Archive for November, 2010

In light of all the political garbage recently purporting to save American healthcare, I propose that we have the power to save ourselves. Being only partially employed while I go to school, I have no employer backed health insurance, and even when I did, the insurance was still expensive and left a lot to be desired. It started me thinking.

Health insurance should be like other types of insurance, it only covers the disasters. Does your car insurance cover oil changes and windshield wiper fluid? Would you want to pay a higher premium to cover those types of expenses? I would think not. Does your homeowner’s insurance pay for cleaning supplies and new lightbulbs? Of course not. So why do we expect health insurance to cover the little dribs and drabs of regular healthcare?

I have bought insurance through one of the major companies with a $1000 copay, and coverage for hospitalization, and emergency room care that involves a procedure like splinting or admission to the hospital. It costs me about $133 dollars a month, though I am sure that is going to go up when the health care “reform” starts to take effect. I did however, have similar coverage before with another company and when they raised the rate to $180 per month, I switched. Granted, I have no major health problems, even at my age of fifty+. However, I do take care of my health, I don’t smoke, try to maintain my weight at a reasonable amount, and don’t use any chemical substances as happiness substitutes (Alcohol included. My consumption of a glass of wine at a holiday dinner constitutes my drinking).

So, people I talk to say, “Oh my goodness, how terrible, you don’t have access to regular healthcare!”.  What CRAP that is! Of course I do. It’s called patient managed healthcare, or PMH. This is how it works.

I wake up one morning and I have a pain in my right side, bad pain. It doesn’t go away for a couple of days. Okay, this needs to be taken care of. I call my family doctor’s office. Note: I did NOT go to the emergency room. Emergency rooms are for emergencies, like gushing arterial bleeding, heart attacks, strokes, knife sticking out of your back. Stuff like that. Not diarrhea, the flu, a pimple on your butt, a cut on your finger, or a headache. Getting back to the story. I call my family doctor’s office, make an appointment for later in the day.

Some people will say, I don’t have a family doctor, or my doctor would never get me in the same day. This is where the PMH comes in. Several years ago, when I first moved here, I asked around for a recommended MD in the area. I went to the one suggested, tried him for a while, didn’t like him, fired him. Next, I asked nurses where I worked for a recommended doctor. (Nurses are the best ones to ask…) A couple of names came up. I called the offices of those doctors and asked to interview the doctor before I signed on with them, one refused, the other agreed. This doctor let me come in that day over his lunch break to talk. Definitely a good sign..we talked for quite a while, negotiated our health care agreement and Bingo, I had a family doctor. The negotiations included the fact that I am a bit stubborn, like to do things a certain way (as few drugs as possible for example, and I like vitamins, etc.) and am not the type to blindly follow directions. He, bless his heart, was good with that and agreed to discuss options with me for every problem, and let me do it my way if it was within his parameters of feasible care, and we would switch to his way if mine didn’t work. I LOVE this doctor. Over the years, I have stopped arguing with him and I trust him now completely. I pay him a reasonable fee for a visit depending on the length of the visit, usually around $50-60. He also has open scheduling so that there is always an opening if I am ill and need to be seen that day. All good.

So, I go to my appointment, he listens to my presenting complaint and history of current illness. A physical exam follows. The differential diagnosis includes the possibility of a kidney stone. The normal route for a kidney stone is a urinalysis, a CBC and a CT scan. The urinalysis is done in the office. The CBC is important since it will tell us if there is an infection somewhere, so that is a must.

The CT scan is expensive, but in the negotiation, we decide the CT can wait, the CBC can’t. The urinalysis did not show blood, which decreased the chance of the kidney stone, but does not rule it out. I went to the lab across the way and got the CBC, it cost me $23.85.  I went home with a strainer and some samples of a med to help the ureters relax to help pass the stone. If the stone didn’t pass, or the pain got worse, then we would have to do the CT scan.

Luckily, the pain passed, and if the stone did, it was very small and I didn’t catch it. The total cost for this illness, including the lab, was around $125. If it had been done the usual way, it would have been thousands in ER costs, CTs, etc. Since I was in charge of it all in partnership with my own physician who knows me, the cost was minimal.

The bottom line: each individual should have a HSA where they put, say, 1-2% of their income from day one, have insurance only for catastrophies, and have a family physician or family nurse practitioner that they have a good working relationship with, and a sense of responsibility for their own health and health care. The price of medical care would drop like a stone. If labs, hospitals and imaging places knew everyone was shopping around and paying CASH, good old capitalism and market influences would do their magic. The other bonus is the large reduction in costs for the physicians, with the massive reduction in paperwork.

Oh, and get the fricken lawyers out of healthcare: TORT REFORM. Please! I know that this isn’t the total answer, but it would be a starting point. Some other people are getting the same idea though, see  http://www.faircaremd.com/about_us    http://www.patmosemergiclinic.com/     

There just has to be a better answer than the monstrosity the government is trying to foist on us. My mother just moved back to Europe, the model of socialized medicine we are supposed to emulate, and told me she could not get her colonoscopy or other screening tests there because “they don’t do those screenings for people over 70 years old. They save that kind of stuff for the younger people, because there isn’t enough money.” My mom is over 70, what happens if she gets sick? I shudder to think.


