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Frequently asked questions to PatientProtect.com
Here some questions frequently asked (FAQ, Q&A), by patients, to PatientProtect.com. To obtain the answer to a question, select the question in the list below.
Iwould like to present my case to PatientProtect.com. What do I have to write?
Can one really do nothing more against my pain?
Which are the doping drugs and other prohibited substances?
How to choose a good physician?
How to choose a good hospital?
Do I have to really undergo this operation?
What information must I gather for an operation?
Why do I have to be hospitalized?
Why did I catch this infection during my hospital stay?
What can I do to protect myself again hospital infections?
How to keep the doctor/physician away?
Shouldn't a specialist doctor be consulted?
Can I ask to consult the doctor specialist of my choice?
I am allergic. Does the risk from the anaesthesia that I must have, increase?
Wasn't it my doctor's job, to find what went wrong with me?
Why didn't my doctor devote me more time?
Was normal this complication which occurred?
Am I a victim of medical accident or negligence?
How can I help other patients?
Do I have to ask for a forensic examination, and by who?
Which questions do I have to ask to the expert?
How to contact the extrajuducial forensic examination office of the Swiss Medical Association?
Isn't my hospital invoice exaggerated?
How much do my drugs really cost?
What questions about a new prescribed medicine should I consider to ask my physician?
Can I, or must I, change my sicknesse and accident insurance?
What are the difference between a health insurance and a health care plan?
What are the questions to ask an HMO?
Am I in rather good health, to face this operation and this anaesthesia? Which are the risks?
What do I have to do to decrease my risk factors?
What are my rights as a patient?
How to protect my right to privacy with my medical record?
When should I call my physician?
I would like to present my case to PatientProtect.com. What do I have to write?
Hereafter the information needed to submit case/condition to PatientProtect.com.
Patient
details:
Age:
Sex:
Your personal medical history or your anamnesis::
Your current condition/diseases/diagnostics/prognosis:
Your treatment and your drugs/medicines:
The information which you received from your doctors
Description of the effectiveness of your treatment or follow up:
Description
of the event which has occurred:
(adverse, unfavourable or undesirable event, side effect, complication,
critical incident, accident, failure, near miss, mishap...)
Doctors, nurses and other people involved:
Description
of the outcome:
(in particular lesion/damage/injury that you incurredand after effects)
Your dissatisfaction and the facts that you reproach, and who you blame for:
Your interpretation of the facts:
Other notes:
The
questions you want answered by PatientProtect.com:
Steps already taken:
When I bring to the consultation printouts downloaded from Internet my physician react with a mix of irritation, hostility, and rejection.
A new syndrome is spreading fast amongst the patients, known as Internet Printout Syndrome (IPS). Faced with this new syndrome described by Doctor Harry Brown, the reaction of most doctors will be, as you noticed: irritation (why having to spend time dealing with theses printouts), hostility (the patient has questioned what the doctor has said), rejection (every thing on the Net is rubbish) and fear (the patient knows more than the doctor). This attitude has the potential to undermine the doctor-patient relationship and drive patients and their families to seek alternative help or self-manage their medical problem.
The trick, therefore, is to present your information and research in a way that the doctor will find least threatening and most useful!
Do
Remember that you are going to see your doctor to ask for his professional advice, not to tell him how to treat you!
Prepare a list of written questions based on your research. Make a copy for your doctor.
Prioritize your appointment objectives. A typical consultation lasts less than 10 minutes. Make sure you ask the most important questions first.
If you suspect or know that your doctor is highly sceptical about the Internet, try introducing information you have found with phrases like "this information is from a non-profit/government-sponsored organization..."
Send copies of the most important Web pages/articles that you want to discuss with your doctor, in advance of the consultation, with a brief explanatory note. Highlight the most relevant sections, so your doctor can quickly assess this information.
Critically appraise the information you find before mailing it to your doctor.
Know your sources (authorship and information).
Be assertive and polite.
Look for an other doctor skilled in people management, psychology and this new trend to patient education via the Internet.
Don't
Assume everything you find on the Internet is true.
Go to the consultation armed with printouts.
Send your doctor everything you can find on the Internet about your condition.
Tell the doctors their job.
Appear too knowledgeable.
Be agressive.
From: Presenting research to the doctor - some "do's" and "don'ts" by Doctors Robert Kiley and Elisabeth Graham (The Patient's Internet Handbook. RSM Press. London. 2002).
A recent article in the Medical Journal of Australia, (P.J.Pemberton and J.Goldblatt. MJA. 169:594-595. 1998), welcomed the fact that the Internet provides the opportunity for the patient to take more responsability before their own health care and urges all the doctors "to embrace the concept of the informed patient and to use their web surfing skills". Your doctor may do well to cooperate with the patients surfers in changing the concept of whose responsability it is to own the information.
Advice from doctors Pemberton and Goldblatt to their colleagues: dealing with the Internet-literate patients and their families.
Do
Try to react in positive manner to information from the Internet.
Warn about the variability in the quality and reliability of material from the Internet.
Warn about your time constraints regarding information overload.
Develop a strategy for dealing with Internet information from patients (eg. get patient to e-mail a sumary before visiting).
Accept patient and family contributions as part of the management team.
Accept that they may have valid information that you have not come across.
Don't
Be dismissive or paternalistic.
Be derogatory of comments made by others on the Internet.
Refuse to accept Internet material.
Try to one-up your patients and their families regarding the information.
Break normal rules of patients confidentiality via the Internet.
Can one really do nothing more against my pain?
