HealthPerspective October 2013 Copyright 2013 The Valley News & The Herald-Journal
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What is an internist
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Taking pills safely By ANUJ WADHWA, MD Internal Medicine CRHC
Sometimes it can seem as though every time you go to see your provider, you are given a new pill to take. If you are seeing more than one provider, or if you get admitted to the hospital, it can get really confusing. Here are a few tips to keep your medications straight, and to keep yourself safe from unwanted side-effects. 1) Tell your provider about all the pills you take, including over-the-counter and herbal medications. It may be best to bring the pill bottles with you every time you see your provider. 2) Be sure to mention any allergies, including what the reaction was. You must understand, though, that some effects from medicine, e.g. - nausea from antibiotics
may simply be a side effect, not an allergic reaction. It may be safer for you to take that antibiotic rather than a replacement which is not as effective. On the other hand, lip swelling from any medication is serious, and you should not take that medication or certain other related medications. 3) Let your provider know if you could be pregnant or are breast-feeding, so that they can select the safest medication for both you and the baby. 4) Educate yourself. Keep a list of the medications that you take and why you need to take them. Also, make sure that you understand how you should Anuj Wadhwa, MD take your pills - on an empty stomach, on a full stomach, before meals, first thing in
the morning or last thing at night. Know whether you can stop them on your own, and if so when. For example, most antibiotics should be taken for the prescribed duration even if you are feeling better, because a partially treated infection breeds resistance. Most painkillers, however, can be stopped or taken on an as-needed basis if your pain gets better. If you are prescribed a new medication, your prescriber or pharmacist can tell you about the common side-effects, and you can also read the printed information that comes with your prescription. 5) If you are not getting any better, you should go back to see your provider to check if they need to change the dose or switch to something else. A word of caution, though. Many medications, e.g. - painkillers for sprains or medicines for depression do not work instantaneously and do not work miracles. You should not suffer unnecessarily, but you should have realistic expectations.
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6) Do not take more of the medicines than prescribed. If one is good, two are not always better! In fact, two may have little benefits while increasing the side-effects to annoying, and even dangerous heights. 7) Do not take medicines prescribed for someone else. You may have a different medical issue, although your symptoms may be similar, and you may have other medical problems or you may be taking medicines that make it unwise for you to take that medicine, or you may need a different dose. 8) Store your medicines away from the reach of children. 9) Throw away medications past their expiry or medications that have been discontinued.
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Just what is an internist anyway? Internal Medicine CRHC
With several internists new in our area, people may be wondering just what has arrived. Our area has long had family physicians, doctors who provide care for patients â€œ f r o m critical to graveâ€?, from birth through Steven Freeman, childhood MD and into advanced years. Internists focus on medical care for adults only. Internists are doctors of internal medicine. The term internal medicine is an old one, originating in Germany in the 1800s.
For many years internists were the â€œdoctorâ€™s doctorâ€?, or â€œdiagnosticiansâ€? who other doctors turned to for diagnosis and treatment of complex adult patients. Internal medicine is the mother specialty for the various medical subspecialties, such as cardiology, pulmonology, nephrology, and so on. To this day physicians who want to learn those subspecialties first go through training in the specialty of internal medicine, then sub-specialize from there. Now days, internists often describe themselves as â€œdoctors for adultsâ€?. In fact, the American College of Physicians has used that as a motto. Much like pediatrics is the medical care of children, internal medicine is the medical care of adults. They serve as a â€œpersonal physicianâ€? or primary care physician to adults, providing medical care to adults all ages. They often ask
lots of questions, then examine patients and order tests to arrive at a diagnosis. They then prescribe medical treatment, or if needed refer a person for further evaluation, or for surgical or other treatment. They deal with a wide range of problems, varying from minor illnesses to complex webs of multiple medical problems. For patients with multiple problems and multiple subspecialists, they often serve to coordinate care amongst the various subspecialties. In the hospital and in the clinic they may not only manage multiple medical problems but also treat skin conditions, remove minor skin lesions, deal with mental health issues or substance abuse, deal with womenâ€™s health issues, or provide preventive medicine exams and advice. Internists spent 3 years in residency training after medical school to acquire these skills.
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Internists who choose to subspecialize will spend another 3 or more years in fellowship training to become oncologists, cardiologists, and so on. Internists bring more depth of knowledge about diagnosing and treating adults. There is a trade-off between depth of knowledge and breadth of knowledge. Some internists also trained in pediatrics. However, internists do not have the same breadth of knowledge as family physicians, and do not usually have training in pediatrics, and do not train in obstetrics or surgery. Those they defer to other physicians. Instead they provide care for their patients in the office, the hospital, and even in the nursing home, from young adulthood to advanced years, through the span of adult years and the various medical challenges that accompany them.
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By STEVEN FREEMAN, MD
Obamacare is the shorthand name for the Affordable Care Act, approved by Congress in 2010. Some provisions already have rolled out, but Oct. 1 marks a major new chapter: startup of the insurance marketplaces for purchase of individual policies. While the term â€œObamacareâ€? initially was used by opponents of the legislation, it has since been embraced by President Barack Obama. Often during the 2012 campaign, when health care policy was a key point of difference with Republican challenger Mitt Romney, the president said, â€œYou want to call it Obamacare -- thatâ€™s OK, because I do care.â€?
