doctor patient relationship

If you're like me, open enrollment--that time of year when you sign up again for your employer's health insurance plan--is a bit like deciphering hieroglyphics. Every term is cloaked in an abbreviation--and even the decoded terms are confusing.

Here's a list of common benefit abbreviations and what they mean.

SPD--Summary Plan Description
The Summary Plan Description is also known as the Certificate of Coverage. The SPD is provided with your health insurance policy and outlines the policy's rules, limits, bylaws, fees and benefits. It's often thick and difficult to read. But you should at least scan the highlights. That way you'll know what you're in for should you get sick in the coming year.

FSA-- Flexible spending account
FSAs (sometimes called a cafeteria plan) let you divert part of your income pre-tax to pay for anticipated medical expenses. If you spend $50 a month on prescription drugs, for example, you can set aside this amount in your FSA to cover those expenses in the next year. Your employer will deduct money from your check each pay period.

There are some drawbacks to FSAs. There is a limit to the amount of money you can put in an FSA. That limit is set by your employer and federal law. In 2012, employers can allow employees to set aside up to $5,000 in FSAs. In 2013, that drops to $2,500.

You forfeit any money you don't spend by the end of the year. And not every medical expense is eligible. For example, the federal government excluded many over-the-counter medications from reimbursement last year.

Some companies may offer a limited purpose FSAs. These are used for eligible dental and vision expenses only. They are limited to policies with health savings accounts.

FFS--Fee for Service
This is a traditional insurance plan. Under such plans, you typically pay a percentage of your health bill and your insurer picks up the rest. FFS plans focus on treating health problems and not preventing them. As a result, they don't usually cover annual check-ups and other "well" doctor visits that can quickly amass costs, especially for families.

HDHP-High Deductible Health Plan
This is what it sounds like. An HDHP has a high deductible--ranging from hundreds to thousands of dollars and may be favored by low-income individuals or young people who rarely need healthcare. One of the benefits of a high deductible health plan is lower premiums. However, you have to pay for all medical expenses up to your high deductible.

HSA-Health Savings Account
A health savings account is a tax-exempt account that you set up with a qualified trustee to pay or reimburse certain medical expenses you incur. You must meet certain qualifications to have an HSA: You must be covered under a high deductible health plan, have no other health coverage and not be enrolled in Medicare. You also can't be claimed as a dependent on someone else's tax return.

Health reimbursement accounts (HRAs) work similarly to HSAs--only your employer is the only one who can make a contribution.

CDHC--Consumer Driven Health Plan
This is a term for a plan that combines high-deductible health plan with a health savings account. In other words, CDHP=HDHP + HSA.

PPO--Preferred Provider Organization
This kind of health plan offers both in-network and out-of-network benefits. To get the maximum benefit, you have to choose one of the in-network providers.

HMO--Health Maintenance Organization
Plans tied to an HMO typically require you to see only doctors or hospitals that are on a specified list of providers--or network.

ERISA-- Employee Retirement Income Security Act
ERISA is a federal law that protects the health benefits of people in the U.S.

The phrase "high quality, low cost health care" gets thrown around quite a lot these days. Unfortunately, no one seems to be able to agree on what it means. Are there really ways to cut costs and improve the quality of healthcare at the same time, and how do we find them?

A group of doctors from the National Physicians Alliance (NPA) recently listed several common patient problems for which medical care could be improved and costs lowered. Hear are five of the most frequently mentioned areas where less may truly be more:

Sinus Infections
People with mild to moderate acute sinus infection do not generally require antibiotics unless symptoms have lasted more than a week (or if there is worsening after initial improvement).

This one is near to my heart as an infectious disease specialist. Fellow healthcare workers often seem annoyed or hurt when I fail to give them antibiotics in hospital hallways for this problem. (I suspect they quickly slip off to descend on another unsuspecting colleague.) Most new sinusitis episodes are viral infections, and antibiotics are not helpful, though they are prescribed in a clear majority of cases.

EKGs and Heart Disease
Annual electrocardiographs on low risk patients without any symptoms of heart disease are unnecessary. This is another classic case of more is not always better. Routine EKGs are very unlikely to improve health outcomes in such patients, and they can lead to an "off to the races" series of more invasive tests, often with possible serious complications as well as significant costs.

Pap Tests
Screening Pap tests are not necessary in women younger than 21 or in women after hysterectomy performed for reasons other than cancer. Most abnormal tests in adolescent women return to normal spontaneously over time, and such abnormal tests can lead to unnecessary further testing as well as needless anxiety.