In spite of great progress last years, pain is regularly dealt with in an inadequate way. Reasons are multiple. The patient has the right to require of his physician that his pain is being evaluated and treated. Any specialist in anesthesiology can help you personally, or even in particular cases, recommend a physician or a service to you. You can find names and addresses of Swiss doctors specialists in anesthesiology under: www.SGAR-SSAR.ch. Following websites deal with pain: www.interpain.ch. and www.douleur.ch.
Which are the doping drugs and other prohibited substances?
The list is extremely long. You can obtain this information on following websites: www.dopinginfo.ch and www.swissolympic.ch.
Will know that there are not only drugs and substances prohibited or subjected to certain restrictions like stimulants, anabolic steroids, opiates, diuretica, hormones (peptides and glucocorticosteroids), alcohol, local anaesthetics, betablockers, canabinoides etc... but also prohibited methods such blood doping, other handling of blood and its derivatives etc...
How to choose a good physician?
See the following website page: too choose your doctor. How to choose a good dentist? Consult what appears in the excellent site Quackwatch (www.quackwatch.com) of Doctor Stephen Barrett, M.D. Board Chairman, Quackwatch, Inc, at following page: www.quackwatch.com/04ConsumerEducation/dentalchoose.html.
How to choose a good hospital?
See the following website page: to choose your hospital.
Do I have to really undergo this operation?
Except vital emergency, one never should be pressed, or be made pressed to be operated, or subject oneselve to an invasive or not investigation. After having obtained all the due information of the doctor proposing the intervention or the investigation, one should not hesitate to ask for a second opinion. See also the following website page: to deal with your doctor.
According to ethics, physician must prohibit himself, in diagnostic investigations and surgical operations for example, which he practises, as in therapeutic ones, that he prescribes, making run an unjustified risk to the patient. Throughout disease, doctor must take account of the patient personality in his explanations, and take care of his comprehension. If patient is out of state to express his will, doctor cannot intervene without the patient close relations being warned and informed, except in an exceptional situation, such reanimation for vital emergency or impossibility.
You can of course ask question, after having briefly exposed your case. Mailto patientprotect@bluewin.ch.
What information must I gather for an operation?
See the website www.medical-accident.co.uk.
You may wish to ask questions like:
Have I been fully prepared for this operation?
Have all the options available to me been fully explained and understood?
What are the risks associated with this operation?
What are the risks of this operation?
How do I investigate these risks?
How do I assess theses risks?
What is the chance of any of these risks actually occurring?
How do I successfully manage any risks?
Can I make an informed decision?
What is my surgeon's and my anaesthesist's track record (how many, how successful etc) and how does it compare with others?
Has the anesthetist been fully briefed in advance about my medical condition?
Who will actually operate - consultant / junior doctor?
How long will he / she have been on duty when they operate (NHS + Private Hours)?
Also the anesthetist? How many hours has he / she been on duty in the past 7 days (NHS + Private Hours)?
Also the anesthetist? How long since he / she has had a break?
Also the anesthetist? Has he / she got the resources they need to do a good job?
Have my views been listened to?
Does the consent form reflect my views?
Do things run smoothly from what you have seen and heard since you made contact with the hospital?
What post-operative care and drugs will I need?
How frequent are post-operative infections in this procedure?
Who is the person taking overall responsibility for me?
There are very few true severe emergencies. Any doctor must weigh in conscience advantages and risks of each therapeutic decision, according to the particular case of each patient considered individually, and his therapeutic step must be conditioned by the only patient interest.
To answer you, PatientProtect.com needs more details on your case and your affection. Mailto patienprotect@bluewin.ch.
Why do I have to be hospitalized?
It is true that very often, there does not need to make the expenses and to run the risks to be hospitalized. Any doctor must give, to the patient whom he examines, looks well after, treated or advises, information honest, clear and adapted on his state, alternatives therapeutic and diagnostic investigations and care that he proposes, or on the need or not for a hospitalization.
An unnecessary hospital stay can be your most costly medical expenditure. Some patients are insistent on admittance, under the misguided perception that hospitalization will provide the most effective care. Before you enter a hospital, ask these basic questions:
Why am I going?
What will be done?
How long will I need to stay?
What results will it produce?
What will happen if I don't go?
Can I be effectively treated as an out-patient?
How much will it cost?
To answer you, PatientProtect.com needs more details on reasons for which you were hospitalized and on reasons for which you remained hospitalized. Mailto patientprotect@bluewin.ch.
Why did I catch this infection during my hospital stay?
Can be quite simply because you would have to leave hospital much more quickly. Can be that you had the bad luck to choose a hospital where nosocomial infections are frequent.
PatientProtect.com needs details to answer you. Mailto: patientprotect@bluewin
If you need a medical expert in hospital hygiene and nosocomial infection, we recommend to you to contact Professor Georges Ducel, expert at WHO and chairman Foundation HYGIE. 15-17, rue du Tunnel. CH-1227 Carouge/Genève Tel: 022/343.52.26. Fax: 022/342.26.54.
Many hospital infections can be avoided by using simple, inexpensive measures. Strict adherence to cleanhand policies alone can prevent the deaths of thousands of patients.
Dirty hospitals kill many patients a year. An investigation by The Chicago Tribune, based on federal and state records, court cases and internal hospitals files from 5810 institutions belonging to American Hospital Association, (the numbers include only serious infections that directly caused or played a major role in patient deaths), estimated 103.000 deaths linked to hospital infections in 2000.
The US Centers for Diseases Control (CDC) extrapolating from a recent study of records from 300 hospitals and other sources estimated 90.000 deaths that year. Nearly three-quarters of the deadly infections, or about 75.000,were preventable, the results of unsanitary facilities, germ-laden instruments, unwashed hands and other lapses.