A majority of business have already added many features of Obamacare. By STEVE JORDAN World-Herald staff writer
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staff, and most employers already have adopted the main features of Obamacare or have included them for years. “In the big scheme, I don’t see this dramatically impacting the way the employers are acting,” said Omaha attorney Craig
see Obamacare, Page 5
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Kovarik, who advises businesses on health plans. For example, most employers have “open enrollment” periods each year where employees can sign up for coverage regardless of their health history. That meets the Affordable Care Act’s ban on re-
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employees. Otherwise, most employer plans are expected to be stable in 2014. Businesses for the most part will continue their long practice of offering health coverage to employees as a benefit intended to attract and keep good people on
Tuesday’s kickoff of the Obamacare marketplaces is aimed at less than 15 percent of Nebraska and Iowa residents -- people who couldn’t or didn’t want to buy health insurance before. That leaves the remaining 85 percent. This includes people covered by group plans through their employers. For most of them, the biggest change for 2014 will be familiar: costs rising in a range that six health plan experts in the region estimate at 6 percent to 15 percent. The increases are mostly because of higher medical prices and more use of medical services, the experts say, although the Affordable Care Act will contribute between 1 and 5 percentage points to the rise. Bret Sesker, a principal with Omaha benefits firm SilverStone Group, said he expects medical costs alone -- increased use and price inflation -- to rise between 8 percent and 11 percent for 2014. For employer groups, actual percentage increases will vary widely, from nearly zero to increases in the high teens, with at least part of the cost passed on to
jecting insurance applicants who have pre-existing medical conditions. The law also prohibits lifetime benefit caps and sets annual maximum out-of-pocket costs at $6,350 for an individual and $12,700 for a family. Many group policies already have lower limits on annual costs. And many businesses, in their attempts to curb cost increases over the years, have stressed wellness plans and smoking cessation -- the kinds of preventive measures emphasized in Obamacare. Aside from cost increases, the group policies that cover the average employee will contain similar benefits as in recent years, said Jerome Rewolinski, director of account management for Blue Cross Blue Shield of Nebraska. Even though the group plans aren’t required to have all of the “essential benefits” of the Obamacare marketplace policies, he said, many group plans already include most of the same benefits. “The key,” Rewolinski said, “is if you’re covered by a company plan today, you can still remain in that plan -- and in most cases you’ll be best served by having that employer coverage,” because
OBAMACARE Continued from Page 4
employers typically pay a big share of the cost. Among the lawâ€™s new features that do affect group insurance plans: a $63-a-year transitional reinsurance fee per covered person, a health insurance tax (estimated to increase premiums by as much as 2.5 percent annually) and a patient-centered outcomes research fee of $2 per covered person. The insurance tax wonâ€™t hit employers who donâ€™t buy insurance but who instead pay their employeesâ€™ claims through a health plan administrator. Thatâ€™s called a self-funded plan or self-insurance, and more businesses are considering it partly because of the new tax. The most important factor in group costs, said the experts interviewed, is not Obamacare but the claims experience of group members. Duncan Aviation of Lincoln is paying about $200,000 a year in fees from the Affordable Care Act, but employees will pay only a 2 percent increase in premiums next year, the same as this year. Medical claims have been flat, said Michael Cox, vice president of human resources. That 2 percent is just to â€œstay aheadâ€? in case of unexpected
large claims in future years. Employees enrolled in Duncanâ€™s high-deductible plan with health savings accounts have had no increase in premiums since the plan began three years ago. The company pays 75 percent of premiums for the health plans and hasnâ€™t cut benefits in recent years. Cox credits more than a decade of Duncanâ€™s emphasis on wellne ss, including on-site clinics at the 2,000-employee companyâ€™s two locations and financial incentives for people to take care of their health. â€œI think itâ€™s a cumulative effect,â€? Cox said. â€œItâ€™s not something in one year or two years or five years where you see huge dividends. Itâ€™s more of a long-term strategy. Itâ€™s part of the culture. People think about it.â€? Some employees of Royal Composites, an aircraft parts manufacturer from Minden, Neb., will benefit from the Affordable Care Act because they can use its marketplace instead of paying high rates through the stateâ€™s insurance pool for people with high-risk medical conditions. Phillip Gill, president and CEO, said he will double the companyâ€™s wellness budget in 2014 to try to control costs, but he expects another 10 percent increase. So far he doesnâ€™t offer insurance for his 140 employees, instead reimbursing them
for policies they buy on their own. The lawâ€™s penalty for employers who donâ€™t offer insurance has been delayed a year, and Gill is thinking about offering a group plan but is unsure. Meanwhile, heâ€™s offering incentives to workers who take part in the wellness program. â€œThatâ€™s the only leverage we have, is people working to get a little bit healthier,â€? he said. â€œStop smoking and quit eating sugar, and everybody would be in good shape -but thatâ€™s easier said than done. Weâ€™re trying to make it a positive thing.â€? Sesker, from SilverStone, said businesses that emphasize wellness can save on medical costs. â€œThey can beat those claim trends,â€? he said. â€œIt takes a while to really have an impact, but itâ€™s worth the time and effort.â€? The Affordable Care Act includes some efforts to reduce health care costs. Any significant cost reductions are more likely to come from the health care industry itself, said Kim Lobato, senior vice president for AON Risk Services in Omaha. Payment methods for medical providers are changing to emphasize care of patients, for example. â€œThere isnâ€™t anything yet that has really impacted (medical) inflation,â€? Lobato said. â€œThereâ€™s a lot of cost-shifting that goes on,â€?
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