Firing my doctor

Yesterday I fired my doctor. It felt great.

Last July we joined Kaiser. We had heard endless horror stories about Kaiser but ultimately it came down to money. Blue Shield was costing us about $35,000 per year and Kaiser was going to cost $15,000. Maximum. We figured we could always go elsewhere if we had a problem but that will never happen: Kaiser is giving us excellent care. Astonishing care. Coordinated healthcare that is fifty years ahead of the haphazard treatment we received while managing everything ourselves. You know all the magazine articles about the need for computerized medical records? Kaiser has it, and it works.

But this isn’t the story. I asked my primary to refer me to a cardiologist; Sharon and I met with him for about 20 minutes; I told him his advice was bullshit, and then I fired him.

The cardiologist was a Jewish guy, about fifty, who looked like Paul Giamatti except not as pretty. He walked in to the examination room, introduced himself to us, glanced at my file, and said, “What are you doing about your weight?”

Did I mention that Dr. Pretty was fatter than Paul Giamatti? I should have. But anyway, he said, “What are you doing about your weight?” and I immediately took the opportunity to brag. “I’m really happy with my weight. I was very obese for most of my life and passed 300 several times, but about ten years ago I learned how to get my life under control. I lose about 6 or 8 pounds a year, I exercise regularly, I’ve put on a huge amount of muscle, and relative to my age I’m healthier than I’ve ever been.” I thought it was a great story but the Doctor wasn’t impressed.

“Half a pound a month? Do you want to reach your goal weight when you are eighty? What are you going to do about your weight?”

(Me, weakly) “I’m really happy about my weight. I stopped yo-yoing up and down; I’m wearing the same size pants that I wore when I got married...”

Dr. Pretty wasn’t interested in my recent success. “Are you kidding? You are at severe risk of a heart attack and it might kill you. You need to lose it now, in the next few months. And why aren’t you taking aspirin?”

“I took aspirin for about two years after my heart attack but it gave me ulcers. I figured it was a bad trade-off. And if I lose weight too fast I’ll just gain it back.”

“You had a heart attack?” Somehow the Great Cardiologist had missed that detail when he glanced at my file. He looked again. “And it says here that you aren’t taking Plavix either?” What are you going to do to prevent your platelets from clumping together and killing you?”

Sharon drove me to the hospital twice while I was having heart attacks. She saw me code out once and had to watch through a window as they shocked me back to life with a defibrillator. Now, I looked at her and thought she was the one who would need the paddles. She was turning white.

I decided to stay calm – and purposely sound a little academic. “Forgive me, doctor, but I thought that Plavix and aspirin were contraindicated in patients with a history of gastritis.” He dismissed this argument (and me) with a disgusted wave of his hand.

“Why aren’t you taking any blood pressure medicine?”

“Because I don’t need it. My blood pressure is low - my systolic is rarely above 115 and my diastolic is never above 70.”

“Of course you need it!!! You had a heart attack!!” Actually, I’ve had two and both were documented in my file, but apparently he wasn’t a good reader. And trying to sound academic wasn’t working. “And your numbers weren’t that good. The nurse just read 129 over 79.”

Now, I’m not a cardiologist but those are pretty good numbers. A lot of men would sell their left testicle (or maybe their left ventricle) for those numbers. “I parked about a mile from your office and then pushed my wife’s wheelchair from the car to your office. Two minutes later your nurse took my blood pressure. I think those numbers are pretty good…”

“You had a heart attack! You are at severe risk of another and you need to be on a beta blocker and an ace inhibitor!!!!”

“I don’t know if you read my file (the insult drifted over his head) but I’ve had bad results with blood pressure meds. They make my blood pressure drop too low. I’ve seen it drop to 90/50. My pulse goes into the thirties.”

“Are you using the crappy meters they sell at the drugstore? They aren’t accurate. Throw it away.” I wasn’t winning.

“Actually, I’ve tested myself with two meters and three heart rate monitors. They all agree.”

“Then you did it wrong. And why are you taking Zocor? Why aren’t you taking Vitorin or Lipitor?”

