Tip of the week: Don't EVER get sick in Irvine!

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Gollini: Where=Russia (and yeah, there are other risks all right :)

But I stand by my comment about the healthcare system. It is awesome and doctors are awesome (they are not millionaires there, state pays them a government-employee salaray). So, when you come into their office, they truly want to make you feel better, not to get most money out of your insurance. I don't want to generalize, since there are many good docs here who are just as good and even better, as I said in my previous post.

Who pays? The state, with taxpayers' money (by the way, did you know that most people who have to pay taxes are in 13% tax bracket? I am not kidding.

About antibiotics: do you really believe that the reason most drugs are sold by prescription only b/c they are dangerous if misused/overused? I don't buy that at all. I wonder how people in Canada & Europe haven't become extinct yet, since there you can buy most of these drugs over the counter. Oh, and don't we currently have antibiotic-resistant staph bacteria scare here in the U.S.? And that is in the country where antibiotics are prescription-only. Oh, and I also love it when doctors give you a prescription for antibiotics to treat a virus (antibiotics have not effect on viruses, only bacteria) or "as a precaution" if you have a tooth extraction?

I don't need a doctor to know that I need a painkiller with codeine if I have a terrible toothache to last me till I get to the dentist, so why should I ask a doctor to write me a prescription for that? Maybe because doctors can bill my insurance for that. Of course, you can say that it is done to prevent some painkiller-addict from buying painkillers by pound. Sure, but what prevents the same addict from complaining to a doctor about horrible pain and getting to exactly the same result?

I totally agree btw that overuse and misuse of any drug is dangerous, but I don't think that prescription system takes care of that problem.
 
My wife had really bad stomach ache about two weeks ago. We nearly went to the Irvine Regional ER. Then it went away after two hours. Must be some sort of virus...
 
Most of the antibiotic overuse which is really causing problems is the standard use for farm animals. They are raised under pretty horrible conditions, which would normally cause them to become sick, so are fed antibiotics to prevent sickness. Especially chickens. I try to buy meat and milk that has not been fed antibiotics nor growth hormones, which usually means going organic. Which is expensive of course.
 
If your company offers it or you get independent insurance, Kaiser has been very good to us. They are opening a new hospital in Irvine off Sand Canyon. We have received great care from primary care doctors and specialists. Urgent care services or same day are also great. The urgent care off Sand Canyon is open but few people know about it so there is never more than a couple people waiting (at least the 10 or so times I've been there.)



IMO, very reasonable rates and wonderful for a HMO.
 
lawyerliz: I second that. Have you tried Henry's organic chicken? it costs about 70% of Trader Joe's organic chicken.

house of cards: does Kaiser hospital only accept patients with Kaiser insurance?
 
Healthcare in Russia was fairly good in the Soviet-era as Russa has the 2nd-highest per-capita ratio of physicians to citizens in the world. As blackacre describes, healthcare is socialized and (technically) free to all citizens. However, it is also widely recognized that since the collapse of the Soviet Union, healthcare in Russia has steadily and quickly deteriorated.





Quoting the Moscow Times: "Medical care in Russia is among the worst in the industrialized world. A 2000 World Health Organization report ranked Russia's health system 130th out of 191 countries, on a par with such nations as Peru and Honduras. This is one of the few nations in the world where life expectancy has declined sharply in the past 15 years. The average Russian can expect to live only to age 66 - at least a decade less than in most Western democracies, according to a 2005 World Bank report. For men, the figure is closer to 59 - meaning many Russian men do not live long enough to start collecting their pension at age 60. Compounded by alcoholism, heart disease claims proportionately more lives than in most of the rest of the world. Death rates from homicide, suicide, auto accidents and cancer are also especially high. Russia's population has dropped precipitously in the past 15 years, to below 143 million in what President Vladimir Putin calls "the most acute problem of contemporary Russia." In 2004, according to the Organization for Economic Cooperation and Development, Russia spent $441 per capita on health care, about a fifth of what the European Union spends."





Most wealthier Russians no longer use the public healthcare system as it has fallen into disarray and corruption; they use private clinics staffed by Western-trained physicians equipped with U.S.-made technology.





