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  • About Gayle
    • Community Education
    • Gayle's Blog
    • In The News
  • Learn More
  • Testimonials
  • FAQs
  • Resources
  • Contact Us

Questions to Ask Your Doctor

11/21/2019

 
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A friend recently sent me a great TED Talk titled: 4 Questions You Should Always Ask Your Doctor (by Dr. Christer Mjaset*). She knew I’d be interested because I speak to community groups about how to talk to your doctor.

The 4 questions Dr. Mjaset recommends we ask our doctors are:
  1. Is this really necessary?
  2. What are the risks?
  3. Are there other options?
  4. What happens if I don’t do anything?

These questions work in all sorts of situations:
  • Prescribing a new medication
  • Recommending surgery
  • Whether to get an MRI or other medical test
  • Deciding on a new treatment option

Your concerns may be medical/clinical (e.g., are there side effects?) or they may be financial (e.g., will my insurance cover it or will I have to pay out of pocket?). While you may not think you can question your doctor’s advice, trust me, you can! 

Examples:

  • Several years ago, I had unexplained vertigo-like symptoms for months. No doctor could figure out the problem (or frankly, seemed that curious, but that is perhaps a topic for another newsletter!). Several doctors wanted to prescribe migraine medication for me. However, I did not have migraines and the side effects of the medication included dizziness and lightheadedness - which were exactly the symptoms I was complaining about! So after asking questions and evaluating the responses, I chose not to take the medication and instead kept searching for an answer. 
  • An elderly client had stage 4 lung cancer. The doctor ordered an MRI. My client was extremely anxious at the thought of having to lie still for the MRI considering she coughed nonstop whenever she was lying down. It was also challenging for her to get to the hospital for the test. I called the Radiology department and spoke to a manager/technician about whether there were any options that would allow my client to be more comfortable during the test. I then called the oncology nurse navigator to discuss how important the test was and whether it would change any of the care my client was receiving. It was decided and agreed upon by all parties that there was no benefit to my client undergoing the MRI. 
  • My son broke his finger a few months ago. It hurt badly enough that he actually asked me to take him to the doctor. The doctor looked at my son’s finger, said “yep, it’s broken” then proceeded to tape it up with a splint. He then said I should take my son for an x-ray. I’m on a high-deductible health insurance plan, and it was late on a Friday afternoon, so I told the doctor that and asked “what will you recommend we do differently based on the x-ray?” He said he wouldn’t do anything differently, thought for a moment, then said that if it’s still bothering my son in a week, THEN I should take him for an x-ray. (Note that I love and take care of my kids and if the doctor said my son definitely needed the x-ray, I would have taken him for one!) Meanwhile, the next day, my son untaped his fingers, took off the splint, and went out and played football with his friends. I would not have been happy if I had spent hundreds of dollars on an x-ray!
As I emphasize when I speak to community groups, it is okay to ask your doctor questions! It is extremely important to understand what is being prescribed or suggested, the risks and benefits of it, and whether it fits with your goals and preferences.

*
Christer Mjåset, M.D. is a neurosurgeon, author, columnist and lecturer who currently works as a Harkness fellow in Health Care Policy and Practice at Harvard T.H. Chan School of Public Health in Boston studying value-based health care models.

Health Insurance Check-Up Time (Open Enrollment)

10/18/2019

 
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Choosing the right health insurance plan can be overwhelming. It may be tempting to just keep the plan you currently have rather than look at spreadsheets and dense, hard-to-decipher descriptions of coverage options.

That’s a mistake. Whether you’re over 65 and inundated with advertising about Medicare open enrollment options,  getting your insurance through the Marketplace, or working for a company whose annual open enrollment is taking place this fall, it’s imperative that we review our current plan and see what our options are for 2020.

