The Importance of Earnest Service

In a holiday card a friend mentioned that she suffered from a condition I wasn’t familiar with. So I looked it up on Google, but I did so reluctantly. I figured that my SPAM file would soon be filled with remedies for the disease and that commercials about them would appear every time I opened Facebook, CVS or Amazon.

In The New York Times Metropolitan section Charles Ornstein wrote “Dying in the E.R. and on TV,” about a family shocked to learn that their father/husband’s last minutes on earth in an ER appeared on “NY Med.” His wife happened upon the program during a sleepless night about a year after her husband’s death. He’d been run over and doctors were shown trying to save him. They couldn’t.

Nobody got his or the family’s permission to film him nor were they aware that a film crew was in the ER. Even though the health department concluded that the hospital “had violated” the patient’s “rights and indeed, its own privacy policy” regulators “did not impose any sanctions on the hospital,” wrote Ornstein.

He continued, “Federal health officials are still reviewing whether NewYork-Presbyterian was obliged to get permission” from the patient “or his family before allowing a TV crew to film him.” The hospital’s lawyers argued in State Supreme Court that you need permission to share information after a person has been examined/treated but that the film was shot before. An appellate panel dismissed the case. The conduct “‘was not so extreme and outrageous’ to justify a claim of intentional infliction of emotional distress,’ the judges wrote.”

The hospital also claimed that they didn’t identify the patient and nobody would know who he was. However a woman who knew the family called the patient’s wife and asked if she’d seen the program as she’d recognized her husband on the show. The wife and children said that they were traumatized.

The family wants the case to go in front of a jury as they feel that their peers would agree that “a wrong was done.” At the moment apparently there is no case. The dead man’s wife said that if there wasn’t a law to prevent such filming there should be one and she plans to make it her business to get one.

Would you want to be photographed in the E.R. without permission while out of it or subject a family member to the same, regardless of outcome of the treatment? Do you feel this instance was a breach of privacy? Do you think that the judges, who wrote that there was no “intentional infliction of emotional distress,” might say the same of anyone who has injured someone in an accident that clearly they did not mean to happen? Wouldn’t such a precedent remove the potential of millions of lawsuits in any number of instances?

I keep hearing on newscasts and in quotes by doctors and politicians how we shouldn’t panic about the ebola virus, that you can only catch it if you come in direct contact with an infected person’s fluids; that if you share the air of an elevator or plane with a sick person, you won’t catch it and that this or that city is ready to isolate and harness any case that crops up.

One of the doctors pointed out that only one person has died of ebola in this country in comparison to 20,000 who die each year of flu. [I checked the Center for Disease Control website to confirm this figure. It can't track a statistic as states are not required to report deaths from flu of people older than 18.]

The problem is how often have public figures told us not to worry when it turned out we should? Christine Todd Whitman, former New Jersey Governor and administrator of the Environmental Protection Agency told workers at the World Trade Center pile that they were in no danger of getting sick. Since then many have succumbed to cancer. Perhaps she was instructed to say this. Not only did it trash her political career, it was one more nail in the coffin of the public forced to question the people they are supposed to believe.

Congressional committees have let corporate executives get away with product safety claims for years while the facts proved otherwise: Smoking is one glaring example.

What about the crumbling infrastructure? Governor Christie cancelled a train tunnel project between New Jersey and New York called “Access to the Region’s Core” which would build a new tunnel. The existing one was built between 1904 and 1908, according to Wikipedia. True, “they knew how to build things in those days.” But is counting on an essential 106 year old structure realistic just because the Governor says it is? Especially if you suspect the real reason is that he doesn’t want to spend the money under his watch?

Do you accept what you hear and go about your business or are you more skeptical?

Iris Bell described the impact of her cataract operation in an enlightened way. She is a graphic artist which is apparent in her descriptions of color.

If you know someone faced with such a procedure and is hesitating, it would be worth passing along her narrative. She noted: “It’s as if the very stuff the world is made of has changed.”

This is what else she wrote:

I had the cataract in my right eye removed and replaced with a lens that gave me 20/20 vision. The result: I see colors accurately and have perfect distance and night vision.

People who’ve had similar procedures told me the effect was dramatic. I knew the brownish cast of my cataract had made it hard for me to see the difference between my blue and green bracelets unless I looked at them under a strong light. Over the last year I also noticed I had trouble seeing outside after dark.

