Holley Navarre Medical Clinic - Joel Rudman, M.D.
My Blog

No, Politics Isn't Worth Losing Friends- Ask a Bush or Clinton

I want everyone to take a deep breath and realize one thing as we enter the last week of the Presidential campaign.

To the politicians, it’s just a game, folks.

And if you take this stuff too seriously and end up fighting with your brother, your neighbor, your church, or your friend, you are a sucker, falling for the bait- hook, line, and sinker.

Need proof? Look at the many entrenched Republicans who, after decades of framing the fight against Democrats as a matter of life and death, are now admitting that Hillary more closely reflects their views than their own nominee! Look at political operatives James Carville and Mary Matalin, a diehard Democrat and firebrand Republican, respectively, who have managed to stay married despite backing totally different candidates with profoundly disparate agendas. And there’s the almost-too-cozy way the Bushes and Clintons have combined forces, even though the elder Bush referred to young Clinton as a “bozo” when it was his job on the line.

It’s a game, folks.

Other countries, especially the European ones, learned this lesson a long time ago. People in Britain or Germany don’t even talk about politics in public; it is beneath them, a separate part of society fit only for bureaucrats and bloodsuckers. Other countries tend to vote for party over personalities; their citizens tend to leave the muckraking and the scandals to the politicians.

It’s a game to the politicians, folks.

I know, this is your final chance to turn America around. You are worried about jobs, healthcare, ISIS. This is a landmark election, even though the political parties say every Presidential election is a landmark election. And even though this country has serious issues facing it, our nation is bigger than any one politician. Although a strong leader could definitely aid in the turnaround, be assured it will take a lot more than a Hillary Clinton or a Donald Trump to ruin what this country has built over centuries.

And surely there is no politician who perfectly mirrors your ideals and beliefs. I may like a particular candidate, but there is no candidate that speaks for me on every single issue. And there is no candidate on Earth that would matter more to me than a good friend, a trusted neighbor, or a valued patient.

Because guess what, everybody? The very next day after the election, those 2 candidates have already made up and exchanged pleasantries, while you are now no longer on speaking terms with your spouse, patient, or client, all because of some politician’s “talking points”. Don't let this happen to you! 

It’s a game, folks.

Maybe not to you and me, especially when we think about the future for our children. But to the professional politicians out there searching for votes, it is most definitely a game, no different to them than a college football contest, or a vote for homecoming queen. And it’s certainly no reason to disown friends, family, or neighbors.

In preparation for election season, I spent the evening decorating the office in alternating Democrat and Republican motifs. As I was preparing the Democratic room, I remembered the prosperity of the Clinton era, the promise of the Kennedy years. And as I was sitting in the Republican themed room, I could not imagine any American slandering such great Republican leaders like Abraham Lincoln or Ronald Reagan. Sure, we may not always agree, but we can all admit that no one party has a monopoly on leadership. There have been some truly remarkable Presidents from each party, on that we can all agree. And somehow, when the other party won, the republic survived. Imagine that.

So remember this when you are talking to neighbors, colleagues, guests. Be respectful, and be aware of all the inspirational leaders-both Democrat and Republican- that have helped make this country the greatest nation on Earth.

The Greatest American President?

