Index of Blog Postings

The following is an index to the entries listed on The MedFriendly Blog, organized by subject area. It is my hope that you will visit (or revisit) some of these entries and post some comments. Trust me, you won't be disappointed.

• Celebrity Commentaries
  
• Clinical Observations
  
• Controversial Issues
  
• Guest Blog Entries
  
• Nutritional Tips
  
• Origins
  
• Passing thoughts
  
• Rants
  
• Safety
  
• Self-deprecating humor
  
• Self-help/Patient-Centered Guides
  
• Weird News
  
• You Can't Make This Stuff Up

Celebrity Commentaries:

Terrell Owens: was it a suicide attempt?

Tom Cruise is misinformed

Tribute to Phil Hendrie

Clinical Observations:

Appreciate What You Have

Bedside manner

Back Breaker

Candy for the call bell

Communication and the captain

Doctors Don't Know Everything

Family Ties

Free TV for everyone

Humanizing the patient

Insurance games

Making it Up

Medical mistakes

Out in the Open

Out in the Open

Quality of Life

There's a person under those covers

Quality of Life

Tacky blood donor solicitation technique


Working in hospitals without getting depressed.

Controversial Issues:

Medical marijuana

Guest Blog Entries:

Dr. Anonymous

Emergiblog

The Independent Urologist

The Medical Quack

Scalpel or Sword?

Toni Brayer, MD

Nutritional Tips:

Say cheese!

Origins:

This is the entry that started it all, an entry on humanizing the patient.

Passing Thoughts:

Passing thought #1

Rants:

ADHD for everyone!

Despicable

Five Things I Can't Stand About Going to the Dentist

Five Things I Can't Stand About Going to the Doctor

Proofread your dictations!

The Misuse of Physician Assistants and Nurse Practioners in Modern American Medical Practice

Publish or perish

Tom Cruise is misinformed

Safety:

Lawn Sense

Roadside Wrongdoings

Self-deprecating Humor:

The Snowblower

Self-Help/Patient-Centered Guides:

7 ways in 7 days to be happy

"Independent" Medical evaluations

Know your doctor

Medical negligence

Medical records

Multi-tasking

The patient centered guide to workers compensation

Sexual predators

Very important link

Weird News:

Sex change

You Can't Make This Stuff Up:

This is a series of posts on some amazing stories I have encountered over the years during my interactions with patients.

You Can't Make This Stuff Up: #1

You Can't Make This Stuff Up: #2

You Can't Make This Stuff Up: #3

You Can't Make This Stuff Up: #4

You Can't Make This Stuff Up: #5

You Can't Make This Stuff Up: #6

You Can't Make This Stuff Up: #7

You Can't Make This Stuff Up: #8

You Can't Make This Stuff Up: #9

You Can't Make This Stuff Up: #10

You Can't Make This Stuff Up: #11

You Can't Make This Stuff Up: #12

You Can't Make This Stuff Up: #13

You Can't Make This Stuff Up: #14

You Can't Make This Stuff Up: #15 (The Pizza Man)

You Can't Make This Stuff Up: #16 (Hey, You Never Know)

Guest Blog Entry: Five Suggestions for an Emergency Department Visit

This week's guest blog entry is from Kim, a registered nurse who runs the popular website Emergiblog: The Life & Times of an ER Nurse." I hope you all enjoy this excellent entry, written exclusively for MedFriendly. And please take some time to visit Emergiblog. With that, here is the guest blog entry:

No one wants to come to an ER. You feel sick and you are probably scared. Here is a list of things to do before and during your visit that can help make your visit as comfortable and as easy as possible.

1. Before you come to the department (before you are even sick!), make a list of all your medicines, the dosages and when you take them. Do the same thing with any medical conditions and surgeries. You will probably be in no condition to be able to give all that information, but it will be asked and it is important. Contrary to popular belief, the ER does not have access to your records at the doctor's
office. In an emergency, the information has to come from you. ( Here's a side note: if you are taking a medication, you have a medical problem. Your blood pressure medicine may be working great and your blood pressure is fine, but you are still considered to have high blood pressure.) Make a list of all the information, keep a copy of it in your wallet or purse. Even better, make sure your spouse has a copy in their wallet or purse!

