Health Care & Money, Bad docs, Medical Research, Obesityhelp.com warning,blogs

I had heard (and of course, always check things out) that obesityhelp.com sends reviews back to the surgeon. If they don’t like it, obesityhelp.com will delete it and not allow you to post. This is the surgeon experience form. When I asked about this, the response I got on 3/18/2014 at 11:14 am from membermail said, “Send us what you want to post and we will review it before you post it. Also let us know what surgeon it’s for.” Now if I have to have it approved, do you feel obesityhelp.com is a fair place to get ALL comments about a surgeon or is it only going to list their good ones. How can you learn if you only have good and don’t see how they deal with the not so good ones?

THE LATEST:
On 3/22/2014 5:32 PM, ObesityHelp Staff wrote:

When a member writes a testimonial on a surgeon, the surgeon receives a notice that a testimonial has been left on their profile. We do not review testimonials before or after they are written. We will conduct a review if a testimonial violates our Terms of Service and is reported to us by a member, a lurker or a professional. Unless a testimonial violates our Terms of Service, is slanderous or involves a potential legal action, we do not remove testimonials. If a testimonial is removed for slander or a legal issue, we do so for the protection of our member. Whenever a testimonial is removed, we notify the member by PM.
Member Services

Here are some recent items that go over money and health care, misbehaving surgeons & other doctors, selling nutritional supplements, and money/healthcare as a business. I also include retaliation that was done to a nurse, a single mom of two who had life miserable made for her due to whistleblowing when she served indigent & low income patients.

Syracuse Hospital Says it may be sued over patient slapping

Hospitals turn a blind eye to bad physician behavior
“Hospitals often turn a blind eye to bad behavior by physicians, especially if the doctors generate a lot of revenue, according to Syracuse.com.”

“Although experts say the vast majority of physicians aren’t troublemakers, bad behavior clearly isn’t an isolated problem. There have been several cases of physicians throwing objects in the operating room, yelling and hitting patients, and sexual abuse, the Association of Health Care Journalists reports. However, in most of these instances hospitals didn’t investigate the claims, according to Syracuse.com.

Hospitals often don’t do anything about the problem because the accused physician brings in a lot of money, Michael A. Carome, M.D., director of health research at the nonprofit consumer rights advocacy group Public Citizen, in Washington, D.C told Syracuse.com. And when hospitals do report cases to state medical boards, it’s rare for physicians to receive more than a slap on the wrist for the misconduct, he said.”

“In many instances, the bad behavior distracts the healthcare team, which can lead to medical mistakes.

“When we allow bad physicians to remain in practice, that can ultimately expose hundreds if not thousands of patients to substandard and unprofessional care,” Carome said.”

*** Just so you know, my blog links to items showing a 45% profit rating

Lawsuit on docs who mocked patient during anesthesia
The suit is emblematic of the decline in doctors’ professional reputations in recent years. “The once-venerable medical profession has taken quite a tumble from its pedestal, with the terms ‘untrustworthy’ and ‘greedy’ used to characterize doctors more often than ‘respected’ and ‘benevolent,'” Linda S. Ellis, M.D., of the Frank H. Netter M.D. School of Medicine at Quinnipiac University wrote in an opinion piece for Live Science.

Pressure on physicians to always be “right” contributes to a mistrustful culture where physicians fear asking questions or conceding mistakes, according to Ellis. “We tell one another and our students to never admit wrongdoing,” she wrote. “[E]ven worse, we model bad behavior to our medical students and residents, training new doctors to perpetuate behaviors that engender distrust.”

Hospitals bullies pose danger to patient safety
This isn’t just psychologically damaging to staff, according to Yurkiewicz; it also affects patient outcomes. For example, an abusive attending physician may discourage residents and nurses from openly discussing a patient’s problems, which gives time for those problems to worsen. “In a system dependent on hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up.”

“This correlation echoes results from a 2013 study in the UK, which found that one in four doctors and surgeons and one in three nurses said bullying has caused them to behave in ways that are bad for patient outcomes”

Johns Hopkins unveils $11Billion hotel/hospital
Johns Hopkins today unveiled plans for a new $1.1 billion hospital with a “hotel-like” atmosphere, The Baltimore Sun reported. As one of the largest hospital construction projects in the country, the 1.6 million-square-foot building will feature 560 private rooms, 33 operating rooms, new adult and children’s emergency rooms and include gardens, artwork, sound-proofing, Internet and food options. The new hospital replaces the East Baltimore campus, constructed in the 1930s and 1950s.