     As a junior studying abroad at the University of Wales, I was so glad to find an interesting politics class to take amongst all my required chemistry courses. The class in question was a political science class about post-WWII American Presidents. Wow, I figured, a class about something I've actually experienced! Should be an easy A, right?
     Unlike American colleges, the British university system prefers to inundate its students in intensive lectures with one final exam at the end of term, as opposed to grading homework, quizzes, and multiple tests during the semester. So as the end of the semester approached, I received the topic of our final exam essay-who was the greatest post-WWII American President, and why?
     In a small class with about 15 Brits, I figured this essay was working to my advantage. After all, I and 2 other American exchange students in the class had actually lived this history. To the Americans in the class, there was no research necessary; the answer to the question was obvious.
     Because of the small size of the class, it was customary for the professor to pass out the essays and have each student defend their work. The professor, a pleasant British scholar with a love of all things John F. Kennedy, asked for a volunteer to present their argument. Again, feeling confident that the subject matter was in my wheelhouse, I volunteered to go first.
     I presented my argument on the greatest U.S. President in modern times- Ronald Reagan. I spoke convincingly about all things I remembered and experienced- the release of the Iranian hostages, the resurgence of American patriotism, the strength of the U.S. dollar, the strong economy, military superiority, and the winning of the Cold War. After all, it was 1991, so the fall of the Berlin Wall was fresh in everyone's minds. The other two Americans in the class, a young lady from Illinois and another from California, wrote similar papers and were in agreement with every one of my points. To all three of us, this question was a no-brainer, and we all thought we slam-dunked it. A's all around.
     The British professor pointed to a classmate from Wales, a British poly sci major who fancied himself an American scholar. He asked that student to present his paper and contrast it with mine.
My Welsh classmate proceeded to give his take on the greatest U.S. President of the 20th century- Jimmy Carter.
     I and the other two Americans nearly laughed out loud! Oh, this poor, misguided Brit! How could he have possibly confused the worst President of all time for the best? We considered his position foolish, if not totally indefensible.
     Imagine our surprise as the professor systematically nodded and supported each statement made by his star pupil! This couldn't be! We Americans were stunned. I personally remembered the heartache and pain of the Carter years. I was only 9, but I vividly recall the daily recital of the evening news as Walter Cronkite started each broadcast with "Day number __ of the Iranian hostage crisis". I remember long lines at the gas station and $2 a gallon gasoline at a time when gas was normally under a dollar. I remember my parents' feelings of hopelessness and despair.
How could those years be considered examples of strong presidential leadership?
     According to my political science professor, we Americans were seeing it all wrong. From a European perspective, President Carter stayed out of their affairs. Although unsuccessful, he worked for peace and stayed out of wars. I guess the fact that many Americans were jobless, suffering, and financially challenged mattered little to British lecturers in their ivory towers in Cambridge and Oxford. On the other hand, every British student argued that Reagan was a "nut" who brought the world to the brink of nuclear war. Our lecturer called him "reckless" and mentioned how alot of British citizens did not want to take part in his brinksmanship with the Russians. In their eyes, Reagan endangered the entire world by staring down the Russians. Apparently, they had grown up with a popular British TV show, Spitting Image, that depicted Reagan as a senile old puppet controlled by the military industrial complex(you can see the Reagan puppet from that show in the Genesis video "Land of Confusion").
     In the end, all the Brits who said "Carter" got high marks, and we three Americans who supported Reagan were lucky to get out of there with good grades. Now, be honest, how many of you would have answered the title of this article with "Jimmy Carter"?

Yeah, I thought so!
       

An Antibiotics Cheat Sheet

With so much dubious information out there on the internet, I thought this might be a helpful guide to educate patients on why doctors choose certain antibiotics for them. Any questions, please come and see us- we are always happy to help you!

THE MAJOR ANTIBIOTICS

PENICILLINS (Amoxil, Pen VK, Augmentin)
PROS: These are extremely good for throat infections and dental problems, like tooth abscesses. Because they are broad spectrum antibiotics (they hit a wide range of pathogenic bacteria), they are useful for the numerous organisms that live and grow in less than sterile areas. A good example would be an animal bite.
Very safe, even for pregnancy. Used extensively in pediatrics.
CONS: It is very easy for bacteria to become resistant to these, only requiring one single mutation to convey resistance. Therefore, in certain settings, penicillin drugs may not work (I tend not to use them for ear infections due to 30% resistance).
DO NOT TAKE IF: allergic to penicillin.

CEPHALOSPORINS (Keflex, Omnicef, Ceclor, Cefzil, Ceftin)
PROS: Broad coverage for a wide variety of infections. Good for throat, ear, sinus, even urinary infections. Keflex usually is the drug of choice for skin infections. It is harder for bacteria to become resistant to cephalosporins as opposed to penicillin.
Safe for pregnancy and kids.
CONS: due to its broad coverage, may actually kill your "good" bacteria, especially the stronger agents like Ceftin. When used unsupervised (without a physician's involvement), may lead to C. difficile infection.
DO NOT TAKE IF: Cephalosporins are cousins of penicillin. Patients that are penicillin allergic have a 20% chance of being allergic to cephalosporins. Therefore, as a rule, I do not write cephalosporins for my penicillin allergic patients.

