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.

Regular vs. Diet Soda

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.

Health Insurance is not actually Insurance

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.

It’s Not “Just A Virus”

During my urgent care shifts, I see 20-30 people with viral upper respiratory infections. They are all feeling miserable, and they just want to feel better. They want an impressive-sounding diagnosis to justify their suffering to themselves, their spouses, and their bosses. They want a prescription medication which will immediately cure their illness, so they can get back to their lives. Their faces fall when they receive their diagnosis and recommendation for over-the-counter cold medications. “Just a virus?” they cry! “Then why do I feel so terrible?”

There seems to be a public perception that bacterial infections are serious and viral infections are not, but this could not be further from the truth. Nobody would refer to HIV, Hepatitis, or Ebola as “just a virus”. HPV causes over 40,000 cases of cancer in the U.S. annually. Tens of thousands in the U.S. and hundreds of thousands worldwide die from the influenza virus every year. Over one million die from the malaria virus every year. The measles virus caused 2.6 million deaths annually prior to the invention of the measles vaccine in 1963. Vaccination has eliminated the crippling effects of the polio virus and has significantly decreased rates of death, disability and birth defects due to varicella, mumps and rubella.

Doctors hate viruses as much as patients do. We love to help people feel better, and we feel pretty helpless when our patients or our family members are suffering from viral illness. We especially hate it when we have a viral infection because we are notoriously bad patients and do not give ourselves time to rest and recover. My colds always last at least 2-3 weeks. I’m on the tail end of one now and have been coughing for over a month! A post-viral cough can last for up to three weeks after the infection has resolved. We believe that you are suffering; we have all experienced it, too.

Viruses cause over 98% of sinusitis and over 90% of bronchitis. Antibiotics only treat bacterial infections; they do nothing to treat viral infections and can cause potentially severe side effects. If it’s not effective or safe to prescribe antibiotics for viral infections, why do so many doctors do it? Simply, it’s the path of least resistance. With a click of the mouse, you can give a patient what they came for, make them happy, and move on to the next patient without any argument. Most of the time, the antibiotic seems to work because the patient is seen mid-way through their illness, and the viral infection resolves before the antibiotic course is finished. Also, the placebo effect is real, so patients who believe that an antibiotic will make them well, will start feeling better after they take it. However, patients who come in on the first day of their cold to “nip it in the bud” or “get ahead of it” will inevitably get worse on antibiotics and then call back to get “a stronger antibiotic”.

The problem, in addition to the risks for individual patients, is that bacteria are becoming resistant to antibiotics, and we could face a future in which we are unable to treat serious bacterial infections. The most popular “placebo” given for colds is a Z-pak (azithromycin). Bacteria in the upper respiratory tract are resistant to this antibiotic, so it does not work for bacterial sinusitis. In the U.S., azithromycin is used to treat Chlamydia, but in Europe, Chlamydia is now resistant to azithromycin due to inappropriate overprescribing for viral illnesses. Azithromycin is a potentially dangerous medication and can cause a fatal heart arrhythmia, so using it as a placebo is not just bad medicine, it’s malpractice. So next time you’re sick, and your doctor does not offer you an antibiotic, thank him or her for caring more about your health and about public health than about patient satisfaction scores.

Female Physicians Prioritize Patients over Profits

2018-09-03 11.58.29

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.