Consumer Survival Kit; 301; Family Medical Care

Consumer survival kit family medical care number three a one Maryland Center for Public Broadcasting. For Public Broadcasting. Hello I'm Larry Lohmann. People have always been fascinated by doctors and medicine and we've celebrated them in many ways. This painting for instance and television has brought us a succession of media doctors who could mend broken hearts in more ways than one with that idealised world has never taught us how to cope with a realistic need

finding decent affordable health care for ourselves and our families. Money as well as health is at stake. The price of health care is rising faster than anything else in the family budget out of its own pocket. The typical family of four spent eight hundred twenty two dollars a 975 for health care and health insurance premiums. This week we'll look at ways to get the best value for the money we spend on Family Health reify can looks at prepaid care at a health maintenance organization or HMO. Bob Smith shows how to be not just a patient but a competent patient. Fran Johansen has our survival kit publication and we'll look at how our daily living habits influence our health and vigor. But first a quiz. Number one adults over 35 need a complete physical every year. True or false. Number two children should be vaccinated for measles at the age of 12 months. True or false. Number three specialists must have more training than general practitioners. True or false. Let's see how you do. Number one is faults as a general

rule. Adults over 35 do not need a complete physical every year. A recent national taskforce on preventive medicine suggested that adults who feel well should see a doctor for a physical exam at least once every five years. During the period from age 35 to 64 and every two years after 64. Now of course your state of health family history sex or occupation might call for more preventive services or more frequent ones. The new idea in preventive medicine is to tailor the kind and the frequency of exams tests and medical counseling to the individual rather than recommending a general annual checkup across the board. Since the cost of a complete physical with tests can run up to $200 and even higher this approach may save you money as well as making good sense medically. Number two is true children should be vaccinated against measles at 12 months. The most serious of the common childhood diseases measles can cause deafness

blindness mental retardation and even death. Yet one third of preschool children are not protected against this disease. We're getting sloppy about other vaccinations too including the three necessary vaccinations against polio. So please take the time to review your family's immunization records. Most local public health departments will give immunization shots free or at minimal cost. Number three is faults. Specialists do not have to have more training than general practitioners. Once a doctor is licensed which is possible after 4 years of medical school in one year of hospital training or residency he or she can legally practice any medical specialty. Many specialists however are board certified. That means they've completed additional advanced training. A longer residency and four sub specialists such as cardiologists a fellowship after residency. Then they passed special exams. Doctors have satisfied all the requirements except passing the final special exams are said to be

board eligible. An uncertified specialist may be a very good doctor but with a board certified or at least board eligible specialist you know your doctor has completed advanced training in his specialty to find out if your physician is board certified. You can check your public library for the directory of medical specialists. You can also check a physician's specialty status by simply asking him or his secretary. Today most doctors do specialize in specialization has its obvious value but it can leave the consumer with a very fragmented feeling and a puzzling dilemma. I have to admit we've had a few health problems this year. First my throat was bothering me so I saw an otolaryngologist I had some trouble with my stomach so I went to a gastroenterologist. Then my knees started acting up and that sent me to an orthopedist. Then I got a bad cut. So I got it sewn up in the emergency room.

I'm beginning to feel like company don't do don't they make whole person doctors anymore. They do still make whole person doctors but there's a shortage of them. It's easier to find one if you don't wait until you're sick by a whole person Doctor. I mean a primary care physician who can take care of most of your health care needs he or she is the doctor you go to first. He should keep your medical records and your schedule of preventive services and act as your medical adviser. That means knowing when you need a more specialized physician and referring you to the right one and a good primary care physician doesn't forget about you after referring you to a specialist. He stays in the picture to coordinate your care. Let's take a look at the kinds of physicians who provide primary care. General Practitioners used to go into practice after four years of medical school and a year of hospital residency. Some have additional training. Their numbers have diminished sharply since the move toward specialization.

The other physicians who get primary care are actually specialists. They may be board certified. Family Physicians who specialize in the new specialty of family practice. Their training includes pediatrics internal medicine psychiatry surgery obstetrics and gynecology and Community Medicine internists specialize in internal medicine. They're trained in everything except surgery Pediatrics obstetrics and the treatment of bone and muscle ailments. Pediatricians of course specialize in the care of infants and children as to their fees. When medical economics magazine did a survey in 1076 it found that general practitioners charge median fees of nine dollars for a follow up office visit family physicians charge $10 internists charge $12 and paediatricians $10. Now how do you find a primary care physician. Well good doctors tend to know other good doctors. So if you're moving see if your current physician can recommend someone. You can

