Posts Tagged ‘Family nurse practitioner’

I know I said I was done with writing on my blog, but now I have to put in my 2 cents on the so-called Affordable Care Act, more commonly known as Obama Care. My own health insurance rates have double in the last 2 years so that I could cover my children (which are over 30 and have been on their own for years), and so I could get maternity care and 2 free breast pumps a year (in my 50’s), and so my deductible for the year would be lower….. my husband and I have been buying our own health insurance for years, basically a catastrophic plan which would cover expenses in case we were hit by the proverbial bus or needed surgery, with a $2000 annual deductible. We are both healthy in general, don’t smoke, don’t drink, get a reasonable amount of exercise, eat pretty healthy and try to keep our weight within reason.

I got a notice from our health insurance company that we would have to “transition” to another plan in August, when we are up for renewal. This tells me our plan meets the guidelines, but that the insurance company can get a lot more money out of us with the new plans set up for Obama care. After a little research (went on the now-infamous website) and found out that only one health insurance company is authorized in our county (so much for competitive rates) and it is the one we have now. Checked on available plans, found one equivalent to what we have now, more or less. This is the so called platinum plan, and it will cost us a whopping 4 times as much as we pay now, frankly, more than the highest mortgage we ever paid. The bronze plan would cost us twice what we pay now, plus a $6000 annual deductible and they pay only 60%????? Say, what???? A 40% co-pay??? Where is the affordable part of the health insurance here? When I went on the health insurance company website, the plan quoted to me on the government site actually costs 50% MORE than the government quoted. 

I was hoping at some point to get a knee replacement as my right knee is pretty much crunching at this point, daily Aleve and repeated steroid injections have kept it going. The average cost of a TKR in Florida is about $40,000. So first I have to pay over $6,000 (that is just my insurance, double the cost for both of us) in insurance premiums for that year, then $6000 in deductible, and 40% of $40,000: $16,000. This is not including the PT I will need afterwards. Cost of knee replacement with “insurance”: $28,000 out of pocket plus PT. Uhm, what is wrong with this picture? With my current insurance, I would pay $2400 for insurance, $2000 in deductible, and that’s it.

Bottom line is I will have to pay so much money for “affordable care” health insurance for me and my husband, that we are not going to be able to save any money at all. I would have to save up $20,000 above the cost of insurance for the surgery. We will be reduced from feeling financially stable and able to save money for a “rainy day” to living pay-check to pay-check. WTF!!!!! Did I go to school for over 8 years for this? I am working in a little town for a single doctor, I am not making a huge amount of money. I love my job, and don’t want to go somewhere else to make enough money to pay for the damn health insurance. This is all F-ing ridiculous. To be honest, I have cried over this. I can’t even begin to imagine what it is like for a family with kids and less income. 

We are already getting many patients who have lost their doctors through retirement (recently, all of a sudden) and due to the insurance companies not coming into this county anymore. 

The politicians are so glib and smug, thinking they are able to FIX all of our problems. Well, they FIXED me all right, and lots of other people.

Honestly, when they said this is all about wealth redistribution and not health care, that was the truth.

“The trick is figuring out how do we structure government systems that pool resources and hence facilitate some [wealth] redistribution — because I actually believe in redistribution, at least at a certain level to make sure that everybody’s got a shot.”

Obama, 2008


Well, I make my own shot through hard work, and he is taking it away from me. The shame is, NO ONE is being helped in this restructuring of the government. 


“This is also an income shift — it’s a shift, it’s a leveling to help lower income Americans. Too often, much of late, the last couple three years the mal-distribution of income in America is gone up way too much, the wealthy are getting way, way too wealthy, and the middle income class is left behind. Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America, because healthcare is now a right for all Americans, because healthcare is now affordable for all Americans.”

US Senator Max Baucus (D-Mont.)

Oh, really?

Sigh, I guess I will never get that knee.