2. Don't bring the entire family. In some cultures it is normal for multiple generations to come to the ER with their family member. The ER will try to accommodate you, but space is very limited and all those family members will wind up waiting in the waiting room. Bring one person with you. I've seen entire families come to the ER at three A.M. that include four children under the age of five, all
roused out of their beds to sit in the ER while their sibling is treated.

3. If English is not your first language, make sure you bring someone who can speak English. It will help to make things go a lot easier a lot faster. If there is no one, the hospital will provide a translator for you, either in person or by phone. For the record, it is best not to have a child interpret for you. Illness can be very complex and a child is not old enough to understand what they are interpreting.

4. Bring a book, magazine or something to do while you are waiting. I'm serious! It's the Law of the Emergency Room: if you bring something to occupy your time, you probably won't have to wait very long! Not all visits to the ER are serious illnesses, but there is waiting for labs and CT scan results. Time goes faster if you have something to do while you wait. This also goes for the person who comes with you. There is an old saying that in the ER we "wait quickly". Lots of action followed by lots of waiting!

5. Be comfortable. This may sound odd, but bringing your own pillow or a small blanket from home can go a long way to helping you feel more comfortable. Some ER stretchers feel like torture racks and the departments are notorious for being cold. Of course, the first thing we do is ask you to undress! Your own warm blanket is better than anything the ER can provide, trust me!

No one wants to come to an emergency department, but being prepared ahead of time and following these few suggestions can help make it an easier experience!

Five Things I Can't Stand About Going to the Dentist: part 5 of 5

My last thing I can't stand about going to the dentist….Well, I have to be honest in that the following only happened once, but I was so annoyed about it that I mind as well list it here. When I was in graduate school, I was going to a dentist who I thought was pretty good. The first time I saw him, he identified a cavity where I was having pain, which no other dentist was able to find. Each time I went to him though, he always found another cavity. No matter how much I brushed, flossed, or used mouthwash, he ALWAYS found a cavity. I couldn't understand it. When I moved from grad school and on to internship I needed to find a new dentist because I was in another state. The new dentist told me I had THIRTEEN cavities. Of course, I thought he was lying and trying to rip me off. So I went for a 2nd opinion. Thirteen cavities. And a 3rd opinion. Thirteen cavities. I didn't want to believe it, but it must be true.

Frustrated, I called the original dentist and told him about the situation. His response? "Oh yeah, I knew about all those cavities. But I didn't tell you about them because I figured you didn't have the money to pay from being a student and all. So I just figured I would tell you about a new cavity each time and focus on the worst one."

Excuse me, but…."WHAT???!!!!" I literally could not believe what I was hearing. It took years and put me in a lot of debt when I had no money at the time, but I got the cavities taken care of. Too much soda drinking, but that's a story for another day. Anyway, these decisions should be left to the patient, not the doctor. Well, that raps up my series on the dentist. If anyone has any dental stories they would like to share, I would love to hear them.

Five Things I Can't Stand About Going to the Dentist: part 4 of 5

Another thing I can't stand about going to the dentist is being told that something cosmetic or voluntary should be done, as if I have no say in the matter. For example, I've had bonding between my top two teeth for over 10 years. It has broken and needed to be redone by several dentists in the past. Having moved around often, I would invariably wind up with a dentist that was different from that one that did the original bonding. I've had several times over the past few years where the new dentists has said something like, "Yeah, we'll redo that bonding the next time you come in." I always have to say that I am fine with how it looks and that when I need it changed I'll let them know. The dentists don't push it after that point but it would have been nice to be asked about having new bonding done rather than being told about it.

