House passes health care bill on 219-212 vote

[Beryana]

Originally Posted by AOII Angel

The first bold isn't really correct. Physicians elect whether or not to accept certain insurance providers. They don't "make deals" with them. Physicians actually have very little bargaining power when it comes to insurance companies. We can just refuse to see patients from companies that we don't wish to deal with.

The second bolded section caught my eye because I wonder if you told him that you were willing to pay for the tests even if your insurance company wouldn't cover them. I can feel the frustration in your story, but T3 and T4 levels are not covered for hypothyroidism for a reason. If your physician didn't know you would pay for them regardless of the price, and he knew they were not indicated, he probably thought it was best to exclude an unnecessary test rather than have you charged for it. If you did tell him, than shame on him.

Also, your symptoms may not be related to hypothyroidism. The thyroid gets a bad rap for lots of symptoms, ie. fatigue, weight gain, sluggishness. There are lots of things that can cause these symptoms other than the thyroid, and treating hypothyroidism doesn't magically give you tons of energy...that would be giving you hyperthyroidism! My husband is an endocrinologist. He complains all the time about the misconceptions people have about all the magic the thryroid can do.

So even if you are the best doctor for me, because I happen to work for a place that offers the 'wrong' insurance and chose the 'wrong' company for my own policy I can't see you without paying out of pocket? How is that truly helping the patient? "I'm sorry, but I won't see you because of the insurance you carry and can't afford to pay the bills out of your own pocket.. . ." I understand doctors are running a business, but shouldn't the patients be at the heart of that business? (and I did offer to pay for those tests - and was still given lip service).

How is it my pituitary gland is what is tested to see how my thyroid is working? Wouldn't you actually want to see how the thyroid is actually functioning in order to properly medicate? Yes, I am a silly lay person who has done research by talking to other hypothyroid patients - and only one of the symptoms you listed is on my personal list of concerns. Your responses are why I am going 'outside the system' to someone who will actually work with me about my symptoms and all that - and if it should happen to be something else, let's work on that but most of what I'm experiencing are the same things experienced by other hypothyroid patients - and looking at the whole picture is better than one test of a gland not related to the thyroid. why treat individual symptoms when they can all be related - and you just can't see that without looking at the whole picture?

[AOII Angel]

Originally Posted by Beryana

So even if you are the best doctor for me, because I happen to work for a place that offers the 'wrong' insurance and chose the 'wrong' company for my own policy I can't see you without paying out of pocket? How is that truly helping the patient? "I'm sorry, but I won't see you because of the insurance you carry and can't afford to pay the bills out of your own pocket.. . ." I understand doctors are running a business, but shouldn't the patients be at the heart of that business? (and I did offer to pay for those tests - and was still given lip service).

How is it my pituitary gland is what is tested to see how my thyroid is working? Wouldn't you actually want to see how the thyroid is actually functioning in order to properly medicate? Yes, I am a silly lay person who has done research by talking to other hypothyroid patients - and only one of the symptoms you listed is my concern. Your responses are why I am going 'outside the system' to someone who will actually work with me about my symptoms and all that - and if it should happen to be something else, let's work on that but most of what I'm experiencing are the same things experienced by other hypothyroid patients - and looking at the whole picture is better than one test of a gland not related to the thyroid.

Wow! I was going to post a huge post, but it's not worth it. I can tell that you are frustrated, but endocrinology is a very complicated system. I can assure you that you are very confused as to how the thyroid and pituitary gland interact. I hope that you are able to get your symptoms under control, but there is no great insurance/physician conspiracy to keep hypothyroid patients in insurance plans that keep them from seeing physicians that will help them. If you are willing to pay out of pocket to see someone who will order exams the way you see fit, more power to you, but that is the exact opposite of the cost cutting measures that are in the pipeline for the future like it or not.

[Beryana]

Originally Posted by AOII Angel

Wow! I was going to post a huge post, but it's not worth it. I can tell that you are frustrated, but endocrinology is a very complicated system. I can assure you that you are very confused as to how the thyroid and pituitary gland interact. I hope that you are able to get your symptoms under control, but there is no great insurance/physician conspiracy to keep hypothyroid patients in insurance plans that keep them from seeing physicians that will help them. If you are willing to pay out of pocket to see someone who will order exams the way you see fit, more power to you, but that is the exact opposite of the cost cutting measures that are in the pipeline for the future like it or not.

