No generic doctor for me Derek Alger From the Editor

perm_identity No generic doctor for me

by Derek Alger

Published in Issue No. 153 ~ February, 2010

I was fortunate to have a great doctor, a great general practitioner, for some 18 years. My sister thought he was strange, and my brother considered him weird, based on his somber, methodical manner, what seemed an intense serious manner, not one inviting cordial conversation or small talk, but he was a devoted, committed physician who always thoroughly monitored his patients with preventive medicine in mind.

Dr. Nacht was not much older than me, maybe seven or eight years, but I always thought of him as much older. He could appear overly stern to the nervous or insecure, but he knew his stuff, and for some reason he was more open and confided in me more than others. He didn’t smile much, and I suppose that’s why some thought he was detached. He wasn’t, though. He was actually quite passionate behind a stoic facade, his somewhat impersonal outer appearance simply shielding his feelings well. He once told me his mother died when he was eight, then paused, before adding, “I think that’s one of the main reasons I wanted to become a doctor.”

I was somewhat surprised he felt a closeness to me, especially since I’m not the ideal patient, and my behavior and lifestyle fly in the face of preventive medicine, the anxiety of the moment far greater for me than any possible future malady, or so it seems. Dr. Nacht discovered early that my cholesterol was not just high, but astronomically high, and this was long before cholesterol infiltrated mainstream America as an ubiquitous presence, with commercials claiming certain cereals and a host of other products would lower cholesterol, and then later, competing medications actually promising, almost guaranteeing, to eliminate high cholesterol levels for anyone and everyone if they just believed, and properly took, the appropriate touted pill.

Dr. Nacht suspected I had high cholesterol based on my family history, that my father, who was also his patient, had heart trouble, a quadruple bypass at age 57, seemingly coming out of nowhere, no signs, no previous indications. In my case, Dr. Nacht recommended medication. I, of course, naturally resisted. I was in my thirties at the time, still very much looking ahead, but not far enough ahead, apparently. Okay, it wasn’t an emergency, Dr. Nacht conceded, and I was given an opportunity to try and lower my cholesterol through diet and exercise, though I knew full well the proper exercise of the kind expected wasn’t going to happen. I did go on a Spartan diet for three months. No soda, no eggs, no red meat, basically living on coffee, tuna fish and fruit. I actually was pretty successful at keeping to the regimen, staying completely away from ice cream, didn’t even have one slice of pizza. The day finally came to have my blood taken and tested by Dr. Nacht and I remember feeling confident, not overly confident, but still fairly confident my cholesterol readings would be in the acceptable “healthy” range.

Dr. Nacht seemed pleased when I told him about the diet. I noticed a slight smile on his otherwise gloomy face, a major achievement coming from him, though it disappeared just as quickly, and I wasn’t surprised, because I knew Dr. Nacht relied on facts and data, and much of the time, the facts and data were very disheartening.

A couple days later Dr. Nacht called with the results. The good news was my cholesterol wasn’t any higher, but it still remained in the unacceptable, bordering on astronomical range, despite three months of eating fish and chicken, and following the advice of numerous clippings from newspapers and magazines on lowering cholesterol slipped to me by my mother whenever I stopped by to see her.

I didn’t know what to make of it. Heredity was proving to formidable foe.

I complained to a good friend, a tough guy with a college degree in history and street smarts, who worked as a plumber for the Post Office. “How high?” he asked with concern about my cholesterol level. When I told him, his immediate response was, “Be careful.”

Careful of what? So, my friend knew history, and how to unclog drains, but apparently his knowledge of human physiology was on the same paltry level as mine, meaning almost non-existent. My faith in Dr. Nacht, however, was stronger than my denial that I needed medication to help lower my cholesterol.

I remember debating Dr. Nacht, using my own personal logic to challenge the so-called medical experts. I thought I successfully discovered a loophole, or at least an interesting observation, when the acceptable cholesterol level was lowered from 250 to 200 by the medical authorities, usually meaning based on the results of some highly respected study published in a prestigious medical journal, such as The New England Journal of Medicine.

I told Dr. Nacht that in one night literally millions of folks went to bed with acceptable cholesterol levels, only to awaken in the morning with high cholesterol levels which needed to be treated. Imagine, if your level was 250, which I would have celebrated if mine had been so low, and then, in a snap, you were classified as having high cholesterol. Dr. Nacht wasn’t buying my premise at all, though I think he was amused at what he considered ingenuity in my line of argument. Things change, he said, new developments, new findings, new advancements, ever onward, now health practitioners were better equipped to face the daunting task of treating the ever growing cholesterol nation.

