WELCOME!

These are the thoughts of a cantankerous ol' gynecologist who remembers when things were a little different. I try to find a little humor in my life and the people I meet along the way. Come meet the characters in my world.

Saturday, December 31, 2011

Grandchildren and other little ones who don’t go home with you

Family gatherings are fun, especially when there are little ones there.  They are sooo cute.  The best part, at my age, is that the little ones do NOT belong to me, and I do NOT have to take them home.

My niece has a daughter who is not quite a year old.  She is great to watch.  She reminds me of all the things my kids did at that age.  Lots of falling on her (well padded) bottom.  She cruises the furniture but doesn’t walk quite yet.  She discovers new things and gets that wonderful grin on her face.  Her giggle makes everyone in the room light up, too.  I said I understand why there are so many laughing baby videos on YouTube. 

She is in that “Mommy adhesive” phase right now.  That’s too bad, because I would have loved a cuddle.  Oh, well.  Maybe when she gets a little bigger and gets to know me better, I’ll get a few hugs.  I did get some wonderful smiles today, though. 

Just don’t call me great-auntie, ‘kay?

Wednesday, December 28, 2011

Techno – Dino 7 – I’m learning


My friend the Computer Geek was impressed with my Christmas post.  Not as much as I was, but he was impressed.  He did ask why he didn’t have a nickname or a place on the sidebar. 

Sooooo, today I decided to put Computer Geek and Yearbook Gal on my sidebar.  Unfortunately, they refused to appear in bold print.  Don’t ask me why. 

I, however, figured out (all by myself, mind you) how to go in and modify the html to make it bold.

If you don’t speak computer, I modified the language behind the program to get the print to be heavier like this because the little button that’s supposed to do that wouldn’t work properly. 

How cool.  Who knows what I’ll do next.

It’s all because Computer Geek showed me how to add those Amazon banners so you can order from Amazon right from my blog.  It took me forever to figure them out.  Just click on them, and you’re there!  Neat-o?

Maybe I’ll learn to do attachments to my e-mail next?

Laser

Sunday, December 25, 2011

Oh, those college kids!

Remember our troops


As I am reminded by another blogger

 (http://emergency-room-nurse.blogspot.com/), not everyone is home for Christmas. 


Photo from emergency nurse's blog.  I don't know where she got it.  It just seems appropriate.


Don’t forget them.
Merry Christmas.

Thursday, December 22, 2011

Techno-Dinosaur 6 – Christmas Post


I worked really hard on my Christmas post.  I figured out how to get my word processing program to translate “Merry Christmas” into a bunch of languages.  I was so proud of myself.

Then the column thingie wouldn’t work and I had to redo the entire page.  I wanted all of it on one page.

Then I found out that clip-art won’t post on the blog.  At least I can’t get it to (yet – oh, Adam……)

So I had to find my old Photobucket account, get a new password, remember how to download and upload pictures…. Did you notice the ones with motion?  I’m particularly proud of them.

I accidently put the same picture under two different languages.  I can’t have that.  I guess I have a little OCD.  So I inserted the one I intended to have there.  The old one didn’t come off.  OMG!!!!  Don’t panic!  Which button do I push now?

This one post has taken me the better part of a week, off and on.   I’m sure there are 6 or 8 hours of work in it.  I learned stuff, thank goodness.  I’m glad it has been a little slow in the office, or I would still be working on it. 

Merry Christmas

Merry Christmas


Joyeaux Noël!  (France)

 Wesołych świąt!  (Poland)


Καλά Χριστούγεννα!  (Greece)

Buon Natale!  (Italy)


God Jul!  (Norway) 

Glædelig Jul!  (Denmark)



สุขสันต์วันคริสต์มาส  Thailand



Веселое рождество (Russia)


Glad Jul!  (Sweden)


Iloista Joulua!  (Finland)



Christmas Alegre! Portugese (Brazil)


Mutlu Noeller! (Turkey)



¡Feliz Navidad! (Spain)

Wednesday, December 21, 2011

Rituals and Musical Memories


There are certain things we learn in childhood that carry over to adulthood.  I was raised in a household where regular church attendance was expected.  The church service and the hymns are impressed in my memory. 

