Thursday, October 18, 2012
The cost of making assumptions By Dr. Anthony Policastro I recently reviewed a complaint from a patient who was concerned that her doctor was asking her to come for a visit just to make money from her. She had a rash and did not know what it was. She felt that she needed to see a dermatologist to determine what the type of rash was, but her primary care physician wanted to see her first. She saw no reason for that extra visit. The problem with the complaint was the fact that it was based upon an assumption. The assumption was that the primary care physician also did not know what the rash was. She assumed that the only reason for the visit was to get money for sending her to the dermatologist. What she failed to realize is that several things could have happened at that visit. The first was that the primary care physician might have known what the rash was. If that were the case, treatment could have been given and there would not be a need for a dermatology visit. The care would be less expensive, thus reducing our future insurance premiums. The second was that the primary care physician might have determined that the rash was something serious and the referral would have gone from routine to more emergent. In that case a referral would be made in a more timely fashion which might prevent the condition from worsening. The patient would have been treated before there were complications which would mean that the care would be less expensive and it would reduce our future insurance premiums. A third possibility is that the rash might have suggested another medical condition. For example, a condition known as Lupus often presents with just a rash. In cases like that, the referral needs to be to a specialist who can treat the underlying condition. A dermatologist would only be able to address the skin symptoms. A visit to the dermatologist in this case would be more expensive because it would be unnecessary. Avoiding such a visit would be less expensive and reduce our future insurance premiums. A fourth possibility is that the primary care physician might not have known what the rash was. A referral could have been made to the dermatologist. However, there are a few treatments that work for many rashes. One of those treatments could have been started while waiting for the dermatology visit. If the treatment worked, then the dermatology visit would not be necessary. This would be less expensive than seeing the dermatologist and would reduce our future insurance premiums. The last possibility is that the primary care physician might not know what the rash was. Interim treatment might not have worked. A referral would have been made to the dermatologist and the diagnosis would then have been made. Treatment could be begun. This would be the most expensive course of action. However, in this circumstance, it would have been the correct course of action which would have made it the most cost effective. For this patient, the best approach was to see the primary care physician. Unfortunately, the patient made an assumption that this was just a money grabbing tactic. In reality, the course of action that the patient requested - seeing the dermatologist first - was clearly the one that was the most expensive approach. While it might not have cost her more money directly, it would cost the system more money in the long run. That extra cost would in some way be passed on to everyone else even if it was only in terms of an insurance premium. These kinds of assumptions by patients add cost to our medical care system. We all pay for those incorrect assumptions.

Go Red scholarship program The American Heart Association and Macys, national sponsor of Go Red For Women, announce the second year of the Go Red Multicultural Scholarship Fund which is designed to help women of diverse backgrounds achieve a dream of working in a healthcare position. This years deadline is Nov. 30 and several prizes will be awarded in the amount of $2,500. For more information, or to apply online, visit

West Nile case in Middletown Delawares Division of Public Health (DPH) confirmed a human West Nile virus case in the Middletown area, bringing the states total cases to seven. The case was mild and the individuals prognosis is good. Seven cases is the second largest yearly total in state history; surpassed only by 2003 in which there were 17 West Nile virus cases. West Nile virus is transmitted by mosquitoes, generally from spring to fall. Nearly 80 percent of people infected with West Nile virus will not become ill. About 20 percent of those infected will develop West Nile fever, with mild flu-like symptoms, and one in 150 people infected will develop severe infection (West Nile encephalitis or meningitis). Delawares mosquito control season runs from mid-March through mid-October and sometimes until early November, depending upon weather conditions. For more information on Mosquito Control, call 302-739-9917 or visit For more general information on West Nile Virus, go to

Tobacco cessation classes Bayhealths seven week Tobacco Cessation program offers support and guidance to help you quit using all tobacco products. The next series of classes begins Tuesday, Nov. 6 and is held every Tuesday for seven weeks, ending on Dec. 18. The class will be held from 5 to 6:30 p.m. in the Rehab Conference Room at Bayhealth Milford Memorial. This series of classes offers strategies to improve your lifestyle thorough behavior modification, diet, stress reduction, exercise and nicotine replacement therapy. The quit week is the fourth week of the program. This program is free to all Delaware residents. Call 1-877-453-7107 to register. You must be at least 18 to register and be able to attend all sessions. For more information, call Bayhealth Clinical Educator Terry Towne, MSN, RN-BC, NE-BC, at 744-6724.

Baby Boomers asked to get tested Delawares Division of Public Health (DPH) advises Delawares baby boomers to speak to their doctor about getting a one-time blood test for the Hepatitis C virus (HCV). People born from 1945 through 1965 currently account for more than 75 percent of adults infected with the Hepatitis C virus in the U.S. and are five times more likely to be infected than other adults. Hepatitis C is primarily spread through contact with blood from an infected person. Many baby boomers could have been infected from contaminated blood, blood products, or an organ transplant before widespread screening of the blood supply began in 1992. Others may have become infected from injecting drugs, even if only once in the past. Still, many baby boomers do not know how or when they were infected. CDC estimates that implementation of these recommendations will identify more than 800,000 additional people nationwide with Hepatitis C. Linking these individuals to appropriate care and treatment would prevent the costly consequences of liver cancer and other chronic liver diseases and ultimately save more than 120,000 lives. For more information or to report a case, call DPHs Viral Hepatitis program at 302-744-1050.

