Category Archives: healthcare

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Pre-Election Thoughts on Healthcare

Back of an Ambulance

Back of an Ambulance (Photo credit: Wikipedia)

Last summer, a member of my family with a chronic disease had an acute worsening in their condition that almost led to their death. My sister calls it a miracle because it is only by chance that we discovered the condition, administered first aid, and got my loved one to the hospital. Not a day goes by that I don’t thank God and guardian angels for the decision to check on this person. Not a day goes by that I don’t think about what my life would be like if they had died rather than lived.  I find myself still feeling thankful that I didn’t have to plan a funeral. It was the most terrifying, out of control, awful thing I’ve ever experienced and I would not wish the situation on anyone. It devastated my family.

Sometimes, in the wee, quiet hours of the night when I can’t sleep and my mind jumps back to that day, I remember how, at every step of the way, the medical and nursing staff assured me that because we had “good” insurance, we had lots of options. We were lucky, they said, even though it’s hard to consider yourself lucky when you’re standing beside an Emergency Room bed hoping someone will live. At that moment I would have paid any price to save them. Mortgaged my house, cashed out my retirement, pawned every last bit of jewelry, sold my soul. I would have done all of those and more. But I had good insurance and that gave us options. I had good insurance because of Obamacare.

Other families have not been as lucky.

Michelle Morse, a full time college student at Plymouth State University was diagnosed with colon cancer in 2004. Unfortunately, in order to remain on her parent’s health insurance, she had to continue at school full time while undergoing her cancer treatment, that or lose her health coverage or pay for her insurance at the higher COBRA rate.  She didn’t have the option of taking time off for cancer treatment.  Since her death “Michelle’s Law,” signed by President Bush in October 2008 has afforded college students with serious illnesses up to 12 months of medical leave without the risk of losing their health insurance.

In 2007, 12-year-old Deamonte Driver,  died from an untreated tooth infection that spread to his brain.  He had Medicaid insurance, but his mother couldn’t find any dentist willing to treat Medicaid patients.  Instead she took him to an Emergency Room, where he was treated with antibiotics and pain medications, and sent home.  Unfortunately the infection in his tooth had spread to his brain and his next trip to the Emergency Room was his last.

It doesn’t take long to find there are plenty of people without options. People who everyday watch their loved ones suffer and die because they don’t have access to healthcare or because they can only get healthcare if they meet certain conditions. But, I was lucky. My family had options.

We didn’t have to worry about the $900.00 ambulance ride. We didn’t think twice about the $3,224.50 Emergency Room stay, the $27,931.11 inpatient hospitalization, or the $5,100.00 and counting outpatient fees. We had good insurance. We had options.

Thanks to Obamacare, many families now have options.  Among other needed changes, the bill prohibited insurance companies from discriminating against people with pre-existing conditions and it allowed young adults up to age 26 to stay on their parent’s policies.

And trust me when I say that having “good” insurance gives you options.  One of them is not having to plan a funeral.  And no matter the outcome of the election, I hope that our country can rally behind the idea that all Americans deserve and should have access to “good”  healthcare insurance.  Too many of our fellow citizens have died from lack of it.

English: President Barack Obama's signature on...

English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

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You’ve Reached Big Patty’s Sex Toy Emporium

English: This is an example of the angst cause...

English: This is an example of the angst caused by the use of a telephone. (Photo credit: Wikipedia)

 

I love to vote, but I hate election time. Being a resident of New Hampshire, the “first in the nation primary,” brings with it a lot of extra, unwanted attention. Most of it in the form of phone calls and junk mail. Starting at 8 am most days, the phone starts ringing with surveys, research calls, and robocalls telling me why I should vote for a candidate because their opponent is an awful, evil person.

 

It makes you want to give up your phone.

 

You’re not even protected by the Do Not Call registry.  One political research marketer said he’d love to put me on their do not call list, but couldn’t because it would violate federal law. Now, the Do Not Call registry states “Because of limitations in the jurisdiction of the FTC and FCC, calls from or on behalf of political organizations, charities, and telephone surveyors would still be permitted,” but really? It’s a violation of federal law to take me out of your databank?