Officials say the upgrades are needed to maintain business by luring patients and keeping doctors and other personnel, the article noted. “Our new facilities will enable us to provide that excellent care with greater comfort and private for our patients and their families in a state-of-the-art environment,” said Edward D. Miller, dean and chief executive of Johns Hopkins Medicine.

*** Maintain business?

Medicaid debt isnt stopping Maine hospital construction
“Hospitals in Bangor, Augusta and Portland found the capital and loans for major construction projects even though they’re owed $484 million in overdue Medicaid payments from the past four years. The construction boom comes as hospitals warn of having to phase out services or lay off workers to cope with the Medicaid debt, the paper notes.
Eastern Maine Medical Center in Bangor, for example, recently resurrected its plans for a $250 million addition, a project the state approved in 2008 but was delayed in part by Medicaid debt–now more than $75 million, according to the paper.”

*** So how much is spent on patient safety?

Patient litagation over insurance billing practices

“St. Luke’s Health System in Kansas City, Mo., will pay $3.5 million and attorneys fees after it refused to accept health insurance from hundreds of patients injured in car accidents in lieu of trying to collect potentially higher payouts from automobile insurers instead.

Three patients sued the hospital after it attempted to recoup payments they received from their automobile insurers for medical treatment. Such payments are often higher than what St. Luke’s can collect from health insurers because the automobile insurers don’t negotiate payment levels in advance, according to the Kansas City Star.

If the automobile insurer didn’t offer a settlement, St. Luke’s often filed liens against patients directly.”

Putting the Patient First
Putting the Patient First — Using the Expertise of Laboratory Professionals to Produce Rapid and Accurate Diagnoses

Doctors & ethics of selling nutritional supplements
Is It Right for Doctors to Sell Nutritional Supplements?

Great blog on how a hospital is facing lawsuits from patients who were lied to on mammograms.
In summary, Perry Hospital technician Rachael Rapraeger lied about the results from over 1,200 mammograms. In her plea deal with a criminal court, Ms. Rapraeger said she got behind in her work and created negative readings for over 1,200 mammograms….mammograms that were never reviewed by physicians. Patients were lied to. Ten patients actually had positive readings, and two have since died. Ms. Rapraeger apologized for her conduct and was sentenced to six months in jail, 9.5 years of probation, a $12,500 fine, and is banned from the healthcare profession for 10 years.
Perry Hospital is currently facing 30 lawsuits from Ms. Rapraeger’s actions, and the hospital issued the following statement after her plea deal: “We are pleased this component of Ms. Rapraeger’s unfortunate action is concluded.”

How rude! Workplace incivility hurts bottom line

CA senator demands hospitals reduce rampant medical errors

“Building a differential diagnosis is in several steps of John Brush’s 12 point diagnostic process outlined that’s been taught for over 100 years. Wouldn’t this help diagnostic errors?”

*** Note that in Virginia, a doctor can “plea bargain” something from the Medical Licensing Board. There is a doc in Va. named as a “top doc” in the DC area that is on the brink of their license. Nothing in the public record for 3 years. Someone mentioned in another list that they should rename boards to something like a Protective Agency. In Florida, the doctor can see your complaint but you can’t see the doctors’ response. So if they lie, the lies are *protected by the state* as the *physician*. It is the same in Va. where you can’t comment on anything. They also don’t consider anything other than their own reports, nor how or where they get specialists to review other specialists, and whether there are conflicts of interest.
Boards of licensing are not transcribed/recorded. The doctors know this. Wonder why they get told that? They’re not sworn to tell the truth either.

Whistleblower lawsuit & what they did to the whistleblower
“Frohsin & Barger Qui Tam Suit Prompts Amedisys to Pay $150 Million
In 2009, Frohsin & Barger client, April Brown was a nurse and single-mother of two, struggling to make ends meet in the sleepy town of Monroeville, Alabama, best known as home to writer Harper Lee and the inspiration for her fictional town of Maycomb in To Kill a Mockingbird. Brown travelled rural Alabama caring for homebound patients: elderly shut-ins and the indigent infirm. What she witnessed about her employer’s Medicare billing, however, eventually caused her to become a whistleblower in the groundbreaking case of United States ex rel. April Brown v. Amedisys, Inc., CV-10-BE-0135-S (NDAL 2009), which today resulted in the largest home health fraud settlement in U.S. history, prompting the company – which denied all wrongdoing – to return $150,000,000 to the taxpayers, according to court documents.”

New WellPoint CEO Swedish Took Home $17 Million in 2013
(with Table: 2013 Compensation Among Five Highest-Paid WellPoint Executives)

General items:

Your rights and responsibilities according to Blue Cross Blue Shield.

Patient Advocacy:

Activated Patient
Patients are people too
Patient Visit Guide
Health Coaching

Protein Issues:
How much protein do I need each day?

