Taking Control in the Face of Opposition

This is a non-gardening post and it’s not short, so my feelings won’t be hurt if you skip it.  I have at least two gardening posts I think you’ll enjoy after this one.  If you do read this, I’d love to know if you were already aware that this kind of stuff happens because I was caught off-guard.

First, some good news.  Yaaaa!  I don’t owe $107,000 or $3,500 to the hospital for my hip replacement.  I owe zero.  (Found this out yesterday.)  Whew, what a relief!

Okay, so I used to be a nurse but got out of nursing in 1995.  I worked so much overtime that I rarely saw my family.  My husband and I talked it over and decided the family was worth more than money. I took an office job, which paid less but was more family-friendly.

I’m not embarrassed to say I have Type 2 diabetes.  I learned I had it in 2007.

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Above is the glucometer I use to test my blood sugar. I prick my finger with a lancet and put the blood on a tiny strip that I insert into the glucometer.  110 mg/dl was my fasting blood sugar for this morning, which is a good number for a diabetic.

Being a nurse, I already knew a bit about diabetes and diet, so at the start, I handled the diabetes through diet, but diet became less effective as the years passed, and I gained weight.  (I worked in a sedentary job.)

In short, my blood sugar became extremely high and as much as I hated to do it, I went on an oral diabetic medication.  At that point, I decided to take control of my health.  I changed my diet, lost 30 lbs (full disclosure, the medicine reduced my appetite), and began walking about 30 minutes every day. I also met with someone who held a Ph.D. in nutrition for advice and quit my stressful job with 85 “bosses”.  (Not all were technically my boss.  They were wonderful people to work with, but the workload was overwhelming.)

Since then, I’ve kept my blood sugar under control primarily because I don’t want the awful things that come with uncontrolled diabetes such as Alzheimer’s disease, blindness, kidney failure, gangrene of a limb, nerve damage, or my teeth falling out (just to name a few).

If this means anything to you, I went from a blood sugar of almost 500 mg/dl to one that varied daily between 96 and 135 mg/dl. My hemoglobin A1C went from 11.something to 6.2 and then 6.7.  I tell you this only to show I was serious about my lifestyle change.

Then I moved to this small town.

After living here a few months, I randomly pulled the name of a local physician’s clinic from MD listings on-line and made an appointment.  I saw a nurse practitioner who was friendly and efficient.  She immediately insisted I needed an EKG.

I told her I’d recently had an EKG as well as a CT scan of the heart, which showed no blockages or plaque build-up, so I didn’t feel I needed a second EKG.  I’ve also never had high blood pressure.  She responded it was office policy.

I firmly said “no” and she said, “Why would you care?  Your insurance will pay for it.”

Why would I care?  Hmmm. Because if everyone has unnecessary medical tests, then private health insurance costs will rise for everyone on that insurance, and the cost of this in-office EKG was $400.

Two months later without warning the doctor’s office called and told me I’d been scheduled for 3 tests.  What 3 tests?  No one mentioned any tests. I didn’t even know what the tests were for.   I said, “No way.”  A week later I received a letter from the medical practice stating they would no longer treat me.

Wow.

A local friend and fellow gardener recommended her doctor, and I became his patient.

Here is where the surprise comes in.

With my blood sugar under control, there is no reason to see a doctor every three months, but my doctor’s nurse told me my diabetic medication would not be renewed unless I scheduled an office visit every three months. She said the government mandated it. 

What?

I responded, “There is no way the government mandates how often a person needs to see their doctor. That would mean we live in a dictatorship.”   Although the nurse didn’t use this phrase, she basically implied, “Tough sh*t, Sherlock.  You want your medicine, You MUST come in.

So I did.

When I saw my doctor, I got straight to the point.  Please note, I was never rude.

First, I asked him whether he thought the doctor-patient relationship was a partnership or a dictatorship. He answered, “Well, that depends.”

I asked him point blank why I needed to come in so often since my blood sugar is under control.  I told him I was a former nurse.  (I didn’t have to see my doctor every 3 months in Austin, Texas.) I explained I’m retired and coming every three months is a hardship on many levels.  There is an out-of- pocket copay, and I feel it’s overkill if nothing has changed health-wise.

He answered by saying, “The government mandates it.”  He went on to explain that when the Affordable Care Act was enacted, the government mandated people with diabetes see their doctor every three months and that he was forced to send information from all diabetic patient’s medical records to the government.  He said this created a big headache for his practice

Please note, he did NOT say Medicaid, Medicare, or all Affordable Care Act patients who are diabetic.—Those would all be patients who use some form of government health care.  He said ALL patients including those patients with private insurance.  I asked him this question specifically, and he said “ALL.” 

