Sometime nice guys finish first

Welcome to you stray readers from the Fat Cyclist's blog.

If you've read a few posts from this site, you may have come across a story in which I deal with a patient dying from a bleeding ulcer. Things go well, I'm able to stop the bleeding, and the patient survives, only to die of something else ten or twenty years from now. And I swear it won't be my fault.

In retrospect it would have been a better post had I not whined about not getting paid for my services; after all, the poor man was uninsured and had had tough financial circumstances. I really did not expect any reimbursement.

My patient accounts coordinator, AKA billings and insurance lady, was surprised to receive a call from said patient. "You know," he said, "I've gotten a bill from everyone involved in my care but good old kindly Dr. Juspasenthru. I'm going to get mad if he doesn't tell me how much I owe him."

My insurance lady told me this and, after she had revived me with smelling salts, submitted my bill which the patient has paid. In full.

To be honest, after that phone call I would have been perfectly content if he had sent me some chickens and some homemade marmalade, like they used to do in the old days.

Cash works well, too.

Survey

Dear Beautiful Fields of Happiness Healthcare Insurance Company,

Thank you for thoughtfully sending me a "participating provider survey" two days after you refused to authorize nutritional counseling for a patient with recently diagnosed celiac disease. Please excuse the writing on the back of the survey, but as all your questions were designed to get a favorable response from your "providers" and you left no space for comments, the back was the only place I was free to write.

I really appreciated your thoughtful response to my letter of appeals (a copy of which is included in my last post). Don't you think you are being a bit too generous for giving me a whole five days to provide you with PROOF that my patient really has celiac disease? After all, I'm only a board-certified gastroenterologist who has signed thousands of documents reminding me that if I misrepresent a patient's illness in order to facilitate obtaining benefits, I've committed fraud and could go to jail. I see hundreds of patients who BEG me to put them on a highly-restrictive diet that they have to follow for the rest of their lives. I'll be damned if I give in to any of them. Let them eat cake, I say.

Once you give in and authorize nutritional counseling for celiac disease, just where would it stop? Counseling for patients with dumping syndrome from prior stomach surgery? Counseling for patients with weight gain before they become diabetics? Crap, can you imagine a more outrageous deal than to try to PREVENT diet-related health problems? What a waste of the CEO's year-end bonus, er I meant to say our precious financial resources.

By the way, your reimbursements suck and certainly don't cover the aggravation your company gives me. Don't come whining to me when you guys tank.

Have a good day.

Translation

Yesterday I had a great bike ride, except for a nasty spill leaving me just a little banged up. In a perverse way I've come to covet crashes; maybe it's because the injury kicks up endorphins that so generously flow afterwards.

The endorphins were flowing at full tilt until I returned to my office to do "admin work", known by some as "stoopid B.S. flung about by bean-counters to prevent patients from getting care and doctors from getting paid". I view it as performing penance to the Lord of the Free Market: it's necessary, but whether it's Evil or not is in the mind of the supplicant.

Recently I had made the diagnosis of celiac disease on a patient. Making the diagnosis gives us a warm and fuzzy feeling; with proper treatment, which consists of a very strict wheat-free diet, patients live full and healthy lives. The flip-side is also true: without proper treatment, the patient develops all sorts of bad things and can die a miserable death. Making the diagnosis and getting it treated is definitely a "win-win" situation.

Unless you're a bean-counter for the Beautiful Fields of Happiness health plan. A short while after scheduling the patient for a meeting with a dietician, we received this letter, which I am embellishing, but not a lot:

Dear Profit-loss center, AKA Healthcare Provider:

We will not cover your request for our client to receive Dietary counseling for his celiac disease. If you would have looked on page 127, paragraph 4 of the patient handbook and explanation of lack of benefits, you would have noted that dietary counseling is approved only for type II diabetes mellitus. Whatever celiac disease is, (we don't have time to look that crap up, we got a business to run here, you know) it does not appear to be type II diabetes mellitus. If you or your client don't like it, you can protest to our appeals board, or send a letter to the state insurance commissioner, or write your congressman, or camp out in front of the president's ranch. We know that if you're like most doctors, you'll lose patience (get it? har har) with it and just let the whole matter drop. We don't give a damn. Now go away.

Early in my career I would take this stuff personally, but know I realize that it's not personal. It's just business. Dutifully I write my appeals letter. I'm providing you a copy, with the translation provided in bold:

Dear BFH appeals person AKA contemptible bean-counter,

I have received you letter refusing to authorize nutritional counseling for my patient and your client. Celiac disease is a type of allergy to wheat to requires the patient to adhere to a strict and complex diet which you would have known if you would have picked up your stupid Merck manual . The standard of care known as things that cost a lot of money to you folks is for patients to receive proper dietary counseling. If they don't receive it and follow the proper diet, they will develop all sorts of gruesome complications and die a miserable death as listed on page 348 of the Merck manual, if you ever get three minutes to look at it.

