Ask The Doctor

If you have a healthcare question, send it my way via the Contact Dr. Neustatter page. I'm happy to help or refer you to a more appropriate resource if I can.If I think the question and answer would be helpful to others, I'll publish them here anonymously—never with your name or any identifying information.Some disclaimers:

As a primary care doctor, I'm the proverbial “Jack of all trades, master of none.” I'm not a specialist, nor a lawyer, CPA, financial advisor, insurance agent, or psychic. I'm also not your doctor. I can't perform a physical examination, order tests, or write you a prescription. I can only offer ideas of avenues you might pursue, not actual medical advice.

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Lots of moneyHospital bills can be very confusing—not to mention completely unrealistic, and they commonly have errors.

Hospitals use a “chargemaster” list of prices for each service they provide. As Steven Brill points out in his revolutionary 2013 TIME article “Bitter Pill: Why Medical Bills Are Killing Us”, these charges bear no connection to costs.

He mentions Tylenol being charged at $1.50 per pill when you can buy 100 generic acetaminophen (the ingredient in Tylenol) for $1.49. He cites the case of a cancer patient charged $13,702 for one shot of Rituximab, which the hospital bought for no more than $3,500. That’s “a 400% markup on a single dose of a life-saving cancer drug,” he notes.

Without looking at your bill, it’s hard to tell what’s what; different hospitals use different terms, but the CPT (current procedural terminology) code is the same between hospitals. I’d guess “R&C Int & C Int” at a daily charge of $12,356 is for admission to an intensive care unit—not a cheap place to stay.

Medical RecordNot only are hospital bills often stratospheric, they frequently contain errors. Medical billing expert and advocate Edward Waxman of Edward R. Waxman & Associates says, “If you’ve ever spent time in a hospital, you’ve almost certainly been overcharged.”

Look at your hospital bill and look for mistakes. When you get it, compare the EOB (explanation of benefits) from your insurance company to the bill and make sure they match. Query the hospital if they don’t, or the insurance company if there’s anything they refuse to pay.

Consider trying to negotiate some of the unrealistic prices, especially if you are uninsured (many hospitals give an automatic discount if you are, but you often need the chutzpa to ask). Here’s a good article that explains a lot of the vagaries of hospital billing. You can also get help with your hospital bill through the Patient Advocate Foundation.
Going to the doctor can be an intimidating experience. There’s usually a pretty profound power imbalance, emphasized by the whole preamble of having to plead for an appointment.

Then the nurse gets you ready for this crucial meeting with the person the whole establishment pivots around (or “encounter,” to use the official term for such a meeting, which itself connotes confrontation and intimidation).

Then you’re left sitting, twiddling your thumbs, waiting and waiting to be graced by the doctor’s presence.

You’re often in the uncomfortable position of being nearly naked, with perhaps some absurd paper garment to wear, not to mention you often have to talk about personal matters that can be embarrassing (and there’s no reciprocation from the doctor). And the doctor may poke around in places usually considered out of bounds to any but your most intimate partners, all while he or she is secure in the white coat uniform.

Some doctors are intimidating as part of a strategy to keep appointments rolling over efficiently, stifling questions and conversation.

Most intimidating people are bullies, psychologists tell us. And bullying behavior is a symptom of insecurity. Usually, the best way to deal with bullies is to stand up to them. Remember, the doctor works for you, even if it doesn’t always feel like it.

Often, when doctors become a bit hostile, it’s out of frustration due to being time-pressured, so be concise and prepared (consider going to your appointment with a list of things to cover). But also be realistic.

I had a patient bring me a diagram of a stick figure with little bullets on the different parts of the body where she was having problems. It was adorable. But she had 15 bullet points and a 15-minute appointment.

Nicely ask questions to be sure you understand what the doctor is telling you. Maybe phrase it as, “So I don’t have to bug you again later, let me be sure I’ve got this right…”

Bringing a friend or relative to your appointment provides helpful support when you need to stand up for yourself. This also means a second set of ears to confirm you heard everything correctly, which can be great if you’re discussing something truly serious.

Friendly DocIf you’re prone to feeling intimidated, the hardest thing to do may be to confront it head-on by mentioning it to your doctor, but it’s probably the best route to a resolution. Remember the tactic of talking in first person, rather than making accusatory “you” statements. Say, “I find the way you talk to me makes me uncomfortable,” rather than “you are talking to me in a way that makes me uncomfortable.” Many doctors aren’t aware of the extent to which their patients feel intimidated, and you may be the one to help not just yourself, but your fellow patients too.

If you can’t get to a satisfactory resolution, the final solution is to find a more personable doctor.
Hopefully the staff at your doctor’s office will be sympathetic to your sensitivity about your weight (you’re certainly not the only one). You can ask them not to weigh you, but you may get some resistance from the nurse who checks you in, as this is part of the routine.

That’s because your weight, or more accurately your BMI (body mass index, which is your weight taking account of your height, calculated by dividing your weight in kilograms by your height in meters) and weight changes are an important “clinical sign.” Like your blood pressure and pulse rate, it gives insights into your health.

Ideally, your BMI should be between 18.5 and 25. Above 25 is overweight, above 30 is obese. Being significantly underweight is far less common, but it can also be a health risk.

For those who are sensitive about being overweight, yes, it’s a risk factor, but it’s only one of many. Blood pressure, blood sugar, cholesterol level, family history, how much you exercise, and what you eat are all crucial factors in your health.

Where the fat is distributed on your body is also significant to your risk; pear-shaped is healthier than apple-shaped (fat on your abdomen instead of your butt and hips). So it’s recommended that a woman’s waist should never be above 35 or a man’s above 40 inches.

Food and Tape MeasureAs confirmation that weight is not so much of a risk factor on its own, a study showed the risk of death is not increased in “overweight” people with a BMI of 25 to 29.9. It’s possible to be perfectly healthy if you exercise and eat right. In such cases, sensitivity about being “overweight” is just a reflection of what weight our culture tells us to be.

Changes in your weight can be a sign that something is wrong. If it’s going up, you may have some illness like an underactive thyroid or heart failure making you retain fluid. Losing weight when you aren’t trying is probably a more sinister sign. It can indicate some hidden illness like cancer.

If you’re not letting the doctor keep track of your weight, make sure you are keeping a record of any changes. Monitor your weight and tell your doctor if you are gaining or losing. Report how much weight you’ve lost or gained and how quickly.

Providing you understand the significance of your weight, and monitor it yourself, it’s not unreasonable to refuse to be weighed when you go in for an office visit.