Deaths linked to hospitals germs represent the fourth leading cause of mortality among Americans, behind major heart diseases, cancer and lungs ailments. Each year, these infections kill more people than motor-vehicle accidents,fires and drowning combined.
What can I do to protect myself again hospital infections?
Hospital infections can occur after many medical procedures, particularly if you are having surgery. But there are things you can do to help ward off a nasty bug.
Do not hesitate to remind,doctors, nurses and technicians to wash their handsbefore working with you.
Wash your own hands carefully after handling any type of body fluids, and especially after going to the bathroom.
If you have an intravenous catheter, make sure your nurses keeps the skin around the dressing clean and dry, and ask the doctor to replaces the dressing if it works loose or gets wet. If you have a drainage tube, let your nurses know if it becomes loose or dislodged.Since catheters, intravenous and drainage tubes are all entrypoints for germs, discuss with your doctor when they can be safely removed (the sooner the better).
If you have a dressing on a wound, tell your nurses and your doctor if it gets wet or loose.
If you have diabetes, discuss with your doctor the best way to control your blood sugar before, during and after your hospital stay. High blood glucose increases the risk of infection significantly.
Losing weight, if you are overweight, will reduce the infection risk after surgery.
If you smoke, consider a smoking cessation program. This will reduce the chance of developing a lung infection while in the hospital and may improve your healing abilities after surgery.
Ask wellwishers not to visit yourself if they feel ill.
Enlist the help of friends and relatives to active members of your health care team.
To check out a local hospital or clinic, read their anual report and look for hospital infections statistics.
From: M. J. Berens. Death beds. Dirty hospitals kill 75.000 patients a year. Unnecessarly. Reader's Digest. February 2003.
Why as soon as my children start again the school, they catch a cold and a sore throat/tonsillitis after the other?
Because the teachers make the coffee-cigarette pause during the recreations of the children and do not make so that the children continuously do not put the fingers in their nose, and above all wash their hands, in particular before each class beginning. The contamination is done above all by the hands. The door handles of a school class are dirtier and contagious that the toilet bowls!
Research will soon make it possible to correct this defect of education. Indeed, thanks to the researchers of Massachusetts Institute of Technology of Boston (Jorg Tiller), one day close, the door handles etc... could be covered with a permanent bug-proof disinfectant coating (hexyl-PVC) which kills up to 99 % of the dangerous bacterias like E. Coli. This coating generates a charge which destroys a bacteria's cell walls and membranes. Thus handles of doors, toilet bowls, telephones, subway and escalators straps, etc... short all that is public, could be upgraded from questionable to convenient. These daily objects would be made suitable whereas today their hygiene is more and more questionnable. (Fiona Maazel in GQ).
How to keep the doctor/physician away?
Curing disease is only part of what makes modern medicine so remarkable, and may be not the most important part! Triumphing over disease is one thing, but it's far better never get sick at all. The new science of preventive medicine draws on breakthroughs in our understanding of how the body works. Scientists have uncovered secrets about how exercise and nutrition can stave off everything from heart disease to aging. The 21st century turn out to be the era in which the cures became irrelevant.
A vaccine alert immune system specialized cells that an incoming agent could be a problem, and allow the immune system to respond more quickly and effectively than if it had never seen the bug before. The vaccine move up the immunologic-response chain of events so the final, acquired response kicks in faster. Soon inoculations may protect us from killers like AIDS, Ebola, heart disease and even cancer.
Couldn't these investigations have been made as a day patient (ambulatory), i.e. without me to hospitalize?
Except if your general state is very bad and requires a hospitalization, it is exceptional, that a diagnostic investigation whatever it is, requires a hospitalization.
Freedom to choose his doctor is a personal patient's right, insured or not, to have oneself and his body at one's disposal. It is an inalienable basic right guaranteed by Humans Rights European Convention . If you are conscious of inalienability of this right and if you dare to assert it and to defend it vis-a-vis any politico-financial power of health insurances ideologial collectivist lobby, you have right to choose your physician.
Avoid to sign health insurance contract which limits your patient rights, or to make you to hospitalize for example in a public hospital which limits physician choice to some doctors which obtained, one wonders well why, privileges. Read again attentively your insurance contract and inform you before making you hospitalize. In the Swiss Medical Directory, the good hospitals usually specify: " free doctor choice", or " freier Arztwahl ", ou encore "libre choix du médecin".
Yes, except if you signed an insurance contract which limits your patient rights on this precise point. PatientProtect.com can only encourage you to supplement your basic insurance, at least by a complementary insurance for hospitalization in all swiss hospitals.
Shouldn't a specialist doctor be consulted?
All depends on what you have.You are most likely to see a specialist when your primary care physician wants to confirm a diagnosis or get a second opinion. In most cases, it is unwise to self-refer to a specialist as the visit may be unnecessary. On the other hand, the right to self referral is something you want to preserve.
A specialist is a doctor with two or more years of additional specialty training called a residency. Many take more years of training called a fellowship in a specific area of their specialty. After taking the extra training, many doctors will become board-certified by passing a rigorous examination administered by a national board of professionals in that specialty field. They are designated as Diplomates. Most board-certified doctors become Fellows of their medical specialty societies after meeting the full requirements of that society. For example, FACS after a doctor's name means he is a Fellow of the American College of Surgeons. Because of their additional training and expertise, fees for specialists are usually higher than a general practitioner.
To answer you, any doctor at least needs precise details on your affection, that is to say your personal anamnesis in particular. Mailto:patientprotect@bluewin.ch.
Can I ask to consult the doctor specialist of my choice?
Yes, except if you concluded an insurance which limits your rights, as it is the case more and more often, unfortunately.
