Insights

10 Misunderstandings about Health Care

In the on-going and ever fervent debate about health care in America, we want to share what we perceive to be some important misunderstandings Americans have about it. While the Affordable Care Act will allow confusedmore people to have access to health care, there are some important misperceptions out there that will not likely be affected by the new laws and regulations. At Good Medicine, we want our clients to have a better understanding of how things really work-so they can get the best care possible. Here are 10 common misunderstandings we think should be cleared up!

1. Medicare will cover most needs when you reach age 65 including nursing home care: Reality:  You get 100 days of skilled nursing covered by Medicare (that’s 3 months)  that is directly related to an illness for which you have spent 3 nights in a row in the hospital. To receive Skilled Nursing, services such as physical therapy, speech therapy and Occupational Therapy must be needed for Medicare to cover it.  If you require long term help or assistance with your “activities of daily living”, help with “usual care” such as feeding and bathing, these are not covered. The rest of your care comes out of your own pocket. Only 10% of seniors have long-term care insurance. This is the type of insurance that covers a caregiver or an assisted living facility that cares for people when they are no longer able to care for themselves. For more information, visit Medicare.gov

2. Your doctor will know what you want and need when a critical decision about your health arises.  Reality: Your primary care doctor who has known you the longest will not likely be the person treating you when you develop a terminal illness. That will be a cardiologist, an oncologist, a neurologist or an intensivist. Furthermore, few primary care doctors follow their patients in the hospital anymore.  The advent of Hospitalists, doctors who only care for you when you’re in the hospital, make it very likely that you will be cared for by someone who has never met you before when you are critically ill. Finally, the default setting for medicine is treat…but the outcome may not be what you ever intended. Creating an Advanced Directive, Living WIll or Advance Care Plan is essential.  The first step for all 3 is to name a health care surrogate that will speak for you if you are unable to speak for yourself (critical illness, stroke, head injury, dementia). These surrogates should be familiar with your goals in life: what you can live with and what you can live without–and could be asked to make complex decisions about your care based on those goals.

3. The care reccommendations you receive for any given condition are the “standard of care” that is used in US Medicine: Reality: As shown by the Dartmouth Atlas Project, there are wide variations in care practices across the country. All medicine, like politics, is local, and costs are variable. Moreover, the most expensive or aggressive treatments do not always have the best outcomes. When making major decision about your care, it’s best to get second opinions–and it may be worthwhile to leave your geographic region to get one. HMOs will pay for second opinions if you can show there is significant variation of opinion about course of treatment. Spend the time to see more than one specialist-maybe even one outside your area if the decision you are making is important.

4. The internet is a good place to find answers about your health. Reality: The internet is full of unfiltered information and can be an unreliable and frightening place for lay people to find answers. While patient forums and chat rooms have given a lot of patients comfort and support-they can also provide false information: or what my colleague likes to call Oprah Medicine (“I saw someone on Oprah who survived….”) Beware of the perverse incentives on the internet too–sites that look credible and unbiased are often proprietary. On the other hand, it’s ok to ask your doctor about something you read on the internet (and they should not roll their eyes about it). Doctors need to keep tab on what’s out there on the web to be able to discuss things honestly with their patients.

5. Getting an annual physical with recommended screening tests will catch cancer/heart disease early and lengthen my life: Reality: Broadly applied, screening tests (PSA, mammography, colonoscopy and cholesterol testing for example) don’t lengthen life span,  but applied to the right situation, they can have a significant impact.  Look at American Health Research and Quality (ahrq.org) or the US preventative Task Force website and print out the recommended or NOT recommended screening tests for your age group….and bring it to your doctor for discussion. Most screening tests have not been shown to lengthen life for the general population, but if you are at particular risk for a disease ( family history or smoking history, for example), a screening test may be beneficial and potentially extend your life. The age at which screening tests become more beneficial is significant too. You won’t be surprised to learn that the older we get, the more likely we are to have a cancer somewhere. That’s why it is a collaborative decision making process with your doctor. For an extended discussion, see our 31 Flavors Blog Post!

6.  A full genetic profile will lengthen my life: Reality: We aren’t there yet.. The $1000 full genotype is coming to a med center near you–but you likely will be doing researchers a bigger favor than they are doing you. We need people’s genomes to corollate emergence of diseases to certain genes–but do not have much proof that knowing your risk of certain diseases will affect if you get them or not. That knowledge is a good 20 years away (likely) It’s a different story for some cancer treatment and there are more and more examples of cancers that have specific targeted gene therapies that make a difference in survival statistics. However, getting a tumor genetically mapped is not a common offering for the average patient yet.

7. If I have a cardiac arrest and someone with me knows CPR, I have a good chance of survival: CPR was developed for the person who only has coronary artery disease (or drowning victims), but now we apply it broadly to all patients, including those dying of something else. The survival rates are about 7% for witnessed out of hospital and 15% in-hospital CPR. New technologies such as AEDs (Automatic External Defibrillators) and post-arrest hypothermia therapy are improving outcomes–but outcomes are still much worse than “seen on TV” (where one researcher estimated that 67% of those receiving CPR survive!) People don’t consider what the risk may be as well: dying in the hospital, neurologic damage, rib fractures etc. At a certain stage of life, or with a known illness (other than heart disease) people should think hard about their wish to receive CPR.
Here is a link to the most recent data about cardiovascular deaths and CPR.

8. If I find the right doctor, it doesn’t matter what hospital he/she practices in: Reality: A recent study showed that outcomes for heart procedures were much more dependent on the volume of cases done by that particular hospital than the experience of the doctor. Furthermore, different hospitals have different safety profiles and hospital-aquired-infection rates. The California Healthcare Foundation has created Hospital Compare for California Hospitals to give an overall sense of which hospitals do better than others.

9. I can put off enrolling in Medicare Part D because I’m not taking many medicines: Reality: If you do not enroll in Medicare Part D when you are first eligible (age 65), and do not have another drug coverage plan, you will pay a monthly penalty when you do enroll for the rest of your life. They calculate the penalty as 1% of the national average monthly benefit multiplied by the number of months you went without coverage. For those around age 65, be aware of this rule! For more info: Medicare Part D

10. There isn’t much I can do to change how long or well I’ll live: Reality: The drumbeat is getting louder and louder for one thing that can help us all live longer and better, but no one is gong to make money off of it: light-moderate exercise for 20-30 mins a day! That’s all. Watch 23.5 hours on You Tube. It’s the best health education video we know of right now.

-Jennifer Brokaw, MD

References:

1. http://www.kaiserhealthnews.org/features/insuring-your-health/michelle-andrews-on-long-term-care-policies.aspx
2. http://www.ahrq.gov/research/endliferia/endria.htm
3. http://www.dartmouthatlas.org/
4. http://familydoctor.org/familydoctor/en/healthcare-management/self-care/health-information-on-the-web-finding-reliable-information.printerview.all.html
5. http://www.cancer.gov/cancertopics/pdq/screening/overview/patient/pagehttp://www.consumerreports.org/health/conditions-and-treatments/heart-health/heart-test.htm

6. http://healthland.time.com/2012/05/25/why-genetic-tests-dont-help-doctors-predict-your-risk-of-disease/
7.http://www.compassionandsupport.org/index.php/for_professionals/molst_training_center/cpr
8. http://medicalxpress.com/news/2012-05-higher-hospital-volume-important-surgeon.html
9. http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx#LateEnrollmentPenalty

Jennifer Brokaw, MD is the founder of Good Medicine. She has written on health care for The Washington Post and Dartmouth Medicine Magazine. 

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