3: Medicare Mindfulness

The Vedala brothers bring in Bortier Manison to the Vital Visions podcast. Bortier is the annual Medicare wellness specialist at their clinic, Primary Care – South OKC. Bortier gives tips for patients approaching Medicare age, what his processes are to ensure the clinic’s patients receive the care they need and more. This episode is full of helpful information for those who are nearing the age of Medicare coverage or anyone who may be taking care of someone of Medicare age!

Links:
Norman Regional Primary Care – South OKC
Medicare website
Verify your insurance with Norman Regional

This podcast is for educational purposes only. The information in this show is not to be used as medical advice. If you are needing medical care, please consult with your physician.

Norman Regional is hiring! See all our open opportunities here: https://careers.normanregional.com/careers-home/

Transcript

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Welcome, friends.

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This is Dr’s Krishna and Veer Vedala.

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And we are Vedala Bros.

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We are delighted to bring you our brand new podcast, Vital Visions.

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So in this podcast, we'll be discussing important medical topics

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that affect your community.

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We'll be looking into medical research, health and wellness tips

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and also available health

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care resources brought to you by the Norman Regional Health System.

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That's right.

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And in each episode, we'll also be joined by medical professionals,

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local community leaders and even some of our friendly neighbors

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as we talk through various issues that are affecting our community.

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So if you want to lead healthy lives or learn about the new healthy trends,

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we want this podcast to be your go to resource.

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Welcome back, folks.

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We are the Vedala Brothers and we're back again

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with another episode of Vital Visions, where we talk about all things

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vital, empowering our community one topic at a time.

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And today we have Mr.

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Bortier Manison, who is our annual Medicare wellness nurse at our clinic.

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He's our rock star.

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Um, Bortier is a huge Denver Broncos fan.

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Since last season, Russell Wilson has kept him up all night long.

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Sometimes. It's been rough. Yeah, it has been rough.

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We won't talk about it anymore.

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But he's also an OSU Cowboys fan, which I give him a hard time for.

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But that's okay.

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That’ll be forever, I guess. You know what's the rank?

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90 to 18.

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OU, OSU? Oh we won't talk about that either.

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We're both in misery this last season. I know. Football wise

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We were.

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We were.

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But I don’t want to talk about that part either.

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So, um, Bortier is, like I said earlier, he's our clinic rock star.

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Um, he really, um, is the one that, uh, keeps up with all of our Medicare

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patients.

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And Medicare is a huge, huge part of, uh, of the United States' health care system.

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Uh, and so, uh, we wanted to make sure that we had an episode about this.

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Um, a lot of our uh, uh, patient population

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is, uh, kind of in the Middle Ages and not some of them

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do seem to have questions regarding, well, what are the next steps?

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Uh, how do I get into Medicare?

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How do I, you know, take care of this and make sure that, uh,

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I'm not going to be without health insurance as I get older.

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And I think it's not just our patients, right?

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I mean, even as, uh, primary care docs whose parents are maybe

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getting onto Medicare, like, it's important information for us to,

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to that way we can teach our patients as well.

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We had the same issue with our dad the other day.

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Yeah. Yeah. Just like what's Medicare. I'm just kidding.

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Well, uh.

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We'll give it all hand it off over, to Bortier

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But here, um, tell us a little bit about yourself.

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Uh, so I am a nurse,

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an LPN, uh, here at Norman Regional,

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and uh, I've been working

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as a nurse for seven years.

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Uh, it's, it's a nice, rewarding experience to be a nurse.

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And, uh, I transitioned into a role

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of doing annual Medicare wellness visits, primarily

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once I moved here to Norman Regional

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from another hospital system.

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But my main focus is annual wellness

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visits, and I do that every day for these two brothers here.

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And I also have three other providers

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that I work with as well.

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And that's awesome.

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And we can't thank you enough, man, because it's so helpful when you, uh,

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when you go in there and, um, take care of our Medicare patients for us,

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can you quickly go over what a medicare wellness visit is?

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Yes. So Medicare wellness visit is covered by Medicare once yearly.

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And depending on which Medicare situation you have, like

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if you have a say, for instance, a Medicare Advantage plan, like,

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United Healthcare

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or Humana, you could do it once every calendar year.

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Otherwise, if you have like original Medicare,

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then it's once every 366 days.

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But mainly it's to go over preventative items

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to make sure that we're hitting all of those, getting your colonoscopies,

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mammograms, bone density, things of that sort and nature,

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also immunizations and talking about,

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uh, advance directives,

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uh, and just general health care for the patient.

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I work kind of as a net to catch things

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that may not come up in visits with the providers

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and to make sure that the patients are taking care of to the fullest extent.

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Yeah, it's just so nice having that extra layer of support

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from people like Bortier here that helps us take better care of our patients.

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And it also makes our job.

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It also makes our job easier too.

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So keeping track of all those things related to Medicare

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is very tedious task, and having Bortier there makes it simple.

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Uh, it makes it easier.

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Really, um, puts into perspective things like, we are a team here.

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Exactly.

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Once again, you know, uh, medicine itself is a team sport and we cannot emphasize

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that because without our support staff, we would not be able to do what we do.

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Yeah.

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Should be like talk about like Medicare in general for a little bit probably.