I am allergic. Does the risk from the anaesthesia that I must have, increase?
Particular allergies can represent an anesthesiologic risk, especially if you did not inform your anaesthesiologist of it, and that this physician could not anticipate and prepare himself with this possibility.
Wasn't it my doctor's job, to find what went wrong with me?
Perhaps well, but it is also necessary to hold account that medicine is not an exact science by far, and that uncertainties are quite existing. To answer you, PatientProtect.com needs details on your case and its evolution. Mailto: patientprotect@bluewin.ch.
Why didn't my doctor devote me more time?
There are several possibilities with that. Either you clearly did not express your requirements. See the following website page: to deal with your doctor.
Either your insurance, health network or HMO, oblige your doctor employed by this insurance or organization to make less possible expenses for his employer.
Or your doctor is, say, unreliable.
To give you a valid reason, one needs more details. Do not hesitate to contact us: mailto patientprotect@bluewin.ch.
That went wrong... The physicians affirm that it was inevitable. They speak about inherent risks. Do I have to believe them?
You do not have any obligation to believe them. It is true that there are inherent risks in every dealt with and treatment in medicine. Certain complications happen, in spite of a practice of medicine according to code's of practice, and are inevitable.
There is one thing your physician cannot give: a guaranteed result. Since people invented automobiles, it is fair to expect them to give warranties. But nobody is smart enough to design a human body, and spare parts are unavailable. All medical decisions are based on probability. Despite tremendous developments, our understanding of the body is still very limited, and many diseases and problems are beyond our power to cure. The only guarantee your physician can make is that he will treat you with respect, and use the full extent of his training and wisdom in providing your care.
To give you an answer, PatientProtect.com needs much more information. Make contact and communicate at least to us what went wrong and in which situation: mailto patientprotect@bluewin.ch.
Was normal this complication which occurred?
Certain complications are inherent, inevitable and are not the consequence of fault or negligence. They are thus normal. Others are due to doctor negligence or fault, or due to another health professional. Other complications, most in fact, are due to the system, represented for example by a hospital with his latent defects. To give you a first answer, it is at least necessary to know, which was the complication, who dealt with you and why, and how the known complication occurred. Do not hesitate to contact us by e-mail at our address. Mailto: patientprotect@bluewin.ch.
Am I a victim of medical accident or negligence?
See the following website page: victim of a medical error.
Which are the precise reasons which do you suspect, or believe? Mailto: patientprotect@bluewin.ch.
How can I help other patients?
You can help websites like ours and www.medical-accident.co.uk to help other patients by:
Telling other people about these websites.
E-mailing other people about these websites.
Making these sites one of your 'Favourites'.
Sharing information with us, which we can share with others.
Running Patient Education seminars.
Mailing others with patient education sheets / newsletters.
Lobbying newspapers with information to support patients.
Leaving patient education messages on message boards.
What can, and will you do, to help others? We want to hear from you! Mailto:patientprotect@bluewin.ch
Please share any ideas you have to support patients!
Do I have to ask for a forensic examination, and by who?
If you are convinced, or the answer to one or more above questions is affirmative, you have the right to ask for an expertise. Before asking for such examination, PatientProtect.com advises you, to avoid engaging you with large expenses, to ask a rapid evaluation of your case and your chances to be right finally.
See the following website page: victim of a medical error.
Do not hesitate to contact us. Mailto: patientprotect@bluewin.ch.
In 1990, Dr. D. Schwander published an article entitled " Recommendations to experts and witnesses " (Hôpital Suisse, 5: 39-44, 1990). A table summarizes there the good expert profile.
Which questions do I have to ask to the expert?
The questions are numerous. In general they are connected with: Quality of medical file? Quality and titles of physicians and nurses implied? Patient information and fulled enlighted assent? Patient care and treatment? Patient health before event? Current health, therefore after event? Appreciation of patient evaluation before treatment? Care and treatment appreciation? Did the responsible physician practise like would have a good doctor, before, during and after the incident? Serious fault or negligence occur? Is fault or negligence at the origin of the complication or the attack to health? How are divided responsibilities between doctor, hospital direction, nurse, etc...? Has the medico-legal expert other remarks to make in connection with this case?
How to contact the extrajuducial forensic examination office of the Swiss Medical Association?
This office, for french Switzerland, is in Lausanne. It is placed under the responsibility of Mrs Brigitte Mottet (Tel.: 021 652 16 74, fax: 021 652 33 85). Can I trust this extrajudicial forensic examination office expert? If the forensic examination corresponds to standards, for example, those described in Dr. D.Schwander article, quoted above (Hôpital Suisse, 5: 39-44, 1990), and with this office rules, yes.
Let evaluate these fees by your insurance medical adviser. If you are not satisfied by his answer, send fees invoice, insurance medical adviser, and a calendar of services and visits which you had, to PatientProtect.com. Mailto: patientprotect@bluewin.ch.
Isn't my hospital invoice exaggerated?
Let evaluate this invoice by your insurance medical adviser. If you are not satisfied by his answer, send this invoice, insurance medical adviser evaluation, precise details on your insurance type, and a calendar of the days of hospitalization, services and physicians visits which you had, to PatientProtect.com. Mailto: patientprotect@bluewin.ch.
How much do my drugs really cost?
In Switzerlan consult Interpharma website: www.sl-preise.ch. It is there possible to consult the production price of the drugs and the selling price to the public, as fixed by OFAS.
I am under chronic medicamentous treatment (for heart etc...). Which are the ways to reduce my medicines costs, without harming the effectiveness of my treatment and risking my health?
1. Take only the medicines you need really and with the just effective dosage. Drugs are not always necessary. Belief in recovery always is.
