Should I Get A Medical Alert Bracelet? (Upselling Healthcare)

A question from WarmSocks:

When should someone wear a medical alert bracelet? Nobody has ever recommended that I should consider it, but my med list seems awfully long so I'm wondering if it would be appropriate?

The purpose of the alert bracelet is two-fold:

1. To provide vital information in an anticipated emergency.
2. To make money off of people with illnesses.

Should I wear a bracelet? Do you have a condition likely to cause you to be found unconscious, and have something about you that would make your care different than the average unconscious person? You should probably carry a brief list of your medical conditions and medicines, but most of those things don't require a bracelet.

These bracelets are marketed to people with things like insulin-dependent diabetes or heart rhythm problems. The bracelet basically says, "This is likely the reason I'm unconscious and this is what to do!" I've seen a lot of diabetics and heart patients with such bracelets, but I've never seen these bracelets make much difference. Paramedics always check blood sugar and heart rhythm as soon as they find you in such situations, so in my experience people with and without these bracelets get about the same care.

The best reason I can see for a bracelet is a rare condition that rescuers aren't going to be thinking about. Diabetics need not worry—we check a sugar on everybody that's unconscious, bracelet or not. (Other reasonable situations to have a bracelet would include: severe anaphylactic reactions to medicines or if you don't want to be resuscitated if your heart stops. )

The second reason for bracelets is to stimulate the economy. The healthcare industry is massive and you—the patient—are the cash cow. If you stop consuming all the medical accessories and extras then the Healthcare economy might shrink! Proven, effective care can be a narrow margin business, but all the physical and pharmaceutical accessories that you see marketed keep the Healthcare Business healthy even in lean times.

If you call a bracelet company they will say that your daily aspirin or history of ankle sprains should definitely qualify you for a bracelet. "Let's bill your insurance, and for a bit more you can get a stylish 14 K gold band for it!"

Your doc should be able to tell you if your condition really needs a bracelet or not.

But be careful if you doc is offering bracelets or any other "value added" products in their office for your convenience! With Primary Care profit margins razor thin, a lot of doctors are going over to the darkside and letting corporations talk them into adding "secondary income streams" to their practice. If your doctor is selling something (bracelets, supplements, skin rejuvenation, etc.) other than medical care you should run the other direction. Your doctor should be an advocate for you, not the spokesperson for some product line.

Is Doctor D may be alone in his righteous anger about MDs who sell extras in their practices? D was highly offended when Little D's doctor was selling vitamin products at the clinic. Mrs. D told Doc D to quit being a pinko Commie and accept that capitalism works this way. Do you mind if your doctor makes extra by selling products?

The Best of D (Friday Links)

This blog has grown so much recently that Doctor D's big doctor ego deemed we should link to all the fun and informative older posts buried in the archives. So if you will direct your attention to the right side of the screen you will notice AskAnMD's new feature:

Doctor D's Best Answers

Of course, if you've been visiting Doctor D's virtual clinic as long as WarmSocks you've already read it all, but if you are new here you can go check it out for loads of doctor-patient enjoyment.

Yes I realize that it is sort of cheating to count a "best of" page as this week's Friday Links, but D is suffering from an acute case of laziness today. Sorry. I will be back on my game next week.

Pregnancy Quiz

So Doctor D normally isn't one to tell stories about his patients' wackiness, but some things are just so odd they demand a teaching moment in the form of a Grumpy-style multiple choice quiz:

You are 39 weeks pregnant and you start feeling the "really bad pain" that keeps coming every 5 minutes. You should:

A. Call your OB

B. Get to the big hospital where your OB delivers babies

C. Wait about 14 hours till you just can't stand it anymore, then drive yourself in the other direction to the tiny hospital ER with no delivery rooms, no neonatal resuscitation equipment, no surgical backup, and ask Doctor D if he can do anything to make the pain stop.

If you answered C it was an honor to be a part of the miracle of your child's birth this morning, and yes, that is what labor feels like so please choose A or B next time.

Thank God women have been having babies without doctors since time began, because all Doctor D had to resuscitate this slippery kiddo was an oxygen mask and his own two hands!

Any readers have fun stories about babies joining our big bright world?

Primary Care: The Best and Worst Job in Medicine

Shawn the medical student asked Doctor D:

As a medical student, I am constantly wondering what type of physician I will become. So my question is, what kind of doctor are you, and how did you decide that field?

Doctor D is a Family Medicine doctor. He chose this career because he is a glutton for punishment! Actually, D chose Family Med because he likes people much more than he likes the technical aspects of medicine. As a jack-of-all-trades doctor I can usually help anyone no matter their age, gender, or medical history, but my knowledge on any specific subject is limited. I can sew up lacerations, give end of life care, deliver babies, prevent future illness, and educate people on how to handle most common medical problems. I did this because I enjoy working with human beings and want to help people with their physical needs.

Should you choose Family Medicine as your specialty you will be constantly looked down upon by other physicians. Even though you probably store more knowledge in your brain than any other doctor, specialists assume you are slow-witted because you don't know as much about their particular disease of choice as they do. You will make much less money than other doctors because insurance doesn't think keeping someone healthy is nearly as worthwhile as doing big tests and procedures. You will constantly be pressed to see more patients in less time because the reimbursement for your work is continually dropping.