 

Thanks FTC and FCC.

 

In frustration, I finally decided to have fun with the phone calls and callers. I started off simply. Whenever the phone rang and I didn’t recognize the caller ID, I’d pick up the phone and yell “Go!”  Then I’d say absolutely nothing. A few times an apologetic voice would try to identify themselves, but most people would hang up.

 

When that got boring, I decided to answer with, “Who you betting on?” I tried to make my voice a raspy snarl. Again, mostly hang ups, but one brave soul started to do her pitch until I interrupted her to say, “This is a bookmaking line, dummy. You’re costing me money.”  Click.

 

When that got old I switched to the psychic hot line. Mainly because I thought it would be fun, and maybe I’d make a few extra bucks. “You’ve reached the Psychic Hotline,” I’d intone. “Please press 1 for Visa, 2 for Mastercard, and 3 for American Express.” Again, a few attempts at conversation, but mostly hang ups. I also noticed the calls were slowing down. Could the political telemarketers  have some sort of secret communication system I wasn’t aware of? I decided to bring out the big guns.

 

“Big Patty’s Sex Toy Emporium,” I’d answer the phone in a cheerful, peppy voice,  “because bigger is better. How may I direct your call?” This met with silence and the occasional giggle. I think it was because the image of Big Patty, I’m thinking a redheaded six footer who ropes calves in her spare time and has a sexy rodeo outfit, stopped people dead in their tracks. I experimented with different tag lines. “No hole to0 large,” seemed unnecessarily sexual. “We guarantee our toys have never been used,” seemed too obvious.  Before I could perfect my pitch, the phone calls dried up.

 

From a high of approximately 15 nuisance calls a day, my phone now is quiet. Today, for instance, no political calls at all. I am grateful for the silence, but a little sad in that I didn’t get a chance to fine tune Big Patty into a robocall stopping machine.

 

I guess she’ll stay silent until 2016. Until then, if you want to reach me, I’ll be at Big Patty’s Sex Toy Emporium.

 

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Let’s Call A Dick A Dick

English: "No Swearing" sign along At...

English: “No Swearing” sign along Atlantic Avenue in Virginia Beach, Virginia. (Photo credit: Wikipedia)

For me, fall is a time of reflection and contemplation. I don’t know why fall has such an effect on me, but nine out of twelve job changes have occurred during the fall. While dusting off my resume recently, I looked back and thought about how lucky I am that I can count the number of disruptive physicians I’ve worked with on one hand.

Disruptive physician is code for doctors who are dicks. Whether it’s the surgeon who picked up a nurse manager and put her down in a sink or the neurosurgeon who had to be removed from the Operating Room by the police after flipping out when his request to use unsterilized instruments on a patient was ignored. Some doctors believe they can act in ways that would get them punched or arrested in the real world, but in the hospital, they can do no wrong.

The problem is so pervasive that in 2009  The Joint Commission, a voluntary accreditation agency for hospitals, started requiring hospitals to have standards in place and procedures to deal with disruptive behavior, including physician disruptive behavior.

Unfortunately, some physicians believe there is an ulterior motive to disruptive behavior policies. In 2008  American Medical News.com has these two quotes:

“If somebody’s not a ‘team player,’ individuals will try to remove them from the team, and the disruptive physician policy is one mechanism by which that can be done,” said Dr. Gregory, a general surgeon and trustee at the Muskogee Regional Medical Center in Oklahoma

Interesting perspective. I’ve just never worked in a hospital that targets well-mannered, kind, respectful physicians who aren’t team players.  Oh, unless not being a team player is a code word for a doctor who’s a dick.

During my nursing career, I’ve had a surgeon approach me in the nurse’s station and loudly yell that it was my job to fill out the preoperative consent and, when I refused, accused me of doing it for the other surgeon.  He thought the nurses played favorites.  Luckily that was at a hospital where our policy was to laugh at dicks in person and hang up on them when they called. Really.

I’ve also had a specialist scream at me in a hallway because no one told him I would be observing in the clinic he worked in that day. He (not the owner of the clinic, just another hospital employee) didn’t think anyone should be allowed in the clinic without his permission. Every time I tried to (politely) interrupt, he yelled louder until I walked away.