also call the nearest medical school teaching hospital or accredited hospital and ask for recommendations and you can check the directory of medical specialists for board certified family physicians internists and pediatricians. You may get some good suggestions from other health professionals such as dentists or nurses. You may want to ask friends for recommendations and you can call the local medical society for names from their referral list. When you have assembled the names of a few possibles call their offices and ask some questions. Does the doctor treat both children and adults. Some are qualified to do both. Did the doctor complete a residency of more than a year. And if so where a residency with a hospital that's affiliated with a medical school is desirable. At what hospitals can the doctor admit patients. Does the doctor have teaching responsibilities doctors who teach have to stay on their toes. Does the doctor practice in a group or alone group practice may be more stimulating for the doctor and may give you better coverage.

How does the doctor cover emergencies on nights and weekends. What is the usual wait for a routine appointment and what is the charge. Of course the final choice rests on meeting the Doctor. If you can't stand him he's not for you. No matter how well qualified to use an alternative setting for health care is the health maintenance organization or HMO. There are now 170 HMO JWs across the country offering prepaid medical care to six million subscribers reify can visited one in Columbia Maryland. Subscribers here at the Columbia medical plan pay a monthly premium when they need medical care they come to this modern facility assembled under one roof. Our primary care physicians are specialists and the rate of such services as laboratories X-ray facilities and urgent care center an optician and a pharmacy. Besides the convenience of centralized

health care many subscribers are attracted to him those because they can lower a family's medical costs. In fact one study showed that subscribers to the Columbia plan save about 32 percent or one hundred seventy dollars a year on total medical costs compared to other families in the area covered by traditional health insurance. How did the HMO cut costs. For one thing routine procedures are often done by nurse practitioners under a doctor's supervision. HMO those also reduce costs by hospitalizing patients less. One reason is that many diagnostic tests and minor surgery can be done at the HMO facility instead of the hospital. How does prepaid care really work. This is Mrs Harriet Lancaster. She and her husband have three children. They pay forty six dollars a month. A typical fee as subscribers to the Columbia plan. Mr. Lancaster's employer contributes

the same amount. Today. This is Lancaster has brought a line in for a checkup. This visit will cost Mrs. Lancaster two dollars as visits to. Some HMO don't require any extra payment. Routine check ups like this are rarely covered by traditional health insurance. For routine visit alone it is seen by this nurse practitioner. She specially trained to distinguish the normal from the abnormal. The quality of the physicians at HMO stands to be high. The percentage of board certified doctors that HMO knows compares favorably with fee for service doctors. Also doctors at most a gem owes regularly review each other's work. But age and those are not without their critics or problems. Some subscribers feel that the entire system is bureaucratic and impersonal. In fact if

you're considering joining an HMO you may want to talk to a few subscribers first. Are you satisfied with the system of medical care. Overall I am yes. Tell me a little bit about it has it been possible for you and your family to establish a personal relationship with the physicians here in pediatrics. Yes it has we've been with the plan since it opened which I believe was about seven years ago and we've had. Very good continuity and good contact with our pediatric staff and adult medicine and in the specialties there's been more turnover in staff and we haven't had the same kind of intimate relationship with them. How's the plan been financial and all it's going to be. We have three young children lots of trips to the doctor as you can imagine. In addition my husband was hospitalized for four five days last winter and we were presented with a bill of almost $600. The plan covered all the $2. Do you think that there is more emphasis on preventive medicine with a system like this than when you use a regular physician.

To begin with. There was but that's changed over time. I don't find anybody calling me up having looked over my records and telling me I think you might have a problem here. It's required aggressive. Consumerism on our part. And I've had to act as the coordinator of health care for my family and make sure that we were all adequately cared for. But it has worked out well. Thank you very much. Her heart lung cancer and many others. And you know when you're looking at medical care. If you're interested in locating an HMO in your area the Group Health Association of America can help you there at 1717 Massachusetts Avenue Northwest Washington D.C. 2 0 0 3 6 at 1717 Massachusetts Avenue Northwest Washington D.C. 2 0 0 0 3 6. There's another way to get pre-paid health care in about 100 cities. It's called a Medical Care Foundation and it's usually run through the county or state medical society

like an HMO. You know what your annual bill for medical care will be. Unlike an HMO you're on your own and selecting physicians from all the doctors in the community who participate. For more information contact the American Association of foundations for medical care. Box 230 Stockton California 9 5 2 0 0 0 1. That's the American Association of foundations for medical care locks to 30 Stockton California 9 5 2 0 0 1. Here are a few more alternatives for primary health care. The hospital outpatient department. If you go this route try to use a hospital that's affiliated with a medical school to find out which hospitals are you can call the nearest medical school. Every state has a medical school with these exceptions. Alaska Idaho Maine Montana and Wyoming. You can also see if your library has this guide to the health care field published by the American Hospital Association. If you don't have a hospital affiliated with a medical school in your area look for one approved to give residency training in medicine and surgery.

