Phone Etiquette -3- Voice Mail

I really don’t understand this one.  Perhaps someone who is a couple of decades younger than I am can explain it to me.  Leave something in the comments if you can!

We ask our patients to leave us a number that we can call.  This number is to give them lab results, remind them of appointments, call them if we have to reschedule or for any other reason that we need to contact them.  Often this will go to “voice mail”. 

Personally, I’m not fond of voice mail.  I leave messages, but tend to get confused when talking to machines.  I know you young folks are better at it than I am.  However …..every message we left the day before Thanksgiving for the Monday after Thanksgiving was lost or “not received”.  Every single patient called about their appointment.  Princess called every patient on the schedule. 

Excuses included “my phone was turned off”, “my kids use the phone and delete my messages”, and a couple of other things.  They also had appointment cards from their previous appointments.  We were accused of not calling.  We were closed on Friday.  So were most of the rest of the business world except the retail stores.   Our patients know we don’t do “robo-calls”.

I just don’t get it.

It Takes a Village (Literally)

It Takes a Village (Literally)

This video from the small Yupiq Eskimo Village of Quinhagak, Alaska, was a school computer project intended for the other Yupiq villages in the area. It is going “viral”.  If you haven’t seen this treatment of one of Handel’s greatest works usually done at Christmas, it’s worth the four minutes or so it takes to watch this.  You might get a couple of smiles.  I did.  Enjoy.
http://www.youtube.com/watch_popup?v=LyviyF-N23A

Shop Amazon's Christmas Corner - Holiday decor, tableware, and entertainment

“Uncompensated” Medical Care - Charity

Back in the old days, doctors used to do a certain amount of what they called “charity care”.  They would care for people who were truly poor.  They knew that they were not going to get paid in cash.

Sometimes a church, a school or some other organization would raise money to help pay some of the costs of that care.  People paid what they could.  They paid in chickens or pigs or apple pies.  If you couldn’t pay with money, you might come by and mow the doctor’s lawn or do some other work that needed to be done. 

Martha who kept the doc’s books would kind of figure out when your bill was paid.  Everyone (except possibly the IRS) was happy.

Sometime after WWII, employers started offering “health insurance” instead of increasing employee’s wages.  Doctors didn’t mind, because they got paid what they charged in real money. 

Then Washington decided that the government needed to get into the insurance business.  Medicare and Medicaid were born.  The government decided that it was not going to pay the whole bill.  Instead they would pay what they wanted to pay. 

More and more people qualified for these programs.  As the cost of the programs went up, what the government paid went down.  Doctors at first made up for this by working harder, and by charging other patients more. 

Insurance companies decided they didn’t want to pay the whole bill either.  They started to demand the same discounts as Medicare.  Doctors worked harder.   Patients got less time for each visit.  Our hours got longer.  Your waits got longer. 

Medicare and insurance companies developed more rules and regulations like prior authorizations, formularies, preferred providers and ICD and CPT codes.  Did that sound like a bunch of garbage to you?  Until I started “doctoring” it did to me, too.  They didn’t teach you all that stuff in medical school when I went, either.

Doctors had to hire people just to do the billing and “chase down the payments”.  Then they weren’t payments, they became “reimbursements”.  “Patients” became “Insureds” and office visits and surgeries became “claims” and “procedures”.  Insurance companies started “bundling” all your care.  Surgeons get paid the same no matter how many times they see you in the three months around your surgery.  OB doctors get paid the same for the entire pregnancy and 6 weeks afterwards.  It doesn’t matter how many times they see you in the office or the hospital.  The only thing that increases the fee is a cesarean section.  Some insurance companies won’t pay extra for that. 

There isn’t enough room here to discuss what happened when the lawyers got their fingers in the mixture.  Besides, my doctor wants me to watch my blood pressure.  Let’s just say that a lot more testing goes on these days to keep from being sued.  It costs lots of money and doesn’t add much to the answers we get.  Lots of paperwork ensues. 

