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.

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.

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...

Do I surprise you??

I'm behind in my blogging and need a little inspiration. I figured I could write one about some recent controversial issues and politics, but I'm not really in the mood right now. But stay tuned if you are into that stuff. Instead, I got this idea from my friend Heather's blog and thought that it was a pretty cool idea. One that I've put off too long. It's a list of 200 things that I have or have not done in my life. The things I HAVE done are in bold and italicized. There's quite a few things I still hope to accomplish, and if you want to help me accomplish them, let me know. If you've known me for a while maybe something will surprise you...

200 Have and Have-not's
1. Touched an iceberg
2. Slept under the stars
3. Been a part of a hockey fight
4. Changed a baby's diaper
5. Watched a meteor shower
6. Given more than you can afford to charity
7. Swam with wild dolphins
8. Climbed a mountain
9. Held a tarantula
10. Said "I love you" and meant it
11. Bungee jumped
12. Visited Paris
13. Watched a lightning storm at sea
14. Stayed up all night long and watched the sun rise
15. Seen the Northern Lights
16. Gone to a huge sports game
17. Walked the stairs to the top of the Statue of Liberty
18. Grown and eaten your own vegetables
19. Looked up at the night sky through a telescope
20. Had an uncontrollable giggling fit at the worst possible moment
21. Had a pillow fight
22. Bet on a winning horse
23. Taken a sick day when you're not ill
24. Built a snow fort
25. Held a lamb
26. Gone skinny dipping
27. Taken an ice cold bath/Shower (well, maybe not really ice-cold)
28. Had a meaningful conversation with a beggar
29. Seen a total eclipse
30. Ridden a roller coaster
31. Hit a home run
32. Danced like a fool and not cared who was looking
33. Adopted an accent for fun
34. Visited the birthplace of your ancestors
35. Felt very happy about your life, even for just a moment
36. Loved your job 90% of the time
37. Had enough money to be truly satisfied
38. Watched wild whales
39. Gone rock climbing
40. Gone on a midnight walk on the beach
41. Gone sky diving
42. Visited Ireland
43. Ever bought a stranger a meal at a restaurant
44. Visited India
45. Bench-pressed your own weight
46. Milked a cow
47. Alphabetized your personal files
48. Ever worn a superhero costume
49. Sung karaoke
50. Lounged around in bed all day (does it count if I was sick?)
51. Gone scuba diving
52. Kissed in the rain
53. Played in the mud
54. Gone to a drive-in theater
55. Done something you should regret, but don't
56. Visited the Great Wall of China
57. Started a business
58. Taken a martial arts class
59. Been in a movie (does a mission video count?)
60. Gone without food for 3 days
61. Made cookies from scratch
62. Won first prize in a costume contest
63. Got flowers for no reason
64. Been in a combat zone
65. Spoken more than one language fluently
66. Gotten into a fight while attempting to defend someone
67. Bounced a check
68. Read - and understood - your credit report
69. Recently bought and played with a favorite childhood toy
70. Found out something significant that your ancestors did
71. Called or written your Congress person
72. Picked up and moved to another city to just start over
73. Walked the Golden Gate Bridge
74. Helped an animal give birth
75. Been fired or laid off from a job
76. Won money
77. Broken a bone (do teeth count?)
78. Ridden a motorcycle
79. Driven any land vehicle at a speed of greater than 100 mph
80. Hiked to the bottom of the Grand Canyon
81. Slept through an entire flight: takeoff, flight, and landing
82. Taken a canoe trip that lasted more than 2 days
83. Eaten sushi
84. Had your picture in the newspaper
85. Read The Bible cover to cover
86. Changed someone's mind about something you care deeply about
87. Gotten someone fired for their actions
88. Gone back to school
89. Changed your name
90. Caught a fly in the air with your bare hands
91. Eaten fried green tomatoes
92. Read The Iliad
93. Taught yourself an art from scratch
94. Killed and prepared an animal for eating
