Sometimes it feels so hopeless trying to manage paralyzed patients. None of them seem to have physical medicine doctors. Their bladder spasms and muscle spasms are terrible and I am arguing with their insurance companies to get them to physical medicine doctors who can do a better job of managing these issues. Why do I need to argue for a new wheelchair cushion when a pressure ulcer is so expensive to treat? I thought HMOs were supposed to be focused more on prevention. It doesn’t seem that any of them are doing a very good job of preventive care for paralyzed patients.