TIME Research

15 Diseases Doctors Often Get Wrong

Doctor looking at x-ray
Chris Ryan—Getty Images/OJO Images RF

When you experience strange pains, mysterious digestive issues, or other unexplained symptoms, you’d hope a trip to the doctor would solve your health woes. But sometimes, doctors have just as much trouble identifying certain disorders and conditions as their patients. “A lot of symptoms are nonspecific and variable, depending on the person,” says David Fleming, MD, president of the American College of Physicians and a professor of medicine at the University of Missouri. “On top of that, many diagnostic tests are expensive and aren’t done routinely, and even then they don’t always give us a black and white answer.” The following 5 conditions are notoriously difficult to pin down.

Health.com: 27 Mistakes Healthy People Make

Irritable bowel syndrome

Some conditions are difficult to diagnose because there is no real test to prove their existence; rather, they require a “diagnosis of elimination,” says Dr. Fleming, as doctors rule out all other possibilities. Irritable bowel syndrome (IBS)—a chronic condition that affects the large intestine and causes abdominal pain, cramping, bloating, diarrhea, and/or constipation—is one of these cases. According to diagnostic criteria, a patient should have symptoms for at least six months before first being seen for a formal evaluation, and discomfort should be present at least three days a month in the last three months before being diagnosed with IBS.

Celiac disease

So much confusion surrounds celiac disease—an immune reaction to gluten that triggers inflammation in the small intestine—that it takes the average patient six to 10 years to be properly diagnosed. Celiac sufferers would, in theory, have digestive problems when eating gluten-containing foods like wheat, barley, and rye, but in fact, only about half of people diagnosed with the disease have experienced diarrhea and weight loss. Celiac disease can also cause itchy skin, headaches, joint pain, and acid reflux or heartburn, and it’s all too easy to blame these symptoms on other things. A blood test can diagnose celiac disease no matter what symptoms are present, and an endoscopy can determine any damage that’s been done to the small intestine.

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Fibromyalgia

Fibromyalgia, which is characterized by widespread musculoskeletal pain, involves “medically unexplained symptoms”—a term doctors use to describe persistent complaints that don’t appear to have an obvious physical cause. When doctors can’t find a root cause for a patient’s chronic pain and fatigue, they often settle on this diagnosis. This may involve seeing specialists and ruling out other diseases, some of which prove equally difficult to diagnose, says Eugene Shapiro, MD, deputy director of the Investigative Medicine Program at Yale University. “There are studies that show that people with certain symptoms who show up at a rheumatologist will be diagnosed with fibromyalgia, but if the same patients show up at a gastroenterologist they’ll be diagnosed as having irritable bowel syndrome.”

Rheumatoid arthritis

Unexplained aches and pains may also be caused by rheumatoid arthritis (RA), an autoimmune disorder. Unlike osteoarthritis (the “wear and tear” kind that appears as people get older), RA causes inflammation and painful swelling of joints and can occur at any age. “Early stages of RA can mimic many other conditions—sometimes it’s just a sense of aches or stiffness in the joints, which could be caused by a lot of different things,” says Dr. Fleming. Blood tests can help detect the presence of inflammation in the body, he says, but an exact diagnosis of RA also must take into account a patient’s medical history and a doctor’s careful physical exam.

Multiple sclerosis

Another autoimmune disease, multiple sclerosis (MS) occurs when the immune system attacks the body’s own nerve cells and disrupts communication between the brain and the rest of the body. Some of the first symptoms of MS are often numbness, weakness, or tingling in one or more limbs, but that’s not always the case. “Multiple sclerosis can be episodic; the disease waxes and wanes,” says Dr. Shapiro. Depending on the number and location of lesions in the brain, he adds, signs and symptoms may be more or less severe in different people. Once a doctor does suspect MS, however, a spinal tap or MRI can help confirm the diagnosis.

Health.com: Could You Have MS? 16 Multiple Sclerosis Symptoms

Lyme disease

You probably know to look out for tick bites and the telltale bullseye rash that can form around them if a person is infected with Lyme disease. But not everyone develops this rash—and Lyme disease’s other symptoms (like fatigue, headaches, joint pain, and flu-like symptoms) can easily be confused for other conditions, says Dr. Shapiro.