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Monday in a rural health clinic is, well, interesting. As in the old Chinese curse “May you live in interesting times”. I am sitting in my little office cubby at the back of the building tackling the teetering pile of charts that have messages or lab and test results to be read, when I hear a panicked voice yelling “We need you NOW!”. Dashing out, I am directed to the waiting area where a young man is laying on the floor and the other patients who were waiting to be seen are backing out the door, wide-eyed.

The man was unconscious, not responding and his breath whistled whheep, whheeeep, wheeep, like a kid with epiglotitis. Oh, crap, he probably has something lodged in his throat. I turn him around to check his airway, and check his mouth and he coughs a little, mucous tinged with blood dribbles out. I put him back on his side. Panicked staff crowd around, “What do we do?” one yelled. “Call 911, get me oxygen and the ambubag!” I replied.


He is still not responding, though the wheeping is slowing down a little, and suddenly stops. “Shit, he stoppped breathing!”, I have a sinking feeling in my chest, this guy is going to die on me. I grab him by the shoulders and shake him. “Don’t you DARE stop breathing!” I yell into his ear. He suddenly gasps a little, with a more normal sound, and starts to come round, his eyes open. He whispers “Anxiety attack”. The 911 crew arrives, just as he is starting to sit up. They ask the story and I tell them what happened. At the mention of the words “anxiety attack”, their interest cools considerably. A staff member hands me the patient’s chart, as they now know who it is. He has esophageal ulcers, asthma and GERD listed in his problem list. I pass this information along to the now bored EMTs. I mention they might want to check his lungs as possibly he may have aspirated some stomach acid, they say “thanks, sure” and out they go.

Two days later, the guy shows up for an office visit with his mom. She thanks me profusely for saving his life. When I asked him what precipitated his anxiety attack, he said “Nothing. I was just driving along and started coughing, I couldn’t catch my breath and then the panic started.” I see on his med list he is supposed to be taking Advair for asthma, and Nexium for acid reflux and the esophageal ulcers. He admits to not taking his medicine, that he didn’t feel it was necessary. I explained that a combination of refluxed stomach acid and bronchial spasms from the asthma had probably led to his coughing and panic attack. His mother gave him the stink-eye and said “I TOLD you to take your medicines!” The guy sheepishly promised to take all of his meds in the future.

Later, a guy walks in with a hospital gown on over his jeans and a hard neck brace on his neck. He hands me a pile of papers which are hospital records from an ED visit last night. The records show he has a transverse C4 fracture, nondisplaced. The story of how he got the broken neck was colorful and included beer, motorcycles and police officers and a total lack of memory about how it happened. There were multiple scrapes, bruises and marks on him, one of which looked like a boot print. Quite a night.

“I was supposed to see a spinal surgeon today,” he tells me. “But, the one I was told to see doesn’t take Medicaid. He said I had to get a referral from my primary.” That would be us. The nearest spinal surgeon that accepts Medicaid is at Shands, which is over an hour away. The patient would have to drive himself. When our scheduler called Shands, they told us they would call back to set an appointment after noon tomorrow. Our scheduler “suggested” that she would fax the referral and the pertinent information from the hospital records now and she would call them first thing in the morning to see what time the patient should show up tomorrow. We’ll see how well that goes. I pointedly reminded him to keep the brace on and not try to turn his head until seen by the spine doctor.

The sad part is, if the hospital had admitted him, he could have been seen by the local spine surgeon in the hospital, had his surgery and it would have been covered by Medicaid.

What is wrong with this picture?



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Well, it is happening. The clinic I work in will be closing its doors soon, partly due to money issues and partly because the physician is retiring, and I am back on the employment search train again. The sad part about this, though the PA I work with is going to try to take as many patients along to the next job (and mine will go with me), is how many physicians won’t take Medicaid anymore. It just doesn’t pay, and the loss of income on each patient, coupled with the impossibility of finding specialists to refer Medicaid patients to, and the restrictions on what we can and can’t order for them, it is not a viable option for a lot of physicians to take Medicaid. On the patients’ side, if they have share of cost, it is often so high, they can’t afford to get healthcare anyway. The whole thing just stinks.

