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How do we really get help? When to Speak up, When to Say No and When to Not Give up

I can only speak about the medical system in the United States.  Over the past several years, the insurance companies have effectively taken control of what medical procedures can happen and those that can not.   I know many people believe that the Insurance companies do have the medical insight to make decisions based on financial reasons.   I do know that many Insurance companies do in fact have medical staff on board to review requests.  My only thought about that is the fact that they are representing their company, they are not going to approve just anything that is going to cost them something.

So, how do we get things done?  How do we get those MRIs?, Cat Scans and all the other diagnostic tests that are so important into diagnosing our problems. Its the responsibility of the doctor to provide the proper justification and rationale to have any test(s) performed on their patients.  But that also assumes that the doctor believes those actions should be done.   Some times, patients come in because they are having a problem and insist on having diagnostic test (ABC) done.  The doctor has to do a complete evaluation of that patient to determine what tests should or should not be done.   If they are not done, many people will blame it on the doctor, or blame it on the insurance company.   Before blame is placed, we need to review why that decision was made!  If the doctor said, no tests, then Why? Everyone one of us deserves that answer and courtesy.

There are many times when the patient wants this, that and everything.  I can understand that.  They are hurting and want some answers.  But insisting on some test being done is not always the best course of action.  Instead, it would be WHY isnt that test important?  Let the doctor explain that to you.  And if they dont, thats when you do not GIVE UP

You deserve a rationale response.

The point of this is to just say, that we all cant march in and tell the doctor we want this or that.   Instead we need to discuss this with your doctor and if nothing has identified the problem, then we say What else should we do?   And that should be words enough to tell any respectable doctor to do their homework,

Many times in these forum discussions, I've talked about good and bad doctors, just as well as good and bad physical therapists, nurses, admin folks, etc.     Its just the nature , we have good and we have bad.   We only hope for the good.  But when there is bad, so many times, we get shunned aside as a trouble maker for asking questions or wanting something else done.   There is always a fine line here.  I have found over the years, that having the opportunity to speak to the doctor directly makes a big difference.   Some times, the admin staff will make a decision without the doctor's  knowledge.  That is so wrong, those admin folks do not have a degree in medicine and should never make decisions about health issue

What infuriates me more, is the connections that a person needs to have to make things move along.   My mother in law just passed away last weekend.  My wife was in Italy prior to this happening.  So, I was up front in dealing with doctors and other medical staff.  I was appalled at some of the answers and I am sure that some of the doctors were totally annoyed at me for speaking up.   Sorry, to bad.

But the bigger problem was that my wife was able to text a few doctors, a few case workers to make things happen they way they should be.   Everything was done in the proper sequence to care for my mother-in-law.    From the time of moving her from the Hospital to short term Rehab to Hospice was done through some of the connections we have with the medical field.

That bothers me so much!   If we didnt have these connections, if we didnt know these people, what would have happened?  My Mother-in-law would have stayed in the hospital until they said nothing else can be done and then shipped off to rehab

I am very grateful for the care that the medical field took towards my Mother-in-law.    I appreciate that!   But what about the people that dont have connections, dont know who to call, basically dont know what to do and rely on the current medical team to tell them what will be done.

This bothers me, because it is is very clear without connections, things may never happen.   That applies beyond the health field, it goes into just about any phases of our lives.

I dont know how to correct this or to make it stop.   The only thing I know is words from my wife years ago....  Speak firmly, speak clearly and ask the right questions and do not take bogus answers.   You have  a right to know.   We all have the right to know

I know folks like DavidG and EMSGuy who have been in the medical field understand all of this.

Life changing situations should always be about the patient and not who you know

Ron DiLauro Veritas-Health Forums Manager
I am not a medical professional. I comment on personal experiences 


  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 377

    Ron, I understand your frustration. In our crazy busy hi-tech world it seems everyone lives at a dead run and the only way to get and receive appropriate attention is through connections, network, friends and/or family. IMHO, the Affordable Care Act has negatively affected the standard of medical care we receive. It is great more people have access to medical care but having more people seeking the finite medical resources results in less time and attention for each of us. It is so routine to be seen 1 or 2 hours past appointment times and for MD visits to be 10 minutes or less that most accept this as "normal" medical care. Unless a lot more money is put into the system I don't see the standard of care improving. I've noticed an increase in the number of MDVIP practices where you pay a fairly significant annual fee, outside your medical insurance to have access to a personalized, higher level of medical care. I doubt most people can afford the MDVIP medical care. Many people are in favor of a national healthcare system similar to the Canadian or UK versions but I'm not aware of a lot of satisfaction with that set up either.