Patients – pay attention here – that’s you! – are now so far removed from what things cost that they don’t care about what tests are done.  They want the CT scan or the MRI.  They want all the blood work, all the nuclear medicine testing, and all the consultants.  The insurance is paying for it after all.

Not really.  If you have private insurance, your premium goes up if you keep getting tests.  If you have “public insurance” the taxpayers pay for it.  Either way, it’s busting our system. 

Ask people who don’t have any insurance.  I have lots of them in my practice.  You see, I don’t take insurance any more.  I have gone from 4 employees to 1.  We will give you the papers to submit your insurance, but we won’t fight it for you.  That saves us hours on the phone.  I don’t participate in Medicare and Medicaid.  I don’t have to take those huge discounts.  So I get paid for my time. 

I get to spend more time with my patients.  My overhead is a whole lot less.  So I don’t have to charge for all those people that used to work here.  We have time to help figure out where the least expensive place for an MRI is and help our patients find other doctors to help them.  I also found a lab that gives discounts for cash.  We also decide what tests we really need, not what insurance will pay for. 

This is what I went into medicine for. 

Here’s another blog with another version of this:

http://roadtohellth.com/2011/11/why-does-the-cost-of-healthcare-keep-going-up/

Vaccinate YOUR Kid, or Keep Him Away from Mine

I get really tired of hearing parents talk about not vaccinating their children.  They have all kinds of issues with the schedule of vaccinations, the number of vaccinations, what’s in the vaccinations, or who knows what else about it.  My theory about that is:

GET OVER IT! Or, if you choose, take your children and live with all the other parents that feel the same way.  But don’t live where my children, my parents and I live. 

Vaccines were developed to protect us from some really nasty diseases.  Fortunately, they aren’t around much anymore.  Many of them still were when I was a child.  Remember, I have told you I am a very old person.  It’s true.  I had the chicken pox when I was about 4 or 5.  It was awful.  I can still remember.  I also had the Mumps and the German measles.  There were no vaccines for those when I was little. 

We used to worry about stuff like (partial list):

1.     Brain damage from chicken pox (Varicella Zoster), Pertussis, German measles, Hib

2.     Paralysis from Polio

3.     Sterility from Mumps

4.     Birth defects from Rubella (German measles) and other viruses

5.     Liver Cancer from Hepatitis B

6.     Cervical Cancer and Throat Cancer from HPV

7.     Chronic Pain from Shingles (same virus as Chicken Pox – Varicella Zoster)

8.     Death from measles, tetanus, Pertussis, Hib or the flu (influenza).

With vaccines, we have managed to almost completely eliminate most of these problems.  This does require that healthy individuals are vaccinated. 

Some people cannot be vaccinated.  They are immune compromised from cancer or other problems.  If your unvaccinated child gets one of those diseases and goes near one of those people, you may very well be signing their death certificate.  Are you really prepared to be responsible for people dying because you didn’t want your child to have a shot?

We get flu shots at my house every year.  One of my sons has asthma.  The year there was a shortage, he was the only one that got the vaccine.  We all still managed to get sick.  The virus was everywhere in the community.  My son wasn’t ill enough to stay home from school, but coughed enough to vomit at least once a day in school.  He would then get his mucus plug out, and go on about his business.  For some reason this seemed to disturb his teachers!!!!!  Since he always does this when he has a respiratory virus, it didn’t bother me!

My kids were also vaccinated as infants for Chicken Pox.  When they were about four, one of the teachers at their pre-school got the disease and exposed the entire school.  Those who were unvaccinated got to be miserable.  One of my kids had six red spots that lasted a couple of days.  He had no fever, and he didn’t feel bad.  They still made him stay home until the spots were gone. 

So, if you want your kids to be at risk, fine.  Just keep them away from my kids.

Family and Holidays – Therapy or Not?

Most families have certain holidays or occasions where they gather as a group.  It may be only weddings and funerals.  In some families, it’s every Sunday for “dinner”.  Now that we are more geographically spread, I think my family doesn’t get together as often as it did before.

