Putting off seeing a doctor

This is part three of a four part series about the four main reasons why people put off seeing a doctor:

Reason #1:  It will go away.

Reason #2:  Money.

Reason #3:  Time.

Reason #4:  Fear

 

Why people put off seeing a doctor?

 

Reason #3:  Time.

 

I find that in this busy world today that time is a precious treasure.  God gave each of us 24 hours a day to use however we want.  There are many demands on time with the family work, church, and recreation whatever people use their time for that is decision it must make.  Time is there and how one uses it is a choice.  When there is pain involved and sickness, the decision that patient makes is how bad is it because, “I only have so much time and therefore I have to determine how much time I may need to take for this problem.”  It usually is the severity of the problem that dictates how much time the patient takes to address this problem.  When it comes to TMD and sleep disorders, the pain is not that severe often times and it is episodic in nature and therefore the patient puts it off because he does not have “have the time” to deal with this situation.  The reality is that the longer it is put off, the more time it is going to take to recover from it.  That is the conundrum that exists when it comes degenerative disorders such as temporomandibular disorder and sleep apnea.  The longer treatment is put off, the more time it is going to take both in evaluation and in treatment and in future loss of time dealing with this disorder because permanent damage has occurred because of this degenerative disorder.  Therefore, it is actually a good use of time to deal with a problem or degenerative disorder such as this early on.  It takes few hours off of work to figure out what is the problem and then determine the best course of treatment from there.  Once people realize this, they would know that it is a good use of time to go and see a doctor who has had specially training in this type of disorder.  The time is well spent because at the end of the initial evaluation, the patient will understand their problem and also understand how to manage future time allotment addressed to the particular problem they have.

 

One of my look at is an investment in the future.  Investment of her few hours for the initial evaluation can save much time in the future.

 

Dr. Prehn

Putting off seeing a doctor

This is part two of a four part series about the four main reasons why people put off seeing a doctor:

Reason #1:  It will go away.

Reason #2:  Money.

Reason #3:  Time.

Reason #4:  Fear

 

Reason #2:  Money

 

Many people delay treatment because they think they are trying to save some money.  They believe, by waiting until later, either it go away or they feel like they do not have the money to pay for the initial evaluation.  They feel that the initial evaluation is too expensive and that it should be much cheaper.  They believe, we have heard people say  “how much can it possibly cost for the doctor to listen to me for five minutes and look at my joint and tell me what it is wrong.”  Some people have many expenses, family emergencies, and other medical conditions and they are trying to way the benefit and the cost.  This is understandable and I believe that at some point when the decision is made to actually see at me, they have come to realization that the value of knowing the problem is worth the money they have to pay.

 

The other aspect of money that people complain about is that they think insurance will pay for it.  They also believe the insurance should pay for it because they have insurance that pays for other medical problems.  What they do not realize is that they have been in the insurance world up to this point and it has failed them.  The insurance only pays al little as possible so that  they can make a profit.  The insurance company wants to make that profit and they do not really care about anybodies health, no matter what they say.  They have shareholders to please.  Nevertheless, many people have brought into the lie that insurance companies are going to take care to care of them and therefore they are unwilling to put out money to care for their own problems.

 

Money is not the problem and value is the problem.  People who do not come to see us because they think it is too expensive, do not value their health or they did not value knowing what is their problem.  That is a personal decision that they all have to make.  People never buy what they need.  They always buy what want.  When they want to have their condition look at and diagnose properly, then they will pay for it.  Some people can live with the pain and they do not think it is worth pain money to figure out what it is going on.  Some people have no understanding of what the pain issues are and they accepted as the way life is.

 

I just wish they would realize that putting a little bit money into the proper diagnosis can save them a whole lot money later.  Since temporomandibular disorder is a degenerative process, early intervention can slowdown this degenerative process significantly and even to the point where they could save significant amount of money and surgical costs, and physical therapy for the rest their life.

Also, an ounce of prevention is definitely worth a pound of  cure when it comes to temporomandibular disorders.