Five things I can't stand about going to the dentist: part 3

Another thing I can't stand about going to the dentist is when my tooth is killing me and the dentist can't determine the cause. Inevitably, many explanations are then offered which I know are not true. You know what they are…the usual list of suspects. They are always offered as possibilities because there is no immediate way to prove it wrong. My favorites are: 1) It could be your sinuses, 2) Maybe you grind your teeth at night and you don't know it, and 3) Maybe you have a microscopic crack that can't be seen. I have no confidence in any of these explanations. Why? I was given all of these explanations once and changed dentists because I was fed up. The first time I went to see the new dentist, he zeroed in on a tooth that hurt me, tapped it with one his dental tools, and voila! He found the source of the pain and said it was pretty obvious. If I would have listened to the first dentist, I would have had pain for a much longer time than I needed to.

Five Things I Can't Stand About Going to the Dentist: part 2

The next thing I can't stand about going to the dentist is the lecturing. I understand I need to floss at least 2 times a day, brush at least two times a day, use mouthwash, etc. I've done that religiously for 6 month time stretches between cleanings and it never seems to matter. I always get a lecture. And it's not like I am missing my teeth or anything. They are all here, nice and white, and nice and straight. Yeah, I drink a lot of soda and yeah there are a some nights I fall asleep in my office chair and don’t brush my teeth that night, but hey, no one's perfect. Does anyone else get the lecture every time or is it just me? Click here for the next post

5 Things I Can't Stand About Going to the Dentist: part 1

So now I am going to turn my focus to dentists. Yes, dentists deserve their own special little category. We all have things we do not like about going to the dentist, and I am going to run down the 5 things I dislike the most about going to the dentist in the coming days, in no particular order. So let's begin. I have to say that one of the things that annoys me more that anything is when the dentist asks me conversational questions when I have gauze between my teeth and gums and all sorts of devices stuck in my mouth while it is open. Helloooooo! I CAN'T TALK WHEN MY MOUTH IS LIKE THAT! Every single dentist I have been to does this. For the life of I don't get it. I mean, can we hold the conversation until after you've drilled through my teeth? I'd love to talk to you about golf and all, but umm, my mouth is being propped open by a plastic device right now. Sheeesh. Click here for the next post.

5 Things I Can't Stand About Going to the Doctor: part 5 of 5

The last thing I hate about going to the doctor is poor bedside manner. You all know what I am referring to and I would welcome hearing your examples of this. Let me offer my own brief story on the matter. When I was in college, I spent a lot of time studying in my room. I would sit on my bed with the back of my head pressed against the wall and my legs extended out to relax. Sounds uncomfortable I guess but it wasn't that bad actually. Or so I thought. Within days, I began to get excruciating pains when exercising, especially anything that required neck pressure like sit ups or bench pressing. I became so worried that I went to the Emergency Room. I was explaining the symptoms to the ER physician and I said to him that after thinking about this, the only thing I could think of that would be causing this would be me pressing my head against the back of the wall for long periods. The doctor literally yelled at me and said, "I'm the one who is the doctor here so why don't leave the figuring out part of this to me!" I was stunned and told him I was just trying to help. He just stormed away, ordered an MRI (which was normal), and I was discharged home with some pain medications. I stopped pressing my head against the back of the wall and the pain never came back. Gee, thanks doc.

5 Things I Can't Stand About Going to the Doctor: part 4 of 5

If there is one thing I cannot stand about going to the doctor, it is poor customer service from support staff. All you need to do to have good customer service is to smile and be responsive to the patient. It is amazing how difficult this can be for some. For example, how about the nurse that comes in the examining room and barely says two words to you throughout the interaction. I am not there for a social visit but being around pleasant support staff can really help put the patient at ease. Or how about the receptionist who is seems annoyed that you are checking in at the front desk or need to ask a question? I don't have much tolerance for any of this and will usually mention it the physician. If enough people mention it, maybe the physician will address the problem with the support staff or replace him or her if necessary. Click here for the next post.