A blood test can check for Lyme disease antibodies in the blood, but those usually don’t show up until a few weeks after infection and the test is notoriously unreliable. It’s important to remove the tick immediately and see a doctor right away. Quickly removing a tick can possibly prevent the transfer of dangerous bacteria, and antibiotics for Lyme disease are most effective when given immediately.

Lupus

The most distinctive sign of lupus—another chronic inflammatory disease—is a butterfly-shaped rash across a patient’s cheeks, but that’s not present in all cases. For those who don’t develop the rash, diagnosis can be a long and difficult process, says Dr. Shapiro. “Lupus can present in different ways; it can affect the joints, kidneys, brain, skin, and lungs, and can also mimic many different issues.” There is no one way to diagnose lupus, but blood and urine tests, along with a complete physical exam, are usually involved. Treatment also depends on a patient’s individual signs and symptoms, and medications and dosages may need to be adjusted as the disease flares and subsides.

Polycystic ovary syndrome

Irregular periods, unexplained weight gain, and difficulty getting pregnant can all be symptoms of polycystic ovary syndrome (PCOS), a hormonal disorder affecting women of reproductive age. Many women with this condition also have enlarged ovaries with numerous small cysts, but not everyone with PCOS has these enlarged ovaries, and not everyone with enlarged ovaries has PCOS. To be diagnosed with PCOS, a woman must also be experiencing infrequent or prolonged periods or have elevated levels of male hormones, called androgens, in her blood. Androgen excess may cause abnormal hair growth on the face and body, but women of certain ethnic backgrounds (like Northern European and Asian) may not show physical signs.

Appendicitis

You might think that an inflamed or burst appendix should be easy to identify, and often, it is: typical appendicitis symptoms include nausea, pain and tenderness around the belly button, and possibly a low-grade fever. But not always. “Some people have an appendix that points backward instead of forward in the body, so the symptoms present in a different location,” says Dr. Shapiro. “And sometimes people do have pain, but then the appendix ruptures and the pain is relieved so they think they’re fine.” In this case, he says, intestinal fluids can seep into the abdominal category and cause a potentially life-threatening infection—but it can take days or even weeks before these symptoms appear.

Endometriosis

Many perfectly healthy women deal with menstrual pain and discomfort, so it’s not surprising that endometriosis is often misdiagnosed. However, women with endometriosis (in which uterine tissue grows outside the uterus) often report pelvic pain, cramping, and heavy bleeding that’s far worse than usual, and that gets worse over time. A pelvic exam can sometimes detect endometrial tissue or cysts that have been caused by it. In other cases, an ultrasound or laparoscopy is required for a definite diagnosis.

Migraines

For many migraine sufferers, nothing could be more obvious than the severe headaches, which are usually characterized by intense throbbing or pulsing and can be accompanied by nausea, vomiting, or sensitivity to light and sound. But some people may get migraines without even knowing it, says Dr. Fleming.

“Sometimes migraine symptoms can be very severe, where the patient can even develop paralysis, and other times they can be very subtle,” he says. “Patients might feel dizzy or lightheaded or feel a vague discomfort in their heads, and oftentimes they’ll get treated with medication that might not be appropriate for a true migraine.” A neurologist should be able to rule out other possibilities, and make the proper diagnosis.

Cluster headaches

Another headache disorder that’s often misunderstood, cluster headaches are extremely painful but also very rare—affecting less than 1 million Americans. Cluster headaches tend to occur close together, often on the same day, and last 30 minutes to three hours, on average. Scientists aren’t sure why, but cluster headaches tend to occur when seasons change. Because of this, they can sometimes be misdiagnosed as allergy-related sinus headaches.

Hypothyroidism

Hypothyroidism (also known as underactive thyroid) is a condition in which the thyroid gland produces an insufficient amount of the hormones that help regulate weight, energy, and mood. In the early stages, thyroid problem symptoms are subtle and can include fatigue, weight gain, dry skin, muscle aches, and impaired memory. “It can mimic depression, fibromyalgia, and many other conditions,” says Dr. Shapiro. And because hypothyroidism is most common in people (especially women) over 60, it’s easy to attribute its symptoms to simply getting older and more out of shape.