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Here are some things to keep in mind regardless of where you get your health insurance:

  • It’s not all about premiums. To get a sense of how much you may spend during the year, you  need to look at all costs including deductibles, co-pays, co-insurance, out of pocket maximums. Click here for an article that defines these and other key health insurance terms.
  • The provider network may or may not matter to you. It’s a personal decision whether you want to trade lower costs for having to switch doctors, travel further, or have a smaller network to choose from.
  • Look at the health care services you think you’re most likely to need and try to find a plan that meets your specific needs. For example, if you know you’re going to need a lot of physical therapy (PT) next year, it may make sense to pay more in premiums for a plan that provides better coverage of PT visits.
  • Do you have a second home in another state? Provider networks will be important in this scenario.

Medicare

Medicare Open Enrollment started October 15 and you can’t watch TV these days without seeing commercial after commercial about different Medicare insurance options. During Medicare Open Enrollment you can:
  1. Switch from Original Medicare to Medicare Advantage
  2. Switch from Medicare Advantage to Original Medicare
  3. Switch from one Medicare Advantage plan to another Medicare Advantage plan
  4. Switch from one Part D (prescription drug coverage) plan to another Part D plan

A few tips:
  • Be sure to check the formulary (list of covered medications) in your current Part D plan and any Part D plans you are considering to make sure your medications are included. You can do this on Medicare Plan Finder.
  • If you’re in a Medicare Advantage plan, be sure to check whether your providers will still be in network next year.
  • You can download the 2019 Guide to Medicare Open Enrollment from the Medicare Rights Center.
  • This article, 3 Ways to Prepare for Medicare Annual Enrollment 2019, has helpful advice. 

Health Insurance Marketplace and Employer Health Plans
  • Open enrollment for the Health Insurance Marketplace/Exchange is from November 1 - December 15.
  • Open enrollment timing and options for employer-based plans vary. 
  • For either, here is some helpful advice about Choosing A Health Plan from FAIR Health.
  • More general advice about open enrollment for health insurance and other benefits from Forbes and U.S. News

​Bottom line: Be sure you understand your options, get your questions answered, and know your preferences (cost, access, convenience, willingness to accept risk, etc.) before you make a decision. Contact me if I can be of help. 

Is This Credible Health Information?

9/18/2019

 
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“My doctor put me on XYZ medication? Do you think I should be taking it?”

“My 3 year-old has a rash and is throwing up. My doctor said to bring him to the office. What do you think I should do?

“My dad sometimes seems confused and sometimes doesn’t. Does he have Alzheimer’s disease?”

The above are simplified versions of actual posts I have seen on community Facebook groups. Then 50-100 people respond with their opinion. While these groups are useful for many things, the people responding are not medical experts — and if they are health care professionals, they do not know all the specifics of your situation. If you want credible health information, you need to go to credible health sources to get it.​

So, what is a “credible health source?”

Your doctor. You might not like what your doctor has to say, or you may not feel the information you get from your doctor is complete, easy to understand, or right for you, but your doctor/health care provider should be a credible source of health information. If you don’t feel that way, it may be time to try a new doctor.

SOME sites on the Internet. Not all. How do you know the difference?

The National Institutes of Health provides information for evaluating whether a website has reliable health information. The photo on the right shows a summary of what they suggest you look for.

The NIH’s National Center for Complementary and Integrative Health also has great information about evaluating health information on the Internet, social media, and mobile apps. There is also a section on Are You Reading News or Advertising?

The U.S. National Library of Medicine also has a number of resources on their website. They even have a tutorial that takes you step-by-step through evaluating two websites. 

Look for information from nationally known health centers (e.g., Mayo Clinic), trusted disease-specific associations (e.g. Alzheimers Association), government sites (e.g., National Institutes of Health), or academic institutions (e.g., Harvard Medical School health newsletters).  

A good rule of thumb is that if the site is filled with “BUY NOW” links, it’s not a reliable, unbiased source of health information. Find another website!

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Source: National Institutes of Health. ​https://www.nia.nih.gov/health/online-health-information-it-reliable

In The News: Death & Chocolate (Larger Than Life Conversations)

8/16/2019

 
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This Chicago Tribune article perfectly captures the spirit of a program psychotherapist Allison List Hutner and I have been facilitating. Please contact me if you’d like to learn more about the program or have us facilitate a session for your organization, book club, family, or friends. You can also participate in this program at the Vernon Area Library on Wednesday, October 2 at 7:30pm (register here) or the North Suburban YMCA on Thursday, November 7th at 11:15am (register here).

