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floridanative

Anyone Else See Sicko?

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I thought you guys might enjoy this:

Three doctors are waiting in line to get into the pearly

gates. St. Peter walks out and asks the first one, "What

have you done to enter Heaven?"

"I am a pediatrician and have brought thousands of the

Lord's babies into the world."

"Good enough to enter the gates," replied St. Peter and

in he goes. The same question is asked of the second

doctor.

"I am a general practioner and go to Third World countries

three times a year to cure the poor." St. Peter is impressed

and allows him through the gates. The third doctor steps up

in line and knowing the question, blurts out, "I am a director

of a HMO."

St. Peter meditates on this for a while and then says, "Fine,

you can enter Heaven...but only for 2 days."


Karen

positive bloodwork, positive biopsy

Celiac, collagenous colitis, hypothyroidism

endometriosis (at age 20)

spinal stenosis (early 20's)

Biopsy August 2006 confirmed complete villous atrophy despite being gluten-free for years and bloodwork within range showing compliance with diet. Doctor has confirmed diagnosis of Refractory Celiac Sprue.

Endoscopy also showed numerous stomach ulcers, have started taking Losec.

Mother to Eileen 13 yrs

Rhiannon 8 yrs

Daniel & Connor 6 yr twin boys......

"Joyfulness keeps the heart and face young. A good laugh makes us better friends with ourselves and everybody around us."

Orison Swett Marden

Laughter is the shortest distance between two people.

-- Victor Borge

"An optimist laughs to forget. A pessimist forgets to laugh."

Tom Nansbury

"Doctor to patient: I have good news and bad news. The good news is that you are not a hypochondriac."

Unknown

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I'm quite selfish in my reason to not want socialized medicine: socialized medicine will bring everyone towards the average, but half of us have above average care, so our medical care will get worse. I've got good insurance, my doctors have been good (and the two I had that weren't, I fired - something you can't do in socialized medicine so easily, if at all), and my health care has been quite reasonable given it's complicated-ness.

In the case of Canada's Healthcare, you can switch to any doctor you wish. We are not told by an insurance company which group of doctors we can choose from. Now, it can be difficult finding the best match for a family practioner, but you can keep switching doctors until you find the best match...it just takes time. When it comes to specialists, a family doctor can refer you as needed...if you want to see a specific practioner there shouldn't be a problem with referring to them. When it comes to wait times, it depends on the health issue (eg elective knee surgery could be a long wait, but cancer treatment is immediate.) Children often get priority as well...my son was able to get an MRI very quickly as compared to the wait for an adult...again, it depends on the health issue.

In addition, there is limited coverage for seeing alternative practioners as well (chiro, pt, etc.) Though it does help if one has extended health coverage to fully cover the costs for alternative care.

Michelle

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Several years ago I went to the Humane Society with a friend as she wanted an unwanted dog. She had to pay $75 for a "used" dog. I asked the Society why the fee and they answered : if you get something for nothing you treat it like that: like it's nothing. When there's a fee, the person doing the purchasing has more of a stake in it and a bond of responsiblity is created. Free health care is like adopting a pet then. When that bond isn't made it's abused and overused and taken for granted and tossed away. But having to achieve health with sweat from your brow will make you hold it more dear to you. Perhaps in Canada certain procedures should have a copay to show people that this is serious and that it's not to be taken lightly or sucked up like pigs at a trough. Health care should be approached with reverent respect. (In insurance terms it could be considered a "moral" hazard when the only people buying and using the insurance are claimants, but I digress).

I object to Canadians being called pigs at a trough. Our healthcare is not free, you know. We pay through our taxes, and we pay fees outside covered expenses too. There are certain procedures and tests that are out of pocket expenses (like allergy testing.) We also have extended healthcare insurance (depending on employer) that we pay into. Dental care is not free, and only partially covered through extended plans. Neither is eye care. Prescriptions are not covered unless you have extended health, and often only a percetage of the cost is covered. There is some measure of preventitive medicine as well, and people are encouraged to not run to the doctor demanding drugs (or antibiotics!) for every little cold or sniffle.

Finally, anyone who needs treatment gets it. No one is turned away, regardless of whether they are citizens or not.