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And so we were kind of wondering, Bortier, if you could kind of,

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um, you know, describe to us what the different parts of Medicare.

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There's like A, B, C, and D, but what do they mean?

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Yeah, exactly.

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So Medicare A is the hospital benefit.

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So that covers like inpatient care,

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home health

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and things of that nature to help

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make sure the patient is taken care of if they have a major event.

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Medicare Part B is the medical insurance.

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So that is what you guys mainly handle.

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Like when they go for doctor's visits,

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they go for outpatient care, uh,

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x rays, things of that nature.

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Medicare Part C is the Medicare Advantage plans.

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So those are your, uh, United Healthcare plans, your Humana

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plans, your alternative Medicare plans that the patients can sign up with,

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that Medicare helps pay for their care,

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and then they may have extra costs outside of that that they would cover

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as far as the patient would cover.

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And then Medicare Part D is the prescription drug benefit.

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It's an optional benefit that if you have original Medicare,

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you can you can have that optional,

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If you have one of the alternative care plans,

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then it's usually included in the cost of that plan too.

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So part A is mostly just hospital coverage.

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Part B is your outpatient services.

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Part C is kind of like a, I guess an alternative, uh, company

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that takes care of your Medicare funds, and Part D is, is basically for prescriptions. Correct.

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D for drugs. Exactly. So that makes sense.

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That makes it easier, right?

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That is true.

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Um, I guess, uh, just to expand on that,

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so does, if you have Medicare, when you turn 65, you can get on Medicare,

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um, are all your covers, pretty, uh expenses pretty much covered then and,

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or do you have any co-pays or, or premiums have to pay.

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Yeah.

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You have a premium that you pay with Medicare

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and you also have premiums

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that you would pay for your alternative Medicare plans as well.

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Part C plans. Okay. Yeah.

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And how much?

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Um, sorry, I can kind of put you put you on the spot,

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but how much usually do those premiums like average out to be?

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Uh, usually around like 180 bucks to 200 something to that.

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Okay. Yeah. So we, we better than, uh, commercial insurance I guess.

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I, I guess so. I guess so.

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Um. Yeah.

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And so

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is it always at 65 is that when they really need to start looking at, well,

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I got to get on Medicare or because I've heard, uh, you know,

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70 is also a new, uh, possible age limit what we're looking at.

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So right now, uh, if you are looking at Medicare,

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it is 65, unless you have a disability,

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which you can qualify for Medicare early, earlier.

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But typically the patients 65 years old,

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you can enroll into Medicare,

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you have a seven, seven months enrollment period

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and that is three months before you turn 65, the month that you turn 65,

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and then up to three months after you turn 65.

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So that's the initial enrollment period.

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So if you missed that, uh, that's great info, by the way. Bortier, thank you.
We did not know that.

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Um, but if you had, like, a, uh, if you had missed that initial enrollment

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period, that seven months,

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can you still sign up for Medicare or is there like a, like a charge fee? Yes.

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You can still enroll in Medicare after you missed that period,

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but there's typically a monthly

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penalty that is added on to your.

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Oh, man. Yeah.

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Added on to your care.

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And that's not just like a one time penalty.

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It's like throughout your Medicare. Oh, my gosh.

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So you want to make sure you want to make sure you sign up for that

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initially during that period, if you can, there are some special, um,

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special allocations or special situations

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like say for instance, if you have care through your employer

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or your spouse's employer, as long as you or

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the spouse who's covered is still employed,

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then you have a period of time that you can enroll

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after that employment ends.

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And okay, so it's like an eight month period

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after the employment ends and the health or the health care

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coverage ends, whichever comes first.

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Okay. Okay. So that that makes sense.

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And once you're on Medicare, you can make changes to your coverage

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plan, right?

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Like if you didn't enroll in C before, you can do it later.

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Correct, Yeah.

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So you can change your Medicare coverage every year.

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That's the period that I'm sorry, I don't have it right off the top of my head.

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Oh, that's. Right. That's okay. Yeah, I'm just curious. Yeah.

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So there's this period each year that you can go ahead and change your coverage.

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And I believe it's October 15th to December 7th.

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It's the time period and you could change your plan

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as far as you can go from original Medicare to an Advantage plan.

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You can pick up the prescription drug coverage, things of that nature.

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And every January 1st to March 31st,

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if you have an advantage plan, you can change advantage plans

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or you can revert back to original Medicare coverage.

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So so it's curious that you bring up the advantage plan.

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What are some of the benefits

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and some of the drawbacks from being on an advantage plan?

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So with the Advantage plan, it's through private companies

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like United Healthcare, Humana, etc.

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You can

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you can get coverage,

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but you only have certain providers that you can see and they have networks

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and you have to go off of those networks in order to see a provider.

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So say, for instance, if you're both covered on original Medicare,

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but only one of you, you're covered on the United Healthcare

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then patient can't see the other provider.

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Yeah,

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another benefit

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to the benefit to the advantage

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plans are say for instance, my parents have United Healthcare

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and with United Healthcare they have a benefit

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that they have a monthly allotment that goes towards gyms

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so they can go to the gym, they have a gym membership that's covered.

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They also have

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parts that help cover

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drug costs, things of that nature.

