The Importance of Earnest Service

Wait a Minute Doc!

A friend had a very bad reaction to an injection so she returned to the doctor’s office. Her arm hurt so badly she couldn’t lift it, she felt weak and dizzy and ended up missing two days of work.

She learned that she was to have this inoculation once every five years and she just had one last year.

There’s a hefty co-pay on her insurance plan so when a bill for $92 came for the second visit, she called the doctor’s office to say she didn’t plan to pay it. She explained that had it not been for the office’s mistake—nobody had checked her chart before calling her to come in for the shot and at the time she didn’t know that this was not a yearly precaution like a flu shot—she wouldn’t have had to come back to check out the side effects.

The takeaway: It’s up to you now. Before getting an innoculation, check online or with someone to confirm it’s an annual event.

Arf, Meow

Another friend took her pet to the vet and part of the checkup was extensive [expensive] blood work. She got the results and one was missing though she’d been charged and had paid for it. She had to go back with her pet and hoped that she wouldn’t get another bill for the doctor’s time. I can’t imagine she would. [Patients are never reimbursed for their time.]

The takeaway: Don’t just read the top line when reviewing blood test results. Make sure you see the results for each test you paid for.

Juicy Fruit

I stop by a street fruit and vegetable vendor on my way home from work at least three times a week. The quality is tops, the prices low to rock bottom and inevitably, when I buy a few things—four oranges, tiny sweet tomatoes in an attractive display, a couple of boxes of blueberries for example—he always knocks down the total by a few dollars. I ask for two potatoes and there are four, no extra charge. It’s quite fun to buy from him as I never know what the surprise will be.

The takeaway: If you are lucky, you find a vendor like this.

Do you have examples of when you’ve felt inappropriately charged or when a person has given you a welcome if undeserved price break?

With $67 billion of student loans in default it appears that some of the borrowers aren’t asking the right questions. Janet Lorin wrote: “Almost two-thirds of U.S. student-loan borrowers misunderstood or were surprised by aspects of their loans or the student-loan process, a study shows.”

She continued, in “Student Borrowers Lack Understanding of Loan Terms,” on Bloomberg.com: “About 20 percent of the respondents in an online survey said the amount of their monthly payments was unexpected, according to the study released today by Young Invicibles, a nonprofit group in Washington that represents the interests of 18-to-34 year-olds. The respondents had an average of $76,000 in student debt.”

In addition, borrowers probably didn’t calculate what their potential salary might be in their chosen field, what the job opportunities are and what the added value would be to attend a private school with its $60,000/year tuition, room and board–taking Georgetown as an example–vs. a state or community college where they can live with relatives. Undergraduate tuition at the City University of New York is $5,130.

How do you Feel?

Meanwhile, the Justices of the Supreme Court are looking at the legality of Obamacare. What they are considering is if there are limits to Congressional intervention in people’s lives. Talk show pundits refer to this question as “Can Congress make you eat your broccoli?” Wonder what the answer will be.

Hot Topic

I heard an articulate spokesperson make her case about tanning beds in a radio interview. She wanted the legislation in her state to follow California where it’s against the law for teens under 18 to use them. Emma Jones on Limelife.com reported on these findings by the Skin Cancer Foundation: “…indoor tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors. What’s more, across the US each year, 2.3 million of tanning bed users are teens.”

Jones also reported:  “California had previously banned minors under the age of 14 from using tanning beds, but allowed those between 14 and 18 years of age to use tanning beds with parental consent. Texas has also banned the use of tanning beds for children under 16, but California’s new bill has made them the first state to set a higher age limit.”

When the MC asked this spokesperson: “How many tanning bed businesses are there in the US and how big a business is it?” she had no clue. Within a minute of hanging up, his producer had the answers. The takeaway: When you are a spokesperson, think of the obvious questions you’ll be asked about the topic you’re covering and keep the answers at hand. It’s so easy to do these days!

How Taxing

On his radio show about money, Ric Edelman was trying to make losers feel better about the outcome of the Mega Millions lottery. He told the audience about a winner of $10 million who divided her winnings: 49 percent for herself, 51 percent for her mother and siblings.

She lost a court case in which she fought the tax man, ending up paying 90 percent of her winnings to gift taxes.

Before picking up her winnings, she should have asked a whole bunch of questions. She’d have learned that the maximum amount of money she can gift someone without paying a gift tax is $13 thousand a year. She’d have been better off to have picked up the winnings with family members as a group. Ric was being funny when he said she should have hired an accountant and lawyer even before buying the winning ticket.

Have you landed in a spot because you didn’t ask the right question or weren’t prepared with the answers?

On the Gallop Healthways’ Well Being Index website Jeffrey M. Jones wrote “U.S. Financial Worries Rival Those of 1992,” on January 25. He noted that “Americans’ worries about maintaining their standard of living (51%), or being able to pay medical bills (43%) or losing their job (34%) in the next 12 months are among the highest Gallup has measured in the past 20 years, on par with the levels seen in 1991 and 1992.”

Worry about medical bills is 5 percent less today than it was 10 years ago, though many of the people I know [of all ages] were not polled. One friend’s co-pay for essential medicine just jumped 800 percent. Another who’d had heart bypass surgery called for a checkup and learned that his longtime doctor no longer takes his insurance, nor does one of mine. She requires cash or a check on the spot–no credit cards.