Health.com: 19 Signs Your Thyroid Isn’t Working Right

Diabetes

Type 2 diabetes can’t stay hidden forever; if left untreated, it can cause life-threatening damage to the body’s major organs. Before signs of diabetes develop, says Dr. Fleming, adults can have diabetes for years without knowing it. “There are a lot of people out there with elevated blood sugar levels who aren’t getting to the doctor regularly, so they aren’t getting checked for it,” he says. “They won’t realize it until it gets severe enough that they start developing side effects, like problems with their vision or numbness in their feet or hands.” To avoid these problems, watch for earlier symptoms like increased thirst or hunger, frequent urination, sudden weight loss, and fatigue.

Inflammatory bowel disease

There are primarily two types of inflammatory bowel disease (IBD)—Crohn’s disease and ulcerative colitis. Both cause inflammation of the digestive tract, as well as pain, diarrhea, and possibly even malnutrition. Because there’s no one test for IBD, however, it is diagnosed primarily by excluding everything else. “If a patient comes in with severe abdominal pain, we might first think it’s their gallbladder,” says Dr. Shapiro. “If he comes in with loose stools, we might think it’s an infection. So we go through a litany of tests—imaging, blood tests, assessments—and sometimes we finally come down to the fact that we’ve ruled out every other possibility, so this is what we’re going to treat you for and we’ll see if it works.”

15 Diseases Doctors Often Get Wrong originally appeared on Health.com.

TIME Liberia

Ebola Kills Liberian Doctor, 2 Americans Infected

+ READ ARTICLE

(MONROVIA, Liberia) — One of Liberia’s most high-profile doctors has died of Ebola, officials said Sunday, and an American physician was being treated for the deadly virus, highlighting the risks facing health workers trying to combat an outbreak that has killed more than 670 people in West Africa — the largest ever recorded.

A second American, a missionary working in the Liberian capital, was also taken ill and was being treated in isolation there, said the pastor of a North Carolina church that sponsored her work.

Dr. Samuel Brisbane, a top Liberian health official, was treating Ebola patients at the country’s largest hospital, the John F. Kennedy Memorial Medical Center in Monrovia, when he fell ill. He died Saturday, said Tolbert Nyenswah, an assistant health minister. A Ugandan doctor died earlier this month.

The American physician, 33-year-old Dr. Kent Brantly, was in Liberia helping to respond to the outbreak that has killed 129 people nationwide when he fell ill, according to the North Carolina-based medical charity, Samaritan’s Purse.

He was receiving intensive medical care in a Monrovia hospital and was in stable condition, according to a spokeswoman for the aid group, Melissa Strickland.

“We are hopeful, but he is certainly not out of the woods yet,” she said.Early treatment improves a patient’s chances of survival, and Brantly recognized his own symptoms and began receiving care immediately, Strickland said.

The American missionary, Nancy Writebol, was gravely ill and in isolation in Monrovia, her husband, David, told a church elder via Skype, according to the Rev. John Munro, pastor of Calvary Church in Charlotte, N.C.

Munro said the couple, who had been in Liberia for about a year, insisted on staying there despite the Ebola threat. “These are real heroes — people who do things quietly behind the scenes, people with a very strong vocation and very strong faith,” Munro said.

There is no known cure for the highly contagious virus, which is one of the deadliest in the world. At least 1,201 people have been infected in Liberia, Sierra Leone and Guinea, according to the World Health Organization, and 672 have died. Besides the Liberian fatalities, 319 people have died in Guinea and 224 in Sierra Leone.

Ominously, Nigerian authorities said Friday that a Liberian man died of Ebola after flying from Monrovia to Lagos via Lome, Togo. The case underscored the difficulty of preventing Ebola victims from traveling given weak screening systems and the fact that the initial symptoms of the disease — including fever and sore throat — resemble many other illnesses.

Health workers are among those at greatest risk of contracting the disease, which spreads through contact with bodily fluids.

Photos of Brantly working in Liberia show him swathed head-to-toe in white protective coveralls, gloves and a head-and-face mask that he wore for hours a day while treating Ebola patients.

