To Deliver Preventive Care Enhancing Population Health After Covid-19

While not about health, Franklin was first to say an ounce of prevention is worth a pound of cure.

What were the additional medical setbacks the American public suffered during the Covid-19 Pandemic…..

To Deliver Preventive Care Enhancing Population Health After Covid-19

On the Houston Healthcare Initiative podcast, Dr. Steven Goldstein said that it was possible to reverse the preventative care reversals suffered during the Covid-19 pandemic.  Everyone can stay healthier, and possibly live longer by re-committing to prevention as part of our collective health regimen.

The Houston Healthcare Initiative podcast can be heard on: Apple Podcasts, Audible, Audacy, iHeart, Listen Notes, Podcast Addict, Podbay, Podnews,  Stitcher, Soundcloud, and Player FM.

Pandemic Pull Back

prevention
Routine health medical tests and exams designed to prevent illness fell during the Covid-19 pandemic. Dr. Steven Goldstein expects the number of tests to return to pre-pandemic levels.

How much did Americans miss when it came to preventative or elective care during the pandemic? Quite a bit according to Dr. Goldstein. “The drop off was precipitous and happened in a very short period during the spring of 2020,” he told his listeners. “Vaccinations dropped by 60% in April 2020. In the same period practically, no one got a colonoscopy with an 88% decline for those.”

What Will Happen Now?

Dr. Goldstein said to expect preventive care use to return to its pre-pandemic rates. “But the gaps created over the last year have critical implications for patients’ long-term health and could potentially lead to poorer outcomes over time,” he stated.

The Full Impact of Covid-19

The full effect of the pandemic on the American public is not known yet. But hospitals and health systems are aware of trends caused by delayed health screenings and the worsening of some chronic conditions.

The COVID-19 pandemic led to a decrease in preventive screenings because some patients were hesitant to see their health care provider. That was understandable. “But with more and more places opening, it’s important to get back to the preventative tests, screening and medication that helped you and everyone stay healthy and manage those chronic conditions,” Dr. Goldstein concluded. “Preventive care helps everyone stay healthy.”

The Norm of Preventative Care

Preventative care is and has always been considered best practice for all physicians and their patients.  Finding something and treating it early generally means a better outcome for patients including less expensive treatments. Screenings are important to avoid future health problems or catch them early when they are easier to treat.

Preventive care measures things like cholesterol, body mass, along with breast cancer screenings, prostate cancer screening and some general health counseling. Screening and test diagnosis helps doctors find abnormalities sooner than later. Cancer is the example most know about.  But the same caution with respect to blood pressure, arterial blockages in the heart and other organs are just as important.

“An ounce of prevention is worth a pound of cure.” This saying is reflected in proposed health reform plans and the efforts to increase investments in prevention throughout the U.S. healthcare delivery system. With evidence that nearly 40 percent of all deaths in the United States are due to behavioral causes, attention to prevention has encompassed obesity and tobacco smoking prevention in addition to vaccinations and cancer screening.

Chronic diseases are the leading cause of death and disability worldwide and are linked to increasing health costs. Preventative care is advocated as part of a population health approach and includes both clinical preventative services and screening tests.

Identifying and preventing potential problems downstream is one strategy for controlling utilization and improving health outcomes.Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you. This includes plans available through the Health Insurance Marketplace®.

About the Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

 

Enhancing Population Health Approaches After Covid – 19

Podcast on what's after Covid
Enhancing Population Health Approaches After Covid – 19.

Enhancing Population Health Approaches After Covid – 19.

On this edition of the Houston Healthcare Initiative Dr. Steven Goldstein, will discuss the reversals in preventative care the American public experienced during the Covid-19 pandemic and what we can all do to stay healthier, and possibly live longer by re-committing to prevention as part of our collective health regimen.

Criticism of Doctor Prescribed Treatments Could Put Patients At Risk

Off Label Prescription

Criticism of Doctor Prescribed Medicine Is A Bad Idea

Off Label Prescription
Off Label Prescriptions. Doctors have the right to prescribe medication for conditions other than the one approved.