ZITHROMAX and the MACROLIDES (Erythromycin, Biaxin)
PROS: I separate Zithromax out from the other macrolides because it really is the gold standard of antibiotics. These meds can be used for multiple conditions and are very effective for throat, ear, skin, dental, sinus, and respiratory issues. Zithromax is also easy to take, 6 pills lasting a total of 10 days. Great choice for penicillin allergic patients. Hardly anyone has a true allergy to macrolides. Zithromax is safe for infants and pregnancies.
CONS: The other macrolides, especially Biaxin, are known for GI side effects. If you have a sensitive stomach, you may not like these antibiotics. Biaxin is known for its awful taste. Erythromycin and Biaxin also have some drug interactions that may be important. I would not choose these as my first choice for urinary infections.
DO NOT TAKE IF: you get easily nauseated or have an allergy to erythromycin.

CIPRO AND THE QUINOLONES (Levaquin, Avelox, Floxin)
PROS: very effective for urinary infections. Sometimes used for atypical/resistant sinus infections. Effective when used in combination with Flagyl for intra-abdominal infections (diverticulitis). Levaquin is considered our "biggest gun", and we reserve this for overwhelming infections. I tell patients on Levaquin that it is the last resort to keep them out of the hospital. Extremely useful when used in drops for swimmer's ear. Not many organisms are resistant to it.
CONS: a lot of unfortunate and misguided information out there about side effects. In my experience, side effects are encountered more with haphazard use or using the medicines in a regular, nonchalant way. We are very judicious about when we use quinolones. Not recommended for pregnancy. Cannot be taken by mouth in youth. Expensive.
DO NOT TAKE IF: you are a child (ear drops are OK) or if you are pregnant.

BACTRIM/SEPTRA
PROS: One of only two medicines effective for MRSA. Good for UTIs. OK for acne/skin infections.
CONS: may cause a terrible rash in sensitive patients. Requires a large dose to be effective. Not safe for pregnancy.
DO NOT TAKE IF: you are pregnant or if you have a sulfa allergy.

TETRACYCLINES (Minocin, Doxycycline)
PROS: good for skin infections and acne. OK to use long term. One of only two antibiotics that treat MRSA.
CONS: very weak for most other infections. Cannot be used in young children. Makes people extremely sun sensitive. Cause upset stomach. Not safe for pregnancy.
DO NOT TAKE IF: pregnant.

MACRODANTIN (Macrobid)
PROS: good for certain UTIs. Safe for pregnancy.
CONS: extremely weak, not useful for any other infections.
DO NOT TAKE IF: you are a child or if you have any other infection other than UTI, it will not work.

CLINDAMYCIN (Cleocin) AND METRONIDAZOLE (Flagyl)
PROS: both are used topically for skin issues. Dentists love both because they kill the harmful bacteria that grow in the human mouth. Flagyl is used in combo with Cipro for intra-abdominal infections. Very effective in killing what we call anaerobic bacteria (the things that grow in the colon, the mouth, urogenital area).
CONS: difficult to take due to side effects. Not helpful at all for any other infections (most infections in the sinuses, ears, chest, and skin are caused by aerobic bacteria). Not recommended for youth or pregnancy.
DO NOT TAKE IF: you have a standard, run of the mill throat, chest, skin, urine, ear, or sinus infection. These antibiotics are for specific problems only.