Oh, I understand how they interact - but that does not mean that one test shows the entire picture of how well they are currently interacting. And I'm NOT looking for a doctor who will diagnose only as I think something should be diagnosed - but rather a doctor who will actually WORK with a patient. Should I have had to call to see when I needed to come back to have blood work done again? Should I have to follow up with the doctor to let her know the medication is not really doing anything other than giving a good test number? Isn't that what PATIENT care is about? How about the breast biopsy that I had done that wasn't healing three weeks after it was done and was causing pain - to which I got a response of 'we can get you in in a week'? All of these are issues I have with my current doctor (and why I typically don't go to a doctor). Will there be a 'perfect' doctor? probably never. Am I looking for a doctor that will at least believe that I know my own body, what is normal, what is not, what is 'normal' that shouldn't be (i.e., consistent body temp of 95.9 - 96.2 is NOT how things should be working but that is currently 'normal' for me) and work with me where things aren't working the way things should be. Basically I am looking for a doctor who will remember that the patients are the reason you all have jobs - and sometimes the patients DO know a thing or two about their own bodies or want to be involved in (and know why) things are done a certain way.

The whole health case system/industry IS messed up - and mostly because the patient has been taken out of the equation and not allowed to be involved in many of the decisions which are made about their own health.

[Alumiyum]

Originally Posted by Beryana

Oh, I understand how they interact - but that does not mean that one test shows the entire picture of how well they are currently interacting. And I'm NOT looking for a doctor who will diagnose only as I think something should be diagnosed - but rather a doctor who will actually WORK with a patient. Should I have had to call to see when I needed to come back to have blood work done again? Should I have to follow up with the doctor to let her know the medication is not really doing anything other than giving a good test number? Isn't that what PATIENT care is about? How about the breast biopsy that I had done that wasn't healing three weeks after it was done and was causing pain - to which I got a response of 'we can get you in in a week'? All of these are issues I have with my current doctor (and why I typically don't go to a doctor). Will there be a 'perfect' doctor? probably never. Am I looking for a doctor that will at least believe that I know my own body, what is normal, what is not, what is 'normal' that shouldn't be (i.e., consistent body temp of 95.9 - 96.2 is NOT how things should be working but that is currently 'normal' for me) and work with me where things aren't working the way things should be. Basically I am looking for a doctor who will remember that the patients are the reason you all have jobs - and sometimes the patients DO know a thing or two about their own bodies or want to be involved in (and know why) things are done a certain way.

The whole health case system/industry IS messed up - and mostly because the patient has been taken out of the equation and not allowed to be involved in many of the decisions which are made about their own health.

I'm worried that problem will get worse with the new bill's provisions.

I've switched doctors twice in the past year because there is something wrong with me, and over worked doctors don't care, essentially. I am always tired, always in pain, and lose hair. I've come up with, on my own, based on these and other symptoms a list of possibilities and believe me I'm far from being a doctor. Because these are vague symptoms and I don't appear to be dying, doctors don't bother to make a diagnosis. I've found that more than once tests that blood was taken for were never ordered. In the long run, covering these tests and making sure to order necessary ones-and NOT run frivolous tests will waste far less time and money on both the doctor and patient's end. I'm sure it's hard to be a doctor with a large number of patients, a full schedule, a family, and the stresses that come with such a job, but health care could be improved simply by doctors finding a way to more efficiently balance these things to find the problem quickly and efficiently so that it could be treated-quickly and efficiently.

[AOII Angel]

Originally Posted by Beryana

Oh, I understand how they interact - but that does not mean that one test shows the entire picture of how well they are currently interacting. And I'm NOT looking for a doctor who will diagnose only as I think something should be diagnosed - but rather a doctor who will actually WORK with a patient. Should I have had to call to see when I needed to come back to have blood work done again? Should I have to follow up with the doctor to let her know the medication is not really doing anything other than giving a good test number? Isn't that what PATIENT care is about? How about the breast biopsy that I had done that wasn't healing three weeks after it was done and was causing pain - to which I got a response of 'we can get you in in a week'? All of these are issues I have with my current doctor (and why I typically don't go to a doctor). Will there be a 'perfect' doctor? probably never. Am I looking for a doctor that will at least believe that I know my own body, what is normal, what is not, what is 'normal' that shouldn't be (i.e., consistent body temp of 95.9 - 96.2 is NOT how things should be working but that is currently 'normal' for me) and work with me where things aren't working the way things should be. Basically I am looking for a doctor who will remember that the patients are the reason you all have jobs - and sometimes the patients DO know a thing or two about their own bodies or want to be involved in (and know why) things are done a certain way.

The whole health case system/industry IS messed up - and mostly because the patient has been taken out of the equation and not allowed to be involved in many of the decisions which are made about their own health.