He asked if I believed him.  I said I did.   I didn’t.

Since he did not test my blood nor would he accept my glucometer readings, this meant he would not renew the prescription for my diabetic medication.

Total cost for this unnecessary doctor’s visit was $155.00.

When I returned home, I began to research what he told me.  I scoured the Internet, but found nothing regarding a government mandate for diabetic patients to see their doctors every three months.  I called my private health insurance and asked if they could verify the government made this requirement and whether the government was collecting medical data from private patients.  The insurance representative said she’d never heard of this.

I talked to my adult kids, one of whom used to work for a doctor, and one who still does.  The first daughter said straight out that my physician was lying. The second daughter said her doctors were all surgeons so she didn’t know for certain, but didn’t think this was true.

Next, I contacted the Affordable Care Act folks.  They, too, said they’d never heard of this for private patients; however, they also told me they were primarily versed in how to sign up for the Affordable Care and not much more.

Because I wanted a definitive answer, I called a close friend who contacted her niece.  The niece works in a high position within a medical organization in Houston.  Apparently, the niece knows all of the new insurance codes and rules, the Affordable Care Act rules, government rules with regard to medicine, medical privacy rules, etc. My friend said her niece is an authority about this kind of stuff.

Long story short, the niece said my doctor lied to me. The government does NOT mandate that diabetics must see their doctor every 3 months nor do they collect data on private insurance patients.

That’s what I thought.

Finally, I found this article on ways physicians can increase their revenue.

You can read the article in its entirety but to cut to the chase, it is about easy ways for physicians to make extra money.  One suggestion is for doctors to schedule appointments every three months for patients with chronic diseases because this will net them more money. The article even recommended double-booking patients for the same time slot.  Kind of like United Airlines.

You might be thinking, “Well, why don’t you change doctors?”  It’s not so easy.  There are only three clinics in this town, and the third one doesn’t have the greatest reputation either.

Since I need a doctor here, not miles away, I will not make a big stink; however, I refuse to let any doctor control me to make an unnecessary profit.  This physician will continue to see me (or I think he will), just not for my diabetes.

Since I’m no longer able to get my medication unless I make an appointment every 3 months, I decided I would make an even bigger life change.

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Red Miso paste makes a great low cal. soup base if you add vegetables.  It’s high in sodium, but I don’t have an issue with sodium.

After going off the physician-prescribed diabetes medication, three weeks ago, I changed my diet yet again–fewer calories, more fiber and protein, and less & better carbohydrates.  I’ve begun to walk an hour or more every evening to lose a final 20 pounds, which will put me at the right weight, and I’ve begun taking an over-the-counter combination of herbs, which to my surprise, is working.–I had serious doubts.

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Dinner tonight:  Small portion of fish high in Omega 3’s, a protein drink without sugar or milk, and spinach with onions sauteed in olive oil.  Yum!

I feel for those who cannot afford health insurance. I can’t imagine how scary this would be.  I know I’m lucky to have private insurance, but I refuse to be taken advantage of and I don’t like to be lied to.

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I am left with a loss of trust for doctors in this town, but I also feel empowered that I took control of the situation and made the changes necessary to keep my blood sugar under control.

I end this post with the following:  Has this happened to you?  How would you have handled this?  And moreover, is the “everyday man” just a pawn for those who abuse their authority and/or have power and money?  It seems to me the system is crooked, and I don’t know think I can fix it.

2 thoughts on “Taking Control in the Face of Opposition

  1. What an awful experience and what a scam. I can understand your quandary if you have limited choice of medical clinics in your town. Living in a big city makes it easier to walk away if you are not happy with a particular doctor. You are doing the right thing with your diet and exercise and it should make a difference. When there is a health problem in our family we always check on treatment options and never blindly follow medical advice. There have been too many mistakes and bad side effects with prescribed drugs in recent years. It is important to take control of your own health.

    Liked by 1 person

  2. Thanks for your comment. The bottom line is I never expected this. I want to trust my doctors. I think most people do, but I agree it’s important to control ones health. I think this happened for a reason (maybe even a positive reason), but I don’t know why yet. Maybe I’ll find out 10 years from now that the prescribed medication I was on had long-term negative effects.

    Liked by 1 person

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