Did these doctors suffer any ill consequences from their dickish actions? No. Most hospitals will forgive physicians who bring in business. Sort of like your top used car salesman. If he sexually harasses the secretary, do you really want to lose him to keep her?

Instead of trying to get rid of disruptive physicians, most hospital administrators would rather keep the doctor. Even when there are multiple complaints. Even in the face of staff turnover. Even when patients get hurt because of the doctor’s behavior.

When doctors whine, yell, threaten and bully other healthcare workers with questions or concerns, those questions and concerns are going to dry up. Pretty soon no one’s going to be calling them in the middle of the night to deal with a rapidly deteriorating patient because no one wants to take the verbal abuse. Rapid response teams were formulated because too many patients died while physicians blew off concerned hospital staff and family members.  That’s why in a hospital with three wrong side brain surgeries, no neurosurgeons lost their jobs. Instead the nurses were told not to give the scalpel to the surgeon until he verified he was on the right side or the nurse would be punished. When that didn’t work, they hired staff to go into operating rooms and monitor that doctors were properly identifying the correct side.

There is a price to be paid for healthcare’s refusal to address the problem of disruptive physician behavior and the price is paid every day by patients as well as by the people who leave healthcare careers. I think that calling the problem what it is might be a step in the right direction.

Let’s call a dick a dick.

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Jane, You Ignorant Slut, A Vaccine Doesn’t Cause Promiscuity

Sexually transmitted disease

Sexually transmitted disease (Photo credit: Wikipedia)

What if an immunization existed that made young girls become sexually active? Sounds like a horror story that I might write one day. Realistically, though, no pharmaceutical company would be interested in developing a vaccine that made young girls sexually active. Vaccines are developed to prevent disease, not to promote unwanted behaviors.

In June 2006 a vaccine for HPV (Human Papilloma Virus) was licensed. The vaccine information statement provided by the CDC has this to say about HPV:

“Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. About 20 million Americans are currently infected, and about 6 million more get infected each year. HPV is usually spread through sexual contact.”

Sounds like a disease one would wish to avoid.

“Most HPV infections don’t cause any symptoms, and go away on their own. But HPV can cause cervical cancer in women. Cervical cancer is the 2nd leading cause of cancer deaths among women around the world. In the United States, about 12,000 women get cervical cancer every year and about 4,000 are expected to die from it.”

Cervical cancer bad, right? Minimizing the chances of getting it would be good. I mean, children are vaccinated against diseases like hepatitis B, polio, and flu. Protecting them from a virus that causes cancer should be a no-brainer.

So why did so many parents opt out of HPV vaccination when it was first introduced? And why did so many states battle to make sure it wasn’t required?

Maybe because HPV is a sexually transmitted disease aka STD and you can’t catch STD’s if you are abstinent. Abstinence education believes that “the only 100% effective protection from the physical, emotional, mental, and social consequences of sexual activity is to save all forms of sexual activity for marriage” (source: http://www.ampartnership.org/) If children are abstinent, they have no risk factors for HPV and don’t need the vaccine. Further inflaming the abstinence educators was the recommendation that HPV vaccine be given to girls age 11 and up. Obviously giving them a vaccine to prevent STD’s at that age would send a tacit message that they were expected to have sex.

Really. Like if you get a Hepatitis A vaccine you’d lick watermelons bathed in raw sewage because you’d be protected against a disease spread by infected bowel movements. Or if you have a tetanus vaccine you’d start jumping on rusty, dirt covered nails because you wouldn’t be worried about a disease spread through cuts or wounds. If the above were true, clearly immunization against HPV would encourage young girls to have casual sex with multiple partners.

In reality, giving the vaccine to children before they are sexually active gives the best bang for the buck. The vaccine only works against HPV types the person has not been exposed to.

Sexual contact = potential HPV exposure = less effective vaccine.

Simple. Give it to people who haven’t had sex and, if they wish to remain abstinent until marriage, they’ll be protected then. You know, in case their spouse carries the HPV virus.

