We promote self-directed medical care.
We educate and provide resources for individuals to manage their health.
We focus on what individuals want and need, not on population health, big data, and behavior control.

What's new?

My diet sheet: keto v. plant-based



Benefits of Private Medicine

  • Shorter waits to get in to see your doctor; spend less time with him/her when you get there

  • Benefit from a direct contract with your doctor; YOU are paying for the service, not the insurance company or the government

  • Your doctor is not getting a kick-back for providing you with less care

  • Pay less for your laboratory tests

  • Communicate by text or email or phone when that is more appropriate than a visit

  • More privacy than in a big hospital

Benefits of Independent Medicine

  • Get more out of each doctor’s visit by being prepared to ask the right questions

  • Recognize when a doctor is biased to do too much or too little

  • Become more saavy about medications

  • Learn what to do when your test or medication or treatment is not covered

  • Maximize your health and minimize your trips to the doctor

  • Better understand when your problems are severe or urgent, and when they are not


Benefits of APIM Membership

Sign-up for APIM Membership

  • Help with your medical history

  • Help interpreting medical reports

  • Access to the APIM forum to ask questions, make suggestions

  • 50% discount on SPF membership

  • Ability to request a topic summary

  • Free copy of my diet wars analysis

  • Prewrites of sections of Simple Medicine and free copy of book when complete

Independent Medicine Tracks

  • Resources, Tools, and Products

  • Direct Primary Care

  • Your private medical record

  • Medications

  • Price transparency

  • Simple Medicine

  • Insurance, Policy, and Politics


Recent topics in the APIM Blog

The physician as gatekeeper
Tracking your medications
What is direct primary care?
The single payer system

Keeping your Personal Medical Record

Shouldn't your doctor do that? | Shouldn't Medicare do that? | Shouldn't your hospital do that?
| Don't they all share information, and doesn't someone organize it in a concise and coherent way?
No, No, No, and No!
No one but you will take the time to organize and verify your medical record.
| Without your constant vigilance, your record will be scattered, incomplete, erroneous, and voluminous.

Knowledge Empowers!

After you take responsibility for the integrity of you medical data, the next step is to learn how the body works.
How do I know where to get reliable medical specialty information?
Why do I have to know about my medical conditions? Isn't that my doctors' job?
A Simple Guide to Weight Loss -$5

Insurance, Health Policy, and Politics

Man is free, so long as he need obey no person - solely the law.
Liberty DatabaseAPIM BlogA history of health policy in America

Price transparency

It is one think for medical care to be expensive. It is worse, when you have no idea what the cost will be.
What is a a chargemaster price?
How do I get a reliable price quotation?

Medications

What is medication reconciliation an why should I care?
Why do medications cost so much?
What is the difference between generic and trade name drugs?

Direct Primary Care

What is direct primary care?
Is it the same as concierge medicine?
What are the advantages?
Can I afford it? Is it available near me?


Please complete our survey

It is short. Here are the questions:

how did you find the APIM site?

Does health care need more freedom or less?

Where are you on political spectrum?

Do you consider yourself basically healthy, intermittently ill, chronically ill?

How are you insured?

When the single payer system takes over, should private medicine alternatives be illegal?

Does your doctor let you participate enough in medical decision making?

Do you have a private medical record?

Do you know your medication names, indications, and side effects?

What else


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Disclaimer:
The medical facts and recommendations found on this site are for general information only. APIM does not mean to replace advice from your personal physicians who have access to all of your medical information, who have examined you, and who have assessed any signs or symptoms you might have over time. Any medical information provided on this site is geared towards making you a more informed consumer: better able to recognize quality health care when you see it; better able to decide when or how soon you need medical evaluation for a new problem; and better able to ask incisive questions that will push your physicians to a deeper analysis of your medical situation and clearer explanations to you.


Send us a question or comment


Benefits of Membership

Help to clarify and document your medical history
Help interpreting medical reports
Access to the APIM forum:
-- ask questions
-- suggest additional resources
-- request topics

50% discount on SPF membership
Free copy of diet wars analysis
Prewrites of sections of Simple Medicine and free copy of book when complete


Database
Blog
A history of health policy in America

If not the ACA, then what?
How did we get where we are?
What safety net should be there be?
Has the free market failed?
How do I judge quality medical care?
What is essential and what is fluff?