Other patients blogs:

Was a bubble butt.
Ad Winters
Bariatric Beginnings
Beauty & the Bypass
Judi’s great spot
Bariatric Girl
What another patient went thru
Another link from Gary

Information on the bariatric surgeries from less than 6 months ago:
BMI Loss Lasting w/3 Bariatric Surgery Options.
Firing of Rex doctor

Vitamins: Bariatric offices & Flintstones

One item I’m seeing popular is the selling of vitamins and the like by bariatric groups. They have their own or you can purchase vitamins and the like from them. The question is why? When any of the vitamins will do, why do they have this “amenity”? Is it due to profits? Getting people back in for visits so that profits can be made? What about associated exercise centers? Do you have to pay for those? Are they part of your “surgery package”?

The main question being: is this for my health or does it provide a bigger profit range, or even both? If so, how do you know this is for you? How many people take advantage of these “amenities” and if so, what are the demographics? That might help you to know whether or not it is going to help YOU in your INDIVIDUAL journey.

Flintstones aren’t compliant with the Guidelines of the ASMBS (American Society for Metabolic and Bariatric Surgery). Some “Centers of Excellence” do recommend them, but ask why.

ASMBS Guidelines for the surgical weight loss patient/
Vitamin & Nutritional Guidelines

After a bypass, we need about 200% of the RDA of most vitamins and minerals. The reason for this is because part of the intestine is bypassed and that’s where a lot of vitamins and minerals are absorbed (some but not all). So you’ll have to take extra.

If you look at Flintstones vitamins, you’ll see that getting 2 of them a day is not going to give you 200% of the RDA for most vitamins and minerals. Some but not all. You’ll only get 120% of Vitamin A, 25% of biotin, 150% of niacin and nothing for Vitamin K (btw, the author took this vitamin and at 2 years post op, was so Vitamin K deficient blood levels didn’t register in tests, along with bleeding episodes). If you have to take more than one in a day, you’ll end up getting a lot more of some vitamins and minerals than others. Vitamin toxicity can be an issue – as can too much iron (Iron overload or hemochromatosis and a href=”http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=total_copper_blood”>copper).

Just an FYI: the type of Vitamin A is beta carotene. This is not Vitamin A but turns into it in the body. There is a lot of beta carotene you need to turn it in to Vitamin A (also known as retinol). Children can convert this into Vitamin A easier than adults. So its more suited for kids than adults. So if you take 4 Flintstones and get 240% of beta carotene, which may not be enough to turn into retinol.

Ask your surgeon why they still recommend Flintstones for post surgery bariatric patients. If they’re not up on this data, or their group isn’t, how up to date are they going to be on other items?

If a doctor treated you this way, how would you feel?

I have several examples. I’ll leave things like a doctor operating on you and never calling for a followup appointment. You end up calling and getting an appointment TWO MONTHS LATER.

First example:

I had a cake that I was going to make that resembled a 3D doctors’ bag. It was from a 2 week long diaper bag (and other baby items) cake class. The teacher agreed to allow me to make the doctors’ bag versus the diaper bag (and; other baby items). I attempted to contact the bariatric surgeons’ nurse, a couple of weeks before, to make sure my bariatric surgeon would be at work on that Friday. I had a bit of trouble getting to her. Because it was to be a surprise, I was pretty anxious to talk to her because of the time involved my own time, materials to make the cake. I told the nurse after I got in touch with her why I was so insistent on talking to her right then. She understood and said she would keep it secret. I was having to call so that it wouldn’t be seen in my electronic health record (in case the bariatric surgeon would see it). The bariatric surgeon called me up at home and fussed at me for needing attention right then, they get to me when they can, they paid more attention to me than any one else, etc. I didn’t say anything. Now here I’m getting chewed out for doing something NICE for this doctor! Then that Friday, I got to sneak the cake in, with the help of the staff. I had a few other things made also. I was waiting in a room (no appt.) and the nurse told him to go in, without telling him why. He came in and was very surprised but acted pleased. I told him that he got mad at me for being so insistent calling a few weeks ago, but this was for him. He just laughed. (and then wanted my gelatin flower too! “Is that for me?” “No!” … I am not getting in bad with my church for him. ) Not one word of apology, ever, for chewing me out, instead it was laughter. What do YOU think about what this says about a bariatric surgeon, a surgeon, or even any doctor?