Unfortunately logic didn’t stop the outcry that allowing a child to have the vaccine gave approval for the recipient to have sexual activity and lulled the (now) sexually active child into believing they were impervious to STD’s.  Parents, legislators, and religious leaders all loudly railed against this vaccine.

Recently a three year study published in Pediatrics journal concluded that girls who received the HPV vaccine showed no increase in pregnancy rates, STD rates, or contraceptive use when compared to girls who didn’t receive the HPV vaccine. In other words, vaccination did not turn the girls into sluts. Instead it protected them from infections with HPV types 16 and 18, the cause of  approximately 70 percent of cervical and anal cancers.

And, as the years go by and research continues, there should come a time where  there is a clear difference in cervical cancer rates between those vaccinated with, and those who didn’t get, the HPV vaccine.  When that time comes, I think it will be damn hard to explain to your child that you didn’t protect them against a deadly disease because you misinterpreted cancer prevention as an assault on your child’s virtue.

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Yelling is Always Optional

English: A hungry baby yelling and crying.

Sometimes things get screwed up. You plan on a sunny day and it rains. You want a laptop for your birthday and you get a vacuum. You think you’re dog’s well behaved enough to leave out of the crate and he eats your favorite pair of shoes. Shit happens. It’s not always someone’s fault and it’s not always repairable, but life goes on.

Which is why I’m always confused when I get a phone call from an unhappy, pissed-off person who thinks that yelling at me will solve the problem. Wrong. And, I mean, they have to know that on some level. I am not the Queen of the Universe nor am I She-Who-Must-Be-Obeyed. The best you’ll get from me is an “I’m sorry” and maybe a promise not to do it again.

But lately I feel that people don’t want apologies or excuses. They want to yell at someone, stomp their feet, threaten physical violence, make a scene. Since those are the things guaranteed to make me either walk away or hang up, there must be some other reason why people use these tactics.

Remember when daytime television consisted of Jerry Springer, Maurice, Jenny, and Montel? For many of us, it was our first glimpse of people who didn’t follow the rules of polite society (well, the first glimpse of people out of diapers who didn’t follow the rules). Screaming, interrupting, throwing things, and fisticuffs were all part of the spirited debate. It got to the point where, even with closed captioning on, it was impossible to figure out what was being said as everyone yelled over one another.

When the yelling stopped, the physical fights began. We were introduced to press-on nails, weaves, and the concept of kicking off one’s shoes to signal a readiness to punch someone (though Jerry eventually added the dinging sound of a boxing match bell). We quickly went from expecting a fight, to demanding one.

Eventually, like Jimmy Choo shoes and Coach handbags, the rest of society coveted what they saw on television. If the former baby momma could lay hands on the current one, why couldn’t we take out our aggressions against the neighbor who always parked in our spot? If someone cut us off in traffic, why take that silently when we could chase them down and trade gunshots? Instead of a nation of polite discourse and problem solving, we became a nation of loud-mouthed wannabe gangsters and thugs.

And then it was only a hop, skip, and jump til we got to the point where yelling, threatening, and even physically assaulting people became commonplace. Fights don’t need to be settled with words when fists and guns are available. In Kentucky, a 12-year-old boy was shot in the back after playing ding-dong-ditch at the home of a 56-year-old with a shotgun. McDonald’s drive thru patrons assault the occupants of the car in front of them when the line doesn’t move fast enough. Someone cut you off at the deli counter? Ram their cart and tell them what you think of them.

We are no longer afraid or ashamed to raise our voice or our fists as a first response. And that’s not a good thing. Because aggressive behavior doesn’t help, it only shuts down the conversation.

So I challenge you the next time you’re in the express lane and the person in front of you has more than the allotted number of items, be quiet. The next time someone cuts you off in traffic, keep your hands on the wheel rather than on the horn. The next time a scared fifteen year old screws up your McDonald’s order, take a step back and suck it up. There’s no rule that says we have to go over the top. We can become polite, courteous human beings again. It’s really not hard as long as we’re willing to act like adults rather than pissy-panted toddlers.

And who knows, maybe you can attract more flies with honey than with vinegar.