The good news is that there are several options for me and I will not be jobless for long, if at all. The bad news is that things are so up in the air that I haven’t found a lot of emotional space to write in my blog recently, though I did get a new bike, well actually a recumbent trike. An arthritic girl’s best friend! And my dog’s favorite thing, too!


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Sorry I haven’t blogged for a while. I had to make a trip to Europe as my mother as very ill, and did pass away. In a way it is a relief as she had been ill and in pain for quite a while. She is at rest now. My family and I have to deal with international laws about wills and estates, which has taken up a lot of time and energy. Mom wasn’t quite as organized as we would have liked.

Back at home, I am still loving my new job. I get to see all the basic day-to-day health issues. Last week was allergy and sinuses week, seasoned with occasional bronchitis. This week was thrush and cerumen impaction week. There also has been an increasing stream of PAPs, the ladies are catching on to the fact that there is a female provider in the house now. I did request, rather strongly, that I wanted to have the clear plastic speculums (specula?)and not the ancient metal ones I found in the drawer. They complied, thankfully. It is hard enough to peer down a vagina and locate a cervix with the lamp over your shoulder, without also having to deal with old-fashioned metal speculums. This IS a rural health clinic, but I have to draw the line somewhere. 🙂

It is great getting positive feedback. The assistants and the PA and physician all keep telling what wonderful things the patients are saying about me. Someone get a pin, my head is getting bigger. This afternoon, a patient was dropping off his Hemoccult cards (he refused a colonoscopy even though he has a history of polyps), and the nursing assistant said he didn’t look too good. The patient agreed to come back and let me have a look at him. When I walked into the room, he told me “My wife thinks you walk on water.” Well, that is tough to live up to, and I remarked that I hoped I wouldn’t fall off that pedestal, to which he replied, “well you wouldn’t drown if you did.” The hemoccults came back positive x3, his labs which I had ordered the last visit showed anemia. A glance at the last two notes showed a weight loss of 8 pounds in a month, and he was complaining of some vague abdominal “twinges”. I wasn’t able to locate the site of the pain when I palpted his abdomen, but I thought I felt something, well, thick. I told him about the hemoccult tests and the anemia. He agreed to go to GI to be checked out. I told the girl p front to make sure that he got an appointment as soon as possible. I am frankly worried about him.

This afternoon, when I was getting ready to leave, the physician sat down next to me and said “Did you hear about the 85 year old woman you sent to get an ultrasound of the abdomen and pelvis because she had some tenderness and a little vaginal bleeding?” I hadn’t, she had come back while I was away. “I just wanted to let you know that she has ovarian cancer and is getting surgery soon. I am glad you caught that.” Wow.

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A classmate who is a term ahead of me, (well actually she has just graduated and passed her certification exam, too) told me that when she first opened the instructions for the scholarly project, she almost threw up. When I first read the instructions, I felt the same way. It is like a thesis in a nutshell. What doctorate students do in acouple of years, we get to do in 15 weeks. Kinda like reading Harrison’s in 15 weeks (2880 pages)…

Our first assignment was to post our understanding of what the project is:

My understanding of this project is that we are to:
1. Identify and research an issue related to family practice which can improve health care in some way, by changing a protocol or creating an educational tool for patients, as examples.
2. Research this topic through an extensive literature review to determine the latest and best information on this topic, and give reasons why the topic is important and appropriate. We will describe in detail how and where we found the information, and analyze the studies using a research matrix to organize and make sense of the findings, and write a report of the research findings.
3. Use the information to develop an intervention such as a protocol change, an educational tool or presentation or evaluation tool, etc., using a theoretical framework appropriate to the topic. We will find established or create new tools for measuring the outcomes of the intervention plan.
4. Implement this plan and evaluate its effectiveness or impact using the measurement tools.
5. Make a comprehensive presentation of the topic by writing a scholarly paper.
6. Present the entire project to the class via a powerpoint presentation
7. Provide feedback to our classmates throughout.

