Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, September 10, 2008

Why Are You So Surprised?

  • Polypharmacy is bad, especially in the elderly.
  • Try to limit the number of drugs your elderly patients take.
  • The elderly take too many pills.
I hear; I agree; and I obey.

So my lovely little sharp-as-a-tack 85-year-old lady is only taking three pills -- a BP pill and a pinch each of a diuretic and a thyroid pill. Everything is fine. She's happy. I'm happy. Presumably the writers of guidelines regarding polypharmacy in the elderly are happy.

So what happens?

She gets a call from her insurance company (I won't say which one, but it's named for a color and a shape) offering her their health counseling services. She's not quite sure what they're talking about, but she agrees; and another nice woman comes on the line.

She asks for the patient's street address; the patient gives it.

Then her birth date; she complies.

What medicines does she take? She names them.

Is that all? Yes.

Is she sure? Yes.

You don't sound like an 85-year-old lady.
After deciding they really didn't have anything of use to offer her, the patient had a great laugh over it, while I was left wondering what the hell an 85-year-old is *supposed* to sound like.

I also wish this particular, nameless insurance company would stick to doing what it's supposed to be doing (pay for health care) even though it doesn't do it very well, instead of trying to justify its bloated premiums by offering all kinds of other -- mostly useless -- services.


At Wed Sep 10, 07:52:00 AM, Anonymous Anonymous said...

Lemme guess: are they related to Keystone HealthBastards?

They've been calling me once a week, on average, to "counsel" me about my asthma. Apparently, you need to prescribe six more medications, so I can be considered a normal asthma patient.

I took the liberty of telling them they could blow you and you'd get right on that. Hope that wasn't presumptuous.

At Wed Sep 10, 10:48:00 AM, Blogger Lynn Price said...

Good lord, Cranky, is there ever a time you don't send coffee shooting out my nose?

I agree, Dino, Color-Shape insurance should stick to underpaying you docs and screwing their clients. It's what they do best.

At Wed Sep 10, 12:50:00 PM, Blogger knitalot3 said...

And if I have a possible life threatening emergency or an illness or a poisoning, I am not going to be calling their "nurse advice help line" so they can tell me to call poison control or go to the ER or call my dr. Ha! I am smarter than a fifth grader, most days.

At Wed Sep 10, 01:46:00 PM, Blogger ANATOTITAN said...

Same company, same calls and emails and snail mail to help "counsel" me. What are we all going to do when this company starts to figure "counseling" into their rates, because I bet they do down the line. If you don't get "counseled," they'll charge you more.

At Wed Sep 10, 02:22:00 PM, Blogger Rogue Medic said...

Pink Triangle insurance for an 85 year old LOL. That does blow the stereotype.

Every now and then, I run into a patient in their 90's with no medical history and on no medications. They all give the same reason for their health - staying away from doctors. Of course good luck, good genes, not doing stupid stuff, and taking care of themselves has a lot to do with it.

At Wed Sep 10, 02:52:00 PM, Blogger jmb said...

Insurance companies counselling ashthma patients? Was it a physician on the line? Wouldn't that make them liable?

Indeed what does an 85 year old sound like? All my friends in that age group sound just like everyone else. One of the advantages of the telephone (along with the keyboard) you are judged by what you are saying not by what you look which seems to allow people to write you off as an old person not worthy of notice.

At Wed Sep 10, 03:19:00 PM, Blogger Jon said...

LOL. I was just in the hospital having a minor procedure done and the nurse who delivered my oxycontin takes a peek at my chart and says: Wow! You're 47 years old and there's nothing wrong with you. That's amazing!! And I'm thinking, geez, am I supposed to be decrepit already?

At Wed Sep 10, 03:20:00 PM, Anonymous Anonymous said...

jmb, sorry to tell you that insurance companies are immune from liablity, whether they are "counselling" patients or denying care (they claim they're not practicing medicine when they do this). I have yet to encounter any disease managment or counselling from any insurance company that does a nickel's worth of good in terms of patient's compliance or outcome. I get these wordy letters from nurses who recommend blood sugar machines that aren't covered on the plan and patients can't afford, etc. I have suggested to them that maybe they should encourage the patient to keep their followup appointments (that might actually be helpful) but they never too. The topper was a letter from the inusrance company when I had surgery 3 years ago in which the assured the surgeon that "we will be calling _____ to see how she is doing and to answer any questions." Like they think if I have problems or questions I'm going to call some nurse who couldn't/didn't want to do nursing in a cubicle somewhere instead of my doctor? Get real, people. For the record they didn't call, so I missed the opportunity to tell them to go pound sand.

At Wed Sep 10, 03:32:00 PM, Anonymous Anonymous said...

Ugh, I can't stand that insurance company and they insure our family. I basically pay them for nothing because it seems like nothing is covered on our plan.

At Wed Sep 10, 06:43:00 PM, Blogger Irritated said...

I use to do home health and I swear it would take me an hour to enter all the meds into the computer... and then have to type a letter to the doc about all the interaction advisories! SHEESH!

And don't get me started on the color/shape company has managed to screw me more than once!

At Wed Sep 10, 08:05:00 PM, Anonymous Anonymous said...

Am I the only paranoid person who doesn't give out any personal data (phone number, address) to someone I didn't personally call?

At Thu Sep 11, 03:23:00 PM, Anonymous Anonymous said...

I agree w/ a previous poster -- you might advise your sharp-as-a-tack patient not to give out her address & birthdate to someone who phones HER. Not smart.

But the overall story sounds oddly familiar -- when my husband went to the emergency room for a first-and-last-gallbladder attack (which you, Dr. Dino, were brilliant enough to diagnose by phone, remember?) the nurse in the ER taking his medical history appeared to be ready for a long saga, and was nonplussed to learn that a 55-year-old man had no known health problems and was on no medication. "Oh, really?" she said, realizing perhaps that this history-taking wasn't going to be as time-consuming as she expected.

Kensington MD

At Sun Sep 14, 08:23:00 PM, Anonymous Anonymous said...

Color-Shape attempts to do this in my area (hint: the 'parent' association of said company's HQ is here - approximately 75% of those w/health insurance in this state are covered by said company). If you politely refuse this (cough, cough) 'valuable service' as an invasion of privacy because you don't want to discuss whatever they're calling about with a telemarketer, you won't get bothered again.


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