Dr. Brooks blogs on weekly basis on HOTNationTalk.com. Keep an eye out for his blogs on KevinMD.com as well!

These blogs are meant to both inform and educate clients about the possible concerns and nature of the health care industry. If you have any further questions, please contact Dr. Brooks by email.

  • Ten Principles For Affordable Healthcare Reform

  • This is the first of a five-part installment about ten principles that can be followed to create a true reform of the American healthcare structure that will be of little relative Cost to the taxpayer.

    First, there is no "right" answer to this issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far, and likely in the future, the reform will be political and thus costly, painful and will not address the core issues involved in fixing the inherent systemic problems. There have been many things written with regard to this topic and I suppose one chooses to read that which comports with one's leanings on the subject. In my case, I have tried to access diverse opinion sources from Brookings and Rand to Cato, National Center for Policy Analysis, The Hudson Institute and everything in between. I have taken the best thoughts from individuals with whom I have corresponded and have incorporated those thoughts, as well as, in a larger measure, my own herein. If some of these words are similar to others you have heard or read, it is not because I choose to plagiarize them, it is because they have become part of the lexicon of my thinking. This thinking and these principles are also offered as a consequence of extensive American, Canadian, and, to a lesser degree, British experiences as a physician, surgeon, instructor, and cardiac transplant patient (in the former of the three healthcare systems). They are meant to provoke thought and discussion, and are not offered as sole solutions, though they may have some individual merit by virtue of their common sense. I offer them ten principles for healthcare reform and they are of comparatively little cost to the taxpayer when compared to the current Act. They are, in summary, as follows:

    • Healthcare is not a right, but a responsibility.
    • We do not require a single payer, but, rather, a single payment system.
    • Changes should be made in small increments, easily understood by the People.
    • Rationing is a logical outcome in any system with limited resources and high demand.
    • Efficient, effective healthcare must be provided to the truly needy
    • Medicine must be practiced in a manner and place that is economically efficient, evidence based, specific to local community needs.
    • All members of Congress, their dependents and all federal employees must live under the same healthcare rules that they themselves create for those that pay their salaries and provide their pensions- We the People. No waivers can be given to any company or entity.
    • American pharmaceutical companies must decide at what end of the drug development / delivery-to-patient pipeline they wish the American taxpayer to subsidize. They can no longer take from both ends.
    • Healthcare reform cannot occur without tort reform.
    • We must create a national healthcare database so that best practices may be established

    1. Healthcare is not a right but a responsibility. If one does not accept responsibility for his or her actions, there are no consequences for a particular behavior and when translated into the delivery of medical care, that only means increased expenditure. "Rights" are either things you, as a free citizen, may do either without interference (with the implicit caveat that you do no harm to others during the conducting of the specific activity deemed a right) or may not be done to you without permission (such as search and seizure). What is implicit in a right is a protection but not a gift of goods and services created because of the work, sweat, time and capital investment of others. If healthcare is indeed a right, then these healthcare goods, as it were, must then be seized forcibly, by law or by theft, from others who have provided them in what, in my estimation, is a frank violation of their rights of not to be robbed of their property. This then begs the question of whether the absolute right to healthcare also involves the right to steal from those who produce the goods and services necessary for that care. In a broader sense one must also ask where do one's rights end? Do they extend to food, or housing or a job?

  • The Top Ten Musts for Your Hospital Visit

    Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things about which you must know, and certain things that you must do in order to ensure that your reasonable expectations will be met.

    The following is the short list and it is followed by a more detailed explanation:
    1. Know the terms and limits of your health insurance policy
    2. Don't be afraid to ask questions of your doctor; he or she is responsible to you. Have a list of questions ready beforehand.
    3. Get to know the doctor's office staff, as they are his gatekeepers.
    4. You are your own best advocate.
    5. Do not feel you will be improperly treated because you ask questions.
    6. Set up the discharge at least 48 hours ahead of time with the hospital's Discharge Planner assigned to your case.
    7. Understand the medications you or your loved one is prescribed at discharge. If possible, obtain the prescriptions prior to discharge so that they may be filled ahead of time.
    8.Understand the discharge instructions; have the doctor or his P.A. explain them to you. Make sure you have the things you need to care for yourself or your loved one at discharge.
    9. Request the hospital records at the time of discharge; you are entitled to them.
    10. Once you receive the explanation of benefits (EOB) from your insurance company, make sure the hospital bill is accurate.

