Monday, April 29, 2024

Speak up - I did not hear you

Hearing loss as we age is universal. In young adults, hearing loss is rare and usually mild, but as we pass 60, it becomes both more common and more severe. Past 80, the vast majority have hearing loss, and it is usually at least moderate.

Most hearing loss is gradual and so often not recognized by the individual. Family are in a better position to notice – they may comment on why you have the TV or car radio up so loud.

Age-related hearing loss is almost always worse at higher frequencies. Because women have higher-pitched voices than men, this is a possible explanation for the “selective hearing loss” that lets men hear their buddies talk football while claiming to not hear their wives ask them to do something.

Hearing loss can have a major negative effect on quality of life. You miss out on conversations, feel “left out,” and may begin skipping events. Those with risk of dementia may experience a more rapid decline in mental acuity because of lack of interaction with others.

If this is a possible issue, get your hearing checked. The best way to do it is with an audiologist, who will have you in a sound-deadened room with headphones, and will check the hearing in each ear at different frequencies. Most health insurance plans will pay for this. A fallback is an on-line hearing test you can do for free. Not as accurate, but very convenient.

If your hearing loss is more than minor, you ought to get hearing aids of some sort. Traditionally, you could only get hearing aids from an audiologist, and they were very expensive. Starting in 2022, hearing aids became available over-the-counter, and so price options have expanded.

Price is important, because Medicare does not cover hearing aids, though some Medicare Advantage plans offer partial coverage, and for those under 65 many commercial plans also do.

How expensive? I went to a national chain site and the audiologist was recommending a set that went for over $8000.

If price is no object, go to an audiologist and you will get custom programming of the devices and free adjustment and tuning. A good option for those without insurance coverage but who want hand-holding during the process is to go to Costco (or another Big Box store), where you will get similar technology at about half the price, albeit with less customization.

If your health insurance has a hearing aid benefit, you will almost certainly have to use a vendor who is on their list, so check before you see anyone.

Finally, if you have no insurance coverage, and are on a limited budget, buy an over-the-counter device. The New York Times Wirecutter, Consumers Reports and Forbes have all published good reviews of these products, so browse them first. Recommended products came as low as $800/set.

If the budget is really tight, get a “PSAP,” a personal sound amplifying product. These have only volume controls and are clearly not perfect for anyone, but can be bought on Amazon or Walmart for as little as $50! Using one of these devices is much better than constantly saying “what.”

Prescription for Bankruptcy. Buy the book on Amazon

Sunday, April 21, 2024

How much will that cost me? On hospital pricing

Hospital pricing is notoriously difficult to understand. Until very recently, it was also impossible to find out how much a hospital was going to charge you for a test or procedure until you got the bill.

Starting January 1, 2021, each hospital operating in the United States was required to provide clear, accessible pricing information online about the items and services they provide both as a comprehensive machine-readable file with all items and services and in a display of shoppable services in a consumer-friendly format.

Initially this rule was largely disregarded, and those hospitals that did post prices did so in a way that only computer geeks could access. Gradually, more hospitals are complying.

Does this matter to you? If you have good health insurance, it may not matter that much, as your insurance company will have negotiated rates for most hospital services. If you are uninsured (still 10% of the U.S. population) or if you are among the many more with high-deductible plans, it matters a lot.

If you have a high-deductible plan, you may have to pay the entire charge for an MRI of your knee, and so if it is $800 or $2800 matters.

There are two things you need to know before “price shopping” for a test or procedure.

The first is that prices vary wildly, and with little correlation between price and quality. A recent study found that the hospital charge for uncomplicated vaginal childbirth varied from $1183 to $55,221 (that is not a typo!).

The second is that if you call the hospital billing department and ask the price, there will often be a major difference between what you are told and what is posted on the hospital website. In only 15% of hospitals that both posted prices on-line and gave them over the phone were the prices the same, and differences often exceeded 50%.

So…if you are uninsured or underinsured, take the time to price shop when you can – when it is not an emergency. Try the websites for several hospitals near you to get an idea of which are at the high end and which at the low end. Then, try calling the billing departments. If they quote you a lower price than the on-line price, get in in writing by email or post.