When the single payer system comes, will private medicine be illegal?
Who benefits from the doctor-patient interaction?
Why is health insurance owned by our employer and not by us?

The right to purchase:
What kind of testing equipment sho?uld I have at home?
Why do I need a doctor's prescription to get some devices but not others?
Why can't I get a blood test or an x-ray when I want

Expanding Home Care
The death of hospitals
Info about Christian healthshare - what we had to agree to: benefits, potential problems: Repath
When the single payer system comes, will private medicine be illegal?
Who benefits from the doctor-patient interaction?
Why is health insurance owned by our employer and not by us?

Simple Medicine
Specialty Medical Information

How do I know where to get reliable medical specialty information?
Why do I have to know about my medical conditions? Isn't that my doctors' job?

After you take responsibility for the integrity of you medical data, the next step is to understand the basics of human physiology, medical care, your illnesses, and your

When do you really need to go to the emergency room?

Every doctor's office you telephone greets you with a recording that says "if this is a medical emergency, hang up and call 911."

But how do you know if it is a medical emergency?

Is treatment in the emergency room always better?

Starting from scratch.

Doctors are not omniscient.
UpToDate

Calculate Body Mass Index (BMI)

Under = <18.5
NL = 18.5–24.9
Over = 25–29.9
Obesity = BMI >=30

waist to height ratio and data


What is medication reconciliation, and why should I care?

Why do they ask me what I'm taking every time I go to my doctor's office? -- tracking? explain medication reconciliation


Tracking your medications

Individuals should understand what is meant to be an ongoing medication and what is a time-limited prescription. Antibiotics and pain medication are usually time-limited whereas most other medications are meant to be ongoing, at least until further evaluation.

Patients given no refills or 2, 5,or 11 refills for 3, 6, or 12 months may infer erroneously that they should discontinue the drug when the prescription runs out. On the other hand, the physician may intend to discontinue a drug, but the pharmacy sends an automatic refill request by fax anyway. Patients calling to inquire whether they should continue a medication or not may be directed by the phone tree to call their pharmacy to initiate a refill request. This can lead the patient to take a medication perpetually that was discontinued. Everything is handled electronically, and no one thinks about it. Dose changes often lead to confusion.

The coders of modern electronic medical records seem to think that a new prescription is written every time a dose is changed, but that is simply wasteful. The clumsy handling of medication lists by electronic records systems often provides more confusion than clarity. Medications fall off the list prematurely or persist long after the physician discontinued them. Duplicates abound. Dose changes are not captured. Because of the confusion generated by electronic records and by rotating staff in big offices or hospitals, the best source of knowledge about what medication and what dose the patient should be or is taking is the patient herself. Commonly, when I ask a patient what medications or what dose they are taking, they point and say, "I don't know, it's in the computer." My response is that it doesn't matter what the computer says, the only truth is what the patient is actually putting in his mouth.

A drug that you are not taking cannot be causing your symptoms or helping control them. A drug that you are taking that I don't know about could be causing you harm that we aren't addressing. For your safety, you must know your medication list, the dosage, and your allergies. If you don't have it in your head, write it down!


Other Medication Questions

Who determines what drug can be sold over the counter (OTC)?
How do I ensure my medications are not contaminated?

Why do medications cost so much?

For generic drugs, the problem is usually your insurance company. They act as though they are doing you a favor by "negotiating" with the drug companies for a good price. Most of the time, however, the price you pay with insurance coverage is higher than the cash price you would pay if you did not have insurance.

Try it some time. Ask your pharmacist to give you the cash price for the prescription. For a generic drug, you may save $5-$20.

This also works if your insurance company declines to pay for your prescription because they don't believe the medication that you and your doctor have selected for your condition is the right drug for your condition. It is unlikely that they understand your medical condition better than you or your doctor, but do your research to be sure. When you are sure it is the right drug for you, go back and pay cash.