Earlier this year, the American was quoted in a posting about the dangers facing health workers trying to contain the disease. “In past Ebola outbreaks, many of the casualties have been health care workers who contracted the disease through their work caring for infected individuals,” he said.

There is no known cure for Ebola, which begins with symptoms including fever and sore throat and escalates to vomiting, diarrhea and internal and external bleeding.

The WHO says the disease is not contagious until a person begins to show symptoms. Brantly’s wife and children had been living with him in Liberia but flew home to the U.S. about a week ago, before the doctor started showing any signs of illness, Strickland said.

“They have absolutely shown no symptoms,” she said.

A woman who identified herself as Brantly’s mother said the family was declining immediate comment when reached by phone in Indiana.

Besides Brantly and the two doctors in Liberia, Sierra Leone’s top Ebola doctor and a doctor in Liberia’s central Bong County have also fallen ill.

The situation “is getting more and more scary,” said Nyenswah, the country’s assistant health minister.

Meanwhile, the fact that a sick Liberian could board a flight to Nigeria raised new fears that other passengers could take the disease beyond Africa.

Nigeria’s international airports were screening passengers arriving from foreign countries, and health officials were also working with ports and land borders to raise awareness of the disease. Togo’s government also said it was on high alert.

Security analysts were skeptical about the usefulness of these measures.

“In Nigeria’s case, the security set-up is currently bad, so I doubt it will help or have the minimum effectiveness they are hoping for,” said Yan St. Pierre, CEO of the Berlin-based security consulting firm MOSECON.

An outbreak in Lagos, a megacity where many lived in cramped conditions, could be a major public health disaster.

The West Africa outbreak is believed to have begun as far back as January in southeast Guinea, though the first cases weren’t confirmed until March.

Since then, officials have tried to contain the disease by isolating victims and educating populations on how to avoid transmission, though porous borders and widespread distrust of health workers have made the outbreak difficult to bring under control.

News of Brisbane’s death first began circulating on Saturday, a national holiday marking Liberia’s independence in 1847.

President Ellen Johnson Sirleaf used her Independence Day address to discuss a new taskforce to combat Ebola. Information Minister Lewis Brown said the taskforce would go “from community to community, from village to village, from town to town” to try to increase awareness.

In Sierra Leone, which has recorded the highest number of new cases in recent days, the first case originating in Freetown, the capital, came when a hairdresser, Saudata Koroma, fell ill. She was forcibly removed from a government hospital by her family, sparking a frantic search that ended Friday. Kargbo, the chief medical officer, said Sunday that Koroma died while being transported to a treatment center in the east of the country.

TIME Military

Navy Nurse Refuses Gitmo Force Feed Order

Guantanamo Hunger Strike
In this photo Nov. 20, 2013 file photo reviewed by the U.S. military, a U.S. Navy nurse stands next to a chair with restraints, used for force-feeding, and a tray displaying nutritional shakes, a tube for feeding through the nose, and lubricants, including a jar of olive oil, during a tour of the detainee hospital at Guantanamo Bay Naval Base in Cuba. Charles Dharapak—AP

A detainee described the act as a conscientious objection

A Navy medical officer at the U.S. military prison at Guantánamo Bay, Cuba has refused an order to continue force-feeding hunger-striking prisoners in what one detainee lawyer described as an act of conscientious objection.

“There was a recent instance of a medical provider not willing to carry-out the enteral feeding of a detainee. The matter is in the hands of the individual’s leadership,” a Pentagon spokesperson said in an email. “The service member has been temporarily assigned to alternate duties with no impact to medical support operations.”

It is the first known instance of a U.S. service member rebelling against the Pentagon’s force-feeding policy. An unknown number of the 149 detainees at Guantánamo’s Camp Delta have been on hunger strike for the past year and a half to protest their indefinite detention.

News of the refusal comes to the public by way of an attorney for one of the detainees, who, according to The Miami Herald, says his client described how some time before the Fourth of July a Navy medical nurse suddenly shifted course and refused to continue force-feeding prisoners. The nurse, he said, was abruptly removed from duty at the detention center. The attorney said his client described the nurse’s action as a conscientious objection.

