Demystifying Medicine One Month at a Time

Medical GPS

I’ve been thinking about writing a book called “Medical GPS.”

Tell me if it makes any sense:

There are dozens and dozens of medical self-help books out there, telling us how to eat, how to exercise, how to beat this or that disease.

But what about a primer to the medical system?

How do we learn about doctors and navigating the health care-industrial complex? First, our parents. Later, our own experiences interfacing with the system. Our friends offer us advice. Our neighbors and co-workers tell us their recommendations regarding which doctors and alternative practitioners to see.

Should everyone have a cardiologist? Heart disease is the number one killer in the U.S. and many other places. If you live in Florida and you’re a Medicare patient, you’re likely to see at least three different types of doctors regularly.

My sister hurt her knee jogging. Does she need to see an orthopedist or would her primary care doctor be the right place to start?

My uncle’s PCP referred him to a urologist for some prostate symptoms he was having. What should he be prepared for when seeing the urologist? What questions should he be ready to ask?

We all have a sense of what doctors do, and why we go to see them. Yet some medical consumers do their own “shopping,” picking and choosing from among different specialties according to what body part ails them.

Other patients are very happy to be referred by a primary care doctor to specialists, but often without adequate communication as to what to expect from the specialty visit or why they’re being referred in the first place.

Medical GPS will help tell you where you’re situated, and give you some examples of how to think through your interaction with the health care system–whether you’re young or old, sick or well.

It’d be a consumer’s guide to doctors and hospitals, without going into specific details or reputations of doctors or health care institutions. If there was sufficient demand, of course, we could publish follow up volumes that are based on geography (e.g. “I live in the ¬†Southwest–where should I seek cardiac care?”), age or gender.

Tell me what you think. Is this a good idea or a repetitious and superfluous one? How would you improve it or make it meaningful?

10 Comments

  1. John Ballard

    Your idea is not only good but is central to the “medical home” model which I had never heard of prior to the healthcare reform discussion. As I understand the concept, upon selecting a provider the patient’s whole medical picture is integrated into a plan insuring a level of coordination not typical of the “referral” model (by which final outcomes are passed along a string of providers). The idea derived from pediatric and family medicine in the late Sixties and seems now under consideration for general practice.

    Except for a couple of kidney stones, an annoying wrist disorder and elevated blood pressure I have been blessed with overall good health and disease resistance. Medical care for my family has been more important than for me, so the old “family doctor” concept prevailed. When my wife and I graduated to Medicare last year we looked for a provider with an array of services that fit that model, but thus far the place we selected is still doing business with the referral model, so I’m still looking.

    Another term I have heard lately is “accountable care organization” which may be some variant of “medical home.” Have you any opinion about “medical homes”? As a consumer I would value a guidebook to finding such providers.

    • glasshospital

      I hadn’t heard “accountable care organization” before (ACO replacing the vilified HMO?). Though the idea at the core is good, it’s a TERRIBLE name, and furthers the idea (and general perception) that medical care has gone from an art/science endeavor to just another commercial enterprise.

      I know that this IS the reality, and it’d probably be better if we all accepted it, but I still cling to romantic notions of doctors as healers and being situated ‘above the fray’ of daily commerce.

      As for the medical home model: you’re absolutely right that Pediatrics and Family Medicine have long promulgated this idea. Internists (the American College of Physicians “ACP,” the largest single specialty medical group at >100 thousand members) have belatedly joined organized medicine’s call to validate, support, and implement this model.

      I think there’s a decent chance that health care reform and the subsidies for adopting EHRs will incentivize groups to share information and promote this model.

      But it’s only a decent (in my mind <50%) chance. There are all kinds of unintended consequences playing out (HIPAA for one, Medicare's SGR is another) of past legislation that will continue to be a hindrance to further medical system integration.

      I foresee the evolution of BIG vs small medical care. BIG will be the large institutions that have leverage and 'scalability' to pilot, study, and adopt change and push the boundaries of care delivery.

      The small guys will survive, because of the American ideal of the yeoman farmer, er doctor, and people will always want to patronize the folks where somebody knows your name. But the economics of it suggest to me otherwise.

      Medical Homes are a good idea for a future post (and I hope further dialogue!)-thanks.

      -GH (Dr. John)

  2. John Graf

    I don’t think it’s repetitious but certainly useful. Could be an enormous job to develop and maintain. A job for webmd or some other authorative, unbiased entity, not to say that webmd is unbiased.

  3. Alex @ Happiness in this World

    John,
    You already know I think this is an awesome idea for a book that readers would find intriguing and concretely valuable. I LOVE the title. Get writing!