I really enjoyed Thanksgiving.  I hadn’t seen everyone since last Christmas.  I’m not sure exactly how many people were there.  I’m guessing around 40.  That may include the dogs (2 or more) and cat (1?). 

You would think this would be complete chaos.  However, I grew up in a house with 4 brothers and 2 sisters.  There were always people in and out.  Holidays have always been like this.  Since we weren’t at my house, I got to enjoy watching, help where I could, and get caught up with what everyone was doing.  It was like a great big warm hug.

My autistic son, I think, suffers a bit from all the people.  He has learned to bring a video game system and games.  We have learned to find a place for him to set up and be “separate” and quiet.  He sets a departure time before we get there.  I am never ready to go. 

This time we forgot his coat.  He fussed and fussed when we discovered this.  I called my sister.  They had found it after we left.  We agreed to wait until Saturday to exchange Mr. Impatient’s coat.  No way was I going out on Black Friday.

Imagine my surprise when my brother-in-law came to my door on Friday.  He had ridden an hour and a half on his motorcycle to bring us the jacket.  He said my sister was having a group of women over for a Black Friday card making party.  He had to get out!  I think it was a gorgeous day for riding in the mountains.

Mr. Impatient had a grin on his face for the rest of the day.  So did I.  Isn’t family great?

Around the Web – Broaching the End of Life Topic with Loved Ones

There is a campaign around the web to have all of us discuss with loved ones how we want our end of life care handled.  It is called The Engage with Grace Blog Rally.  The web site is: http://www.engagewithgrace.org/Default.aspx

There are a few basic questions that every person should answer concerning this time in our lives.  The people behind this organization have decided there are five questions. 

http://www.engagewithgrace.org/content/theoneslide.pdf

If you can’t get this printed from the blog, it is available on their web site. 

I agree that it is wise to have this discussion.  It avoids the family arguments that happen in emergency departments and intensive care units all over the USA.  Settle things now to avoid pain later. 

Doctors and Creativity

When I was in medical school, I noticed that most of my class had other interests besides medicine.  Many of them were and are quite creative people.  While most of us are indeed science geeks, there is also some creativity that has to get out.

I have met some awesome photographers, painters, and authors.  We are also poets, carvers, and sculptors.  Many (mostly women) physicians work in fabric art, making awesome quilts, knitted or crocheted pieces or embroidery. 

Then there are the musicians.  One of my friends writes symphonies.  Many of us play instruments.  And an astonishingly large number of us are singers. 

Even as old as I am, I feel the need to produce music.  I have told my blog friends that my husband plays the organ, and that two of my children are in the marching band (see the photo on the blog).  Three Speed plays the trumpet and Tall Guy plays the saxophone.  Mom is a singer.

I sing with a women’s group.  This is our eighth season together.  Our numbers vary depending on who can spare the time.  Our ages vary from late teens to late 70’s.  Our occupations vary from farmer to teacher to student to shop owner.  Our concert was last week.  This is the web site that has our music posted:

http://www.youtube.com/user/AntietamSingers

The individual pieces are also posted:

Emma Lou Diemer:

http://www.youtube.com/user/AntietamSingers#p/u/0/FVwHc5q0QFY

Afrika Kyrie na Sanctus:

http://www.youtube.com/user/AntietamSingers#p/u/3/AJRkYy0K6Fg

Missa Brevis, Eleanor Daley:

http://www.youtube.com/user/AntietamSingers#p/u/2/BT2Fc1HtjDA

Messe Breve by Leo Delibes:

http://www.youtube.com/user/AntietamSingers#p/u/1/EBsnWiTee5s

Techno Dinosaur 5 Web based documents

I learned something new today. This may actually increase the amount of writing that I do. No groaning out there. I heard that.

My son showed me how to make documents on the internet. This means I can start something at home and finish it at work, or the other way around. The only problem I have is that I have no idea how this will look on the blog.

It’s great to have teenagers who learn stuff at school, then come home and teach their technologically challenged parents. When you tell Three Speed, make sure to tell him who you are, so I can find out who read the blog and told him. Make a point to tell him to tell me, because he forgets.