Throughout this period of change I wondered what the real colors of some things were and how bright or intense colors and whites might be. After the surgery my husband, Paul, and I took the bus home. For 10 blocks I looked out the window at the familiar shop fronts, checking back and forth between my eyes, one as yet uncorrected. The effect was as if I took on and off sunglasses with brown lenses.

When I got home I was overwhelmed by the feeling of joy the colors gave me. It was exciting to look at my things with my corrected eye. I’d bought many items for their special colors because they have a major effect on my emotions.

With my uncorrected eye my periwinkle items looked grayish blue. With my corrected eye I saw the color I loved. I’ve always thought of periwinkle as the last blue before a color become lilac. The cataract hid the essential subtle reddish tint which turns a blue into periwinkle.

In subsequent days I’ve been shocked by rediscovering the true colors of things I’d lived with for years: A kitchen sponge is vibrant lilac; a sparkle-covered fingernail file an elegant purple not what I’d previously thought of as an unremarkable pinkish purple and a ream of paper and bath towel are the color of the newest spring grass with sunlight shining through…not the dull hue of older grass. And I’d forgotten how bright green bok choy at my favorite Chinese restaurant looked.

Dyes on different fabrics are too subtle for my uncorrected eye to register and the intense purple underside of a vine I’ve grown under plant lights for years is back for the right eye.  The gas flame in the stove startled me,  transformed from dull aqua to a brilliant spectrum blue with a fine edging of purple.    

There was a loss: My corrected eye sees the russet and golden grapes in a photo hanging in the kitchen as bland pastels, no longer the richer colors tricked by the cataract.

The most startling effect of the surgery lasted only a few minutes some 10 hours afterward. We were in our supermarket just before twilight: The clear glass front window looked as if it had been replaced by blue stained glass. We’d spent time walking in the grocery, with its warm lighting. I was now looking out at the cool light of early evening. It had been years since I’d recognized either of these types of light. My brain didn’t know what to do with them. By the time we were on the sidewalk I was getting proper information from my brain, there was nothing special to see, no bright blue light. Only if I was planning to paint a watercolor would I study the quality of the light and notice it had a blue cast to it. Non-artists usually don’t notice the color of light.

One of the reasons I wanted the operation was that my night vision was  so poor that I was uncomfortable walking outside after dark, even on our block. People would suddenly appear walking toward me. I’d only see them when they were several feet away.  The day after my surgery it was hard to believe this block had always been this brightly lit between the street lights, decorative lights on buildings and from entryways.

This new world of lovely colors and light sources is a pleasure to experience. I’m not ready to have my other eye corrected quite yet, I’m having such fun comparing the two worlds I see with my two eyes.

Since she wrote this, Iris said she plans to have the other cataract removed in a few months.

Not once did she mention discomfort or pain. Isn’t it remarkable that she took a bus home after an operation that once kept people in the hospital for a week? Have you undergone a procedure–or known someone who has–that has similarly so dramatically [and effortlessly] transformed a life?

My husband, Homer Byington, wrote this post a few hours after he returned from having his appendix removed.

As Jeanne well knows, and suffers through patiently– usually — I am one of the world’s most notorious pessimists,  a doubting Thomas, a Luddite, a true Cassandra and chronic complainer who is always telling anyone who cares to listen that life was better 50 years ago.

Like so many others, I have been knocking the way medicine functions in this country for years and even more so recently as a consequence of the inauspicious startup of Obama care. Yes, all sorts of things are wrong with the system, and much needs fixing. But people like me tend to forget how lucky we have been to have had the great doctors and nurses we’ve had and great treatment we’ve received at various hospitals both on an inpatient and an outpatient basis. Today was a good reminder.

This morning, just a few hours ago, I was in an operating room at Lenox Hill Hospital under the knife of a surgeon, Dr. Jeffrey Aronoff, [Photo at right] who was trying to resolve what he described as an “enigma.” I’ll skip writing about medical stuff because I’ll just get it wrong, and it is quite complicated, but both he and I fully expected my hospital stay to be considerably longer than just a few hours. Dr. Aronoff and my wife and I go back more than 20 years when, as low man on the totem pole of a team of five doctors doing colonoscopies, he first treated us. Then, when he went out on his own, we followed. Why?

