It’s Back-to-School time, the season of busy. Following the summer vacations, relaxation, and time home with family, we catapult ourselves into after-school activities, athletic practices and games, school projects, PTA, scouting, etc. We wear our busy like a badge of honor. When acquaintances ask how we are, we exclaim, “BUSY!” We believe that this sense of overwhelm is the inevitable result of the items on our to-do lists, but is it really? The truth is that we create a lot of unnecessary anxiety with our thoughts: “I have a MILLION things to do!” “There’s NEVER enough time!” “We’re gonna be late!” The first step is realizing that you don’t actually have to DO anything. Sure, you might not like the consequences if you stopped showing up to work, feeding your children, or paying your taxes, but it is ultimately your choice. Once you admit that you actually WANT to do everything on your list (or at least delegate it out), you take back your power, and your stress level will fall. And it doesn’t have to be perfect. It’s okay to be late, to bring store-bought cookies to the PTA Bake Sale, or to throw a frozen pizza in the oven instead of cooking. But why the heck does a doctor care if you’re busy? When you are busy, overwhelmed, anxious and stressed, your stress hormone, cortisol, increases. When your cortisol level is high, your blood pressure, blood sugar, and weight all increase, which puts you at increased risk of heart disease, heart attacks, strokes, and stomach ulcers. Also, your immune function drops, making you more susceptible to infections and even to cancer. You can still do all the things, but the frenzy is optional. For your mental and physical health, give up the busy, doctor’s orders.
Whether you’re at the beach, on a boat, or at a BBQ, summertime is all about sipping on sodas. It can be hard to resist a cold, sweet, bubbly beverage on a hot day. You’re probably already aware that soda contains a ton of sugar and that sugar can increase your risk of obesity and type 2 diabetes, but did you know that it can also increase your risk of heart disease, liver disease, depression, anxiety, ADHD and dementia?
“No problem, Doc, I’ll just have a diet soda!” Not so fast. In addition to the increased risks of bladder cancer, kidney disease, and heart disease associated with artificial sweeteners, they ALSO increase the risk of developing obesity and type 2 diabetes. Our brains cannot distinguish between sugar and artificial sweeteners, so when you taste something sweet, both your dopamine and insulin levels will increase. Dopamine is the “pleasure chemical” in the brain which promotes habit formation and can lead to addiction. Insulin is a hormone which decreases your blood sugar by storing it as fat, and when levels are high, your body is literally programmed for weight gain.
So, how about reaching for a cold, bubbly beverage without the sweet, such as carbonated water over ice with a spritz of fresh lemon or lime? Once you make the decision to give up soda, you really won’t miss it, and your body and brain will thank you.
Honestly, I have never been a big fan of insurance. I am not much of a gambler, and paying for insurance feels like betting on my own misfortune. I have never purchased insurance for a cell phone or appliance. I would rather save the money and make an effort to take care of my possessions. I reluctantly have car insurance, home owner’s insurance, disability insurance, life insurance and health insurance. The only insurance I have ever used is health insurance, and that’s because health insurance is not actually insurance.
Typically, insurance works by charging a large amount of people a low fee to protect against an unlikely catastrophic event, such as a house fire or a totaled vehicle. Health insurance was previously used this way. Patients paid their doctors directly for medical care and turned in their own insurance claims when needed. Routine medical care was affordable for most, and doctors would often write off bills for patients in need. Insurance was used for major surgery, hospitalizations, or cancer treatment. Health insurance has morphed into a comprehensive pre-paid healthcare plan with unaffordable premiums. Many families spend over $20,000 annually on health insurance premiums and STILL pay out-of-pocket for all of their medical care due to high deductibles. Insurance is meant to protect against financial catastrophe, but in the case of healthcare, insurance IS the financial catastrophe. Patients do not realize that their doctors are receiving ever lower reimbursement and are spending over half their time engaged in meaningless insurance paperwork to get paid and to get the appropriate treatment for their patients. They cannot understand why their healthcare quality continues to drop as they pay more and more.
Imagine if your car insurance worked like your health insurance. You would be forced to pay $1000 per month for car insurance, but it would cover gas, oil changes, car washes, tires, windshield wiper blades, regular maintenance, and repairs. Of course, the prices for all of these services would increase dramatically, and you would have no way of knowing the price until months later. Also, you would pay a $20 co-pay for all services and would be responsible for the first $3000 of costs each year. However, after paying that first $15,000, all costs associated with your car would be FREE! Keep in mind that you would need to stay in-network. You may have a habit of swinging into the Wawa every morning on your way to work, but one day you learn that Wawa is now out-of-network, so now you are responsible for paying $250 for a tank of gas. Of course, you could drive 15 miles out of your way to get your tank of gas covered at 7-eleven, after you pay the co-pay and deductible. Also, you have to go inside, wait in line, show the gas station attendant your car insurance card, and fill out five pages of paperwork prior to filling your tank.
Americans have been brainwashed to believe that our current healthcare system is the only way to pay for healthcare. Of course, this is not true. The main reason that healthcare is unaffordable is because of the health insurance companies and all of the administrative middlemen who profit off this system. The only way for this system to change is for doctors and patients to demand better. If doctors stopped billing insurance and instead offered affordable cash prices for medical care, patients would not need to purchase these expensive pre-paid healthcare plans and could opt instead for affordable catastrophic plans or for health-sharing plans, such as Sedera, for as low as $136 per month. In my Direct Primary Care practice, patients get all the primary care they need for $75 per month, and I help them navigate the system to find the best prices on screening and diagnostic testing, medication and other treatments.
Gender politics aside, let’s talk about why the way doctors get paid matters to you as a patient. Female physicians don’t just get paid less because they prioritize their families, they get paid less because they prioritize patients. In the fee-for-service model, doctors are paid per patient visit, so the more patients they see, the more they get paid. This means that the worst doctors are paid the most. Healthcare administrators love “productive” doctors like Dr. Tigges who see 40-50 patients per day in 5-10 minute visits. These doctors make a ton of money rolling patients through the assembly line, and they produce even more money downstream with all of their referrals and tests and frequent return visits since their patients’ problems are never adequately addressed. One local hospital group times all patient visits, and any physician who spends longer than 15 minutes with a patient is reprimanded. The best physicians are literally punished for prioritizing patient care over profits.
Doctors who spend more time with their patients are better diagnosticians because they listen to their patients, get a thorough history, and perform an appropriate exam. They are less likely to need to order expensive tests or refer out to a specialist. The best doctors consider the cost of care and take extra time to ensure that their patients are getting the most affordable medications and that they are not subjected to costly and unnecessary testing. The best doctors respect their patients’ time and avoid making them return for another appointment for a skin biopsy or joint injection. Spending more time with patients is also important in building trust and motivating them to make healthy changes, such as smoking cessation or weight loss. Female physicians have been proven to have lower mortality rates, probably because they choose to spend more time with patients, make thoughtful diagnoses, order testing judiciously, address financial concerns for patients, and make sure that their patients understand and agree with the treatment plan.
I know many excellent physicians, both male and female, who make patients their priority and give them the time they deserve. However, this is very difficult to accomplish within the current system, and many good doctors get swept up in pleasing their bosses and paying off their medical school loans. The solution, for doctors and patients alike, is Direct Primary Care. By paying an affordable monthly fee, patients get access to a doctor who has plenty of time to give them the best possible care. Doctors are paid fairly because they are providing a valuable service directly to the patients who pay them.