Ideal vs. Real

October 9, 2019

Sometimes I’m just stupid.  This is one of those times.  When I first started blogging in 2011, I created this site to better educate my patients and teach them to advocate for themselves.

In 2011 the practice of medicine was changing rapidly, and the changes were not good.  Over the next few years, my articles became increasingly political and I began attacking the medical insurance companies and Medicare.  Eventually, the insurance industry hit back, threatening to drop my practice from their plans.  I quit blogging.

I’ve always said, “If you can make something good come from something bad, then the bad can’t be too bad.”  MY PHYSICAL CONDITION, BACK PROBLEMS AND PARKINSON’S, ARE THE BAD.   Being able to resume my blog is the good. While I promised myself that I would not become political again and that this site would be strictly educational, I find I have to break that promise.

It’s Medicare enrollment time and the commercials are flooding the air. The ads infuriate me!  I get angry!  What angers me? The ads for Medicare Advantage promise you lots of freebies like transportation to the doc, vision care, …   The ads also talk about the fact that the plans have “narrow networks.” So, what do you give up to get the new freebies? Your network of physicians, hospitals and labs.

Do you know what a “narrow network” is? I do!  A ”narrow network” means that there are few docs in plan and that, to see a specialist or have a test may be nearly impossible.  To see a subspecialist, you may need to wait months and drive far from home.  Medicare Advantage should be called Medicare DisAdvantage.  When the guy on the street corner promises to sell you everything for next to nothing, beware!  Ideally, you buy the best insurance and supplements you can.  Realistically, you may need to take a lesser policy due to the expense.  Buyer beware.  Know what you are truly buying into.  Don’t complain when your doc can’t get you that referral, test or procedure in a timely manner.

As I promised that this blog would be educational, I am republishing “Ideal vs. Real.”   It’s well worth reading.

February 22, 2015

I have spent a great deal of time writing about the ideal way to care for yourself and those you love. When I recommend a treatment course, whether it be diet or medicinal, I recommend the ideal approach. When I prescribe a medication, I recommend the ideal brand or generic, whichever is best. 

I recognize that there is often a difference between the ideal and the real. That difference is getting wider every day. The poor economy, the insurance industry, the government and the internet all are having a negative impact on our ability to live up to the ideal. Life, in general, and the practice of medicine have become compromises.

When is it ok to compromise? How much are you willing to compromise? What is the cost of compromise? These are all important questions. It is clear from looking at my parking lot that many of my patients will not compromise on transportation. They drive very safe, very nice cars. The price of those cars is often exorbitant, leading them to compromise elsewhere. Does it make sense to drive a Mercedes and compromise on medical care and treatments?

Case in point:  a Mercedes owner complained that he could not have a procedure because he had a high deductible and the test would be in excess of $2,000. Having the test is ideal; the real is something quite different. In his case, the answer was simple. His Mercedes has every safety feature imaginable and safety was the reason he bought it. He had been in a life threatening accident and wanted the best protection even if it was not truly affordable. The ideal test for his condition is a valuable safety feature for his health. Without it, he may be heading for a major accident. After explaining this to my patient in terms he could relate to, he relented and will find a way to afford the test.

Make sure you inform your doctor when the ideal is truly not possible. Be ready to negotiate and compromise. In order to make the safest decision possible, find out why the ideal choice is the best choice. Find out what the risks of compromise are. Compare the financial, physical and emotional costs of both the ideal treatments and the negotiated treatments are and then make the best decision you can. Most importantly, be prepared to live with your decision and its effects on you, your family and friends. 

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