classes and a large number of patients. While concierge patients get a special contact number, they cannot truly get the same quality of care as in a pure model since their doctor is still seeing upwards of 1,000 patients.

In pure practices, a clear distinction is made upon conversion that a doctor's practice is at once a concierge practice. Each of her patients receives the same treatment and no uncomfortable jockeying takes place at the office. Each patient has 24/7 access and the doctor does not have to make the precarious - and ethically questionable - judgment call of the urgency of a patient's condition versus their established payment arrangement.

Second: Insurance (Revenue Streams)

Not all concierge bills are built the same. Some concierge doctors rely on private insurance and Medicare for a portion of their revenue. By taking insurance, they may also be subjecting their patients to co-pays and co-insurance. When reviewing an annual $1,800 fee, it may be easy to overlook the additional per visit fees and find it a bargain compared to a $3,000 sticker price.

Health insurance (as it exists today) in concierge medicine complicates the relationship for patients and increases financial and regulatory risk for doctors. As Washington changes the face of healthcare delivery (including Medicare's inclusion of executive physicals as a covered expense) the window for concierge doctors to find revenue outside of direct patient billing is closing. This means one of two things: doctors out of business or hefty rate hikes for those practices relying on insurance reimbursement.

Like price point, hybrid/pure and insurance factors create divergent experiences, yet practices across the spectrum are collectively referred to as concierge medicine, private medicine, direct primary care, etc.

Conclusion

In practice, we at Direct Care Group define direct primary care (or direct care) as a concierge medicine experience where each patient has the potential for the same direct relationship with their health care providers. Patients have enhanced access, are given the time necessary for quality treatment, and receive whole-lifestyle care of a primary care physician and his team. Our doctors' all-inclusive fees are moderately priced, their offices are pure concierge practices, and we do not require insurance for visits.

How long will hybrid operations in which a doctor provides some patients with a "Cadillac" product and others "Chevy" service last? How many offices depending on co-payments, co-insurance, and reimbursement from private or public health insurance will continue to operate successfully? Will these healthcare models go the way of the steam engine? We're not sure, but we believe the solution is direct care - which is why we've based our business on it.

Misinformation & Politicization of the Pandemic

It is honestly impressive the extent of misinformation and politicization has been running rampant since the start of the COVID-19 pandemic. People taking "sides" on an issue that to most in the medical community shouldn't have any sides. My goal here is not to politicize anything, I'm strictly going to stick with facts as we currently understand them. As research continues our understanding may change along with how we approach them. I hope that I can be a source of up to date information for you that you can actually trust to give you the truth.

www.starlighthealth.com

Is COVID-19 Really as Dangerous as the Media Portrays?

I understand that it is difficult to understand what all the fuss is about. The media, regardless of what channel you watch or trust, has to sell their story and narrative to you as a viewer. Fear mongering, spin, and false narratives have become all too common in today's age. So, let's just stick to facts and see if we can understand what makes COVID dangerous. COVID-19 has been labeled a "novel" coronavirus. The reason it has been labeled as "novel" is that it is new. While there have been similar viruses in the past such as SARS, MERS, and others, this one, in particular, is different enough from anything else that we have seen that it is considered an entirely new virus. The problem with something new is that there is no known and accepted way to properly treat it. When you look at a virus like Influenza, there have been cases of Flu for generations. The last great pandemic was the Spanish Flu over 100 years ago. In that time we have developed vaccines, Tamiflu, treatments, and various other protocols to keep people alive, safe, and get them back to their lives. We have studied the Flu sufficiently enough that a majority of cases of patients with flu with mild, moderate, and even severe disease can be successfully managed. None of that experience applies to COVID-19. The antiviral medications, treatment protocols, and everything else we have used to manage the flu does not work with COVID-19. In time, as treatment protocols are developed, COVID-19 may become less dangerous and more successfully managed but the problem is that currently, there is no known treatment. There is no known antiviral, no known steroid, no known medications, vitamin, or lifestyle change that can guarantee an improvement in the course of illness... yet. That's the problem. There is no known treatment. If you catch COVID-19, for all intents and purposes, our ability to intervene and save your life is extremely limited. We treat the symptoms as they emerge, give oxygen when your short of breath, ventilate when you can't breathe on your own, but overall the course of illness you go through as a patient is unchanged and we do not know how to change that yet.

Why are people passing away from COVID-19?