My FIL was quickly diagnosed with a brain tumor when he was out-of-province (BC.) He had immediate surgery and was offered further treatment there. When he chose to return home (Alberta) for the rest of his treatment, all of the pertinent health info was promptly sent to the drs at the cancer treatment facility and they were ready to take on his case as soon as he arrived. And then he was given the newest technological care. I think that is a pretty good example of how the Canadian healthcare system can work well. Finally, he was given excellent hospice care in hospital (in a small town) during his final month.

BTW, my FIL had very little need to take advantage of our "free" health care during his lifetime (missed all of couple of days of work due to illness), but was able to get the best care when it really counted.

Michelle

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Car insurance. To me this is the perfect solution. The worse the driver the higher the premium. I have had weight issues my whole life. I am currently obese. I am at fault for it. The diet that is required for me to stay skinny, was to difficult to stay on. That is one else's fault but my own. This is my hand and my choice. I am currently (paying out of my own pocket, as I should) getting blood work done to find out exactly what I can and can't eat. Now, all this being said, as I am currently a higher risk, I should pay more. Once I take it upon myself to fix the problem, then part of the reward is lower rates. This is how car insurance is run. Also, car insurance doesn't pay for maintenance.

To answer the question I will not see the film. I understand what he is supposedly trying to do, but all I see him doing is making a profit that does nothing to help anyone.

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In the case of Canada's Healthcare, you can switch to any doctor you wish. We are not told by an insurance company which group of doctors we can choose from. Now, it can be difficult finding the best match for a family practioner, but you can keep switching doctors until you find the best match...it just takes time. When it comes to specialists, a family doctor can refer you as needed...if you want to see a specific practioner there shouldn't be a problem with referring to them. When it comes to wait times, it depends on the health issue (eg elective knee surgery could be a long wait, but cancer treatment is immediate.) Children often get priority as well...my son was able to get an MRI very quickly as compared to the wait for an adult...again, it depends on the health issue.

In addition, there is limited coverage for seeing alternative practioners as well (chiro, pt, etc.) Though it does help if one has extended health coverage to fully cover the costs for alternative care.

Michelle

Michelle: You are describing an HMO (limited list of doctors). Most doctors participate in most HMOs. And most plans include alternative practioners now. It depends on the plan you or your employer buys. At the point of sale the insurance rep tells you the various plans and what they cost. If you want to save money, you then are taking the limited plan. It's like buying auto insurance: if you don't take comprehensive and collision coverage and have an at fault accident you have to pay for your own car's damage.

Most employers are starting to go with "Direct Access" that if your doctor isn't in the Plan you can see him but there's a bigger co-pay.

Or there's a annual deductible of like $500 per person, $1500 per family to help offset the premium costs. Herein you decide if you want to go thru the plan or outside of the plan.

Many people who are in good health when they start their insurance choose the cheapest plans and then when get a health problem they want a certain doctor, who isn't in their plan, they are upset that they didn't take the better plan. I only know this because I am in health insurance business and we sell policies and go over the plan with the customer, only to have the customer come back 6 months later with this complaint.

What you need to do when you sign up is review the list of doctors BEFORE you sign up; check out if your doctor participates; call your doctor's billing office; all the offices of any specialist you might use: ob/gyn, orthopaedic, urologist, internist, etc. Play the game "pretend you need a specialist" and call the ones you'd probably use, one by one, to see if they participate in the plan you are about to take.

When it's the employer who takes out the plan, you have less control. Talk to your HR or personnel people and find out if they can improve on your plan BEFORE the next renewal.

Even if you get turned down by the insurance company for a test or procedure - send a written appeal to the insurance company at the special address they use for appeals. You might even want to call your state's Dept.of Insurance to complain. The state Dept. of Insurance regulates all insurance - some states have stronger regulatory bodies than others.

Only once was there a doctor I wanted to go to which was not on my HMO list...and it was a dermatologist but there was list of many more dermatologists who were just as talented and capable.

Sometimes when a doctor isn't on a HMO it's because the doctor is deemed incompetent by the HMO regulatory board.. I'll repeat that. HMO's screen the doctors and if they find that the doctor has too many complaints or isn't up to snuff, the doctor will not get picked up by the HMO.