Guest Blog entry: Toni Brayer, MD

It is my pleasure to present this week's guest blog entry from Dr. Toni Brayer (MD),which was written exclusively for MedFriendly.com. Dr. Brayer runs her own successful blog which can be accessed by clicking here. I encourage you to visit. Dr. Brayer has practiced Internal Medicine in San Francisco for over 20 years. Dr. Brayer has served as President of the San Francisco Medical Society and Chief of Staff at California Pacific Medical Center. With that, I give you Dr Toni Brayer...

Hangover 101 – what you need to know
Most everyone who has experienced alcohol has also experienced a hangover. A night of partying and having one too many with friends can lead to a day of misery afterward. What causes a hangover?

The physiology of a hangover is straightforward. Alcohol is turned into ethanol by the liver enzyme alcohol dehydrogenase. Another enzyme called acetaldehyde breaks ethanol down further into acetic acid. Acetaldehyde is toxic and it impairs the liver’s ability to deliver glucose to body tissue and the brain. That leads to hypoglycemia. The metabolism of alcohol also uses up the body’s supply of vitamin B12. Couple the dehydrating effect of ethanol and the toxins of acetaldehye, with glucose depletion (hypoglycemia) and low vitamin B12 and voila!! You awaken with dry mouth, headache, weakness, fatigue, inability to pay attention and crankiness. That, my friends, is a hangover.

Ready for some added hangover facts?

Certain alcohol drinks cause more hangover symptoms. That is because of “Congeners”. These are by products from the process of fermentation of alcohol that contributes to the taste, color and aroma. These congeners also contribute to hangover symptoms. Dark spirits like brandy, whiskey, and red wine have more congeners. Clear liquids like vodka have less.

Zinc or other metals are added to sweet liqueurs. These sweet drinks can make a hangover worse.

There are lots of old wives tales about hangover remedies. Here is what works:

• Time – the body must metabolize alcohol via oxidation through the liver. The breakdown of alcohol takes time and sleeping it off is the best way to spend that time.
• Rehydration- drink water, Gatorade, tomato juice and avoid caffeine (even more dehydrating).
• Take B vitamins with magnesium. Advil as an anti-inflammatory will help the headache.
• Eat something. Food neutralizes the acids in your system and replaces glucose.

5 Things I Can't Stand About Going to the Doctor - part 3 of 5

Another thing I cannot stand about going to the doctor is very long wait times. Part of the reason this happens is because many doctors double-book patients for the same time slot to avoid losing money from no-shows. As I noted in an earlier posting, patients should be provided full disclosure of office practice that can adversely affect them. So if you are double booking patients for the same time slot, let patients know that their 3:00 appointment may happen at that time but that there can be up to a 30 minute delay. This way, the patients' expectations coming into the appointment are appropriate and if they are seen earlier than 30 minutes they will be happy. The patients will also bring things to do to keep themselves occupied for 30 minutes rather than harassing the receptionist because the appointment is not being done on time.

Let me tell you of the worse experience I ever had with a wait time. I needed to bring one of my children to an ear, nose, and throat doctor one day. The doctor was the only one in town who was highly recommended and we really needed to get something checked out. I took off from work to help with the logistics of the appointment since both children were quite young and in a stroller.

To this day, I cannot believe I waited this long, but we waited three hours to see the doctor! I asked the receptionist numerous times and I could never get a straight answer as to when the doctor was coming in. My poor kids were bored to death and getting quite frustrated being in the same depressing-looking office setting for 3 hours. I kept trying to entertain them, but how many times can you wheel them around the same coffee table and say "Wheee!." When we were called in, there was absolutely no apology from the doctor. This really irked me. If you are going to make patients wait past their appointment time, it would at least be nice to offer a sincere apology. On the rare times I am even 10-minutes late for a patient, I go out of my way to apologize. A little customer service goes a long way. Click here for the next post.