I remember practicing for the Christmas Pageant every year.  At the time, all the girls were angels.  One got to be Mary.  The boys were shepherds or wise men.  One got to be Joseph (but nobody really wanted that job).  I used to really like wearing the white outfits with wings.  There was a trick to sitting in those pews with the stiff wings we wore every year.

The Christmas story was the same every year… “It came to pass in those days that there went out a decree from Caesar Augustus that all the world should be enrolled….”  I could and can recite it word for word.  Of course, we don’t use the King James Version of the Bible any more. 

All those old churches have wonderful pipe organs.  They are built so that the music surrounds you when the organist plays.  If you sing in the choir, you usually are positioned near the organ, so you get to feel the vibrations through the floor.  The music is not just something you hear, but something you feel. 

I started singing in the choir when I was seven.  I still do.  There’s nothing like the feeling of the organ music and a group of singers tuned together singing music that we all have worked hard to learn the harmonies for. 

Of course, in a big Lutheran church, there are many folks who have learned those harmonies.  You can sit in the congregation and hear the harmonies on the old familiar hymns.  None are more familiar than those we sing at Christmas.  We end our service Christmas Eve with the congregation singing Silent Night by candle light.  This year Tall Guy and Three Speed will be the ones who are putting out the candles.  Mr. Lasermed will be playing the organ.  Mr. Impatient and I will be sitting in the front row by the organ, singing. 

Sleep in Heavenly Peace.

  

Tuesday, December 20, 2011

Random Acts of Kindness

The holiday season is the time of year when we hear about people doing kind things.  Caring acts happen all year long, and are rarely recognized.  As a Mom trying to raise children, I am trying to teach them to be kind to others “just because”.  Some of the conversations we have about this can be funny.

We have an elderly woman in our neighborhood that uses wood for her heat as much as she can to save on her electric bill.  When we have a big storm, there are lots of branches that come down from the trees into our yard.  The children and I gather them up into boxes and take them to her.  It’s a lot of work.  At first they wanted to know who was going to pay us for this.  I explained that we were doing a “good deed”.  Since we didn’t live near our Grandma and Grandpa, we were doing it for someone else’s Grandma.  It took a long time for that one to sink in. 

My Mother had a neighbor who is an author.  When she and her husband were moving to assisted living, she had a lot of books that she couldn’t keep.  The local school wasn’t interested.  Our middle school had recently opened and had few books in its library.  I offered to come get the books and bring them back (two hour drive each way).  She had hundreds of books to donate.  My children carried them up and down the steps in her house and we packed my van full! 

We sorted the books on my dining room table.  Some titles had quite a few copies, some had only a few.  I had no idea how many books she had written over the years.  She had everything from children’s books to adult’s books, with the concentration on books for adolescents.  There are several series of books.  One of them had entertained my children during their elementary years.

The librarian was astonished when school started.   They distributed them throughout the school system here.  A few ended up at the local library.  My children got credit towards their community service in boy scouts.  The author got some nice letters from school children. 
What did I get out of all of this?  I got a feeling that I had improved my community and taught my kids how to volunteer.  We kept the rest of the books in the series that we hadn’t finished.  I also got a lovely note from the author about how she appreciated the work I had done.          



Monday, December 19, 2011

Medical Software Company SNAFU

This is the time of year that I bought my Electronic Medical Record Software.  Every year you have to pay for “support”.  This costs almost half as much as the software cost when purchased new.  I’m sure that it will increase in price annually.  The support people are available if I have any problems.  Like the cable company is available if you have a problem with your cable.  Enough said? 