Home For The Holidays program The holidays can be a particularly stressful time for families coping with Alzheimers but it is also vitally important for these families to spend time with their loved ones during the holiday season. Thats why the Home Instead Senior Care office serving Kent and Sussex County has partnered with Delaware Hospice on a groundbreaking program called Home for Holidays. Presented by Home Instead Senior Cares Community Liaison, Heather Steuer, Home for the Holidays is designed to help families engage their loved one with Alzheimers and manage challenging behaviors through techniques pioneered in Home Insteads Alzheimers CARE program. Home for the Holidays will be held on Wednesday, Oct. 24 from 10 a.m. to 3 p.m. at Delaware Hospice, 100 Patriots Way in Milford. Light fare will be provided. Space is limited so RSVP by Oct. 15 by callingHeather Steuer at 302-697-6435, ext. 804.

Nanticoke offers flu shots Its time to get your seasonal flu shot. Influenza is a serious disease that affects many people, including the elderly and those with serious, long-term health problems. The U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone get a seasonal flu vaccine every year. Nanticoke Memorial Hospital will be offering seasonal flu shots to individuals 18 years of age and older at Nanticoke Memorial Hospitals Mears Health Campus (300 Rawlins Dr., Seaford, Rehabilitation Services Building) on the following dates: Tuesday, Oct. 23 from 11 a.m. to 2 p.m., Thursday, Oct. 25 from 3 to 6 p.m. There is no charge but a donation of $10 per vaccination is requested. Pre-registration is not required. For more information regarding seasonal flu shots, call 629-6611, ext. 8948. For information on vaccinations for those under 18 years of age, contact Nanticoke Pediatrics at 629-6525.

Vitiligo Support Group The last meeting for 2012 of the Vitiligo Support and Awareness group will be held on Friday, Oct. 19 at 7 p.m. in Bayhealths Education Building, 208 W. Water St., Dover. For more information, call Bayhealths Education Department toll-free at 1-877-453-7107.

Sussex County Heart Walk 2012 Join Delaware residents for the signature fundraising event of the American Heart Association. Walk to save lives at the 21st annual Sussex County Heart Walk (5K) on Saturday, Oct. 20, at Delaware Tech University, Georgetown campus. Registration begins at 9 a.m. and the walk kicks off at 10. For more information or to register, call 302-286-5723, email or register online at

Hospice presents suicide conference Delaware Hospices Family Support Center will hold a professional conference, The Aftermath of Suicide, with keynote speaker, Dr. David Jobes, PhD, ABPP, on Friday, Oct. 26, from 8 a.m. to 4:30 p.m., at the Delaware Hospice Center, 100 Patriots Way, Milford. School guidance counselors, social workers, nurses, clergy, counselors, funeral service staff, bereaved and others, who provide grief support to the community, will benefit from this conference. Speakers will explore the top three Whys asked by survivors following a suicide death, effects of vicarious trauma on survivors, and the integration of the new life story. Contact hours (6.25) have been approved for social workers, mental health counselors, chemical dependency professionals, funeral services, nurses, and nursing home administrators. Cost of the workshop is $99 per person or $75 per student, which includes breakfast and lunch.Deadline for registration is Wednesday, Oct. 24. Register or learn more by contacting Vicki Costa, LCSW, associate director of Family Support Services, at 856-7717 or 800-838-9800, x1129, or

Prepared childbirth classes at PRMC Peninsula Regional Medical Center is offering a series of Prepared Childbirth classes in the fourth quarter of 2012. A traditional four week series of classes, which meet only on Mondays from 6 to 9 p.m., will begin on Nov. 19. A four week series that meets only on Tuesday nights from 6 to 9 p.m. will begin on Nov. 20. Parents also have the option of a weekend series on Oct. 27 and 28 or Dec. 15 and 16 that will meet from 8:30 a.m. to 4:30 p.m. on both days. All classes will be taught in the Avery W. Hall Educational Center on the PRMC campus. Meet other expectant parents at this interactive course that includes information about prenatal care, labor and delivery, post partum care and infant safety. Classes should be taken during the 6th to 8th month of pregnancy. The fee is $75 for the mom to be and her coach. Pre-registration is required. Participants are asked to bring a blanket and two pillows to each class. For more information, call 410-543-7126 or visit the Classes and Events section of the Peninsula Regional Medical Center website at for online registration.

HNMH offers CPR classes Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends,and community members the opportunity to learn CPR and need a course completion card. Classes are open to participants ages 12 and up. This program is specifically designed for those who prefer to learn in a group environment with feedback from an instructor.The target audience is those who have a duty to respond to a cardiac emergency. Cost is $40. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and to obtain a listing of class dates/times, contact the Nanticoke Memorial Hospitals Training Center office at 629-6611, ext. 8919. Pre-registration is required.

HIV/AIDS Support Group A new support group for HIV/AIDS will meet every other Wednesday, at 7 p.m., in the Branford Lounge at Epworth United Methodist Church at 19285 Holland Glade Rd., Rehoboth Beach. The group is sponsored by Epworth UMC, CAMP Rehoboth, the AIDsDelaware and Delaware HIV Consortium.For more information, contact David at

Parkinsons support group meeting The Nanticoke Parkinsons Education and Support Group will hold its regularly scheduled monthly meeting on the third Monday of each month, from 10 to 11:30 a.m in the ballroom at the Nanticoke Senior Center. The public is welcome to attend the meeting and stay for lunch and a social timeafter the meeting.