The Doctor is Out.

1930s hanging sign from the collection at the Glenbow Museum

You’d think that having grown up with a doctor in the house that I’d be inclined to visit doctors more often. But I don’t have health insurance anymore, so it’s somewhat impractical for me to spend much time seeking medical advice. But even when I did have excellent health insurance coverage I didn’t go to doctors then much either. My regular family physician in Montana was a bit of an alarmist, and once wanted to send me by care flight to the cardiologist because I felt “funny.” He also suggested that I had leprosy when it was really just poison ivy, but that was a joke I think.

I do have a doctor here: a neurologist I like very much. Her first visit lasted for two hours and cost $250. I see her four times a year at $85 a pop, after which she sends me away with enough samples of migraine medication to last me ’till next time. It’s good value. She’d like me to have an MRI and maybe a few other tests, especially after a few little episodes last spring that seem a little too much like transient ischemic attacks, or “mini-strokes,” which aren’t strokes at all, I don’t know why people insist on calling them that.

But I don’t have health insurance and I haven’t gotten around to calling every MRI provider in the region to see who will give me a good deal. I will, I just haven’t gotten to it yet. She’s the only doctor I see, and that’s the only prescription I have, so you don’t have to do much math to see that my medical costs are under $500 a year.

God help us if something serious happens to me.

I’m not a good candidate for health insurance and I’m hoping that the healthcare reform act may ease that. For a long time, I couldn’t find anyone who would insure me. Then I found that I could get insurance through a high-risk pool. (I fell on my head 34 years ago.) For $800 a month. And an enormous deductible I’d never meet.  So I go on hoping that my lifetime of general good health will continue.

When I was out with a friend the other night, she and I were talking about this. She suggested that if I had health insurance, that I’d see doctors more often, right?  Like the dermatologist?

Ouch. I have rosacea, but I’d never see a dermatologist for it. I can’t stand dermatologists, I think they’re the closest things to charlatans in the medical field. There’s no cure for rosacea. They have found that doxycycline works quite well, but they market it as “Oracea” and charge an arm and leg for a routine antibiotic that’s available for little or nothing. “Oracea” symbolizes to me everything that is wrong with the American Medical system.

No, even if I was well-insured, I wouldn’t be at the doctor’s unless I was too sick to do anything else. Which, I realize, is different from how other people view medicine. We knew this couple, trapped together in a rather awful marriage who each used “illness” as a means of getting emotional support from their partner that was otherwise unavailable.

I’d never seen people who went to the doctor as much as this pair.  They were consumers of medical services. She didn’t just take probiotics to put her gut in order, she went for dozens of invasive and complicated tests that revealed she had IBS and should take  probiotics to put her gut in order. He’s had more rotator cuff surgeries than ten men. A week didn’t pass when one or both of them didn’t have an appointment with the internist, the ophthalmologist, the chiropractor, the podiatrist, the dentist, the gastroenterologist, the orthopaedist, or the cardiologist. Oh, and the therapist.

I have sympathy for them, truly, but this strikes me as a misuse of medicine. They don’t take their car to the mechanic every week, or their dog that frequently to the vet. I don’t think that they’re anymore afraid of dying than any of the rest of us are. I think they’re just lonely. Think about it: the doctor really wants to know how you are. If you’re not as you should be, the doctor expresses concern, and seeks a means to heal you. That could get to be heady stuff.

When I was in college, everyone had a therapist. (This was Boston, which is also part of that.) It wasn’t until I moved to Montana that I realized that it wasn’t that we all needed therapy (though maybe we did) — it was that we were all narcissists and wanted to spend 50 minutes a week talking unabashedly about ourselves and our real or imagined neuroses.

I’m sorry that single payer health care reform didn’t take hold here. It is a simple means to provide health care for a population– and we already have the mechanics for it in Medicare. (If you’re gearing up to write me a comment about the ills of socialized medicine, let me stop you from wasting your time. I’ve been an occasional patient in socialized health care systems since I was 10 years old, and can find no fault with them that doesn’t exist in our system. I have seen them from the point of view of both patient and doctor. I know it works, that’s why the rest of the civilized world uses it.) But a uniquely American problem with that kind of system would be what to do about the “medical consumers,” those people who seek out doctors not just for health care, but for entertainment.

I don’t know what the answer is. I hope I don’t end up paying more to be insured than I pay for health care, but I probably will. Perhaps there will be peace of mind in knowing that if I had to deal with something really bad, we won’t lose our house to pay for it. In the meantime, I’ll go on taking my probiotic, and eating stuff that makes me feel good and trying to get a little more exercise; whatever it takes to keep me upright.

….

Target today 71. Steps. 2392

Breakfast: scrambled eggs with a little cheese and a tortilla. Lunch: yogurt with granola Dinner: home-made shrimp tacos with avocado, crema, cilantro. 

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