The Herald reports that the prisoner who provided news of the incident described the nurse as a roughly 40-year-old Latino man most likely with the rank of lieutenant in the Navy.

Last year, civilian doctors writing for the New England Journal of Medicine declared that medical professionals taking part in force-feeding was unethical and called the Guantánamo medical staff to refuse to participate.

TIME Books

Read to Your Baby, Say Doctors — But Which Books?

Baby Reading
Tetra Images / Jamie Grill / Getty Images

The American Academy of Pediatrics is urging members to encourage reading to newborns

When her son was very small, Dr. Pamela High noticed something funny: she would come home and find the babysitter in the rocking chair with the boy, reading out loud from whatever book she happened to be working on herself at that moment. As her son got older and began to respond more to the words themselves, the babysitter switched to reading children’s books — but the image made an impression on his mother.

Now her son is grown up and High is the lead author of a new policy paper released by the American Academy of Pediatrics that recommends pediatricians advise parents to read aloud to young children “beginning in infancy,” to encourage word learning, literacy and positive family relationships. The report notes that reading to children is correlated with family income level — and, as the New York Times reports, Scholastic is donating 500,000 books to the literacy advocacy group Reach Out and Read, which works with pediatricians to get books to low-income families — but even in families that make 400% of the poverty threshold only 60% of children are read to daily.

But what exactly should they be reading? If your one-day-old baby doesn’t understand the words, does it even matter?

“I don’t think that there’s a huge amount of information on that,” High tells TIME, noting that her own experience with the sitter reading to her son is just an anecdote, not research. “The research is primarily about reading children’s books.”

Part of the issue is that it’s hard to measure understanding, to say that at some number of months of age it begins to be important that you’re not reading a kid something totally inappropriate like 50 Shades of Grey. Language is acquired gradually, and High says that she’s personally seen evidence of understanding even before the 1-year marker at which most children can point to pictures that correspond with spoken words. Plus, she says, “I think [babies] understand the emotion in the words that are being read to them very, very early.”

But there are some things that parents should keep in mind, she says. For example, it’s developmentally appropriate for children to chew on books, so you shouldn’t read to a baby from a valuable and rare manuscript. Colorful illustrations can help keep a child’s attention, but even so you shouldn’t expect a very young infant to concentrate on the book for longer than about 90 seconds. And finally, it’s important that the parent not think the book is annoying. “It starts with the parent’s enjoyment and then becomes a shared enjoyment,” High says.

With that in mind — chewability, enjoyability and calm or positive emotions — here are a few books parents might consider reading aloud to their newborns:

For actual newborns: Can’t & Won’t by Lydia Davis. This short story collection, which came out in April, is a book for grown-ups, by Man Booker International Prize- and MacArthur grant-winner Davis. But it’s great for tiny babies because the short stories are, in some cases, very short. If your kid doesn’t understand the words yet and you can only sneak in a minute of reading a day, and it’s perhaps a minute out of the precious few moments of “me time” you have, you can get up to date on a buzz-worthy literary release. Plus, if the baby’s too young to do too much damage to the book, investing in a hardcover isn’t such a risk.

For slightly older babies who will one day get English degrees: Shakespeare’s Sonnets. Because emotion is more important than content, a nice big collection of lovey-dovey poems that take about a minute to read is perfect. As High points out, reading is often used to help a baby wind down at the end of the day, and the regular rhythm of a rhyming sonnet can’t hurt. If the baby can’t understand Shakespearean words, that’s no big deal; if a word or two does sneak into her brain, there’s nothing inappropriate to worry about.

For kids old enough to touch the book: Farm by James Brown. This picture book made the 2014 Best Books for Babies list, an annual list put together by the Carnegie Library of Pittsburgh, the Pittsburgh Association for the Education of Young Children and the Fred Rogers Company (as in, Mr. Fred Rogers). The selection committee commended the author for his use of interesting textures to “add tactile appeal” to the book.

For kids who are already growing up too fast: The Poky Little Puppy by Janette Sebring Lowrey. The classic tale of a lollygagging dog was once ranked by Publishers Weekly as the top-selling children’s book ever, having sold nearly 15 million hardcover copies between 1942 and 2000. That means parents are likely to remember reading it themselves. Help your infant’s future literacy and reminisce about your own childhood, all in one place.

