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3 Steps to Make the Most of your Doctor Visits

 Preparing your questions ahead of time makes a big difference. There have been numerous studies in the past few years focused on physician-patient interactions. Physicians continue to be under increasing pressure to move through their patient load as expeditiously as possible. This is true with our primary care doctor as well as with the specialists we frequently need to see.  As a result of this time crunch, we often leave our physician appointments with the sense that many of our concerns were not addressed because the doctor did not have sufficient time for us.
What can we do, as the patient, to facilitate a more effective interaction with our various physicians?
The answer to this question may vary and depend upon a number of variables, including: the type of physician with whom we have an appointment; our familiarity with the doctor's patterns;  and our comfort level with the physician-patient interaction. The more we know about ourselves, the more effective our physicians are in diagnosing our ailments.
1. Prepare for our visit ahead of time.
When we think about our healthcare interactions, we often assume that we don't have to prepare for our doctor visits.  However, we need to recognize the limitations on our doctors time.  We have so much trust in our highly skilled physicians that we think they'll figure it out. Curus' Chief Medical Officer, Dr. Robert Kelman, tells us that frequently the best diagnostic tool at his disposal is a complete history and physical, with the patient's full cooperation. We often prepare more for a visit to the service department of our car dealer then we do for the visit with our physician. 
2. Make a prioritized list of our concerns. 
We sometimes put our physicians on such a high pedestal that we fear the warmth of an interaction with the doctor, such as engaging the doctor and quickly acknowledging the time constraints and pressure that the doctor may be under.  In many of the studies about physician-patient interaction, researchers have found that physicians would reach conclusions at the earliest part of the exam and begin to evaluate treatment based on the set of suppositions they had upon entering the exam room. In preparation for our appointment, we should think about those concerns we have which are of the highest priority, raise those concerns first, and defer those concerns that are least bothersome to the end of the visit, even if it might mean they will not be addressed.  If we prioritize our concerns, with the most important information first, we give the physician data points that will enhance the diagnostic process.
3. Bring someone along.
While privacy is a concern, we also must be aware of our own limitations in understanding or remembering all of details after we leave the office.   Accountability is necessary for follow-through, particularly as we age and become senior citizens or have too much on our plate.  Bringing a close relative or friend with us to a medical exam is advantageous as it allows us to have someone else help us to remember, understand and implement our physician's suggestions.

Like most things in life, the more prepared we are, the more likely the outcome will be to our satisfaction.



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Filed Under: healthcare quality, patient satisfaction, concierge healthcare, family medical history, preventive healthcare

The Healthcare Conundrum

Over recent decades, healthcare has been at the forefront of the political agenda in the United States. Each of the two major parties have suggested that they have the solution to bringing down costs and improving the quality of care. Yet, they only debate the cost of healthcare delivery and never address the issue of quality. This is because we can quantify the cost of care, but we have a hodgepodge of metrics to try and determine quality.


The recipients of healthcare are the ones who are impacted daily by this quality confusion.  As the debate continues about who should pay for care, there continues to be a limited focus on the delivery of care. An article in the Wall Street Journal, in early December 2019, entitled “Treating Disease is No Substitute for Caring for the Ill”, focuses our attention on the real healthcare puzzle. The author of this article is Dr. Arthur Kleinman, a professor of medical anthropology and psychiatry at Harvard Medical School.  His expressed perspective is that "…the American healthcare system focuses overwhelmingly on curing acute problems. It needs to do far more to provide ongoing support for patients with chronic maladies." The author is speaking with passion and compassion as both a highly skilled professional and also as the caregiver of his wife who was suffering with Alzheimer's disease. Dr. Kleinman goes on to say, "Through my work as a psychiatrist, medical anthropologist and teacher, I was fairly familiar with the workings of our healthcare system, but not until I became one of the estimated 50 million Americans acting as a family caregiver did I understand the tragic inadequacies of America's system of providing care for the chronically ill.” 