It would be a shame for my patient and your customer to go through all of this just because of your refusal to authorize the nutritional counseling, not to mention that I don't give a rip if your CEO gets less than a $52 million bonus this year. Would you reconsider this ill-advised decision? You and I know that I'm bluffing here. If all those things bad things happen, you get blanket immunity from lawsuits from ERISA. On the other hand, I can get sued out of my pension.

cc: my patient and his lawyer. We can always hope.

A quick note to the commentary-spammers

Comments (and site-meter hits) are the coin of the realm to us zeta-bloggers. Long ago I gave up on Glenn Reynolds A-listing or B-listing or listing me at all, so hits above 20/day, or even one thoughtful comment on my posts makes my day, engenders warm and fuzzy feelings, puts a smile on my face and a song in my heart, and results in long wandering sentences full of cliches which is what anyone might naturally expect from a doctor.

Hey, if you want good prose, go check out the Fat Cyclist or somebody.

If comments are the coin of the realm, then the comment-spammers are evil conterfeiters. I scan my posts and see several comments, experience a moment of satisfaction for having stimulated considered responses, and then I see that the comments are nothing more than form-letters advertising male-enhancement products and other worthless garbage.

Well, just stop it.

Let be be clear: I do not endorse any male-enhancement product. They've never worked for me. Save your money (OK, I'm thinking of a very funny scene from the Full Monty).

I would also die a thousand deaths, and the tortured soul of each would endure a thousand hells before I would endorse ANY lawyer, trial or otherwise (thanks be to the author of the Kite Runner for inspiring the last remark).

Finally, if I have to tell you once I've told you a thousand times a thousand: quit wasting time on this and get back to your Latin class.

The imitation of self is the sincerest form of vanity

I waste a huge amount of time on the local mountain-biking website. It enjoys a wider circulation than this blog, I'm sure. I would hate to have what I consider to be some pretty good lines go to waste, so they are reproduced below.

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When I see an obstacle in the distance I try to quote to myself what Gen.. Patton would say, at least in the movie: "L'audace, toujours l'audace". But then when I get right up to the obstacle I remember that I can't speak a lick of French, and down I go.

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It was a good ride, folks.

My thanks to Moe, Larry, Curly, and Wolf-Man for breaking me in with my first ever group ride.

It was a bit humbling. I hammered down, faced the fork, ate the cookie, tossed the cookie, and used up some long-saved good karma to enter the Mystical flow and achieve Speed that I heretofore had never Even Dreamed Of. Then I looked up and there wasn't a soul there; not even Curly, who had been anti-trash talking about how much slower he was than I. Everyone waited for me, though, which was very kind.

Yep, I'm that slow. I've gone through Shock, Denial, Anger, Bargaining, and Acceptance of my 'velocity-challenged state'. I can live with it.

The only thing that hurt was someone saying "Yeah, some of your posts are weirdly amusing. You're the one who's always hitting up on (a female MBA member).

No, no, no. I am an adherent to conventional Judeo-Christian morality, and I have Great Fear for the combined wrath of my wife, two daughters, son (the infamous T. wrecks), and numerous other friends who only want the best for me. Any appearance of hitting on anyone is coincidental.

Come to think of it, I'm glad I wasn't accused of hitting up on some MALE MBA member. That REALLY would have hurt. Bad.

And now, a shower, nap, and back to the salt mines.

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A note to all the good trail gnomes:

I for one could grovel in the dirt and kiss your feet, or perhaps buy you a large container of mead or whatever you view as acceptable libation. There has always been an evil little Trail Troll who lives near the Seminary. That little offspring of an unwed mother always grabs at my back wheel when I take the switchback in question with the erosion, etc. More than once I've had to struggle for my life while that b%st%rd tries to drag my bike into it's lair in the creek.

That little bridge was fantastic. Thank you for building it. The next time you gnomes work let me know so I can at least leave milk and cookies out there.

BTW, for the bikers who don't think the sport is any fun unless their life is in danger: hop the fence at the lachrymose Loop and take off down the interstate during rush hour. It will keep you on your toes.

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I've done some careful research into the fancy-dan beers you folks like drinking. Here are my findings:

Berghoff Bock Beer--tastes like beer.

Petrus Triple Ale, in a tiny little bottle that cost $3.59 --tastes like beer.

Arrogant Bastard--I'm saving this for the weekend when I am not on call, as it comes in a very big bottle. I bet this'll taste like, well, beer too.