For kids old enough to laugh : Toot! by Leslie Patricelli. Yes, this book is about farts — but it was also, just today, named Amazon’s top book of the year so far for babies age 0–2.

MONEY Health Care

The Mystery Behind Your Doctor’s Charges, Unveiled

Illustration of man unlocking filing cabinet of doctors
Medicare is providing consumers with a new way to research health care pricing. Paul Blow

A quick peek into some Medicare data can help you reduce your medical bills. Here's how to use the new tool.

Medicare has pulled back the veil on what doctors, physician assistants, physical therapists, and other health care providers charge, letting everyone see the rates for a wide variety of procedures in advance for the first time. “This is a big step forward and will be very enlightening,” says Jean Mitchell, a health economist at Georgetown University.

Health care researchers and fraud investigators are salivating over the data—already it’s revealed that some doctors favor the most expensive in-office intravenous drug treatments, likely because Medicare pays them a percentage of the cost, says ­Gerard Anderson, a professor at Johns Hopkins University.

As a patient, you can use the numbers, which are from 2012, to conduct your own research into prices and practices. Even if you’re under 65, you can glean valuable insights. Head to the Medicare Physician and Other Supplier Look-Up Tool to find your doctor. You’ll see how many times he or she did a particular service and the average charges. Then here’s what to make of the information:

If you’re facing surgery
See how often your doctor operates; for complicated procedures, frequency pays. “Research shows doctors who perform more than 50 hip replacements a year have fewer complications,” says Andrew Fitch of Nerdwallet Health. Yet about half of orthopedic surgeons did fewer than 20 a year on traditional Medicare patients, a Nerdwallet analysis of the data found.

The tally excludes operations on patients with private insurance or a Medicare Advantage Plan. Still, a low number compared to other MDs should prompt you to ask how often your doctor does the job, particularly for hip and knee replacements, says Fitch. If the figure is high, keep in mind that at times every physician in a group practice bills under one name.

If you’re on traditional Medicare
For a price preview, calculate the difference between the “average Medicare allowed amount” and the “average Medicare payment.” That’s your share of the bill before supplemental insurance kicks in. One caveat: What you see in the Medicare database are charges per service. So ask if you’ll face other bills or a facility fee if you’re cared for at a hospital or surgical center.

If you have private insurance
Check out the “average submitted charge,” which is the doctor’s full retail price. If you go outside your network, you’ll owe the difference between this amount and what your insurer deems a “customary and reasonable” rate (get that from your insurer), on top of your co-insurance.

You should negotiate with out-of-network docs, and the Medicare allowed amount is a good starting point. If the provider balks at that, go as high as 35% more, which is the national standard for a reasonable charge, says Anderson.

TIME Cancer

What Doctors Should Say When Patients Want a Miracle

Hospital patient
Getty Images

A new tool teaches doctors how to talk to patients about miracles

Many doctors, when delivering difficult news, have heard sick patients say they’re hoping for a miracle. That conversation can be difficult for physicians, whose careers are grounded in science—but who are also in the business of saving lives. While “miracles” may seem a silly thing to wish for, a 2008 study, 57% of randomly surveyed adults said they believed God’s intervention could save a family member even if physicians declared treatment futile.

In order to help doctors navigate this common situation, a team of physicians at Johns Hopkins Kimmel Cancer Center have created a helpful conversational tool called AMEN (affirm, meet, educate, no matter what), recently published in the Journal of Oncology Practice. AMEN is meant to teach doctors an alternative to either challenging the patient’s beliefs, remaining silent or changing the subject when conversations take a turn. Instead, it gives physicians a tool to affirm hope while keeping intact their role as the provider of accurate medical information. Here’s what it stands for:

  • Affirm the patient’s belief. Validate his or her position: “Ms X, I am hopeful, too.”
  • Meet the patient or family member where they are: “I join you in hoping (or praying) for a miracle.”
  • Educate from your role as a medical provider: “And I want to speak to you about some medical issues.”
  • No matter what, assure the patient and family you are committed to them: “No matter what happens, I will be with you every step of the way.”