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So there's little, little advantages here and there.

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But then you also have to take consideration that you're actually paying

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a little bit more than you would pay for.

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Yeah, I didn't know about the gym membership.

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The gym membership thing is great. That's really. Cool.

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There's a lot of patients that love that, so that's great.

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Yeah.

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You know, you joining them?

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Are you guys living together? No.

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I need to, though.

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I need to.

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I try to get my like my wife and I starting going to the gym

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and try to get my mom to work out with this one day.

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And she's just like, I hurt.

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But now they're trying to do yoga together.

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That's really interesting. Mhm.

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Um, but gosh, that's those such good info Bortier.

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Thank you. Thank you.

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Um, do you have any like

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what, what brought you into, uh,

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joining our team as, as being our Medicare wellness representative.

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And, you know, how did you get here?

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So I was working

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for another hospital system and

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my drive time was really, really long and

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it was nice to have somewhere that was close.

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So we're close to my son's, uh,

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care facility, daycare facility, too.

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But also, the thing that drew me

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in was coming in and meeting everybody here.

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It felt like it was a place I could be home.

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Yeah. Yeah.

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And, uh, so it's been, it's been a real blessing being here

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and meeting everyone and getting to know 
all the providers here at Norman

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Regional and, uh, getting to know them closer

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than just being a coworker

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has been a real blessing in myself and my boys.

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We both, or 

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We all three of us see Norman providers and that's been really cool.

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Yeah.

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And it's a blessing to have you as part of our team too.

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It's it's a. It really goes to say

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They were actually,you know, family 
oriented here at Norman Regional. Yeah.

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We actually are. It's just great.

00:14:20:00 - 00:14:22:23
Um, one of the questions that, uh, some sometimes

00:14:22:23 - 00:14:26:24
I get from my patients is, um, in addition to Medicare, do they really need

00:14:26:24 - 00:14:30:25
to buy other like secondary supplemental insurance, like another private insurance?

00:14:31:15 - 00:14:31:23
Yeah.

00:14:31:23 - 00:14:35:09
So supplementary insurance would be great to help

00:14:35:21 - 00:14:38:22
cover costs. Um.

00:14:39:00 - 00:14:44:15
Because sometimes, you know, the your inpatient visits

00:14:44:15 - 00:14:49:05
or your outpatient visits may be more than what Medicare would cover. Mhm.

00:14:49:09 - 00:14:52:11
And so having that supplemental insurance kind of acts as a

00:14:53:06 - 00:14:56:16
kind of acts like a net to help cover those costs.

00:14:56:16 - 00:15:00:25
So I would highly advise patients to get supplementing insurance if they.

00:15:00:25 - 00:15:03:13
Can afford it. Yeah, that's, that's great.

00:15:03:13 - 00:15:06:07
Um, any like great stories you've had with your patients?

00:15:06:07 - 00:15:07:05
Cause you know, there's,

00:15:07:05 - 00:15:10:18
there's a couple of things um, we want to things we relate to in

00:15:10:18 - 00:15:13:19
this podcast is try to bridge that communication gap between,

00:15:14:02 - 00:15:17:28
um, physician and, and patient and provider and patient

00:15:17:28 - 00:15:21:11
and you being one of our team members, you're like, part of that bridge.

00:15:21:12 - 00:15:21:23
Yeah.

00:15:21:23 - 00:15:23:20
Um, so we wanted to see, like, Hey,

00:15:23:20 - 00:15:26:27
have you had any patient experiences to where you, um,

00:15:27:15 - 00:15:30:18
we found it to be moving or of a success story that you'd like to share

00:15:31:04 - 00:15:33:17
and we have some questions to bounce off of you after that.

00:15:33:17 - 00:15:34:08
Okay.

00:15:34:08 - 00:15:37:22
Yeah, I can think of a particular situation

00:15:37:22 - 00:15:42:06
where I had a patient who normally he doesn't like going to.

00:15:42:06 - 00:15:46:22
The doctors just happened to catch him for the annual

00:15:46:22 - 00:15:50:01
Medicare wellness visit, encouraged him to go and get a

00:15:51:09 - 00:15:52:14
lung scan.

00:15:52:14 - 00:15:56:25
And we were able to catch lung cancer before it became something.

00:15:57:04 - 00:15:58:28
And incredibly. That's great.

00:15:58:28 - 00:16:01:17
Yeah. So congratulations that. Yes.

00:16:01:17 - 00:16:05:00
So I mean, there's there's stories, all sorts of stories like that where,

00:16:06:03 - 00:16:09:07
you know, the patient typically wouldn't have something done

00:16:09:07 - 00:16:12:23
or maybe they usually refuse to have it done.

00:16:13:00 - 00:16:16:04
And having another person there to kind of encourage them

00:16:17:02 - 00:16:21:15
to give them a little bit of a nudge or push is what pushed them over the edge

00:16:21:15 - 00:16:26:23
to actually get it done and prevent something catastrophic from happening.

00:16:26:27 - 00:16:28:21
Yeah, yeah.

00:16:28:21 - 00:16:32:17
Um, just to piggyback off of that, like, and part of the Medicare wellness

00:16:32:17 - 00:16:38:09
visit is trying to talk about goals of care and planning for planning ahead.