Physician prescribed Ivermectin to help treat Covid-19 may not be the biggest challenge facing doctors today. The bigger problem is likely the deliberate interference with a doctor’s ability to prescribe and treat patients as they believe is best. This is the subject of the latest edition of the Houston Healthcare Initiative Podcast which can be heard on : Apple Podcasts, Stitcher, Podbean, Soundcloud, and the Houston Healthcare Initiative website. The virulent criticism and mischaracterization of doctor prescribed Ivermectin as a possible treatment for Covid-19 is one sign that medicine can be and is politicized.

Off Label Prescriptions

This repercussions and longer-term consequences of political interference with doctors and their patients includes the freedom to prescribe ‘off-label.’  Off-label prescriptions occur when a physician gives a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition other than the one diagnosed. The pressure on Ivermectin and last year’s with Hydroxychloroquine, were both more affordable remedies than other top dollar treatments or even vaccines.

Why The Controversy? Politics

The government under both Republican and Democratic administrations tried to dictate what treatment should be used to treat Covid infections. “The now vice president of the United States declared during the debates in 2020 that she would not take a vaccine based on who the president was and what he recommended,” Dr. Goldstein said. “Any medical recommendation from anyone other than a doctor familiar with a patient’s history is not credible.”

Off Label Successes

There are many examples from the history of medicine where an individual physician working alone has made a major breakthrough with what was at the time thought unconventional. “Dr. Ignaz Semmelweis saved the lives of numerous mothers by suggesting OB doctors wash their hands before delivering a baby,” Dr. Goldstein said. “He was ridiculed by the medical establishment at the time as the germ theory of infections was not yet discovered.”

More recently two Australian doctors, Barry J. Marshall and Robin Warren, found that stomach ulcers were caused by bacteria. “They also were ridiculed by the medical establishment until they won the Nobel Prize,” Dr. Goldstein told his listeners.

Stop Politicizing Medicine

Dr. Goldstein’s conclusion from this latest flap regarding off-label prescriptions, “allow physicians to pursue different treatments for Covid. Stop politicizing the treatments and stop publishing premature articles in the press for or against any unproven treatment.”

About The Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

Physicians Rights: Off Label Prescriptions of Ivermectin for Covid-19

Physicians Rights: Off Label Prescriptions of Ivermectin for Covid-19

Off Label Prescription
Physicians Rights: Off Label Prescriptions of Ivermectin for Covid-19. Doctors have the right to prescribe medication for conditions other than the one approved.

Even in the year 2021 the more things change, the more they stay the same. This is reference  to the off-label prescription options doctors have always had that are still controversial when it comes to the ongoing global Covid 19 pandemic. Off-label prescribing is when a physician gives a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than the one you’ve got. This practice is legal and even common. In fact, one in five prescriptions written today are for off-label use.

Same But Different

Last year Dr. Goldstein discussed the controversy and government interference with how hydroxychloroquine, a common treatment for Malaria was prescribed off-label for patients suffering with Covid-19. Fast forward from September 2020 to October 2021 and the same thing is happening with a drug called Ivermectin, a drug that is approved for treatment of certain parasitic worm infestations, and its possible use as a treatment for Covid-19.

 What is going on with this latest controversy?

Unfortunately, the controversy involves politics. The government under both Republican and Democratic administrations has tried to dictate what treatment should be used to treat Covid infections. In truth, the development of treatments should not be political and should be left to the medical profession. Government should limit itself to funding research and to providing additional equipment and hospital beds as needed. The CDC can be a clearinghouse to provide  data to physicians and researchers about the pandemic. A classic comment sticks in my craw. During the Vice Presidential debate, Kamala Harris famously said if Donald Trump said to take the vaccine she would not. But if Joe Biden said to take it she would. Think about it. What does either man know about Kamala Harris to advise whether or not she should take the vaccine?