“I use the AMEN mnemonic pretty much every day. Maybe my patients need more miracles than other doctors’ patients, but it is a common occurrence and an underlying theme in many people’s lives,” says Dr. Thomas Smith, the director of palliative medicine at Johns Hopkins.

“The heart of the AMEN protocol is the commitment to joining rather than placing more distance between patient and provider,” the authors write.

They recommend that when patients say they are hoping for a miracle, doctors say something along the lines of “It is God’s role to bring the miracle, and it is my role as your physician (or nurse) to bring you some important information that may help us in our decision making.”

Restoring and maintaining hope, the authors say, is one of their responsibilities—and learning how to navigate that is critical to patient-doctor relationships.

 

MONEY Health Care

Rx Relief: How to Save Up to 80% on Prescription Drugs

Five strategies to help you leave the pharmacy without having to swallow a bitter pill.

The average American filled 12 prescriptions last year, according to the IMS Institute for Healthcare Informatics, and as a result the pharmaceutical industry grossed $329 billion. (You’re welcome, Pfizer.)

Minimize your pain at the pharmacy counter by taking these steps when your next script is written:

1. Use coupons. For expensive prescriptions, you can save 50% or more this way. There are a lot of ways to get your hands on prescription coupons, but start by asking your pharmacist. Call ahead or ask at the counter; the pharmacist may have some on hand or be able to tell you where to find them—most likely online. If you want to search yourself, try the drug company’s website first, then check the website of your pharmacy.

2. Try mail order. Mail-order pharmacies save you money by skipping the bricks-and-mortar middleman and sending the drug directly to you, typically in 90-day quantities. Your health insurer may work with a specific mail-order house, and often you’ll get better pricing by going this route. Alternately, your prescribing doctor’s office may have a preferred pharmacy they work with regularly, so inquire when the prescription is written.

3. Ask your doctor about pill splitting Most drugs come in more than one dosage, but aren’t priced on the same scale as the dosages. This means that, per milligram, higher dosages of the same drug are often cheaper—and you could save money by purchasing double doses of your prescriptions and halving them. Not every drug should be split, so consult with your doctor first. If you’re given the go-ahead, make sure to purchase a pill splitter from a drug store to ensure consistent and equal dosing.

4. Opt for generics If there’s a generic version of your brand-name drug available and you’re not taking it, you could be wasting a lot of money—on average, generics are 80% to 85% cheaper than their brand-name counterparts. Contrary to the myth that generic drugs are held to different standards than brand-name drugs, there is no significant difference between them. Generic drugs are allowed to differ from brand-name drugs only insofar as appearance and inactive ingredients. By law, medication dose, safety, quality and instructions must be the same. Stores have gotten into price wars over generic drugs: Target now charges $4 for hundreds of medicines, for example, and Meijer and Publix are among those that offer some drugs gratis, which is why you may want to…

5. Compare pharmacies. Drug prices can vary widely between pharmacies, even locally, so you may want to shop around before simply going to the nearest drug store. Websites like GoodRx and LowestMed compare pharmacies within zip codes for specific medications, and even offer coupons and drug information. You may be surprised to find that some drugs vary by $50 or more for the same supply and dosage. In that case, the cost of convenience may just be too high.

 

More stories from NerdWallet Health:

So You’re Pregnant? Here’s What You Need to Know About Your Maternity Coverage and Benefits

How to Save On Asthma Medications

Patient Advocates: Your New Best Friend for Managing Your Health Care Experience

TIME health

Now Doctors Can Use Google Glass to Record Your Visits

Google Glass Prescriptions
John Minchillo—AP

Google's face-computer may be coming soon to a doctor's office near you

Doctors, nurses and other medical professionals are about to get a new tool in the medicine bags: Google Glass.

Drchrono, a digital health startup, claims to have created the first “wearable heath record” that can be accessed through Google’s futuristic face-computer. Doctors can use the app to store patients’ records as well as record medical visits and even procedures via Glass’ camera for consulting later on.

While some patients may be hesitant to let doctors record their visits, Drchrono says its Glass application complies with HIPPA standards which protect patient privacy — and patients will have to give permission to have doctors record their visits via Google Glass.