At the very least make sure the hospital is accredited. This guide will tell you all those things. Some outpatient departments have rules about where you live and how much money you make. Payment scales vary from hospital to hospital. A variation on the hospital outpatient department is the family practice center. There are close to 300 of these around the country. Their basic purpose is to train young physicians in the new specialty of family practice. They enroll the whole family and they try to set an atmosphere that's more like an office practice than a hospital. Again check payment scales. Then there are community health centers. The federal government funds more than 200 of them. You can check with your state health department for more information. There's usually a geographic residential requirement and payment on a sliding scale depending on income. Again check the back up hospital. Finally there are free clinics. Several hundred of them because they rely on volunteer professionals. Free Clinics may not offer comprehensive care. Free means no

hassle. You do contribute some money if you can. However no one is turned away and there are no eligibility requirements no matter where you get your health care your satisfaction depends in part on the way you use your time with the physician. The typical followup office visit with a physician lasts 12 minutes so you don't have any time to waste more about using that time from Bob Smith. Hi. The Words to live by for today are. Passive. Patients are passé. To show you what I mean. You're about to see a consumer survival kit at school see scenes from the pilot. But this season's poignant continuing medical drama and. Conflict. You think that title is dynamite cast. What brings you here today. I have a runny nose and Kong. How long has this been going on. I was well until three weeks ago. I thought I might be getting a cold or the flu.

However my temperature has been ninety eight point six and I don't have any aches and pains and what I have a cold it usually over within a week. Now you may find the plot a little thin but I call that a superb example of a competent patient presenting the chief complaint and the story of the present illness. It's concise it's logical and the doctor didn't have to dig it out of me. This is all part of the medical history that any good doctor takes and this is the part of doctoring where the patient has direct control. But to continue our story. Doc would you please check my blood pressure sure. I happen to think it's a good idea to get my blood pressure checked when I have the opportunity. Most doctors will take the opportunity to. The point is you should get out

there all exam no matter what your complaint is. If the doctors seem to be skipping something just ask. Could you go over that again. That business about systematically checking to see if there's something in my environment that could be causing this irritation. Of course I think I better take some notes. Will your doctor think you're weird. If you take notes why he takes notes doesn't mean he should. Competent doctors make lots of notes and competent patients make sure they understand and remember what the doctor is telling them. They ask questions they ask him to repeat. They write down instructions then they file them. That sounds obvious but lots of patients don't. They of course are not competent patients. Then two competent patients don't just grin and bear it if the course of treatment doesn't seem to be working or if there's a reaction to a drug they get back to the doctor and figure

out where they go from A. Competent patient. Ratings may not be overpowering but it is a great family program. Breaker 1 8 1 8. Anybody want a modulator. Come on. Frank. Well I got a lot on my mind good buddy Big Duck says cut you know into the hospital and that was the. Way. First your first you're going to take me a bundle of Green Stamps lay me up for six weeks come on. But it makes no sense. Juanita don't want me. Yes mama. Welcome on your wall the wall and all.

That much. Man. Oh man I got used to my guy and why is he sorry. Oh my bad news my mercy sakes my mind scrambled just like a big mixing bowl come on. Break or what I this is so. Well pick at nap time if you're bothered about the big Okay just take yourself over to another big dock and get a second opinion. You mean people ask more than one doc for a shirt good buddy check it out. The second big box is the same as the first big. It's gone on scramble Uma. Bags and for less than good buddy has been real nice modulating with you and you keep your nose between the ditches in them smoke is out your branches come all. The way down. Yeah I'm going to say myself another big dog.