2. If you take four medicines together or more, ask your doctor to control the interactions between these four medicines or more. Perhaps that you take already one of too much which poisons you.
3. Say clearly your doctor how much you spend monthly for all your medicines. Ask him if he cannot propose a therapeutic alternative cheaper to you.
4. Cut your pills in half. The price you pay for many drugs which you buy in pharmacy depends above all on the number of pills prescribed in package not the dosage. If your doctor says your medication can be cut in half, (or to take twice less often a dosage twice stronger, what is the same), ask for pills the doble the dose and split them in two.
For example a year's worth of 350 pills with 20 mg daily of a antihypertensor (i.e. a medicine to treat a too high blood pressure), could costs 1000 CHF to purchase in the pharmacy, whereas 175 pills with 40 mg of the same medicine may cost you only 500 CHF. Cut 40 mg pills in half and you could save 500 CHF.
5. Look into "me too" medicines. Seek a generic medicine or brand-name option, which is often much less expensive. But do not compromise quality for savings. There is generic and generic.
6. Find out about freebies. Ask your doctor if he does not have free samples to give you to begin your treatment. Pharmaceutical companies provide doctors each years millions free medicines samples for their patients. So before taking a prescription to the pharmacy, ask your doctor if part of it can be "filled" on the spot for free with medical samples.
7. Go shopping. Go round the pharmacies. It is the same as for tires salesmen. There are pharmacists more expensive than others.
8. Buy large package and ask for even a reduction of quantity or good customer.
9. Directly pay your drugs with your pharmacist then make refund them to you by your insurance and especially do not ask the pharmacist or his assistant for advice. You will thus avoid paying a tax of advice and a tax of opening a file. Why ask the deliveryman or the salesman for advice after having taken with your doctor the medical decision to take such or such medicine?
10. Buy your vitamins etc... in a supermarket like Walmart.
11. As far as possible, buy your medicines abroad (by comparing the price, dosage, number of pills etc... and manufacturer).
12. Require your political representatives that your national authorities permits parallel sales networks and imports of medicines and liberalizes much more the market of the medicines which one can buy without medical prescription (OTC or " over the counter).
What questions about a new prescribed medicine should I consider to ask my physician?
Will what has been prescribed cure my medical problem?
Mask my medical problem?
Help my medical problem?
Create new medical problems?
What side effects are there to what has been prescribed?
How will I be able to differentiate between the effects of my disease and the side effects of the medication?
Will what has been prescribed have toxic effect the longer I take the medication?
What are the interactions between the new prescribed medicine and my other medicines?
Can I, or must I, change my sicknesse and accident insurance?
If you are not satisfied with your health insurance services, made quote by concurrent insurances to you.
Currently inSwitzerland, Dr. D. Schwander would hesitate between the EGK-health insurance in Laufon (www.egk.ch) and ACCORDA in Freiburg (www.accorda.com). ACCORDA is apparently the only insurance in Switzerland which publishes his accounts! If you buy an action of this insurance, you will profit from a reduction on your premiums and you will have a voice to control its operation and its accounts. It is a weighty argument there.
What are the difference between a health insurance and a health care plan?
There is a difference between true insurance and a health care plan, even though the terms are frequently used interchangeably. The best way to understand medical insurance is to think of your auto insurance. You pay a premium for coverage with a deductible. If your car sustains major damage, you pay the deductible portion of the repair bill, and the insurer pays the rest. You don't expect your insurance company to pay for routine maintenance and minor damage, such as carwash, oil changes, or replacing wiper blades, nor would you expect or want the insurance company to actually make the repairs. In contrast, health care plans act as both the insurance company and the mechanic. Also called managed care, these prepaid plans combine medical insurance with a medical delivery system. They provide both the coverage and the care. There are different types, of which HMOs are generally the most restrictive. Increasingly, such plans are attempting to get out of the business of insurance, which is the business of taking risk, and passing the risk along to doctors, hospitals, and patients.
Health Maintenance Organizations (HMOs): HMOs provide "comprehensive" medical care for prepaid monthly premiums. Services are provided by a specific group of medical professionals who receive a fixed, monthly payment for each subscriber, regardless of the services given or not given. And subscribers are limited to the physicians, hospitals, and other providers approved by the HMO. Here's how that works: you choose a primary care physician from the list provided by the HMO. That doctor then becomes your "gatekeeper"' and decides whether to recommend a test or procedure, to refer you to a specialist, or to admit you to the hospital. At first glance, HMOs may seem like a way to save money. But in many cases, you are exchanging small savings for quality and choice. Here are some things to consider: HMOs make more money by giving you less care. They get your payment in advance, then try to hold on to it by rationing or delaying care. You have no guarantee that you can see the doctor of your choice. HMOs may prevent you from beeing refer onto the doctor or specialist of your choice (called a consultant) who is not in their network. Your doctor may be dropped or "deselected"' from the plan for spending too much on your care. And many HMOs don't have to give a reason. Many doctors are rewarded with an end-of-the year bonus if they cut back on care given. Referrals to specialists and lab studies come out of this bonus. Many impose gag rules which prevent your doctor from telling you the truth about the plan. Or they may be prevented from telling you about procedures which may be available but not covered by the plan. Total cost of the plan may be hidden. A committee, not your doctor acting alone, usually must approve your medical treatment. That committee may consist of an accountant, an HMO manager, and one doctor. And that committee may meet only once a month.
What are the questions to ask an HMO?
Do primary care gatekeeper doctors get more money if they deny referrals to specialists (consultants), testing centers or hospitals?Please describe the existing incentives.
What percentage of the monthly HMO premium actually goes to the doctors?
What percentage of the monthly HMO premium actually goes to the hospital?