A brief summary of the usual indications for each drug:
EAR INFECTIONS- Zithromax, penicillins, cephalosporins
THROAT- penicillins
SINUS (acute)- Zithromax, penicillins, cephalosporins
SINUS (chronic)- Penicillins, quinolones
SKIN- tetracyclines, Keflex, Bactrim, topical clindamycin
BRONCHITIS- Zithromax, penicillins
PNEUMONIA- Augmentin, Levaquin
ATYPICAL CHEST INFECTIONS- Zithromax, Doxycycline
UTI- Bactrim, Macrobid, Cipro
DENTAL-PCN, Clindamycin
MRSA- tetracycline or Bactrim
GI infections- PCN, flagyl plus Cipro
STD- Zithromax, Penicillin
LIFE THREATENING- Levaquin


Presidential Preferences Are A Matter of Perspective

     When I was in medical school, I was a vocal Bill Clinton supporter. In fact, I was the only one. Once I heard the Arkansas governor speak of middle class tax cuts for my parents and his desire to strengthen the family doctor's role in medicine, I was sold.
     Of course, my presidential choice was not a popular one in the Deep South, not even during the Bush recession of 1992. My position was made even worse by the fact that I was surrounded by old-money, conservative, Southern classmates who were the children of wealthy surgeons. In a class of 100 young adults, my view was outnumbered probably 90 to 10. And my position was so unpopular, the other 9 like-minded colleagues (a few African American friends and an Asian American friend) were too afraid to back me up! Often, after I received verbal thrashings from my conservative classmates at the anatomy table, the few closet Democrats in the class would come up to me afterwards and say, "Man, thank you for sticking up for Clinton like that! I'm with you!" Gee, thanks. Why didn't you say that publicly?
     The story gets worse. Later that year, I was in Hattiesburg, Mississippi, eating at a Cuco's restaurant across from USM with my wife. I was wearing my Clinton/Gore shirt, something I chose for no reason- it was the next T-shirt in line. Big mistake in rural Mississippi right before an election. A middle-aged gentleman in line at the restaurant saw my shirt and said in a voice loud enough to be overheard by anyone, "Look at that kid. I bet he doesn't pay any taxes. If he paid taxes, he wouldn't be wearing that shirt!"
     Four days before the election in Jackson, Mississippi, I was able to shake Governor Clinton's hand. Perhaps foreshadowing the way Clintonian politics were to be played, I had to lie and say I worked for a Democrat big-wig in order to get close enough to do so (to this day, I have a friend that calls me "the kingmaker", because when presidential candidates shake my hand, they win. I did not meet John McCain, nor have I met Donald Trump).
     We know how the Bill Clinton saga ended. Within four years, President Clinton's promise of middle class tax cuts had turned into middle class tax increases, his focus on family doctors had morphed into the "gatekeeper" philosophy of the hated HMO insurances (the forerunners of the disastrous Obamacare), and I was earning my first real paycheck as a medical resident physician in Florida.
And darned if that loud-mouthed gentleman in Hattiesburg wasn't right!

Part 2:"The Greatest President of the 20th Century", coming soon.





An Inspirational Movie

I saw the movie Ben Hur recently, and it left a profound impact on me. I left the Breeze Cinema inspired and ready to face the upcoming work week with a renewed passion. My inspiration- a bit player in a Roman drama named Jesus of Nazareth.
     For those of you who have not seen the new version of Ben Hur, the storyline takes place in Jerusalem in Biblical times. As the main players interact and the drama unfolds on the screen, the attentive theatre goer notices an unnamed, unassuming man in the background who appears briefly in multiple cameos. He is seen doing small acts of great mercy, like consoling the grieving, offering water to the condemned and thirsty, even carrying a prisoner's cross for a brief moment. Each time, the act is performed despite the threat of violence from nearby Roman soldiers, and each time, this Jesus of Nazareth is the only person among mobs of onlookers to step forward and offer aid. The gestures are relatively small, and, in the case of the condemned, will ultimately not change the outcome of that person's fate. However, to the individual, this Jesus provided a needed and necessary comfort at the time of greatest despair.
     As a physician, is that not the calling we answer, as well? Are we not asked to provide comfort in times of distress, aid where it is needed? How often in today's society are we sought out just to provide a kind word or a receptive ear? And how many times do we physicians fall short? How often do insurance requirements and schedule delays and office distractions interfere in a doctor's delivery of the simplest of  acts, a kind word or a sympathetic look?
     I know there are many times where I feel I have fallen short in my attempts to help those in need. As a physician, anxiety and frustration creep in from many angles as I assess each patient. Often, I struggle with the reality that someone may have a problem- brain tumor, dementia, liver failure- that has no physical cure or balm. That feeling of failure sometimes clouds a physician's view of what is really needed. Like that no-name carpenter from Nazareth, physicians are in a blessed and enviable position to be able to offer kindness and mercy to those who need it most. My patients going through cancer or illness or divorce may not be in my office looking for a Zpak, a miracle cure, an undiscovered elixir for their terminal disease. The victims that Jesus helped in the movie were not asking the unattainable. They didn't expect someone in the crowd to help them escape or to free them from their captors. All they wanted was a two second respite from their whipping. Or water.
     I hope those of you that have visited me the last 2 weeks have noticed a subtle difference as I start each day remembering the lesson of Jesus. A doctor's help does not have to be heroic or miraculous to be considered substantial. Thanks to this underrated but powerful remake of the classic Ben Hur story, I now ask myself during each encounter what simple comfort can I offer, what water can I provide, for this person in need in my exam room.