Getting a second opinion from another doctor on another driver is accepted practice any time you have doubts about your diagnosis or treatment. As long as there's no emergency it's a very prudent thing to do. Whenever surgery is suggested or you want to consult a qualified specialist in the appropriate field of surgery. How to find one. Your primary care physician may have suggestions. You can also call the nearest teaching hospital or accredited hospital and get a recommendation. And there's our old friend the directory of medical specialists. Some experts think it's best to use an independent consultant one who has no association with a doctor who recommended surgery or the hospital where he has privileges and who doesn't expect to perform the surgery himself. When you've made your choice of a consultant ask your doctor to arrange an appointment. Getting a second opinion will probably cost about $75. Most of the time the consultant will confirm the need for surgery some of the time he or she will recommend against it or urge a wait and see attitude. If there are two

conflicting opinions it's up to you to decide if you need more help to make up your mind. You can seek a third opinion. All this leads us to a great debate that's going on right now. How much unnecessary surgery is done in this country. Studies in some areas have found that the amount of surgery seems to expand to fill the hospital beds and the surgeons time available. Studies after the fact of one type of operation hysterectomy have shown that anywhere from 3 percent to 53 percent were medically unjustified according to the standards set by the studies. But the definitive answer about unnecessary surgery just isn't in yet. One of the studies that's being watched very closely is going on in New York members of a labor union got mandatory second opinions whenever surgery was recommended. Now that a few years have gone by it looks like about 11 percent of these patients will not have surgery and a majority of those who don't won't even need medical treatment. If you were advised to have surgery be sure to check out the surgeon's credentials. And here are

some questions to ask. Why do I need this operation. How often do you perform. What's been the result. Exactly what will be done. What are the risks. Can I expect full recovery. What psychological effects does this operation have. And most important what will happen if I don't have this operation. You'll need help to get answers about your questions about surgery. But when it comes to your general state of health you can do a whole lot for yourself. Yes. That's an exercise in weight of drinking and smoking at all. It's a good feeling. You've been hearing things like this all your life. Get enough sleep eat breakfast don't eat between meals

watch your weight get regular exercise drink moderately if at all don't smoke. Pretty basic stuff. Well a California research team asked 7000 adults about their daily living habits and they found something very interesting. On the average people in their late 50s and early 60s who followed all seven of these good health practices were about as healthy as people 30 years younger who followed few or none of them. Furthermore beginning at age 45 their life expectancy was 11 years longer for men and seven years longer for women. The results seem to underline what doctors are saying more and more insistently to a great extent. Your health is in your own hands. Women can take another preventive step themselves by examining their breasts every month. Early detection means a good chance of surviving breast cancer. Still the leading cause of death from cancer in women adults without symptoms don't need complete annual checkups. They do need to see a health professional. Often enough to establish what's normal for them. So there's something to measure against if anything goes wrong later and when you see a doctor you should

be getting medical counseling too. Advice about nutrition alcohol drugs smoking family planning and your own personal schedule of screening tests to check for certain conditions in the treatable stage pap smears blood pressure checks tuberculosis screening glaucoma tests and other screening tests are often available for little or no cost from local public health departments or voluntary organizations like the American Cancer Society or the American Heart Association for Children immunization and vision and hearing checks are usually also available through health departments or voluntary organizations. It's important to remember that you still need a primary care physician because of a screening test shows positive results. You'll need a doctor to complete your diagnosis and plan your treatment. Now more information about making the health care system work for you. From publication editor Frans Johansson. In this week's survival kit author Victor Cohn urges his readers to quote choose a doctor at least as thoughtfully as you choose a new car unquote.

His article will give you the information you need to make a thoughtful choice. Other articles give you questions you can use to judge a hospital and the Bill of Rights for hospital patients. We have more information about health maintenance organizations and other alternatives for health care as well as the schedule of immunizations and a medicine cabinet checklist. Do you know when you need a hospital emergency room and when you get better and cheaper care in your family doctor's office. We have a very informative article that will help you to make that kind of decision. Some emergency rooms are better than others. The article shows you how to tell the difference and gives you tips on how to get good service once you're there. As usual we've included a reading list and a summary of a television program to get your publication send $1 to cover the costs of reproduction postage and handling to family health box 1977 Owings Mills Maryland. 2 1 1 1 7. That's $1 to family health box 1977

Owings Mills Maryland. 2 1 1 1 7. Please allow 3 to 4 weeks for delivery. Finding a good primary care physician and then really working at being a competent patient. These are the cornerstones of good medical care for you and your family. If surgery is suggested and there's no emergency getting a second opinion is a very prudent thing to do. Take a fresh look at your daily living habits. If you're interested in preventing illness and preserving health. And remember that immunizations which can prevent some diseases and simple tests which can detect others while they're still treatable are within everyone's reach of public health departments and from voluntary organizations. Here's to your good health and to seeing you next week on consumer survival. Me.

And good. Guy. That's not my thing and that's not me. This program was produced by the American Center for Public Broadcasting which is solely responsible for its content. Major funding was provided by public television station. Additional support was provided by unrestricted general program grants from the Corporation for Public Broadcasting and the Ford Foundation. We're.