I know of one doctor here in NJ who was rejected by the HMOs and he tells his patients that he won't "deal" with HMO's because of their nonsense, but in reality it's because he is incompetent and THEY don't want him in their plans. So it can go both ways.


Husband has Celiac Disease and

Husband misdiagnosed for 27 yrs -

The misdiagnosis was: IBS or colitis

Mis-diagnosed from 1977 to 2003 by various gastros including one of the largest,

most prestigious medical groups in northern NJ which constantly advertises themselves as

being the "best." This GI told him it was "all in his head."

Serious Depressive state ensued

Finally Diagnosed with celiac disease in 2003

Other food sensitivities: almost all fruits, vegetables, spices, eggs, nuts, yeast, fried foods, roughage, soy.

Needs to gain back at least 25 lbs. of the 40 lbs pounds he lost - lost a great amout of body fat and muscle

Developed neuropathy in 2005

Now has lymphadema 2006It is my opinion that his subsequent disorders could have been avoided had he been diagnosed sooner by any of the dozen or so doctors he saw between 1977 to 2003

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Car insurance. To me this is the perfect solution. The worse the driver the higher the premium. I have had weight issues my whole life. I am currently obese. I am at fault for it. The diet that is required for me to stay skinny, was to difficult to stay on. That is one else's fault but my own. This is my hand and my choice. I am currently (paying out of my own pocket, as I should) getting blood work done to find out exactly what I can and can't eat. Now, all this being said, as I am currently a higher risk, I should pay more. Once I take it upon myself to fix the problem, then part of the reward is lower rates. This is how car insurance is run. Also, car insurance doesn't pay for maintenance.

To answer the question I will not see the film. I understand what he is supposedly trying to do, but all I see him doing is making a profit that does nothing to help anyone.

All insurance is based on "statisical probability" - the higher percentage some occurrence will happen (increased liklihood) the more expensive the insurance is.

Rates for all insurance are based on this probability. Acturaries review payout records for clips of 10 years past or so and base future rates on what occurred in the past...what claims came in, for what type of occurrence, how much was actually paid and then they "set" the rate for the new year. If the losses can be accurately measured by the past, then they can with some degree of accuracy predict what will occur in new year and how much premium will need to be collected to go against future claims.

Health insurance isn't maintenance insurance because they cannot predict what people will do. But illnesses are common during certain periods of life and can be more accurately predicted. Health insurance is conservative because unlike a driving record there's less predictability for each person indivudally but as a a group more predictable.

I hope this makes sense....


Husband has Celiac Disease and

Husband misdiagnosed for 27 yrs -

The misdiagnosis was: IBS or colitis

Mis-diagnosed from 1977 to 2003 by various gastros including one of the largest,

most prestigious medical groups in northern NJ which constantly advertises themselves as

being the "best." This GI told him it was "all in his head."

Serious Depressive state ensued

Finally Diagnosed with celiac disease in 2003

Other food sensitivities: almost all fruits, vegetables, spices, eggs, nuts, yeast, fried foods, roughage, soy.

Needs to gain back at least 25 lbs. of the 40 lbs pounds he lost - lost a great amout of body fat and muscle

Developed neuropathy in 2005

Now has lymphadema 2006It is my opinion that his subsequent disorders could have been avoided had he been diagnosed sooner by any of the dozen or so doctors he saw between 1977 to 2003

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What you need to do when you sign up is review the list of doctors BEFORE you sign up; check out if your doctor participates; call your doctor's billing office; all the offices of any specialist you might use: ob/gyn, orthopaedic, urologist, internist, etc. Play the game "pretend you need a specialist" and call the ones you'd probably use, one by one, to see if they participate in the plan you are about to take.

That's ridiculous. How in the heck is a person supposed to guess what kind of specialist they're going to need before they're sick? How much time would it take to find the right fit? So you'd be going by recommendations about how good a particular doctor is, and pick a plan based on his/her participation...but what happens when you do need their services, but they aren't as great a fit for you in the end? Your suggested process of shopping around puts way too much owness on the consumer for knowing what their needs will be down the road.

The health care issue is a big one to me...its one of the things that makes the thought of moving to the U.S. undesirable. I'm happy to have the care we have here, even with its faults.