I was thinking it was time to pay the support bill.  The other day I checked my online banking, and – SURPRISE!!!! – they had taken their money out of my checking account.  There was no warning.  No: “Dear Dr. Lasermed – next week we are going to take a huge chunk of money out of your checking account.”  Nothing.  I got an e-mail the day they took the money.

I generally don’t authorize anyone to take things out of my accounts without letting me know first.  I don’t have credit cards.  I only have debit cards.

I called the company.  They said “it’s in your contract”.  The contract is 8 pages of little tiny legal printing.  They didn’t say that they warned me a year ago.  They also said they assumed that the card was a credit card. 

I spoke with the nice people at my bank.  They have dealt with this problem before.  If I deposited cash before closing, there wouldn’t be a problem.  I could write a letter to the company so they didn’t do that again.  Check and check.  Blood pressure is beginning to come down. 

It’s amazing how the only times I ever have problems with my account are when some business takes something they are not authorized to do.  The woman at the software company said “THEIR SOFTWARE IS NOT SET UP TO SEND NOTIFICATION BEFORE THEY DO ANY BILLING”.  I want to know why they can’t fix their software, since that’s what they do, write software?  She really didn’t know. 


Thursday, December 15, 2011

Playing with the box – not the gift

I have a niece who is almost a year old.  I have been reminded of my children’s second Christmas.  Since they were born in the summer, they were still infants the first year.  The second year they were walking, babbling human beings.  They really enjoyed watching orchestral Christmas music on TV.  Their favorite movie was Toy Story. (To Infiggity and beyond…..)

This was the year that Christmas lasted and lasted.  Each gift was really two gifts.  If it had a box big enough, the box was a toy, also.  Boxes were for climbing in, building with, making trains out of, putting on their heads, using for shoes and any other activity they could think of.  Then they would play with what was in the box.        

One toy would make my boys happy for several days. 

There was no rush to open all the presents.  Nobody was greedy.  When it seemed like they had started to get a bit tired of any particular toy, we would get out the next set of packages that looked the same.  We would repeat the process. 

This year Christmas lasted two or three months.  Every time they got to open another “set” of presents, we went through the same process.  Peals of laughter rang through my house.  There was lots of crawling around on the floor chasing kids who were chasing toys. 

It was a glorious time.  They are only little once.  Enjoy it Moms and Dads. 



Wednesday, December 14, 2011

Around the Web – Medicare Patients Readmission Rates Unacceptably High

Doctors have noticed these trends for years.  Because of insurance company pressures, we are sending patients home earlier and sicker.  There is pressure not to keep a patient in the hospital very long.  Are they being sent home before they are completely recovered?  Possibly.  Do you rest better in your own bed without someone coming in to take your temperature and blood pressure at 2 AM?  Definitely!

Medicare is now keeping track of how often patients who are discharged from a hospital are readmitted, and how soon this happens.  They have figured out that this costs them a lot of money.  Within 30 days, one in five people are back in the hospital (20%).  Within 90 days, one in three patients are back (34%).  This is costing Medicare over $17 billion per year.

Some patients develop infections.  Some patients have bleeding.   Something happens to an incision.  Something absolutely unrelated to the original problem will happen.  (Since when is a broken leg related to pneumonia for example?)  There are readmissions for medication problems.  People end up in the ER, and back in the hospital. 

Patients are leaving without really understanding what they are supposed to do when they go home.  Medications may have been changed while they are in the hospital.  They are unclear about which medications they are supposed to take when they get home.  Here are suggestions about what you as a patient (or caregiver to the patient who is coming home) should know and do:

1.     Know your diagnosis and any procedures that you had.

2.     Know when you should have a follow up appointment, and who it should be with (surgeon, family doctor, physical therapy, etc.)

3.     Schedule your follow up appointments ASAP.

4.     Make sure your regular doctor gets copies of any and all paperwork from the hospital.  If the hospital doesn’t send them, call your doctor’s office to let them know you were in the hospital so they can tell you how to arrange for records to be sent.