Using a service like GoodRx can help you to quickly find the lowest cash price. You may or may not be able to pay the GoodRx price and get the credit towards your yearly out-of-pocket maximum.

GoodRx pharmacy discount

FROM THEIR WEB SITE:
"GoodRx gathers current prices and discounts to help you find the lowest cost pharmacy for your prescriptions. The average GoodRx customer saves $355 a year on their prescriptions.
GoodRx is 100% free. No personal information required."
(NOTHING IS FREE)
"We use third-party advertising companies to serve ads when you visit the GoodRx website or use the GoodRx app. These companies may use information (not including your name, address email address or telephone number) about your visits to this and other websites in order to provide advertisements about goods and services of interest to you. GoodRx adheres to Digital Advertising Alliance principles."
Advertising on GoodRx


When the insurance company says "no" it does not mean you cannot have the drug, it means they will not pay for it. Often, the drug they want you to get costs you more, but the insurance company less. It is unlikely the insurance company is looking out for your welfare more than you and your doctor are. They have investors to satisfy and high-salaried vice-presidents to pay. By paying cash, you save money unless your medical costs exceed your deductible for the year, then sometimes you pay nothing. But paying nothing for a $10 drug in December that you paid $20 for for the first 11 months of the year means you are still contributing $90 to your insurance company's profits.

For generic drugs, the problem is usually your insurance company. They act as though they are doing you a favor by "negotiating" with the drug companies for a good price. Most of the time, however, the price you pay with insurance coverage is higher than the cash price you would pay if you did not have insurance. Try it some time. Ask your pharmacist to give you the cash price for the prescription, in case you don't want to use your insurance. This also works if your insurance company declines to pay for your prescription because they don't believe the medication that you and your doctor have selected for your condition is the right drug for your condition. It is unlikely that they understand your medical condition better than you or your doctor, but do your research to be sure. Get the cash price. When you are sure it is the right drug for you, go back and pay cash. When the insurance company says "no" it does not mean you cannot have the drug, it means they will not pay for it. More likely than not, the drug they want you to get costs you more, but the insurance company less. It is unlikely the insurance company is looking out for your welfare more than you and your doctor are. They have investors to satisfy and high-salaried vice-presidents to pay. By paying cash, you save money unless your medical costs exceed your deductible for the year, then sometimes you pay nothing. But paying nothing for a $10 drug in December that you paid $20 for for the first 11 months of the year means you are still contributing $90 to your insurance company's profits.

This video explains further why you might want to pay to pay cash.

Name brands are a different story.
Newly developed medications a granted a period of patent protection by the government, during which time they can set the price they want, and no other companies can produce the same drug.

Watch this video to find out.
Pharmacy Benefit Managers and Group Purchasing Organizations = a government-approved kick-back scheme that would be illegal in any other businessLearn what you can do about it at
The American Association of Physicians and Surgeons
and
Physicians for Reform
Good Rx won't help as much, but the price does vary, so is worth shopping around with GoodRx or by any other means.
I get my generic prescriptions from my Direct Primary Care physician
My letter to the manufacturer of Repath (post)


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suggestions for products at home

Dispatch Health


Your Private Medical Record: Learn why and how to take charge of your own medical data.

Shouldn't my doctor do that?
Shouldn't Medicare do that?
Shouldn't my hospital do that?
Don't they all share information, and doesn't someone organize it in a concise and coherent way?

No, No, No, and No!


What are the benefits of a personal medical history?

Always know your medical history when you see a doctor

Be wary of health care providers who may propagate mistakes about your conditions via cut and paste or carry-forward text.

Always know what medications your are taking in what doses for what reasons.

Control what is in your medical record and what is not

Have a complete medical history at your fingertips whenever you see a new doctor

Have your parent's (spouses, children's) medical history at your fingertips (literally, on your smart phone

No one but you will take the time to organize and verify your medical record.

Without your constant vigilance, your record will be scattered, incomplete, erroneous, and voluminous.


A word about privacy

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O

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Getting started with your private medical record

I use an online outlining program to track my medical history. It is organized in the way and contains all of the information that allows it to function as a complete medial history that a physician would create and use.

The are a number of good programs out there, but my favorite is Dynalist.