00:16:38:22 - 00:16:39:24
Yeah.

00:16:39:24 - 00:16:43:12
What do you think would be a good way or um, in your experience

00:16:43:12 - 00:16:46:24
that patients can approach either you or a provider to talk

00:16:46:24 - 00:16:50:09
about those decisions like end of life wishes and preferences and things?

00:16:50:19 - 00:16:50:27
Yeah.

00:16:50:27 - 00:16:54:04
So in my normal course of my annual

00:16:54:04 - 00:16:57:09
wellness visit, I ask all the patients and also

00:16:58:10 - 00:17:00:19
anyone who's in the room with them

00:17:00:19 - 00:17:03:20
who comes along, if they have an advance directive,

00:17:04:07 - 00:17:06:27
something that communicates their medical wishes

00:17:06:27 - 00:17:10:00
that they would like done if they're in an end [of] life situation.

00:17:10:21 - 00:17:13:25
And it I think it helps

00:17:14:00 - 00:17:17:10
a lot with the patient because then they know

00:17:17:10 - 00:17:21:05
what they would like done is being done if they, if that comes up.

00:17:22:13 - 00:17:25:14
But also it helps take a weight off of the patients.

00:17:25:27 - 00:17:30:21
But I can think of a story that I had a patient

00:17:30:21 - 00:17:33:23
come in, him and his sister don't talk anymore

00:17:34:16 - 00:17:38:10
because he had to make a decision for his mom

00:17:38:23 - 00:17:41:24
as far as ending her life

00:17:42:23 - 00:17:44:15
and it's something

00:17:44:15 - 00:17:47:22
that an advanced directive would help take care of.

00:17:48:17 - 00:17:51:25
He could show that to a sister or say, Hey, this is what mom would like done.

00:17:52:06 - 00:17:54:12
This is what we had talked about.

00:17:54:12 - 00:17:58:13
And so who are we to really disagree with what she has to say?

00:17:59:14 - 00:18:00:09
So one of the things

00:18:00:09 - 00:18:03:13
that I've sometimes noticed is, um, what happens

00:18:03:13 - 00:18:06:14
when when a patient of ours declines a wellness visit.

00:18:08:01 - 00:18:12:02
So yeah, so that happens. That a great question. It's a disappointment

00:18:12:02 - 00:18:16:15
because there's a lot of, a lot of work that goes into prepping for each patient.

00:18:16:15 - 00:18:21:04
And so when you get that declination, it's it's really tough.

00:18:21:18 - 00:18:25:24
But I also try my best to follow up with the patient

00:18:25:24 - 00:18:28:26
and see if we can try again and again

00:18:28:26 - 00:18:32:13
to see if they would be willing to do the annual wellness visit.

00:18:32:13 - 00:18:36:18
But ultimately, ultimately, it's the patient's wish

00:18:36:18 - 00:18:38:05
that I want to be fulfilled.

00:18:38:05 - 00:18:41:22
So if they really don't want to talk to me, I'm a nice guy to talk to you.

00:18:42:03 - 00:18:44:08
But if they really don't want to talk to me then 

00:18:44:08 - 00:18:44:28
So be it.

00:18:44:28 - 00:18:46:13
And he needs a very nice guy.

00:18:46:13 - 00:18:48:00
We can vouch for him.

00:18:48:00 - 00:18:50:19
I always tell my patients I'm like, He's a gamer too.

00:18:50:19 - 00:18:51:24
Just like me. Oh yeah, yeah.

00:18:51:24 - 00:18:54:02
And I always sort of tell everybody... All the 70 year olds are like,

00:18:54:02 - 00:18:55:11
yeah. They're like yeah. 

00:18:56:28 - 00:19:00:00
I tell everyone, Bortier is my security guard, just in case if something happens.

00:19:00:00 - 00:19:00:20
Yeah.

00:19:00:20 - 00:19:06:02
Um, I guess the if they do decline it is that like if they get punished or do

00:19:06:02 - 00:19:10:01
we, do we, the providers get punished if the patients decline a wellness visit?

00:19:10:06 - 00:19:12:15
Oh, no, no.

00:19:12:15 - 00:19:13:19
So you guys are good.

00:19:13:19 - 00:19:15:01
The patient's good.

00:19:15:01 - 00:19:18:14
It's not going to keep them from getting coverage or whatnot.

00:19:18:14 - 00:19:24:16
But I always like to tie this back to, you know, time and money, the patient.

00:19:24:20 - 00:19:26:02
It's a part of their benefit.

00:19:26:02 - 00:19:29:04
And so if they don't do it, then they're basically

00:19:29:09 - 00:19:32:07
losing out on the benefit that they have

00:19:32:07 - 00:19:35:08
as part of Medicare or the Medicare Advantage plans.

00:19:35:08 - 00:19:36:20
Yeah, I get that.

00:19:36:20 - 00:19:40:17
This is a great opportunity to like, you know, our patients turn 65,

00:19:40:17 - 00:19:42:10
like what are some things that we want

00:19:42:10 - 00:19:44:15
our patients to get screened for at 65 right? 

00:19:44:15 - 00:19:45:27
Indications wise, right.