Five Things I Can't Stand About Going to the Doctor: part 2 of 5

The next thing I hate about going to the doctor (especially the dermatologist) is when they ask you to take all of your clothes off and put on some dinky little paper-thin smock-like piece of clothing. They are always too small and contain the most depressing drab colors. I realize that the doctors don't want to pay for something expensive and that these things probably can't be re-used, but good grief, could someone come up with something better than this?! They make guys look like we are wearing a mini-skirts. The worst is when the nurse tells you to wear this thing and then leaves you in a freezing room in your scantily-clad outfit, waiting forever for the physician to show up. Possible solutions are to let the patient wear boxers or briefs, get some nicer-looking and bigger smocks, and don't tell us to change into them until the doctor is ready to come in. Click here for the next post.

Five Things I Can't Stand About Going to the Doctor, part 1 of 5

Today kicks off a new blog series entitled, "5 Things I Can't Stand About Going to the Doctor." Each day will focus on a new thing that I just can't stand. I am sure many of you will share my experiences and if you do, I would love to hear about it. Also, feel free to post about your own things that YOU cannot stand about going to the doctor. As a disclaimer, I love doctors. They are who help us when we are sick. So if you are a physician reading this, please don't take it personally. One of the reasons I am writing these posts is because I hope some physicians may read these posts and reconsider the way they run their practices.

With that said, the first thing I cannot stand when I go to the doctor is when they try to do a bait and switch and have me seen by a physician's assistant or nurse practitioner instead of the doctor. Now, I don't have anything against anyone in these fine professions, but when I make an appointment to see the doctor, I expect to see the doctor. Call me crazy. A perfect example of this happened a few months ago when one of my family members had an appointment with a neurologist. We made the appointment by phone and received a letter in the mail saying "Your appointment with Dr. Smith is on such and such date and time." Again, call me crazy, but when I get a letter from Dr. Smith's office saying we will get to see Dr. Smith, when I get there, I better see Dr. Smith or I'm going to be angry.

So after sitting forever in the waiting room we were finally called in by a nurse practitioner. She began to ask us questions about symptoms and I stopped her and asked if we were going to see Dr. Smith. She said no and added that we will be seeing her and that she works in consultation with Dr. Smith. This is code for telling us that she does the entire evaluation herself, determines the impression and plan, and that we may or may not see Dr. Smith at all. What Dr. Smith will do is look over some scans and co-sign the notes that she writes. Having the nurse practitioner is a way for Dr. Smith to see more patients and run his practice more efficiently, but at what cost to the patient?

Remember, we made an appointment to see a physician who did special intense training in a particular field of science. As great as nurse practitioners are, there is no way that they know more about neurology than neurologists do. So then I had to pull the "doctor thing" and tell her than I am a doctor and that when people call my office to make an appointment to see Dr. Carone, they expect to see me and not someone else. The woman was obviously annoyed, feeling we did not think she was smart enough. But it really wasn't about that. It was about insisting that we be seen by who we were told we would be seen by. I would not have a problem if Dr. Smith told patients that they will be scheduled with a nurse practitioner ahead of time, giving people the option to refuse if they want to. What I don't appreciate is sandbagging patients at the last minute like this and then putting the patient in the uncomfortable position of confronting the medical staff. We held our ground and insisted we be seen by the neurologist. Sure enough, Dr. Smith walked in 10 minutes and did a full evaluation on my family member. Sometimes, you have to stand up for what you believe in. Click here for the next post.

Workers compensation blog series: the end for now

For now I think that I am done with the workers compensation blog series. I hope that the insights and tips that I have provided have been of some usefulness. I am sure that I will have additional updates in the future about workers compensation and when I do, I will post some additional entries. My parting thoughts are these:

1. If you do not really need to be on workers compensation and are trying to game the system, do yourself and others a favor by going back to work. The reason the system is so screwed up is because the insurance companies are taking defensive measures since people try to take advantage of the system.

2. If you have a genuine work-related medical injury/illness and it is possible to return to work, please consider doing so when you are reasonably recovered. You will always make more money by working as opposed to not working. Also, the stress related to the workers compensation system is probably only going to make your symptoms worse.

3. If you must be on workers compensation, please use the tips in this guide to help you and let us know of any tips or experiences you have to share.