​Read the entire article here.

Important Information for Older Adults

8/16/2019

 
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I recently came across two important articles for older adults and wanted to share them with you.

This article provides an excellent framework for having an honest, helpful discussion with your surgeon before deciding whether to have surgery. It provides questions that really address and explore a patient’s values about quality of life. I encourage you to take a few minutes to read it. 

Did you know that many regularly used medications can cause confusion in older adults? Be sure to read this article to learn more about anticholinergic drugs (eg, antihistamines) and how they can be harmful. Searching the Beers list for potentially inappropriate medications use in older adults is also a must; if you see medications on the list that you or a family member is taking, don’t hesitate to ask your doctor about it.

June is Alzheimer's and Brain Awareness Month

6/24/2019

 
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​Did you know that every 65 seconds someone in the U.S. is diagnosed with Alzheimer’s? It’s the 6th leading cause of death and affects 10% of people age 65 and over. In addition, family and unpaid caregivers provide over 18.5 billion hours of care - and have high levels of physical, emotional, and financial stress as a result. (More facts available from Alzheimer’s Association.) This month’s blog provides resources about Alzheimer’s and other dementias including symptoms, care options, and caregiving support.
First, it can be confusing when people talk about Alzheimer’s and dementia. Are they the same disease? Dementia is an umbrella term that includes Alzheimer’s disease, vascular dementia, Lewy body dementia, mixed dementias, and frontotemporal degeneration. Alzheimer’s disease is the most common form of dementia. If you're concerned about yourself or a loved one, be sure to consult with a health care professional.

Wondering what signs and symptoms you should be concerned about versus what is considered “normal aging?” Here is a link to 10 early warning signs to watch out for, courtesy of the Alzheimer’s Association. Symptoms can range from frustrating, difficult to manage, or harmful for the person as well as for family members and friends. For example, hearing someone tell the same story over and over can be frustrating but it’s not harmful; however, wandering off in the middle of night can be extremely dangerous and needs to be addressed appropriately. This article has a lot of detail about symptoms, stages of the disease, and coping tips.

Caregiving is tough as well as rewarding. An important message caregivers will hear, regardless of the illness, is that self-care is critical. A wise person once told me, during a health crisis, to remember what we hear every time we go on an airplane: you have to put your own oxygen mask on before helping someone else put their’s on. In other words, if you can’t breathe, you can’t help somebody else breathe. Look for local caregiver support groups, find someone to give you a break so you can run errands, exercise, have dinner with a friend, or do whatever reenergizes you.

If you are caring for someone with Alzheimer’s or a related dementia, take time to learn tips and techniques for maximizing cognitive symptoms, engaging the person in meaningful activities, and having a person-centered care mindset. Techniques for caring for and helping someone maximize their cognitive function include: 
  • Be present in the person’s reality
  • Avoid arguing
  • Compliment the person
  • Avoid embarrassing the person
  • Match the person’s behavior
  • Set the person up for success
  • Do tasks alongside the person, not for them

There are options for getting help with caring with someone with Alzheimer’s or related dementias including in-home caregiving, adult day care, respite care, and memory care communities. Don’t feel like you have to do it alone. Search for options that work for you and your loved one. These can be expensive options but there may be programs in your area that provide free or reduced services depending on financial need, veteran status, or other factors. If you’re considering placing your loved one in a memory care community, here are some questions to ask when touring the communities.

If you have long term care insurance, be sure to know what services and options are covered. Usually, someone with Alzheimer’s or related dementias will need to provide evidence that (1) they have severe cognitive impairment, and (2) they need substantial assistance with at least 2 activities of daily living (ADLs) such as bathing, eating, dressing, and transferring. Read your policy ahead of time and be sure to work with your physician to document these needs appropriately.

If you’ve been reading my blog, you know I often talk about the need for advance care planning, making your end-of-life wishes known to family members. It is critical to have these conversations and have documents in place before a person’s Alzheimers or other dementia gets too advanced and they no longer have the capacity to make these decisions. You don’t want to find yourself in a situation where you are wondering what your loved one would have wanted you to do. Find resources here.