A month or two ago, to resolve my problems, Dr. Aronoff suggested a routine preliminary colonoscopy. Then the question arose whether he, a busy surgeon working 12 plus hours a day, or another doctor should do the job. He told me bluntly, “I’m doing it. I’ve always done yours.” That is the nature of the man. In this cynical age, how could anyone resist such a doctor’s loyalty to his patients?

The O.R. on the 10th floor of Lenox Hill Hospital is a busy place at 6:00 a.m. Milling about are staff and patients of every shade of color, sex, age, accent and language, but it is an orderly and well-paced chaos managed by experienced professionals, a scene a little like what one might see in a well-danced modern ballet. It sure didn’t hurt that the two R.N.s who interviewed me first were old timers who fondly remembered our family doctor cardiologist Dr. Paul Bienstock. Each of them then spontaneously volunteered that I was lucky to have Dr. Aronoff as my surgeon and said that he was the best. (It did occur to me that they said that about their doctors to all the patients they interviewed, but in this case, I think they both meant it, and their positive words bucked up my already considerable confidence about what I was about to have happen to me.) Then the doctor stopped by. We chatted, and he listened and did not later forget something enigma-related that I had suggested to him.

A few minutes later I was on the operating table, and there he was again with a bunch of other people cheerfully doing various complicated looking things. The mood was calm and positive. An hour and half later when I came to there was Dr. Aronoff smiling. “You can go home. It turned out to be your appendix after all. It was pretty inflamed and I took it out. Everything else looked O.K.” We talked a minute and then he went off to the waiting room to update Jeanne.

The recovery room fascinated me, especially the interplay between all those different people with different problems and different duties. Like the prep area it was an ordered chaos, but all the professionals, busy as they were, took the time to be solicitous to their patients. There may have been the usual friction between staff members that occurs in hospitals and nursing homes, or, for that matter, at any large institution, but it certainly wasn’t evident here. Somebody brought me a cup of ice chips for my throat; somebody else, a cup of tea and a plate of crackers. Even one or two doctors I didn’t know who were coming to see other patients smiled or said, “Hi.” Or, “How are you doing?” Jeanne showed up an allotted five minutes to make sure I was alive, and then Dr. Aronoff visited yet again to check up on me.

Next I was moved to the main floor recovery room, Jeanne in tow, where one terrific nurse gave us common sense, understandable answers to all sorts of questions like when I could take a shower and what I should eat. We were not rushed but as soon as I felt ready, off we went home just before 2:00 p.m.

Looking back on the experience a few hours later, I thought to myself that this is how medical care should be delivered. Maybe I received special attention, but I don’t think so. Everyone else around me seemed to be being treated the way I was.

At least ten different professionals dealt with me and they all acted like they cared about what they were doing and about me. There is no way for me really to know whether Dr. Aronoff is the miracle worker I think he is, but his results do speak for themselves. Here I am at home, never in pain– and hardly at all during the day –and painkiller free, writing a blog post just after having had two procedures performed on me, my inflamed appendix removed, and I am damn near 80. Now that’s great medicine! Yes, we haven’t doped out all of the enigma that brought me to the O.R. in the first place, but we may have that answer also by the time pathology gets through with my appendix.

The question is if Lenox Hill and Dr. Aronoff were able to deliver like they did for me in the middle of a healthcare crisis, shouldn’t we trust them, and the many like them, to come up with a sensible, efficient way to keep us healthy instead of the Washington politicians who seem to be at the beck and call of Big Business, Big Insurance, Big Labor and their battalions of highly competent, self-serving lobbyists?

Friends and relatives post all matter of information on Facebook and Twitter thinking it will never adversely bounce back at them. I hope it never does.

Think of the contradictions. On the one hand we’re horrified that the government is spying on us—with good reason. Yet many hand scofflaws buckets of ammunition by  posting photos of family members [kidnapping?], sharing intimate information [will anyone be home when you’re at a funeral?] and political views [potentially losing clients or a job] without a thought of the future.

We purchase security systems and ask a neighbor to empty the mailbox so would-be robbers bypass the house as we simultaneously post photos of ourselves in front of the Eiffel Tower and the family waving from a gondola in Venice.

Art Caplan, PhD.

The head of the Division of Medical Ethics at NYU Langone Medical Center and contributor to NBC News, Art Caplan, Ph.D., told of a young man who was removed from a liver transplant list because he posted a transplant-damming photo of himself on Twitter. In “Is your doctor spying on your tweets? Social media raises medical privacy questions” he wrote: “There he was for all the world to see, surrounded by booze, hoisting a cold one in a picture he himself had posted,” wrote Caplan. The photo was seen by a person on the transplants team who sent it to a psychiatrist who was about to approve him for the list.