Michelle

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Sometimes when a doctor isn't on a HMO it's because the doctor is deemed incompetent by the HMO regulatory board.. I'll repeat that. HMO's screen the doctors and if they find that the doctor has too many complaints or isn't up to snuff, the doctor will not get picked up by the HMO.

I know of one doctor here in NJ who was rejected by the HMOs and he tells his patients that he won't "deal" with HMO's because of their nonsense, but in reality it's because he is incompetent and THEY don't want him in their plans. So it can go both ways.

It can go both ways. There are many doctors that will not deal with an HMO because of their nonsense. They are great doctors but refuse to accept the amount that an HMO will pay or have to jump through their hoops.

I know this because I had a doctor that I had to leave because he was not part of an employers new HMO. The next year when they went back to a traditional insurance, I went back to him. He had no complaints with the state board and he was a perfectly capable doctor. He just refused to deal with an HMO, and I don't blame him.

I would fight for all I was worth before having to go back to an HMO. It is much like Socialized Medicine. Your primary care doctor becomes the gate keeper. Everything has to go through them. Want to see your GYN before your year is up, check with the primary care. So what that you have a breast lump. Need to see an Ophthalmologist, call your primary care. Need eye surgery, hope that they have space for you before you lose your sight.

The last time I had an HMO, I went to the emergency room and was admitted. And the HMO, at first, refused to pay the claim. They said it wasn't an emergency. :rolleyes: Hello, I was admitted. After threatening to go to the state board, they paid.

The last thing I would want would be someone telling me when I was allowed to see a doctor. With traditional insurance, I can call for an appointment whenever I feel I need to. If I need to see an Ophthalmologist, I call his office and see him. If I abuse the system, I pay for it through my copay and through our increased rates with the insurance company.

Both HMO's and Socialized Medicine would stop me from making my own decisions about my health. I just think about how the government has screwed up Public Housing. Would anyone choose to live there if they had another option? Why would we want Public Health?

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I would fight for all I was worth before having to go back to an HMO. It is much like Socialized Medicine. Your primary care doctor becomes the gate keeper. Everything has to go through them. Want to see your GYN before your year is up, check with the primary care. So what that you have a breast lump. Need to see an Ophthalmologist, call your primary care. Need eye surgery, hope that they have space for you before you lose your sight.

The last time I had an HMO, I went to the emergency room and was admitted. And the HMO, at first, refused to pay the claim. They said it wasn't an emergency. :rolleyes: Hello, I was admitted. After threatening to go to the state board, they paid.

The last thing I would want would be someone telling me when I was allowed to see a doctor. With traditional insurance, I can call for an appointment whenever I feel I need to. If I need to see an Ophthalmologist, I call his office and see him. If I abuse the system, I pay for it through my copay and through our increased rates with the insurance company.

Both HMO's and Socialized Medicine would stop me from making my own decisions about my health. I just think about how the government has screwed up Public Housing. Would anyone choose to live there if they had another option? Why would we want Public Health?

I think your perspective on "socialized medicine" is a bit off. Canadian Healthcare doesn't work that way. I am in complete control over decisions about my health care. It is difficult to find the right family physician initially (ie when we moved from out of province), but I've now found a doctor that is supportive and willing to work with me in providing thorough care for me and my family.

Yes, there are many specialists to whom you need an initial referral, but once you become a patient with most of those specialists, you can continue to see them directly. So, no, our family doctor is not the gatekeeper. My doctor also has no say in whether I seek out alternative health care. For example, hiring a midwife is a legitimate choice here that is supported by our health care system (though not paid for by Alberta Health or extended health) with full hospital priviledges and the ability of midwives to refer for other health care as needed (like high risk cases.) My family doctor was not consulted for pregnancy care or birth...it was entirely my choice.

Some specialists do require a referral each time, but it is up to that specialist to decide if that is the way they want to work with patients. The GI whom is doing my procedures is like that. She will not take on patients on a regular basis, she wants them to be referred each time as necessary. My dermatologist (also is an internist) is different. Once I was referred (for patch testing) I chose to continue seeing him as my regular dermatologist. Me & my daughter were accepted as regular patients, and any of my family members can become patients too, without the need for referrals. Same goes for my GYN, allergist, and my son's pediatrician.