5.     Make sure you know what medications you are supposed to be taking when you go home.  Are you supposed to resume any of your previous medications?  Are any of the medications you are given different names for the same medications you take at home?  DO NOT LEAVE THE HOSPITAL UNTIL YOU KNOW THIS!!!!!

6.     Find out what you should expect that is normal.  Bruising?  Aches?  Swelling?

7.     Find out what you should look out for that is not normal.  Fever?  Redness?  Pain getting worse?  Shortness of breath?   

8.     What are you allowed to do?  What are you not allowed to do?  Lifting?  Showering?  Childcare?  Do you need someone with you?

9.     Who should you call if there is a problem day or night?

10.                        If you have dressings, stitches, a cast, drains or other surgical “stuff”, ask for directions on care and cleaning.  Ask about when things should come out. 

11.                        If there are test results that you are waiting for, ask how you are supposed to find out the results.

12.                        Before you sign any papers, make sure you understand everything.  Ask someone to explain it until you are sure you know what you are supposed to do.  Don’t let anyone rush you through this process.

13.                         If you have questions or problems after you go home, call the hospital where you were or the emergency number you were given.  We like to “head off” problems before they get big.  Sometimes a simple office visit will avoid a hospital stay. 

14.                         Bring a copy of all your papers to your follow-up appointment.

Hopefully these tips will keep you from having to go back to the hospital.  As doctors, once we send you home, we want to see you well and in our clinics or offices, not back in the hospital.  We hate those hospital gowns as much as you do!








Differential Diagnosis – Mom of Toddlers


When my children were little, one of my favorite parts of the day was right after I came home from wherever I had been.  The three little guys would drop whatever they were doing (unless they were eating) and come running.  It was “climb on Mom time”.  Literally.  

As they got bigger, I learned to sit down on the floor as soon as I could so we could have our “group hug” / “pile on Mom” without me getting hurt.  I still would end up with bruises from feet and hands grabbing.  I considered them badges of honor.  We would roll around and hug and tickle.  I got to hear the laughter and excitement of my little guys. 

I also spent lots of time getting my glasses adjusted from getting them grabbed or knocked off.  I stopped wearing jewelry for quite some time because it was so fascinating to little hands. 

Now you know how to tell those Moms of toddlers – no jewelry, bruises in funny places, often a short haircut or hair pulled up, dark circles under the eyes, a little disorganized, speaking in “small words”, correcting your grammar, and always talking about their kids. 

It’s a phase.  I wouldn’t have traded it for anything in the world. 


Tuesday, December 13, 2011

When Something is Wrong With Your Child

A parent knows his or her children.  As a Mom of triplets, I often say “I have age-matched controls”.  In other words, I have two others who are EXACTLY the same age (OK, there is a 4 minute difference, but, for purposes of comparison, we can call it exactly).  If they are not doing things at about the same age, I know there is a problem.  

I do try not to over-react.  I also remember that they are individuals.  The boys are fraternal, so I expect some variability.  They started getting teeth at different times.  Mr. Impatient was last, then he got five in one week.  Poor guy.  Walking was within a month or so, but Mr. Impatient didn’t walk for six months after the other two.  It turns out he had a foot problem that should have been addressed at that time. 

My pediatrician told me that Mr. Impatient was “just a little slow”.  Just like the teachers at school told me that Three Speed was “just being a normal boy”.  I listened at first, but things just didn’t seem to be right, so I got other opinions.  Mr. Impatient is autistic.  Three Speed has ADD.  Dealing with their problems has made a major difference in our lives.  Then we had Tall Guy tested.  He's in the accelerated program.  His IQ is way up there.  Three Speed might have been there, too, but he couldn't pay attention.  

Mr. Impatient got early intervention, special classes, speech therapy, occupational therapy, physical therapy, social services, a special diet, and appropriate medical interventions for other problems as they came up.  He has had a pediatric metabolic geneticist, a pulmonologist, an ophthalmologist, ……   He finally started talking when he was six.  We still work with him all the time.  He continues to make amazing progress. 