What percentage of your primary care doctor's practice is HMO?
What percentage of your primary care doctor's income comes from the specific HMO?
How much money per month is actually received by your primary care doctor from your premium?
Does the HMO contract with the doctor allow the HMO to terminate the contract if the HMO believes the doctor is overutilizing services?
Does your plan have an "experimental/investigative"' exclusion? Do you understand it? Can they explain it?
What are the most frequently requested procedures presently being denied by your HMO on the basis of "experimental/investigative" or "not medically necessary" exclusions?
Do the primary care physician (gatekeeper) receive bonuses at the end of the year from the HMO if they limit referrals to hospitals or specialists (consultants)?
Am I in rather good health, to face this operation and this anaesthesia? Which are the risks?
You are right well to worry you that. For operation, speak to your surgeon. For anaesthesia, speak to your doctor anaesthetist. You can also consult Dr. D. Schwander. He is a doctor specialist in anesthesiology. Mailto: patientprotect@bluewin.ch.
If you are not satisfied with your surgeon answers, or your doctor anaesthetist etc... do not hesitate to ask a second opinion to a second doctor specialist of your choice.
What do I have to do to decrease my risk factors?
Take care of your invaluable and single small body. See the following website page: take care of you.
As a patient, confronted with the need for being anaesthetized and operated, as an anaesthetist doctor, Dr. Schwander, what do you expect from your doctor anaesthetist and his anaesthetist nurses?
I would wish that:
My doctor anaesthetist and his nurses are competent.
My doctor anaesthetist and his nurses are vigilant.
My doctor anaesthetist has great conscientiousness and probity.
My doctor anaesthetist and nurses are equipped with good work instruments.
My doctor anaesthetist and his nurses are thrifty.
My doctor anaesthetist informs me correctly so that I would be really co-decision maker.
My doctor anaesthesist has no other master than I.
I learned that, according to swiss legal doctrine, doctors are under obligation to inform patients in a two-step procedure. For my last operation, my surgeon inform me, even on three occasions. But the consultant anaesthetist just saw me once, the day before the operation. I could not even ask him questions. Is this correct?
You are right entirely. In October 1994 already, in a three pages letter, the Swiss Medical Association (FMH) recalled doctors of what consisted their duty to inform patients.
In november 1997, the Swiss Society of Anesthesiology and Reanimation (SSAR)(www.SGAR-SSAR.ch) sent to doctors anaesthetists recommendations concerning information and patient full enlightened assent. In these recommendations it is well specified:
That the patient must be informed of provisions and measures planned for his anaesthesia, as of risks which can result from this.
That the patient must give his agreement.
That he must thus be co-decision maker.
That relevant information must be made in a two-step procedure .
Thus only, the patient has sufficient time to understand, reflect, get information, choose among the alternatives, and finally decide.
For the information first step, SSAR Commission on professional recommendations worked out a model of information document intended for patients, whom would owe you, and whom I would also like, as a patient, to receive and read quietly.
According to SSAR, such a note must contain:
Short comment on anaesthesia techniques and their own risks.
More detailed and more specific information on provisions and measures envisaged, like on postoperative phase.
Codes of conduct to be followed by the patient before and after anaesthesia.
A remark drawing patient attention to the possibility which is offered to him to raise questions which he wishes with the doctor anaesthetist, during the talk which will follow.
The information second step takes place at patient pre-anaesthetic visit time by doctor anaesthetist. The principal points which must be approached during information are:
Description of anaesthetic act and post-anaesthetic phase.
Risks and benefits.
Discomfort and antalgy.
Alternatives and failures.
Composition of anaesthesia team.
Special measures.
Questions.
Enlightened assent (consent to treatment).
At the end of this pre-anaesthetic visit, the doctor anaesthetist must consign in writing, place, date and hour, contents of information as well as of the patient assent.
Example of information document regarding anaesthesia
This document is intended to inform you on anaesthesia, its advantages and risks. We ask you to read it attentively, in order to be able to give your assent to the anaesthetic procedure, which will be proposed to you by the doctor anaesthetist. You will be able to also ask this doctor questions about this procedure. For the questions relating to the medical act which justifies this anaesthesia, your surgeon is at your disposal to answer your questions.
What is anaesthesia? Anaesthesia is a whole of techniques which allows a surgical, obstetrical or other medical (endoscopy, radiology, etc) act realization, while removing or attenuating pain. There are two great amaesthesia types: general anaesthesia and loco-regional anaesthesia.
General anaesthesia is a state comparable with sleep, produced by drugs intravenous injection and/or ananaesthetic vapor breathing, using a suitable device. In majority of cases, artificial ventilation is necessary without you not feeling anything.
Loco-regional anaesthesia makes it possible, by various techniques, to deaden only your body part on which the operation will proceed. Its principle is to block area nerves, by injecting with their proximity a local anaesthetic product. General anaesthesia can be associated or become necessary, in particular in the event of loco-regional anaesthesia insuficiency. Rachianesthesia and peridural anaesthesia are two particular forms of loco-regional anaesthesia, where the anaesthetic product is injected near the spinal cord and nerves which leave this one. For these two particular loco-regional anaesthesia techniques, the anaesthesia duration of interested zones is variable and felt effects are successively: feeling of heat, disappearance of sensitivity and, finally, disappearance more or less marked of motricity, i.e. impossibility of moving the legs.