Caplan noted that no liver transplant team would accept a person who was drinking alcohol.  Result of this photo, according to Caplan, “in all likelihood a death sentence.”

With his ethics hat on Caplan asked: “Should this doctor or any health care professional have checked the transplant candidate out on social media?” He continued: “But even if ethical restrictions existed, it is probably fair to assume that a lot of doctors and those who work with them, many who grew up with Facebook and Twitter and the like, will be tempted to do so.

“Take for example, you say your back really hurts and you are disabled — let’s take a peek at your Facebook page to see if you manage to hit the tennis court, the jogging path or the golf links. Promise to be abstinent due to your venereal disease—what are you doing on dating sites on Craigslist? Swear to stay away from fatty foods and high calorie treats—why did your doctor just read a review by you of barbecue joints on Yelp or Zagat?”

He continued: “I think the transplant candidate had the right to know that he tweeted himself right out of a shot at a liver transplant. And you need to realize that information you put up on social media sites may wind up being used by your doctor, hospital, psychologist, school nurse or drug counselor.”

He concluded what we know—the Internet is the Wild West, without rules. “If they [doctor and patient] are going to continue to trust one another then we need to recalculate existing notions of medical privacy and confidentiality to fit an Internet world where there is not much of either.”

Do you think that it’s fair game for a doctor to research a patient’s social media sites to check up on them? Do you believe that there will ever be rules impacting social media? What’s the point of lying to your doctor anyway?

Photo: cdc.gov

As I awoke early on a recent Saturday I heard newsman Joe Bartlett on his WOR 710 radio program interview Dr. Blake Cady, professor emeritus of surgery at Harvard Medical School and Mass General. The doctor shared highlights of a study about mammograms and his findings about the age women should begin having them.

His conclusion—they should start at 40–represents a 10 year difference from what experts previously touted. While earlier screening doesn’t prevent cancer it has a dramatic impact on dying from it—far fewer women do.

I wasn’t near paper and pen to take notes while listening so I checked out some of the details of Dr. Cady’s conclusions on healthday.com. Reporter Kathleen Doheny wrote: “New breast cancer research reveals a significant death rate among women under 50 who forgo regular mammograms and casts doubt on recent screening guidelines from a U.S. panel of experts.”

Doheny reported that more than 70 percent of breast cancer deaths in the study of 600 women happened in mostly younger unscreened women—those who never had a mammogram or had one more than two years before diagnosis.

She wrote: “In 2009, the U.S. Preventive Services Task Force, a panel of experts that makes recommendations about health practices, said women aged 50 to 74 should get screening mammograms every two years.”

The task force describes itself as “…an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).”

Doheny continued: “Women under 50, the panel said, should talk to their doctors and decide whether to be screened based on potential benefits, such as early detection, and harms, including over-treatment and anxiety caused by false-positive results.”

The specter of insurance wasn’t mentioned either during the radio interview or in the healthday.com article but I fear that five mammograms over 10 years multiplied by women in the 40 to 50 demographic– and who will pay for them–[once again] enters the picture at the cost of lives.

Aren’t patients better off being anxious about a false-positive than not having the test and having a cancer go undetected and untreated? The task force appears legitimate so I hesitate to sling arrows yet I wonder if insurance considerations are lurking in the background. Do you schedule regular health screenings according to your doctors’ or public health recommendations?

I first wrote a Full Measure post in 2010, a topic very much related to the Service of Inflation series launched the year before and I risk little in predicting there will be more to come. An eye doctor appointment, results of New York city and state student tests and a newspaper article inspired today’s post.

Insurance strikes another black eye hitting doctors and patients where it hurts

Before seeing my doctor and his staff for my annual eye exam the receptionist gave me an agreement–a first. I would check one box if I was willing to pay $75 to be tested for refraction; another if not.

In a nutshell the form explained that most insurance companies will no longer pay for a doctor to test for eyeglasses.

This was the wording: “Refraction is the testing done with lenses to determine and correct the errors in the eye causing problems with both distance and near vision. This information is required to prescribe glasses. Insurance carriers do not consider refraction a medical procedure. Medicare and most commercial carriers will pay for covered benefits only. When you receive a service that is not a covered benefit, patients are responsible to pay for it.”