Forms Every 18+ Year-Old Needs

5/24/2019

 
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A few months ago, my friend’s daughter, a freshman in college, had a health scare. Fortunately, everything turned out okay! But my friend hadn’t had her daughter fill out any of the necessary forms to allow the doctor and hospital to release information to her or even to speak to her about her daughter’s medical concerns. Trying to get a busy (and uninterested) college student to fill out the necessary forms while in another state in the middle of a semester was not quick, easy, or painless. 

There are privacy laws (HIPAA) that restrict what a health care provider can share about any adult 18 years or older. Yes, this applies even if your adult
child is still on your health insurance plan. Please refer to this article with advice from a lawyer about what forms - and an explanation of each form - you should have your 18+ year-olds sign. You can complete these forms on your own or meet with an estate planning attorney. (Special thanks to Emily Rozwadowski of Spencer & Rozwadowski, LLP for reviewing this information.)

Briefly, the four important documents are:
  1. Health Care Power of Attorney - allows you to designate someone to serve as a your proxy or agent in case you are unable to make medical decisions on your own (Illinois form)
  2. HIPAA Authorization - a document that allows health care providers (and others) to share specific health information with people who you designate to receive that information (sample form from the American Bar Association)
  3. Durable Power of Attorney/Power of Attorney for Property - allows you to designate someone to act on your behalf for financial matters
  4. FERPA Release (Family Educational Rights and Privacy Act) - permission to access educational records (more info and model forms here).
If your adult child is attending college in another state, it may be safest to fill out forms for each state. Some colleges have their own forms as well (e.g., the University of Illinois has this authorization to release confidential health information form); this is something worth asking about at parent orientation.

Once you’ve filled out the forms, keep them in a secure place. Also, be sure to scan them so you can easily access them from your phone as well as from your child’s phone.

So, while you’re checking towels, sheets, comforter, etc off of your college packing/to do list this summer, please add “fill out important forms!”

Disclaimer: this blog does not constitute legal advice. If you have specific questions about what forms to use or how to fill them out, please contact an estate planning attorney.  

Let's Talk About... Death Over Dinner?

4/26/2019

 
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Do you know what conversation most Americans are NOT having with their loved ones that they should be having? It’s actually not one conversation but a series of conversations… about end-of-life issues and about life-issues… How do we want to die? This is really about how we want to live, what is important to us, what we want our family and friends to know. After all, it’s hard to have a “good death” without having a good life.
I recently became intrigued with a program known as Death Over Dinner. No, it’s not a murder mystery party. And it’s not as depressing or morbid as the title may suggest. It’s also not just for older people.

Last week, I facilitated this program with an amazing group of women in their 40s and 50s. Many of them were hesitant and skeptical ahead of time. We discussed deep, important topics. “if you had an hour left, what would you feel was unresolved?” A discussion on what we would say if we had to give our own eulogy. And more. Some of the comments after the program included “that was so worthwhile” “can we do this again?” “this was hard, thought provoking and inspiring.” “I felt exhausted when I got here but energized when I left.”

The long term goals of the program are multi-fold: 
  • Start thinking about your own mortality, share your end-of-life wishes with your loved ones.
  • Feel more comfortable having the conversation with your aging parents, your spouse, your adult children. Gain ideas about how to start those conversations.
  • Think about how you’re living your own life and whether there are changes you want to make.
  • It doesn’t hurt if, as a result of having this conversation, you decide to get your advance directives (healthcare power of attorney, living will, POLST documents) and estate planning in order!

My colleague (and traveling Medicare-certified social worker), Allison List, LCSW, and I will be facilitating this program at the Vernon Area Library and the North Suburban YMCA this fall (click here for program dates), and are talking with several other organizations. If you’d like us to facilitate a program at your organization or for your family/friends, please contact me.