I can tell you from LOTS of experience that very FEW people know their own bodies and what is normal. We get far too many people in ERs for abdominal pain thinking they have appendicitis because they haven't taken a poop in too long, women in breast centers who think they have breast masses but it turns out to be normal breast tissue, people in doctors' offices asking why they have a twinge or pinch or ache when they do this or that motion. Unfortunately, if every doctor worked up every single complaint because every patient "knows their body" we'd spend so much money and find next to no pathology. The body has aches and pains. 98.5 is a normal temperature that you see in nobody. Why are you checking your temperature anyway? Throw away your thermometer! You are still WRONG about the thyroid and T3/T4 levels. It's rather insulting, too, that you think that your research with hypothyroid patients trumps 13 years of education that endocrinologists have with regard to the thyroid. Maybe they know what they are talking about. Taking extra synthroid may make you feel better, but it's also associated with a lot of other side effects. You do what you want, but leave the ugly commentary about physicians behind.

[Beryana]

Originally Posted by AOII Angel

I can tell you from LOTS of experience that very FEW people know their own bodies and what is normal. We get far too many people in ERs for abdominal pain thinking they have appendicitis because they haven't taken a poop in too long, women in breast centers who think they have breast masses but it turns out to be normal breast tissue, people in doctors' offices asking why they have a twinge or pinch or ache when they do this or that motion. Unfortunately, if every doctor worked up every single complaint because every patient "knows their body" we'd spend so much money and find next to no pathology. The body has aches and pains. 98.5 is a normal temperature that you see in nobody. Why are you checking your temperature anyway? Throw away your thermometer! You are still WRONG about the thyroid and T3/T4 levels. It's rather insulting, too, that you think that your research with hypothyroid patients trumps 13 years of education that endocrinologists have with regard to the thyroid. Maybe they know what they are talking about. Taking extra synthroid may make you feel better, but it's also associated with a lot of other side effects. You do what you want, but leave the ugly commentary about physicians behind.

And you are the reason I don't go to the doctor very often! I can tell you with 100% certainty that on or off the levothyroxine I feel no different - and yes, this is being off the drug for WEEKS (why be on a drug if its not doing anything - and why take a pharmaceutical if a thyroid issue is because I have been lacking iodine or some other part of a diet). I DON'T go running to the doctor for every little thing (the breast biopsy and mammograms are because my mother has breast cancer so I thought it would be a good idea to have a baseline for myself). As to taking temps, well that's what my cousin (who is a nurse) said to do to make sure the biopsy issue was not causing a fever due to infection. . . and after doing that for a while, a person starts to notice trends. . . .And when I am sitting in a 70 degree house in a sweatshirt, jeans and sock and am FREEZING cold, something is wrong (simple progression here: thyroid = metabolism = energy = heat and I learned that in high school physics class - and my heart and veins are all very healthy.)

I respect doctor's for their years of schooling, however doctor's also have to give patients the benefit of the doubt rather than treating them like school children who don't know anything. Are there exceptions to the rules? Of course - on both sides. And experiences also speak for a lot - I don't like specialists based on my experience. The more specialized you get the less of the big picture you are able to see - and the big/overall picture is VERY important, especially when dealing with a person's health and how interconnected ALL the systems are.

[PeppyGPhiB]

Originally Posted by AOII Angel

You are still WRONG about the thyroid and T3/T4 levels. It's rather insulting, too, that you think that your research with hypothyroid patients trumps 13 years of education that endocrinologists have with regard to the thyroid. Maybe they know what they are talking about. Taking extra synthroid may make you feel better, but it's also associated with a lot of other side effects. You do what you want, but leave the ugly commentary about physicians behind.

I will tell you that my sophomore year in college I gained 40 lbs in one year despite eating better and getting a great workout every day on my hilly campus. I was pre-med at the time and noticed that I had a number of symptoms of hypothyroidism (we were studying the endocrine system at the time). So when I went home at the end of the year, I went to the doctor. And she wouldn't test me. Told me I was too young to have hypothyroidism and that I just needed to exercise more. By the time I came home from winter break of my junior year, I had gained another 20 pounds. I went to the doctor, crying, and she finally tested me. My TSH test came back at a 45 - but she still didn't want to treat me! So I asked for a referral to an endocrinologist and I've been treated ever since. Through REALLY hard work, and medication, I've been able to lose 20 of the pounds, but not all 60. My TSH is still around 10.