 

 

 

Dr. Prehn

Putting off seeing a doctor

This would a four part series one after the other as I consider the four main reasons why people put off seeing a doctor:

Reason #1:  It will go away.

Reason #2:  Money.

Reason #3:  Time.

Reason #4:  Fear

                             

Reason #1:  It will go away. 

 

People seem to delay coming to our office for treatment because they believe that the condition will go away.  This is directly proportional to the number of episodes that the patient has had and the severity.  If the patient has had very few episodes and do not seem to be that bad in severity, then they would think it will never come back again.  They believe if they waited it out, it will eventually fade away and never come back again.  They also believe that it will go away if they could figure out what actually causes to happen and they can avoid this event by avoiding what triggers it.

 

Often people would try over-the-counter medications or self help treatments to address the TMJ disorder.  It is amazing what lengths people go to avoid seeing a doctor.  I have seen people who have been taking eight Tylenol a day for months before they come to see me.  I had this one patient, who was having massages every other day for a month to see if that would make the pain go away in order not to a doctor for condition.

 

The problem with this approach is that the patient is self-diagnosing.  Sometimes this patient can be a real doctor!  I have some doctors who come to my office and they have diagnosed their own problem and thinking that will go away with certain over-the-counter medications and so forth.  I reminded them of the old saying “A doctor who treats himself has a fool for a patient.”  This can be extrapolated to anybody who tries a treatment themselves for a condition they are not aware of.  People who delay seeing the doctor for a condition that they have been made aware of is self-diagnosing and this could lead to further permanent damage and breakdown of the TM joints.  Delay of treatment could also make the prospect of healing much more complicated and costly.

 

My thinking is, a person with any type of degenerative disorder such as this should get a proper diagnosis and understanding of what the degenerative disorder is and then they can make their own decisions on treatment.  If they decide to delay treatment after they understand the condition then that is understandable.  But for somebody who avoid seeing a doctor because of a condition, is not understandable to me.

It is my wish and desire that anybody who has a temporomandibular disorder gets a proper diagnosis.  I realized that I may not be the one to treat them; however, I want to maintain my fees at the initial examination as low as possible in order to have anybody and everybody have access to the knowledge I have to be able to diagnose that condition.  This I believe is one of the purposes of my practice in the Houston area and wherever else I am practicing.  The purposes to properly diagnose people’s degenerative joint disorders so that they can make informed decisions about their treatment.

 

Check back next week as I discuss Reason #2:  Money.

 

 

Dr. Prehn

Some thoughts on socialized medicine from a physician

Here are some thoughts from my brother Robert Prehn who is an ENT surgeon up in Oshkosh WI. I asked him what impact on my practice socialized medicine (as proposed by Obama) would have on the care of my patients. I am not usually politically minded and I don’t want this blog to be a source of debate. I am only posting this because I thought it was interesting having the view of a MD. He is one of the best surgeons I know, and if he is thinking like this, then the whole system is in trouble as we will lose highly skilled physicians like this in a socialized medical system.

 

Ronald S. Prehn DDS

 

 

In my view, an Obama Presidency will have a disastrous impact on the poor and middle class as far as health care access. The poor and middle class will be relegated to a second class gov’t funded status when it comes to health care, and the rich will simply pay for the Cadillac service that they are used to.

 

And that leads me to the second point, in that it will have almost no effect upon Ron and Fred just like Medicaid and Medicare have no effect now. People have and will pay cash for things in which they feel there is a huge need…cell phones, wide screen TV’s and gold crowns for their teeth. The best thing dentistry did was it included the pt in the fiduciary responsibility for their care. The insurance industry and the govt’ long ago removed the pt from that important part of the relationship in the medical field, which explains why we are where we are.