Step 6: Getting Your Medications

So let's say that you are fortunate enough to have found a physician willing to treat you under your workers compensation insurance. The doctor has prescribed you medications for months, which you are now dependent on. You then receive a letter in the mail from the workers compensation company saying that based on an evaluation by one of their doctors, you no longer need treatment, and therefore, they will not pay for your medications. Now what?

Well, there are several options. The first is to appeal the decision so that your case can be pleaded in front of a workers compensation judge. This can take a month or two so it best to get the ball rolling. The patient generally wins these appeals. If you need an immediate fix, the best option is to use your regular insurance to get the medications. If you do not have regular insurance, things get a bit trickier but you can always apply for Medicare or Medicaid so you have the government pay for your medication. Another option, if you have some money stashed aside, is to ask your doctor to write prescriptions for the generic version of the medication. The generic version is far cheaper than the regular version and usually contains the same exact ingredients. Some department stores such as Walmart are selling these medications for very cheap prices.

Another option includes asking your doctor for free trials of medications. Many people don't know that representatives from the drug companies often bring doctors many samples packets of free medications to try with their patients, with the hope that they will prescribe the medication regularly in the future. Some doctors are nice enough to give these free samples to patients in financial need. Another option is to contact the drug company who makes your medication. Many drug companies have programs established for people who cannot afford the medicine. Also, check with your county health department to see if they have any programs established for those who cannot afford medications. Click here for the next post

Guest blog entry: The Independent Urologist

I will return to the workers compensation blog series tomorrow, but today I am going to take one day of rest from that topic because I am happy to announce the beginning of what I hope to be a new weekly feature. That is, today is the first of our MedFriendly guest blog series. This entry was written specifically for the MedFriendly Blog. The first guest blog entry is from Dr. Richard Schoor who runs a very interesting and successful blog, entitled The Independent Urologist. I encourage you to visit his blog and read his posting below, which discusses some commonly misunderstood urological terms so you can better understand them. And with that, I give you...the Independent Urologist.

Two urologic terms I'd like to clarify.

Most people, if they live long enough, will develop a urologic condition, yet commonplace urology terms are not well understood, not just by lay people, but by many physicians as well. Here are 2 very common tests that I'd like to define in simple language.

The urine analysis (also known as UA): There are 2 varieties of UA, a dip stick UA and a microscopic UA. UA dip sticks look just like test strips used to check pH in a pool, and test for things like urine pH, ketones, sugar, etc. Dip sticks do not test directly for blood products, such as red or white blood cells, or for bacteria. Instead, the strips test indirectly for these elements and turn color in the presence various substances such as blood pigment in the case of red blood cells, leukocyte esterase (a white blood cell enzyme) in the case of white blood cells, and nitrate (which are bacterial breakdown products) in the case of bacteria in the urine.

In contrast, when performing a microscopic UA, the testing personnel look at a sample of the urine under a microscope and can see red blood cells, white blood cells, and bacteria directly. Being able to see red blood cells directly rather than indirectly, as in a dip stick UA, is an important distinction in the 2 tests, since, for example, the presence of blood pigment is normal, but the presence of blood cells in urine is not. So the next time your doctor says that you have blood in the urine or a urinary infection, as him if the diagnosis was based on a a dip stick UA or a micro UA. Knowledge that the correct test was used could save you from unnecessary worry and medical tests.

Urine culture: People are often told that they have a UTI (urine infection) based on a UA (see above). UA's do not diagnose UTIs reliably, only urine cultures can do that. A UA can only suggest that a UTI is present. Urine cultures are laboratory tests that involve taking a sample of urine and placing drops of it on petri dishes that contain special growth media (food) for bacteria. If the urine sample has bacteria in it, the bacteria will grow on the petri dishes and the media will look as if it has specks of mold on it. The number of specks of mold can be counted and used to determine bacterial counts. Many phsycians use these counts to determine whether or not to diagnose and treat a UTI.

