Tuesday, October 28, 2008

One week later...

It's been a full week since I've joined the ranks of the unemployed. Things are going better. No job prospects yet, but I am getting things organized, working on updating my BLS/ACLS certifications and resume, and making the most out of my time.
Here are a few things that did put a smile on my face this past week:
*I went jogging yesterday (it's been a very long time) and I discovered a lovely, quiet avenue that is lined with willows and orange groves as well as rose bushes on the median. It's been my highlight of Riverside so far.
*A friend bought me a super delicious cinnamon bagel with hazelnut cream cheese. It was reeeeaaaly good.
*I also was treated to a wonderful lunch at a Mexican restaurant called Anchos, very delicious.
* A fantastic Halloween party with lots of familiar faces and some new faces as well. And lots of candy.
*More cute nephew pictures on my sister's blog.
*Stopped by a health fair hosted by a local church. There were a lot of volunteers so my help wasn't needed much, but my Spanish did come in handy when I told a man that he had to ge to the doctor ASAP because his blood sugar was super high.
* I did finish watching the first season of "Flight of the Conchords."
*I Reviewed a research paper for a friend, anything to help. I'm still open for service opportunities, just let me know.
*I saved $2.75 with coupons yesterday, which means I can get almost a gallon of gas. Gas being below $3 is enough to put a smile on anyone's face.

Wednesday, October 22, 2008

The Scythe Has Fallen...

The Scythe of the Grim Reaper of Unemployment, that is... Yes, my job is the latest casualty of the healthcare crisis. It was quite an unexpected blow to me. As I was clocking out for the day on Monday, my supervising physician pulls me aside and explains that due to current financial issues (less private-insurance patients, lack of reimbursement from Medicaid patients) the clinic could no longer afford to keep me. The news floored me. I was unemployed as of that very evening.
My emotions are still a bit raw. It is mainly the grief of loss, the unexpected shock, the stress of meeting my financial obligations (I have two loan payments due in a couple of weeks, and seven months left of my lease) and the sudden disruption of a life that had been progressing very smoothly. Today I reflected on Elizabeth Kubler-Ross's 5 stages of death/dying/loss and noted that I had a short moment of denial (the "is this just a bad dream?" thought I had on Monday night), and now passing through the sadness stage and gradually easing into acceptance with the whole thing. I have tried to self-medicate by watching the first season of "Flight of the Conchords." I really could use a laugh. And maybe some chocolate milk... Nevertheless, I feel no anger, no bitterness,* or need to "bargain." The grief is still real, and I have had shed more tears the past couple days than I would like to admit, but I want to arouse my optimistic nature as well. Things will work out. I don't want this to be mistaken as a false happiness to suppress discouragement, but it is as the adage says, "Life is 10% of what happens to you and 90% how you react to it." I also reflected recently on a saying that Joseph B. Wirthlin said, quoting his mother, "Come what may, and love it." So, am I going to love being unemployed? Well, I may not like its effects and stresses, but I can still find joy in today. I have more opportunities waiting for me. More free time, that hopefully I will be able to put to good use including serving others. Anyone need help moving out? Some cookies or empanadas made? Or, hey, maybe I could even go out on a date on a weeknight! (Okay that last one might be a little too optimistic, haha!). My mother suggested a possible visit to see Cutest Nephew Ever I and II. Very tempting, I have to see how the remaining finances** go when I figure them out. I haven't come across too many jobs yet, especially since I may be commuting from Riverside for a while. There's an opening in Thermal (near Coachella/Indio), CA. Like I said, I haven't come across too many openings yet. We'll see what happens.
* I initially felt no anger of bitterness, but I later realized that the way that I was laid off was, as my mother puts it, "despicable" and was very unprofessional. It was an insult to me and to the physician assistant profession. I am not one gets angry very often, but I will say that this issue left me very, very disappointed.
** I have also decided that applying for unemployment is not a bad thing, especially since 1/3 of my paycheck (even my final paycheck) goes to the government anyway.

Thursday, October 16, 2008

On a lighter note...

A couple weeks ago I moved to an apartment. I guess it's my first long-term (more than 6 weeks), all-bills, non-roommate living situation. I've been lucky to get some second hand furniture from the fam and won the battle of the couch with my Mom (it was easier to get her when she was in a good mood and thousands of miles away -- "Ask your father.." Victory!!) As of last Thursday I finally had a place to sit, woohoo!!! I'm still patiently waiting for a table and some chairs. I figured I'll get more "less-needed" stuff such as a television after the post-Thanksgiving or post-Christmas sales.
I think I'm now starting to miss television.
I thought getting by without it would be great for me, I can have more time to pursue other things, less temptations and distractions. I've gone for longer times without it. Now that I go home for lunch I don't get my daily mind rot of "Maury," but I am starting to miss watching the news and being caught up with things going on. I completely missed all the fun of the presidential debates (there's always the internet, I guess). There are those few other shows that I do miss. I had a funny thing happen last week. As I was locking my front door to run an errand, I heard the voice of Steve Carrell subliminally beckoning for my attention. I turned around and from my second-floor door step, I could easily glance into one of the neighbor's living rooms on the first floor across the way. Their sliding glass door was open and I could hear and see "The Office" so clearly on their big screen television. I stood by my doorstep for about a minute or two in my "Office"-induced daze until I realized that this could look very bad. Could my love for "The Office" drive me to become a voyeur? A peeping Thomasina? This would not be a good way to make a first impression with my neighbors.
There's always repeats. And DVDs. My dear "Office," I have not forgotten thee. We just need a little time apart. They say absence makes the heart grow fonder. On to more productive uses of my time...