She should make the decision with the advice of her physician. The government does have a public health role to protect the public from getting infected but not a treatment role. 

Is Ivermectin OK to Use?

There are studies that show Ivermectin has no anti-viral benefit, some that show it has those qualities for some diseases and others that show it is a miraculous treatment. So far there is no consensus among physicians about the utility of ivermectin. “My view is that doctors who suspect it to be of value should be allowed to study it,” Dr. Goldstein said.  There are many examples from the history of medicine where an individual physician working alone has made a major breakthrough. Two examples come to mind: Dr. Simelweis saved the lives of numerous mothers by suggesting that OB doctors should wash their hands before delivering the baby. He was ridiculed by the medical establishment at the time as the germ theory of infections was not yet discovered. More recently 2 Australian doctors, Barry J. Marshall and Robin Warren found that stomach ulcers were caused by a bacteria. “They also were ridiculed by the medical establishment until they won the Nobel prize,” Dr. Goldstein told his listeners. “Allow physicians to pursue different treatments for Covid. Stop politicizing the treatments and stop publishing premature articles in the press for or against any unproven treatment.”

With more much-needed insight is respected neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein on his regular podcast.

Click the link to listen: https://houstonhealthcareinitiative.libsyn.com/ivermectin-off-label-prescriptions-for-covid-19

3 Goals: Healthcare Changes to the American Families Plan Could Create Affordable Healthcare

3 Goals: Healthcare Changes to the American Families Plan Could Create Affordable Healthcare

Hand writing What You Need To Know with marker, business concept background

3 Goals: Healthcare Changes to the American Families Plan & Health Savings Plans Could Make Medical Expenses More Affordable.

The new administration, like all of them, has plans for Americans and their healthcare. On this edition of the podcast Dr. Steven Goldstein, who founded the Houston Healthcare Initiative, will get us all better acquainted with what those proposals are and explore other possible ways for how healthcare can be fixed. The Biden administration has three goals.

3 Healthcare Changes are Goals for the Biden Administration.
There are three healthcare priorities for the Biden administration plus one more that Dr. Steven Goldstein suggests.

To listen to the podcast, click this link: https://soundcloud.com/harold-nicoll/three-biden-administration-healthcare-goals-plus-one-not-included. 

The Covid 19 Response

Of the three goals, first is the Covid-19 pandemic response. Part of the goal is to prevent over capacity of limited hospital beds and critical care space during spikes in the virus outbreak, like those occurring now. Others include the ability to establish temporary hospitals and better ways to track Covid surges via technology. Making telehealth options more widely available, tasking all relevant federal agencies to set up temporary hospitals and getting the Center for Disease Control (CDC) to develop real-time tracking dashboards to better predict when surges will happen, where they are and other details needed to better inform healthcare professionals about the evolution of the pandemic.

The Affordable Care Act

The second of the three priorities has to do with the Affordable Care Act, or as it is more popularly known, ObamaCare.

The idea is to reduce medical costs for the American public. As part of a separate pandemic relief bill, there is $34 billion to help Americans who buy insurance from the health plan marketplaces that were created by Obama Care now through 2022.  Those who know about it state that this would help lower and middle-income Americans who have fallen through the cracks of the government’s eligibility requirements for ObamaCare subsidies. It would also help people who choose policies with lower premiums and higher deductibles. There is also assistance for the unemployed.

Medicare Reform

One of the more visible proposals is to increase the age of people who are eligible for Medicare from the current 65 to 60 years of age.

“While we can think of these as beneficial to society, there is a considerable cost that comes along with it,” Dr. Goldstein told his listeners. “Instead of transferring more money to people, there are other ways to use existing healthcare payment strategies that will benefit everyone.” So why not fund Health Savings Accounts (HSA’s) with this same amount of money?  It is tax-advantaged when received, if the money earns interest while in the health savings account the account owner can keep it and be prepared to pay cash for more health-related expenses. So what is a health savings plan?