Michelle

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Yes, and in Canada, once you are into one specialist, they will often send you to others, and it is very efficient. My endo sent me to a haemotologist at the beginning of my find-the-reason-for-my-chronically-low-iron problem...he in turn sent me to a gastro, where I got the celiac diagnosis. From him, I got into my dermatologist. These are all specialists whose patient lists I am on now, indefinitely. It can work very well.


Emily

diagnosed type one diabetic 1973

diagnosed celiac winter 2005

diagnosed hypothyroid spring 2006

But healthy and happy! 253.gif

11 year-old Son had negative blood panel, but went on gluten-free diet of his own volition to see if his concentration would improve, his temper abate, and his energy level would increase. Miraculous response!

The great are great only because we are on our knees.

--Pierre Joseph Proudhon (1809-1865)

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That's ridiculous. How in the heck is a person supposed to guess what kind of specialist they're going to need before they're sick? How much time would it take to find the right fit? So you'd be going by recommendations about how good a particular doctor is, and pick a plan based on his/her participation...but what happens when you do need their services, but they aren't as great a fit for you in the end? Your suggested process of shopping around puts way too much owness on the consumer for knowing what their needs will be down the road.

The health care issue is a big one to me...its one of the things that makes the thought of moving to the U.S. undesirable. I'm happy to have the care we have here, even with its faults.

Michelle

You're right. The Traditional plans are best where you can go to any doctor or facility - medium deductible and sensible co pays

My suggestion of "finding doctors" before you need them is based on my own personal experience when I had to change plans. It's my only suggestion for this. Only a suggestion.

As to "pigs at tough" comment --- not directed towards anyone in particular or any area of world but just overall opinion of how people act when it's a govt program. Just commenting on basic human nature in general. Sorry to have made it sound otherwise.


Husband has Celiac Disease and

Husband misdiagnosed for 27 yrs -

The misdiagnosis was: IBS or colitis

Mis-diagnosed from 1977 to 2003 by various gastros including one of the largest,

most prestigious medical groups in northern NJ which constantly advertises themselves as

being the "best." This GI told him it was "all in his head."

Serious Depressive state ensued

Finally Diagnosed with celiac disease in 2003

Other food sensitivities: almost all fruits, vegetables, spices, eggs, nuts, yeast, fried foods, roughage, soy.

Needs to gain back at least 25 lbs. of the 40 lbs pounds he lost - lost a great amout of body fat and muscle

Developed neuropathy in 2005

Now has lymphadema 2006It is my opinion that his subsequent disorders could have been avoided had he been diagnosed sooner by any of the dozen or so doctors he saw between 1977 to 2003

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You're right. The Traditional plans are best where you can go to any doctor or facility - medium deductible and sensible co pays

My suggestion of "finding doctors" before you need them is based on my own personal experience when I had to change plans. It's my only suggestion for this. Only a suggestion.

As to "pigs at tough" comment --- not directed towards anyone in particular or any area of world but just overall opinion of how people act when it's a govt program. Just commenting on basic human nature in general. Sorry to have made it sound otherwise.

It's unfortunate that you have an opinion that is based on stereotype rather than fact. And it sounds as if you are equating public healthcare with welfare (which is another unfortunate stereotype as well...as there are those here on welfare who do not abuse it, but use it as the "hand up" it was created to be.)

Our entire country has public healthcare. The Canadian citizens who use this system encompass all sorts of walks of life, ages, economic backgrounds, etc. I have yet to meet anyone in my middle class community who acts as such (pig at a trough.) There may be some who abuse the system, but the vast majority use it only as needed.

I am happy to live in a country that has government programs to support its citizens. I wish that the government was even more supportive...many programs are axed when budgets are slashed. I have no grudge about my taxes funding a program that supports others, but may not have a direct impact on me. I am happy that all get health treatment when needed. And I am disgusted when I hear about people elsewhere being turned away because of lack of health insurance or becoming bankrupt to pay outlandish hospital bills.

Michelle

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Yes, and in Canada, once you are into one specialist, they will often send you to others, and it is very efficient. My endo sent me to a haemotologist at the beginning of my find-the-reason-for-my-chronically-low-iron problem...he in turn sent me to a gastro, where I got the celiac diagnosis. From him, I got into my dermatologist. These are all specialists whose patient lists I am on now, indefinitely. It can work very well.

