Direct Care Independence

October 1, 2015: Independence Day


Atrocities were being committed against everyday citizens. There was no privacy, and property rights were nearly non-existent.

The Boston Massacre was a result of British officers firing into a crowd of citizens. Sam Adams rightly used the event to spark a fire, which eventually lead to a declaration and a long, hard-fought war for independence.  July 4, 1776, will be a day of celebration as long as there is a United States of America to celebrate.

Today, atrocities are being committed against everyday citizens—our patients.

There is little to no privacy regarding medical records, and a patient’s medical records are NOT considered his/her own property. Insurance companies and the government have determined what they finance belongs to them. Physicians are being sent to federal prison, NOT for purposely committing fraud, but because they dictate a technical mistake (that does not change the costs) in their notes on a procedure, and the “system” wants to make an example of them. A new set of “codes,” a language of sorts for the medical community, is being forced upon all of those who bill insurance and government health systems in any way, shape or form.  Physicians are no longer to be referred to as physicians; rather, they are “eligible professionals” along with podiatrists, dieticians, audiologists and advanced practical nurses. If a physician opts to not do business with the Centers for Medicare and Medicaid Services (CMS), the Secretary of CMS shall have the option to decide whether those physicians’ prescriptions will be honored. There is a push, through the Interstate Medical Licensure Compact, to utilize a national licensure as opposed to a state licensure program for physicians, which would punish those who either don’t continue their board certification because it is an expensive “club,” or who anger the national board(s) in any way to render them unable to get a license to practice in ANY state of the Union.  There is a war on doctors; and friends, whether you want to acknowledge it or not, it cannot be good for patients no matter WHO pays the medical bills.

For those of us who:

  • Have dared to go around the “system”
  • Have had enough of getting insurance companies’ approvals for medications or treatments we deem necessary for our patients
  • Have had enough of hospital administrators practically begging us to make more “clicks” on our computer for them
  • Who refuse to have our livelihood tied to the amount of individual patient data collected
  • Who find the presence of insurance carriers, the federal government and middlemen palpable in the once private exam room
  • Who declare our independence from these barriers and are re-establishing the sacred patient/physician relationship

We declare that Thursday, October 1, shall be OUR Independence Day!

That is the day all others must start complying with ICD-10, a copyrighted product of the American Medical Association (AMA). ICD-10 is a coding program that destroys privacy of the patient and sets the physician up to fail. We—the direct-care physicians and medical clinics of America who do not bill insurance of any kind—WE say “ENOUGH!”

  • We are independent from a system that places the physician and the patient together on the “road to serfdom”
  • We do not code our visits
  • We do not have to code our visits, because codes are not helpful to patients; codes are solely a form of forced collaboration with a system that seeks to subjugate us all
  • WE shall proudly flood social media with #iamdirectcare on Thursday, October 1—our Independence Day
  • We will proudly proclaim our freedom before those poor souls who continue to slave away for the “system”

We shall fly our own flag, and defiantly wait for the inevitable Santa Anna to “come and take it.” They will try, because we fly in the face of their right to command us. Yes, they will try. They will use several methods, and they may succeed. We may fail, but we will fail as free people, not as indentured servants. And we, like our patriotic forefathers, will remain steadfast.  We shall, like them, pledge to each other and to our patients, “our lives, our fortunes and our sacred honor.”

Caring for Your Kidneys

Don’t Tell the Cardiologist, but the Kidney Rules


In the first year of medical school, we learned how the human body works. All the anatomy and physiology was focused on the healthy, well-working human body. We learned what goes on at the molecular stage on to the macro-biologic. Second year we learned pathology—disease states, infections, when things even at the molecular stage (or especially at the molecular stage) goes awry. There was some snootiness between professors during the first year, but when the specialists came to speak to us in lectures, this is where it got a bit more heated.

