Is this a disrespected elder or a crotchety old woman?

Ok it’s not quite that simple, but a lot of people have a good part of their pensions locked up in money-market funds which ultimately are tied to secondary mortgage markets. That means that their pensions get poorer as mortgage defaults rise.

We have to understand that we are all connected to each other. The old “6-degrees-of-separation”; one person’s expenses are somebody else’s income.

Oh wait, I forgot, you are more than educated enough to teach yourself. Good work.

Great to find this here!!! I’d love to hear how you and the wife are doing… feel free to e-mail me- I ended up in Greeneville, TN…

Thanks for the above articles. There certainly are economic concerns about primary care. The AAFP has been attempting to address these over the last few years, and are proponents of the Patient Centered Medical Home. While there is a long way to go, there are some potential bright spots. One that I will mention briefly is a “per member per month care management fee.” This is a fee of $5-$10 per member per month (and, in some cases, the value is much higher…) that is paid to practices, if they are able to meet standards and can provide the services needed. I would encourage you and any readers to go to transformed.com and take the TMED MHIQ (banner at the top of the site). Granted, many of the changes may not be easy– but it could certainly be well worth it in the long run! There is also much more information about the PCMH and Family Medicine at aafp.org.

Thanks for this blog– I look forward to keeping up!

I’d definitely agree with #1 and #5.

#2 - The physician who determines that the patient is disabled is the physician who should be filling out the paperwork. You’re right, physician’s should not shirk their paperwork responsibilities.

#3 and #4 do lie in a gray zone because not every diagnosis in medicine can be objectively established, and there are conflicting opinions amongst the “major medical authorities” about the diagnosis and management of many disease processes.
Physicians should take each patient seriously and should thoroughly evaluate the patient’s symptoms. If the patient does not agree with the physician’s opinion, then a second or third opinion should be sought.

Thanks for commenting!

2. Refusing to fill out forms such as disability papers. The specialist says it’s the primary care doctor’s job. The primary care doctors says it’s the specialist’s job. And then have the nerve to say to the patient something like that he’s not some secretary. Paperwork is a large part, of every white-collar professional job, up to 100% and often one-third. Doctors are not specially entitled to drop the ball.

3. Making a personal judgment that the patient isn’t really disabled. Even when the patient is actually functionally bedridden or housebound. Because they don’t believe in or agree with certain diagnoses. Even when the consult comes from a professor of medicine at a top medical school! Disability status and forms aren’t just for money. They are for being able to get your old job back when the patient does recover even if the leave is completely unpaid. There are only a very few cases where doctors eventually get what I mean here, and that is when they later on by chance end up getting the same condition that their patient had and then realize oh my, it is real and incredibly disabling.

4. Refusing to treat patients with certain diagnoses. This is an incredibly widespread practice. Because they think it is okay to make the call that some conditions, even though they have standard guidelines from the major medical authorities, aren’t real.

5. Doctors who lie. Even, or especially, in the more subtle ways. Including “I’d be happy to see you as a patient” when they are not because of #4 above.

Thank you for your offer, but I’m not interested.

Ironically, your FAQ page states that “MyJunkTree cannot currently reduce junk mail addressed to businesses.”

Thank you for your comment.

I don’t measure medication adherence in my office, but if I had to guess at it, I’d say that I probably have about 50% to 60% adherence. I approach medicine with the idea that I am responsible to provide the patient with information so that they can make an informed decision as to whether or not they will chose a treatment or not. Beyond that, it is the patient’s responsibility to remain adherent. I will rehash evidence and recommendations with them if needed or requested.