Who knows what I’ll learn next? Perhaps how to get my electronic medical record to write letters? I still can’t figure that one out!

Meditation “Dona Nobis Pacem.”

Meditation

Meditation may be thought of as a modern invention.  It is actually an ancient practice, going back to the Hebrews, the ancient Chinese cultures, and many other parts of the world.  The word comes from Latin.  It may mean the third step of an ancient form of prayer.

Modern science has studied the process.  There is concentration, relaxation, and an altered state of awareness as the brain waves shift from the right frontal cortex to the left frontal cortex.  Blood pressure is reduced, heart rate slows, respiratory rate slows, and oxygen consumption slows.  Seratonin increases, which decreases insomnia, depression and headaches.  Other benefits include less muscle tension and increased attention spans.

Where do we see meditation used today?  We see doctors using it in pain management and stress relief.  It is the basis of the Lamaze method of labor pain relief.  Any time someone has you breathing to help with a difficult or painful procedure – it’s a form of meditation.

Yoga is another organized form of meditation.  The stretching and breathing together keep you focused on your body, your posture and how you are feeling.  In fact, many forms of meditation have you concentrate on breathing.

What brought this subject up?  I had two concerts this weekend.  I realized how much singing is another form of meditation.  We sang several different settings of the Mass.  It takes intense concentration on breathing and on all the other singers to make the music be right.  It flows through the body and into the church, echoing and wrapping around all of us.  The organ leads and joins. 

For a few moments, we are all one.  It’s a transcendent experience. 

I hope you find something like this in your life.

We ended with the phrase “Dona Nobis Pacem.”

Give Us Peace.

Black Shoes

Autistic Children and Habit

Mr. Impatient went to the pulmonologist the other day.  He is doing well with his asthma.  When he took off his shoes to get weighed, he told me he needed new shoes.  They looked fine to me!

When we got home, I looked at his shoes.  Sure enough, there were holes in the sides of his shoes.  I really can’t remember when he got shoes.  I’m sure if I asked him, he could tell me. 

He fussed and fussed that evening and the next morning until I promised I would take him after school to get shoes.  We had a meeting to go to first.  He fussed throughout the meeting about his shoes. 

When we got to the shoe store, he headed right to the sneakers.  He wanted “black shoes”.   He won’t wear any other kind.  He has a specific brand that he likes.  I thought he wanted Velcro, because he doesn’t tie shoes.  Nope.  He wants tie shoes.  Mom gets to tie them.  Dad and other people do too, but it seems to me that it’s my job most of the time.

We picked out a shoe that looks almost the same as the ones with the holes, tried it on for fit, laced it up and tied it.  I made him walk up and down the aisle.  He was done.  No more fussing.  He was ready to pay and go home.  I asked if he wanted to try another color.  “NO, Mom!” 

Off we went.  

Of course, I don’t take him shoe shopping with me unless I want …… black shoes!

HOW IT ALL STARTED

In ancient Israel, it came to pass that a trader by the name of Abraham Com did take unto himself a young wife by the name of Dot.  And Dot Com was a comely woman, broad of shoulder and long of leg.  Indeed, she was often called Amazon Dot Com.

And she said unto Abraham, her husband, "Why dost thou travel so far from town to town with thy goods when thou canst trade without ever leaving thy tent?"  And Abraham did look at her as though she were several saddle bags short of a camel load, but simply said, "How, dear?"

And Dot replied, "I will place drums in all the towns and drums in between to send messages saying what you have for sale, and they will reply telling you who hath the best price. And the sale can be made on the drums and delivery made by Uriah's Pony Stable (UPS)."

Abraham thought long and decided he would let Dot have her way with the drums. And the drums rang out and were an immediate success.   Abraham sold all the goods he had at the top price, without ever having to move from his tent. To prevent neighboring countries from overhearing what the drums were saying, Dot devised a system that only she and the drummers knew. It was known as Must Send Drum Over Sound (MSDOS), and she also developed a language to transmit ideas and pictures - Hebrew To The People (HTTP).

