Is there anything that patients can do about this without making the doctor mad? Should patients be asking “which lab tests are you ordering?” and, if it’s not one we recognize, “why?” I’d rather trust my doctor to do the right thing than have him think I’m second-guessing everything he does. But I just learned that my RD ordered a test for HLA-B27Ag. No wonder my lab work was $200 more than normal! This is a test for something that typically affects (1)men, (2) onset ages 20s-30s, (3) main symptom: lower back pain. I do not fit ANY of these criteria. I don’t have any idea why this test was run and honestly feel that the guy was just running up my bill. How can the patient help control these costs?

One of the reason people haven’t jumped on this faster than they have is that they see it as an issue of greed on the part of the doctors. The problem is that the docs in the best position to help the patients in this way are the ones least able to afford a decrease in income: the primary care docs. PCP’s get 1/2-1/8 of the pay of specialists, and many of them are simply leaving because of the way the system is going.

So for you, you could have someone who has incentive to make sure you get the preventive services, blood tests, and medications you need to stay away from the ER and minimize hospital stays. As it is now, the system pays more if we do a bad job with you. The medical home tries to right that wrong.

I don’t see any comments about this particular line, but it scares the bejeezus out of me. I happen to have AIDS and have been HIV positive for 20 + years, so I fall into that “uninsurable” category. Could you tell me exactly what a “Medical home” would entail? Because quite frankly it doesn’t sound too far removed from the camps. Are you advocating putting people like me away like they did Typhoid Mary? Where and how, exactly, would you “place” people in one of these homes? Quite frankly I enjoy living with my husband, even if he and I have a tougher time getting insured (or even if we cost the rest of the population a little extra money), I hardly think being put in a “medical Home” sounds reasonable. I think suggestions like this particular one are quite scary.

Not to mention when you place someone in a “medical home” don’t you then take over the cost of housing, food, and other costs? Or would we just use those detention camps the Bush Administration had built for FEMA and Homeland Security? Would I have my freedom to move about the country, or would I be checked in without the ability to check out? Medical Home sounds a lot like detention facility or better a medical prison.

Beowulf: No, 5% is not the % of the “uninsurable,” I just used it to demonstrate the lopsidedness of spending. I would bump that number to 10% or even 15% of people who have chronic illness. Many (most) of them are of Medicare age, so “uninsurable” is a misnomer. The bottom line is that we need to control the cost in a small segment through better management of these high cost patients. Any problems with the system (such as over-utilization and poor communication) are amplified in them, and so savings would also be more dramatic.

T Joey: I actually initially wasn’t against the DTC marketing, as they had some good in educating the public. The problem is that it gives the public a slanted view of things – slanted toward views that would recommend buying lots of products from Pharma.

RLS is real and treating it can be dramatic, but education of physicians would be far more fruitful than the public. The problem with that, of course, is that they are limited in educating physicians as well. They may not be well-liked, but the have to be able to advertise somehow.

They led me to ridicule a condition because they don’t represent the condition accurately and couldn’t in a 30 second ad. I was left to imagine who could have such a condition and my brain equated restless with a child’s energy level being unspent – ie the leg being restless because the person was lazy and leaving the energy (too many calories) unspent.

Listening to the ads I can only think that they are: a) suggestive – possibly inducing psychosomatic symptoms b) frightening – the side effects and the gravity of them can not be digested in a 30 second add, and c) a costly redundancy – how much are those ads costing the company and why not save on that budget entirely and let the doctor do what he is trained to do and will do anyway – he’ll get your drug out to the marketplace if it is the appropriate remedy. If it isn’t the appropriate remedy may it would worthwhile seeing if there is a better use of your R+D dollars. I’m sure the good doctor can correct me but I’m 99% convinced Restless Leg Syndrome is a your legs begging lazy people to go for a walk.

I can only imagine the seed that gets planted into people’s heads as they head to the doctors office with a legitimate symptom thinking they’ll be treated with Brand XYZ’s new drug only to be written a Rx for something different causing frustration on the part of the consumer questioning the care being “sold” to them as they forget they are a patient of a doctor who has been trained to prescribe prescriptions appropriately.

Besides, I hate those ads on top of what I can only imagine the harm they are doing to the health care system.