Some doctors who are more recent graduates and know all of the latest research on this stuff may know better than their patients, but not all doctors keep up on current research and treatments. Any patient who has had to change doctors due to new insurance or lack of "chemistry" with a given doctor knows that there is a huge variety of doctors out there, all with different methods. My doctor was old school, about five years out from retiring, and though she was a smart lady, she used old-fashioned approaches that were not appropriate for an unusual case like myself. She needed to recognize her areas of weakness and refer me to someone who knew more about my condition than she did.

[VandalSquirrel]

Originally Posted by PeppyGPhiB

I will tell you that my sophomore year in college I gained 40 lbs in one year despite eating better and getting a great workout every day on my hilly campus. I was pre-med at the time and noticed that I had a number of symptoms of hypothyroidism (we were studying the endocrine system at the time). So when I went home at the end of the year, I went to the doctor. And she wouldn't test me. Told me I was too young to have hypothyroidism and that I just needed to exercise more. By the time I came home from winter break of my junior year, I had gained another 20 pounds. I went to the doctor, crying, and she finally tested me. My TSH test came back at a 45 - but she still didn't want to treat me! So I asked for a referral to an endocrinologist and I've been treated ever since. Through REALLY hard work, and medication, I've been able to lose 20 of the pounds, but not all 60. My TSH is still around 10.

Some doctors who are more recent graduates and know all of the latest research on this stuff may know better than their patients, but not all doctors keep up on current research and treatments. Any patient who has had to change doctors due to new insurance or lack of "chemistry" with a given doctor knows that there is a huge variety of doctors out there, all with different methods. My doctor was old school, about five years out from retiring, and though she was a smart lady, she used old-fashioned approaches that were not appropriate for an unusual case like myself. She needed to recognize her areas of weakness and refer me to someone who knew more about my condition than she did.

Seriously, I've had some not great doctors and I think what we need people to do is to learn to advocate for themselves and do some research. I don't mean spending hours on WebMD, but keeping track of changes/norms so when something comes up there is a baseline and a time line. If I go to the doctor and my blood pressure is high and I ate a high salt meal or was running late, that would make sense. If I just drank coffee, that could account for an elevated temp. So much of that behavior for me is left over from having to keep track for health issues I just kept doing it and I always bring that to an appointment, as well as writing down my concerns. I want to make the most of my time and the doctor's time.

I was dismissed once for breast cancer and I was so fortunate the ENT surgeon (huge a-hole, but good surgeon) refused to operate until a doctor he trusted ruled out cancer as the person I normally saw was on maternity leave and the other doctor didn't find my concerns important (that person is no longer in the practice). I have the option of a second opinion but it is so annoying when office #1 will not send your records in a timely manner to office #2. If I had cancer and they blew me off I'd have considered filing a law suit because it shouldn't take three months to send records. I go to the biggest practice in town and thankfully they also run the Urgent Care but one practitioner doesn't get butt hurt if you see someone else because they aren't available, nor is there drama if they consider different treatments. Living in a rural area makes it hard at times, and many people make the 1.5 hour drive to Spokane for specialists.

My time in Alaska is always a crap shoot because the clinic is either 30-100 miles away and because I'm an outsider the med student who is doing a rotation always wants to see me because I'm less likely to object (I don't have tinfoil underpants and believe in conspiracy theories) and have some strange shizz in my medical history. I've only been cranky once when one young woman was telling me I should be concerned about osteoporosis, when my only risk factor is being female. No one in my family has had it, I've never broken a bone, my bone affected surgeries healed freakishly fast, I'm not lactose intolerant, and I'm Norwegian so eating cheese on the daily.

My temp is low though, constantly, about 97.5-97.9 but allegedly it is genetic. I'm willing to have my thyroid checked though because I tolerate cold too well for some people's liking.

[AOII Angel]

Originally Posted by VandalSquirrel

Seriously, I've had some not great doctors and I think what we need people to do is to learn to advocate for themselves and do some research. I don't mean spending hours on WebMD, but keeping track of changes/norms so when something comes up there is a baseline and a time line. If I go to the doctor and my blood pressure is high and I ate a high salt meal or was running late, that would make sense. If I just drank coffee, that could account for an elevated temp. So much of that behavior for me is left over from having to keep track for health issues I just kept doing it and I always bring that to an appointment, as well as writing down my concerns. I want to make the most of my time and the doctor's time.