And the young men did take to Dot Com's trading as doth the greedy horsefly take to camel dung. They were called Nomadic Ecclesiastical Rich Dominican Sybarites, or NERDS.

And lo, the land was so feverish with joy at the new riches and the deafening sound of drums that no one noticed that the real riches were going to that enterprising drum dealer, Brother William of Gates, who bought off every drum maker in the land. And indeed did insist on drums to be made that would work only with Brother Gates' drumheads and drumsticks.

And Dot did say, "Oh, Abraham, what we have started is being taken over by others." And Abraham looked out over the Bay of Ezekiel, or eBay as it came to be known. He said, "We need a name that reflects what we are."

And Dot replied, "Young Ambitious Hebrew Owner Operators." "YAHOO," said Abraham. And because it was Dot's idea, they named it YAHOO Dot Com.

Abraham's cousin, Joshua, being the young Gregarious Energetic Educated Kid (GEEK) that he was, soon started using Dot's drums to locate things around the countryside. It soon became known as God's Own Official Guide to Locating Everything (GOOGLE).

That is how it all began. And that's the truth.

(e-mail from a friend - I LOL'd and had to share the humor.  Hope y'all enjoyed!)

National Prematurity Awareness Day

Today is National Prematurity Awareness Day.  This was passed on to me by MOST.  MOST stands for Mothers Of SuperTwins, an organization that supports parents of triplets and more.  Our pregnancies are at high risk for early delivery with all the problems that ensue. 

We end up on bedrest a lot.  We have premature labor.  There is a high risk of miscarriage and pregnancy loss.  As a general rule, the more babies, the earlier the delivery.

My triplets were almost 35 weeks.  They didn’t have any breathing problems.  They did have some feeding problems.  They came home when they were nine days old. 

Now is a good time to thank my doctors and friends for helping me through all of that.  My Mom was awesome.  I learned a lot from her.  My husband put up with all my moods, my hot flashes and my insomnia. 

My boys are now 17.  They show no sign of being 4 ½ pounds at birth.  They are seniors in high school.  Wow.  Who would have thunk it?

Getting a Person, Not a Computer

This web site comes recommended by some of my doctor friends.  If you are trying to get through to companies and would like to get a person, not a computer, try it.

http://gethuman.com/

Contact numbers, reviews, tips are available.

Feedback appreciated.

Teenager Audio Reception Problem

Do You Think I’m Talking Just to Hear Myself?

I’m sure every parent has had this problem.  I have asked my children to do the exact task for the last three or four days.  It isn’t difficult.  It is something I am not physically capable of doing.  Last night I specifically asked to have it done after dinner.  Again. 

What I asked them to do was restock the refrigerator in our garage with drinks so we would have cold beverages.  This is not hard.  But I am having issues with postural hypotension from medications, so can’t deal with it right now.  

Evidently they each assumed the other one was going to do the stocking.  This morning, when I went out to get our morning drinks “to go”, there were none in the refrigerator. 

Do you want to know how mad I was?  This was not the way to start my day.  I got some wimpy excuses on the drive to school, but nothing to make me happy.  I discussed communication, since they had not discussed it.  They just both assumed that the other one was going to do it.  We will have to have a “sit down when I am not angry.   I discuss stuff better when I am calm. 

That’s something I have learned over the last (number deleted to preserve my dignity) years. 

Errors at the Pharmacy

I spend a large portion of my time communicating with pharmacies.  Over the years I have worked with pharmacists that I respect immensely, and a few that I would prefer never to have to call again.  There is also associated staff that may make things interesting.  They are not as highly trained.

Most pharmacists are a wonderful source of information.  They spend their whole day working with drugs and doses.  They have information in their brains that it would take me forever to find.  If they are out of something, they can suggest an alternative.  If my patient is allergic, they can tell me what else we can use.  If something has been discontinued, they can tell me what we the current drug is.  They often know what your insurance will and will not cover (though not always).

Most pharmacies fill hundreds of prescriptions a day.  I know everything is done to minimize errors, but they still happen.  My friend, The Pharmacy Chick (http://pharmacychick.blogpharm.com/) details some of the reasons for this.  You can also refer to the Frantic Pharmacist (http://franticpharmacist.blogspot.com/).  Both good blogs.