With respect to obtaining antibiotics without a prescription, it is illegal to do so in Canada and in most European countries. If you know a pharmacy in Canada that is dispensing antibiotics without prescriptions, please inform me as to their contact information so I can inform the proper authorities for investigation and prosecution. As to whether or not its a good idea for a layperson to decide on his own when to take an antibiotic and which kind, let me ask you this: Your wife has all the signs of a simple urinary infection. Do you feel comfortable treating this on your own? Okay, how about if she's also diabetic? Has a fever of 101 degrees F and back pain? Still feel comfortable? Okay, which of these antibiotics do you prescribe and at what dosage? 1) amoxicillin, 2) azithromycin, 3) macrodantin, 4) ciprofloxacin, or 5) cefuroxime. What if she also has a history of seizures?





I'm not trying to be rude, just trying to make a point. Maybe its true that 99% of the time a pharmacist or nurse would be fine in choosing a medication for a patient, and I don't know about acceptable adverse outcomes rates "where you are from", but "where I'm from", if one patient dies in a 100 getting a simple antibiotic, its NOT ACCEPTABLE.
 
blackacre,





I'm not sure about that. My guess is that for non ER visits, you must be a Kaiser member (unless you bring cash perhaps). Of course the ER has to accept anyone regardless of insurance, but you or your insurance will be billed.
 
I got my drive-through flu shot at the Sand Cyn Kaiser. Love Kaiser, yes I do. And no, ya can't be seen at any of the facilities without a Kaiser member number. I guess by law they can't turn you away from the ER.
 
interesting, I'll look into getting a Kaiser insurance if I ever move to Irvine. I used to drive by that hospital on my way back from work, and the facilities look pretty impressive.
 
Allergy Doc quizzed>>>>Okay, which of these antibiotics do you prescribe and at what dosage? 1) amoxicillin, 2) azithromycin, 3) macrodantin, 4) ciprofloxacin, or 5) cefuroxime. <<



Erm, I would have prescribed mydixafloppin but that's not on the list...no wait! I just realized, that's the posh name for Viagra...



Luckily I'm not a Doctor, I could have killed someone!!
 
Irvine Allergy Dr: no worries, differences in opinion are welcome. I can't resist, however, to point out a fact that you are a doctor judging by your nickname. And I wouldn't expect doctors to support switching to no-prescription-for-anything system. Not that you don't make legitimate arguments.

I lived in Russia for 20 years (most of them post-Soviet era), and I hadn't had a chance to witness any deterioration in the healthcare system, it is about the same. A few years back, state-of-the-art squeaky-clean modern hospital was built in my hometown that has everything any American hospital has. Fees for services are income based (if you are lower than a certain income bracket, you don't have to pay). You can walk in there (no app't necessary) and get: EKG, MRI, many other things. All-by request for a very reasonable fee (you don't need to go beg a doctor to send you there for any kind of test you want). You get staff doctors to interpret the results for you the same day. Life expectancy is not determined solely by healthcare (although I agree it is a factor). What contributes to a short life expectancy in Russia is mostly alcoholism (very common in rural areas especially) and overall unhealthy lifestyle (bad nutrition, lack of exercise, etc.)

if by wealthier Russians you mean someone like Abramovich, I am sure he's never seen a doctor from a public hospital :)) I know a few wealthy Russians, and here is what they do: they use private clinics or even public hospitals. Some of them get a private doctor. A friend of mine hired a private pediatrician for her toddler (costs 50 bucks a month), who makes weekly visits to their house and runs all the tests that can be done at home and responds to emergency calls and decides whether the kid needs to be hospitalized for anything or any lab tests done. Compare to U.S. pediatricians, who never make house calls, and some of whom don't even want to respond to your frantic middle-of-the-night calls for help and just send you to emergency rooms, where you sit for 5 hours with your little baby and wonder if he is going to catch something from other people coughing their hearts out at the emergency waiting areas.

As to the Russian press: we Russians learned a long time ago that you don't trust anything written in the newspapers. I personally always look at who owns a particular media outlet and then think whether a particular article serves their agenda.

I am not aware about particular Canadian pharmacies dispensing antibiotics, but I did purchase antibiotics over the counter while in Europe.

Your hypothetical does present a situation when a doctor's opinion would be necessary. But I can't resist by taking a crack at it (and I am a layperson here):

Your wife has all the signs of a simple urinary infection. Do you feel comfortable treating this on your own? Answer: So far, yes. Among the antibiotics you suggested, she would have to take ciprofloxacin. Dosage for mild or moderate urinary tract infection: 200 mg, twice in 24 hours, for 7-14 Days.