Monday, October 13, 2008

Can Universal Healthcare Reeeeeaaaally Work?

This was the question I asked my boss during a political discussion not too long ago.
"Sure," he replied, "they just have to lower their costs." If only it was that easy...

This is my first attempt at a political blog, so bear with me. I have been thinking about blogging on this topic for a while. Part of this blog was a response I wrote on an online q&a board a few months back. Last week I had thought about it while I was frustrated with an insurance group but I didn't want to spoil the happy auntie euphoria. This weekend I thought about it some more as I engaged in activities that included exploring bat-infested abandoned mines and scrambling up and down boulders with the consistent thought: "I don't have health insurance, I better not break anything..." It may seem a little ironic that the licensed health care provider who performs physical exams and prescribes your kid's drugs does not have health coverage herself. Fortunately, for me that will change in a few more weeks. Unfortunately, that's not the case for millions of Americans.

We all know that the current health care system is wracked with problems. Our healthcare system is crippled. We pay more money per capita on healthcare than any other developed nation in the world, we still have large populations of the medically underserved, health care costs are grossly inflated, insurance companies have way too much overhead/administration costs (CEOs are being paid way too much), there is a severe problem of Medicaid fraud and abuse, and health care providers and patients are frustrated. No one wants an elderly person on a fixed income to struggle with paying for their medications, a person to be denied a surgery due to their inability to pay, or a child to go without proper medical care. My last point is what I am going to use as a model for this blog because most children, if their parents are responsible enough to look into it, are able to get healthcare, whether through government sponsored insurance (Medicaid) or private insurance. No child should be going without proper medical care in the United States (or at least in California, anyway). I know this because all of my patients are covered under two Medicare insurance branches. For the past couple months I have been able to get a greater understanding of this type of insurance and have pondered about its potential as a model for a universal healthcare system that many politicians are pushing for. Another question: Is a single-payer system the best cure for America's healthcare crisis? I'm not sure if it is, but if it happens, there has to be A LOT of CHANGE on everyone's part. Everyone including every citizen of the country. Below are some points to consider when comparing healthcare systems and some of the negative points of why such a system may not be the best/easiest option (nothing will be easy) for the United States. This is also keeping in mind that the single-payer system will either be controlled or otherwise heavily influenced by the government.

1. Every health care system in the world has three main objectives: Access, Quality, and Low Cost. Unfortunately you can only pick one or two of those things for your system. No healthcare system can have all 3 nor is there a perfect system.

2. Different American mentality. Americans want the best, Americans want choices, Americans want it now. Someone with bone-on-bone knee arthritis living in daily chronic pain doesn't want to wait 5 years for a knee replacement (I heard that's the average wait in Canada). A friend's father flew from Canada to New York for his heart bypass that he paid with his own money because he didn't want to wait months and months for it and risk having another heart attack while he's waiting. I have struggled recently as one of the government health insurance groups has began to crack down on medications that are not listed on its formulary. An allergy sufferer who had been on the same medication for a very long time was trying to get refills. I write on the prescription, "intolerant to A." The pre-authorization was turned down. The insurance company only offered two choices of nasal spray: Drug A or Drug B. "But he's allergic to drug A!" says the grandmother (intolerant to the side effects most likely). Still can't get favored drug... Drug B it is, or nothing...

3. There will always be people who abuse the system and wastes tax-payer money. It already happens with Medicaid, I've seen it. Just one example from a universal-healthcare country: My uncle was in an accident in Norway and his hospital roommate, who was perfectly healthy, was there just because he wanted a "holiday." But it's okay, the government will pay for his holiday. People get ticked off when their tax dollars are misused. People aren't too crazy about how high taxes would have to go to provide universal healthcare. On another level, people will feel like they can go to the doctor for every sniffle or insect bite they get (trust me, I see it every day), because, hey, they're paying for it with their taxes. Never mind the fact that they are exposing themselves to more germs in overcrowded clinics...

4. Reimbursement for government-sponsored programs is horrible. I was talking with one of the other doctors who sees some of the same patients that I do and she says that we (healthcare providers) are only paid for one visit per patient per month, and it's not much of a payment to start with. Therefore, a patient can come back as many times in a month (i.e. follow-up for visit #2, mosquito bites for visit #3, runny nose for visit #4. cough three days later for visit #5 - trust me, this happens) and the provider is paid for the first visit only.