COVID -19, is causing a multitude of effects that is causing fatalities. The actual statistics of which can be debated endlessly which one can see in the evening news, but suffice it to say, that it is generally considered more infectious, transmittable, and fatal than influenza. And influenza has claimed well over 50 million lives. This is a hard number to take at face value since medicine has progressed far since the time of the Spanish Flu, however it is still good to understand the numbers.

At the current state of our understanding of COVID-19 patients are dying from a variety of effects. COVID-19 has been found to cause respiratory failure, organ failure, blood clots, and a host of other effects. The exact mechanism in which it is doing this is not known and therefore the best way to treat and prevent it is likewise either unknown or currently not possible.

Let's start with the Blood clots, for some reason, COVID-19 is causing the blood to coagulate and form clots. These clots are presenting inside of organs, tissues, and various other places causing mass damage and organ failure. Currently, it is being proposed that patients coming into the hospital are placed on blood thinners to prevent these clots. However, this treatment is experimental. It is a proposed treatment that is being tried but not necessarily accepted yet. What this means is that they are giving it to patients in hospitals under the close scrutiny and observation a hospital can provide as opposed to in an outpatient primary care clinic.

Next, let's talk about Respiratory failure. Respiratory failure is essentially when a patient is unable to breathe. They take a breath but no matter how hard they try they cannot get oxygen into their bloodstream. Again, the problem is here is that we are not entirely clear on "how" it is doing this. Currently, our understanding is that it is causing what is known as a "cytokine storm". Cytokines are inflammatory markers that our bodies use to manage inflammation in the body. A cytokine storm is when these markers are released in such an abundance that the virus and normal tissue alike are destroyed in the process. Respiratory failure ensues as the normal structures of the lungs become obstructed, damaged, and destroyed. Here is where we see reports of the Dexamethasone in the news. Dexamethasone is what one might call a double-edged sword. It has one major effect - suppress the immune system. So in patients who are at risk of a cytokine storm, it is useful to suppress the immune system from creating the abnormal response that is proving fatal. However, it also the fact that you are suppressing the immune system means it is unable to properly fight the virus. There is a delicate balance of suppressing the potential for cytokine storm effect and actually inhibiting your body's ability to fight the virus. This is why again, only hospitalized patients are receiving Steroid treatments, and to give it on an outpatient basis is proving more fatal than not getting treatment at all.

Why is Fort Collins shutting down again?

Our lovely town has seen an uptick in numbers over the past few weeks as numbers across the nation are exploding. For most of the past week, new cases across the nation have surpassed 100,000 per day. The past 3 days have been over 150,000 per day. (https://www.worldometers.info/coronavirus/country/us/) In addition to these numbers exploding across the nation, we have also seen an uptick in the number of hospitalizations. Last week I received an urgent message from the DORA medical board projecting overloading of our Intensive Care Units to treat severely sick patients. Current projections are suggesting that we will reach statewide ICU capacity by January 1st if no changes are made. What it means if ICU capacity is reached is that if you become seriously injured or ill, there would be no hospital in the state that could accept you. There would be no ventilator machines, no nurses, doctors, or other providers with the ability to help you. There is not an infinite supply, the resources are, unfortunately, limited. There would be nothing to do except hope for the best. To curb this potential scenario after advisement by the medical boards the local government has decided to upgrade "safer at home" to level 2 with further restrictions on gatherings and as of today shut down all grade levels in the Poudre school district to remote learning only. You might be asking, why shut down the school districts? It has become well known that by in large, the young and healthy are not as affected by COVID as other populations. To our current knowledge, this is absolutely the case. While children are not necessarily at risk to be a serious patient, they are super spreaders. By their nature, children share and spread more germs than any other population. And all children come home to their parents. The goal here is to reduce the caseload, to reduce the number of ICU admissions so that we do not reach capacity and let people suffer through COVID at home on their own. This measure, good or bad, is intended to "flatten the curve". That's all the mask-wearing, closures, and other measures governments around the world are for - is to reduce the number of cases at any given time to levels where we can maintain our access to hospitals and Intensive care units. Some countries, such as New Zealand have been able to control to the point of near-total elimination of COVID-19 through lockdowns. This unfortunately may not be possible at this point in the USA. Though it can be controlled if proper precautions are taken

Should I see my Doctor when I’m healthy?