I have a name that is unique in our area.  My husband has a more common last name.  [Nobody changed their names when we got married.]  One of my sons shares his first name with several other older men in the area with his last name.  Pharmacies are supposed to check birthdates if the name is similar.  If necessary, they are supposed to check IDs. 

So, when I go to pick up my own prescriptions or those of my family, I have had some of the following issues:

1. My husband was handed medication for another man this week.  Last name same, first name the same as our son.  Wrong medicine. 

2. Our son’s medicine has been billed to this other man.

3. I had issues at one pharmacy when I switched my prescription over because “the doctor’s name and the patient’s name were the same”.  Did they call me back to see what was going on?   No.  They just didn’t bother to fill the prescription until I got there.  For Motrin equivalent.  Sometimes it’s easier to call myself than call my doctor’s office to do this stuff.  I did this because it was on the $4 list and I was switching to the generic.  I checked with my Mom and Pop, and will be going back there next refill. 

4. Pharmacies get very confused because the triplets have the same birthday.  All three of them.  They take the same antibiotic for their acne.  I finally gave up and call the Mom and Pop pharmacy where I’m on a first name basis with the pharmacist.  She knows me, my husband and all the kids.  It makes things much easier.

5. Argued with a pharmacy technician about a generic medication when I specifically asked for brand.  She said the generic is cheaper.  I said I knew that, but the generic didn’t work for me.  I had also had a problem with it.  I now have another medical problem because of it.  I have to take another medication for the rest of my life.  She did not want to let me talk to the pharmacist to get my medication changed. 

6. Argued with another pharmacy tech about an early refill for my autistic son’s inhaler when he was about 5.  He managed to get the thing and pushed it a few extra times.  I got the lecture about how expensive the medication was, etc.  I tried to tell her about autistic kids, but she was having none of it.  I was an irresponsible mother.  This was the first and last time I got an early refill for this reason or any other.  He had gotten quite the lecture when we found out what he had done. 

Do you want to know which pharmacies I patronize and generally refer my patients to?  Guess!

Techno-Dino 5 - An Anthem

One of my doctor friends couldn’t figure out how to copy a web site so you could just click on it.  It took me quite some instruction to learn to do the same thing when I learned.  My children, of course trained me.  They gave me lots of looks like “She’s really never going to get this!”

I told my friend that I was a techno dinosaur.  She suggested I look up the following video from Trout Fishing in America:

http://www.youtube.com/watch?v=synDS-IJb1g       (When I was a Dinosaur)

I also enjoyed a couple of others on that same site by the same group.

This one is for all my coffee loving friends:

http://www.youtube.com/watch?v=w-ia13f72-4&feature=related      All I Want is a Proper Cup of Coffee

This is for the Moms and Dads and Pediatricians out there:

http://www.youtube.com/watch?v=CnplhUelCZg&feature=related  I Think I’ll Need a Band-Aid

Enjoy!

Nothing Went Right

It's been a bad week around here.  I already posted about Three Speed’s accident.  Yesterday was my weekly trip to the “big box store”.  No names, but I’m sure you have one like it near you.  Traffic was awful.  They still haven’t finished the construction on the interstate that has been going on since the spring thaw.  They are also still working on the major intersection by the store.  They changed the timing of the light, so you have to sit at the turn for about 4 cycles before you get through. 

When we pulled into our space, a nice fellow came over to tell us that our front tire was “a little low”.  When we went inside, they didn’t have any of those little scooters that some of us with health issues use to get around the “BIG” box store.  I decided not to wait, since I had Tall Guy with me, and he was being cranky.  This turned out to be a bad decision. 

I have been having cardiac arrhythmias for the last six months.  My heart started to act up somewhere around frozen foods.  This is all the way in the back of the store.  Then I accidently grabbed the wrong item because someone had placed a similar item in that spot.  After we checked out, Tall Guy noticed.  We had to go to Customer Relations to exchange the items.  The people check your items at the door, so the ticket has to be right.  It took forever to explain to the Customer Relations Person that we had already gone and gotten the item we wanted to exchange for.  You don’t have to be a rocket scientist to work there.

