DIFFERENTIAL DIAGNOSIS

Pain is the result of an abnormality or injury.  True or false?

Pain can cause pain. True or false?

It is better to treat the cause of pain. True or false?

It is better to treat pain regardless of cause. True or false?

Doctors worry about treating pain. True or false?

Believe it or not, all of the above statements are true. So, which is more important, the cause of the symptom or the symptom itself? Patients usually focus on the symptom.   “Doc, I’m having terrible spasms in my right forearm causing excruciating pain.  I need something for the pain.”  Something for the pain usually translates to hydrocodone and prescribing hydrocodone makes docs nervous.

The doc’s job is to diagnose the cause for the pain, directing treatment at removing the source.  Using hydrocodone is the equivalent of putting a Band-Aid on a cut.  Finding the cause of the pain/spasm can be difficult and often, in many cases, requires a thorough history, exam and testing.

Take, for example, my forearm pain.  I’ve been getting excruciating right arm muscle spasms causing severe pain and disability. It’s gone on for week;s and, at times, it felt like the spasm would break my bones.  Initially, I thought my deep brain stimulator was causing the spasms as the pain would go away when the stimulator was turned down.  When the pain was severe, I turned off the stimulator. The pain persisted.  Obviously, the DBS was not the cause.  Right?

Wrong.  Remember, spasm can cause spasm and my spasm had gone on for weeks.  One spasm was accompanied by a loud pop in my elbow followed by an inability to fully extend the elbow.

As you can see from my example, the diagnostic process can be difficult.  Before you see your doc for a problem, make a list of your symptoms and any possible causes.  Please do not search the internet!  According to google, everyone has cancer and other rare diseases.  On occasion, all you’ll need is a Band-Aid.  When I practiced medicine, I preferred diagnosing the cause of the pain as opposed to applying a Band-Aid. If I could diagnose and treat the origin of the symptom, then I had a chance at a permanent cure.

The next time you see the doc, remember how complex diagnosis and treatment can be.

Here’s today joke:

My wife yelled from the bedroom asking, “Do you ever get a shooting pain across your body like someone’s got a voodoo doll of you and they’re stabbing it?” I replied, “No.”

She yelled back, “How about now?”

SCARE TACTICS

Scare tactics!  Yep, that’s what the commercial I just watched amounts to.  In response to candidates promising to reign in the cost of medicine, Pharma is threatening to stop research and production of new medications.  All I can say is, “Bull Shit!”

Pharma develops and sells medications on a worldwide basis.  Many of our most popular drugs are produced overseas.  Did you know that in many countries medication cost far less than in the United States?  Everyone knows about   Canada. 

So, if much of the world sells medication for less than we do, how come Parma continues to develop new meds?  The answer is easy.  Pharma has huge profit margins! 

Don’t let them scare you.  Vote for candidates who promise to cut the cost of medication.  Then hold their feet to the fire!  It’s time Congress keeps its promise.

PAY THE DOCTOR CASH

A recent article on KEVINMD.COM entitled, “Keep your medical insurance, but pay the doctor with cash,” was of particular interest to me.  My practice was unique in that I ran a Concierge practice side by side with a typical fee for service practice.  Comparing the two practices is easy.

The Concierge practice was fun.  If I needed a test or procedure, I could order it without many hassles.  Concierge patients bought their freedom by paying cash and were more appreciative of their care then their counterparts. 

Fee for service/insured patients relied on their insurance company and gave up their freedom, trading it for a copay.  Their care carried more overhead than the Concierge patients and they really didn’t understand how much back office work it took just to get them an x-ray.

You may not know it, but your doctor’s office is forced into taking insurance products and putting up with the insurers’ discounts.  Did you ever stop to think that your doctor is your banker, carrying your debt until the insurance company pays him/her?  Did you realize that your $10-$40 copay represented the majority of your family doc’s paycheck?  I bet you didn’t know that it cost me money every time I sent you a bill.

Giving a discount for cash paying patients makes sense.  The only drawback is a theoretical one.  Medicare and your insurance company could look at your doctors’ discounted fee as his/her real fee and claim that your doc over charged them.  Medicare could then claim that your bills were fraudulent and file criminal charges against your doc.  Sound insane? It is!

Insane rules created by your insurer and government guaranteed that your doc and their patients had little recourse when it came to arguing over billing and the cost of medicine.  While I was in private practice, I fought to keep costs down and to get my patients the referrals they needed.  I wonder who is going to fight for your rights in the corporate world of medicine that exists today.

By the way, “Pay the doctor with cash” does not mean hand your doc a credit card.  Credits cards charge your doc a percentage of the amount charged.  For those of you old enough to remember cash, there is no charge for the use of cash.  Every little bit counts.

Here’s a true story to think about.  I was standing in the check-out line at the Vet’s office.  The man in front of me was told his dogs bill was $245 and included the doc’s time and lab work.  His dog had a urinary tract infection.   The man paid his bill.  He did not complain, he did not tell the office to bill his insurance.  In my office, the bill for a UTI would have been $200.  I would have gotten a $20 co-pay, billed insurance, and written off the insurer’s discount, collecting a grand payment of $100.  Many of my patients would have griped about the co-pay despite the savings. 

If you like your doc, pay your doc!  Use your insurance for big ticket items.

Here is today’s joke:

A bank robber gets hold of the cash he needs but before fleeing the scene he demands the regular customers to stand in a line

The bank robber asks the first guy in line: “Did you see what happened here?”

First guy: “I sure did! And I’m gonna tell the police exactly what happened and what you look like…”

The bank robber shoots him in the head and asks the next in line the same question.

Second guy: “I assure you I did not see a thing… but my wife here did”

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