Oookaaaaay…..I know I can, I know I can…just call me Thomas the train.

Well, they say you can eat an elephant if you do it one bite at a time…

So the first bite is deciding on the topic after voluminous research including only primary sources. Primary sources include clinical trials, case controlled studies, etc. Lots of digging through databases including Med Line and CINAHL, reading about correlation, significancy, variants, samples and cohorts, analysis with various esoteric formulae. A little light reading,  hahaha.  All those mad scientists out there love to write up their research in a way to make you crazy yourself trying to figure it all out.

Okay, one bite at a time, what will my project be about? Let’s try diabetic feet.

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Well, my last term starts Monday. I just got back from a week of vacation in upstate South Carolina, again. We do love it there. I managed to wash and dry my cell phone (we thought the dryer was clumping kind of loud) and so no-one could call me. That actually was kind of nice. We took walks in the woods with the dogs, explored the area and discovered some new things. Generally relaxed and lollygagged (also gained a few pounds, oops). I took several school books with good intentions of doing some reading. Yea, right.

Now, I am home again, faced with the pile of books I meant to do some reading and studying in and the new term looms. I was good today, read a few chapters in my orthopedic book. Orthopedics is one of my weaker areas and I need to bone up a bit. It seems strange that there is only one more term, 15 more weeks. I am so not ready to go out there and BE a nurse practitioner. Emotionally scary, that. I suppose that is how all new grads feel when they go out there, so I will try not to perseverate about it.

My big concern this time is the SCHOLARLY PROJECT…..the dreaded thesis of yore. A classmate who is a term ahead of me stated she almost threw up when she read the syllabus and expectations of the scholarly project. Okay, I suppose that is good to know ahead of time. She did say to really work your ass off the first week to fill in the “matrix” and the rest would flow.  Now if I could just think of a good subject, which is a little hard to do if you don’t know the expectations. I have fiddled with the ideas of diabetic foot care, the shingles vaccine, medication compliance issues and fall prevention in the elderly. 

Last term I was still excited about getting the books and prepping my work space. This term is different, motivation seems to lower. The difference must be pretty much sheer exhaustion, mental and physical, and also the realization that, once this is done, I need to go out there and apply for jobs. Yuk, I hate applying for jobs. In the past, every time I thought I was getting a good one and the people seemed nice and all that, the job turned into a disease. The employer owned you for a salary, and always took advantage. I am too damn old for those games now. I hope that I can find a nice quiet little corner to do my thing, working with nice people who appreciate me. Is that too much to ask? Hopefully not. I work hard, I am honest, I care about how and what I do. Sending up prayers, God, that the right place will come up for me. Heaven knows I have worked hard enough to get to where I am educationally.

So, here we are, sitting at the desk. It is dusty, there are coffee rings on the surface. The books are stacked a little haphazardly. The pencils are not sharp. Piles of old clinical log sheets and papers take up half the space. The laptop is new, the old one fell off the sofa and died a spectacular death. I never saw such weird patterns on the display before…at least that was after I took my final. Do I feel like making it all pretty and tidy? Not this time. The piles of papers will have to go on the floor to make room for the new ones. I will push enough stuff aside to make space for the new stuff, and I will continue to plug away at all of this, including the “matrix”, until is done. 15 more weeks…

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I am assuming that uconn stands for University of Connecticut, also assuming it is the medical school. I have recently received several really nasty comments on my postings from email addresses with uconn.edu as the place they came from. I am choosing not to allow the comments as they contain words like “cowards” “phonies” and “losers” and other such names.

I am hoping that this is not the average med student’s mentality. God help us if it is…I would think the real loser is someone who stoops to petty name calling when speaking to people who are trying to do some good in this world by caring for and about others.

I would have hoped someone who is in medical school would be above kindergarten name calling. Unbefrickenlievable!


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