I can’t really complain. The medication prescribed by Dr. Nacht did indeed almost miraculously lower my cholesterol in no time to a level which was acceptable even under the new standards.

The main feeling I always had about seeing Dr. Nacht was confidence because I knew regardless of how I might personally feel, Dr. Nacht would recognize if anything was truly wrong. And based on my frequent visits to monitor my cholesterol level, and my blood pressure, and other routine readings, in doctor terms, he was on top of things, which was helpful to a semi-hypochondriac like myself, who suffers from an active, and when it comes to my health, highly negative imagination.

Maybe because my father was a doctor — albeit, a psychiatrist — and Dr. Nacht, and other specialists I’ve seen over the years have been so professional and experienced, as well as ethical, I don’t buy the complaint that most doctors make patients take additional tests for financial reasons, for reimbursement from insurance companies. It just ain’t true from what I’ve seen. But since early childhood, and once again, my father being a medical doctor, who was forced to pay an outrageous amount for malpractice insurance, just like Dr. Nacht, and almost every other doctor I know, our family always trusted and believed in the individual physician, and the concept of a generic doctor, given the stamp of approval by a health insurance bureaucrat, regardless of the health insurance plan, was an alien concept.

Fortunately, since Dr. Nacht treated patients from all classes and economic backgrounds, he accepted almost every legitimate health insurance plan in existence. That’s why when I went to work for a corporation in the Bronx, N.Y., working as the editor of a community newspaper, I was relieved that my health benefits were covered by Dr. Nacht, and all remained as before.

I remained at that job for over five years, in a horrific political environment, where there were two factions continuously and relentlessly vying for power, factions which could only be accurately described as “bad” versus “evil,” and ultimately, “evil” prevailed and took over the corporation. Most employees, or at least the ones not fired immediately, simply, complaisantly changed armbands and accepted the new regime. I suppose some might call me too judgmental, or believe my values were too unrealistic, but truth be told, I knew if I continued in that job under the new conditions, oppressive conditions from my standpoint, I would feel sick with myself for willingly becoming part of an operation that was no better than a contemporary equivalent of Pravda, so, of course, I quit.

As it turned out, the bureaucratic process of leaving the job was more cumbersome than what I went through when I was initially hired and compelled to satisfy all the mandatory requirements of being accepted as a bona fide employee, with most of such preparatory procedures no doubt in place as a bulwark against potential future litigation over almost everything and anything imaginable. So, there you go, it was almost like having a job to successfully get to the point where you could indeed have a job — drug testing, sexual harassment seminars, this and that, scheduling an appointment for identification badges and photo, and completing multiplying forms ranging from medical benefits to life insurance, to whom to contact in case of emergency. Somehow, after what seemed like endless hours of waiting over the span of a couple days, I was officially hired and started working for that corporation, staying on the job for over five years.

Time to leave, and the cumbersome process started rewinding in reverse, in which I was forced to meet and satisfy all the exit requirements. More forms, 401k transfer, official letter of resignation, stating unequivocally that it was my choice, I was leaving of my own free will, not due to intimidation or any unsavory pressures, and perhaps most important, at least on a practical level, switching my medical coverage to COBRA, for which I had to make monthly payments, but at less cost than if I had such coverage on my own. And so, I ventured off, plying my trade as a freelance writer, with COBRA in place for the next 18 months.

Uncharacteristically, since I’m not a great administrator, and care more about results than backup paperwork, which is probably more detrimental than commendable in current times, I was aware of the exact date my COBRA ran out, and therefore, began to take the appropriate steps to transfer from COBRA to a personal medical insurance plan with Aetna. I was proud of my diligence, and of course, expected no problem. It seemed simple enough to me, I was covered by Aetna while an employee of the corporation in the Bronx, and still covered by Aetna under COBRA, and I informed Aetna two months ahead of the date my COBRA was set to expire, and I wanted to continue with personal medical coverage under Aetna, and a cheerful, helpful woman from Aetna assured me I had put everything in motion, with plenty of time to spare, there should be no interruption in my medical coverage.

Back and forth I went, once again filling out appropriate forms, making follow up phone calls, and just when I was near what I thought was the finish line, I got smacked with an unexpected fact that left me stunned. While Aetna was willing to cover me, and there was no problem switching from COBRA to a personal medical insurance plan, since I lived in New Jersey, I could only see a general practitioner in New Jersey. I was not allowed, or maybe the word eligible was used, to see Dr. Nacht. Even though Dr. Nacht accepted Aetna, and was approved as a participating physician by Aetna, Dr. Nacht’s practice was located in Manhattan, and I had previously been covered by Aetna of New York, but now I was going to under Aetna of New Jersey, and therefore would no longer have coverage if I went to see Dr. Nacht as a patient.

