Dear Frannie,
Q. I just heard on the news about Peter Jennings' death. Everyone was saying how brave he was up until the end. I can't help thinking that those with chronic illnesses are considered whiners and complainers. Is this the way we are thought of to others? And then today, Dana Reeves announced she was just diagnosed with lung cancer. The Television speaks of how brave she has been. My family doesn't think of me as brave. I guess it makes me feel bad that because although I have don't have a life threatening illness, my illness is invisible.

A. Interesting observation, and a frustrating feeling, isn't it? Chronic illness can be invisible to others. And dealing with illness can be a lonely struggle. It is human nature to question that which one cannot see. It is almost as if our vision of something confirms its truth. This is a reality we cannot change. But what we can change, is how we view things deep inside ourselves.

Instead of seeing yourself as others view you, perhaps it is time to shift your sights on how you see yourself. Do you view yourself as a chronic complainer? Do you see life in a negative light because of your illness? Is that negative energy draining not only from your life, but possibly the lives of those around you?

It's time to see your life in a different way, a sort of paradigm shift. What I mean is, it's time to see the "flip side" of your illness. Do you have a family? Children? A partner? A home? A pet? Do you wake up in the morning and see the sunshine? Or do you concentrate on the chance of rain?

Whether sick or well every human being comes to a point in their life where they no longer weigh heavily what other people think. Some call it maturity. To a certain extent chronic illness speeds up this process. We must take care of us. We must still love our families. We must exist and function. We must eat, sleep and clothe ourselves. And we can search for answers, and ask family members to help with this. But we cannot erode the relationships we have with them with consistent negativity and despair. And yet sometimes it becomes hard to think of our affect on others, we are so busy taking care of ourselves. It is a fine balance, isn't it?

Yes, our pain is important. Yes, our discomfort can sometimes if not consistently be overwhelming. These do become some of our truths. But do not lose sight of the other truths in your life. The ones that make you smile and give you happiness. The ones that make a day a beautiful day. The ones that give you satisfaction for a job well done. It is all about finding a balance.

The media draws attention to famous people going through adversities. Their intent on doing this is to show us how these people deal with them. Famous people however are not in the same situations as most of us are. They have support from not only their friends and families but from the public. And they have resources that most of us don't have. Don't get fooled into thinking you should be handling things the same way, or become envious of all the energy that surrounds them. For most of us living in this world, we must create our own energy. And we do this by loving others, helping others, learning, and seeing the good things in our lives, no matter how bad the pain.

Chronic illness is invisible. Some of us have learned to use that to our advantage. For as you get further on your journey, you don't want other people's sympathy, you want their respect. As you get deeper into relationships with others, you can choose whether or not to reveal your illness to them. This is the flip side of the undiscernibility of chronic illness....you can pick and choose who to share it with. It isn't so overt that you get comments and sympathy wherever you go.

What's the most important, isn't whether or not you think others respect you, its whether or not you respect yourself. You are walking down a path that many people do not reach until old age. You are brave. Your journey means giving up your old life and building a new one. You are learning how to cope with this. And as I have said so many times before, you are already far along on your journey. They will need your help and expertise from your experience, when they will undeniably someday start theirs.

Dear Frannie,
Q. I have a chronic illness and see my doctor just 3 times a year to keep my costs down. I just went to my doctor's office for the first time in a few months and posted on the wall of the reception area and also the wall of the examining room was a note to the patients. It said "Our doctor's time is limited. Please limit yourself to 3 questions for your scheduled appointment."

Is this legal? Can a doctor limit me really to 3 questions and then send me on my way? Or make me pay again to have a 4th one answered? It reminds me of going to the grocery store, and I am not a loaf of bread, I am a human being.

A. Yes, first and foremost you are a human being! And you are smart not to lose sight of that. Many of us have felt like the "loaf of bread" you are speaking of, and unfortunately have accepted that for what it is. Our medical system is broken, and it is up to the kinder, gentler doctors, and the patient consumers to save it. As long as we accept this kind of degrading treatment, it will prevail.

Many years ago I accompanied my husband to an appointment with a doctor whose office posted such a sign as well. I was appalled. With some conditions there are many questions, not just 3. And we arrived at that appointment with many questions. My husband doesn't see that doctor any more. It was our opinion that the solution to this problem was not to limit patients' questions but for the doctor to limit the amount of patients he sees!

I do understand the insurance companies are creating a difficult dilemma for most doctors. In order to compensate for the never-ending paperwork that is non-reimbursable time, a doctor must limit patients' visit time instead. Doesn't this seem to you as a problem between insurance companies and doctors? One that they should be solving together? Instead of finding a solution to this problem, the patient is literally being sandwiched in the middle!

