17 Jan 2009 06:29 pm

Writer’s Block Jan 17

Jan 17, 2009

Health Care Reform and Sciatica Recovery


Okay, you’re correct, sciatica has nothing to do with health care reform, but it’s been such a busy month that I’ve decided to give you a tufor… that is two blog posts for the price of one. Both are short and I promise to get right to the point.

First off, since the theme for Grand Rounds this week is Health Care Reform, I will start with that one, which I have aptly named…

Part One: Health Care Reform

I don’t know about you, but I’m not too enthusiastic about what some would call socialized medicine, however, it looks like we’re going to get a national health care plan whether we like it or not. With that in mind, let’s hope they come up with one that’s not a bureaucratic nightmare.

Naturally, the ultimate goal of a national health care plan would be to lower costs while maintaining and improving quality of care. With that in mind, here’s a brief shopping list of what I’d like to see as a consumer.

I. A National Health Insurance Policy

The ideal plan would include the following points:

  1. It should be optional, not mandatory
  2. It should be affordable so that most will purchase it
  3. Its main purpose should be to cover major medical expenses
  4. Minor expenses such as routine office visits, etc., need not be covered or could be a secondary optional policy (a rider) with some form of deductible or co-pay provision

Having two separate policies would allow major medical to be less expensive. Furthermore, two separate policies would allow for independently adjusting rates to match the cost of each area of coverage. Major medical would not have to bear the weight of routine care and vice versa.

II. Malpractice Tort Reform

Perhaps we should also have a national medical malpractice insurance program.

Key points would be:

  1. Coverage for lost wages and medical-related expenses only
  2. Create a victim’s fund that cannot be used for any other purpose
  3. Eliminate punitive damages in malpractice lawsuits

To clarify that last point:

Suing an insurance company for punitive damages amounts to whipping Paul because Peter did something wrong. The errant physician suffers punitive repercussions from the malpractice suit itself.

The public is not served by attaching a monetary value to some esoteric concept of punishment. We consumers end up paying the cost in higher health care expenses.

Eliminate punitive damages and you will eliminate the incentive to sue for profit. Frivolous lawsuits fueled by greed or other ulterior motives would be greatly reduced.

Cutting the burden of malpractice insurance would have a major impact on cutting health care costs.

III. Medical School Student Loan Reform

Student loan repayment should be waived for any medical student that agrees to serve a certain number of years in primary care upon graduation.

Key points:

  1. Medical students could simply apply for a “primary care” deferment upon graduation, which would become permanent after serving the required number of years in the field
  2. Taxpayers would not fund students who fail to become primary care physicians
  3. Physicians would still have the flexibility to change their specialty if primary care turned out not to be right for them

The above scenario would not change the educational process and would provide students with the flexibility to choose a specialty in the usual manner while still offering an incentive for those desiring to enter the less lucrative field of primary care.

IV. Serious Medical Intervention

Lastly, I think doctors should go back to passing out lollipops. I distinctly remember my pediatrician used do this following the exam. The last one I got was green. I felt much better.

Part Two: Sciatica Recovery

Okay, now back to business.

Since I get a lot of email asking for my advice or opinion on the topic of sciatica, I’ve decided to start out the New Year by condensing all of my usual answers into one concise list. Here it is…

Key points to remember when dealing with sciatica:

  1. Sciatica symptoms are caused by a pinched or irritated sciatic nerve
  2. The symptoms will persist as long as the nerve continues to be irritated
  3. There is no time frame for how long it will take to get the bulging disc, bone spur, scar tissue, (or whatever) off the nerve so it can begin healing
  4. Once the source of irritation is removed from the nerve, it will still take a minimum of (an additional) six months for the nerve to heal

So there is no set timetable for recovery. Most find it to be a long, slow — sometimes-frustrating — process.

Rehabilitation is the ideal outcome, but sometimes isn’t possible.

Some rehabilitation exercises may irritate the nerve and have to be modified or eliminated from your program. For example, when dealing with herniated discs, some people find that skipping the forward bending exercises (and avoiding forward bending / sitting postures as much as possible) helps considerably.

How’s that for keeping it short and to the point?

Till next time,


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