    Alex

  4. Joe Marlin

    Good idea. Some articles in the various “lay” health care magazines do some of this (Consumer’s Guide to Health” from Consumer’s Union, and the Harvard Men’s Health Magazine, but its scattered, not in one place, and not always so easy to remember where you once read about it. But as you know many people are not so rational about their health, don’t follow health advice, are in denial about problems, etc. But I think it would be a worthwhile effort if no one has done this. But if you do it will the people who most people would think most need to read it be the least likely to buy, borrow or steal the book?

  5. Emily B.

    What a great idea!

    Would you also include information about how consumers should incorporate insurance into their decision-making? To use your example– your sister might need to make a different choice about whether to start with her PCP or an orthopedist, depending on whether her insurance carrier is an HMO, PPO, etc. It would be tough to incorporate this information without making the book too unwieldy… but I think it would be tremendously valuable to consumers to include it.

    • glasshospital

      I hadn’t thought of that. That really is a good idea. We could include an overview chapter or a ‘primer chapter’ on insurances that addresses these concerns, so as to make it more ‘wieldy.’

      Thanks, Emily!

  6. E.G.

    Good idea. As a patient, it took me many years to realize that the doctors didn’t know everything. Interestingly (and horribly), I went through many years of hell because of undiagnosed Thyroid Disease. Visits to my PCP with vague symptoms yielded a blood test showing TSH levels “within normal.” These PCP’s didn’t do anything wrong particularly.

    I had other other symptoms I didn’t think to report – (depression – emotional outbursts – sleeping too much) – I’m not a doctor and I didn’t think these were “symptoms.” (I thought I was stressed form work, a bad person, immature). All I knew was that my hair was thinning. No other questions were asked of me – are you sleeping too little? too much? are you depressed? are you experiencing emotional outbursts? Are your eyebrows thinning? (I’m female and penciled in where my eyebrows were thinning – so you wouldn’t know it just looking at me). Funny little half-eyebrows can be a symptom of thyroid disease.

    I wonder now, why, with my history of mantle radiation (age 20, lymphoma) that not one of my physicians (including my oncologist) taught me about my thyroid and its importance in health, and that I was at a significantly higher risk of developing thyroid disease. I might have had a better life – maybe not – whose to say – but years of untreated thyroid disease can’t have helped. Something seemingly minor has repercussions over an entire life.

    I know more now – but only because I did the research.

    I had to get ovarian cancer to have my thyroid disease diagnoses. Baseline PET scan post-chemo revealed it. Even then, I returned to my PCP for further diagnosis and treatment. Just the blood test – no exam, no questions – doctor didn’t even think he needed to see me or talk to me.

    The old TSH came back “normal.” The nurse was actually hanging up the phone, believing that that one test concluded the matter when I yelled (because the receiver was halfway to its cradle) “WAIT! What about the PET scan?” “Oh, do you want to see an endocrinologist?” I did not know that there was a specialist for Thyroids – if I had known I would have asked to see one early on in the process.

    Long way to get to YES – PUBLISH A CONSUMER GUIDE TO MEDICAL SPECIALISTS – help us understand that there are physicians who specialize in certain body parts – it allows us to ask our PCP’s about them and whether a referral is warranted. It opens up the discussion.

    This was a big deal – 10 years of my life gone – because a few key questions were not asked. I can’t trust the current crop of PCP’s because of this. There were 4 different PCP’s over 10 years (same practice – they kept leaving – should have been a clue) so, perhaps that was the reason. No continuity of care even within the same practice.

    I’m going specialist every time now – no messing around with PCP’s. Too much hubris. And now, the one I sort of see now – doesn’t even have a nurse. She has a medical assistant and an attitude. Really? I’m supposed to get medical advice from someone with a high school diploma or GED & 2 months training in a trade school? That’s who’s gate-keeping for my doctor?

  7. Shalon Rabal

    I like your post.

  8. Elizabeth

    It would have to be done in collaboration with someone people already trust, like Consumer’s Union. I would be instantly suspicious of an all-in-one application like that. I would think, “Who’s paying for it?” and probably assume, unless it cost thousands, that it was sponsored by a large insurance company trying to trick me into buying a different policy.

    I know it sounds cynical, but my experience with the medical system is purely one of commercial dissatisfaction. I had my children at home and bring them to the pediatrician for their shots but shy away from anything else. I personally haven’t been to the doctor in years because I believe I will not be listened to anyway (see the person above about thyroid–I have similar symptoms, also cannot keep on weight, history of thyroid problems in the family, the doctor I saw incidentally to get birth control cut me off in the middle of the sentence and told me my levels were normal… although they were taken when I was pregnant!).

    So it would really have to be connected to someone outside the fray, and sponsored in a very transparent way. If you could manage that, I’d consider buying one.

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