Three Speed’s teachers weren’t convinced about the ADD.  That is, until his pediatrician started him on medication.  I had several of them stop me in the hall and tell me that he was a different child.  He wasn’t a bad kid, just wasn’t reaching his full potential because he couldn’t focus.  These are the same teachers who didn’t believe me.  A parent knows. 

If you are concerned about your child, get a professional opinion.  Sometimes getting a second or even a third opinion from someone who doesn’t know the child well and can look at him or her with fresh eyes may help.  It worked for me. 

Monday, December 12, 2011

Random Acts of “It’s not my job” – 2 – Eye care from a gynecologist

Whose job is it to take care of this patient? 

Her primary doctor 

Does she have one? 

No 

So who gets to do the work?

Guess:

I have had patients released from the hospital without follow up care.  One patient was under the care of a hospitalist.  These doctors only see patients while they are in the hospital.  This was also in the next state.  This becomes important because she has our state’s Medicaid.  Most doctors don’t take Medicaid from another state because they don’t get paid.  If you are on the border, sometimes you have to.

While she was in the hospital for her eyelid infection, she had a surgical procedure.  The doctor used a suture that would have to be removed.  She was discharged when the infection was controlled, but the suture was not ready to come out.  No arrangements were made for follow up with the eye doctor.  His office refused to schedule an appointment because she has out of state Medicaid.  They did not refer her.

She came to my office for a regular visit with the stitch still in place long after it should have come out.  She was starting to react to the suture.  What am I going to do?  What any good physician who has the appropriate equipment will do.  I took the stitch out. 

Then I arranged for follow up with a local ophthalmologist who would see her with her in state Medicaid card. 

Not my job.  Not my field. 

It was just the right thing to do. 


Friday, December 9, 2011

Ganging Up On Mom


My kids have developed interesting opinions on lots of things.  Sometimes they disagree with me.  I’m not sure if they were right or not this morning.

We were on the way to school.  I have found a radio station that plays Christmas music full time.  The song was unfamiliar. We were trying to decide what the style of music was.

I thought it was Jazz.  Nope.  It didn’t have trumpets or saxophones, my boys from the Jazz Band said.  So it couldn’t be Jazz. 

As I’ve said before, I’m not at my best before I’ve had my coffee.  There was no budging these two, especially since they were fresh from a superb performance of the Eagle Jazz Band Extraordinaire. 

So:  For those who need a definition of Jazz, (that would be Tall Guy and Three Speed), Mom has now had some coffee, and some time to cruise the internet.  Since I am informed that they are not regular readers of this blog, those of you who are may inform them that I have posted this.

Jazz is actually a form of music.  “The musicians make do with whatever instruments they have.”  “No instrument is off limits.”   The instruments vary with the style of music being played.  The most popular instruments are piano and saxophone.  Usually the Jazz band will also include trumpet, double bass, drums, trombone and clarinet. 

Other common instruments include coronet, guitar, conga, banjo and tuba.  Instruments that were also mentioned in my web search (between and after seeing patients) included wood blocks, flute, harmonica, vibraphone, oboe and COWBELL!
Some even offered coupons!


Don’t forget the vocalist. That would often be the sexy voiced siren hugging the microphone out front, or leaning on said piano. 

Gotcha, guys.




Stuff I Learned This Week:


1. The ships at Pearl Harbor are still leaking oil. 

2. If a section of instruments (like the saxophone section, for example) all play together in an orchestra, and the rest of the orchestra does not play, it’s called a soli.  Thanks, Tall Guy.

3.  During WWII, we had German and Italian Prisoners of War in many states in “prison camps”.  Their accommodations were the same as our GIs who were guarding them.  The “prisoners” in some camps took over the cooking, and cleaning.  They were also used for labor on the farms and elsewhere.

