Brother, can you spare a dime ...

... Well, this recession or correction or whatever is hitting people pretty hard.

I'm not going to pretend that I'm some financial wizard or economic know-it-all; I've always been a selfish bastard when it comes to the vagaries of the economy and the GNP et al. I want to know how it affects me and mine. What action do I need to take to ensure I get to retire before I'm old and limbless or let me buy the flat screen TV without having to skimp of necessities - fast food, "man toys" and Peter's shoes.

I thought that by being in the medical field, I was insulated against recessions. Hell, everybody gets sick - everybody needs health care.

Or so I thought.

My clinic schedule has been anemic the last few months; probably only seeing 1/2 to 3/4 the usual amount of patients. My phone and email "in basket" however is overflowing with work.

While some of my less fortunate patients have lost health care altogether, others can't afford the co pays. So instead of coming in for a cold, the medication refills for hypertension, the "itching down below" and the occasional growing lump - I'm getting deluged with people wanting to be treated over the phone or the Internet.

I understand and I can treat sometimes, but most times, I can't - practically (ever have a patient try to describe a rash over the phone? "It's red") or legally (who wants to be the doc who misses the patients signs and symptoms of a stroke because they aren't able to do a good neurological exam?).

Patients invariably get upset and complain about high-deductible plans and that I'm saying they need to come in because I need to pay off my yacht, etc. Or serve my poodle steak tartare.

I empathize, but believe me, I don't have a yacht and my wife's allergic to dogs. Yes, I make a good amount of money but I'm 39 and still will be paying off my student loans (which amount to a nice sized mortgage payment every month) until I''m 50!

I feel the recession too. Less patients mean less income for me. Most physicians are not paid on salary, then get paid according to a compensation package that is based loosely on seeing patients. So, at this point in my life, I'm getting trickled down upon - or is that trickled up? Who knows? All I know is that it sucks.

Getting back to patients who don't want to come in - I had a gentleman, whom I knew pretty well, contact me to complain about belly pain. This is a big, old stubborn Minnesota man who never complained of anything - ever - even after getting shot in the head in the Korean War. We played phone tag with symptoms for days and finally I told him he had to come in for an exam and there was nothing else I could do over the phone.

He reluctantly showed up for the appointment and bitched the whole time. After a few minutes, it became clear that the "belly pain" he was referring to was actually lower chest pain (I guess he missed anatomy class in high school). I got an EKG and a chest x-ray ("doc - this isn't covered by my deductible!") - it looked like he was having a stuttering myocardial infarction probably due to an aortic aneurysm that was slowly rupturing in his chest. I told him we had to get him to the ER immediately and he needs surgery within the hour or he was going to die.

He sighed, looked at the ground for awhile and finally said, "shit ... this is going to fuck my premiums up."

He had the surgery and didn't damage his heart (too much) and is doing well postoperatively, thank god. But if he didn't come in, he would've died. If he came in sooner, he might have saved some of his heart muscle that infarcted.

As stated earlier, I don't know what's wrong with the economy - but for all my reasons, it's gotta get fixed. Soon.


For now, I'm just waiting on my tax refund.