Free Medicine

October 4, 2019

I woke up this am in pain with a very stiff back.  My Parkinson’s symptoms were marked, making it difficult to walk.  I took my meds and tried to convince myself that I should get into my lift chair and try to go back to sleep.  I failed.  The only thing I wanted to do was to go to the office and get ready to see my patients.  The problem with that is the office is gone.  There are no patients. 

Actually, I’m a patient.  I don’t like being a patient.  I want to find a way to reconnect with those I’ve cared for over the years.  Now that I’m a patient/doc I have a lot to offer.  Being ill has given me a new perspective in life.

My phone beeps notifying me that I have a text message. The message reads, “32 years ago today you were just leaving Good Shepherd Hospital after spending 3 hours with Ted and me and baby Bob, giving us a foundation on how to be parents and care for a baby, thank you!”  I smile from ear to ear.  

That message is just what I needed.  It made me realize that the connections to my patients are still there and, in many cases, will be there for my lifetime.  Now, if I can only figure out how I can use those connections to improve the health, happiness and “wellth” of my former patients, I’ll be complete again.

This blog will serve to keep the lines of communication open and provide an educational platform for my readers.  Unfortunately, I’ve not been able to get the comment section running which leaves me able to reach out to you but no way for you to contact me.  Until I can figure out how to fix that issue, you can reach me at ssegal@lzftc.com.

Secondly, I do not have a list of former patients and therefore have no way of spreading the word that I’m writing again.  I need your help.  Spread the word that www.livewellthy.org is the place to go for medical education on the internet.  You don’t have to be a former patient of mine to use this site.   That brings me to problems number three.

I stink as a web developer.  My home page does not catch your attention and therefore most readers who find my site move on immediately.  Yes, Google monitors everything and lets me know how many pages are read, by how many visitors.  If any of you are web developers and can help me improve this blog, please contact me.

Once again, as I read my old blog, I find answers to my own questions.  In 2013, while I was fed up with the outside constraint that had been placed on my medical practice by the government and insurers, I could still dream.

Many of you have asked me who they should transfer their care to.  That’s a hard question to answer.  Having had a hybrid practice that offered a Concierge Choice option, I can tell you that concierge medicine is as close to “free medicine” as you can get.  Perhaps, you should look for a concierge doc.  

Dinosaurs still exist.  Dinosaurs tend to be older docs who remember a pre-computer world and strive to give their patients the individualized care they need regardless of the insurer’s edicts or the computer’s algorithm.  Some dinosaurs even see patients in the hospital.  Perhaps you should look for a physician who will care for you in the hospital, as well as in the office.

Yes, the idealist in me dreamed of being able to provide the individualized care my patients both needed and deserved without artificial constraints, prior authorizations, codes, etc.  Look for a doc who has similar dreams.

October 23, 2013

When I grow up, I want to practice “Free Medicine!”  You may be asking yourself, “What is free medicine?  Does he mean he wants to run a free clinic or give out free pills?”  “Free Medicine (FM)” is a concept I just created in response to a comment from a reader on yesterday’s article.  My reader is a brilliant doc, educator and writer who serves both as mentor and colleague.

Dr M’s comment pointed out the fact that primary care docs are already a medical bargain.  While the world clamors over the ever-rising cost of medical care, Dr. M reminded me that the cost of seeing a primary care doc is miniscule in comparison to the cost of chemotherapy, surgery or going to the Emergency Room.

“Free Medicine” is an old idea whose time has come.  FM means being able to practice medicine as it was meant to be practiced, unencumbered by governmental and insurer rules and regulations.  Yes, I dream of being able to provide the individualized care my patients both need and deserve without artificial constraints, prior authorizations, codes, etc.  

FM means the ability to shelter my patients’ most private problems from the intrusion of modern day medicine’s fixation on sharing virtually everything with insurers, government workers and statisticians.  While their intent may be laudable, the information amassed in “The Cloud” may be used to destroy the very health we are pledged to preserve (witness the anxiety and depression of those whose data was recently stolen from a large hospital chain).

FM opens a physician’s mind, allowing him/her to be creative in coming up with difficult to make diagnoses and treatment plans.  “Best Practices” close the physicians mind, stressing compliance with “established” protocols.  Heed my warning, cookbook medicine, better known as evidenced based medicine, has infested my profession and stolen our freedom to think and act as highly educated professionals.

“Free Medicine” means being a DOCTOR, not a provider, gatekeeper or service technician.  FM means working for you, my patient; not corporate America.  Yes, I dream of being free.  I also have nightmares.  In my nightmare, I am being sucked into a huge vortex, falling uncontrollably into the world of ACO bondage.  I know there has to be a way out:  I just can’t see it!  Finally, it’s there; the door to freedom opens.

What is cost of freedom?  What’s it worth to you?  Will you be sucked into a world where your healthcare is provided in accordance with protocols created by insurers and Medicare or will you break free?  Will I survive long enough to find my door to freedom?  I pray so!

My door to freedom lies in cutting the tether that binds me to the accursed computer and its EMR.  Breaking off from Medicare and insurers and starting a fee for service/cash only practice of medicine is freedom.  Once again, proudly hanging out my shingle and opening my door to all that would want to come in, all that cherish their freedom, is freedom.

Primary care accounts for a miniscule amount of the cost of medicine in this country.  If we were free from filing insurance and Medicare claims and free from coding and accumulating meaningless reams of data, we primary care docs could  reduce our fees and do what we love best:  care for you, the patient, who places your life in our hands.

Yes, I dream of the day I am part of the “Free Medicine” movement.  The question is, will you join me?  I can’t do it unless you think freedom is worth paying for.  I cannot exit the vortex and leave all those souls I am currently responsible for to be sucked into the depths of illness without me.  I am truly torn! Captains are supposed to go down with their ship, aren’t they?  

“Attention on deck.  The ship is sinking!  All hands man the lifeboats!”

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