00:19:45:27 - 00:19:48:28
Yeah, I think it's a good thing, opportunity for us all to talk about that.

00:19:49:02 - 00:19:49:22
Right.

00:19:49:22 - 00:19:53:04
And so you brought up DEXA scan, correct?

00:19:53:04 - 00:19:55:02
Right. Uh, what else, Krishna? 

00:19:55:02 - 00:19:58:05
Like, um, uh, triple abdominal aortic aneurysm for anyone.

00:19:58:05 - 00:20:01:23
Um, any males between the age of 65 and 75 with any history of smoking?

00:20:01:28 - 00:20:04:07
Yeah, that's one that I think often gets missed

00:20:04:07 - 00:20:07:25
because most people we don't really look into it as often, but it is a big deal.

00:20:07:25 - 00:20:11:02
You know, if you have an abdominal aortic aneurysm and it's growing

00:20:11:02 - 00:20:14:03
and we have no idea that that can rupture and it could be a severe

00:20:14:03 - 00:20:15:17
medical emergency.

00:20:15:17 - 00:20:19:17
So, you know, these are things that we can't afford to miss.

00:20:19:17 - 00:20:23:26
And then that's where, once again, the wellness visit really comes into play.

00:20:23:26 - 00:20:27:10
And how important it is to make sure that we catch these things.

00:20:27:16 - 00:20:28:23
MM. Yeah.

00:20:28:23 - 00:20:30:08
Pneumonia vaccines. Right?

00:20:30:08 - 00:20:34:03
Yeah, pneumonia vaccines, flu vaccines, shingles, shingles.

00:20:34:03 - 00:20:35:00
Oh my gosh.

00:20:35:00 - 00:20:35:17
Oh, yeah.

00:20:35:17 - 00:20:36:13
Great point, sir.
00:20:36:13 - 00:20:39:22
And another, to the shingles point.

00:20:39:23 - 00:20:43:13
A lot of patients had been apprehensive

00:20:43:17 - 00:20:46:16
about getting the shingles shot just because of the cost.

00:20:46:16 - 00:20:51:17
But starting this year, a lot of a lot of companies are starting to cover it 100%.

00:20:51:17 - 00:20:56:01
And then even Medicare's covering it at a better rate than what it was before.

00:20:56:01 - 00:20:58:16
So is that 65 or earlier?

00:20:58:16 - 00:21:01:16
Uh, 50 and above. 50 and above. Okay. Alright. 

00:21:01:16 - 00:21:03:06
So that's probably going to be your Shingrix,

00:21:03:06 - 00:21:06:04
which is the two shot vaccine, correct? Yes. That's awesome.

00:21:06:04 - 00:21:09:21
Yeah, that is really great news because it would be like 200 something dollars.

00:21:10:01 - 00:21:12:22
Yeah, when it first came out, it's $200 a shot.

00:21:12:22 - 00:21:16:15
And I think other than vaccine hesitancy, the price was the next

00:21:16:15 - 00:21:18:03
biggest barrier. Big time.

00:21:18:03 - 00:21:20:08
Um, even I think we were giving it at our clinic,

00:21:20:08 - 00:21:23:28
but then we would not use them and then, you know, that was $200 a shot.

00:21:23:28 - 00:21:26:27
So that's why we stopped, uh, carrying Shingles shots.

00:21:26:27 - 00:21:28:16
Because of how expensive they were.

00:21:28:16 - 00:21:30:07
Right. So.

00:21:30:07 - 00:21:32:06
Man, I have a great question for you guys.

00:21:32:06 - 00:21:33:11
I just thought of it.

00:21:33:11 - 00:21:38:24
Okay, So part of the wellness visit is doing our mental status exam,

00:21:39:10 - 00:21:42:21
and that has backfired for me a couple of times

00:21:42:21 - 00:21:45:08
where, like, patients are like, why do I need to do this?

00:21:45:08 - 00:21:48:20
Or if the family has concerns, the patient does want to cooperate, you know,

00:21:49:05 - 00:21:52:03
Have you had experiences with that and how did you guys,

00:21:52:03 - 00:21:55:00
uh, combat that or not combat it, but, you know, address it?

00:21:55:28 - 00:21:57:26
Yeah. So

00:21:57:26 - 00:22:00:27
a lot of patients, whenever I do have

00:22:01:02 - 00:22:03:24
that exam, they

00:22:03:24 - 00:22:05:27
a lot of them say, is this the dementia test?

00:22:05:27 - 00:22:08:28
And they get really nervous and stuff like that.

00:22:08:28 - 00:22:12:00
I'm like, listen, I'm, I'm not the one that's going to,

00:22:12:07 - 00:22:14:28
you know, determine if you have dementia or anything like that.

00:22:14:28 - 00:22:19:05
This is a good way to talk about these things, and a good way

00:22:19:05 - 00:22:23:25
to have a good baseline to help assess

00:22:23:25 - 00:22:26:26
if there's even an issue to begin with.

00:22:27:03 - 00:22:32:02
And so doing the test shouldn't be something that anyone should be nervous

00:22:32:09 - 00:22:33:12
about.

00:22:33:12 - 00:22:37:00
We do it if there's something major that comes up, then, you know,

00:22:37:01 - 00:22:40:26
I bring it up to the providers to elaborate

00:22:40:26 - 00:22:44:10
and go a little further in with the patient and then go from there.