Okay, how about if she's also diabetic? Answer: That is where we need to see a doctor.

Has a fever of 101 degrees F and back pain? Still feel comfortable? Answer: these are symptoms of a kidney infection, so need to see a doctor as she would need a larger dose of antibiotics and possibly hospitalization.

How did I score on your test? :)
 
"How did I score on your test? :)"



Well, I was trying to make a point, not quiz you, but since you asked:

1) The standard treatment in the U.S. would be 250mg twice a day for three days for an uncomplicated UTI

2) You didn't mention what you would do if she had a history of seizures, so let's say for kicks you forgot to ask your wife, and since the last time she had a seizure was when she was nine, she forgot to mention it; Cipro lowers the seizure threshold and your wife has a generalized tonic-clonic seizure on the third day of treatment with Cipro, she is now on the floor and you think she may have swallowed her tongue, now what do you do?

3) Forget the whole seizure thing. Did you perform a physical examination of your wife before dropping by your local pharmacy to buy the Cipro? No? Okay, let's say the Cipro seems to have fixed the problem after three days. Three weeks later, she has the same exact symptoms, but also some mild lower abdominal pain. Being your wife, she doesn't want to worry you so she doesn't mention the pain and asks you to go buy the Cipro again. This scenario repeats again a month later. You are worried at that point and finally see a physician, who performs the physical exam, asks the right questions, and discovers that your wife actually has pelvic inflammatory disease caused by bacteria semi-resistant to Cipro (which is not by itself standard of care for PID). He tells you not to worry, the chance the PID has caused scarring to your wife's fallopian tubes and thus infertility is only 20%. Was this an acceptable outcome?
 
<p>lawyerliz, </p>

<p>You are so right. I visited this doctor once. I waited over an hour. And he literally spent 2 minutes with me. He was running from one patient room to the next. It was like he was playing musical chair.</p>

<p>Yeah, yeah...I can hear the cry that doctors are overworked. But this guy was in private practice. So no excuse.</p>

<p>And another thing. Have you ever wonder why your doctors only prescribe certain medications to you? Even though, there are many choices out there? It's because they get kick backs from the drugs companies. Ever seen those pharmaceutical salesmen in your doctor's office? Again, profiteering behind the pure white coats.</p>
 
<p>I don't care how smart they are, if they don't spend more than a couple of minutes with you, they can't really figure out what's wrong with you and you are just playing Russian roulette with whatever they give you.</p>

<p>I think this is true, even if you've been diagnosed and they are just seeing that your pressure or blood sugar is ok.</p>

<p>None of them know about herbal medicines, and what they don't know about, they are against. I have a skin condition called Haleys Haleys and found my chance that an anti wrinkle skin cream I got at the health food store works 99% as well as the steroid cream she gave me. Mostly I don't tell them what I take because they always tell me to stop, no matter what it is. I will tell her about the cream, because she is a good egg, but dollars to doughnuts, she will not pass that info on to anybody else.</p>

<p>And this is a case where the cream, based on olive oil and hydalauric acid is utterly harmless, and if I don't do the steroid cream, nothing happens, except the breakouts don't go away.</p>

<p>Drs die younger than any other profession. If I see more than 2 or 3 new people in a day I am exhausted, because I have to focus in on them. They may think their problem or solution is simple, and it may turn out to be something else entirely. I can't tell you how many times somebody comes in for "a simple quit-claim deed".</p>

<p>I have to spend at least an hour finding out all about their family circumstances and why they want to do what they want to do and the homestead consequences and the tax consequences, etc, etc.</p>

<p>Now, if I have to spend all that time on a simple-ish matter, how does a dr figure out in 2 seconds what is wrong with you? Even with that stomach flu--yeah, they're probably right, but maybe YOU have something wrong that looks the same, but isn't.</p>

<p>I bet Allergy Dr. may have spent more time writing up his defense than he spends with some of his patients. Sorry if I'm wrong allergy dr.</p>

<p>I hate drs far more than I will ever hate realtors (my attitude towards realtors is indifference). They are often so pompous. They stop listening to you instantly after they make up their minds. They care nothing for your time. They spend no time any more in reasurance. They are so scared of their patients that they avoid any personal relationship. Boy, when they hear I'm a lawyer!!! Tho used to be a real estate lawyer (don't know what I am now), and wouldn't touch a medical malpractice case with a 10 foot pole.</p>

