 |
 |
JAY, BONNIE and everyone- I knew my answer was going to raise some controversy. I am both stating an opinion and asking questions. I have had to deal with such questions as a physician, a patient, and (until recently) a taxpayer. We have questions to raise as a society given budget constraints. What is the government to do given limited resources? Should everyone who develops an illness that develops a disability that could be treated be put on SSDI? Where do we get the money for research if it is being eaten up by people who "should" be able to be productive? Assuming an individual is able to get relief from an agonist or L-dopa and that prolongs his/her ability to work and function productively by another 3-5 years without immediate unacceptable side effects (recognizing the probability of developing dyskinesia at least with l-dopa use in the future) is it the government's responsibility to fund him as disabled? What happens in the system when this is adopted as a general principal for all illnesses? If a person refuses low-risk surgery or medications that can relieve any condition and cannot work should social security provide disability payments to that individual since their disability is partially "voluntary". Jay, in your case you were given SSDI with what in my view was inadequate. You are under a physician's care who shares your philosophy and therefore you are receiving disability payments. Jay, in your case you were given SSDI with what in my view was inadequate. To take this out of the realm of PD for a moment and into analogous questions I have had to deal with as a physician, I present a hypothetical but very plausible example: As a psychiatrist I see a patient with a moderately severe clinical depression who after a trial of ST. John's Wort and vitamin therapies prior to seeing me says she is philosophically opposed to antidepressant medications (which have about an 80% chance of helping). I inform her that my recommendations include an antidepressant and psychotherapy but I will go along with her wishes and omit the medications for now and we start psychotherapy. Over the next 3 months her symptoms become worse. Because of her depression she takes a medical LOA from work with my concurrence. While under less pressure she improves only slightly. She applies for Social Security Disability benefits: The Social security ajudicator should: A. Recognize her right to receive any medical treatment she chooses and since she legitimately can't work with the degree of disability she has grant her funding. B. Ask me (the psychiatrist) whether the patient is complying with my recommendations and do I feel that she has a reasonable chance of improvement if she would accept the antidepressant. I reply I think that if she took the antidepressant she would stand a substantial chance of recovery with minimum risk of side effects. The disability claim is rejected. C. Same as in B but wanting my patient to get the best financial settlement she can I omit my medication recommendation. The adjudicator knowing the statistics on recovery from depression requests an independent medical exam. The independent psychiatrist recommends antidepressant treatment. Since as the attending physician I did not strongly push antidepressants (But was not against them) the claim is granted D. Same as C but since I was not doing what was the generally accepted standard of care, reject the claim on the basis of inadequate treatment. And taking it a step further- let us assume that the patient has been on several different antidepressants without response. Since the most effective treatment is Electro Convulsive Therapy and that had still not been tried- and clinically there was reason to believe it might work for this patient should she then be denied benefits. It is our tendency AS PATIENTS to take the side of the maximum choice for the patient whether it relates to disability, or health insurance. In a recent post I came down on the other side supporting a patient's need to be hospitalized. I rebel against the bean counters until I realize that we have a rapidly dwindling store of beans. Then I think that I need to do my part to conserve those beans without letting anyone go hungry. I am interested in other's views on this area. Charlie Jay A. Henkelman wrote: > > >HI Bonnie, > > > >I have comments on the 45 yo man who has chosen not to take PD meds > and > >is applying for SS disability. It certainly is his choice as to > whether > >he takes meds but the society has the right to set the qualifications > >for disability payments as for the patient to be cooperating with > >generally accepted medical treatment. This man likely could still be > >working (and much more comfortable and functional) if he was taking > an > >agonist or l-dopa. I don't think he has the right to expect society > to > >support him financially if he refuses generally accepted treatment > and > >then is disabled because of that refusal. > > > >Charlie > > > > > >Bonnie J. Rupert wrote: > >> > >> Hi everyone, > >> > >> I have 2 questions from Support Group members- > >> > >> There is a young gentleman in our support group who has been > diagnosed > >> approx. 5 years and he is 45. He has never taken a medication for > >> Parkinson's -- He believes in vitamins and herbal therapy. His PD > is > >> interfereing in his daily life. He has applied for SS Disability > and > >> has > >> been turned down on the basis that a doctor decided he "should" be > >> taking > >> meds. Do we not have a choice how we treat Parkinsons? He > certainly > >> has > >> no medication side affects. > >> > >> Also, there is a Lady in our group who is elderly and her concern > is > >> that > >> her left foot freezes - sometimes her right also. Her question is > what > >> are some of the ways people handle this. She also has trouble > backing > >> up > >> and she would just like some input. > >> > >> Thankyou > >> > >> Bonnie R. 56/3 > > > >-- > > > >CHARLES T. MEYER, M.D. > >Middleton, WI > >[log in to unmask] TO BONNIE & CHARLIE: > > I find this issue envolving the forty-five year old individual very > distubing as well as perplexing. (my usually absent tremor has > arrived!) A > few of the relevant questions are as follows: > 1. Because a person opts to treat a disease via holistic therapies > including > vitamins and herbs; Does this negate ones disability? > 2. As a requiste for a SS disability award, should individuals > diagnosed with Parkinsons be mandated by government to consume > specific > drugs? Does this same government offer to pay for the cost of these > drugs > of $150-500 per month? > 3. Must we be limited in our treatment options and/or philosophies > as a > condition for receiving SS? > > The irony here is quite simple. I have had symptoms of Parkinsons for > 7+ > yrs and although I didn't apply for SS until approximately one year > ago, > I'm currently receiving SS disability. The only drug that I take is > dyprenyl along with my herbs and vitamins. My physician is letting me > make > the choice as to whether I want additional medication, ie; sinemet or > an > agonist. Our philosophy being that sinemet has a limited span of peak > theraputic value and then all the > "stuff" starts to happen. After all, sinemet has always been > considered by > mainstream medicine as the last line of defense. If so, doesn't it > make > sense to hold off as long as possible especially when questions remain > unanswered regarding sinemet. For readers clarafication, I have some > serious manifestations including equilibrium, gait, bradykenesia etc. > > Lets pray for a cure & each other! > > Jay Henkelman 47/7 > [log in to unmask] -- CHARLES T. MEYER, M.D. Middleton, WI [log in to unmask]