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I performed additional research this weekend while visiting my daughter in Greenville, S.C., with a side trip up to Asheville, N.C. Here are two additional data points:

Duck-Rabbit Ale--this was a featured ale served at the restaurants of the Biltmore Estates. A product of a Western Carolina microbrewery, it is touted as an autumnal brew because of having bold chocolately/caramel overtones. Just regular beer in which someone working in an abandoned warehouse in Asheville mixed with melted Rollo's? I don't know.

The most striking detail about this beer was the name, no doubt related in some way to the label, which had a drawing of something that looked a little like both a duck and a rabbit. Was the label a result of some private family joke, like the two favorite animals of the brewer's daughter being a duck and a rabbit? Or did someone doodle out a duck-rabbit on a napkin or tablecloth and say "Cool! What a great idea for a name of a beer!" I don't know.

I poured the bottle into a glass and noted the dark rich color. My nostrils flared with both anticipation and apprehension as I wafted in the chocolate aroma. I lifted the glass to my lips, and just then decided that I didn't really like beer. I ordered a diet Coke.

Arrogant Bastard Ale--I've never tasted rat pee, but if you took rat pee and mixed it with PGA, I wonder if it would taste a little like Arrogant Bastard Ale.

A rant consummated

In my nocturnal passion I neglected to mention that I'm planning on writing a book along the lines of Robin Cook or John Grissom. It will feature the gruesome deaths of members of a large corrupt personal injury law firm.

It will be a comedy.

A word from our sponsors

One of the appeals of mountain biking is that it requires total focus. If your mind wanders during a ride, you will find yourself wrapped around a tree or bounced off a large rock in short order. It's a wonderful diversion; on the trails I couldn't ponder our friends, the lawyers, even if I choose to.

In our fair city the buses have been painted to resemble giant milk cartons, advertizing local car dealerships and storm window salesmen. About a year ago one of our personal injury lawyers began to peddle his wares on the sides of the buses, his gentle smiling face beaming from the Breckenridge Special . He is the brother of an excellent local physician so I was willing to overlook this otherwise classless mercantile legal display.

It was soon followed by ads for a much larger personal injury law firm. There is no gentle smiling face on the bus for these gents; instead, they feature a highly paid actor glaring indignantly (probably at some doctor) demanding that justice be done.

Not to be outdone by his competitors, a snivelling little twerp by the name of A.K. plastered his face on the bus's backside, snarling: "Injured? Call A.K., he'll make 'em pay". I have to look at this face every day I drive into the hospital.

There are positions that may be right in some way but are so repugnant that I'm glad I never have to offer justification for them. Who knows, maybe late-term abortion/infantcide is a good thing, or euthanasia, or pedophilia, but I'll never have to worry about prostituting myself in order to present an argument on their behalf. I occasionally receive comments or emails regarding our sacred right to sue to the crap off our fellow man, and maybe this is a good thing, but I'm still glad I don't have to defend the tasteless, classless display of trolling and playing on the worst impulses of people in order to make a living. Lawyers advertising on the side of city buses? No thanks. I'll deal with the nice clean colons of the community instead.

Catching up

I'm back due to popular demand, as defined by one of my daughters (I'm not sure which) and all the person who thinks that, based on careful demographic study, my reader(s) would be interested in male enhancement products.

Mostly I've been too tired to post. On weekends I undertake epic mountain biking journeys which leave me so exhausted that it takes several days to recover to where I can get back out on the bike again. I've been pleasantly surprised; although the only way I can get as good as I'd like is to quit my day job (the defenders of the Public Trust will do everything they can to help out, I'm sure), I have gotten quite a bit better over the last several months.

This weekend my son and I returned to one the first trails we had ridden, a trail riddled with huge roots, rocks, and abrupt Plutonian descents. It is a trail my son had not wanted to travel because it has a reputation of being a hang-out for Folks Who Are Just Like Us, Except That Dark Genetics Forces Over Which They Have No Control Compel Them To perform Oral Sex On Each Other In Broad Daylight In A Public Park (otherwise known as FWAJLUETDGFOWTHNCCTTPOSOEOIBDIAPP).

I'm so ashamed. I've done my best to teach my son about the wonders of Tolerance and Diversity and that the revulsion he experiences over watching men perform oral sex on each other in public places is nothing more than cultural bias. I've obviously failed. I have half a mind to send him to public school where they can properly condition him.

It took a lot of assurances that I personally had never seen any couple so much as read poetry to each other there before I could coax him on to the trail. As beautiful a day as it was, we encountered very little traffic: one trail runner, two mountain bikers, and a bevy of beautiful young women, all of whom had cool-looking tattoos on the back of their right shoulders and were walking angry-looking dogs.

As for the trail, we discovered that with several months of conditioning and gear upgrades, it was no problem to ride up to an imposing obstacle, hop off the bike, deftly lift it up with one arm, and drag it down the trail to safer climes.