00:22:44:10 - 00:22:45:20
So absolutely,

00:22:47:01 - 00:22:47:16
yeah.

00:22:47:16 - 00:22:50:04
What about you, Krishna. Have you had those experiences?

00:22:50:04 - 00:22:53:03
Well, I mean, I think the the thing is with, with many mental status

00:22:53:03 - 00:22:56:27
exams, um, at the end of the day, uh, I've had a few patients

00:22:56:27 - 00:23:01:04
that were, uh, a little bit apprehensive about why I was doing it.

00:23:01:17 - 00:23:06:26
And um, as long as I think we explained it to them, this is the reasoning why.

00:23:06:26 - 00:23:09:27
And we just want to make sure that, um, you know,

00:23:09:27 - 00:23:13:24
there's no early signs of dementia or, or mild memory loss.

00:23:13:24 - 00:23:15:17
I think they were understanding.

00:23:15:17 - 00:23:19:23
Um, but the thing is, is it is an important component to look into.

00:23:19:23 - 00:23:22:27
Um, one of the things that we've seen over the last, uh,

00:23:23:07 - 00:23:26:11
century is, is the rise in the diagnosis of dementia.

00:23:26:19 - 00:23:30:12
And that could, that may be because now we know better, now we know how to,

00:23:30:21 - 00:23:34:26
uh, recognize early signs, but it is a pretty,

00:23:34:27 - 00:23:38:15
uh, debilitating disease, not because of just its,

00:23:38:15 - 00:23:41:27
um, it's adverse effects, but because of how slow it can be at times.

00:23:42:09 - 00:23:45:17
And not not only affects the patient but also affects their families.

00:23:45:17 - 00:23:50:06
And so I think it's a very important test to do, uh, because you want to just

00:23:50:06 - 00:23:51:07
not just take care of the patient,

00:23:51:07 - 00:23:54:03
but also their caretakers and their families down the road.

00:23:54:03 - 00:23:57:06
So in some of the tests, like on uh, like for example,

00:23:57:06 - 00:23:59:18
we like talking about the mini mental status exam, right?

00:23:59:18 - 00:24:02:19
And so some of those questions are hard, like serial sevens is where we ask you

00:24:03:05 - 00:24:04:28
to count backwards from 100.

00:24:04:28 - 00:24:06:00
Yeah on a bad day I don't think I could. 

00:24:07:02 - 00:24:07:11
That's.

00:24:07:11 - 00:24:08:23
Hard. Yeah.

00:24:08:23 - 00:24:11:07
And so, yeah, I think, I think people

00:24:11:07 - 00:24:14:20
with dementia, you know, if you're, it's a scary, it's scary thing.

00:24:14:20 - 00:24:18:21
Um, and uh, I think, uh, empathizing with our patients

00:24:18:21 - 00:24:22:20
and sometimes I try to like, incorporate something on myself, like, um,

00:24:22:26 - 00:24:26:12
I tell them to follow commands, I have them, my commands are like,

00:24:26:27 - 00:24:30:11
take this folder, put it up in the air, throw it on the ground.

00:24:30:11 - 00:24:32:05
To expresss some ugh after that serial sevens test.

00:24:32:05 - 00:24:33:13
Hahaha.

00:24:34:09 - 00:24:37:10
But, uh, I think it's, uh,

00:24:37:12 - 00:24:40:14
I think it's important that we tell them why it's important.

00:24:40:17 - 00:24:42:15
Yeah.

00:24:42:15 - 00:24:43:01
I just.

00:24:43:01 - 00:24:44:18
I've had it happen recently. That's.

00:24:44:18 - 00:24:46:03
I thought about it.

00:24:46:03 - 00:24:47:04
Yeah, that's, uh.

00:24:47:04 - 00:24:48:22
That's a very important test to do.

00:24:48:22 - 00:24:51:00
And it's a very important test that I think

00:24:51:00 - 00:24:53:20
everyone needs to look into getting done.

00:24:53:20 - 00:24:55:11
Just, uh, just to be careful.

00:24:55:11 - 00:24:55:21
Right.

00:24:55:21 - 00:24:59:10
So. And to what you're saying about explaining why it's being done.

00:24:59:10 - 00:25:01:02
I think a lot of times

00:25:01:02 - 00:25:04:20
that, and I haven't seen this here in our hospital system,

00:25:04:20 - 00:25:07:21
but I think a lot of times people have had things done

00:25:07:23 - 00:25:10:12
and not explained to them as to why it's being done.

00:25:10:12 - 00:25:12:05
So it could be very scary.

00:25:12:05 - 00:25:13:27
And so taking the time to explain

00:25:13:27 - 00:25:18:02
why it's being done and the importance I think helps lower that anxiety.

00:25:18:08 - 00:25:18:16
Yeah.

00:25:19:15 - 00:25:22:06
That's a yeah, that's like the entire point of this podcast.

00:25:22:06 - 00:25:22:25
Exactly.

00:25:22:25 - 00:25:25:26
We need to be on the same level as our patients.

00:25:26:18 - 00:25:28:15
Proper communication, bridging that gap.

