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Robert B. Howard <[log in to unmask]> wrote well on several aspects of the very important interactions that comprise medical treatment. I applaud your efforts in doing this. I consider the difficulties in accomplishing optimum medical care to be formidable for most, but well nigh impossible for a significant portion of the low income, inadequately educated, often less-than-fully-competent Parkinsonians and otherwise ill elderly persons especially. The divergence of income range has worsened exponentially (see my home page for more on this if you wish) - and the elderly poor have insufficient income to obtain medical care that is appropriate. I will try to limit the rest of this commentary to one aspect. Bob wrote: <<One thing has become clear to me in the past decade as a CG, however, is that doctors see chronic disease patients as a series of snapshots: "This is the way a PD patient looks (today)" - "This is what diabetes is like (today)'.Some patients exaggerate their symptoms., others minimize them. Some do both at different times. Earlier in the course of my wife's PD, she put on a "really good show" every time we would go to her neurologist. She would seem just great, tell about cross-country skiing, etc. to show that she really didn't have bad old PD. An hour or two later, she would crash and guess who would have to deal with the reality - naturally the CG. I have concluded that the chronic disease is not really a series of snapshots; rather it is a movie, moving sometimes slowly, sometimes rapidly, but always inexorably to its denouement. There is no way for the doctor to see this movie -really see it- unless he/she is the victim or CG.>> I will add that the patient and doctor often "spar" with each other in challenges - and have too much agenda by orders of magnitude for 15 minute treatment time allocation. Perhaps some strawman protocall document for improving the visibility and understanding of chronic neurodegenerative and gerontological losses of mental and physical competences could be a project of some of us in this forum or self-help support groups. The availability of clarifications about obtaining optimum and appropriate medical treatment to nurses, doctors, hospitals, clinics, insurers, patients, and patients-to-be could improve efficiency and reduce waste. ron 1936, dz PD 1984 Ronald F. Vetter <[log in to unmask]> http://www1.ridgecrest.ca.us/~rfvetter/