Second example:

Another interaction with my bariatric surgeon: I didn’t want to be weighed because I had been losing so much weight. I finally said no to getting on the scale. This group is part of a system that, on the internet, guarantees you can refuse tests/care and still be treated. Legally you do have the right to refuse. Well, when I refused, the nurse said she would get the doctor. He comes in with his nurse. He ends up telling me ‘if you don’t do as I say, I will put it in your records. Other doctors will see it and wonder why’. Now if someone is concerned, and they’ve been mentally, negatively, been treated about the loss of so much weight in such a short time, would this make you feel better? To be coerced against your will against taking a medical test that you legally have the right to refuse and still get care? That they would do this to put a wedge between you and your other doctors?

Third example: Another instance: on the day I was released from the hospital from malnutrition (a Monday, June 25, 2012), the surgeon told me to see him next Wed. Then he said oh wait, next Wed. is July 4th, see me that Friday (July 6). Ok I said. Well I got a call later on and someone was very unhappy because I didn’t call and make an appt. for Friday June 29th. I said it was “see him next Friday”. “Well I didn’t know what I was thinking”. Well neither did I but I was written up in my medical record! I was BLAMED for their MISTAKE.

Fourth example: After my gallbladder surgery, I was told 2 weeks before I could do anything (meaning swimming). Then a couple of days after the surgery and I had come home from the hospital, I asked and then it changed to three weeks. I said (from my electronic health record): “3 WEEKS? That’s not what he said before, it was 2! What was he smoking, toking or testing from the OR gas passers before he gave you that answer? After all the food I brought (didn’t go to bed Sun night & started some stuff on Sat night), even made fresh turkey/chicken wraps & got fruit/veggie trays with homemade potlatch seasoning for dip. And he says I push HIS buttons?

** I brought a boatload of food for the doctors & nurses in the surgical areas. The doctor had told me before that “I pushed his buttons”.

The response from his nurse was: “Ok, he said AT LEAST TWO WEEKS…..”.

How easy is it going to be to follow a doctor who changes your directions and then believes you were the one at fault for it?

Fifth example:
See example 4. When a doctor tells you you push his buttons, maybe the doctor needs to learn to be professional and not have patients that “push buttons” when people do their research and ask questions.

Sixth example:
I actually had my surgeon tell me, ‘You know I don’t like it when you do that’. Now since when does what a doctor LIKES matters? When a bariatric surgeon, says in a video publicized that they have all sorts of people who have surgery and names firemen as an example, that means that there should not be any problem doing any sort of physical activity.

Its not about:

the surgeon selling you a particular surgery because
: that’s the one they do
: or the one that makes them the most money
: or the one that gets them their quota of X surgeries for the year
: or keeps them coming back to you.

It is about what is right for you!

One note: sleeve surgeries are noted (as of 3/2014) to have a problem with reflux or GERD. This means if you already have it, or you don’t have it, you have a greater chance of getting it or keeping it or it getting worse with this surgery. You would need conversion to RNYGB (gastric bypass) possibly to fix it. So choose a surgeon who has NO vested interest in the $$$ from the surgery or one that keeps you coming back to them. You want what is best for you!

The other is the personality of the surgeon. If you like them, you’ll keep your followup appointments. Plus it makes working with them easier if they have a personality you can deal with. In my case, I had a very paternalistic surgeon. While that works for some, that surgeon stated once about a particular treatment he chose: “I did what I thought was right”. EXACTLY! What THEY thought was right by THEIR values, mores, and standards, not what worked best for ME and my life, job, friends, family, etc.

How many of you would allow the company to build your house to choose your carpet, wall paint, etc.? This is the same thing. The surgeon should be giving you the options and letting YOU make the decision. If not, are you going to be happy for the rest of your life having this person make decisions on your health?

THINK ABOUT IT!

One other item: a center of excellent (which all are in the Hampton Roads area) means that a group or hospital has hit certain milestones & fulfilled criteria. It means NOTHING as to whether or not a surgeon is good or not.

A big item is experience with the particular type of surgery you want done. I refer to this in my questions for surgeons categories of posts. One item about the RNYGB (bypass): the stoma, link from the pouch or stomach, to the small intestine, can dilate or become wider. That means a lack of restriction. This area is made to keep food in the pouch so that you feel full. Once it dilates, food isn’t held in the stomach and you’ll start to feel hungry. Since malabsorption happens within really the first 2 years (or less, the intestines “relearn” or adapt to be able to absorb more, regain can restart. The more intestine bypassed, the more malabsorption happens.