I was dismissed once for breast cancer and I was so fortunate the ENT surgeon (huge a-hole, but good surgeon) refused to operate until a doctor he trusted ruled out cancer as the person I normally saw was on maternity leave and the other doctor didn't find my concerns important (that person is no longer in the practice). I have the option of a second opinion but it is so annoying when office #1 will not send your records in a timely manner to office #2. If I had cancer and they blew me off I'd have considered filing a law suit because it shouldn't take three months to send records. I go to the biggest practice in town and thankfully they also run the Urgent Care but one practitioner doesn't get butt hurt if you see someone else because they aren't available, nor is there drama if they consider different treatments. Living in a rural area makes it hard at times, and many people make the 1.5 hour drive to Spokane for specialists.

My time in Alaska is always a crap shoot because the clinic is either 30-100 miles away and because I'm an outsider the med student who is doing a rotation always wants to see me because I'm less likely to object (I don't have tinfoil underpants and believe in conspiracy theories) and have some strange shizz in my medical history. I've only been cranky once when one young woman was telling me I should be concerned about osteoporosis, when my only risk factor is being female. No one in my family has had it, I've never broken a bone, my bone affected surgeries healed freakishly fast, I'm not lactose intolerant, and I'm Norwegian so eating cheese on the daily.

My temp is low though, constantly, about 97.5-97.9 but allegedly it is genetic. I'm willing to have my thyroid checked though because I tolerate cold too well for some people's liking.

First bold- YES! I am a doctor, but first I am a patient. You have to be your own advocate. Doctors are human. We make mistakes. We have biases. Don't take it if a doctor gets "butt hurt" if you see someone else if they weren't available. My neurologist did that to me and actually YELLED at me while I had a migraine. I never went back to him again. It was unprofessional, and I can find a new neurologist that will treat me with respect. Even physicians get the run around when they become patients. It is hard to be a patient...even harder when you don't know what you are getting yourself into, so educate yourself!

Second bold...ahhh, Alaska!

[AOII Angel]

Originally Posted by PeppyGPhiB

I will tell you that my sophomore year in college I gained 40 lbs in one year despite eating better and getting a great workout every day on my hilly campus. I was pre-med at the time and noticed that I had a number of symptoms of hypothyroidism (we were studying the endocrine system at the time). So when I went home at the end of the year, I went to the doctor. And she wouldn't test me. Told me I was too young to have hypothyroidism and that I just needed to exercise more. By the time I came home from winter break of my junior year, I had gained another 20 pounds. I went to the doctor, crying, and she finally tested me. My TSH test came back at a 45 - but she still didn't want to treat me! So I asked for a referral to an endocrinologist and I've been treated ever since. Through REALLY hard work, and medication, I've been able to lose 20 of the pounds, but not all 60. My TSH is still around 10.

Some doctors who are more recent graduates and know all of the latest research on this stuff may know better than their patients, but not all doctors keep up on current research and treatments. Any patient who has had to change doctors due to new insurance or lack of "chemistry" with a given doctor knows that there is a huge variety of doctors out there, all with different methods. My doctor was old school, about five years out from retiring, and though she was a smart lady, she used old-fashioned approaches that were not appropriate for an unusual case like myself. She needed to recognize her areas of weakness and refer me to someone who knew more about my condition than she did.

I agree, which is what I told her in the beginning.

[AGDee]

Originally Posted by Beryana

So even if you are the best doctor for me, because I happen to work for a place that offers the 'wrong' insurance and chose the 'wrong' company for my own policy I can't see you without paying out of pocket? How is that truly helping the patient? "I'm sorry, but I won't see you because of the insurance you carry and can't afford to pay the bills out of your own pocket.. . ." I understand doctors are running a business, but shouldn't the patients be at the heart of that business? (and I did offer to pay for those tests - and was still given lip service).

That's the reason I'd like to see it removed from the employer completely. I want to select whichever health insurance I want, NOT the health insurance my employer (who happens to OWN the health insurance company) wants me to have. It is entirely possible that I would still choose the same insurance, but I want that choice. Just as my employer doesn't mandate who I get my auto insurance from, who I get my home owners from, etc., I don't want them controlling my health insurance either.

[AOII Angel]

Originally Posted by AGDee

That's the reason I'd like to see it removed from the employer completely. I want to select whichever health insurance I want, NOT the health insurance my employer (who happens to OWN the health insurance company) wants me to have. It is entirely possible that I would still choose the same insurance, but I want that choice. Just as my employer doesn't mandate who I get my auto insurance from, who I get my home owners from, etc., I don't want them controlling my health insurance either.

Of course, right now in many states, there is little choice even if you didn't have to take who your boss picks.

[AGDee]

Originally Posted by AOII Angel

Of course, right now in many states, there is little choice even if you didn't have to take who your boss picks.

Agreed! Also a problem.