By Martine G. Brousse
"The Medical Bill Whisperer... and insurance stuff too"
Patient Advocate, Certified Mediator
June 5, 2023
“Medical errors are a serious public health problem and a leading cause of death in the United States”, as widely reported in the media, and by governmental agencies (https://www.ncbi.nlm.nih.gov/books/NBK499956/).
While many errors are caught down the line (for example by a pharmacist catching a counter-indication), too many result in treatment delays, additional costs to insurances and patients, aggravated stress, avoidable side effects, adverse outcomes, complications, prolonged hospitalization or need to care, potential life-long impairment, disability, and in too many cases: death.
Here are some reasons for this breakdown:
· Incomplete assessment of patient’s symptoms & history,
· Rushed office appointments due to excessive physician workload,
· Missed complexity of symptoms,
· Wrong action taken or lack of proper action,
· Improper prescribed treatment, or incorrect medication or treatment administered
· Easy dismissal of patients' complaints,
· Language barrier,
· Test results inaccurately interpreted or ignored,
· Poor access to or ignorance of other medical records,
· Lack of communication or cooperation between treating physicians
· Limited scope of expertise by a physician or substandard medical management
· Staff fatigue, shortage or with poor supervision
· Negligence in meeting expected standards of care
While counting on medical staff and physicians to do their proper diligence, I must argue that patients' involvement is crucial to help reduce errors and minimize consequences. At every step of the way, patients be kept informed by their physician, but also remain alert to and communicative of their own observations. While no process is full proof, patients' participation in their own care and communication with the medical staff are essential.
Here are some recommendations to bring about a more accurate diagnosis and treatment, and ensure more successful outcome.
1. Keep your Med List current and accurate
There are quite a few apps and websites offering templates. Here are 2:
Include any prescribed drug, over the counter medication, vitamin, supplement, herb or OTC remedy you use. Dosage and frequency of use should be included. Indicate the symptoms or conditions they treat, and who prescribed them. Evaluate their usefulness, and length of time used.
Don't forget to list any pharmacy you would like your prescriptions sent though. Your insurance can help you locate a pharmacy "in network" or with preferential savings.
You can also often download a list of prescriptions from your online insurance or Rx portal.
Medicare patients are entitled to a once-a -year “Medication Therapy Management” assessment. Designed to lower costs, reduce the risk of dangerous drug interactions, avoid duplication of prescriptions and therapies, educate patients to benefits, alert them of possible reactions and confirm the effectiveness and need of each treatment, this service should be used by every eligible senior, once a year. A pharmacist will help create an up-to-date personalized medication list, which every one of your treating physicians you should get copied on. You will get detailed information on every prescription and over-the-counter medication: dosage and curative intent, when and how to best take it. Unnecessary, duplicate and ineffective treatments will be pointed out, for your physician to review. One good thing: switching to a new generic version, or stopping an obsolete treatment will save you money too! This is an excellent time for questions, and to make sure you are getting the most appropriate and cost-effective prescriptions. For more info, visit:
2. Keep track of Symptoms & Side Effects
Do give your doctor all the relevant information of your history and symptoms. Before your appointment, prepare a list of every ongoing or new symptom, detailed description and occurrence, and any trigger or means of amelioration.
Throughout treatment, be alert to worsening or acute symptoms, new side effects and improvements. Contact the office for sudden or severe reactions. Your pharmacist and the 24/7 nurses at your insurance can also advise you.
3. Provide records and History
Don’t forget to give the office a list of allergies, important health events, previous diagnoses and treatments, and the names and contact information of any physician you have recently or are currently seeing.
A family history of relevant or serious medical conditions is in order, especially if genetic or affecting several members.
4. Ask Questions
Many errors could be avoided with appropriate and timely questions to your physician. Ask how probable the given diagnosis is. is the prescribed treatment the only/best option or is a less severe/expensive/radical one available?
Ask about side effects, effectiveness and anticipated time frame for a cure.
Understand your responsibilities: what to do, when to return, when to call, what constitutes an emergency. Be aware of diet restrictions, of impact on your daily and professional life, of specific requirements on your part to ensure the best outcome.
Do not rely on a follow-up appointment down the line to indicate a worsening of your condition or the appearance of new problems. If the treatment is not as effective as you were led to understand, report it. Do not miss a scheduled lab or imaging test.
Repeat the doctor's instructions, or write them down so that you leave the office with full recollection and understanding of your involvement.
Communicate any new treatment prescribed by another physician, even if seemingly unrelated.
6. Stay informed
Consult: http://www.nih.gov/ and http://www.nlm.nih.gov/medlineplus/ for up-to-date information on diagnoses, medications, nutrition and other health-related topic. While your physician is always your primary source, his time to educate you may be limited.
7. Be proactive
Set reminders for medications, appointments or to check your health status at regular intervals.
Keep a chart or journal for observation of symptoms and self-administration of prescriptions.
Forward any record from a new medical provider, or older ones that might be important.
Contact the office before any planned intervention, medical or dental, as a drug you take or might be given may provoke negative side effects. Check about any refill several days before you run out. Authorizations, if needed, may take a few days to clear, and your prescription may be in shortage.
I call for lab or test results if the office does not contact me. Last year, a test result did not get to my Dr’s new location. After my call, she got a copy and issue a prescription.
8. Trust your gut feeling...to a point
If your physician is not listening, treats you like body parts rather than a person, does not care about your questions or feelings, or expects you to follow directions without explanations, you may want to consider your options.
Express your need (and right) to disclosure, trust and self-expression. Physicians are often so tied to a busy schedule that their communication skills take the back seat.
You should be heard as your input is invaluable in helping establish a diagnosis, and adhering to the best prescribed treatment.
Getting a second opinion, guaranteed to be covered by your insurance under most policies, is an option to consider.
All every step of the medical process, communication is essential. Nurtured by trust and mutual respect, the relationship between patients and doctors can only be optimum if all parties are equal participants.
Keep involved, keep self-aware and keep communicating.
These will go a long way to avoid costly medical errors.
Martine Brousse, the "medical bill whisperer" is a Patient Advocate and Certified Mediator located in CA and the founder of AdvimedPro, which she started after 20 years as a billing manager for physicians.
(424) 999 4705 - F (424) 226 1330
@ Martine G. Brousse 2023
@ The medical bill whisperer 2023