And then I understood. He wasn’t an angry bully; he was an angry robot. He gave everyone the same advice, regardless of the patient’s medical history, lifestyle, or needs. He only knew one way to practice cardiology: throw every medicine available at every patient. Lucky for me he had never read Catch-22 or he would tell me to paint my toes with Gentian Violet.

“I don’t take Vitorin and Lipitor because they have side effects. I maintain a healthy diet so I don’t worry about dietary cholesterol.”

“You should. And do you take fish oil?”

“No, fish is one of my largest sources of protein.”

“I want you to go to Costco and pick up a bottle of fish oil supplements. Take two with each meal.” Apparently Dr. Pretty’s limited reading ability was matched by limited listening skills. “And I want you to purchase red yeast rice supplements and take them daily.”

“What?”

“Get it at a health food store. And you need to take an aspirin a day in addition to the Plavix.”

“I’ll bleed so much I’ll become anemic.”

“Get over it. No one has all those side effects. You need these meds or you will be at severe risk of another heart attack.”

Let’s summarize: The gastritis was in my head and he wanted me to take seven new medicines: Plavix, aspirin, fish oil, a superstatin, red rice yeast, a beta blocker, and an ace inhibitor. Seven drugs, including two that are totally unregulated. Apparently he thought he was treating Amy Winehouse. (If he ever did, he would probably tell her to lose weight.)

Dr. Pretty typed my prescriptions as he talked. “You have to lose weight immediately. What are you going to do about it?” He wanted me to go on a crash diet despite the fact that every crash dieter has failed since Adam and Eve threw away their apple and started Atkins. For some dumb reason I stayed with the calm academic voice.

“Every study I’ve ever read indicates that the only way for obese patients to maintain a weight loss is by losing weight very slowly.”

“Your BMI is 39! 39!!! You are morbidly obese!!!”

And now I must digress.

No one knows how much they should weigh. Everyone guesses. And most people want to weigh what they did when they graduated high school. Good luck.

There is only one popular formula to determine how much a person should weigh: the Body Mass Index. The BMI. It was invented in 1850 by a Belgian mathematician named Lambert Adolphe Quetelet, and it should have stayed in the 19th century along with bloodletting and the Theory of the Four Humours. Insurance companies love the BMI because it says that almost everyone is overweight, so most people get rated and pay higher premiums. Everyone else hates it. The BMI is accurate for just one group of patients: short, slightly built, sedentary women over sixty (I’m serious!) For tall, broad, muscular men who perform a lot of cardio exercise, the BMI is ludicrous. I’m 5’9”, I perform a lot of cardio exercise, and like my ancestors I’m built to pull a plow through frozen Russian tundra. Regardless, according to the BMI I should lose 91 pounds. Seriously. I hate the BMI.

Kaiser relies on the BMI heavily even though most docs know it is nonsense. Ask them, and they all say, “It’s the best we’ve got.”

It’s the best we’ve got???? Didn’t doctors once say that about Gentian Violet?

I founded a software house a couple of years ago. We pecialize in wellness. Custom wellness through software. When planning the Company’s product line I decided we should replace the BMI with a modern algorithm, one that accurately predicts a healthy weight for people based on all the pertinent information we could use. The BMI formula considers height and weight only. Our algorithm considers height, weight, frame, age, sex, activity at work, cardio exercise, strength training exercise - 26 variables in all - then predicts a healthy weight zone for a person. Don't weigh more than this much; don't weigh less than that much.

All this sounds like a medical claim but it is not; our disclaimer says it is for entertainment value only. We don’t need the FDA coming after us. But I do think the algorithm is pretty good. It tells me that losing 32 pounds will make me healthier, but losing more will help nothing but my self-image. Somehow, 32 pounds feels right to me. But I digress. Again.

The purpose of the original digression (in addition to copious horn-tooting) was to make a point: I am a bit of an expert on the Body Mass Index. If someone wants to base a medical decision on my BMI, he had better have some backup. Dr. Pretty had none.

“Your BMI is 39! 39!!! You are morbidly obese!!!”

“Doctor, the BMI says I should lose 91 pounds. That’s bullshit.”

And then he shrugged and said what I was waiting to hear: “The BMI is the best we’ve got.”

And I looked at Sharon, and she shook her head, and I fired him. Maybe Amy Winehouse is looking for a new doc.