The Importance of Tracking Your Symptoms

Why track your symptoms?  

Well, have you ever visited a doctor and they asked: “How often have you been having this symptom or that?  How bad has it been?  Is there anything that makes it better or worse?”

If you’re like most people, it’s really difficult to remember all of this and more so if you’re not feeling well.  And, as you try to remember back more than a few days, it can get very fuzzy, very quickly.  Sadly, practically no one keeps a log of their symptoms except, perhaps, for diabetics who track their BGL and hypertensive patients who track their blood pressure.

But without accurate information, it’s hard for your doctor to make a good diagnosis and propose the right treatment.  For example, how is a doctor supposed to treat a headache which can have, literally, hundreds of causes?

When I was much younger, I had very bad headaches but I knew that they were not migraines.  I asked my doctor what could be causing this.  He said: "It could be stress...It could be a brain tumor.  Let's run some tests." (I know that sounds harsh.  I happen to like dark humor like that and appreciated his candor.)

Now imagine I came into his office with a log of my headaches for the past 2-3 months.  The doctor probably wouldn't have to run as many tests and could possibly diagnosis it right there and then.  And with a proper diagnosis, I would have received the correct treatment.  

The alternative is also true.  Without clear data, the doctor could have made an inaccurate diagnosis and given me a treatment that not only could have been ineffective, it could have actually been harmful.

So, here's what you should log:

• Date
• Time of Day
• Symptom type (e.g., pain, dizziness, blurriness, breathing problems, etc.)
• Location of the symptom (e.g., back of the head, chest, left kidney, neck, etc.)
• Intensity (on a scale of 1-10)
• What makes it worse
• What makes it better

That's it.   You don't need to create charts, graphs, or have a lot of complicated information.  The idea is to keep it simple so that it's easy to log your symptoms and easy to read by those with whom you share the info.

That leads to the last, and perhaps, the most important aspect of a symptom log.  It must be easily shareable.  You will want to share it with your healthcare providers, family or other caretakers.  And the simplest way to do so is via email, text or printing.  Having a digital log (e.g., spreadsheet, word doc, etc.) is obviously the best format to enable easy sharing. 

There are many apps on the market that do this.  Most are very complicated and hard to use.  I believe that my app, My Symptom Tracker, is the simplest and easiest way to track your symptoms and share the info.  I invite you to check it out:

Click here:  My Symptom Tracker

Reasons Why You Need A Patient Advocate #14: Emotions

Even if you are a healthcare-literate, intelligent person, caring for yourself or a loved one can be a very emotional situation.  As we all know, when emotions run strong, it can be very difficult to make tough decisions.  The logical part of our brain simply gets overpowered and pushed aside.

I experienced this exact situation yesterday.  My wife has been suffering from the flu for the past 9 days.  It has really hit her hard.  Her fever has been spiking for almost the entire time.  And a couple of days ago, she developed a new symptom, a very sore throat.

Even with all my experience and training, I felt uncertain about the best course of action.  Should I take her to urgent care or not.  I decided to use the UCLA nursing phone service and spoke with a nurse practitioner.  She didn't tell me anything that I didn't already know.  But she was able to be objective and provide some very needed perspective on the situation.  It was incredibly helpful and calming.

Today, I recognize that my emotions were clouding my usual, confident, decision-making abilities.  This is a very common experience for caregivers.

Caring for a loved one who is very ill can make one feel helpless and alone (even if other people are around).  A patient advocate (in this case, the NP) can be invaluable to help one assess and process the current situation.

(Reasons Why You Need A Patient Advocate #14:  Emotions)

Advice From A Patient Advocate

Advice from a patient advocate:

When a hospital offers you a discount to prepay what they calculate is your co-insurance amount...Don't pay it! Their estimates are almost always too high.

Example: Amy went in for a simple procedure. The hospital said that they estimated our amount owed to be $390. But if I was willing to pay it now, they would knock off 20%. I said no thanks and paid them a partial payment of $100 when we were admitted.