00:25:28:15 - 00:25:30:09
And so,

00:25:30:09 - 00:25:32:18
Uh. Sorry, you know,

00:25:32:18 - 00:25:36:05
obviously we're here for our patients and then, you know, and, and um, you guys,

00:25:36:05 - 00:25:39:19
the support staff, you know, if the patients have any questions they can come to us.

00:25:39:19 - 00:25:42:25
But, um, other than, you know, just as, as resources,

00:25:42:25 - 00:25:46:00
if they do have any questions about Medicare where can patients go to?

00:25:46:15 - 00:25:46:24
Yeah.

00:25:46:24 - 00:25:51:23
So the, the main source will be medicare.gov.

00:25:52:10 - 00:25:56:10
That's a great resource to get everything Medicare.

00:25:56:23 - 00:25:59:24
The site's really easy to navigate.

00:25:59:24 - 00:26:03:05
Also, you can live chat with someone there.

00:26:03:05 - 00:26:05:25
24/7 which I thought was crazy.

00:26:05:25 - 00:26:08:25
24/7 You could you could chat with somebody there

00:26:08:25 - 00:26:11:12
with the exception of some federal holidays.

00:26:11:12 - 00:26:14:24
Um, and you also can call 1-800-Medicare.

00:26:14:27 - 00:26:18:23
I mean, they really try to make it as easy as possible to get answers.

00:26:18:26 - 00:26:21:00
Wow, that's great. I didn't know about the 24/7 chatting service.

00:26:21:00 - 00:26:22:14
Medicare.gov and 1-800-Medicare.

00:26:22:14 - 00:26:25:27
We need to put that on our, when we post about it on our social media page and stuff. Yeah

00:26:26:27 - 00:26:28:00
Man, alright Boriter

00:26:28:00 - 00:26:31:01
how do you think the Broncos 
are going to do this year?

00:26:32:08 - 00:26:34:07
Uh, yeah, I don't know.

00:26:34:07 - 00:26:35:26
That's a good question.

00:26:35:26 - 00:26:38:11
Hopefully better than last year since Sean Peyton's there. So.

00:26:38:11 - 00:26:40:11
Yeah, that's true. Yeah, that's true. Yeah.

00:26:40:11 - 00:26:41:24
Any new games you're looking forward to?

00:26:41:24 - 00:26:44:04
Uh, once I graduate. Yes.

00:26:44:04 - 00:26:45:03
Oh, what do...any.

00:26:45:03 - 00:26:47:27
Any. What's, what's on top of your list?

00:26:47:27 - 00:26:51:22
Uh, I'm going to say probably getting back into Call of Duty.

00:26:51:22 - 00:26:53:09
Oh, nice. Oh, man. Classic

00:26:53:09 - 00:26:56:02
Yeah. Uh. Modern Warfare 2, right? 

00:26:56:02 - 00:26:57:22
Yes, Modern Warfare 2.

00:26:57:22 - 00:26:58:13
That's sweet, man.

00:26:58:13 - 00:26:59:19
Definitely. 
Well, we can't

00:26:59:19 - 00:27:02:01
thank you enough for being here today.

00:27:02:01 - 00:27:04:08
Yeah, thanks a lot Bortier, really appreciate it. 

00:27:04:08 - 00:27:07:06
Is there anything you want to say to our listeners before you head out?

00:27:08:06 - 00:27:10:08
Don't be afraid to ask questions.

00:27:10:08 - 00:27:11:00
Love it.

00:27:11:00 - 00:27:13:08
Thank you so much, sir. Thank you. Thank you, sir.

00:27:13:08 - 00:27:14:24
Thank you.

00:27:14:24 - 00:27:18:00
So that brings us back to our last segment of the day,

00:27:18:00 - 00:27:20:18
which is our Question of the Day. Mm hmm.

00:27:20:18 - 00:27:24:23
And so one of the questions, uh, that we got was about vaccinations,

00:27:24:23 - 00:27:28:12
um, specifically about how I can talk to my provider

00:27:28:21 - 00:27:31:22
about concerns I have about vaccinations or immunizations.

00:27:31:28 - 00:27:34:00
And since we already talked about shingles and pneumonia,

00:27:34:00 - 00:27:36:11
I think this is a great question for us to answer today.

00:27:36:11 - 00:27:38:05
And Bortier, please, please chip in. Okay.

00:27:38:05 - 00:27:40:13
Um, what are your thoughts, Krishna, initially?

00:27:40:13 - 00:27:43:26
Well, you know, I have a public health background. 
A master's in public health.

00:27:43:26 - 00:27:47:15
And, uh, if you look at the, um,

00:27:47:15 - 00:27:50:22
the significant increase in human life expectancy over the last century,

00:27:51:09 - 00:27:56:22
what is the single most important, uh, resource or reason for that?

00:27:56:22 - 00:27:58:27
And you'd have to point out to vaccinations.

00:27:58:27 - 00:28:02:23
I know it's a little bit difficult to envision now, but Polio.

00:28:02:26 - 00:28:05:27
Polio in 1900 was just a debilitating disease.

00:28:06:05 - 00:28:11:09
And smallpox up until 1900 was, or the 20th century, was a very debilitating disease.