<p>They often don't even wash their hands. They never inquire about what the patient eats and drinks. (Allergy Dr probably does.) This would be useless, as they don't know about diet anyway. House calls are sometimes useful, to see how a patient lives, but that's not gonna happen.</p>

<p>By the way, talk to any number of people of any age and circumstance, and you will hear a chorus of mild or severe horror stories. The worst one I have heard was the girl who was going in for a d and c and nearly got a hysterectomy. Her husband even had to argue with them before he could get them to admit that they were making a horrible mistake.</p>

<p>Well, I have to get to work, but I'd go on.</p>

<p> </p>
 
<p>UK, </p>

<p> I don't know, I guess we are lucky. My wife has health issues (ex epleptic), so we WAYYY over compensate with insurance. One time we had a small gap in insurance and 6000 dollars later we had 1 prescription done. Wasn't fun, but it teaches you a lesson. I think in the future you're still going to have nationalized health care.</p>

<p>anyways good luck</p>

<p>-bix</p>
 
There are a number of reasons why your primary care doctor may not be spending enough time with you, only one of which might be that he or she is a bad doctor. Probably the most important one though is that the rates that doctors can charge for well or sick visits is largely fixed by what the health insurance companies will pay, and those rates are going down, not up, as HMOs and other private insurers have more and more pricing power. So a doctor's take-home salary is largely defined by how many patients he or she sees in a day. It doesn't matter if the doctor is a great doctor or a bad doctor, they both get reimbursed roughly the same amount per office visit. So already, there is a built-in economic incentive against the patient in the doctor-patient relationship. This is why more and more doctors are choosing to specialize in fields other than primary care; specialists that do a lot of procedures (oncology (cancer), surgery, anesthesia, etc) are reimbursed much higher rates for the amount of time spent than family care physicians, for example.



Contrast that with law, where the rate one can charge is much more dependent on a particular lawyer's skill, experience, and/or success in the past.



Having said that, I firmly believe in being a consumer when it comes to medical care. When you go to see your doctor, be prepared. Have a list of ALL the things you want to discuss about your health, so that you don't waste your time and the doctor's thinking of stuff to ask. If your doctor isn't willing to listen and address each and every one of your issues, switch doctors! Even HMOs offer different primary care doctors within a particular practice or clinic. If you want one who is more comfortable with herbal medicine, find one! There are lots of different doctors out there for different patient needs, and you should have one you trust and are comfortable with. There is absolutely no need to suffer with a sub-par doctor. There are many good doctors out there, just like there are good realtors and good lawyers, if you spend the time to find them.



I go to a doctor in the medical offices on Barranca Pkwy, and I have never felt like he cut short my visit or was in a hurry to get to the next patient. I visited a number of doctors before finding this one, but it was worth the effort.
 
Lawyerliz,





I don't know why you felt it necessary to make a personal attack ("I bet Allergy Dr. may have spent more time writing up his defense than he spends with some of his patients."), but obviously you don't really read my posts as I had promised Peter at least 45 minutes of my time (as I spend a minimum of with all of my patients, including the Medi-Cal patients for which I get paid $70 for - do you charge $93/hr or less Liz?).





Also, most of what you state in your post is not substantiated by facts. Physicians do not die younger than any other profession (quoted from American Journal of Preventative Medicine, 2000 Oct;19(3):155-9):





"Data in this report are from the National Occupational Mortality Surveillance database and are derived from deaths occurring in 28 states between 1984 and 1995. Occupation is coded according to the U.S. Bureau of the Census classification system, and cause of death is coded according to the ninth revision of the International Classification of Diseases. RESULTS: Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6)."


I'm sorry you've had bad experiences with physicians in the past, but I'm sure your sample size is not large enough to make a blanket statement that *all* physicians are heartless, money-grubbing, and/or arrogant. I have no problems with lawyers even though the profession itself is not at the top of any list of "most respected professions", and, in fact, have several lawyers as patients as well as a law student. I also count among some of my closest friends lawyers.





I agree with the previous poster - you just need to spend some time looking around for a good physician if you're not satisfied with your current caregiver. I guarantee when that first major health problem comes around you'll be happy you did.





BTW - your skin condition is called "Hailey-Hailey" disease (named after a pair of physician brothers) but is better known as Benign Familial Pemphigus. Very rare.
 
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