A MEDICAL Q&A ON THE HEALTH OF HILLARY CLINTON

SO WHAT DO WE KNOW FOR CERTAIN?
For me, the only things you can take as fact are the actual reports from her doctor and the things we have personally witnessed, i.e., a fall or a fainting spell. Reports from the patient's critics, political operatives, or hangers-on have to be ignored, due to bias or possible false reporting.
Thus, from the patient's private doctor's letter dated July 28, 2015, Dr. Lisa Bardack admits that Secretary Clinton has an interesting past medical history that began in December 2012 with a concussion sustained from a fainting fall. During this evaluation, she was found to have transverse sinus thrombosis, a rare and potentially fatal condition involving clotting of one of the veins from the brain. She has been on blood thinners ever since.
We also know from videos that the patient falls. A lot. We have pictures of Clinton being physically helped up stairs. We now also have footage of the odd incident on September 11.

WHAT IS SO INTERESTING ABOUT HER HISTORY?
First of all, counting the clot in the head, Secretary Clinton has had three known serious blood clots since 1998. Most healthy patients have zero. Patients with such clots usually have an underlying reason for them, i.e. obesity, smoking, autoimmune disease, cancer, clotting disorders.
Secondly, a transverse sinus thrombosis is an unusually rare condition, even among neurologists and neurosurgeons. It is never seen in practice, and is rarely even a test question for certification exams. I have never ever seen a single case of this in 20 years.
There is also the problem with all these falls, and the wisdom of a patient taking Coumadin while falling with alarming frequency.

COULD DR. BARDACK LIE IN HER NOTES?
I guess, but that would not be wise. She could lose her medical license by doing so. Besides, that's not how a physician would go about things. One just simply wouldn't tell you every single thing, omitting the damaging details.

SO WHAT DO YOU NOT BELIEVE?
Where to start?
Her doctor says she tested negative for clotting disorders. Something had to cause these 3 clots. Pick your reason- sedentary lifestyle, occult cancer, autoimmune disease, etc.
Her persistent coughing fits are NOT "allergies".
Her incident on September 11 was NOT "overheating", " fainting", and certainly NOT pneumonia.

WHY DO YOU DOUBT THE PNEUMONIA?
I don't necessarily doubt the presence of a walking pneumonia, I'm simply saying it would not cause the incident in question. Saying someone has pneumonia is an easy diagnosis to put in a press release, and it is something a doctor could say based on clinical findings. But the collapsing incident witnessed on video and the Clinton campaign's reaction to said incident is not compatible with pneumonia. Pneumonia is a severe infection in the lung itself; it is deadly because people can literally become unable to exchange air. Such patients usually display air hunger, gasping for breath, hyperventilating, and turning blue prior to any loss of balance or consciousness. At no time did Mrs. Clinton show any signs of respiratory distress. Nor did any of her handlers respond as if she were not breathing. The cure for respiratory distress from pneumonia is oxygen. Did anyone bring her an oxygen tank? Why would you not get a paramedic or go to the ER if she had a potentially life threatening pneumonia severe enough to cause a fainting spell? Why was she not on oxygen when she reappeared outside her daughter's apartment?

