Monthly Archives: December 2013
The insanity of it all.
A team of four residents (maximum of two at a time in 12-15 hours shifts at the hospital) and an Attending/faculty doctor cares for our family medicine patients when they are hospitalized. Other services have other team structures. Our patients come from our clinic and a number of satellite clinics and are adult medicine patients, women in labor, new moms and their newborns, and some women with prenatal problems requiring hospitalization. The residents are first year (interns) and senior (second and third year). Our residents are generally smart and attentive and work well with our patients, treating them as individuals with lives outside the hospital and with careful management of the reasons they are in the hospital. They do a good job running between laboring and delivering women and our very ill internal medicine patients.
Recently when a friend was the attending on the service, a patient with complex medical and psychosocial concerns was admitted. The team created the time and space to really unearth some of the underlying physical and social challenges faced by this patient. This led to a carefully orchestrated discharge plan, including where and when she would be seen for ongoing care and what elements that care might contain.
Once again our health care system snatched defeat from the jaws of victory. The patient’s insurance covered our hospital, but it turns out it did not cover being seen in our neighborhood clinic, which is part of the same health system. The patient did not get the necessary outpatient care and was readmitted to the hospital.
Last night I heard that one of the major insurers in this area dropped a contract with a major hospital that is used by many physician groups. Instead they are contracting with another hospital that has its own multispecialty group. Now all the medical groups who have used the other hospital are rushing to see if the approved hospital will give them privileges to hospitalize their patients. If not, their patients will have to be hospitalized at the approved hospital by doctors who do not know them and whose electronic medical records do not communicate with those of the outpatient doctors from the other hospital.
What has always been clear to me: the insurance companies will keep their profit margins. (Oh yes—hospitals and doctors’ groups want to do the same.) None of this is the recipe for improving health and health status or for curbing health care costs.
The task of trying to provide continuous seamless care for our patients just gets harder and more insane.
Every major country with good health outcomes has lower costs. Take a look at the expenditure tables in this Commonwealth report. Look also at : 1) the tables on mortality from index cancers, 2) hospitalizations, 3) deaths in hospital. For all we spend, we do no better than other industrialized nations spending much less. According to The State of the Worlds Mothers 2013 report, we are 30th in the world for newborn deaths on the first day of life. 30th! The top ten with the lowest rates are Finland, Sweden, Norway, Iceland, Netherland, Denmark, Spain, Belgium, Germany, and Austrailia. Our spot, 30th, is worse than any industrialized nation. Life span, you might ask? We are 48th in the world, despite our spending. Each of the industrialized nations with better outcomes than us also has significant government involvement in setting prices and policy, which our electorate continues to fight.
I am far less concerned with the troubles of the ACA website; gee, my electronic medical record crashes on me all the time when I am up late at night doing my charting. I have to live with it, boot it up again, and still get the job done. Even fewer choices of where to get care is ok with me. That may be a price to pay to get more people covered, at least the way we have chosen to go about it in this country. But if fewer choices and inadequate technology are accompanied by insane lack of coordination of care across locations AND by rising profits of insurance companies, well then, I continue to not understand how Americans can fear a single payer plan.
For my birthday (11/5 if you want to remember it in the future) my son gave me The Happiness Project. by Gretchen Rubin. I thought it was an intriguing choice. With respect for him, I won’t spend words talking about the personality styles of my sons. What I wondered was whether this was something he thought particularly appropriate for me or was it a projection of his sense of self. Fairly soon after giving it to me, he checked in. “So how is the happiness project going?”
That makes the question clear, right?
I have been formally and informally evaluated (by numerous bosses, co workers, students, residents, and patients) as being serious, but with a very in tact sense of humor. I have not been evaluated as seeming unhappy. OK if you asked the 7 full or interim chairs of my department if they think I am happy, I confess I have no idea what they would say or what their criteria might be.
Do you have a clue whether your bosses, your co workers, your friends, your family think you are happy? And if you drew a line from 0 to 100, 0 being morbidly depressed and unhappy and 100 being ecstatic all the time, where would you rate… self rating or by others? I admit to a slight bent towards paranoia since getting the book, wondering how many, like my son, think I will benefit from a happiness project, well any more than any of us could. ( i think we all could, but not at the expense of that which drives us to seek and work for a world that is better…OK, I think it is how to have both.)
I am reading the book. There are great tips. I like the “enjoy the now”, “sing in the morning,” and many more that challenge me. Others I do, routinely. And I guess I am glad. Think of the Eeyore my son would think I am if I were not generous, open to people’s feelings, looking for ways to be off the path, collecting (ok very small that way…two means a collection). I do sing, not in the morning. I need other voices around me to find my part and I don’t have other voices with me in the shower, not that I am opposed to it, just is not there. I think I have done a good job at stop nagging. As for not wanting appreciation: I plead I am human. OK, I will take it on…not being a martyr in the not wanting appreciation, that is hard. I am human. It is a work in progress. I am a work in progress.
Write a novel? Forget about results? OK. I have not written a novel. I have written a manuscript. And I cannot forget about those results. I am carrying the stories of many people, including the 30+ contributors to this work, and feel a responsibility to bring it to print. These narratives need to be shared. What shall I do next to get it there while waiting for replies?
Happiness…I think I have it a lot of the time and it is multi-tasked with the things that weigh on my mind: things out of sync with my values and yet realities at work, my kids’ health and challenges, the fears of waiting for the other shoe(s) to drop, and wanting this manuscript to become a book. In the meantime I will read and find those tips in The Happiness Project that can grow me and maybe reassure my son that I am not Eeyore.
To be clear
Some think they missed not getting here yet, like it was over 11/30/13. Nope. NaBloPoMO got me started. This blog is open and ongoing. It is unlikely that I will post daily, but know I will post. So hang around, comment on prior posts, ask about things you want me to blog about, and keep the stories going.
Loose (but not) ends
This is the end of November’s NaBloPoMo. First I want to thank Seiji Pulmano, a graphic and web designer, son of a good friend, and my son’s high school classmate (go Garfield). Seiji held my hand and helped me set up this site and learn the rudimentary parts of navigating it and then was available for questions along the way. Thank you Seiji!
I say if you are looking for a web or design consultant, Seiji is your man. He can be reached at email@example.com. Thanks too, Rae and Bruce, Seiji’s parents, who gave me the gift of his support.
Thank you all who have come and read these pages, for sticking with me as I muse about things that are important to me. The blog will continue but not like November’s daily post. As I said when I opened the doors here, I welcome questions and topics you would like to discuss.
We talk about the moments in our lives throughout our days— in stories that are written, spoken, and sung in prose, poetry and song. There are several wonderful events in December worth publicizing for those in the area or wanting a trip to the area.
The Moth (Moth Radio Hour, True Stories Told LIve) is coming to Seattle in just a few days, Tuesday, December 3, 2013, at the Neptune Theater, 1303 NE 45th, Seattle, Wa. You can buy tickets here.
On December 15, Sunday, come hear some great jazz/gospel Christmas music by one of Seattle’s best gospel groups, Shades of Praise and Jubilation Choirs. The Map of St. Therese (3416 E Marion, Seattle, Washington) shows it really is on 34th Avenue. (They let me sing with them.)
Then two nights later, on December 17th, The Blind Boys of Alabama are performing at Benaroya Symphony Hall. Tickets are still available. See them here too.
Remember to send those letters to the senators and representatives conferencing regarding the farm bill, live on a food stamp budget, and buy the Hedgebrook cookbook and you will have a great gift that supports women’s voices “authoring change.”
Image from: www.whidbeylifemagazine.org