Dr. Kleinman continues, “The USA, in effect, has two health systems. One addresses disease [the science of what makes us sick] and the other addresses illness [the human experience of being sick]. Disease demands treatment, while illness calls out for care.” Our healthcare system has become expert in the intense treatment modalities required to treat disease, as defined by Dr. Kleinman.  In a great many situations, disease is treated as an inpatient event where all of the technology, telemetry and staff skill-sets are focused on gaining control of the disease. Yet, treatment of illness that is in the chronic state is predominantly not a hospital-based experience. The burden of care for a chronically ill patient falls to the patient's support system, whether it be a mental or physical illness. Patients and their families are sent off with a series of "treatment plans" that are to serve as a roadmap for the ongoing care of the chronically ill. In many instances, the patients are being sent home with tubes still protruding from their bodies, due to the reimbursement formulas for specific disease states.  The lay caregiver has limited instructions on how to care for the patient. When the health insurers, principally Medicare, begin to wonder why there are so many rapid readmissions of discharge patients, the answer may be in the failure of the average person to understand that the transition from disease to illness presupposes an ongoing burden on the patient’s personal support system. 

As a patient moves from the disease to illness state, the pressure on the patient’s support system dramatically increases. In the disease state, when a patient is hospitalized, the patient’s family and internal support system have the resources of a highly skilled hospital team to rely upon. Once discharged, however, the entire external support system falls away and the burden becomes solely that of the patient and family, in many situations.


The mental stress placed on the family, particularly the caregivers, has been the forgotten byproduct of our present delivery-of-care model. This emotional stress, which can be defined as profound mental fatigue, takes a tremendous toll on the patient and the caregivers. I am sure that each of us reading this article can think of a family member or a friend who has sacrificed both physical and mental health to the care of a loved one. In the illness state, as defined by Dr. Kleinman, the process is ongoing 7-24-365.


While our elected leadership in Washington continues to debate insurance solutions in healthcare, we in the private sector are focused on how best to handle the urgency of a disease diagnosis with the ongoing pressures of chronic illnesses. The American healthcare system has been amazingly successful in turning many terminal diseases into long-term chronic illnesses. We now need to deal with the need for education, support networks and processes to manage these illnesses over long periods of time.


We at Curus have built a healthcare solutions company that personally guides our members and their caregivers through both the disease and the long-term chronic illness stages, once the disease is under control.  In the disease state, we navigate to the best alternative to deal with the acute issue. While in the illness state, we incorporate both ongoing physical care with mental health solutions, as needed.


In summary, technology diagnoses disease and Curus manages illness.  Curus is your assurance policy to make sure that everything is done correctly, safely and in a timely manner.  Curus fills in the healthcare gaps for our members through a comprehensive, flexible and personalized system of managing both the crisis (disease) and the chronic (illness) phases for our members.  The differentiator for Curus is in the “HOW”.


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Filed Under: Health Management, healthcare quality, concierge healthcare

Avoiding Allergens with Intentional Eating.

Part of large menu by fast-food booth at a street fair-1We live very fast-paced lives these days and the idea that the family sits around the dinner table every night to discuss the day and experience a home-cooked meal is no longer integral to our lives. Those of us who have children of school age are constantly moving them from activity to activity, whether to a dance or sporting events.  Thus, the evening meal has become an ordeal of what can we eat and how fast can we finish our food.  While this change in our lifestyle can be explored sociologically to study the impact it's having on the family, our focus today is only on the ever-increasing notice that food allergies are increasing in both children and adults. When we ate at the kitchen table as families, we knew all of the ingredients of the food we were eating. Today, that is no longer the case.
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The Impact of Marketing Medical Malpractice

In every major metropolitan area within the United States,  you will find the names of leading medical malpractice attorneys, on TV and billboards, alerting you to their availability.  I sometimes wonder if TV and radio stations would face imminent bankruptcy if the advertising revenue from plaintiffs' attorneys and politicians was restricted on the airwaves?  As a licensed attorney for many decades, I can remember when these massive advertising campaigns by lawyers were considered illegal by the respective state bar associations.  However, as time has moved forward, we have achieved this excessive commercialization of medical malpractice. 

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Filed Under: Insider, doctor shortages, healthcare quality, patient satisfaction, changes in healthcare

Decision Fatigue in Healthcare

I once read an article that one of my colleagues left on my desk entitled "2017 Healthcare in Crisis, Needs a Revolution" by Dr. Bill Bysinger, PhD. The opening sentence of this articles states "Having been involved in healthcare since 1980, I continue to be frustrated by the lack of real change or improvement in the industry". In addition, we are confronted every day with news about what our political leaders are contemplating doing in regards to repeal and replacement of the Affordable Care Act (Obamacare). For those of us who spend most of our waking hours involved in the process of healthcare, this is truly a confusing time. Which way will our federal government go? How will it affect our healthcare concerns? Hopefully, the decisions that are made will be in the best interest of the American people and our healthcare.

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Filed Under: doctor shortages, healthcare quality, patient satisfaction, changes in healthcare