The best way to see how this works is to try it out. HERE is a read-only sample file that you can copy and use as a template.

To get the most out of Dynalist, you'll want the pro version. You can get a discount by signing up with this link HERE.

Dynalist has a myriad uses. You can use it for your grocery list (which you can share with your spouse), todo list, random thoughts, or ideas for that book you want to write.


...

...

This video explains further why you might want to pay to pay cash.

...

How do I use my personal medical record?

For your records to be most useful for you and an physician you see, they should be organized in a standardized way - Free PDF

medical chart.jpg
Learn More
Keeping your Personal Medical Record (PMR)

How secure is my information?

AIM PMR Template

AIM PMR sample

Screen shot of sample PMR

A word about HIPAA


AIM PMR Template

AIM PMR sample

Screen shot of sample PMR

Link to my book

Link to the HIPAA page

A word about privacy

A brief guide to starting your own PMR
Get help
Dynalist
Example
For your records to be most useful for you and an physician you see, they should be organized in a standardized way - Free PDF

Private Medical Record Consulting

Comprehensive, concise analysis

Do you need help organizing your medical records? What to save, what to discard? What is important, what is minor? What questions should I ask? What follow-up do I need?

For $60 per hour, I can help, minimum of $5, paid via Paypal. You may submit general questions and I may be able to send you some information form the medical literature to help.

You may want to have me help organized your entire medical record (which could take 30 minutes to a few hours, depending upon how complicated it is).

You may have simple questions about one particular report. Note: if you just send snippet from a report, it may be difficult to assess out of context. It is best to black out your name, date of birth, SS#, and any other "protected health information" (see "A Word About Privacy" above). Scan the document into your computer, then email it to me with your question. Include your age. When your case is closed, I'll delete the email, but it will be pretty safe without any identifiers except your email and your age. Probably less info than you have on Facebook.

You might want to check the blog posts below for useful information on what to keep and what medical data quickly becomes irrelevant or obsolete.

Here is a link to an easy to use, inexpensive scanner.

Database of Services
Suggested products
how and where to find them

Thanks for stopping by!

Here at APIM we promote self-directed medical care.

Many people understand their cell phone apps, their computers, and their investments, but not their medications, their doctor’s reasoning, or their insurance policy.

We believe that knowledge empowers. We help individuals take charge of their own medical care. When they do, costs will go down and satisfaction will go up. Individuals will know what they need and want and how to get it; they will know quality care when the see it; and they will encounter lower and more transparent prices because of market competition. We do this through providing basic medical education to our members: how the body works, how diseases are diagnosed, how doctors think, and what quality medical care should look like. We then discuss the tools necessary to dig deeper into conditions they want to understand better, become educated consumers, co-direct their care with their physician, and become independent of the rule of corporate medicine.

What is direct primary care?
Is it the same as concierge medicine?
What are the advantages?
Can I afford it?
Is it available near me?
Why would I want to pay out of pocket?
How do I find a DPC doctor?
Do specialists do DPC?(ophthalmalogist in Texas, ENT in Arizona) stem cell docs; the spine guy in richmond procedure often not covered, but still billed a chargemaster price, expecting insurance coverage: don't pay it: ask for cash price or medicare price
Carol's CT story - here or somewhere.


Links:
The Wedge and CCHF
THE DPC Coalition at http://dpcare.org
AAPS

""Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients. DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!" - DPC Coalition: https://www.dpcare.org/"

What is essential and what is fluff?
What is "price transparency"?
What is a"chargemaster" price?
Who is responsible for controlling costs?

Thanks for your purchase!

A word about privacy: how HIPAA violates your privacy; Facebook; how Dynalist protects it; one patient, one record - why hospitals, government, and big tech want your medical data;
How are medical records best organized: for you, for your doctor; for big tech - they want you to put it in some apple app with boxes; your doctor may want it that way so he can fulfill his governmental responsibilities you can: 1) comply, but at least you'll have the info; or 2) just give them the text data;

Agreeing to the HIPAA form; your right not to sign - won't do anything, but you show you are informed and whant to fight back
What is in the HIPAA form - copy from skin doctor: Twila's book