I want to add too, that many times a specialist will ask whether a copy of test results should be sent to a family doctor. I especially appreciate having all my test info kept in my family dr's file...makes it easy to reference.

Michelle

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We should not associate a potential American socialized medicine program with the Canadian socialized medicine program - they would likely be very different; just because it works one way in Canada doesn't mean we'd do anything like that in the US.

As for the idea that it's too much onous on a person to know what specialist they need to see... Well, quite frankly, I think the population as a whole needs to take a lot more control about their health, and learn these things. No, I'm not saying it should be done in the dark, and there are certainly times when a primary focal is going to be necessary, but people need to be educated and involved enough to know when *not* to trust their primary care as well. Otherwise, you encourage single-points of failure all over the medical system.

I *greatly* dislike the need for referrals in most cases. It assumes that people are stupid. Unfortunately, as a group, we often are, so I do understand it, but I think the solution is not to guard against stupidity, but to educate. I have been greatly helped, many times, by going directly to a specialist (something that many HMO's - and that is likely the way that any American socialized medicine program would be set up, given the politics involved - do not let you do). And when the specialist I first went to was bad (in the case of my knees), it was very helpful to not have to go back to my doctor and say "oh, I didn't like that guy, I need a referral to someone different". I could go out and find an ortho on my own who was excellent, saved me from surgery, and helped me get back to running pain-free.

As for the idea of medium deductibles, co-pays, and other fees... It's a bit of a bug-a-boo for me, but the actual cost of providing health care is not low. I do not understand why people feel that going to the doctor should be so cheap - you have to pay for anything valuable, and health care is valuable.


Tiffany aka "Have I Mentioned Chocolate Lately?"

Inconclusive Blood Tests, Positive Dietary Results, No Endoscopy

G.F. - September 2003; C.F. - July 2004

Hiker, Yoga Teacher, Engineer, Painter, Be-er of Me

Bellevue, WA

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We should not associate a potential American socialized medicine program with the Canadian socialized medicine program - they would likely be very different; just because it works one way in Canada doesn't mean we'd do anything like that in the US.

Even if the US wanted to, it would be next to impossible to set up the same system as in Canada, because the Canadian system has been in place for many years now, and serves far fewer people than the US system would have to serve.

As for the idea that it's too much onous on a person to know what specialist they need to see... Well, quite frankly, I think the population as a whole needs to take a lot more control about their health, and learn these things. No, I'm not saying it should be done in the dark, and there are certainly times when a primary focal is going to be necessary, but people need to be educated and involved enough to know when *not* to trust their primary care as well. Otherwise, you encourage single-points of failure all over the medical system.

I *greatly* dislike the need for referrals in most cases. It assumes that people are stupid. Unfortunately, as a group, we often are, so I do understand it, but I think the solution is not to guard against stupidity, but to educate. I have been greatly helped, many times, by going directly to a specialist (something that many HMO's - and that is likely the way that any American socialized medicine program would be set up, given the politics involved - do not let you do). And when the specialist I first went to was bad (in the case of my knees), it was very helpful to not have to go back to my doctor and say "oh, I didn't like that guy, I need a referral to someone different". I could go out and find an ortho on my own who was excellent, saved me from surgery, and helped me get back to running pain-free.

I don't agree with this assessment. I don't think that the process of referrals assume people are stupid. If you consider your primary care physician is part of a network in which they have experience and connections with other doctors of various specialties, to get a referral can make the process of finding and accessing a specialist a much easier and faster process. In essence, I'm taking advantage of my dr's connections to get an appointment with the proper specialist. When I am trying to figure out what is going on with my health, my family dr can help direct me to where I need to go to get certain answers. If I already know of a specialist (by recommendation or reputation) I can request that a referral be made there. My drs office then takes care of the legwork in getting an appointment scheduled for me.