I’ve heard it stated in countless different ways, that a patient’s assessment of how healthy they are is based off of when the last time they went to the doctor was. Or perhaps, just simply stating they are “fine”, have no symptoms, and do not believe they need to see a healthcare provider. The truth is, that our bodies are marvelous pieces of machinery. They are filled with all kinds of built in mechanisms that heal, repair and even compensate for problems as they develop in a way that is better, and more sophisticated than anything man can currently match. But that also means that there are countless ways that things can go wrong. Some problems may present quickly and land you in the hospital. Others, have symptoms that develop over the course of years or even decades. Think about a large hydroelectric dam. As an outside observer the only times you may ever know something was wrong was if the power went out or the dam broke and flooded the town. But engineers and maintenance crews are constantly observing it, maintaining the machinery, looking for cracks and patching small problems before they become serious. Your healthcare provider is like these maintenance crews, when you’re healthy we are actively looking for the small things that can turn into big things down the line. A great example of all this is something like hypertension (increased blood pressure). In a majority of patients, they have no symptoms. They do not feel unwell, there is typically no pain, there’s no nausea or other symptomatic complaints. Unless it was bad enough to cause a headache or palpitations, most patients would never know they had hypertension and only find out after a visit to the doctor. So what’s the problem? The problem is hypertension is like the small crack in the dam, it’s a silent killer eating away at the foundations of your health. The consequences for untreated hypertension can be, in a word.. severe. First, the heart has to beat just a little bit harder to continue to pump effectively. Every second, of every day, without rest, up to 100,000 times per day it has to work harder to keep you alive. Not necessarily an issue at first but like all things the heart begins to stress and fatigue with excessive workload. Over the course of months and years this stress can take its toll until the heart begins to fail. Additionally, while elevated blood pressure is not a huge deal to the major vessels in the body, some vessels in the body are small.. Like really small… and fragile. There are microscopic vessels in your body which can, and are, damaged little by little by increased blood pressure. For these fragile vessels, it doesn’t take much for them to rupture and break. These particular vessels are commonly found in two places, the retina of the eyes and the kidneys. So what do you think is among the most common presentations of hypertension? If you guessed vision loss and kidney failure than you would be correct! Unfortunately, kidney failure is also a silent killer. Symptoms of kidney failure are basically fatigue and a general feeling of unwell known as Malaise. But this doesn’t happen over night. Just like everything else the body compensates and symptoms do not appear until the end stages. Kidney failure has 5 major stages and most patients will never feel a single symptom until stage 4 or 5. By the time patients go to see a doctor because they are feeling unwell, it may be irreversible.

There are countless other conditions and disorders that we screen for on a regular basis because of their clandestine nature: thyroid problems, blood problems, kidney, liver, cancers, diabetes, hiv, hepatitis… and the list goes on and on. None of these will typically present overnight as some kind of catastrophic illness, instead they take time to develop. These are the kinds of things we check for on a routine basis even when patients are well. I have already lost track of how many patients have come in to see me for a physical thinking everything was fine and they were wasting their time, only to discover a major oversight in their health. In a handful of occasions we even caught cancer in the early stages before it had progressed and while it was still treatable.

The moral of the story is that feeling “fine” is not a reliable way to tell if you are healthy, the fact that you haven’t seen a doctor is not a reliable indicator of how healthy you are either and nor are they an accurate prediction of how long you will remain that way. It simply means that you have not had any symptoms that are “bad enough” to warrant a visit to your doctor. The reason that providers ask you about your medical history, your family history, if you smoke, if you drink, or any other of a multitude of different behaviors is because they can influence the many different things you may be at risk for and can alter our approach in how we treat you. For example, if a patient came to me with a family history where her mother and father both had heart attacks in their 50’s, then I would be making sure this patient got an EKG and was eating healthy, exercising and maybe even received an ultrasound of their heart in their 40’s, to make sure nothing is developing. This is what preventative medicine can look like, if I started to catch anomalies early we can address them before they reach the stages of a full blown heart attack.

As you can imagine, preventative medicine is often considered to be an unnecessary expense, and that’s because when you are in the traditional healthcare system these tests and diagnostics can run into the thousands of dollars. When you step outside of the traditional system however, prevention strategies become much more affordable, and much more important in your care. With a Direct Primary Care practice, prevention is a key component of your care, we believe it’s important for us to check in with you and make sure everything is going well.