“Are you serious?” I asked, failing to truly comprehend what I was being told.

“Sir, you live in New Jersey, so you can only see a New Jersey doctor.”

“I’ve been seeing my doctor in New York for years,” I said.

“That may be, but you live in New Jersey.”

“Wait a minute, you’re telling me I can’t see my doctor a half hour away in Manhattan but I can see a doctor over an hour and half drive away in Trenton?”

“Yes, if the doctor in Trenton is covered by our plan.”

“I want to keep my doctor,” I said.

“You can keep your doctor if you want, just not under our coverage.”

“You do realize this is insane?”

“I’m sorry, but the regulations are very clear. You live in New Jersey, so you can only see and receive coverage by seeing a doctor in New Jersey.”

“All my doctors are in Manhattan.”

“That may be, but we’re talking about medical insurance coverage, not doctors.”

On and on, I continued arguing and debating, but to no avail, the rigid, inflexible system was in place with too many barricades and blockades for commonsense or logic to stand a chance.

I was left with a simple choice. Continue with Aetna and no Dr. Nacht, or seek other medical insurance, which undoubtedly would cost more, and keep Dr. Nacht as my general practitioner.

It really wasn’t much of a choice. I was willing to accept generic medication at CVS under an insurance plan instead of a more expensive brand name prescription, but there was no way I was going to give up Dr. Nacht for a generic physician in New Jersey.

Of course, the unexpected can always put dents in one’s plans. I was heading up to a lake in Ontario in two days and I only learned about the New Jersey versus New York doctor dilemma the day my COBRA expired, so I was left with little time to scramble and find medical coverage before driving up to the summer cottage with my mother, and what I hoped would be a productive stint of writing.

I truly don’t know how some people do it, how some can maintain a methodical approach while searching for information from within a vast bureaucratic maze, whether it be a medical insurance company, a governmental agency, or the local cable television provider. The automated voice greeting you and giving you options, press one, press two, and when you press the appropriate numeral, yet another automated voice arrives, giving you more options until you finally get close to the extension you want and are told, once again in an automated voice that all lines are busy and a representative will be with you shortly, and then, if you’re lucky, you get to listen to elevator music or wedding tunes, usually on light FM, and if you’re not, lucky, that is, another automated voice jumps in and tries to convince you to accept and sign on to special promotions, which are highly recommended, but only available for a limited time, so you’d better act now.

I was overly aware of the clock ticking, my mother expecting me to pick her up on schedule so vacation could begin. There was no time for comparison shopping or a comprehensive search, I needed health insurance, and I needed it immediately, so I called Dr. Nacht’s office and was referred to a woman he employed as his medical insurance person. Imagine, my doctor didn’t just need a receptionist and a nurse practitioner, he also needed an insurance specialist to help his patients.

And so, I talked with Gloria, and she gave me a list of three or four possibilities of health insurance companies accepted by Dr. Nacht and I was on my way. I selected one, and though it cost almost twice as much as what I was paying under COBRA, as they all did, and I sealed the agreement over the phone and was once again among those who not only had medical insurance, but in my case, could still see the doctor of my choice.

After enduring my little medical insurance ordeal, I almost felt like scheduling an appointment with Dr. Nacht. For what, I don’t know.

Maybe simply general principle. I was stressed and running on adrenaline, and it was late, and I still had to pack, and I couldn’t wait to get on the road, easily choosing a fourteen hour drive with my mother over another two days of dealing with automated voices on the telephone.

  • Alan Gettis

    I think many can identify with this. Great article. Wonder if you shared this with the good Dr. Nacht?

  • yobvazythefierce

    Cheer up they could have sent you to dr mengele

  • What a timely essay, Derek, and one more instance of the madness that is our current health system. I've had trouble with cholesterol myself and lost my favorite doctor when he changed insurance plans, so what you have to say is totally relevant to too many of out here who wanted a single-payer system.

  • WILL ROOT

    My grown daughter in LA has been going through the same sorts of hoops Derek Alger describes, her options being a very cheap Kaiser plan that's worthless (via her company's new owners) or a private plan that costs 10x as much but gets the job done. Alger's piece is clear, conveys the exasperating elements without losing his own cool. I hope that cabin time went well for all concerned.