SO WHAT DID YOU THINK WHEN YOU WATCHED THE VIDEO?

I took away several important points.
First, she was held by the arm and propped up on a concrete block until her car arrived.
Anyone knows you don't ask a lightheaded person who nearly fainted to stand up. You lay that person down, or at least let them sit down. 
Secondly, I was struck by the fact that no one seemed terribly alarmed in her entourage. They all seemed unusually calm, as if this was not unexpected. I would think if I attended a public event with pneumonia and all of a sudden got lightheaded, my family would probably panic or at least call a paramedic over. No one offered her water, no one fanned her. no one gave her orange juice or a Snickers bar.
Third, there was a distinct disruption of muscular tone seen as Secretary Clinton was handed from one person to another. She was either too rigid to walk, or too flaccid to stand under her own power. Several things can give this appearance, including vasovagal syncope, hypoglycemia, hypotension, and seizure activity.
The most important point is what happened next. She was taken to her daughter's residence instead of a hospital or urgent care center. Hypoglycemia would have required sugar measurements and lab workup, especially in someone with no documented history. Hypotension would not have improved without IV fluids and medical intervention.
Vasovagal syncope cannot be diagnosed without first ruling out those other 2 things.

SO YOU THINK SHE HAD A SEIZURE?
I believe, given the acuity of the symptoms, the patient's quick loss of tone and balance, and the nonchalant attitude of her staff before and after the incident, the possibility of a seizure disorder has to be considered.
A person with complex partial seizures could have an event with little or no warning. A seizure could potentially render its victim unable to walk or stand. Those accustomed to dealing with a seizure patient would appear nonchalant and unfazed by an otherwise disturbing development.
The handlers of a seizure patient would know not to go to an ER, they would give the victim a shot of Valium and take the patient home to rest. And finally, a seizure patient could magically appear "fine" 45 minutes later with no ill effects.

ARE YOU AN EXPERT ON SEIZURES?
My oldest sister has had seizures since the age of 5. She can talk and be in a seizure, she can watch a movie while in a seizure. She may blink her eyes, she may "fall out", she could smack her lips, or she could repeat the same phrase over and over.
I recognized that video of the Secret Service shoving a limp Hillary Clinton into her vehicle; it reminded me of all the times my family has had to physically place my sister in the car while having a seizure. Legs will not move, knees will not work.

WHERE DO THE COUGHING FITS FACTOR INTO THIS?
I'm unsure. It could be a separate issue. It could be pneumonia. It could be secondary to aspiration, which is when a person inhales food, liquid, or saliva in a period of altered consciousness or impaired neurological function.

SO, DR. RUDMAN, IN YOUR OPINION, HOW COULD ALL THE PIECES POTENTIALLY FIT?
1. Hillary Clinton has some type of clotting dysfunction, as evidenced by her three clots. The cause of the disorder is uncertain.
2. After not being given long term anticoagulants after 2 serious DVTs, she suffers a clot in her head, which causes the first unexplained fainting episode in 2012. This "fall" could have been her very first seizure.
3. Either the fall itself or the clot causes injury to the brain. We know she didn't have a bleed in the brain, or the clotbuster would have killed her.
4. Complex partial seizures and ataxia (balance issues) result from the injury to the brain.
5. These short but disruptive seizures account for some of the odd behaviors seen, including her falls and loss of coordination/muscle tone.
6. Knowing these are short-lived complex partial seizures, her staff decide to forego ER visits in favor of outpatient medication and Valium pens for emergencies.
7. Because these brief seizures can occur at any time, her staff purposely limits her time in public to minimize the odds of a witnessed seizure. Without the benefit of cameras on cellphones, her events would still remain unwitnessed to this day.
8. Press conferences are kept to a minimum to avoid the potential of a witnessed event.
9. The possibility of seizures could also explain Secretary Clinton's behavior in 2015 when she was late returning to the stage in 2 separate Democratic debates.