It was a standing joke that the cardiologists (heart doctors) made fun of the nephrologists (kidney doctors), and the nephrologists made fun of the cardiologists.  “All the kidney does is go ‘drip, drip, drip” the cardiologists would laugh.

“All the heart does is pump. How hard is that?” the nephrologists would retort.

Meanwhile, the neurosurgeons (brain surgeons) rolled their eyes (and they knew which cranial nerves controlled the roll!)

The heart IS a pump, albeit an electrical pump. If something goes wrong with the electrical wiring, the heart is in trouble. If the heart muscle is starved of “food” (oxygen) it will die off downstream of where the food supply is halted. If the doors are stiff and creaky and don’t close like they should the pump may back up depending on the severity of the hinge problem. And if the pressure is too high for the pump to pump against, the heart muscle has to work harder. This pump is pretty important because the brain really needs the oxygen that the heart pumps to it.  It is a beautiful design and works great, pumping blood to the brain and the rest of the body about 70 times per minute, 4,200 times per hour, 100,800 times per day. The heart tolerates a lot of abuse, from cigarette smoking to drinking energy drinks to high cholesterol diets.

The kidneys, on the other hand, filter the blood. I liken them to an automatic drip coffeemaker. The water is the blood coming in to be filtered. The brewed coffee in the carafe is like the blood as it exits the kidney. If the filter clogs up, or if the water goes through too slowly, the quality of the coffee is not as divine as it is when the filter works nicely and the water is forced through quickly. But, filtering the blood is not all that the kidneys do; they tightly regulate electrolytes. Sodium, potassium, even glucose are all very tightly regulated.  The kidneys also regulate blood pressure. This is why so many medications for blood pressure work in the kidneys. The kidneys even make hormones that do important things like stimulate the manufacture of blood cells and bring calcium into the bones. They do so much that most people have a pair of them—though you only really need one.

When the kidney(s) don’t work like they should, and it gets so bad that the toxins are not filtered out, a patient is put on dialysis. Kidney dialysis was first discovered by Dr. Willem Kolff and is the process by which one bypasses the diseased kidneys and uses a machine to filter the blood.

When the kidney(s) fail, and one requires dialysis, unless you qualify for a kidney transplant, you are looking at usually only 5-10 years of surviving on dialysis (though some folks manage to live a lot longer).

Take care of your kidneys! Don’t smoke – remember that smoking affects the blood vessels and contributes to plaque formation in important arteries. Nicotine can also cause contraction of the smooth muscle in the arteries. There is an important artery that runs to the kidneys; so, let’s not put a crimp in that hose.

Drink enough water to stay well hydrated, but not too much.  4-6 glasses (3-4 pints, or 1.5 liters) a day is good. Eat fresh food—avoiding processed foods helps you avoid the sodium (salt) that is used for preserving the food. Keep active—walk, swim, cycle.  Watch your blood pressure.  Every household should have a reliable blood pressure cuff, and know how to use it. Take your home blood pressure cuff into your primary care doctor and have it checked for accuracy.  Then make sure your kidney function (the blood work) is checked periodically. Some people are very susceptible to over the counter arthritis medicines (Non-Steroidal Anti-inflammatories or NSAIDs) such as Ibuprofen and Naproxen. Even if you don’t have high blood pressure, but DO take these medications on a regular basis, your kidney function should be checked to make sure the medications are not having an ill effect on the kidneys. And, try your darnedest to avoid diabetes. Not only diabetes but also the medications for diabetes are exceptionally hard on the kidneys.

So, don’t tell the cardiologist, but the kidneys rule, and the heart would be nowhere without one.


Relationship provides better care

Higher Quality Medical Care Comes With Relationship, Not Data Compilation


Humans are complex creatures, designed for interaction and the use of ideas and reason to prompt their actions.  A well-established relationship between individuals is essential in the process of communication, which is the basic foundation in any successful interaction.  Therefore, establishing a relationship is important to quality medical care.