Prescription Drugs

The Trump Administration launched a “Transparency in Coverage” ruling in December of 2020 that required health insurers to disclose current drug prices and provide patients with personalized cost estimates. The Biden Administration hopes to increase these efforts by repealing existing laws that prevent Medicare from negotiating lower prices with drug corporations. “Plenty of people believe that the government already uses its mass buying power with Medicare to negotiate better rates,” Dr. Goldstein said. “That is not the case.”

Health Savings Accounts

The Health Savings Account. or HSA, is a type of savings account that is used for medical expenses. HSA’s were established for those with high deductible health insurance coverage. HSAs and high-deductible health plans were created to help control health care costs. The idea is that people will spend their health care dollars more wisely if they’re using their own money. The money deposited by individuals into their HSA account is not taxed.

Further, HSAs feature a triple-tax benefit: money you contribute to your HSA can be written off on your taxes and thus reduce your income tax bill; money in your HSA grows and compounds assuming investments rise. All is tax-free over time; and when HSA money is withdrawn for qualified medical expenses, no tax is paid on the withdrawal. It is owned by the individual so that he or she can pay their healthcare costs. These include everything from doctor visits to blood tests, paid for with cash from the health savings accounts.

As always, information about this and more than 50 other podcasts can be heard and read about at the website, www.houstonhealthcareinitiative.org.

About The Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

How Long Term Pandemic Stress, and Brain Changes Equals Weight Gain

Photo courtesy of Very Well Mind.
How Long Term Pandemic Stress, and Brain Changes Equals Weight Gain. In a study published in Molecular Psychiatry, researchers found that chronic stress results in long-term changes in the brain.3 These changes, they suggest, might help explain why those who experience chronic stress are also more prone to mood and anxiety disorders later on in life. Photo published in ‘Very Well Mind.’

As covered in the U.K.’s Daily Mail

How Long Term Pandemic Stress, and Brain Changes Equals Weight Gain

August 30, 2021– Human brains may not be wired for long term stress. On his most recent podcast, well known neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein, discussed the biological reasons and brain chemistry changes that in part led to the weight gain so many experienced during the Covid-19 pandemic lockdown and how long term pandemic stress and brain changes equals weight gain

The Houston Healthcare Initiative podcast can be heard on : Apple Podcasts, Audacy, iHeartRadio, ListenNotes, Spotify, Stitcher, Backtracks, PodbayFM, and SoundCloud. This and all other editions of the Houston Healthcare Initiative podcast can also be heard on www.houstonhealthcareinitiative.org.

While individuals ultimately have responsibility for what they eat, drink and how often they exercise there are physiological reasons why so many Americans put-on weight during the lockdown.

Brain Chemistry and Weight Gain

When stressed, the brain releases chemicals that make speed and strength available for a short but very intense time. Adrenaline is a hormone secreted by the adrenal glands, increasing rates of blood circulation, breathing, and carbohydrate metabolism, preparing muscles for exertion. But when released over long periods of time those same chemicals demand a lot more brain fuel which causes individuals to eat more and more.

Automatic Brain Chemicals

There are other neurotransmitters like: serotonin, dopamine, and melatonin.

Melatonin in the body lowers at the time of the flight or fight response. Serotonin regulates emotions, appetite, and digestion. Low levels of serotonin increase anxiety and can change a person’s eating habits. Dopamine – another feel-good neurotransmitter – regulates goal-oriented motivation. Dwindling levels of dopamine can translate into lower motivation to exercise, maintain a healthy lifestyle or perform daily tasks. When people are under stress, they also produce less of the sleep hormone melatonin, leading to trouble sleeping.

The Worst and Most Preventable Co-Morbidity

The pandemic lockdown made the existing epidemic of obesity much worse. The American Psychological Association’s “Stress in America” poll, conducted in late February 2021, found that 42 percent of people surveyed reported they were heavier than the previous year. People in a separate survey reportedly gained an average of 29 pounds during the pandemic, with 10 percent gaining more than 50.

