14.5: Choices in Medical Care
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Choosing the right medical professional can be difficult and will vary depending on your day-to-day health status. Below is a brief list of medical professionals you can visit for a variety of health issues:
Primary Care Practitioner (PCP) is a medical professional whom you can go to for routine ailments, preventive care, general medical advice, and appropriate referrals. The primary care provider for most people is a medically trained family practitioner, an internist, or a pediatrician.
Conventional or Allopathic medicine, or traditional Western medical practice, is based on scientifically validated methods and procedures and involves the application of the scientific method; cause and effect.
Complementary medicine and alternative medicine ; unconventional practices used alongside or instead of conventional medicine. Examples include chiropractic’s, massage therapy, acupuncture, acupressure, and herbal remedies.
Other PCP include
Osteopath: general practitioner who receives medical training similar to MD , but is more involved in musculoskeletal focus than internal focus.
Nurse practitioners are professional nurses with advanced training obtained through either a master’s degree program or specialized nurse practitioner program. They have the authority and training to conduct diagnostic tests and prescribe medications (in some states). Nurses may also earn the clinical doctor of nursing degree (ND), a doctorate of nursing science (DNS or DNSc), or a research-based doctorate (PhD) in nursing.
Physician assistants must work under the supervision of a physician and are legally permitted to prescribe drugs in all states.
Other practitioners:
Nurses are highly trained and strictly regulated practitioners who provide a wide range of services including patient education, counseling, community health and disease prevention information, and administration of medications.
Licensed registered nurses (RN) have completed either a 4-year program leading to a Bachelor of Science degree (BSN) or a 2-year associate degree program.
Licensed practical or vocational nurses (LPN or LVN) have completed a one- to two-year training program.
Ophthalmologist holds a medical degree and can perform surgery. An optometrist evaluates visual problems but is not a trained physician.
Podiatrist: specialize in care of the foot; extensive training similar to MD; can prescribe and perform surgery.
Dentists are specialists who diagnose and treat diseases of the teeth, gums, and oral cavity. Orthodontists are specialists in the alignment of teeth. Oral surgeons perform surgical procedures to correct problems of the mouth, face, and jaw.
Questions are the Answer
Whichever health care professional you choose to visit, your health depends on good communication. Asking questions and providing information to your doctor and other care providers can improve your care. Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.
- Your doctor wants your questions.
- Doctors know a lot about a lot of things, but they don’t always know everything about you or what is best for you.
- Your questions give your doctor and health care team important information about you, such as your most important health care concerns.
- That is why they need you to speak up.
Health Facilities
Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers and specialized care centers, such as birthing centers and psychiatric care centers. When you choose a health facility, you might want to consider
- How close it is
- Whether your health insurance will pay for services there
- Whether your health care provider can treat you there
- The quality of the facility
Quality is important. Some facilities do a better job than others. One way to learn about the quality of a facility is to look at report cards developed by state and consumer groups.
Look for a hospital that:
- Is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
- Is rated highly by the State and by consumer groups or other organizations.
- Has a lot of experience and success in treating your condition.
- Monitors quality of care and works to improve quality.
In choosing a nursing home or other long-term care facility, look for one that:
- Has been found by State agencies and other groups to provide quality care.
- Provides a level of care, including staff and services, that will meet your needs.
Choosing the right medications: Brand Name vs. Generic
You may need to take medicines every day, or only once in a while. Either way, you want to make sure that the medicines are safe and will help you get better. In the United States, the Food and Drug Administration is in charge of assuring the safety and effectiveness of both prescription and over-the-counter medicines.
Even safe drugs can cause unwanted side effects or interactions with food or other medicines you may be taking. They may not be safe during pregnancy. To reduce the risk of reactions and make sure that you get better, it is important for you to take your medicines correctly.
Understanding Generic Drugs
Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs. And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.
Generic Drugs: Questions and Answers
What are generic drugs?
A generic drug is identical -- or bioequivalent -- to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price. According to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. Even more billions are saved when hospitals use generics.
Are generic drugs as effective as brand-name drugs?
Yes. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken and the way it should be used.
FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs.
Not every brand-name drug has a generic drug. When new drugs are first made they have drug patents. Most drug patents are protected for 20 years. The patent, which protects the company that made the drug first, doesn't allow anyone else to make and sell the drug. When the patent expires, other drug companies can start selling a generic version of the drug. But, first, they must test the drug and the FDA must approve it.
Creating a drug costs lots of money. Since generic drug makers do not develop a drug from scratch, the costs to bring the drug to market are less; therefore, generic drugs are usually less expensive than brand-name drugs. But, generic drug makers must show that their product performs in the same way as the brand-name drug.
How are generic drugs approved?
Drug companies must submit an abbreviated new drug application (ANDA) for approval to market a generic product. The Drug Price Competition and Patent Term Restoration Act of 1984, more commonly known as the Hatch-Waxman Act, made ANDAs possible by creating a compromise in the drug industry. Generic drug companies gained greater access to the market for prescription drugs, and innovator companies gained restoration of patent life of their products lost during FDA's approval process.
New drugs, like other new products, are developed under patent protection. The patent protects the investment in the drug's development by giving the company the sole right to sell the drug while the patent is in effect. When patents or other periods of exclusivity expire, manufacturers can apply to the FDA to sell generic versions.
The ANDA process does not require the drug sponsor to repeat costly animal and clinical research on ingredients or dosage forms already approved for safety and effectiveness. This applies to drugs first marketed after 1962.
What standards do generic drugs have to meet?
Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. To gain FDA approval, a generic drug must:
- contain the same active ingredients as the innovator drug (inactive ingredients may vary)
- be identical in strength, dosage form, and route of administration
- have the same use indications
- be bioequivalent
- meet the same batch requirements for identity, strength, purity, and quality
- be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products