OUR BODIES, OUR MINDS

BY

HARVEY THOMPSON, M.D. "Saving Gay Health Dollar$"

WARNING: The Surgeon General has determined that the Gay lifestyle is dangerous to your health!

At least it's getting expensive. There's $100 for the hepatitis-

B vaccine, $20 for the ova and parasite exam on a stool, $10 for tetracycline tablets or a bottle of Kwell. Then, there's the office charge for the VD culture, an injection charge for penicillin, lab fee for blood testing, etc. And, if you get the new immune-deficiency syndrome, there goes the house and the car... You can't afford to be sick, and luckily, most of us aren't; but here are a few tips on saving your health dollar:

1) It seems ironic, but for outpatient services, stay away from hospitals, especially emergency rooms, where you can't get your temperature taken for less than $50. Unfortunately, too many patients go there for a weekend treatment of a urethal discharge and spend far more than the $22 weekend office visit-which would include medication and followup!

2) Everyone needs some kind of insurance for unexpected catastrophes: the auto accident, or unexpected pneumonia or hernia. If you qualify, the best is a state financial assistance medical program, like California's Medi-Cal. That's free, and covers most everything. For those without an insurance plan and work and who are ineligible for medical assistance, a hospitalization policy is essential to cover major disasters which could wipe out your savings in a few days at the hospital. (If you're a veteran, check to see if there's a VA hospital or clinic nearby.)

Hospitalization insurance is much cheaper than comprehensive policies, because they exclude outpatient office visits and testing. For those occasional expenses, pay outof-pocket, and you'll still save over the added expensive premiums

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Tor cumprehensive coverage.

3) Take advantage of "freebies." If you have more time than money, have VD testing done at county and free clinics; and ask them what other services are available. Some even do stool testing for amoeba and parasites; at a private lab, you'll pay about $20 for this. Watch Gay papers for free or inexpensive hepatitis-B screeinings.

Attend health fairs; often, blood testing is done there at a fraction of private lab cost. Blood pressure checks there or at a shopping center BP machine is much cheaper than an office visit. If you have chronic high blood pressure, buy yourself a cuff and learn to use it; persuade your doctor that you can do the monitoring, rather than return to him for monthly rechecks. I've seen patients on a weekly basis for blood pressure control that any of them could have done himself.

Compile a health folder of all your previous tests, shots, and records. If you move, carry your records and X-rays with you. Tests are often needlessly duplicated because the doctor finds it easier than waiting for old records to arrive. At least, have your records sent ahead to the new doctor when you move. 4) Question authority. Is an annual physical exam necessary? It may seem as American as apple pie, but current thinking is that one every five years is adequate up to the age of 43; from 45 to 60, every two or three years; and, after 50, yearly. However, with the new Gay immune deficiency epidemic, if you're at high risk because of many partners, or the type and place of your encounters, more frequent complete exams are a good idea.

5) Do comparative shopping. Competition will be an increasing part of health care. Call around to see where you can have a physical done at least expensively. Ask before making your appointment what the charges will be, and object if they are more than you were told, If your condition requires the attention of a specialist -a dermatologist or a proctologist, say -make your

appointment at the appropriate office, rather than with a generalist who will only refer you there after charging you for a visit.

6) Avoid needless tests. Don't let an EKG be done as a routine part of your physical if you're young and healthy. This is frequently a gimmicky moneymaker that tells little about a healthy heart. And why the "routine chest X-ray?" Without specific complaint, it seldom adds information and returns as "normal."

7) Know your insurance policy. Many times, reimbursement is missed because the patient is ignorant of coverage, or isn't motivated to submit the bill and insurance form. You're paying for insurance; use it! Save all your medical receipts to reach whatever deductible it excludes. 8) Watch out for quacks. Gay newspapers usually have 3 or 4 advertisers luring your health dollar with unproven treatments. Don't waste money on vitamins if you eat anything near a normal diet; you don't need them. The person who feels best from vitamens is the supplier, laughing with your money on the way to the bank. Beware of spinal adjustments for the low-back pain that we all get from time to time, but which may be shown to you on an X-ray as a "vertebrae out-of-place."

9) Educate yourself. If you have an illness, read up on it. For example, if you know you have hepatitis-A, and that it has no chronic form and nearly always resolves itself without treatment, why go for followup visits if you seem to be feeling better and better on your own? A doctor who is conscious of your financial situation can arrange followup lab tests by phone.

Don't make an office visit every time you have a cold. There's not that much that can be done. But remember, all sore throats should be cultured; just make sure it's a "strep" screen, rather than the twice-as-expensive complete culture mistakenly ordered so often.

Don't spend hours of time and money on herpes treatment. There is still seldom anything that can be done, and the media have blown the

disease all out of proportion.

Be careful of "fad" diagnoses of hypoglycemia, etc., and the latest diet books. Save money on weight loss; simply eat less. There is rarely an organic basis for overweight, and no easy way to lose pounds.

10) Know about inexpensive overthe-counter medical treatments: nonprescription "RID" for your crabs," "Cortaid" and others for poison oak and ivy, and "Sudafed" or "ChlorTrimeton" for hayfever. Don't waste money on Preparation H, a Madison Avenue hype of no effectiveness; better, use hot sitz baths at home, and soften your stool with bran.

Buy the cheapest aspirin possible and take it with food, instead of buying more expensive buffered products. Goos books to read on the subject are "Pills That Don't Work," or from Consumer Reports, "The Medicine Show" and Health Quackery."

11) Find a doctor you can trust. The Gay Men's Health Crisis in New York offers this sound advice: "If you're the average layman, you're a poor medical consumer. A personal physician is the key to sorting out individual health needs.

"You usually should be able to get an appointment with him on fairly short notice. He should return your calls. He should be abreast of developments in his field and loaded with practical advice on keeping your health. When he's out of town, he should arrange for somepne equally competent to see you. More important, he is intimately familiar with your complete history and lifestyle."

Always tell the health care provider of your lifestyle. If he doesn't like it, go elsewhere, since he probably won't know about your unique diseases either. Hundreds of dollars have been spent on barium enemas, upper GI series, etc., for what was only a parasite, easily diagnosed from a stool sample.

12) Keep yourself healthy. Patients who keep their weight down, exercise regularly, and don't smoke, are rarely seen by the likes of me. C Stonewall Features Syndicate, 1982

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