How Obesity Makes Covid-19 Worse

  • The Centers For Disease Control (CDC) states that Obesity is linked to impaired immune function.
  • Obesity decreases lung capacity and reserve and can make ventilation more difficult.
  • A study of COVID-19 cases suggests that risks of hospitalization, intensive care unit admission, invasive mechanical ventilation, and death are higher with increasing BMI.
    • The increased risk for hospitalization or death was particularly pronounced in those under age 65. 
  • More than 900,000 adult COVID-19 hospitalizations occurred in the United States between the beginning of the pandemic and November 18, 2020.
  • Models estimate that 271,800 (30.2%) of these hospitalizations were attributed to obesity.

In a time when many things are beyond the control of American citizens, eating more vegetables, fruit, and lean meat in place of less nutritious options is something that can be controlled.

About The Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

Pandemic Lockdown Weight Gain & the Medical Reasons for it

Could the coronavirus pandemic exacerbate obesity wrbm large

It’s not all your fault, it’s evolution…

Pandemic Lockdown Weight Gain & the Medical Reasons for it. At a time when Americans should have been focused on their health, as a population they were anything but. During the Covid-19 pandemic lockdown the average American gained two pounds a month, according to a study published in the The Journal of the American Medical Association (JAMA Network Open).

But the reasons for this trend were the result of brain chemistry that evolved in humans over the millennia, according to well respected neurologist, Dr. Steven Goldstein, founder of the Houston Healthcare Initiative. He described these on his regular podcast that can be heard on Apple Podcasts, Audacy, Houston Healthcare Initiative, iHeart, Podcast Addict, Podbean, Backtracks, Soundcloud, and just about anywhere podcasts can be heard.

Stress & More Stress

Dr. Goldstein told his audience that the main reason for the weight gain was related to stress. “The main reason is stress, especially given the really bad news about the seriousness of the pandemic and the controversies about different treatments early on,” he told his listeners. “That was stress of a long duration which exacerbated the physiological accompaniments of stress.”

Fight or Flight Responses

As part of the ‘fight or flight’ response, the human brain goes on high alert. To maintain a high state of alertness requires more energy for the brain in the form of calories. “Heightened states of stress and anxiety like this require more calories to keep the brain on high alert, Dr. Goldstein stated. “We eat sugar to get a boost of energy. Sugar gets converted to energy faster but does not last long, requiring more sugar. It is a cycle that is unhealthy short term, but really bad long term.”

Long Term Fear of the Unknown as part of Pandemic Lockdown Weight Gain & the Medical Reasons for it

On top of that stress was the unknown. No one living had ever experienced anything like the Covid-19 pandemic and closure of practically everything. According to Dr. Goldstein, not knowing was a huge problem for the American psyche. Research shows that the unknown makes people more stressed than when they know something is about to happen. “In late March, April, and May of last year we really didn’t know what we were dealing with, in terms of how contagious the Covid-19 virus was or how potentially fatal it might be,” Dr. Goldstein said. “Obviously then, the unknowns of the virus and the dramatic worldwide lock downs were things none of us had any experience with and that is the perfect recipe for stress, anxiety and the overeating that accompanies both.”

To Flee or Not to Flee

Stress like this is in reaction to the ‘fight or flight’ response that is hard-wired into the consciousness of humans. According to the web site Psychology Tools, the fight or flight response is ‘an automatic physiological reaction to an event that is perceived as stressful or frightening. The perception of threat activates the sympathetic nervous system and triggers an acute stress response that prepares the body to fight or flee.’ When the duration of this automatic response is months or even over an entire year, part of the evidence that Americans endured all this stress is registered on the scale.

Brain Chemistry and the Pandemic Lockdown Weight Gain & the Medical Reasons for it

So what in the human psyche links eating with stress? “Humans evolved such that when faced with stress, the body does what it must to keep the brain on high alert,” Dr. Goldstein reported. “It decreases levels of some hormones and brain chemicals to discourage behaviors that won’t help in an urgent situation, and it increases other hormones that will.” Dr. Goldstein added more details, “our ancestors had to outrun predators and other humans or be ready to fight them. Thus, we evolved to release adrenaline in response to the fight or flight response. From an evolutionary perspective, that stress responses are tuned to environmental uncertainty suggests that they gave people a better chance at survival, depending on who or what was chasing you.”