  • Ron,  First off so sorry for your loss.  I understand how you feel.  When my husband was having issues with his heart and insurance didn't want to pay for some testing he needed, I was told that their doctor did not feel it was necessary at that time.

    My question is how their doctor could disagree with our doctor when he had never even examined him?  We finally got what he needed but I had to make a!ot of calls to the insurance and be pretty forceful til they agreed that a second opinion  would suffice.  The Doctor that did the second opinion could not believe that they were trying to not pay. 

    I remember years ago a minister, at a church I used to go to was speaking about medical and insurance issues and he said that down the road it would be difficult to get certain procedures paid for unless you had money or influence and it kinda looks like he was right.  Isn't that the same as with the justice system?  If you have money enough for the dream team you can get out of just about anything.

    It's a sad state of affairs that's for sure.

    Your Mother-in-law was very fortunate to have the both of you to look after her.  Again so sorry.


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  • Ron I too am sorry that your family suffered a loss.

        And I also know how frustrating it can be at time getting the needed response for proper healthcare of a love one. Dealt with that many time both with my parents and my husband. My daughter went to a cancer specialist yesterday since she had a parent that had early dx colon cancer ( age 38) there is a very high risk she may carry the gene for lynch syndrome.  So her primary sent to to this specialist.  Problem lies in will her insurance company pay for the needed DNA test to determine if she's a gene carrier.  I mean this could affect alot of members in our family..its a shame  she will now have to sit and wait 5 or 6 months as the doctor said the company will have to fight  the insurance company to screen her DNA sample yes she could pay out of pocket but the DNA is being screened for multiple gene mutations so it wont be cheap... I've grown to dislike insurance companies as they have been given the right far too often to dictate our care all while charging high premiums.  


  • Ron, As everyone has said, We are sorry for you and your wife’s loss!  And yes , you are 100% correct in at times, it’s who you know and how it’s written. Its also who you are as well. After my Dads accident, When the Doctors and RNs found out that both myself and younger sister were in the medical field things changed rapidly. Instead of getting a very short daily report from a RN, The One of several MDs would come and talk with us, share the labs, xrays etc..etc..We never had to ask a RN for anything, The MDs kept us informed. Jerome, your statement about the affordable care act was correct but it became where the affordable care act became abused. This is no disrespect to race or financial status but you would have someone bring all 5-6 of their children into the ER at 10 pm for all having a runny nose and cough for a week and pay 5.00 for a ER visit . Or very similar illnesses all which could have been handled by their local MDs but they didn’t want to make a appointment or have to wait a week for a appointment! You think ERs are for Emergencies? Only about 1/3 of patients in most ERs are true emergencies! That’s one area where the system is broken. On the other hand, take a look at Canada’s health care, There are only a few Catscan and MRIs available and you must wait your turn. There are no perfect systems! ....David


    Veritas-Health Forum Moderator

  • dilaurodilauro ConnecticutPosts: 13,434

    David, like all the others, thank you for your words.  My Mother-in-law did it in her terms, so we are all grateful for that.

    ER's  You know more than most, there is so much abuse of this.  Yes, 5 to 8 children in an ER because they have runny noises.
    Its a pure abuse of the ER.   Time should be spent on people that have real emergencies.    But, I know we can not turn people away from getting medical treatment.

    I love the recent addition of these offsite medical centers to handle some emergencies.   This has helped, but one of the problems, is that many of these sites expect payment at time of service and many of the people coming there do not have any money to pay..  So its easier to go to the Hospital ER.    David, you and EMSGuy have probably seen so much, I can only touch on a fragment of what you guys have witnessed.

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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