After his training Doctor D chose to work in a community health clinic to provide primary care for underserved patients. He absolutely loved his job and the amazing people he cared for. He also learned to hate the medical system and the bean counters that were constantly pushing him to cut corners on patient care. In the end the bureaucrats won and Doctor D quit that clinic rather than choose to hurt the patients he cared about. He is currently working odd shifts as an ER doctor in a tiny hospital in the middle of nowhere to pay the bills till he returns to Primary Care. He blogs about patient-doctor relationships because he misses having patients of his own and still has those crazy ideas about "helping people" with his medical knowledge.

Of Course there are days Doctor D wishes he would have never signed on to be a general doctor (or a doctor at all for that matter). But when I realize I can help nearly every person that walks through my door I am certain that I chose the right career. Family Medicine is one of the most frustrating and rewarding paths in all of medicine. I advise med students to seriously consider general primary care—it is the fullest embodiment of the ideal of doctoring—but only select it as your specialty if you are certain you will love it, because it will probably get harder for primary care doctors before it gets better.

Wow, that was a touchy-feely post! I'm afraid Nurse K is failing to make a good hard-ass ER doc out of me. Quick, someone ask a question that will awaken my god-complex angry doctor side!

Patient Eduction (Friday Links)

Doctor D's recent Friday Links have focused on healthcare providers. It is good for patients to hear what doctors and nurses are saying. Conversely it is useful for those of us in medicine to listen to the voices of patients. So today I bring you two patient blogs that Doctor D never misses.

These are patients who write only about one illness: their own.

• ∞ itis: WarmSocks blogs about living with Rheumatoid Arthritis. She was the first blogger who found AskAnMD and sent encouraging emails and a link from her site. I was hesitant to feature her on Friday Links because most readers don't have RA and therefore might not be interested, but the more I read of WarmSocks' practical advice, insight, and humor the more I realize that she is useful for just about anyone who is interested in medical care.

• Neo-Conduit: Even some medical people (like Doctor D) don't know much about a Urinary Diversion, but this blogger's courage after years of difficulty in the medical system is to be admired. She has some understandable frustration with medical folks, but her perspective is worth listening to. Her observations about patient suffering and frustrations are a insightful and never angry. She is on Doctor D's "must read" list every day.

For some other great patient blogs check out the "patient bloggers" section on the sidebar. And if you follow Doctor D's Friday Links for the physician perspectives you should definitely go over to Dr. Rob's site and read Top Ten Ways To Annoy Your Doctor.

Doctor D will be back soon to answer your questions and with a special post with Nurse K! Stay Tuned!

On Asking Doctor D

Sorry about this dull info post.

A lot of the emails Doctor D gets are anonymous. People with sensitive questions about doctor-patient relations often want to keep their identity private. Doctor D understands completely (since he blogs incognito too).

I often get questions from people with excellent blogs. I don't want to write, "Question from a reader..." if you would prefer a link back to your site.

So if you send Doctor D a question in the future please let me know if you want it answered with or without a link to you.

If you have a question in Doctor D's "to be answered" pile, I will assume you want it answered anonymously unless you write me and ask that I link to you when I answer.

Email Doctor D at AskDoctorD@gmail.com

The Purpose of Pain (Why the Painscale Doesn't Work)

Last week I answered a question by explaining the trouble with how doctors interpret your painscale. Doctor D confessed that he doesn't like the painscale at all. Today I will tell you why even if used perfectly the painscale still just won't work:

The 1 to 10 painscale ignores the way the human body uses pain in the first place. The scale assumes that we can observe the sensation of pain and then compare and contrast it to other pains we know or imagine. Your analysis of pain is supposed to produce a number that doctors and researchers can use to make calculations. There are a lot of things the human mind does a great job analyzing, but pain isn't one of them.

The purpose of pain is to get your attention. Pain is your body screaming, “Something is wrong!” It doesn't take much pain to completely capture your mind's focus. Pain functions as a useful warning system. It tells you to pull your hand out of the fire or not to walk on that broken ankle. Your brain pays close attention to pain and obeys its commands. So what if being burned at the stake is a 10 and your broken leg is only a 7? Trust me the broken leg will get and keep your attention till the bone is set.

Asking the mind to quantify pain is like asking it to assign a number to love or fear. It simply doesn't work that way. This is the reason that so many patient's say their pain is 10 of 10. No they aren't feeling the worst imaginable pain, but the pain does have their full attention.

Doctors want hard facts from painscales. We scoff at patients who say things like, “My pain is still a 10, but it's better than the 10 I felt before,” or “It's a 10, but not as bad as when I delivered my baby!” We demand hard facts and we get irritated when patients give us flawed and subjective data.

The worst pain Doctor D ever felt was probably about a 6, but subjectively it was miserable enough to get my attention and keep me from hitting my finger with the hammer ever again. We should listen to patients' descriptions of pain and seek to relieve it, but we shouldn't demand they to turn their pain into a number. The human experience of pain just doesn't work that way!

Doctor D is always talking about the natural purpose of things like hunger, laziness, anxiety, and pain. His theory is that understanding the natural functions of the feelings helps us respond when these feelings give us trouble. What do you think? Would understanding the useful warning function of pain help those of you that suffer from pain problems?