Patient Safety

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_ffg.pdf

 

http://www.bmj.com/content/348/bmj.g2078?utm_content=buffer37be4&utm_medium=social

 

http://www.kevinmd.com/blog/2012/12/culture-coverup-slowed-patient-safety-movement.html

 

http://www.kevinmd.com/blog/2011/08/partnership-patients-improve-patient-safety.html

 

http://www.cfah.org/blog/2014/common-bias-ignored-patients-and-families-lose

 

http://www.geisinger.org/patients/pt_rights_resps.html

 

http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/tips-and-tools/index.html

 

http://osteoarthritis.about.com/od/osteoarthritisdiagnosis/a/talk_to_doctor.htm

 

http://www.ahrq.gov/patients-consumers/diagnosis-treatment/diagnosis/diaginfo/diaginf4.html

 

http://www.timesdispatch.com/opinion/their-opinion/columnists-blogs/guest-columnists/katz-participatory-medicine-encourages-partnership-between-patient-and-provider/article_7cb25dfd-cbfb-505d-b164-11b5c0b45fa9.html

 

Questions for your surgeon and their groups:

At the bottom of the page, I give reasons why you need to research your doctors because the health care system is not what people think. Here is just one reason why you should check out the bariatric surgeon: Bariatric Surgeon’s license suspended

Find out who your insurance company contracts with and get that list. Go to every seminar for every doctor. Doctors put on these information seminars for one reason: to sell their view/version/healthcare groups’ idea of the surgery. The seminar is pretty much the same in every group amongst all the groups in the area. Think of the doctor like a car dealer: they’re there to sell you their own particular version. Each bypass is the same as each sleeve is the same. Doctors pretty much do the same surgery the same way. So choose the surgery FIRST, choose the aftercare, nutrition, follow up, and support group SECOND, and the surgeon LAST.

Find a doctor who does bypass and sleeve & ask them how many of each surgery have they done as the primary, then backup. Ask if they teach the surgery to any other doctors. Find out how you can verify the number, as some can “fudge” those numbers.

Its their skill you want, forget whether or not you like them. You need someone who can get the job done first. It doesn’t matter how slick they are, they have to be good at what they do. If you get a sleeve, it doesn’t matter, because unless something really strange happens (like with mine), everything is the same and you don’t need the doctor after the first year.

Ask for references from good AND bad. If the doctor won’t give bad ones to you or won’t give you the names of those who’ve had negative experiences, what does that tell you? They have all had them, but if the doctor can’t work with people after a bad experience, what does that say about their skill, resourcefulness, abilities? Any one can stick a tube down the throat and cut away the excess stomach, which is basically what happens in a sleeve. If they have problems, how they deal with them, recognize them, who they refer to, THAT is where skill is. Get at least 5 MAJOR issues people, not just “I couldn’t eat that far out after 2 months”, I mean at over 1 year, a sleeve developed a leak, reflux, how did the doctor deal with that and how did the STAFF deal with it.

Make sure that the references you get are NOT from the same hospital group that your doctor works with. Make sure it is someone who has no ties, either from work or personally, to the doctor and/or the hospital or hospital group they work for or with. That includes buddies that they used to know, work for, or clean their houses.

Talk to references in PERSON or on the phone, because any one can have multiple email addresses and give you different accounts, but still be the SAME person.

Google your doctor for not just patient reports but lawsuits, complaints, disciplinary actions.

Ask when and why a doctor won’t do surgery? The superobese? Heart issues? What will the surgeon not take?

One person, Farzad Mostashari, asked the best question: “If your doctor doesn’t use the best data available to them to take care of you, do they really care about you?”

I found not all doctors’ offices are up to date and not everything they do is based on research or science. Below are some reasons why – and support this argument:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123314/>Physicians’ and patients’ choices in evidence based practice
Medical student don’t consider basing decisions on the best available evidence.
They lose their autonomy if decisions are based on science.
Evidence Based Medicine.

“How long does it take for a new treatment for a given disease to make its way into routine patient care — after it’s been proven to be more effective than the previous standard? About 17 years, according to the Institute of Medicine. That huge lag time between the reaching of conclusive evidence for a new protocol and its inclusion into ordinary practice is one big reason that protocols in many practices are obsolete or incomplete, the IOM claims — with only half of today’s patients with many common diseases receiving adequate care.”