The bill came today. The total amount we owed was $189. So we owed the balance of $89. Had I paid the $310, I would now have to wait weeks or months to get my refund.

FamilyDoctor.org

I just discovered this website www.familydoctor.org and I love it.  Until now, I've used a variety of sites when researching medical information:  WebMD, LiveStrong, Drugs.com, RxList, etc.

My main complaint about these sites is that they are all, to various degrees, very user-unfriendly.  They try to include so much information that it makes the UX very unsatisfying and confusing.  One particular issue the prominent display ads that infest most of these sites.  All too often, they are designed so that they look like actual content instead of ads.  So you click on it and are sent off site thinking that you are merely entering another section of the original site.

So while researching content for my new company (www.metisadvantage.com), whose beta is coming soon, I came across FamilyDoctor.org.  This is a site run by the American Academy of Family Physicians.

My first impression is that it is incredibly easy and clear to use.  There are very few ads (although I'm not sure if that is intentional or due to a lack of advertisers).  The navigation is simple and easy.

But what I really like about it is the Disease and Conditions section.  Once you find your particular condition, the article that pops up is easy to read, clear, and loaded with practical information.  If there were a "Dummy's guid to Diseases and Conditions", this is how it would be displayed.

So, I highly recommend visiting this site.  It's relief from the crowded world of medical information.

Who was that doctor?

So who was that doctor that treated my daughter in the ER and the hospital this past weekend??  Who was the radiologist that discovered that object?  Who was the nurse that made the ER visit so bearable?

Easy, right?  Not so much.

My daughter got sick over the Thanksgiving weekend.  She had two ER visits and one overnight hospital stay.  Fortunately, we averted what could have been a critical situation and she is now fully recovered.

This was due partially to serendipity.  We were simply lucky that I took her to the ER in time.  Had I waiting another 12 hours, her condition would have worsened and it's quite possible that the unthinkable might have happened.  But it was more than just luck which prevented that catastrophe.  I credit the many doctors, nurses and technicians who treated my daughter with saving her life.

I want to send a note commending the CT technician who decided to extend the field of view beyond my daughter's abdomen (which caught the potentially dangerous condition).  I want applaud the nurses and phlebotomists who worked so hard to get a good venipuncture.  I want to credit the X-ray technician who decided, on a hunch, to take an x-ray of her colon when all that was ordered was an esophagram.  I also want to find out more about the GI doctor who consulted on the case.

Unfortunately, I don't have this information.  Since my daughter was admitted to the hospital directly from the first ER visit, we never got ER discharge papers and I can't remember the name of the ER doctors or nurses (not an unusual event).  But even if we got discharge papers (such as we did from the second ER visit), it would not have included the nurse's name.  The hospital discharge papers did include the attending physician. But it did not include any consulting physicians.

The only way to give credit where credit is due is get my daughter's medical records and read thru the volumes of pages.  This requires a physical visit to the hospital with my daughter.  I am not even certain that the technicians and nurses' names would be included.

Maybe it's not that important to know the names of all of the team members.  Perhaps, I should simply be content with the positive outcome.  On the other hand, the entire healthcare system is moving quickly towards measured outcomes and accountable care.  This requires access to data on individuals as well as institutions.

Now, I am a big believer in providing constructive feedback not only when something goes wrong but also when something goes right.  I feel that I don't have the right to complain if I don't also acknowledge success.  This belief probably stems from a small poster my father (a CPA) had in his office which said:  "When I'm right no one remembers.  But when I'm wrong no one forgets."

Perhaps institutions want to protect the identities of these people from overzealous patients.  That would certainly be reasonable if an error was made.  Yet, I feel that is the patient's right to know who treated them and who performed the procedures and tests. It should be a lot easier to find out this information.

So who was that doctor?  I don't know.  (Third base.)

P.S.:  Surveying the successes and failures of hospitals is the main mission of Hospital Consumer Assessment of Hospitals Provider and Systems (HCAHPS).  (The data here is great and I wish that more people would access it.)