Two other cost-conscious suggestions:

When you are well, check which hospitals near you are in your insurance network – when you are ill this will probably not occur to you, and going to an out-of-network hospital can cost you dearly.

Just because your doctor says you need something does not guarantee that it will be covered. Always ask if prior authorization is needed before having the test or procedure.

The money you may save will be yours!

Prescription for Bankruptcy. Buy the book on Amazon

Saturday, April 13, 2024

But I read it on Facebook!

The Internet has led to democratization of information access. Information that was locked away in libraries or simply not readily available to most of us can now be found with a simple search.

Along with that, however, has come a flood of misinformation. When you do a Google search, the leading links may be pure gold or utter dross. How can you tell the difference?

If you were to open your favorite social media site and read that Frigidaire appliances were suddenly bursting into flames, would you immediately put your refrigerator out on the street? I doubt it – you would probably check this out on Consumer Reports or call your appliance store. You would also apply your common sense.

So, why is it that some of my patients would come to a visit and say they had stopped their cholesterol medication because they saw a post that the medicine caused dementia?

Anything can be posted on the Internet. Some flagrantly racist or other hate speech may (or these days may not) be taken down, but grossly misleading health information usually stays on-line.

When you search, the top hits are often sponsored links or sites that have carefully managed their description to get a high ranking, with minimal relation to the quality of the content.

How can you tell if a site is worth visiting? Focus on the messenger before looking at the message. The best place to look for scientifically valid and unbiased information are sites maintained by the National Institutes of Health. These will always have the domain as part of their URL. Another great source of information is the National Library of Medicine, whose URL will contain

If these do not give you what you want, go next to websites maintained by major medical centers such as the Mayo Clinic, Johns Hopkins or Mass General-Brigham. These will obviously lean towards attracting patients to their institution, but still have high quality content.

Avoid celebrity sites and those that are trying to sell products or services.

The quickest way to decide if a link is likely to be useful is to go first to those tagged .gov, then to those tagged .edu and third to those tagged .org.

When seeking health information, caveat emptor!

Prescription for Bankruptcy. Buy the book on Amazon

Monday, April 8, 2024

Bird flu - time to panic?

Spoiler alert: No.

What is bird flu? It is an influenza virus, related to the seasonal flu viruses that plague us every winter but one which predominantly spreads among birds. The specifics are that is an H5N1 form of influenza. (Those letters and numbers describe certain proteins on the virus surface and vary quite a bit from year to year, epidemic to epidemic.)

This particular virus has reached pandemic status among birds – it has been found on every continent but Australia and has killed millions of birds. It seems to be spread by migrating wild birds but has been lethal to domestic fowl, leading to the culling of many flocks in Europe and America. The price of foie gras may go up.

The reason for the recent interest is that the virus can spread from birds to mammals. Foxes, cats, seals, dolphins and bears have been infected. Most recently, outbreaks of bird flu have occurred in dairy cattle in the U.S. Herds in at least five states have been infected.

Last week, the virus was confirmed to have infected a human: a farmworker in Texas. This is not new; scientists have known for some time that people who have direct contact with sick birds or mammals can be infected. To date, there have been no known cases of human-to-human spread.

The virus has been found in the milk from infected cows and eggs of infected chickens, but the virus is killed by pasteurization or cooking. It could potentially be spread by consuming raw milk or using uncooked eggs.

To become a serious threat to human health, the virus would have to undergo major mutations to allow human-to-human spread. Not impossible, but unlikely.

Also in our favor is that the few people proven to be infected with H5N1 have had very mild illness. The man in Texas had only conjunctivitis (“Pink eye”).

Finally, the antiviral drugs like oseltamivir (Tamiflu) work well to reduce symptoms, and are readily available.

So… stay away from raw milk for now, be sure to cook your eggs, and, most important, do not pick up or examine dead birds or animals, and warn your children not to do so. A veterinarian called to a north shore beach found that the dead birds were all infected. Let the pros handle it.

Prescription for Bankruptcy. Buy the book on Amazon