Resources to help you start the conversation… and fill out your advance directives:
The Conversation Project
The Five Wishes
State-specific Advance Planning Forms from the American Bar Association

Tips for Talking With Your Doctor

3/20/2019

 
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I recently led an engaging and informative talk about “Talking With Your Doctor: Making the Most of Your 15 Minute Appointment.” I’ve always believed that most of the problems people experience with navigating the health care system are a result of poor communication and coordination. It can be difficult to question providers, know what to ask, and be able to process the information. It is especially challenging to do so when you are emotionally overwhelmed by the situation. 

The most important advice is to Speak Up and Ask Questions! It’s your health, so take charge of it. If you don’t understand what the doctor is telling you, ask them to repeat it. Ask questions about medical tests, medications, your diagnosis, treatment options. Speak up about your symptoms, your needs, your values. 

Prepare for your appointment as if it’s a business meeting - have an agenda, put your priority items first in case you run out of time, and end the appointment with a clear understanding of what was accomplished and an action plan for next steps. 

This brochure about Talking With Your Doctor, from the National Institute on Aging is a great resource for people of all ages about how to prepare for and get the most out of appointments with your doctors. It’s filled with advice, tips, and worksheets. I strongly recommend taking time to look at it and using it to prepare for your next appointment.

Ask me how I can help with your patient-doctor communication… or to schedule a presentation for your organization.


Looking to save money on prescriptions?

2/18/2019

 
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​   A couple of weeks ago, I was prescribed a new medication... that had a
   hefty price tag! My first question was “what’s the cash price?” When that wasn’t
   any cheaper,  I checked with the pharmacy tech about the coupon from the drug
   manufacturer’s website (apologies to everyone behind me in line at my
   local pharmacy). I ended up 
leaving the prescription at the pharmacy and
​   went home to look into more options.

What can you do to lower your prescription costs if a medication you need isn’t covered by your health insurance?​

  1. As I mentioned above, ask if the cash price is cheaper. Sometimes you can get a better price if you don’t use your insurance. Seems counter-intuitive but it’s true.
  2. Check your health insurance formulary (list of prescription drugs that are covered by your insurance plan) to see what alternative options you have, including generics or similar drugs. Share that list with your doctor and discuss whether any of the other drugs are a good option for you.
  3. Ask your health insurance plan to make an exception. This requires some effort from you and your doctor but you can ask your health insurance plan to cover your medication even if it’s not on the formulary. You can learn more about the exceptions process for private insurance here. Medicare has an exceptions process as well.
  4. Look into prescription assistance programs. There are non-profit organizations, pharmaceutical manufacturers (check their websites), and state and local government programs that can provide financial assistance with paying for prescriptions; many programs are not based on income.  Some websites compare prices and offer coupons. Here are a few you can look into:
    1. GoodRx.com - GoodRx finds and compares prices for every FDA-approved prescription drug at over 70,000 pharmacies nationwide. There can be substantial variation in price. You can also find coupons on the site or mobile app as well as get a GoodRx discount card.
    2. NeedyMeds.org - NeedyMeds provides information on how you can obtain assistance in paying for your medications. Search by medication name and find out if there are coupons, rebates, or financial assistance programs from the drug manufacturer. NeedyMeds also has a drug discount card. 
    3. Partnership for Prescription Assistance - PPA is another program that can help you find out what prescription assistance resources you may be eligible for.
    4. Medicare Extra Help - If you’re on Medicare and having limited resources, you may qualify for the Medicare Extra Help program which helps pay the premiums, deductibles and co-pays associated with prescription drug plans.
5. Other options include going to a big box store, using a mail-order pharmacy or getting a larger supply.

​So, what did I do about my medication? Well, in my case, the GoodRx price was only a few dollars less, there were no substantive coupons available for this particular medication, and the pharmaceutical assistance program was income-based. My doctor gave me free samples while we work together to request an exception from my health insurer. It’s a long shot but it’s worth a try because if you don’t ask, then the answer is definitely no. 
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InTune Health Advocates, LLC, Deerfield, Illinois, phone: 847-920-8238, email: Gayle@InTuneHealthAdvocates.com
InTune Health Advocates, LLC does not provide legal, medical, or financial advisory services.