4. There is an Atlanta in Nebraska.

5. It is possible to crochet in the near dark during a choir / band concert.  It’s a bit more difficult when your variegated yarn turns black. 

Wednesday, December 7, 2011

Season of Giving

The holiday season has been commercialized so much recently.  Little children always made their “lists”.  They wait for Santa, Saint Nicholas or whoever the gift giver is in their culture.  The day and the tradition may vary, but the idea is the same.

In days of old, when I was young, we also thought about giving to others.  The holiday season should be a season of renewal and support for others.  The birth of the baby who started all of this was supposed to be heaven’s gift to humankind. 

I remember making cards and ornaments in school to give to Mom and Dad.  My Mom still had many of these up until she died.  Kids – Moms and Dads treasure those things you make, because they are made with innocence and love.  The glitter and glue may be clumpy, and the macaroni may be stuck on at funny angles, but that’s what makes them special.

We have a “mitten tree” at our church.  We put scarves and mittens on it for those who don’t have things to keep them warm.  It’s a good time to think of your local food pantry, women’s shelter, children’s shelter, soup kitchen or other location where people who are having trouble with food or clothing go for help. 

It’s also important to remember this feeling throughout the year.  The need doesn’t stop because the holidays are over.  It just seems to be a little less visible.  Keep up with those “random acts of kindness” throughout the year. 

I’ll try to tell you periodically what I’ve done or seen.  You will probably find those stories under “Random Acts of ‘It’s Not My Job’”.  Here’s one:


Your stories appreciated. 


 

A Day That Will Live in Infamy


Aftermath: USS West Virginia (severely damaged), USS Tennessee (damaged), and the USS Arizona (sunk).
Photo by Lee Embree 38th Reconnaissance Squadron Courtesy Wikipedia


December 7, 1941

It was a peaceful Sunday.  Oahu is a tropical paradise.  The Pacific fleet was unprepared for what was to happen that day. 

The “Greatest Generation” can all recall where they were when they got the news that Pearl Harbor was bombed.  If you know anyone who is old enough to remember this time, ask them about it. 

It truly was “a day that will live in infamy” as President Roosevelt said. 

I have been to the memorial at Pearl Harbor.  It is awesome to think about all the men who died that day.  There are men and women who continue to put their lives on the line every day for our freedom.  Thank a soldier, a sailor, a marine, an airman or any other service member (the other uniformed services are coast guard and public health service) for their service.    

Tuesday, December 6, 2011

EMR Rant – 4 – Templates and Other Fixtures

Techno-Dino (that would be me) is still having issues with that ol’ electronic medical record.  It has things in it that make no sense.  At least to me. 

For example – if the page ends and needs a signature near the bottom, it will almost always put the signature on another page.  I print everything out, because I don’t trust this computer record (dinosaur, remember?).  So I waste a whole piece of paper saying I electronically signed the record. 

I have tried to write letters to consultants on the blasted thing.  It is not yet worth it.  Maybe I will figure it out within the decade.  After all, this is only 2011.  I couldn’t change any spacing of paragraphs, lines, etc.  I’ve been word processing since 1975 (give or take a couple of years – yes, I really am that old, folks), and can’t figure out how to get this one to behave. 

I finally just opened up “Word” and wrote the danged letter over.  I have decided to do this from now on.  I may even save a copy of my letterhead as a shortcut on the desktop because I know how to do that.  I really am somewhat computer literate. 

I’m still learning how to make my own “templates” for things like “normal GYN exam” and stuff.  I probably do a lot more typing than I really need to do. 

Plus, for some reason, now the EMR has spell checker.  However, it doesn’t know how to spell any of the medical words – you know medications, procedures, instruments and other stuff I use all the time.  This includes medications and directions it puts in itself.  So I have to teach it to spell things I didn’t put in – it did????

Remember, this is supposed to make your visit simpler???  I know that the government wants to collect data from these notes.  That’s probably all they are good for.  I’m not sure they are even good for that. 