When Tall Guy started filling up the tire, it started bulging out.  We went back to the big box store, since they sell tires – I got the last batch there.  The nice man at the tire place told me it wasn’t safe to drive on that tire.  (This day is getting better by the minute!) It would be 4 (four) hours until he could get to my van.  It also cost over $300 that was not in my budget right now.  This was after having to pay for the medical care yesterday “out of pocket”.

Mind you, I have frozen food in the back of this van.  I looked at Tall Guy and said, “Shall we call Dad?”

Mr. Lasermed was not happy to have to come 30 minutes to rescue us.  He had to bring Mr. Impatient with him.  You can’t leave him alone.  That’s another story.  Anyone with an autistic child can fill you in.  Mr. Impatient was repeating the same questions over and over and over in Mr. Lasermed’s van all the way to get me.  He had to deal with all the above traffic issues AND Mr. Impatient. 

We also had to stop and pick up one of Mr. Lasermed’s prescriptions on the way home.  We didn’t get it on the way there because I had just called in the refill before we left to go.  When we got to the pharmacy, the amount they told us was different than what the pharmacist had told me before we left.  That’s because the young woman at the window tried to give us the prescription for someone with my husband’s last name but a different first name.  To make it more confusing, this fellow has the same first name as Mr. Impatient.  So we got to hear about that for about 10 miles down the road. 

I think I have recovered today enough to at least write about it. 

Oops! What is a Mom / Doctor To Do?

Three Speed takes a spill!

The reason there haven’t been any posts for the last couple of days is that there has been some excitement in the Lasermed house.  Three Speed fell and injured himself at school in the middle of the school day.  He injured both of his ankles, one more than the other.  When I got home, he was on the couch with an ice pack, pillows and a courageous look. 

We had to make a decision about whether or not to take him to the Emergency Department.  [This is the current terminology, since it isn’t a “room” anymore.]  His ankle was “non-displaced” to my semi-professional eye.  That means it looked swollen, but not bent at a funny angle.  Mr. Lasermed, who was a paramedic in his former life, agreed with this. 

Just to be sure, I called and spoke with the ED doctor.  They don’t have an orthopedist in our hospital all the time.  So we would get an X-ray, a bill from the radiologist, the ED doc, and a fee for using the ED.  OR... We could wait until the AM, and go to the orthopedics office, where they have their own X-ray machine, and we get to see the doctor we need to see.

We decided to wait.  We iced it, elevated it, waited until the next day and went to the orthopedics office. Nothing broken (thank goodness), but he can’t march in band for 6 weeks. He saw the "old man" in the practice.  He doesn’t do surgery any more, but has more experience than any of the other doctors there. The gentleman doesn't like gel packs for icing – he prefers frozen veggies!  I think it’s a waste of veggies, but he says they conform better to the injured part. 

Three Speed is on the couch even as I write this.  He’s feeling better.  Now it’s almost hard to keep him down.  His foot is purpling nicely.  It is still quite swollen.

And we saved well over $1000 in medical charges. 

Triplet Stuff 3 - “No Way Are You Triplets”

My kids told me the funniest story the other day.  They had a band classmate who absolutely could not believe that they were triplets.  All the other kids who have known them for years know all three of the brothers and have no problems with this.  They have been to the birthday parties, seen them in the various grades together, etc.  This young lady had not.  She believed the boys were brothers, but not triplets!

Two of the boys are in the band.  That would be Three Speed and Tall Guy.  Mr. Impatient came back to the band room because they were going to leave from there since the boys had my car.  The band director actually let Mr. Impatient direct the Jazz band for a while.  I understand he did a good job.  Since he has been informally conducting since he was a year and a half old, I’m not surprised.  He just needed to get the time signature, and he was off……

Anyway, there was actually some pulling out of wallets and drivers’ licenses and kids swearing they had known the boys since they were little….  Finally the band director told her that it was indeed true.  Even though they don’t look alike, they are triplets.