Doctors resist basing treatment on science.
Trends in medicine going to science basis.
How do you feel about Evidence Based Medicine
Evidence based reports
Making Evidence-Based Medicine Doable in Everyday Practice
Chart

GENERAL:
* What percentage of the surgeon’s bariatric surgeries are performed laparoscopically versus open?
* What would be some of the criteria for open surgery?
* What would be indications for conversion to open surgery from a planned lap surgery?
* Who covers for the surgeon when they are gone or out of town?
* What is the follow up care plan for support before and after surgery?
* Do you allow participative care or do you have a paternalistic style?
* Do you have people with and without complications who I can speak with in regards to how your surgery & pre/post care is?
* What websites do you recommend for learning about all options and support?
* Obesityhelp.com does have an area where your information is sent to the surgeon. Do you require approval on publishment?
* Do you agree with this or have you ever participated in this or does the center/group you are with does this?
* Should you retire (or be close to retiring), who will take over my care?
(As doctors age, worries about their ability grows: see Docs health.
* Can I choose my surgeon?
* How many surgeries has the surgeon done?
* What are his/her specific complication rates and how do they calculate them? (Do they keep a database?) leak? – pulmonary embolism? – death? – others?
* Who are the members of the team and how will they be involved in your care?
* Are dietitians available for follow-up? How long have you been without a dietician at any time during the program, and what was the reason for that?
* Is there a support group?
* Is there a bariatric nurse? What is their specific experience? How recent is it?
* Is the hospital equipped specifically for the care of the weight loss surgery patients?
* How is the staff in the hospital trained to care for you?
* What is the educational program?
* Who is available to answer questions after I go home?
* Are the surgeons members of the ASMBS?
* How long have they been doing bariatric surgery and how long have you been doing that?
* Do you exclusively do bariatric surgery?

* Latest medical research from http://www.medscape.com/viewarticle/82163 in March 2014 said that the rate of NIDDM (Type II Diabetes) “However, it has become apparent that bariatric procedures do have a significant relapse rate, both in terms of weight loss and type 2 diabetes remission, Dr. Sargsyan said, noting that the 1-year data from the Swedish Obesity Study (SOS) were the first to demonstrate this. The SOS results showed a 72% rate of remission of diabetes 2 years after surgery, which plummeted to 36% at 10 years afterward.” Can you tell me what your statistics are, and how many are lost to follow up at what rate?

COMPLICATIONS:
* What do you define as complications?
* What are the complications that can happen during or right after my surgery?
* What are the complications that can happen 1 year out?
* What are the complications that can happen farther than 1 year out?
* Who takes care of those complications, does the surgeon or another doctor(s)?
* What complications do you send to a gastroenterologist? Who is that doctor(s) and can you check out why and what the relationship is, and if you have a choice, will they work with your GI?
* What are your leak stats (every doctor has them, if they say no, then something isn’t right. How do they deal with them?

For more than a year out, you want to know:
* How up to date is the surgeon on complications that can happen more than a year out?
* How up to date is the surgeon on vitamin research and complications from those?
* How many cases of problems and what types of problems has the managed? Are still managing?
* What tough cases has the surgeon managed?

LOWERING COMPLICATION RISKS:
* What can I do before surgery to lower my risk of complications?
* For which of my medical problems (such as diabetes, heart disease, or high blood pressure) do I need to see which doctor(s) before or after the surgery?
* If I lose weight before surgery, and go maybe just below 40 for BMI, will you still operate?
* What happens if I gain weight while being in the program? What if it is less than 10 pounds? More than 20 pounds?

SUPPORT:
* Can I talk to people who have had weight-loss surgery?
* Can I get a buddy who is a few months ahead of me or someone
* Can I talk to other people who have had complications after surgery?
* Can I talk to other people who have had complications after surgery more than 1 year out?
* Can I talk to other people who have had complications after surgery more than 1 year out who had something other than weight regain?
* What followups do you provide after 1 year out in regards to long term issues with weight loss surgery?
* How far out do your patients get followed?
* Can any of the bloodwork be run by a PCP, and if so, what is the medical basis for return to the office without problems? Is this true for ANY of the surgeries?

VITAMINS:
* What supplements do you recommend I take? (If they says “Flintstones” either find another surgeon or realize that he’s not up to date on the latest studies. Flintstones don’t cut it. See the American Society for Metabolic and Bariatric Surgery guidelines).
* Do you have a list of supplements that are out there?
* How often will you be checking my blood vitamin levels for deficiencies?
* What specific vitamin levels do you check?
* Do you check any other vitamin levels?
* Can I be tested more often if I wish?
* Will I be receiving a copy of the results?
* The stomach produces hydrochloric acid for iron absorption and produces intrinsic factor for vitamin B12 absorption. How will my surgery affect these vitamin levels?
* The duodenum is the major site of iron absorption. How will my surgery affect absorption of this vitamin?
* What other vitamins, minerals, protein, nutrients may be affected by this surgery? What medical rationale is there to take supplements if our vitamin levels are normal?
* What is the basis for the bariatric surgeon’s having someone come back once a year for vitamin deficiencies? Why can’t the PCP run them & interpret them? Do they keep records of return patients for Centers of Excellence? If they say yes, most people have to pay more to see a specialist surgeon when it isn’t needed for THEIR STATS, not for any other reason. My PCP’s have run more bloodwork than my surgeon did and caught more deficiencies: zinc, Vitamin K, Vitamin D, anemia’s, and high copper, for starters.