But guess what? Staff told me that if you go to some optometrists–they mentioned a rip-off eyeglass store chain I’ve been warned by friends and colleagues to avoid–the insurance might pay for the test.

It’s easy to forget the precise differences between the training and expertise of an ophthalmologist and optometrist but it’s pertinent so I checked out webmd.com: “Ophthalmologists are physicians. They went to medical school. After school, they had a one-year internship and a residency of three or more years. Ophthalmologists offer …..Vision services, including eye exams; Medical eye care — for conditions such as glaucoma, iritis, and chemical burns; Surgical eye care — for trauma, crossed eyes, cataracts, glaucoma, and other problems; Diagnosis and treatment of eye conditions related to other diseases, such as diabetes or arthritis; Plastic surgery — for drooping eyelids and smoothing wrinkles.” [I didn't know about wrinkles....hmmmm].

Webmd.com continues: “Optometrists are medical professionals but not physicians. After college, they spent four years in a program and got a degree in optometry. Some optometrists undergo additional clinical training after optometry school. They focus on regular vision care and prescribe eyeglasses and contacts.”

This course doesn’t lead down a healthy road. It means that the physician who chooses to become an ophthalmologist will soon be left only with treating eye disease, severely cutting into his/her income and customer traffic. I also wager that the nations’ eyes will suffer. On the rush to the $500 eyeglass frame counter in the chain, diseases that should be diagnosed and treated/controlled early may be missed. How shortsighted.

Taxing information

New York City spent $25 billion on education, the state $74 billion according to research by WOR 710 NYC radio producer Michael Figliola for the John Gambling Show, yet the results are not equally stratospheric. The state spends more on education than anything else.

Lisa Fleisher wrote in The Wall Street Journal, “Less than 30% of the city’s third- through eighth-graders scored proficient in math and English Language Arts on the new exams, which are an attempt to measure whether students are on track to do higher-level work when they graduate and start their careers.”

Yoav Gonen of The New York Post reported: “The eye-opening passing rates for third- through eighth-graders of just 29.6 percent in math and 26.4 percent in reading reflected the first real measure of how many students are considered to be on the path to success after high school.”

Gonen continued: “Last year, before the exam standards were significantly boosted, 47 percent of city kids passed the reading exams and 60 percent passed math.” In a bulleted list he noted “New York City outperformed the state’s other ‘Big 4′ cities by leaps and bounds. Second-place Yonkers only had 16.4 percent of students pass in reading and 14.5 percent in math.”

What else is there to add?

Nothing to Sneeze At

Desheeting doesn’t relate to making beds, operating sailboats, rain [in sheets] or drinking too much [three sheets to the breeze]. It’s how the tissue and toilet paper industry describes fewer sheets of tissue in a box or roll.

Serena Ng reported in “Toilet-Tissue ‘Desheeting’ Shrinks Rolls, Plumps Margins” that Kimberly-Clark’s Kleenex packages contain 13 percent fewer sheets simultaneously claiming that each one is “bulkier” by 15 percent. Guess they know folks who want bulky tissue instead of lots of it when cold or allergies strike.

While on the subject, here’s some toilet paper trivia brought to us by Kimberly-Clark research via Ng: In five bathroom trips/day, Americans use some 46 sheets of toilet paper and according to Euromonitor International, companies sold $10.6 billion of tissue and toilet paper in the US in 2012.

Mayor Bloomberg, who watches NYC’s waistlines, would approve of some of the additional information in Ng’s article though as a consumer even he might expect the price to reflect less product which I’m certain it doesn’t. “Cereal boxes and bags of chips have in many cases become lighter over the years in what the food industry refers to as taking ‘weight out.’ A regular Snickers bar now weighs 1.86 ounces, down from 2.07 ounces in the past, which Mars says was done to cut calories to 250 per bar. Tropicana Pure Premium orange juice is now sold in 59 ounce bottles, versus 64 ounce cartons prior to 2010.”

I didn’t notice a decrease in my insurance premium to compensate for one less essential covered procedure. Does this new wrinkle smack of lobbyists at work along with insurance greed leaving men and women with limited incomes, their children and another specialty of doctor yet again in a reject pile? Have you examples of paying for and receiving full measure lately or the opposite–which seems to be increasingly in fashion?

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?