What is it you look for in a physician?  Want do you want from your physician?  What kind of return on investment do you seek? What sort of value does having a personal physician have for you?

Ask anyone who is 55 years or greater if they had a physician when growing up.  Unless they lived in a fairly remote area, chances are they will tell you a story of their family “doc,” who “caught” them when they were born, saw them through the childhood diseases and accidents, counseled them as they prepared for college, did their exam and blood work for their marriage.  They will likely remember them with a far-off look in their eye, re-experiencing fondly the antiseptic smell of the office, the creak of the wooden chairs in the waiting room, and the confidence they had that their physician knew all about them.  Ask them, after they tell the story, if they feel they had a higher quality of care than they do today. Ask them to compare and contrast the difference of that relationship with the one they have with their present-day physician(s).

How do their stories compare to YOUR story? Did you have a family physician growing up? Do you have a primary care physician today?  Do you feel there has been a shift of paradigm away from the traditional practice of medicine to an impersonal “healthcare facility?” Unarguably, technology in medicine has greatly increased in recent years, but have human beings changed much as well?  Why has there been such an effort to sterilize the relationship between patients and physicians?  Why have so many barriers been placed between them? Has it been more of a side effect of technology, or has it been purposeful?

Let me ask you more: do you have an attorney? Have you ever needed an attorney, but not had one “on retainer” or in your speed dial? Have you ever found yourself in a situation where you suddenly, urgently, needed an attorney?  Wouldn’t it have been far better to have established a relationship with an attorney well before you needed one emergently? A family attorney would be nice, one who had represented your family for years, who watched you grow up and knew everything about you so that when the need arose you would have someone to turn to. You would know you had someone “in your corner,” an advocate in court. You would also know that anything you revealed to your attorney is confidential.  There are few barriers in the client-attorney relationship.

Why should your relationship with your primary care physician be any less crucial than that with your attorney?  Are the experiences of your mind and body any less sacred than your legal concerns?  Shouldn’t what you discuss with your physician be as confidential as what you discuss with your attorney? Are attorney fees less expensive than physician fees?  Why is there no subsidized exchange to purchase legal insurance?

All these questions are aimed to spark the fire of enquiry.  Think of it this way: you have been programmed to believe that you must have health insurance, and that you must have a physician who bills your insurance, and that that insurance company has the right to all your medical records because, after all, they are paying the bills.  And of course, there has to be insurance oversight, and hospital oversight, and clinic oversight, and physician oversight, because the government is only here to take care of you, to watch over you, to make sure you aren’t harmed in any way by any of these parties. And the result of all this oversight is the achievement of the highest quality of care anyone could have! Or is it? If you KNOW that the insurance company has access to your records, are you more likely to confide your tobacco use or your recreational drug use or your sexual preference or whether you use “protection” to your physician? What difference does it make to the physician? No sense revealing that little problem you had one time with high blood pressure that the insurance company may use to drop you, or increase your rates.  If you have nothing to hide, then why do you care who reads your chart?  But, what if you don’t know whether you have nothing to hide or not? What if there is mining of your records for data of which you are not even aware could be considered suspicious? Are you “non-compliant?”  What does that even MEAN?? Can one have a higher quality of care when there are those kinds of barriers in communication and relationship? Or do you expect quality of care to be higher in a situation of a better, closer relationship?

Good relationships encourage openness and frankness, which helps the physician greatly to better diagnose.  Better diagnoses leads to better treatment plans and better treatment plans lead to higher quality of care.  Physicians who focus on the individual in front of them as opposed to what the insurance company – or the employer, or the Department of Health & Human Services via their “interoperable health information infrastructure” wants documented – will provide better care.

Seek that kind of relationship, seek that kind of primary care physician, and don’t wait until it has become urgent.  Keep that physician and their cell phone on speed dial, keep them on retainer, so when the time comes that is of the essence you don’t find yourself wondering what to do.

And you, the patient, will be happier, and – possibly, hopefully – healthier.