However, there are other cases where I may not need a referral to see a specific practitioner. I likely didn't need an official referral to see my current gynecologist, but that is the route I followed, because I was seeing her for a very specific issue. Otherwise, I wouldn't have been seeing a gyn at all (my family dr is fine for general gyn health and yearly testing.) I wouldn't have needed a referral for my son's paediatrician either (since I see no need to have a regular paed for my kids) but the referral was helpful to get in to see one of the best paeds here for assessing my son's health situation. To get in to see her would have been near impossible otherwise.

As for the idea of medium deductibles, co-pays, and other fees... It's a bit of a bug-a-boo for me, but the actual cost of providing health care is not low. I do not understand why people feel that going to the doctor should be so cheap - you have to pay for anything valuable, and health care is valuable.

Healthcare is expensive...all the more reason to use a referral process. It ensures that time and resources are not wasted with patients going to a specialist unnecessarily.

Michelle

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...

I don't agree with this assessment. I don't think that the process of referrals assume people are stupid. If you consider your primary care physician is part of a network in which they have experience and connections with other doctors of various specialties, to get a referral can make the process of finding and accessing a specialist a much easier and faster process. In essence, I'm taking advantage of my dr's connections to get an appointment with the proper specialist. When I am trying to figure out what is going on with my health, my family dr can help direct me to where I need to go to get certain answers. If I already know of a specialist (by recommendation or reputation) I can request that a referral be made there. My drs office then takes care of the legwork in getting an appointment scheduled for me.

...

I never said that referrals are stupid - you're absolutely right that taking advantage of who your doctor knows is useful. But when referrals become *necessary* (not just an option), it reduces your networking, because it doesn't allow you to contact doctors that you may be able to connect to through people other than your doctor. My doctor's referral for a knee ortho was awful, my boss's reference was excellent; because I didn't need a referral for my insurance, I was able to get an excellent ortho, save the cost/time/risk of surgery, and resume regular activity. On the other hand, my doctor's reference to a gyn who later referred me to a gyn specialist was very useful and possibly the only way I would have gotten in there.

In my experience (personal and vicarious), "requesting a referral" is hit or miss at best, with many doctors preferring to stick with their network than sending a patient out to an unknown. And why should the patient have to wait for the doctor to set that up in every case, or - even worse - go in for a consult first? Why should we pay the medical profession for doing the legwork of getting the appointment when I can do it myself (and not on - in the case of socialized medicine - the government's dime)?

I'm not saying there isn't an important role for a primary care physician - there is a vital role. But it's also easy for that role to become one that functions (be it due to insurance restrictions, time lags, knowledge, or networking preferences) one of a gate if there aren't options. And there is a risk of lower quality care if a patient isn't proactive him/herself in coordinating their own care as much as possible.


Tiffany aka "Have I Mentioned Chocolate Lately?"

Inconclusive Blood Tests, Positive Dietary Results, No Endoscopy

G.F. - September 2003; C.F. - July 2004

Hiker, Yoga Teacher, Engineer, Painter, Be-er of Me

Bellevue, WA

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From my own experience, the "gatekeeper" program in USA HMOs keeps you from getting care in a timely fashion and makes unnecessary paperwork and running around to pick up these stupid slips of paper. Our "Traditional" plans in US never had this stipulation.

Additionally, when I mention that before you change plans you should review your listing of doctors in the plan, that's actually the listing of the doctors that you are allowed to go to in your chosen HMO. Here in US when you have a "gatekeeper" HMO plan your primary doctor has so many patients having different insurance they are not responsible for finding you your specialist. They may throw out some names of specialists but it's up to you to find out if they are "in your plan." This may not be understood by those in Canadian system because it's peculiar to USA (due to multiple insurance companies offering HMOs). You have to take charge of this part of the process. No one can do it for you.

In USA public healthcare *is* welfare, that's not just my opinion. The only people who are supposed to be on public healthcare in USA are the poor. (as to "trough" comment, if you read prior poster she was upset that her brother in law was being overlooked by hospital staff in favor of those patients who were getting elective surgery, and they were perhaps taking advantage of the Canadian healthcare system..so my comment was reflection of case-scenario of other poster).

My opinion of the govt programs is based on facts and not stereotype. It's human nature to try to get something for nothing. If it weren't so, stores wouldn't need to run "sales" and there'd be no thieves. But what I am confused about is : stereotype of what?

It's understandable that someone from another country wouldn't understand our US govt programs.

