Dr. John Ludden - One doctor making a difference
It would take most of us two lifetimes, maybe more, to accomplish half of what Dr. John Ludden has accomplished in his 30-year career: an M.D. from Harvard Medical University, an M.B.A. from Harvard Business School, and a B.A. from, you guessed it, Harvard College. With over thirty years of experience as a psychiatrist focussing on clinical depression and substance addiction, and twenty years as an executive and consultant to the healthcare industry, Dr. Ludden is one of the very few medical professionals that understands first-hand the tension between delivering quality patient care and working with in the limitations and strict budgets of the healthcare system. His twenty-years working with Harvard Pilgrim Health Care were dedicated to improving the quality of HMO service, an institution that has come under a lot of attack lately.
Body1.com: The internet has revolutionized the way that patients access health information. Many patients are now printing out articles about new treatments and medical services and bringing them to their doctors. As a medical doctor how do you feel about this practice?
Dr. Ludden: Yes, it causes problems and the doctor's usual practice gets disrupted. I feel for the doctors, but not much! I think that this is something that doctors; will have to learn to live with. Consumers are so much better informed now. I work with a group of people in Washington promoting research on HIV. This group consists of pharmaceutical companies, academic researchers, government payers, HMO payers and consumers. The consumers know the biology of what we are doing, they understand the drugs and the research and they are asking many of the good questions. On the topic of AIDS these consumers are very well informed. Women with breast cancer are perhaps the next most informed group of patients. I know that in my own practice it seems to be absolutely true that if I and the patient invest the time to understand what their concerns are and what I am doing, it takes a bunch of time in the beginning but in the end what you've got is a collaborator--both sides have a collaborator--and it's much better.
Body1.com: Over the years you have worked with hundreds of patients. What advice would you give someone who is looking for a therapist?
Dr. Ludden: Your therapist works for you, and you can interview that therapist. Keep in mind that you will need to choose a discipline. There are many options including psychologist, social worker, psychiatrist, who are medical doctors and can prescribe medication, and nurses, who in some states can also prescribe medication. Do you want your therapist to be male or female? Does it matter? Young or old? Gay or not gay? Where are they located? It's amazing when I ask someone what they are looking for in a therapist and they don't know, they haven't thought through it. The critical element is that knowing from the beginning that just because you need to see a therapist, if the relationship doesn't work, it doesn't work. If it doesn't fit you go onto somebody else, and you'll know this in a meeting or two with a therapist."
Body1.com: What sort of formal training should your therapist have?
Dr. Ludden: I think that credentials and training are important. Paying attention to credentials is important because it is a check that what you are receiving is a reputable track record. Psychiatrists, psychologists and nurses are all licensed. Licensing doesn't mean everything, but it is important. A psychotherapist may be licensed, they might not be, and their training may or may not have been structured. A person needs to keep in mind that there are different philosophies for each of the clinical specialties. Arranging a consultation is a very important step.
Body1.com: Should a person ask for referrals when they begin a search for a therapist?
Dr. Ludden: I think that people ought to do this more. Recent movements in medicine have tended to say that it's not good to just ask your friends for referral--that it's too casual--but I think that it is a lot better if your alternative is to open up the yellow pages to find a therapist in your local area. Asking your friends for referrals may be tricky, though. For example, if you and I were really good friends and I said to you, "Do you have a good therapist?" You may tell me; you may not tell me. You may not want to run across me in the waiting room. There is a little more tentativeness around this issue. It would be very different if you asked me, "Do you have a good dentist?" Good ways to approach friends would be to ask them, "Do you know of any good therapists?" "Does your plan have a good mental health benefit?" "How easy is it for you to get the mental health benefits that you want in your health plan?"
Body1.com: As a consultant to the healthcare industry for over three decades and as the former Senior VP of Medical Affairs of Harvard Pilgrim Health Care, tell our readers the 5 things people should look for in their health insurer.
Dr. Ludden: This is in no particular order:
- You should look at the company's overall quality. Ask friends whether they like their health insurance company. Check out a company's accreditation status at http://www.ncqa.org
- Know the company's financial status. Do you want a company with a strong or weak bottom line? There are benefits to both, but you will always need to find a company that is financially sound. You can usually find this information on the company's web site.
- What benefit limits are in the insurance policy? The policy may cover you for diseases you've never heard of, diseases that may or may not concern you. You need to research whether a plan fits your life and your medical concerns now and in the future.
- What complaints have been filed against the health plan? I always tell people to ask their human resources person if there are any complaints about such and such insurer. They should ask if the plan they are interested in is restrictive. Mental health is one thing that there is a great variation in how restrictive a plan is. You should ask how much hassle there is in getting the care that you need. For example, you belong to XYZ health plan and you decide that you may need to see a therapist. Your plans says that you need to call an 800 number. When you do they ask you what sort of problem you have and what kind of doctor you need. They make a few guesses about whether you need medication because that would determine if you need a psychiatrist. All of this can feel like a hassle, and it can feel like an invasion of privacy.
- Does the plan have a big network of doctors? Are the best hospitals in their network. Some people may make this their first criteria. Depending on your age and gender what doctors and hospitals you need will change. If you are a male age 25-40 you have a high chance of being in an accident. If you are a female in the same age group without children you will be looking closely at the OB/GYNs the plan has. If you do have children, you will be concerned about their group of Pediatricians, and, if you are over 55 you will have a whole different set of concerns. If you are changing health plans you will want to ask, "Is my doctor and hospital covered by this health plan?"
Body1.com: What do you think is the best thing about the health care system in the US?
Dr. Ludden: The innovations. The rollout from every corner of different ways of doing things. As much as people complain about the cost of drugs, the drugs being made--drugs themselves--are absolutely fabulous. People complain about HMOs but mammography rates for HMOs is way higher than non-HMO rates.
Body1.com: What do you think is the worst thing about the US healthcare system?
Dr Ludden: The economics. It leaves everyone uncertain. It leaves the doctors uncertain. It leaves the patients uncertain. 16% to17% of people are not insured, and that a rotating bunch of people. Healthcare costs a lot and people have to ask questions whether they can afford health coverage; and, if they can afford it this year will they be able to afford it next year? Insurance coverage and rates change so much. There is pressure about what the doctor gets paid, pressure about what the hospitals get paid, and pressure about whether or not there is enough money for research. Most people have health needs that extend over time and if you are not sure whether you will be covered then your medical insurance starts to become like dental insurance. For a lot of people, if their dental insurance is about to run out they go out and get their teeth fixed and they get all the work done while they are insured. This doesn't work for long-term chronic illnesses. Many people get nervous because they think that their insurer may want to know if they've got a long-term chronic illness like hypertension, depression or alcoholism because then they fear they will become a bad risk.
Body1.com: Finally, as the internet changes the way patients and doctors interact what would you like to see all doctors doing more of?
Dr. Ludden: Listening. Listening. Listening.