Sore Throats
Patients with sore throat (pharyngitis) do not require antibiotics unless they test positive for Strep. Once again, most upper respiratory tract infections are viral, but physicians prescribe antibiotics in a majority of patients with these complaints.

Furthermore, most people with sore throat and no fever, no tender neck lymph nodes, and no white patches on the tonsils should not even be tested for Strep throat. Strep is very unlikely without any of these present.

Low Back Pain
Finally, people with low back pain of less than six weeks' duration should not have routine x-ray or other imaging performed unless they complain of neurological deficits such as weakness or if serious underlying conditions such as cancer or bone infection are suspected. Early screening increases costs without improving outcomes.

Always remember that general rules don't apply to every individual or situation. Be sure to discuss with your physician any unusual details of your problem that may require additional testing.

Each of the scenarios above, however, does offer an opportunity to improve care and control costs. We all can hope that the NPA and other physician groups will continue to look for opportunities to lead in health care reform, keeping patients' welfare first while improving care in this era of limited resources.

Nearly every year I ask my mother the same question: "Are you getting your flu shot?"

Inevitably, she has the same answer: "Not if I can help it."

My mother isn't some vaccination skeptic. She isn't lazy or afraid of needles. In fact, she knows how valuable flu vaccines are for public health: She's been a nurse for more than 30 years.

But the vaccination sometimes makes her sick, and, in the years she hasn't been required by her employer to get the vaccine, she's never contracted the flu.

Neither have I. Ever. But I get my flu shot anyway. You should, too. Here's why:

Vaccination is the most effective protection against the flu. Unfortunately, not everyone believes this. In a recent survey conducted by the National Foundation for Infectious Diseases, 71 percent of respondents said there are other effective ways to prevent the flu.

According to a recent study, many older people—among the most vulnerable to the illness—don't get the flu vaccine because they believe that traditional methods such as hand washing and alternative medicine can protect as well as or better than the vaccine.

But this isn't true. While washing your hands can help keep you from getting infected, nothing is as effective as the vaccine in protecting against the flu, according to the Centers for Disease Control and numerous studies.

It probably won't make you sick (despite what my mother says). Only a small percentage of people who get the flu vaccine will have some kind of side effect, most frequently soreness at the site of the shot. Some people experience mild cold symptoms and fever for one or two days. Rarely, someone experiences an allergic reaction to the flu vaccine.

Someone around you may not be able to get it. This is why I've become a flu vaccine convert. Until a few years ago, I eschewed the shot. But my son is allergic to eggs, one of the reasons a person might not get the vaccination, which is grown in chicken eggs. In order to protect him from the flu—he also has asthma, which puts him in a high-risk category for flu—we try to cocoon him, surrounding him with people who've had the shot. Because you never know when you'll be around someone vulnerable like him or any infant under the age of six months, it pays to get the vaccine.

It's cheap. The flu shot typically costs between $10 and $50 a dose. But many employers offer them for free as do many community groups. Even at the high end, the vaccine is a bargain compared to getting the flu, according to cost-benefit studies. Getting the vaccine reduces lost work days and physician co-pays.

There's still time. Although peak flu season varies each year, February is typically the most active month. But the pesky bug begins showing up in October and hangs out until mid-May, which means it's never too early or too late to get the vaccination. Ask your doctor's office if they have the vaccination or use this handy tool to locate a dose near you.

For more flu vaccine basics, visit http://www.flu.gov/.

Related Links:

Just because your sick, doesn't mean you need antibiotics.

Seven flu-fighting mistakes.

You've developed a mild aching sensation in your chest that seems to get worse when you walk the dog in the mornings. You call a local cardiologist and find out that the next new patient appointment is six weeks away. You don't want to go to an emergency room, but you're not sure how serious the situation is and want input from a physician—a specialist—with knowledge in the area of your problem.

You're not alone. Anyone who has needed the help of a physician specialist recently has likely encountered the difficulty of getting timely help in an increasingly crowded health care system. Even in adequately served areas there can be long waits to get appointments, often with complicated referral procedures necessary. Here are a few tips to aid you in getting the most out of a specialist visit in a timely manner.

Get a primary care doctor. Now more than ever it pays to have one. A good primary physician is increasingly essential to receiving good medical care, including timely access to specialists. A primary physician can assess your situation, help decide what specialist is best, and judge how urgent your situation really is.

Just as importantly, he can personally contact specialists to let them know the potential seriousness of your problem and assist in making an appointment for you. Many physicians and some insurance companies even require such a referral from a primary doctor. Forwarding important information such as lab tests and x-rays from your physician can greatly increase the efficiency with which necessary procedures and additional tests can be planned.