5. Many people don't trust the government handling healthcare. They have seen how efficient the government is handling other issues.

6. There are some lifestyle issues that affect the cost of healthcare. People in the United States live differently. There's fast-food on every corner. We spend too much time in cars or indoors. We're overstressed. Other countries get 6 weeks of vacation a year. Poor lifestyle contributes to many chronic health problems such as diabetes, high cholesterol, arthritis, coronary artery disease, high blood pressure, and other problems. Chronic diseases are VERY expensive. A large percentage of people in the United States are overweight. Diabetes care (90% Type 2) used up 10% of government health spending in 2006. That's billions of dollars, and that will probably rise in the years to come. There's other cultural differences that can impact health and health costs.

7. Cost will still be an issue. Where will the money come from? The sponsored-insurance groups of my patients have seen some scary financial difficulty lately, but at least the Governator passed a bill recently that supplied more money. A temporary Band-aid.

8. Are people in single-payer healthcare system-countries satisfied with what they have? Many say no. Some countries are looking for other options. I heard that Canada passed a law making it illegal for Canadians to seek medical care in the United States. I don't have a source on that, but if it was really true...

So are universal healthcare and a single-payer system the main solutions to the United States healthcare problems? That's for the people to decide.

Wednesday, October 8, 2008

Welcome to the World, Lucas Wesley Mitchell!!

I have auntie euphoria! My nephew count doubled on Sunday when Lucas Wesley (a.k.a Cutest Nephew Ever #2) entered the world after a very quick delivery (labor was only an hour, I hope I will share my sister's "labor genes"). He weighed in at 8 lbs, 11 oz and 22 inches, quite a big boy. All is well and he went home yesterday. My mom will be in Alabama until the end of the month to help out mainly with my older nephew. Brian Jr. will be such a great big brother. I can't wait to see them, although who knows when that will be. I am so blessed. My auntie love capacity has doubled. No recession here.

Wednesday, October 1, 2008

My first complaint

This week I got my first complaint from a parent of a patient. Normally, this would be a traumatizing moment for me, as I am a bit sensitive and need to thicken my skin for for future incidents. The last thing I want to do is offend someone or make a bad name for myself, but I know I am not perfect, parents are not perfect, and I will unintentionally offend someone again. I actually found this incident kind of funny and an example of why patients and parents need to use common sense and courtesy.

Monday one of the doctors came to me and said that she received a call about one of my patients. My heart began to race. She told me the conversation and I knew exactly who she was talking about.
Rolling back to Friday... An hour after the scheduled appointment, I see a girl about 8 years old with a chief complaint of runny nose, congestion, and fever for three days. She had not had a fever since the first day, no fever now, and had not taken any medicine for fever (Tylenol or Motrin). No cough, no history of asthma or allergies, no sick contacts. The only thing I found on physical exam was a really congested, runny nose. Meanwhile, the mom had been talking on her cell phone in a heated conversation for about 75% of the visit. Yes, there were signs in the room about cell phones, and I did have the right to leave the room and come back when her conversation was over or have one of the assistants tell her to turn off the phone, but I was feeling a bit laid back and decided to ignore it. I wrote a prescription for some Sudafed Cold and Cough to relieve the congestion; (yes, I prescribe over-the-counter meds all the time because Medicaid will pay for it, and I figure even if it saves them a couple bucks, a couple bucks may be their children's lunch money). I explained that it's most likely a very bad head cold caused by a virus, that antibiotics won't help (when she asked if I was going to give her the "pink" medicine), and with the combination of lack of fever, no sinus tenderness, length of time, and her age, it most likely was not a sinus infection, and that because it was a virus it just needed some time to pass. I told the mom that if it did persist for more than a couple weeks without any relief, to come back in. The mom was not very happy about the medicine and just shook her head on the way out and mumbled about how "this stuff don't work."

Fast forward to Monday and the doctor tells me about the call she received from the same parent of the same patient. The mother said, "I don't mean to be mean, but I saw your assistant on Friday and she told me it was a cold and gave me some Sudafed." The doctor said that the mother's voice got angrier when she started telling her about her experience after the visit. During that same weekend (not sure if it was the same night of her visit or not), she went to an urgent care (wonder if she had to pay a co-pay, but that's another issue). The mother's anger reached it's climax when she said, "your assistant said it was a cold, but they (urgent care) diagnosed it as a VIRAL infection!!" The doctor reassured her that the two diagnoses were the same thing and that I was correct in my decision.

If only this parent had not been on the cell phone, she would have heard me say "virus" at least three times. Oh well. I guess the stronger the medical terminology, the more reassuring it is to the parents... I have also learned my lesson on cellphones: it's gotta be zero tolerance from here on out...