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In general, living in Florida has some bad points for someone who was raised in a more northern clime. Excessive heat and humidity for 6 months of the year have me hiding indoors in the A/C. I spend my time obsessing over the weather channel’s tropical updates as one tropical system after another forms in the Atlantic and comes our way. Anyone living down here knows what the “cone of uncertainty” is, with uncertain being the operative word.

Every now and then, though, there is a certain moment that is pretty spectacular. The bald eagle swooping down and catching the fish in the lake behind our house was pretty cool. The alligator lurking in the same lake looking for a doggy snack, is not so cool. The bird life here is fantastic.

Gators in the river nearby

I had a really nice moment this week. I was laying in bed reading a novel (yes, I have time for a novel again now that my clinicals are done for the moment, woohoo!) and a wonderful perfume wafted in through the window. My nightblooming orchids were blooming, wow. These orchids have a small and delicate looking white flower and release a perfume at night only.

One of the really cool things about Florida is the ability to grow orchids in your backyard. They turn out to be quite tough plants and give you a lot of pleasure for minimal work. A friend described how to grow a type called Dendrobium: get a giant pot, fill 2/3 full with non-melting packing peanuts, then top with orchid bark, place in a slightly shaded spot, add the plants and water when you think about it. The result:

I love to sit out under our pergola (built by my husband and stepson) and enjoy the view. There are perks to living in the subtropics. As a matter of fact, I think I will go out there for a while with some ice tea and enjoy. I feel bad for those who are in blizzards right now. I’ll get started on the Thanksgiving stuff in a little while.

Happy Turkey day everyone.

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Actual studies that money was wasted on:

  • Gaining weight increases risk of heart disease: I thought we knew that already?
  • Heavy drinking is linked to impulsive behavior in teen boys: Do ya think? How about the girls?
  • Sex and alcohol drinking more common in kids who dislike school: No, really?
  • Smokers with breast cancer have a higher risk of death: duh.
  • Study finds heart health benefits of taking chocolate in women over 70: Okay, but what about women under 70?
  • Study links excessive texting (over 120 per day) with sex, drugs and alcohol in high school students: I have a couple of issues with this. I would consider 10 or 20 texts a day as excessive, and if you are sending over 120 a day, when do you have time for sex, drugs and alcohol, not to mention school? Does this mean if you take away their cell phones, they will stay away from the sex, drugs and alcohol?
  • Children of deployed parents have more stress and behavior problems: this is sad, and obvious. I would have preferred this money to be spent in ways to support these families.
  • Sugary drinks may increase risk for diabetes and metabolic syndrome: I think this has been common knowledge for quite a while, no?
  • Brain tumor risk reduced in those who drink at least 3 ounces of tea or coffee a day: Cool, with the gallons I drink everyday, I guess I won’t get brain cancer, 🙂
  • Dog fleas jump higher than cat fleas: now, there is a truly useful bit of info…
  • Teens who engage in oral sex are at higher risk for intercourse: they had to do research to discover this?
  • Teenagers who play video games spend less time on homework: any mom or dad could have told you that for free.
  • Spraying quinine almost continuously on chickens reduces feather pecking: the importance of this research is staggering

Okay, I am going to go now and have some brain tumor prevention fluid.

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I know the title is not exactly an original, but darned if it isn’t true. As my readers know, most of my previous experience has been with older folks, and hospice patients. Now, as part of getting my Family Nurse Practitioner certification, I am in the pediatric rotation.

Of course, it had to be the first rotation. Downright scary. But after 12 weeks with the little munchkins, and it doesn’t seem quite so scary. Lots of sore throats, ear aches and rashes, with a dash of constipation, picky eating and temper tantrums thrown in for variety. I can handle that.

The best part was, you never knew what would come out of their mouths at any given moment. One little tot loudly announced to everyone in the waiting room, hallway and exam areas: “My mom is having another baby!” Mom rolls her eyes and sighs, secret’s out.

Another little gal pointed at my Mr Long Ears and said “I am going to have a stepostope for Christmas.” I asked her if she was going to be a nurse or doctor, “No, I am going to be race car driver.”

I entered an exam room for a school physical on a six year old boy. He was perched, fully clothed on the exam table, a serious frown on his little face. “I will NOT take off my clothes.” Mom and I came up with the idea that I would take the cooperative sister across the hall for her physical, and Mom would try to pry the clothes off the recalcitrant one. When I returned, he was crouched in a little ball with shreds of paper gown fluttering all around him.

He glared at me and said solemnly “I am a MAN, and no-one is going to see me naked!” After a little persuausion, he finally allowed the exam, but when I felt for his femoral pulses (in his groin) he yelled “THAT is what I was talking about!” I could hear some snickering coming from Mom, but she was able to keep from bursting out.

One boy’s name was William, I asked him what he liked to be called, William or Bill or what. He said “My name is Bill, but Dad calls me pain in the ass.

Oh, I gotta go, I just saw a bald eagle swoop down in our lake, I think he caught a fish, so cool!

He did!

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