Since I live in US, and my opinion is certainly as worthwhile as Mr. Moore's, I talk & listen to my own co-citizens and hear them in their machinations of how to "bilk the system" and use it for more than just a "hand" up. Also, if you read my prior posts you'd note that I am for less govt intervention.

I am about to boldy talk about a topic many Americans refuse to face....or are involved in themselves and would rather not comment about...

I find this in all walks of US American life -- over the last 40 years of my living I've noticed or found:

Mid to Upper-middle class older parents who want to hide their assets in case they have to go on Medicaid and want to leave their estates intact to their adult children - and the adult children encourage this - there are even financial estate planners who tell you for a fee how to do this.

These people are avoiding the cost of having to pay their own medical costs and nursing home bills - they feel that the govt will pay for all this and their heirs will get all the money on their deaths. In US, if you die owning a home or have money in bank and you're in a nursing home the nursing home will take your assets or the govt will if the govt has been paying for your nursing care for the last years of your life. This is to reduce the tax burden of the public. Let those using the services who have the money pay for them, in full or at least in part.

Seniors who hide their assets in order to get their prescriptions paid 100% by govt. for the same reasons above or to have the money to keep vacationing, buying new cars, etc. Their children will dole out the funds to them as they need it - not in cash or checks, but for instance adult child buys a new car with the parent's pre-saved hidden money and re-sells it to the parent for a nominal $25 fee so that's there's a legal paper trail;

Women who have children (multiples) and refuse to marry the father of the children (and have told me why they won't marry him - to the point of pretending not to live with the man just to qualify for welfare, food stamps and WIC (I know of a few personally, one of which boyfriend made over $100,000 a year and could afford to support his family...but she wanted to declare bankruptcy and he wanted to save to buy a house - so let the govt. support the children until they have what they want in life.) When having their children, the women state on birth certificate : father unknown. In this way, the courts have no one to go after for child support.) Nice work if you can get it! Again, the burden of supporting that mother and children is shifted to the federal/state/county taxes - which come from income and property taxes.

I have more scenarios but don't want to go them into right now as I am in insurance/financial business so I know the stories of others but cannot state them due to privacy issues.

The above were never clients of mine, but I have heard other stories first hand when I ask the customers simple questions about all the people who live in their house, status of their auto insurance (making sure that their car is adequately insured only to find out that their car is in the boyfriend's name in order to continue this charade.) ..but I live here, I know this stuff firsthand and I know the govt systems, so I take umbrage that you state my opinion is based on stereotype..unless you're talking about something else....

I find that these types of people -- and there are many of them -- are lured by free services. They are financing the bounty of their lives on the backs of the tax-paying public. This is what I take offense to and why I feel it's human nature to take something which is being offered without strings.

You may feel it's a harsh opinion, but let's talk about it when these programs go bankrupt and the real sick or poor have to go without. As it stands now, the govt wants to cut back on these programs as it has become too expensive to run and they are going to go bankrupt. People like me who never used these programs and have big tax burdens are tired of paying taxes year after year only to watch others commiting fraud bleed the system dry when they really shouldn't be doing so.

I would prefer to speak over PM on any further conversation on this topic as to avoid argument on this board. I am answering as politely and with as much personal erudition as I can. I can only ascertain that my meaning in my prior posts were undoubtedly obscured by the imprecise nature of words in posting and emails.


Husband has Celiac Disease and

Husband misdiagnosed for 27 yrs -

The misdiagnosis was: IBS or colitis

Mis-diagnosed from 1977 to 2003 by various gastros including one of the largest,

most prestigious medical groups in northern NJ which constantly advertises themselves as

being the "best." This GI told him it was "all in his head."

Serious Depressive state ensued

Finally Diagnosed with celiac disease in 2003

Other food sensitivities: almost all fruits, vegetables, spices, eggs, nuts, yeast, fried foods, roughage, soy.

Needs to gain back at least 25 lbs. of the 40 lbs pounds he lost - lost a great amout of body fat and muscle

Developed neuropathy in 2005

Now has lymphadema 2006It is my opinion that his subsequent disorders could have been avoided had he been diagnosed sooner by any of the dozen or so doctors he saw between 1977 to 2003

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