GASTRIC BYPASS:
* How small will my pouch be? Do you have a standard measurement, or do you use “anatomical landmarks?”
* What about medications after surgery? I take _____.
* How will surgery impact the absorption rate and effectiveness of this medication(s)?
* I have diabetes/ high blood pressure/ other co-morbidity. I know that gastric bypass often, but not always, dramatically reduces or even eliminates these problems. How closely will you monitor these conditions after surgery, and how will we know when or if my medications should be changed or stopped?
* Will you coordinate with my other health care team members on about the issues?
* Is it possible for my pouch to stretch back out?
* If so, what can I do to prevent it?
* What foods should I or should I not eat? What about drinks?

SLEEVE:
* Sleeves have anywhere from an 8-10% chance of getting reflux/GERD if you didn’t have it before the surgery. Those who are converted to bypass do better. If your surgeon isn’t sticking with you, what happens to your care?

BARIATRIC SURGERIES IN GENERAL:
* I’ve heard diarrhea and gas are a common side effects. Is this true and is there anything I can do to prevent them?
* What do you think is a realistic goal weight for me to achieve and maintain?
* How rapidly do you expect me to lose weight? 10 pounds a month? 30? How wide a range is “normal?”
* Can I expect plateaus? When can I expect them? What do you recommend when I have them?
* How long can I expect weight loss to continue after surgery? Will it ever again become very difficult or impossible to lose weight?
* How hard will I have to work to maintain my weight loss after 18 months, in 2-3 years?
* How hard will I have to work to maintain my weight loss in 2-3 years?
* This is a lot of information to take in all at once. What do you consider are the most important things I need to keep in mind before having surgery?
What does the surgeon do for me afterwards? If I need another surgery that requires a general surgeon, will he or she perform it?

WOMEN:
* What about pregnancy and birth control after surgery?
* Do you dismiss patients that become pregnant before the 12 to 18 month cut off recommended before trying to get pregnant.
* What do you recommend when someone gets pregnant before that time?
* What do you recommend when someone gets pregnant after that time?

OBESITY RELATED DISEASES:
* What are the most common resolution or improvement in percentages of the following issues after surgery?
* Diabetes
* Hypertension/high blood pressure
* Hyperlipidemia
* Obstructive sleep apnea
* Infertility

CLOTHING:
* Do you have a system set up for recycling of clothes or does a support group have regular exchanges or who works with setting up help for when rapid weight loss occurs and what clothes to wear?
* When should I start buying new clothes?

FOOD:
* How do you work with patients who have problems with food?
* What do you suggest for portion control?

THE REASON WHY THE QUESTIONS YOU ASK BEFORE CHOOSING A SURGEON AND PROGRAM ARE SO VERY IMPORTANT:
You are choosing more than a surgeon: you are choosing a support team and a physicians philosophy! Choose wisely and carefully. While it is easy to deal with patients who have no problems, if a surgeon or group does not have experience with problems, and you turn up with those, what happens then?

* Why did you get into this field?
* What methods do you use to keep up with changes in this field?
* Doing the same surgery (or 2 to 3 surgeries) would appear to get boring. How do you stay “fresh” or “enjoy the job”?

PAIN:
* What is the surgeon’s philosophy on pain?

LEAKS:
* When you do the fluoroscopy leak test, do you use barium or a water soluble product? If they use barium and it leaks, you will have barium in your abdominal category. This is dangerous! Barium is not absorbed so it would require surgical removal. The potential for infection is there.

SURGEON’S STAFF:
* What are they like?
* Who are they, what are their titles, and what are they responsible for in terms of when I would need them?
* How easy are they to reach?
* What is the average time of responses to people: before, after, and more than one year out?
* Do you see someone else besides the surgeon at any point?
* Can I speak to them?
* What are they like, what is their practice like, their philosophy on working with patients?
* Why did they get into this field?

INSURANCE:
* How well does your office work with the insurance to getting my surgery approved?
* What is the time frame for my specific surgery type with my insurance?
* Do you get any of this paperwork done before hand?
* What kind of response can I expect if it is denied?
* How do you work through that and how long of a process does that take?

AVAILABILITY:
How soon is the surgeon available? Who is the first assistant or surgical assistant? Is it another doctor? What happens if that doctor is not available?

NUTRITIONAL ADVICE:
* Do you recommend one diet only or can you deal with, have experience in, other dietary issues: celiac, dairy intolerance, other food intolerances, reflux, etc.?
* How much experience, and who with, what types of populations, does your nutritionist have with bariatric surgeries both before and after? How did they get their experience?