00:28:11:09 - 00:28:15:11
And when we got rid of these, mostly because of the vaccinations,

00:28:15:11 - 00:28:18:12
because of the better vaccines that we've developed against them.

00:28:18:23 - 00:28:23:21
And so obviously, vaccines play a huge role in not just, uh,

00:28:23:21 - 00:28:28:09
preventing disease, but also in promoting and increasing human life expectancy.

00:28:28:14 - 00:28:33:10
And so I respect when someone has hesitancy about vaccinations.

00:28:33:23 - 00:28:34:12
You know, I,

00:28:34:12 - 00:28:35:25
I believe that the relationship

00:28:35:25 - 00:28:39:01
between a provider and a patient is about mutual trust and respect.

00:28:39:14 - 00:28:41:27
And I understand their perspective.

00:28:41:27 - 00:28:44:26
But at the end of the day, when you look at,

00:28:44:26 - 00:28:48:07
uh, the advances we've made in the course of the last century and a half,

00:28:48:16 - 00:28:52:17
it's it's mostly vaccinations have played a big role in it.

00:28:52:19 - 00:28:56:27
And unless if there is evidence based data that I can look at that

00:28:56:27 - 00:29:00:16
could say, Oh, well, this vaccine has more harm than benefits.

00:29:01:13 - 00:29:03:27
I would I would recommend vaccinations at all times.

00:29:03:27 - 00:29:04:10
Yeah.

00:29:04:10 - 00:29:07:28
And just to piggyback on those examples, a great example is the HPV vaccine.

00:29:08:00 - 00:29:08:22
Exactly.

00:29:08:22 - 00:29:13:24
Gardasil, you know, HPV causing cervical cancer and the risk of HPV

00:29:13:24 - 00:29:17:15
has drastically decreased since we started given the vaccine earlier on in age.

00:29:17:16 - 00:29:20:25
And that is a huge, uh, when it comes to that's a, that's a huge,

00:29:20:25 - 00:29:24:12
uh, role when it comes to preventing, um, esophageal cancers.

00:29:24:14 - 00:29:24:22
Yeah.

00:29:24:22 - 00:29:27:28
You know, over the last 20, 30 years, you know, uh, what we've, we've seen

00:29:27:28 - 00:29:31:26
this, this trend difference where previously, uh, tobacco

00:29:31:26 - 00:29:35:21
and cigarette smoking was the number one cause of oral of, uh, esophageal cancers.

00:29:35:21 - 00:29:38:01
But these days it's HPV.

00:29:38:01 - 00:29:42:07
And so, and, and, and the Gardasil vaccine

00:29:42:13 - 00:29:45:27
is, um, uh, a big tool and help mitigating that.

00:29:46:26 - 00:29:47:20
Yeah.

00:29:47:20 - 00:29:53:02
Um, and again, going back to individual, uh, respecting our patients wishes

00:29:53:02 - 00:29:55:23
and stuff, as medical professionals, we give our opinion. Mhm.

00:29:55:23 - 00:29:58:23
But if there is a religious preference or if there's a personal preference,

00:29:58:23 - 00:30:02:24
we respect that and we tell them the 
risks and benefits and then go from there.

00:30:02:26 - 00:30:04:05
Mm hmm. Would you agree, Bortier?

00:30:04:05 - 00:30:04:12
Yeah.

00:30:04:12 - 00:30:08:20
I think a lot of the issue that patients have is information.

00:30:08:24 - 00:30:09:06
Mm hmm.

00:30:09:06 - 00:30:13:27
There's a lot of sources, I say sources. Sources for information

00:30:13:27 - 00:30:17:02
that people can can get, but going

00:30:17:02 - 00:30:20:25
to your medical professional, your provider,

00:30:21:08 - 00:30:25:27
and getting that information from them and then using that to weigh your options.

00:30:25:27 - 00:30:27:07
I think is, is best.

00:30:27:07 - 00:30:29:27
Yeah, It's, uh, I think that's a great example.

00:30:29:27 - 00:30:34:05
Um, I know there was a lot of vaccine hesitancy when, even the COVID-19 pandemic.

00:30:34:14 - 00:30:34:23
Yeah.

00:30:34:23 - 00:30:38:15
Um, and we were trying to, you know, teach our patients and,

00:30:38:25 - 00:30:41:02
and our, you know, community about herd immunity

00:30:41:02 - 00:30:42:24
and having getting people vaccinated and things.

00:30:42:24 - 00:30:46:22
But yeah, Facebook and Instagram and all thoss had like so much, uh,

00:30:46:23 - 00:30:48:23
info that couldn't really trust out there.

00:30:48:23 - 00:30:51:01
It was uh, it's an interesting time. Mhm.

00:30:52:06 - 00:30:53:28
But yeah, I

00:30:53:28 - 00:30:57:00
think, I think it's a great, uh, great ending segment guys.

00:30:57:00 - 00:30:57:11
It is.

00:30:57:11 - 00:31:00:02
It is. And for all our listeners and Bortier here today. 

00:31:00:02 - 00:31:02:15
Thank you guys so much for joining us.

00:31:02:15 - 00:31:05:18
And as always, stay classy, my friends.

00:31:05:18 - 00:31:07:07
And stay out of trouble. My friends.