Falling Through the Cracks

A few generations ago, it was commonplace that when going to your local family physician it was easy for them to be the captain of the ship. They would tell you what's going on, what you needed to do, and that would be that. We could trust that our physicians had everything in hand. Over time, healthcare has become more complicated and the relationships that we providers have with our patients have become obscured, degraded, and lost. The fact remains that in today's medical landscape, providers have become overburdened by too many patients and it has become impossible for us to keep up with each patient. Because of this, patients who are accustomed to the old ways of doing things are falling through the cracks. Lab results have gone missing, patients never hearing back from their providers, some patients forget that they were supposed to follow up, some thought that “no news was good news” and assumed everything was fine. The truth is, everything is not fine. The traditional system has too many entities, too many complex systems and too many failure points. We’ve had x-rays that were never sent to us from imaging facilities, human errors, glitches with EMR systems, patients who changed phones numbers and a multitude of other reasons that complicated our care. The healthcare system has become so convoluted that it is no longer safe for patients to assume that your healthcare provider has everything in hand. It has become increasingly important that patients play a more active role by becoming well informed, educated, and personally involved in their medical decisions. With soo many patients, and so few providers, if you want good health care the truth is, you (the patient) need to be actively involved

SHARED DECISION MAKING

The overloaded system has not gone unnoticed to medical schools these days. Every attempt is being made to improve the quality of care and one of them begins by making the patient more involved. The modern medical system has begun teaching new providers about a concept known as "Shared decision making". If you've never heard this term before, it essentially means that it is no longer the job of your provider to "tell" you what to do (though sometimes that is appropriate) but is instead usually our job to "educate" you on the options and to help you decide on what is best for you. We recognize that one size does not fit all. Your preferences, beliefs, and desires for your health are important factors that you need to bring to the table. Finding a provider who has similar beliefs to you and how you approach your health is a good first step to build rapport. Once you have a provider you can trust it becomes easier to become more involved as there is no relationship without trust. The goal is that you are actively involved in the process, aware of what is going on so you, and your provider, can come to mutual decisions together.

It is, unfortunately, all too common for patients to either A) rollover and blindly do what they're told, or B) Ignore a plan because they didn’t like it. You need to be advocating for yourself, you need to be asking questions if you do not understand what is going on. You need to give your opinions a voice so that you and your provider can come to an understanding. Your provider is not a mind reader! If you walk out of a visit with your provider without voicing your dissent to a care plan or have no intention of following through with it, then the time you and your provider spent together was, unfortunately, a waste. In the age of “cancel” culture where we will often just quit and go to a new provider, it can be more beneficial for you in the long run to voice your concerns and come to a mutual understanding rather than just quitting. Be involved, be present, and help your provider come to a “shared decision”

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THE PATIENT ADVOCATE

It is your job as a patient to make sure someone knows in-depth about what is going on with you. What problems you have, what things you are at risk for, what you need to improve. They should know what medications you’re on, what dosages, when your appointments are... Everything about your health should be under control. The person who does all of this is known as a Patient Advocate. This could be a family member, a friend, a spouse, a nurse, or a variety of other people but for most patients, the best (or only) Patient Advocate you will ever get is yourself. If you are not able to advocate for yourself to manage all of your own needs, then who will advocate for you? The patients who do not have someone able to handle their needs are the ones who usually wind up with major issues down the road that could have been avoided.

QUESTIONS TO ASK YOURSELF

Take this time to think about what aspects of your care are you truly knowledgeable about and what are you not?

Am I truly able to advocate for myself?

Has my healthcare provider communicated with me everything they are doing? Is there anything I don’t understand and should be asking questions?

Do I have a list of all of the healthcare providers that I see?

Do I know all of their phone numbers and fax numbers?

Do I know their addresses?

Do I know how long their office typically books out?

Do I have follow up appointments scheduled with them?

Do I have any labs due before I see my providers?

Do I have any medications that might run out before my appointment?

Do I know what my medical history is?

Do I know my family history?

Do I have documentation of these and could readily provide them to a new Provider?

Do I have all my immunization records?

Do I know when I’m due for my screenings?

Do I know what disorders I’m at risk for (due to personal or family history)?

Am I taking steps to address my risk factors? Why not?

etc.. etc.. etc…

I know how quickly all these questions can add up and how quickly they can overwhelm. But they are important to ask and be well managed for patients long term health. When providers are seeing thousands of patients the endless array of questions become harder and harder and patients fall through the cracks more and more. I don’t want that to happen to you, and the first thing you can do is to work on changing your mindset. Treat the healthcare system like you would driving a car and practice “defensive driving”. You should assume that everyone on the road has no idea how to drive and accidents do happen. You can protect yourself by being informed, being involved and making sure you, or someone else, is always advocating for you. Find yourself a provider you can trust, voice your opinion, and be mindful of the broken system.