Prescription medicines for sale for food

One of my patient made a shocking confession today early this morning. This elderly lady told me that she bought Proventil inhaler for 15 dollars. She mentioned to me that her copay if she would have bought directly pharmacy would have been$25 and so this way she saved $10.00.This is the first time she has done it and she plans to do it more often.I asked her how do you know that it has not been used and many have in smaller number of inhalers left over and for that she responded that package was not even open. She further mentioned that people ( patients) sale all of their medicines for some cash so that they can buy their food for survival. I have asked to help me meet with some of these folks so that I can look into this plight and anonymously report to the media. I am keeping my fingers crossed.

Unnecessary tests for patients

The attitude and training of doctors and expectations of patients( how educated and rich they are) and extent of coverage by HMO/PPO determine which tests are needed or not. In HMO setting ,we are taking about popultaion medicine and the appropriate test is decided by n factor or number needed to treat .It is simple to say that what is good for a popultaion in general is good for you and that is what covered by ins company. On the other hand pts with PPO coverage and high deductable want to pay for tests for which may not be necessary, we just cannot say no because pts expectation is high and is willing to pay. There are several executives panel offered by Labs which can cost 3-4K which included several type of scancer screening, is sometimes ordered for such pts.I have never done that. Severeal time sI have had pts who would bring Carotid US screening test for STROKE???? done outsode for which they paid 100-150 dollars, without even asking their doctors?More evidence based medicine needs to be practiced with focus on strong prevention methods. Good practive of medicine needs to be emphasized.

Doctors as entrepreneur: Continuity Of care for patients

Doctors as entrepreneur: Continuity Of care for patients

Continuity Of care for patients

HMO and IPA ( Independent Physician Association) in California and Other states do not believe in pt's continuity of care and that results in poor quality of care being delivered to pt, high dissatisfaction rare and high readmission rate to hospital. I belong to two IPA,mainly,Greater Covina Medical group and Health care partners and both have hospitalists who take care of my patients in hospital.These hospitalist has no clues about my patients and they never communicate either during admission or discharge.Only goal of theirs is to maintain Length of stay and good average bed day .They do not spend enough time with my pts and pt come back from hospital and tell me how these so called hospitalist spend not more than 30 seconds per day and do not even spend time during discharge process. Most of my patients are so unhappy and I have informed IPA about it and told them that let me take care of my patients in hospital,nursninghome and home to make sure there is continuity of care and best of all, these are my patients and I know their problems well and there is trust and they will follow my advise. My request did not have any positive effect instead , they have now SNIFist and Nocturnist and Specialty Clinic Docs( same Hospitalist act as Specialty clinic Docs)...
HMO and IPA do not believe in taking care of patients best interest rather their bottomline.
They have been part of breaking the healthcare sytem in piecemeal and then trying to do patchworks and when it os not working out they come and blame PCPs.
IPA people like medical director will sit down with PCPs and show them number and say "well, these numbers do not look good,you need to take care of pts and keep them away from ER"
In a recent meeting I told them " If I donot have control in hospital care or discharge or any communicaiton with hospitalsit or SNIF care or home care,why should I be responsible" They were stunned with my response. I am still negotiating with them to let me take care of my patients from A-Z. I am hoping good sense will prevail in their heads .
Amen

PrimaryCare Driven Healthcare in America

Healthcare is in shambles and no one has control over quality and cost. Doctors and Patients and hospitals are all looser as a result.Only winner is Payor because they control the purse string.