 

Socialized medicine will drastically change how we (physicians) do business, and may even lead me to explore other career opportunities. I am open to anything, and find the challenges kind of exciting. I have talked with several of my colleagues from Europe at the last several meetings, and they tell me they have two parallel practices. They give two or three days to the gov’t, and 2-3 days to private pay pt’s. The gov’t days are pretty much a wash financially, and the wait list for those pt’s averages around 15-22 months. Private pay pt’s get in within about 3-4 weeks, much like it is now. The exception is Canada, where the gov’t has made private pay illegal. However, the Canadian Supreme Court is currently hearing a case that challenges that very law, and Canadians may soon be able to do what their European counterparts  have been doing for over 15 years. If the US goes the current Canadian route, then I will indeed retire from clinical medicine and pursue other opportunities. However, I really doubt that Americans would go that deep into socialized medicine. Making it illegal to purchase private health care is simply Unamerican.

 

Here are some stats to add to the debate:

 

Number of uninsured Americans: 43 million ( out of over 300  million people)

 

Number who make less than $27,000 : 18 million (these people already are covered by the gov’t if they would only sign up for it…they are either incapable of filling out a form, or are too lazy)

 

Number making over $75,000 without health insurance: 11 million- these people have CHOSEN not to take health insurance. They certainly could afford a high deductible policy, they would rather spend their money on other things. Fair enough, their choice.

 

So, that leaves 14 million people (out of 300 million) uncovered. Are we going to essentially shove our poor and middle class citizens into a federal gov’t run second class medical system to cover everyone including these 14 million. Or, can we do what Mitt Romney suggests, have the states experiment with plans to get these 14 million people covered? His state plan failed, but it was a nice try. Here in Wisconsin we have Badger Care, which has worked pretty well. Find what states can do it right, and empower them instead of a gargantuan gov’t beauracracy infringing on our health care system.

 

Just a thought…

 

Robert Prehn

6/4/08

TMD in a General Dental Practice

The difficulty in treating TM disorders in a general practice setting is subject that it is near and dear to my heart.  In my growth as a restorative dentist I had integrated TMD into my practice early on in my career.  But as I did so I came to realize that treating temporomandibular disorders is a whole different animal than doing dentistry.  I always call doing dentistry a “doing sport” and treating TMD a “thinking sport.”  The patients come to a dentist with a dental problem.  The dentist diagnosis the problem and fixes it.  People come to a dentist with a TMD problem and a dentist has to take a history and cognitively try to workout a complex differential diagnosing and coming up with a treatment therapy.  The difference is profound in both the diagnostic phase and a treatment phase of dentistry versus TMD.  I will have another blog entry on the philosophical aspects of TMD; however, as it applies to a general practice, it is a challenge for a dentist to augment treating TMD into a general practice. 

When I did it as a general dentist, I started by setting aside a part of my schedule for treating TMD patients.  I would make Tuesday mornings my “TMD morning.”  Those mornings I would set aside the type of schedule I need in order to address these patients properly.  The schedule for treating TMD patients is completely different than dentistry.  If it is to be done with any sort of profitability, the staff has to be trained at a higher level, especially the assistant.  The assistant needs to be trained in taking a history, so that she can present it to you in a short period of time.  That is the critical aspect of any profitability of a TMD portion of a dental practice.  Start out making the TMD time on Tuesdays and the TMD practice can grow from there.

Treating people with TMD in a general practice setting will be challenging if the dentist does not segregate the two.  Integration of TMD into dental practice schedule is difficult and disruptive.  The decision a dentist has to make is in his level of involvement with treating these patients.  In order to discern that level of involvement it is incumbent upon the dentist to become very proficient at diagnosis.  If the dentist can diagnose a higher level of diagnostic ability, the dentist is better able to determine which type of patient he can integrate into his practice.  Because once the proper diagnosis is determined, the dentist can then determine how much time and therapeutic management is going to be needed and how he can integrate this into his general practice.  He can also determine, which patients needs to be referred to a specialist and at what levels.  Therefore, it is my contention that to practice dentistry at a high professional standard, TMD diagnosis is absolutely critical.  Without the high standard of diagnosis, I believe the dentist is putting himself into a precarious situation with his patients.  This is both bioethically and legally applicable. Learning all aspects of TMD is absolutely essential in this process.

 

God bless,

Dr. Prehn