FINALLY, WHAT WOULD YOU NEED TO PROVE OR DISPROVE YOUR THEORY ON COMPLEX PARTIAL SEIZURES?
 You would want to see actual medical records, not the one page summary provided by Dr. Bardack. You would want to see if Dr. Bardack has prescribed any anticonvulsant medication. It would also be imperative to see all EEGs on Mrs. Clinton since 2012. Multiple normal EEGs effectively squash the possibility of any seizure disorder.


DISCLAIMER
This report is a medical opinion based on the public information available at present. It is not intended to dissuade anyone from voting for a candidate. I have many patients with seizure disorders who live healthy, productive lives. For the most part, these seizures can be well controlled with oral medication. This report is simply an attempt to use medical knowledge to explain in clear terms a series of events that are nonsensical based on recent press releases.

Why We Should Be Your Urgent Care Option

     You wake up and your only child is lethargic and running a temperature of 103.  Afraid for their well being, you anxiously wrap them up and drive them to a place with no physician on duty. The main "provider" there is someone who never attended medical school. He/she tells you your child has an emergency, even though this person has never worked emergency rooms before.
     Scary, isn't it? Yet, in our area, this may be the situation you are facing when you see a random sign that says "urgent care". Often, these centers have no physician coverage at all or employ providers with no emergency experience that are here today, gone tomorrow.
     I would like to offer you a much better option. At Holley Navarre Medical Clinic, your child would see a physician- a board certified one from the Top 15 in his medical school class. I am the only physician here, so your family would always get the same familiar face and service you expect. I am no newcomer to urgent care situations, having opened a brand new urgent care center in Charlotte for the 4th largest hospital in the nation. I have real life experience dealing with trauma and physical injuries, having worked for NASCAR for over 12 years. In the event your child has a serious emergency, it may comfort you to know that I have years of experience working urgent cares in central Florida as well as emergency rooms from Atmore to Chipley.
     Sometimes in urgent matters, a physician has one chance to get the diagnosis right. I have seen life-threatening conditions in the last year as varied as Guillain Barre and pericarditis.
     My practice is listed as an urgent care for all participating insurances. You do not have to be an existing patient to use us. If your regular doctor cannot see you in a timely fashion, you do have the right to see us- today.
    
    

A Star-Spangled Opinion

     If you're watching the Stanley Cup Playoffs on TV, chances are you're hearing some outstanding renditions of our National Anthem. This got me thinking about a recent controversy in my kids' schools.  I guess the schools now have signs in every classroom where students are told in writing they do not have to stand and recite the pledge. Obviously, I assume someone somewhere must have filed a complaint or perhaps even threatened civil action over having their child recite an oath to this country.
     Really?
     Forget for a moment that the Pledge of Allegiance is pretty much a benign statement and non binding. For some, it is said with the same zeal and enthusiasm as "You're welcome" or "Gesundheit". We say the Pledge usually because it's common courtesy for the situation. Let's say you're in a foreign country and asked to do something  pretty benign but unfamiliar to you. Do you refuse on selfish grounds or do you politely go along with your host? I cannot imagine going to someone's home, being asked to remove my shoes, and refusing to do so.
     Now let's look at the Pledge itself. We live in the greatest country on Earth, and we honor it by saying a beautiful and stirring oath to it. Other countries have pledges and anthems, too. Has anyone ever been to Britain or witnessed the Changing of the Guard and found themselves humming along to God Save the Queen? It's not treason or heresy; it's merely a sign of respect for the greatness and historical significance of the country you are visiting. In fact, it's a shame there's no Canadian teams in the Stanley Cup Playoffs this year. Although I love this country and sing the anthem every chance I get (even at ballgames where I'm the only one in the crowd singing), there's nothing like singing O Canada followed by the Star-Spangled Banner as a goosebump-inducing encore.
     Embrace your country and it's heritage. Be proud of the flag, the anthem, the Pledge. It's called respect. I don't believe that's asking too much.