“Out of Peanut Butter and Jelly Sandwiches, Mom”

Mr. Impatient has learned to make his lunch for school.  This morning he hollered up the steps:

“Out of Peanut Butter and Jelly Sandwiches, Mom.”

“What?”
“Out of Peanut Butter and Jelly Sandwiches, Mom.”

“Do we still have bread?”

“Yup.”

“Do we still have jelly?”

“Yup.”

“Are we out of Peanut Butter?”

“Yes, Mom!”

“I’ll be right down to show you where the extra jar is.”

I also showed him how to scrape the jar and get another couple of days out of it.  And we put PB on the list for our next shopping day.

This is almost word for word the conversation we had this morning.  I’m not exactly positive, because I hadn’t had coffee yet. 

Autistic minds are just a little different.

For Mr. Impatient:

Monday, December 5, 2011

Around the Web – Doctors on End of Life Care

This is an interesting article that a doctor friend of mine shared on a web site I spend entirely too much time on called Sermo. http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/ 

The article is written by a physician.  He talks about those of us who know what all those end of life interventions mean.  Things like CPR, or having a tube in your throat and being on a respirator….   We know the side effects.  We know the risks and benefits.  Some of us have spent our professional lives trying to help patients make the same decisions that we would now be facing.  We administer those treatments. 

I remember a conversation I had with MY mother.  Her father was a physician.  My grandpa sat her down one day and told her that HE didn’t want all those machines when it was his time to go.  He knew what he would face if his relatives wanted to “do everything”.  It was not for him.  Mom felt the same way.  She died at home with hospice. 

I think the article is thought provoking.  I’ve had this discussion with my family.  Think about it.  Have the discussion with your family.  It’s awful when family starts arguing when a member is terminally ill. 

Thursday, December 1, 2011

“I’m on to you” – a patient who “only lied about one thing.”


“I’m on to you” – a patient who “only lied about one thing.”

Today I saw a young female patient with two children.  She supposedly has chronic pain after an accident. I "inherited" her after her last pregnancy. Her OB doctor maintained her on narcotics during her entire pregnancy, then discharged her. I have been seeing her for 5 months. She does have pain, but it is not pelvic.

Technically she should be seeing an orthopedist, but they won’t take her insurance. She has that "good insurance" (Medicaid). I don't participate anymore (you can all clap now) so she pays me CASH. I have been trying to get her to the University to see orthopedics since summer. She has had every excuse in the book.

She has been to the ER twice since she has been coming here. Both times there have been “issues”. The first time she was accused of child abandonment. Both times she was apparently inebriated.

Her story today about the injury that took her to the ER was different than what she told the staff and Doc there. I know for a fact that she was in jail for 7 days for domestic abuse since she was here. I had a call from child protective services yesterday about her.  They are concerned about her children and considering removing them from the home.

She has failed every urine drug screen since she has started here. On discussion today, she really doesn't like that Clonazepam. She just can't feel it. (She was on Xanax when she came here. I won't prescribe it to new patients). So she doesn't take it, and doesn't tell me she's not taking it. Her last two urine screens were negative for it. Others had other problems.  For non-medical people, Xanax is a medication that is used for “anxiety”.  It works fairly fast.  Apparently there is a good feeling with it.  Clonazepam is used for the same thing.  It is long acting, and has no rewarding “good feeling”.

I discharged her today in the office. Gave her 30 days of meds and sent her on her way.  My state requires 30 day notice before discharging a patient.  It’s a stupid rule in my opinion, but it’s the law.   She was shocked. "But I only lied to you about that one thing!" She tried to negotiate for staying without the Clonazepam. Then she wanted to stay "just one more month". Then she wanted to know if I would write her medications for her withdrawal when she got to the end of her prescriptions. 

I hate being manipulated and lied to.  She continued to try with a phone call about something after she left.  “I’m on to you!”