How many seniors opt out of taking their medicine when they reach the Medicare donut hole? Last year the insurance [they pay for] covered drugs-with a co-pay–up to $2840. Then, in the donut hole, the senior pays 100 percent of the cost up to $4,550, after which insurance kicks in for the full amount, minus 5 percent. And what if they can’t spare $4,550?

Robert Lowes wrote in “Medicare ‘Doughnut Hole’ Can Undermine Medication Adherence,” on MedScape Today News “between 11% and 14% of Part D beneficiaries reach the coverage gap each year and receive no subsidy, according to the authors of the study.” There are over 22 million people enrolled in that program.

It’s normal to feel anxious when unforeseen bills crop up for basic medical, shelter or educational reasons which happens increasingly in turbulent economic times. Your head feels above water when wham, a surprise wave looms.

Turning a stiff upper lip into a smile gets increasingly harder. I know admirable people who juggle and work things out regardless of financial haircuts and bad health news followed by exorbitantly expensive solutions. What tips can you share to deal or distract yourself so worries don’t further affect your wellbeing?

We attended a magnificent New Years Eve party with a wonderful group of people who gathered at the country home of friends handsomely dressed for the holidays both inside and out. Our hosts shared two stories that illustrate drastic differences between the care of animals and people.

I’ll start with John’s recent adventure to determine the cause for pain that has laid him low for weeks. During a recent visit to a specialist, the doctor noted that all tests came back negative and he told John to return in several months. Frustrated and wondering how he was supposed to work and live feeling as ill as he still did, [weeks of antibiotics hadn't done the trick], John asked, “Nothing showed on the sonogram either?”

The doctor said, “sonogram?” and scuttled out of the room returning with Xrays that clearly showed his kidneys and three large stones. The stones weren’t going anywhere, said the doctor, who planned surgery to remove them in the New Year. He sounded surprised when he learned from John’s primary doctor that one of the stones had decided to move out on Christmas Eve. [The pain involved in this exit is said to be equal to childbirth.]

Almost simultaneously, John and Bob found the perfect white kitten to join their family and to become their black cat’s sister. Before they could take her home from PETCO, that helps shelters find families for pets, they had to fill out a long form about themselves and agreed to be interviewed by the kitten’s human foster mother/rescuer. [By the way: January 15 and 16 is a National Pet Adoption weekend at some stores.]

Hoping to move the process along, John told the PETCO associate that they had a city and country home, both were employed, had shared their lives with Spooky [the cat] for umpteen years and so forth. The only information that drew any positive reaction was that they had paid thousands of dollars to save Spooky who, as a result of complicated surgery and intensive care, lived an additional eight healthy years. Nevertheless before they’d let John take home the diminutive furry friend, he and Bob would still have to be interviewed and approved by the kitten’s volunteer foster mother–no exceptions.

I’ve been a pet owner for years and I’m impressed that animals aren’t handed out to people helter skelter. But something’s wrong here. How do we beg for human care that’s at least as good as how we treat our pets?

Just how much empathy and compassion should a doctor feel and exhibit? I’m of two minds.

Dr. Sally Satel, who wrote “Physician, Humanize Thyself” in The Wall Street Journal, spoke of the White Coat Ceremony for medical students that she claimed Dr. Arnold P. Gold of the Columbia University College of Physicians and Surgeons popularized. The symbolism of the ceremony, according to the Columbia University chaplain, is for doctors to consider their coats “cloaks of compassion.” Medical schools all over the country now conduct these ceremonies.

And I’m all for it. Having witnessed a top-rated specialist [according to a yearly listing in New York Magazine] treat my husband, who was suffering and weak, with less compassion than a plumber would feel for a pipe, I question the man’s reason for becoming a doctor. We see misfits in all sorts of professions, which is no excuse, but this fellow was all sorts of things he didn’t have to be: Rude, offhanded and wrong to the extreme in his approach to a diagnosis. Turned out my husband did have something in this person’s specialty, generated by a nasty tick bite, causing two+ months high fever and eventually the inability to get out of bed. [Husband is fine now.] A person like this doctor wouldn’t understand the significance of this or any other kind of compassion-related ceremony.

On the other hand, when confronted with horrendous disfigurement and frailty or facing a tricky operation with scalpel in hand, a doctor whose empathy makes him fall apart isn’t of much help, either. Referring to “respectful attentiveness and a genuine commitment to a patient’s welfare” Dr. Satel wrote: “It happens not in the classroom, of course, but ideally on the wards and in clinics under the watchful mentorship of seasoned physicians.” Maybe the nasty doctor spent all his time in the classroom.

Dr. Satel points to government intrusion, at junctures in recent history, as the cause for lack of compassion. As doctors are increasingly robbed of options by insurance companies and/or time–because of paperwork required by government regulation in combination with the numbers of patients they must treat in order to meet budgets and satisfy what Medicare will pay for-they can’t squeeze in anything else, much less compassion. [Medicaid seems to have an unlimited bank account and my advice is if you get really sick, sell everything and go on Medicaid, but I digress].

Satel concludes: “Juggling the timeless injunction to all doctors-be a mensch-with concepts like ‘Medicare metrics’ and ‘standardization’ (the new watchwords in health reform) will make it even harder for the newly coated students to become the kind of doctors that they themselves would like to have. An induction ritual acknowledging as much wouldn’t hurt.”

Wouldn’t a compassionate person still be compassionate under any circumstances? Is it the patient’s fault that a doctor must see 30 patients in the time she/he used to see eight to 10 or that the doctor has a pound of paperwork to fill out after every visit?

What can the public do about changing this increasingly unreasonable turn of events?