Insurance Q&A

I'm comparing insurance plans. What are copays, deductibles, and cost shares?
Insurances typically try and encourage consumers to have some type of financial interest in their health, either in the form of high deductibles or regular copays. Copays are a regular amount due at every visit. Cost shares are usually a percentage of the doctor's bill the patient will owe. A deductible is the total amount a patient will pay before their insurance will begin paying medical claims.

When is a deductible "too high"?
It depends on the situation. If you never plan on seeing the doctor and just want peace of mind, you may be willing to pay less for insurance and accept a higher deductible.
Understand that this is not without risk. If you pay $5000 a year for insurance with a $10,000 deductible and you incur $9000 worth of medical costs, your total out of pocket medical expenses for the year will be $14000, and your "insurance" that you paid for will not even pick up a single bill yet.

I don't have a copay. Why did your staff charge me $77.77 ?
As stated earlier, today's insurance options range from ones with low deductibles and high copays to ones with no copay but astronomical deductibles. In today's high tech world, most offices can verify your insurance online and know ahead of time whether you have met your deductible. If your insurance tells us ahead of time you have not met your deductible, they will not be paying your bill for that visit. In that case, we do our best to estimate how much your visit will cost.


Has it always been this way? Healthcare is so expensive. I thought I remember not having a copay or a deductible.
Prior to the recent government regulation and involvement in the insurance industry, there were many different plans out there. Some plans offered by large corporations or small businesses had great benefits with little or no expense to the consumer. These so-called "Cadillac plans" were for the most part eliminated by Obamacare. So yes, you may have had a plan at one time with zero deductible and no copay, but those are unfortunately exceedingly rare in today's political climate.

I have insurance from my company, but I don't want to use that. I'll just use my Tricare insurance instead. Is that OK?
The way the laws are written, it is not up to the consumer which insurance they choose to use. The insurance companies themselves get to decide which insurance pays the bill. If you have two insurances, the one responsible for the bill is called your primary insurance. Generally speaking, government sponsored plans (Medicare, Tricare) are always secondary to a private insurance. The exception would be if you have a supplemental plan, which by definition is always secondary to Tricare or Medicare.

We just won't use my other insurance or I just won't report it to your office or to the claim. OK?
Absolutely not. Insurances devote entire departments, especially Tricare, to discovering whether or not you have other insurance that should be billed instead of them. Most insurances also have a statute of limitations to file a claim. There have been cases where Tricare has discovered other insurance was available and asked for their money back from us. If you fail to report all your insurances to our office, you will be personally responsible for the bill.

I'm having a hard time finding a doctor that takes my insurance. I don't understand it. It has low copays and covers a lot of benefits. Why don't doctors like it?
I can't speak for other offices, but the main reason our office  chooses not to accept certain insurances is due to burdensome paperwork. Some insurances, particularly Medicaid, HMOs, and Medicare HMOs, have significant bureaucratic requirements that small offices cannot meet. For example, some plans may want every lab or Xray pre-approved by some faceless bureaucrat. Other plans, particularly the Medicare HMOs, want a patient's entire chart mailed to them so they can have a record of everything single thing you reported or did. Aside from the massive amount of red tape this generates, I personally have a problem with sharing your sensitive and confidential information with every employee of Blue Cross or Humana. In my opinion, your insurance company in Jacksonville should NOT have access or proof to the time we discussed tobacco use, marital strife, or work-related stress. In a doctor's office, we are used to hearing extremely sensitive information that should not be mailed to insurance companies. I say no to plans that ask me to violate your privacy.

I received a bill, but I remember paying at the time of service. What's up with that ?
In some cases, a copay is collected up front and we are notified later by your insurance that you owe other cost shares. There may be a deductible applied to your claim. Sometimes an amount was collected based on the service we expected to provide (simple visit), but other charges were incurred (EKG, Strep test, tetanus shot).

A Small Victory

In my profession, I bear witness to numerous small victories every day. For my patients, it may be another day of sobriety. Another day of being in remission. One less cigarette. One more mile to cycle in order to take off one more pound of weight. Perhaps it's a lower blood sugar on their diabetes screen, another marriage counseling session that a couple has attended, or maybe it's another negative mammogram. Whatever your situation, take the time to acknowledge and celebrate those small victories in your life.