A Gut Feeling

Dr. Goldstein also explained that there was a connection between the brain and the stomach. “The brain is connected to the gut through a two-way communication system called the vagus nerve,” he said. “When you are stressed, your body inhibits the signals that travel through the vagus nerve and slows down the digestive process.”  Eating for comfort can be a natural response to stress, but when combined with the lower motivation to exercise and consumption of low-nutrient, calorie-dense food, people can and did gain weight.

About the Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

 

UnitedHealthcare and the non-emergency emergency… Who Decides If You Need To Visit The Emergency Room?

UnitedHealthcare
UnitedHealthcare delayed a controversial decision to retroactively declare treatment in an emergency room not an emergency.

UnitedHealthcare and the non-emergency emergency…

Who Decides If You Need To Visit The Emergency Room?

On the latest edition of the Houston Healthcare Initiative podcast, respected neurologist and Houston Healthcare Initiative founder Dr. Steven Goldstein discusses the proposed UnitedHealthcare policy of after the fact review and in some cases possible denial of  some emergency room visits. The Houston Healthcare Initiative podcast can be heard on: SoundCloud, iHeartRadio, Stitcher, Backtracks, LibSyn, Soundcloud, or the website at www.houstonhealthcareinitiative.org.

Declaring the Emergency, a Non-Emergency

UnitedHealthcare is the nation’s largest health care insurer. In early June 2021 UnitedHealthcare announced that it would change how they assess emergency department claims, and thus allow ‘United’ to retroactively deny claims it deemed “non-emergent” or not an emergency. The aim is for the insurance company and their customers to save money, but others say the consequences could be more costly or even deadly. The new policy was originally scheduled to begin on July 1, 2021 but after a wave of criticism from among others, the American College of Emergency Physicians, United backed off and later said they would wait until the pandemic was past to make a decision about this decision.

Bad Policy With Usual Solutions Tried

Like the American College of Emergency Physicians Dr. Goldstein also believes this policy is unwise. “The answer is not to retroactively deny payment for ER care already rendered,” he told his listeners. “What this does is force the hospitals to refuse care for “non-emergency care” as defined by UnitedHealthcare. However, this is not practical because the hospital is more afraid of a potential lawsuit if a patient is refused care and has a poor outcome as a result. The patient then will be stuck with a large bill that cannot be paid.”

Dr. Goldstein states this is another example of an insurance company trying to “manage care.” “They (insurance companies) see a problem, namely they think that Emergency Room services are over-utilized and think they can manage the problem,” Dr. Goldstein said. “They try their usual method of operation and simply deny payment.”

On The Other Hand

UnitedHealthcare claims there are big problems with the misuse of emergency rooms which costs the U.S. healthcare system roughly $32 billion annually. UnitedHealthcare states that misuse typically manifests as patients seek out costly care for minor ailments that could be addressed through other avenues like an urgent care type of clinic. According to the UnitedHealthcare web site, “two-thirds of hospital ED visits annually by privately insured individuals in the U.S. – 18 out of 27 million** – are avoidable.”

Does UnitedHealthcare Have A Point?

Dr. Goldstein stated that United had a point “if the point is that healthcare administered in an emergency room is too expensive.” But he also point out, “UnitedHealthcare negotiated the prices they pay with the hospitals. If it is too expensive, why did they negotiate such a high price?”

About the Houston Healthcare Initiative Podcast

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To hear the podcast go to:

Dr. Goldstein insists that for the health and welfare of the American public, the congress must pass reforms that limit the influence of the pharmaceutical industry and its lobby.