    Explanations to the above:

    1. You must become informed about the terms and limits of your health insurance policy. See if the fees you are being charged can be negotiated ahead of time. If you do not know the terms and limits of your policy, you will not know the financial field upon which you are playing, and the end result may be significantly displeasing to you.
    2. Do not be afraid to ask questions of your doctor. By accepting you as a patient he or she has made a contract with you to provide you with the best possible care. This means that the doctor must make time to answer your questions. On the other hand, you must realize that doctors do not have much time in today's medical environment owing to the system under which they currently work. Therefore, prepare a list of questions for the doctor each day, and set a time during the course of the day that you and the doctor can meet so that these questions can be answered. If possible, e-mail the questions to your doctor before hand.
    3. As communication with the doctor is critical, it is important to understand that his office staff is the gateway to the physician. Take time to get to know the office staff before the hospital admission, and it wouldn't hurt to send the office staff some flowers or a note on the day your loved one is admitted to hospital, thanking them for their efforts on your behalf in the preadmission process. As my grandmother said, if you want a kiss, you have to give the kiss.
    4. While your physician is your best advocate during the hospital admission, in reality you are your own best advocate. If there are issues regarding the room or the floor on which you are staying, difficulty with the nursing, with the timing of medication, or with any concerns that you may have, your first step is to discuss these concerns with the attending nurse; be firm, but polite. If your needs are not met, then your next step is to discuss the situation with the Charge Nurse. If your needs are still not attended to, you must communicate your concerns to the doctor. If the issues are still unresolved, then you should seek the offices of the hospital administrator or the hospital ombudsman, state the issues and demand to be seen. It is highly unlikely that you will have to get beyond the second step in this process. Most professionals want to meet your needs.
    5. Do not feel that any of the staff or your physician will treat you in any less a manner if you raise the aforementioned issues. It is the job of the nursing staff and your physician to attend to the patient, and any lack of attention to you in the context of proper medical treatment for you or your loved one is a serious breech of professional protocol of which no physician or nurse wishes to be accused.
    6. Make sure that you see the hospital social services worker or hospital Discharge Planner assigned to your case at least 48 hours before your discharge so that arrangements can be made for any equipment or durable medical goods that your loved one may require while at home.
    7. It is also necessary to understand the medications that you or your loved one will be taking upon discharge from hospital, and how they are to be taken, with what frequency and what dosage. If possible, arrange to have the prescriptions written by the doctor or the P.A. a day before the discharge, so that you may arrange to have your pharmacy fill them and they can be picked up before returning home.
    8. Make sure that you speak with your doctor prior to the discharge and that you go through the discharge instructions with the physician or his representative so that you understand each of them. If there are dressings to be changed, make sure that, if you are the one to change those dressings, you completely understand the process to follow and have the necessary goods to perform the task (gloves, dressings, ointments, disinfectants, etc.).
    9. At the time of your discharge, you should request your hospital records for the visit. You are entitled to these records and it is important that you have at least a summary of the visit, an operative note if applicable, any imaging reports, laboratory studies and a discharge summary. These records should be kept in a place that is accessible should it be necessary to refer to them in the future. Having the records may very well save redundant and unnecessary treatment going forward.
    10. Make sure you understand the final hospital bill, in the context of the limits of your insurance policy. If you have any doubt about the amount that you owe, then you should make an appointment with a hospital representative and have them go through your bill item by item so that you understand everything. If you have any question as to whether a charge or drug or item was actually utilized or supplied, you can refer to the hospital records that you have received at the time of discharge.