Any anaesthesia, general or loco-regional, carried out for a nonurgent act, requires a preanesthesic evaluation by a doctor anaesthetist at the latest the day before or just before anaesthesia, according to hospitalization conditions. As anaesthesia is a medical act, this visit is conduct by a doctor anaesthetist. This doctor anaesthetist will thus discuss personally with you before anaesthesia. He will briefly describe you the envisaged anaesthesia course and postanesthesic phase and will answer your questions relating to in particular risks and benefits, discomfort, alternatives, failures, anaesthesia team, artificial ventilation, special measures such as for example vesical catheter, venous and arterial catheters, blood transfusion, blood derivatives and saving blood measures.
Thisnformation document, on the model of the Swiss Society of Anesthesiology and Reanimation (SSAR), is intended to bring some preliminary information to you to prepare you with this maintenance. We ask you, consequently, to express all freely that worries you, to announce to us what you would like to know and not to hesitate to ask us questions that you will consider useful to your information.
The anaesthesia technique choice will be given according to: the act envisaged, your health, results of prescribed complementary analyses/tests. After discussion between you and the doctor anaesthetist, you will choose together the technique which will be appropriate to you best.
How will you be monitored during anaesthesia and during your recovery? The anaesthesia, whatever its type, proceeds in a room equipped with adequate material, adapted to your case and checked before each use. Your body vital functions, like for example, cardiac, circulatory, respiratory activity and your consciousness state are constantly supervised during anaesthesia. All that is in contact with your body is either of single use, or disinfected, or sterilized. At the end of intervention, you will be wake up, then monitored in a way first continuous, then with regular intervals. During anaesthesia and your recovery, you will be taken in charge by qualified specialized nurses, under doctor anaesthetist responsability. A member of anaesthesia team will be constantly by your side.
Which are anaesthesia risks? Any medical act, even led with competence and in respect of gathered science data, involves risk. The current anaesthesia and recovery monitoring conditions make it possible to detect anomalies quickly and to treat them.
Which are general anaesthesia disadvantages and risks? Accidents related to passage of vomiting in lungs are very rare, if fasting instructions are respected strictly, i.e. if the patient did not drink anything nor eat during the 8 hours which precede anaesthesia. Nauseas and vomiting during recovery became less frequent with new techniques and new drugs. Introduction of a tube into trachea (intubation) or throat (laryngeal mask), to ensure breathing during anaesthesia, can cause sore throat or hoarseness. A feeling of cold, shivers during recovery or during a loco-regional anaesthesia are possible, but generally of short duration. Sometimes during general anaesthesia, one is likely to damage your teeth. This is why, it is important that you announce any apparatus or any particular dental brittleness. A painful redness on the level of the vein into which the drugs were injected can be observed. It disappears in a few days. Prolonged position on the operating table without moving can involve compressions, in particular of certain nerves, which can cause a numbness or, exceptionally paralysis of an arm or a leg. In the majority of cases, things return in order in a few days or a few weeks. Transitory memory disorders or intellectual faculties and concentration diminution can occur in the hours following the anaesthesia.They do not last.
There are additional risks inherent in certain particular handling like, for example, installation of a blader catheter, installation of a catheter in a vein or an artery, transfusion of blood or its derivatives. These complications are however very rare.
Unforeseeable and dangerous complications, therefore involving a vital risk like severe allergy reaction, heart failure, asphyxiation, are extremely rare. To give an order of magnitude, serious complications occur only one time on several tens of thousands of anaesthesias. Doctors anaesthetists are trained to diagnose them, treat them quickly and, as far as possible decreasing the consequences by them.
Which are disadvantages and risks of loco-regional anaesthesia? A repetition of the puncture can be necessary in the event of difficulties. Momentary itchings can occur during the use of morphine or its derivatives. After rachianesthesia or peridural anaesthesia, headaches can occur. They require sometimes a rest of several days and /or a specific local treatment. A transitory bladder paralysis can require temporary installation of a urinary catheter. Pains on puncture point level in the back are also possible. Very seldom, it may be that one has turbid sight or impression to have stopped ears, during a few hours. According to the associated drugs, transitory memory disorders or intellectual faculties or concenration diminution can occur in the hours following the anaesthesia.
More serious complications like convulsions, heart failure, permanent paralysis and more or less extended loss of feelings are extremely rare. Some cases are described, whereas tens of thousands of anaesthesias of this type are carried out each year.
What happen with postoperative pain? To relieve postoperative pain, there are various analgesia methods of which you will be informed. The unit of care nurses hold at your disposal a booklet about patient controlled intravenous analgesia (PCA), a therapeutic concept that doctors anaesthetists often advises and applies for acute pains.
What happen with blood transfusion? If there is a probability that you are transfused during your operation, you will receive specific information on techniques and transfusion risks.
What are my rights as a patient?
All patients should be guaranteed the following freedoms:
To seek consultation with the physician(s) of their choice.
To be listened to.
To be respected
To contract with their physician(s) on mutually agreeable terms end to have a say in their own treatment.
To be treated by healthy competent physicians andmedical personnel
To bee treated confidentially, with access to their records limited to those involved in their care or designated by the patient.
To be treated in hygienic conditions.
To use their own resources to purchase the care of their choice.
To refuse medical treatment even if it is recommended by their physician(s).
To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives.
To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians.
To be treated in well-managed organizations.
To receive full disclosure of their insurance plan in plain language, including: contracts, incentives, the full cost,coverage,qualifications of participating physicians, approval procedures, procedure for consulting a specialist, appeals, gag rule.
For more details see the very good and instructive website of the Association of American Physicians and Surgeons (AAPS), particurlarly "The patient handbook": www.aapsonline.org/aaps/patients/handbk.htm.
If you support the above patients rights, please sign the guestbook of the website managed by Patient Support: www.medical-accident.co.uk.
How to protect my right to privacy with my medical record?