8 Questions and Answers… What to Know When Considering a New Doctor

8 Questions and Answers…

What to Know When Considering a New Doctor

What to Know When Considering a New Doctor. Eight answers from a practicing physician. 

May 11, 2021 – What should anyone know or ask when considering a new doctor or primary care physician? On his regular podcast, Dr. Steven Goldstein, founder of the Houston Healthcare Initiative tells his listeners what to know and ask when considering a move and why we all even need our own primary care physician. Below is a list of questions and Dr. Goldstein’s answers to them.

Where to Listen

To hear the Houston Healthcare Initiative podcast, visit one of the following: :  Apple Podcasts, LibSyn, Spotify, Radio.Com, Listen Notes, iHeart Radio, Podcast Addict, Podbay, Backtracks, Player FM, Stitcher, and SoundCloud.

Questions and Answers

  1. Why is choosing a regular or primary care doctor such a big deal?

“If you don’t have a regular or primary care doctor, you could be missing out on a very important relationship with someone in a position to help you stay healthy and live the best life possible.  Over time, a regular or primary care doctor learns all about you and your history. So, choosing one is very important and the right time to find one is when you do not need one for any type of immediate care.”

  1. A regular primary care physician knows us, which is good. But what other reasons are there to have one?

“People with primary care doctors are more likely to get preventive services, including cancer screenings, and report significantly better health care access. According to the Journal of American Medicine, Americans with primary care doctors received significantly more high-value care and reported significantly better health care access and experience. Patients in states that spend more on primary care have fewer hospitalizations and emergency room visits. So, there is no doubt that a regular or primary care physician is an important part of anyone’s health and well-being.”

  1. How does one go about finding a primary care doctor?

“Make sure that the doctor you choose or consider, offers easy access – either by phone, email, telemedicine visit, or office visit. You should shop the price and accessibility in advance so that you are not desperate when a health issue arises. An alternative is to identify a doctor hotline to call in an emergency.”

  1. How does the patient know if he/she can afford care and what is the best way to pay?

“When you make an appointment with a new doctor, ask what the cash price for your initial visit will be and ask to compare it to the discounted price your insurance company has negotiated. You may need to speak to the billing office or the office manager to find this out. A common answer is that it depends on the complexity of your problem. When you hear this ask, ‘can you give me a range from a routine to a complex visit? Can you also tell me what my insurance allows?’ If you have the temperament, you can also try to negotiate a cash price. If you are treated poorly or they refuse to give you this information, find another doctor.”

  1. What should a new patient expect on their initial visit?

“When you first arrive, you will be greeted by a receptionist and given multiple forms to complete in the waiting room. Make sure when you come to the ‘consent for treatment’ form you are not agreeing to any test the doctor orders, but you reserve the right to accept or refuse any test in advance. Then you will be escorted to a room where a medical assistant will record your symptoms, take your vital signs and depending on the doctor’s specialty might wish to perform ‘routine’ tests. You can feel free to question the reason for these tests and have a perfect right to refuse them if you do not understand.”

  1. So, some tests are not really needed?

“Precisely. But it is not because anyone is being dishonest. According to a study in the journal Academic Emergency Medicine, the top two reasons doctors ordered tests was fear of missing something that would help them diagnose their patients, and protection against malpractice. The authors of that survey also say that nearly all of the emergency room doctors—97%—admitted to personally ordering unnecessary imaging tests.”

  1. It’s easy for people to be intimidated by their doctor and not be keen to pose questions. So, to help get us started what should we ask?

“You can ask how the doctor arrived at the diagnosis. You can ask if doing any of the tests ordered will affect his treatment plan and are there alternative ways of arriving at the diagnosis. You can ask about the prognosis and what to expect from treatment including possible side effects and what to expect if the condition is untreated. At the end, send yourself another text when the doctor leaves the room. This will document the time the doctor spent with you and this information can be useful to be sure you are not overcharged, your time with the doctor was adequate and a good value.”

  1. I know my primary care doctor has some lab testing capability in his office and others also have x-ray machines. The convenience notwithstanding, are we obligated to do the tests where the doctor sends us?