It is my opinion that perhaps it isn't a doctor's time with the patient that needs to be reimbursed better but the time that the doctor spends on the paper work that is keeping him away from his patients and the time they require! Maybe a solution to the problem is for the doctors to bill the insurance companies for the time it takes to do the paperwork that they create! Then perhaps the doctor would be reimbursed for his time on paperwork and would be able to spend more time with each patient, instead of taking on more and more patients to compensate!

The bottom line is that patients need not accept these rules from doctors. You are the doctor's employer. You hire him for a service. If he does not complete the service you hired him for, then I say find a new doctor. To place limitations on something as subjective as "human care," and break it down into something as objective as "time units" is inhumane. When you care for your parents or your children do you break your care down into units of time? Human beings are needy creatures. That is the nature of human service. Both doctors and insurance companies need to define whether they are doing a human service or a mechanical service. And I have been told by many doctors that medicine is not an exact science, so human service is what it appears to be.

The doctors response: I do not agree with posting the sign, but the issue may be that you are reducing the number of visits because of cost, still having the expectation that you have as much time as you need with multiple issues when you do come to the doctor. I think this is likely to lead to a strained relationship because your doctor is scheduled for one type of visit and you may be asking for a different type of visit. The way that our payment system works (don't ask me why) is that your doctor is paid less per unit time the longer he stays with you (diminishing returns?). The response in some doctor's offices is to only see patients for short visits (3 questions) but seeing many in an hour. I do not condone this but I understand where it is emanating from. - Joel S. Levine, MD, FACPProfessor of Medicine and Interim Head Division of Gastroenterology-HepatologySenior Associate Dean for Clinical AffairsUniversity of Colorado School of Medicine

We thank you, Dr Levine for your monthly contribution.

Dear Frannie,
Q. Tell me please, what is the difference between being brave and being trapped? I work full time and I am very very sick. I truly do not feel well enough to be working like this, but it seems to me that I really do not have a choice. I am single. How else would I support myself, get all my meds, etc., if I was not working? What do other patients do? Do they all have spouses or family members to help care for them? Savings to live on? Or what?

A. To all....I would like to hear your comments on this. I am not an expert in this area, and can only speak from my own experiences. However, many patients are put in the position of having to work through their illness because they depend upon themselves and only their income to make ends meet. This is a reality for many of you. Share your insights and ideas and I will print them in my next column.

You might try some of the following:

1. Speak with your doctor about whether or not he or she feels you are eligible for disability options. It is important that your doctor agrees on your physical state and will support you in anything you attempt to do. This is the very first step.
2. Speak with family and friends about what you might be contemplating. It is possible you may have an offer to help you until your disease improves or is cured. When we are ill, asking for help is not something to be ashamed of. This is what friends and family are for. Loving you may sometimes mean helping you. Perhaps a family member or friend can offer you a room in their home, or gift cards for food.
3. Finding a roommate is another option. If your home is large enough, consider having someone rent a room and pay you in either food or rent money.
4. Find out if you have a disability policy on your job and see what it covers, if your doctor supports the fact that you are too ill to work.
5. Contact Social security about the possibility of obtaining SSD, which will give you some income, back pay from the time you quit working and also Medicare coverage. Medicare coverage does help some with prescription medications.
6. Contact drug manufacturers for info on discounts or other prescription medications. There are many programs for those with disabilities that help them to obtain medications on discount or free of charge. Try websites such as www.themedicineprogram.com , www.needymeds.com , www.freemedicinefoundation.com
7. Obtain medications from Canada or overseas. Some medications are actually less money obtained this way.
8. Speak with your doctor about other alternatives. If you are alone, without friends or family, and no one but yourself to depend upon. Doctors are aware of drug programs and medical care programs for those with limited means.

These are only 8 suggestions. But there will still be those of you who fall through the cracks and cannot use any of these. Then what do you do? You can try the following:

9. Talk with your supervisor about working some from home, if this is possible. There at least you will be able to be nearer a bathroom, take frequent breaks etc.
10. Change your work schedule to accommodate your needs. For some, 4 day work weeks help a great deal. For others with endurance problems, part time working might be the answer.

I believe you are both brave and feeling trapped. I know you are feeling like you are compromising your quality of life for a roof over your head. I know this does not seem fair. Keep your eyes opened for possible help or solutions. Don't give up. The answer may not be very far from home. Sometimes it takes time to come up with solutions to complex problems. Sometimes other options appear only when you open your eyes wider. Please believe in a solution and a solution will come. And please stay in touch.