I asked if they needed a note from their Mom or a picture from when they were babies.  They said they thought they had gotten her convinced.   

Health Insurance 101-5 “Adjustments”

When an insurance company uses the word “adjustment”, they mean the discount they have “negotiated” (dictated) with your “provider” (doctor, pharmacy, hospital, nursing home…..).  This is the amount of the charge that they are not going to pay.  If the “provider” is “participating”, they cannot collect this money from you.  If they do not participate, they can collect this money from you. 

Generally speaking, the doctor had nothing to say about how much the discount was.  If the group is large enough, or if they are the only group in town, they can cut down the discount a bit.  If the insurance company is powerful enough (think Medicare), this is not possible.

Random Acts of “It’s not my job”

There are lots of days when I do things in my office that are really not my job.  I’m sure other doctors do the same thing.

I have a long time patient that I see quite frequently.  I have been trying to convince her that blood sugars “around 300” are not normal.  I had her do a urine test recently that was positive for alcohol!  I freaked out, until the lab asked me “Is the patient diabetic?”  It seems that sugar in the urine will turn to alcohol and make that positive.

I convinced her we needed to check her HgbA1C last visit.  This is a test of how much sugar is stuck to your red blood cells.  The real name for it is glycosolated hemoglobin or hemoglobin A1C.  Hers was almost twice the upper limit of normal.

So today, I, the gynecologist, spent almost two hours with this nice woman.  I first explained why she needed to get her sugar under control.  I want her to live for a while longer.  Then we went over what medications she used to take, and I wrote prescriptions. 

Then my patient said she was having problems with her breathing.  She has chronic bronchitis with an allergic component.   She hasn’t been able to see the “clinic” about this, either.  We went through all the different medications for this, looking up prices at the same time.  You see, she also has no insurance.  Since these are medications I don’t use all the time, I have no idea what they cost.  I was enlightened, to say the least.

Mrs. Train Wreck said that her previous “clinic provider” had told her that she could stop all her diabetes medications since her blood sugar was normal.  I’m not sure who made the mistake – the patient or “the provider”.  Since she sees a different person every time at her “clinic”, never has a scheduled appointment, never gets any continuity of care and nobody explains anything to her, it is entirely possible that someone did say something along those lines.

Remember, though, the “clinic” care is free. 

Too Much Work?

Dropping Marching Band

Friday was the last football game of the season.  This was the last time I got to see my kids march on the field in High School.  It was incredibly cold and windy, but I was prepared. 

I always chat with the parents that sit around me.  Since I don’t particularly care for football, it passes the time.  The Mom I was talking to was the parent of an 8^th grader who is in the middle school band.  This child has decided to stop playing in the band because he thinks that the marching band is “too much work.”

Our marching band practices marching on a field in front of the school.  They have one week of “band camp” that lasts from 8 AM to 8 PM.  The rest of the time is half days or 9-5.  On days more than 4 hours, they are “fed and watered” (as I call it) frequently.  The entire town gets to see them practice.  The road is the main route through town.  Evidently this scares the kids because it’s “too much work”. 

The kids need to learn to march in formation and learn the program.  This is the first time the freshmen are exposed to walking and playing at the same time.  There is not enough time to teach this after school starts, with the first game the first Friday of school.  Football practices all summer, too.

It is a bonding experience for the kids.  My boys started Freshman year with 90 good friends.  Many were upperclassmen.  They had been running around the school for weeks.  They had new nicknames.  I wasn’t sure who “Bill” and “Jiffy” were, so would just hold out the phone, and one of them would grab it.

They lost weight, shaped up, and complained about all sorts of aches and pains.  I think it was boot camp for band.  The next three years were much easier. 

They have had the chance to travel.  They have had to raise the money to go on these trips.  They have had to learn responsibility.  My children are much better at being on time and remembering to bring all their things.  Plus they have become better musicians.

There are rewards for that hard work.  I feel sorry for the children and parents who don’t see it.