Few areas are more personnal and private than your medical records.The laws and courts recognize a right to privacy by the patients. Yet there are more safeguards for financial records than for health information. With the proliferation of huge medical networks and computerized information, the potential for someone to gain access to and misuse your records is tremendous.Some hospitals, some insurers and health care plans aren't disposed to protect your right. In fact, they frequently coerce you into signing blanket disclosure forms.
If you wish to withhold consent to disseminate your medical records, sign this form and give it to your physician.
I, .........................................., hereby assert my constitutional right to privacy and expressly forbid my physician, and anyone acting under his or her control, from releasing any of my medical records to a third party without my express consent. In particular, I decline to consent to the release of my medical records for the purpose of entry into a computer database which may be accessed by third parties outside of the offices of hospitals utilized by my physician.
Signature:................................................. Date:................................................
When should I call my physician?
Most physicians keep regular office hours during weekdays, and many are offering evening or weekend time to accommodate working families. Check with your physician for his hours and jot them down: physician phones and hours. Unfortunately, your body doesn't always adhere to your doctor's schedule, and medical problems erupt at night, on weekends, or on holidays.
Most medical offices have 24-hour answering services to handle your calls, but it pays to be prepared in advance. Ask your physician about after-hours procedures. In a real critical emergency, dial 144 in Switzerland, 112 in Europe or 911 in The United States. If you are sure something is an emergency, don't delay. Call the 144 and the prehospital emergency service. Their nurses, doctors and paramedics are awake, dressed, equipped, and on the radio.
Situations that need to call the prehospital emergency service and an ambulance include:
1. Unconsciousness lasting more than a few moments.
2. Shock (patient looks pale and clammy, has a weak, rapid pulse, and can't stand up without feeling faint).
3. Sudden or severe difficulty breathing.
4. Severe, crushing chest pain, especially with a cold sweat or nausea or sense of impending doom.
5. An injury with severe bleeding.
6. If you are alone, an injury or fracture which would prevent you from getting to the hospital on your own.
When to go to the emergency room of the nearby hospital:
Some problems call for an immediate trip to the emergency room, but not necessarily by ambulance. Use your common sense about what type of transportation is safe. Some examples are:
1. Bleeding from the stomach or intestines, other than in small amounts. Blood that has remained in the stomach for a time may appear as vomitus resembling coffee grounds or as black, tarry, foul-smelling stools.
2. Sudden, severe headache.
3. High fever if accompanied by a stiff neck or delirium.
Situations that probably warrant admission to the hospital, but which can be evaluated in the physician office first, include:
1.Vomiting in a diabetic.
2.High fever with shaking chills, especially if the patient can't keep down fluids or medicines.
What if you are sick on a weekend, at night or on a holiday?
Some problems can be handled on the telephone, or can wait until morning or monday. Others may require a visit to the physician office or emergency room, but either will cost more than a regular visit. A special trip to the office requires much more time than the usual office visit, and the fee is proportionally higher.
Only you can decide if a trip to the emergency room is necessary. But remember, they're designed to save lives. Care for problems that aren't realy urgent (in their judgment, not yours!) may be slow, inefficient, and expensive. Take two aspirin and call your doctor in the morning? Often, that is not bad advice. People recover from most illness without or in spite of modern medicine. Otherwise, the human race would have been extinct long ago! A delay of a few hours in starting most medicines makes no difference.
If the problem is pain, a few hours may seem like days. If you know the cause of the pain (toothache, earache, sprained ankle) then take some medicine and call in the morning.
If you don't know that you have a minor problem, it is better to be seen than to be sorry.
Should you start taking an antibiotic? Generally no! If you are developing a serious illness, it is important to obtain cultures to identify the bacteria and select the appropriate antibiotics. A couple of leftover tablets of antibiotic may ruin the bacteriological culture. Your physician may suggest some exceptions to the rule, for example a bladder infection. If you are developing familiar symptoms, he might want you to start an antibiotic if you are sure you don't have venereal disease (burning on urination is one symptom) and you are not having fever and chills. Ask about obtaining a specimen before you start taking the medicine.
The doctors have myriad of tests available to help diagnose your problems. But to the layperson they may sound like alphabet soup. Some are expensive and can be intrusive and uncomfortable. To help you understand why a test is needed and know what to expect, ask these questions:
Why do I need this test? Your doctor can explain what he will be looking for, and why it is the most appropriate test for your situation. One of the most important things to know is what difference the test result will make in your treatment.
What can I expect during the test? Ask your doctor to explain the procedure, including pain involved and the amount of risk. Find out the amount of time needed so you can adjust your schedule. Be sure you understand the directions for any preparations that you need to make so that you will get the optimum results.
How reliable is the test? No test is 100% accurate, but you should know the limits.
What if I don't have the test? You have a right to refuse a procedure, but first find out the alternatives or risks.
How much will it cost? Prices vary. Remember, sometimes the cheaper test is not the best deal: low-cost contrast materials used in certain x-rays have a significantly higher risk of side effects, which can be quite serious.
How will I get the results? For especially important tests, such as pathology reports or x-ray reports, you may want to keep a copy in your records. That way you don't need to worry about it getting lost in a huge institution or about delays in getting the report to a new doctor. You should know that many institutions routinely discard x-ray films and recycle the silver after about 10 years. You may want to ask to keep a copy of the actual film. For some conditions like a nodule on a chest film, an old picture that shows the same nodule can save you months of worry or a risky and expensive work-up.
What is the physician's relationship with the laboratory or the medical service? You have a right to know if the physician has a financial interest in the business. It may still be the best and most economical facility, even if the doctor owns it, but you should always be aware of your options.
Do not hesitate to contact us: mailto patientprotect@bluewin.ch.