“No. There is no need to get testing done at the doctor’s office

or at a facility recommended by the doctor. These prices are almost always better at an independent facility and are usually much better than the insurance company discounted price. Your objective is to be as healthy as possible. But no one should have to go broke in the process.”

More Than Just Another Doctor

A primary care physician is more than just a doctor. Over time, he or she learns the nuances of their patients’ medical history, reaction to medications, health goals, lifestyle, treatment preferences and whether or not a caregiver is supporting you in managing the individual’s health. Nothing is more personal. Paying for it is also personal. The time to check prices and ask questions is early in the process of selecting a doctor, not when arriving in an emergency room. Remember too that those who have a regular or primary care physician will be in better shape because of it.

Conclusion

Listen to the over 50 episodes of the Houston Healthcare Initiative podcast on the website, which is www.houstonhealthcareinitiative.org. Plus, there is lots of other information associated with those podcasts and news coverage about Dr. Goldstein and the work he does with the Houston Healthcare Initiative.

 

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

Obesity And Inactivity During Pandemic Caused Greater Covid Infection

April 29, 2021 – On his latest podcast, Dr. Steven Goldstein told his audience that Americans gained a good bit of weight during the lockdowns caused by the Covid-19 pandemic. But that was not the only bad news. The sad irony that obesity increased the risk of hospitalization due to the Covid-19 infection was not lost on him or his listeners as obesity and inactivity during pandemic caused greater covid infection risk. The cruel combination of lockdowns that were supposed to help keep the American public safer created a situation that made the likelihood of infection and a difficult recovery more possible.

Fat people are at increased risk of morbid covidity
The vast majority—78%—of U.S. patients hospitalized with COVID-19 were overweight or had obesity according to the American Medical Association.

The Houston Healthcare Initiative podcast can be heard on: : Apple Podcasts, LibSyn, Spotify, Radio.Com, Listen Notes, iHeart Radio, Podcast Addict, Podbay, Backtracks, Player FM, Stitcher, and SoundCloud. There is a way to repair this and many other weight related health risks if individuals change their eating habits.

The Consequences of Obesity & Covid-19                                                                              

The vast majority—78%—of U.S. patients hospitalized with COVID-19 were overweight or had obesity according to the American Medical Association. The numbers for intensive care, invasive mechanical ventilation and death were nearly the same.  In short, the quarantine was and is associated with stress and depression leading to unhealthy diet and reduced physical activity. “The main culprit in all of this was what we choose to eat before and during the pandemic,” Dr. Goldstein said.

This Century’s Dietary Downward Spiral

The obesity rate in the U.S. steadily increased since the initial 1962 recording of 23%. By 2014, figures from the CDC found that more than one-third of U.S. adults and 17% of children were obese.  The National Center for Health Statistics at the CDC showed in their most up to date statistics that 42.4% of U.S. adults were obese as of 2017-2018 (43% for men and 41.9% for women).

Americans in general consume more calories than needed. “We eat out way more than we ever did before,” Dr. Goldstein commented. “School systems encouraged unhealthy eating practices among children by accepting soft drink and fast-food contracts because they provide large commissions for financially strapped schools. The increase in energy intake or calories has been paralleled by a decrease in physical activity. Not moving is the norm. And that was especially the case during the pandemic.”

Discouraging but Curable

Rather than be discouraged by this news Dr. Goldstein was hopeful because the treatment for this is known and within the reach of all Americans; that they all make better decisions about what they eat.  “Everyone in the USA can literally take control of their own health and well-being with better choices at the table, store and restaurant and that can start right now, for everyone,” he said.

The pandemic and lockdown brought a lot of significant change to American society. The tendency to sit and eat was exacerbated considerably. “With more people moving less than ever while snacking constantly it is no wonder that our collective weight is so far up,” Dr. Goldstein concluded. “This is an easy fix for us all if we will just make the changes.”

About the Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.