The application is currently in its beta phase, though Reuters reports about 300 physicians have signed up to use it. Drchrono, just one of a plethora of startups tapping into the healthcare app market, has also developed digital health records apps for iPads and smartphones.

 

TIME Doctor

My Doctor, the Concierge

Patients who pay an extra $5,000 a year can reach the doctor via office phone and email, but their return call is from the support staff. Patients who pay $10,000 per year may also reach the doctor via texting, Skype, Facetime and Google Hangout, and feedback is from the doctor, who will also make house calls. Getty Images

Forget the Hippocratic oath--welcome to a world of Gold and Platinum patients

It’s not like I’ve never been dumped before. Still, I was ill prepared to be dumped by my GP. For 12 years I thought we got along O.K. Now I continually ask myself, “Was I not sick enough for her?”

The first warning sign was the single-serve coffee machine in the waiting room, featuring festive flavored international coffees and chai.

I eyed it nervously. Had there been an article in an AMA journal offering hints on transforming your drab, predictable reception area into an upscale medi-café? At my next Pap smear, would I meet a barista and be offered a selection of croissants?

“No, no,” I said to myself. “Current wisdom dictates that when her practice becomes successful, she must personalize her brand.”

If this were a movie, the tone of the music cues would begin to get darker as we arrived at the day the glass display cases containing lovingly arranged bottles of moisturizer were installed. “I guess pricey moisturizers are considered medicine now,” I rationalized, wondering about the ever more porous boundaries between beauty and health.

The music cues would grow darker yet as we cut to a scene where I had the flu and found myself waiting for an appointment, surrounded by pamphlets for “facial fillers” and “injectables” like Juvéderm. If she writes me a prescription for a spray tan, I am going to walk, I thought.

But I remained loyal. She was my doctor. Her office still called to remind me about getting my checkups. She was entitled to branch out.

Then, about a month ago, I got The Letter.

“I’d like to wish you and your family a happy holiday season and a prosperous new year,” it began.

Interesting word choice, I thought. Prosperous rather than healthy.

Her reasoning became clearer as the letter went on to explain that we were all being dropped as patients–unless we paid a $5,000- or $10,000-a-year retainer for her services, depending on the plan.

“Our nation is faced with the most difficult time in the history of our health care system,” the letter went on. “As a result, I will now be transitioning my practice to a concierge medical service.”

Concierge? Another interesting word choice. Defined in the dictionary as “a member of a hotel staff in charge of special services such as arranging for theater tickets or tours. A porter. A doorman. A janitor.” Did my doctor now offer restaurant recommendations and tickets to The Lion King?

The letter explained that there would still be a charge for medical visits and that patients would still need health insurance. But the new annual fees would entitle us to a variety of rock-star privileges like “Direct access to the doctor, 24/7.”

As it turned out, the doctor was offering a two-tiered plan with levels designated Gold and Platinum. In Gold, her patients could reach her only via office phone and email. But for an extra $5,000 a year, Platinum patients’ options widened to include texting, Skype, Facetime and Google Hangout.

I admit I was impressed that someone had figured out how to monetize Google Hangout.

There were other differences between the two plans. Platinums got house calls, 20% off on Botox, a complimentary session with a fitness trainer and “prompt telephone feedback with test results by [the doctor] herself.”

Presumably the Golds, with only $5,000 extra to spend, would be called by whoever–whenever they got around to it.

Both plans, however, were eligible for “fast and easy prescription renewals” and “a dedicated support staff.” All of which I seem to recall were always an expected part of going to a regular doctor. The letter contained no information regarding the availability of complimentary lollipops.

In its new capacity as a concierge service, my doctor’s website claims, her practice will traverse a medical high wire reaching from “congestive heart failure” to “muffin top.”

It’s all making me rather nostalgic for the good old days of 2012–when I naively assumed doctors took the Hippocratic oath seriously. That oath ends, “May I long experience the joy of healing those who seek my help.”

If this concierge trend continues, perhaps they’ll update it to include “and for an extra $10,000, I will LIKE your rash on my fan page.”

Markoe won multiple Emmy Awards as a writer for Late Night With David Letterman. Her most recent book is Cool, Calm & Contentious.

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