Thanks for listening,

The Independent Urologist

Step 5: Finding a doctor

I probably should have discussed this earlier, but one of the first problems you are going to run into with a workers compensation injury is that no one wants to treat you. I'm exaggerating to make a point, but seriously, you will find that few doctors are willing to even see you. Why? Well, one reason is that the doctors generally do not want to deal with all of the hassles involved. First, the doctor will be sent extensive paperwork that they do not have time to fill out. Workers compensation knows this, which is exactly why they send the paperwork. Remember, if they don't get the paperwork back by their deadline, then bye-bye benefits. A second reason that doctors do not want to take these cases is because they may be called to a deposition or asked to testify. Doctors generally do not want to deal with this. After all, what doctor do you know that likes being questioned -- let alone by a lawyer. Not many. Another reason why doctors tend not to take workers compensation cases is because they also don't want to deal with the subgroup of patients who are feigning or exaggerating symptoms in order to receive workers compensation payments.

So what is one to do? The first thing you need to do is call the doctors you are interested in seeing and ask if they take workers compensation insurance. If they do, then ask if they will fill out any needed paperwork. Some doctors will only see workers compensation patients under the condition they don't fill out the paperwork. It may very well be that you will need to travel a few hours to find a specialist willing to take workers compensation.

Some people have regular medical insurance in addition to workers compensation insurance. If this is the case, and workers compensation is refusing to pay for treatment, I suggest using your other insurance just so you can get the treatment needed. Then ask you lawyer about billing workers compensation for whatever amount the regular insurance will not pay.

Let's take the worst case scenario: you only have workers compensation insurance and they refuse to pay for all treatments. There are only a few options here: 1) don't get the treatment, which is obviously a problem, 2) apply for Medicare or Medicaid, 3) sign a self-pay form at the doctor's office. Number 3 is pretty risky and will require assuming a large amount of debt, but I have seen some lawyers suggest this because they argue that they will eventually make workers compensation pay for the services. Personally, I would go with option #2, but if you are not eligible you are basically stuck with two tough choices: options 1 or 3. Sad, I know, but this is why the workers compensation system in this country is in need of reform. Click here for the next post

Step 4: Being aware of being videotaped

So let's say you have been receiving workers compensation for a legitimate shoulder injury that has prevented your ability to perform you job as an auto mechanic because lifting your arm above your head for long hours causes intense pain. The insurance company is tired of paying your claim and frankly, is doubtful that your claim is legitimate to begin with. They tried sending you for IME's, getting you to meet deadlines, etc., all of which you have done, and you were able to maintain your benefits. What can you expect next? Well, there is no guarantee this will happen, but one technique the insurance companies use is to hire investigators to follow you in public places and video tape your actions -- with purpose of documenting that you can do what you claim you cannot do. Yes, I'm serious. I know because I've reviewed these tapes before.

Do I object to the video taping? No. The reason is because I have reviewed video tapes of patients I previously concluded were likely malingering (faking for external gain) and the videotaped evidence confirms it. For example, when you have a patient hobbling into your office with a cane after a very minor injury and videotape shows the person going to all medical appointments like this but later jogging in the neighborhood and walking out of the store with a bag in one hand and adeptly balancing two pizzas in the other, this is pretty damming evidence. I support the use of video tape to uncover malingerers because such people make insurance prices rise for honest citizens.

The problem I have is when these video tapes are used to destroy the claims of people with legitimate injuries. Let's take the case I discussed earlier of the auto mechanic. Let us say video tape shows him carrying his garbage to the street or carrying some relatively heavy groceries inside (e.g., a 12 pack). This can be twisted to suggest that the patient is lying about his claim, when in actuality, the patient is just trying to live as normal of a life as possible and even though he is using the injured arm, feels pain afterwards and needs to take pain medication. That won't all be shown on the tape because the video tapes cannot be placed in the house. But the point is this: if you have a legitimate medical injury that you say limits your functioning, you need to be careful about what you do in public because your actions can be used to hurt you in the long run. So listen to the doctor when he says don't overdo it. Click here for the next post.