The Hospital With No Beds

Fascinating story from CNN Money about a virtual hospital.  This is telemedicine taken to an extreme.  Mercy Hospital is a $54 million facility in St. Louis that offers 24/7 medical via iPads and computers.  It is a prime example of the hi-tech/hi-touch movement.   Using tablets along with biometric sensors, Mercy is able to do almost everything that a traditional home visit used to accomplish.  

It is also an excellent example of how to use "navigators" or "advocates" to help address chronic disease management and readmissions.  Patients of Mercy get "visited" twice a week by navigators. This makes it possible to detect problems early on.  It also reduces unnecessary hospital and doctor visits.  

The Hospital With No Beds

$7000 CAT Scan (What would Einstein and Franklin do about it?)

"It is the first responsibility of every citizen to question authority"  (Benjamin Franklin)

"The important thing is to never stop questioning.  (Albert Einstein)

This month I received a bill for an ER visit to my local hospital.  The billed charges for the facility (not doctor fees) were $14,876.59 and the amount that I owed was $2082.72! Though I never received an EOB ("explanation of benefits") from Anthem for this, it certainly looked like the insurance company had paid down this bill somehow leaving me with only a measly $2000+ co-insurance amount due.

(Spoiler Alert:  the actual amount that I owed end up being $0.00!)

After recovering from the sticker shock and shot of scotch, I started to think a bit more clearly. Here's what I did:

1)  I called the hospital's billing department and requested a detailed, itemized list of all the charges.  I had to see how a two-hour ER visit ended up costing over $14k considering the fact that we left without needing any treatment or medicine.   

2)  After receiving the itemized bill, I verified that all of the services were actually rendered.  I also noticed that they charged $7000 for a CAT scan (which costs only $550 at our local radiology facility).  They also charged $900 to administer an EKG which took about only 1 minute.  The basic charge for simply stepping into the ER was $2352.  I actually don't find that charge to be so unreasonable. 

3)  Next, I went online to Anthem to find the EOB and see how Anthem had processed this claim since I suspected that something was amiss.  I couldn't find the EOB which is unusual. Anthem's patient portal is pretty good (albeit very, very slow) and it's usually easy to find an EOB. 

4)  So, I called Anthem figuring that maybe the EOB got stuck somewhere and they could look it up.  Guess what?  They couldn't find a claim submitted by the hospital for this DOS at all.    "OK, Anthem, I'll call the billing department at the hospital and see what's what." 

5)  I asked the billing department to explain to me how the $14,876 was paid and reduced so that my co-insurance became $2000.  "I see here that your insurance company is xxxxxx.  Is that right?"  "Huh?  I've heard of that company. My insurance is with Anthem." 

The hospital had never even submitted this claim to Anthem.  Further, it is a complete mystery how the hospital had the correct insurance information to process the doctor's fees but complete bungled their facility bill.  It's also a mystery as to how this unknown insurance company could have discounted or paid anything towards these charges.

I gave them my Anthem information and they will submit the claim.   Once they do, the claim will be paid at 100% because my wife had already reached her annual out of pocket (OOP) maximum before this ER visit.

This means that the $2082.72 bill is going to go down to... $0.00.  Yeah!

Key Takeaways:

1.  Never trust that the amount that a provider says you owe is actually the amount you really owe.  Always read and question every bill.  (See the above quotes from Einstein and Franklin.)

2.  Always read your EOB.  If you don't have it, get it.  Then read it.  If you don't understand it, make your insurance explain it clearly or find someone who can.

3.   Realize that billing mistakes occur every day.  Perhaps your bill is accurate.  But chances are good that a bill that seems too high has mistakes in it.  If it walks like a duck...

P.S. - I am not certain what would have been the amount I owed if my wife had not met her OOP maximum.   I estimate that it would have been about $1000 which is still a sizable savings from the original billed amount.