  • Matt Hill

    Great story Derek … This insurance coverage fraud known as COBRA (an appropriately reptilian acronym) has been an insult to all of us who have ever been layed off from the corporate meatgrinder, and got stuck with paying these absurdly high premiums that end up barely covering 50% of a major medical bill … I know, because I went though agressive chemotherapy and major surgery, only to have to dispose of 40 grand in not-covered bills through medical bankruptcy filing …

    So, this story, about your cholestrol levels, and managing them with the doctor of your choice, really hits home for me Derek … I'd like to see this article reprinted with a periodical read by millions … Thanks again …

  • Gloria Mindock

    Thanks for writing this Derek. I think so many of us can tell stories of woe concerning health care and what is and isn't covered and what doctor you can go to or not. This was well written and I really enjoyed it. I surely can identify with this as I'm sure others can too.
    Thanks so much-
    Gloria/Cervena Barva Press

  • David Memmott

    I can certainly identify, as so many can, with your experience here, Derek, as well as the desire to hang onto a doctor who's become a good partner in maintaining your health. With the advent of managed care, health care in this country became more of an assembly-line approach to healing with doctors unable to establish relationships with their patients, which I, for one, feel is essential to healing. I wonder how your experience would be different, better or worse, in light of healthcare reform. The only doctor that has helped me after years of disappointment and trying everything from mainstream medicine to acupuncture has been a naturopath, and my insurance will only pay 50% of some visits and if you add in what I'm paying for the insurance, well, somebody's getting the benefits I'm not. And, you know, the first thing this naturopath did to help me was to talk with me for an hour.

  • Nancy White

    This article so perfectly highlights many of the insanities of our age. First, the medical nightmares within our bodies that so many are battling; second, the anxieties we live in because we are so fully aware of our inner workings (never would have happened 100 years ago, right?); third, and most criminally, the systems of insurance that have grown up around our medical knowledge and the practitioners who bring us our healthcare. My husband went through the same cholesterol battle, in fact, so I could relate to that part of the story especially. I have not had to live through the hand-to-hand combat with the insurance world– yet– that Alger describes. But that is a rare luxury in this day and age. Recently a friend couldn't get the pain management meds he'd been prescribed for broken ribs–all because our insurance carrier muffed the mail-in forms. These stories abound. Thanks for the look into the system that so badly needs to change, Derek!

  • Joseph Bosco

    This is a most timely story superbly told by a master wordsmith. Derek, about 30 years ago, while working less than a year for the only corporation I ever have in my writing life—a community suburban newspaper in New Orleans—I fell off of a stage working a story and broke my L-4 vertebrae (lower spine). The newspaper, rather shockingly, tried to talk me into an illegal act so as not to have to file a claim with their brand new medical insurance carrier and up their premiums; they wanted me to pretend I was laid-off from my job and collect unemployment benefits from the state. I cursed a little bit and hung-up the phone. I then made two phone calls: one to the Insurance Commissioner of the State of Louisiana; then to a good lawyer. It took two years of suing them before they finally reached a settlement that included a relatively modest lump-sum payment but more importantly they agreed to pay the full costs of spinal surgery. While the only similarity to my tale and yours is that we both worked for some bad guys operating a community newspaper, I can say that my experience also taught me more than I ever wanted to know about corporations and medical insurance.

    You’ve written a great piece that needs wide dissemination. Bravo!

    Joseph Bosco

  • johnwarwickarden

    Come in Josef K; yr time is up.

    Ye Gods. As an Australian, I have never paid for medical treatment; only for Radium and pharmaceuticals, and the latter merely because they are mostly made by Pfizer.

    As one of the lucky under the 'Westminster system', I have taken an interest in the US health care infrastructure (let us admit at very least that the 'infrastructure' is there, if not the 'care'), much in the manner of an anthropologist studying a strange Picasso like creature with a forearm attached to his forehead, and his genitalia in his armpit.

    This is a curious beast you have here, my friend. I would laugh, but this hurts when I laugh. It hurts you to be laughed at, I'm sure.

    And I'm also sure- it just plain hurts.

    This is no good at all. You deserve better. But what we deserve in life is neither here nor there.

    We get what we get; until all of you stand up and say no.

    ALL OF YOU.

    That is, if there are of you left well enough to do so…

    Keep on marching…here if you need me, as always…

    Your Aussie friend and ally,

    JWA

  • Steve Davenport

    Man, Derek, I'd say I want a Dr. Nacht tee shirt or button to pin on my laptop bag, but the star here is you. Your devotion, backed up by this tribute and your willingness to pay double, is admirable. Maybe what I really need is a Derek Alger tee shirt.

    Steve Davenport

  • Rcbornstein

    This is a great exaple of why we need healthcare reform. With your insurance, what would happen if you had to travel all over the country for your job?

  • Debora

    Great flow of story telling, pulls you right in!

  • Great piece, Derek. What Kafkaesque madness. Darkly humorous and beautifully written.

  • Weems

    How wondrous–how could you NOT write an essay when your doctor's name is Nacht?