Step 3 (maybe): Appeal

So let us say your workers compensation benefits get terminated. What then? Well, you can go back to work if you think you are able to, but like I said, these posts were written for people who are truly disabled and are unable to work due to their disability. Your next option is to appeal the case and this is another reason you need a lawyer. The lawyer can also request that your benefits get restored until the appeal is heard. Your lawyer will also need access to any evaluations by physicians from the workers compensation company, because they typically will not provide that to you. Any incorrect information in those records needs to be brought to the attention of the judge. You can also bring supportive documentation of disability from your own doctors and the judge can weigh this information as well. You should also know that the workers compensation company also has the right to appeal decisions that you are disabled, so it works both ways. This will bring me to my next post which has to do with video surveillances -- yes, I'm serious, video surveillance.

Step 2 (maybe): Rule 35 hearing

If you have been receiving workers compensation long enough, it is inevitable that the workers compensation insurance company is going to ask you to go to an "Independent" Medical Evaluation (IME). I've written several posts on the many problems with IME's before, which you can view here. The main problem is that there is no guarantee that the evaluation is truly independent since the insurance company pays for the evaluation.

Now, many patients have no idea this is the case and go to the evaluation as they are told. The IME doctor often concludes the patient is not disabled and/or that the work injury is unrelated to the current problems. The insurance company then uses the IME results to cut the patient off from benefits. Does anyone see a problem with this?

So what is the patient to do? If you refuse to go to the evaluation, the insurance company will cut you off anyway, right? Not necessarily. There is a legal procedure called a Rule 35 hearing that makes an insurance company need to go before a judge to make a ruling on whether there is just cause to do an IME. This is another reason why you need a lawyer.

If you have a biased IME doctor, the lawyer can file a motion to ask the court to produce the income derived through the lawyer's work for the particular insurance company and if you have a good judge, ask to get his reports. His reports are typically held at the IME brokerage house that is hired by the insurance company to broker the IME. By analyzing the reports, the judge can assess whether the IME doctor is biased towards judging the case in favor of the insurance company and help you avoid an evaluation by such an individual. Click here for step 3.

Step 1: Hire a Lawyer

The first thing you need if you are going to go through a protracted workers compensation case is a lawyer. Look in any phone book and you see the listings. The reason you will need a lawyer is because you will need someone to help fight attempts to cut off your benefits and if you are truly disabled this is going to be difficult for you to do. Keep in mind that these posts are designed for people who have valid reasons to be receiving workers compensation payments, not for people trying to game the system.

The need for a lawyer is all the more important if you have a medical condition caused by work related injury that affects your ability to think clearly (e.g., pay attention, remember). Why? One of the common techniques workers compensation companies use to cut off you benefits is to send you paperwork and tell you it must be filled out by your doctor and returned on a specific date. If you forget to do this, you will then receive a letter saying your benefits have been terminated. I've seen it happen countless times. A lawyer can help you manage any incoming paperwork and demands like this.

Let's take another example. Sometimes a person needs a particular type of medical evaluation due to their injury. For this example, let us say the person needs to see an eye doctor. The eye doctor's company calls the workers compensation company and asks if the visit will be paid and is told that the visit will not be authorized. Now the patient, who needs the evaluation, cannot go because he/she has no way to pay for it. The only way to fight this is to request a workers compensation hearing in front of a judge who will determine the need for treatment. In most cases I have seen, the judge authorizes treatment.

All of these things are hassles. And they are purposeful hassles. Remember what I said earlier…the workers compensation company is a business, not your friend. The more difficult they can make things for you, the sooner you may stop claiming the need to receive payments and get back to work (their perspective). Time and time again, however, I see this strategy backfire because the hassles that some workers compensation companies put patients through only serves to make them more symptomatic. I just recently worked on a case where the treating physician literally wrote in his medical notes to "stop harassing my patient because it is harmful to his health." Click here for step 2.