OFFICE CONCERNS:
* If I have a compliment or concern, who do we talk to?
* Do you retaliate if someone has a problem? Have you ever retaliated against someone for a problem?

OTHER QUESTIONS:
* If I choose a surgery and you don’t feel it is right for me, would you still do the surgery?
* Do you perform revisions? If so, how many and for what time frame, as in 3 this year, 1 the year before last?
* Do you have any licensing issues or malpractice claims pending? Do you have any outstanding or former complaints with the state board of medicine?
* How many long term, long standing issues do you currently cover over 1 year out and can you give me 3-5 examples of protocols?

SPECIFIC TO THE HAMPTON ROADS AREA OF VIRGINIA, BUT MAY ALSO BE TRUE IN YOUR AREA:
* Do you notify patients that in the Hampton Roads Va area, if they lose their bariatric surgeon, they will not have care in the area?
* Do you notify patients that after 1 year after a sleeve gastrectomy, they can be dropped with no care in the area?
* Do you do this or have you done this?
* Do you tell sleeve patients they don’t need a surgeon? Have you ever done so? If so, what medical literature supports this?
* How many complications related to nutrition have you diagnosed out after 1 year?
* If you only see a patient 1 time a year, how would you catch this?
* What types of continuing education do you take in terms of complications and food issues after surgery?
* Have you ever had a patient refuse to be weighed? If so, what did you do? (refusing a medical test is allowed by law)
* Have you dismissed a patient for not following orders?
* Can a medical test be refused and you still get treatment? Is that guarenteed in writing?
* If we request medical basis for a test, do you provide it?
* Have you dismissed patients for ability to pay, and is that guarenteed anywhere in writing?
* What written treatment care plans do you provide?
* What are your guidelines for compliance and non compliance when it comes to obeying a doctors’ orders, even if those doctors’ orders conflict with medical research or is just an opinion of the doctor that does not have a basis in fact/research?
* Do you or have you ever dismissed a patient when compliant?

“If a patient is competent to consent to an operation, the patient is competent to refuse consent as well”, writes Dr. George Annas in The ACLU Guide to Patients’ Rights. “A person is not incompetent simply because the person refuses treatment or disagrees with the physician. If this were so, the entire doctrine of informed consent would collapse into a right to agree with your doctor.

* Is any of my health information used for purposes or medical research papers?
* If I am in a database for the ASMBS, do you alert patients of that?
* Will you get my express permission for any studies or any of my data being used in another other program but the one I sign up for here?
* Are you aware that, by law, retaliation for HIPAA violations is illegal? Yes or no.
* What rebates are available for any “program fees”?
* What if I choose other exercise choices than your center provides or want to investigate options on my own, am I still required to pay?
* Can we choose or switch doctors?
* Even if a doctor is correct in a diagnoses, does this mean they have the right and/or authority to make medical decisions on behalf of a non emergent patient under any circumstances?
* Can patients be removed for non compliance when a patient must accept the “opinion” of that doctor vs. a patient potentially having facts of medical references/peer reviewed literature and/or other doctors who disagree?
* What happens when there are differing opinions between a patients’ doctors? Do you agree that those people should be dropped from care when one doctor states one direction and another doctor states another direction? No matter what, this scenario requires that the patient lose at least one area of care to satisfy another, and potentially both.

Questions from ProPublica, Dollars for Docs – check to see what doctors in your area are on this list of taking $$$ from drug companies:
https://projects.propublica.org/docdollars/payments/checklist/9850920
“Questions you might want to ask your healthcare professional”
* What are the specific circumstances of this payment?
* What is your current relationship with this drug or device company?
* What drugs or devices have you prescribed me or may prescribe to me or others, that are manufactured by companies you’ve taken payments from?
* Are there non-drug or different device alternatives that I may want to consider first?
* Are there less expensive generic alternatives to the drugs you have prescribed or can another device or not device at all work?
http://www.propublica.org/article/lawsuits-say-pharma-illegally-paid-doctors-to-push-their-drugs.”

Reasons to check your docs:

I think these links sum up a lot of good information. There isn’t a lot of reporting to the official governmental oversight groups. This means you need to do your homework.
Hospitals drop the ball on physician oversight
DEA’s Failure to Provide Information to the National Practitioner Data Bank (leaves citizens hanging)
Physician Accountability

Conflicts of Interest

$ for docs
Docs mints millionaires
Doctor says
‘Maybe I am a pervert. I honestly don’t know’

Doctors dine on drug companies dimes

‘In a raft of federal whistleblower lawsuits, former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.’