Check in with your specialist. Once you have an appointment, call your specialist's office prior to the date to check with his nurse or assistant. Be sure they have received all the information necessary to help with your problem. Making sure they have access to all necessary information can speed the process of getting prompt diagnosis and treatment, avoiding unnecessary additional appointments or delays.

Do your homework. Make sure you're ready for your visit with the details of your medical history. (Find out what five things your doctor needs to know during your appointment.)

Make sure everyone's talking. Request that your specialist's opinions and plans be communicated back to your primary doctor. This will ensure that the new recommendations are put into the context of your overall medical condition and that these thoughts are available for your other physicians as well.

Remember, even in this day of increasing technology and medical records innovations, simple communication among your doctors can be one of the most important ingredients in the best care.

Related Links:
With antibiotics, be careful what you ask for.

How to choose the right hospital via CNN.com

Get the most out of your doctor appointment via ArthritisToday.org

Since penicillin became available to the public in the mid-20th century, antibiotics have changed the face of health care. Infections that routinely were fatal 60 years ago are today little more than inconveniences.

Despite these amazing advances, we face critical problems: Bacteria are becoming increasingly resistant to available antibiotics. One cause is the unnecessary use of antibiotics in minor respiratory infections. Next time you see your doctor for a cold or other minor respiratory infection, remember three things:

You may not need antibiotics.
Most upper respiratory tract infections—the common cold, minor sinus infections, and sore throats—are viral and do not respond to antibiotics. (The exception is strep throat, for which there are specific tests available.)

Studies show that we expect antibiotics and a quick fix when we go to the doctor's office for these problems. Unfortunately, physicians sometimes feel obliged to meet those expectations, even though these viral infections usually resolve in a few days without antibiotics.

Antibiotics can be associated with allergic reactions.
Sometimes those reactions can even be life-threatening. Even appropriate use of antibiotics can be associated with Clostridium difficile colitis, a secondary bacterial infection of the colon accompanied by severe diarrhea and fever, occasionally requiring hospitalization.

Antibiotics can also have important interactions with other medications, especially drugs like blood thinners and heart medications.

Taking unnecessary antibiotics can make you more susceptible to resistant bacteria.
Resistant bacteria can be more difficult and expensive to treat. Plus, patients can remain sick longer because of the delay in effective treatment. Children's ear infections, for example, can be hard to clear up, and we even encounter infections in hospitals for which there are no viable antibiotic options.

The next time you or your child goes to the doctor for a cold, remember that medicines to fight symptoms may be all you need. Don't be upset if your doctor doesn't write a prescription for an antibiotic. He or she may be doing you—and the rest of us—a favor.

For more information on antibiotic resistance, see the Centers for Disease Control's website.

Many people go to their doctors with lists of questions, but have you ever stopped to make sure that you're armed with answers to their questions? Providing physicians with all the information they need can make a big difference in getting help for your current problem and warding off future ones.

Here are five tips to make sure your doctor gets the answers required to give you the best possible care:

1. Summarize the reason(s) for your visit into one or two main problems. Helpful facts include how long the problem has been bothering you, how severe it is, and what makes it better or worse.

2. Provide information about your past health. Previous problems can have a big impact on your current difficulty, and it's crucial for your doctor to know about them. Most doctors' offices keep track of these issues in your records, but if you're seeing a new doctor, he or she may not yet have all the necessary information. This includes a list of past hospitalizations and what was done at the time, any prior surgeries or other medical procedures and the reasons, and any specific allergies to medications. Also, don't forget to have a list of all current medications and doses, including non-prescription medicines and dietary supplements.

3. Give details about your habits, including smoking, alcohol intake, exercise and work. Be honest; you'll only hurt yourself by fudging the truth. Be sure to include any unusual exposures such as travel or pets that could put you in contact with less common illnesses.

4. List illnesses in your family members, particularly parents, siblings and children. Conditions such as premature heart disease, diabetes, high blood pressure, and autoimmune diseases (lupus, rheumatoid arthritis) can run in families, Because your family history can help predict your future health, it's important for your doctor to have this information. (Don't know much about your family medical background? Here's an easy Internet-based tool from the U.S. Surgeon General that will help you get started.)

5. Describe any other problems or symptoms that are unrelated to the reason for your visit. Typically, your doctor will ask for this information in a written questionnaire to be filled out while you wait. Sometimes, issues that seem unrelated may in fact be relevant to your problem - or warrant further investigation by your doctor.