95. Apologized to someone years after inflicting the hurt
96. Communicated with someone without sharing a common spoken language
97. Been elected to public office
98. Thought to yourself that you're living your dream
99. Had to put someone you love into hospice care
100. Sold your own artwork to someone who didn't know you
101. Had a booth at a street fair
102. Dyed your hair
103. Been a DJ
104. Rocked a baby to sleep
105. Ever dropped a cat from a high place to see if it really lands on all fours
106. Raked your carpet
107. Brought out the best in people
108. Brought out the worst in people
109. Worn a mood ring
110. Ridden a horse
111. Carved an animal from a piece of wood or bar of soap
112. Cooked a dish where four people asked for the recipe
113. Buried a child (Does it count that it was in a play?)
114. Gone to a Broadway (or equivalent to your country) play
115. Been inside the pyramids
116. Shot a basketball into a basket
117. Danced at a disco
118. Played in a band
119. Shot a bird
120. Gone to an arboretum
121. Tutored someone
122. Ridden a train
123. Brought an old fad back into style
124. Eaten caviar
125. Let a salesman talk you into something you didn’t need
126. Ridden a giraffe or elephant
127. Published a book
128. Pieced a quilt
129. Lived in an historic place
130. Acted in a play or performed on a stage
131. Asked for a raise
132. Made a hole-in-one (Does mini-golf count?)
133. Gone deep sea fishing
134. Gone roller skating
135. Run a marathon
136. Learned to surf
137. Invented something
138. Flown first class
139. Spent the night in a 5-star luxury suite
140. Flown in a helicopter
141. Visited Africa
142. Sang a solo
143. Gone spelunking
144. Learned how to take a compliment
145. Written a love-story
146. Seen Michelangelo’s David
147. Had your portrait painted
148. Written a fan letter
149. Spent the night in something haunted
150. Owned a St. Bernard or Great Dane
151. Ran away
152. Learned to juggle
153. Been a boss
154. Sat on a jury
155. Lied about your weight
156. Gone on a diet
157. Found an arrowhead or a gold nugget
158. Written a poem
159. Carried your lunch in a lunchbox
160. Gotten food poisoning
161. Gone on a service, humanitarian or religious mission
162. Hiked the Grand Canyon
163. Sat on a park bench and fed the ducks
164. Gone to the opera
165. Gotten a letter from someone famous
166. Worn knickers
167. Ridden in a limousine
168. Attended the Olympics
169. Learned to hula or waltz
170. Read a half dozen Nancy Drew or Hardy Boys books
171. Been stuck in an elevator
172. Had a revelatory dream
173. Thought you might crash in an airplane
174. Had a song dedicated to you on the radio or at a concert
175. Saved someone’s life
176. Eaten raw whale
177. Know how to tat, smock or do needlepoint
178. Laughed till your side hurt
179. Straddled the equator
180. Taken a photograph of something other than people that is worth framing
181. Gone to a Shakespeare Festival
182. Sent a message in a bottle
183. Spent the night in a hotel
184. Been a cashier
185. Seen Old Faithful geyser erupt
186. Joined a union
187. Donated blood or plasma
188. Built a campfire
189. Kept a blog
190. Had hives
191. Worn custom made shoes or boots
192. Made a PowerPoint presentation
193. Taken a Hunter’s Safety Course
194. Served at a soup kitchen
195. Conquered the Rubik’s cube
196. Know CPR
197. Ridden in or owned a convertible
198. Found a long lost friend
199. Helped solve a crime
200. Commented on a friend's blog today.

Welcome to Pediatrics

Now that I've been in my job for over a month I guess I can share some experiences. Jumping into pediatrics for my first job has been quite an experience. I've learned a lot and still have so much learning to do. There's been some ups and downs. Downs including demanding parents (PLEASE check your attitude at the door), kids coughing in my face, the shock of having over a third of my paycheck go towards the government, and a few others. Ups include the sincere thank yous, working with great staff, the smiles that I get from kids of all ages, the opportunity to express standards and morals (monitoring TV programs, abstinence, etc...) while being viewed as "an authority" - that part is still a little weird. I appreciate those little opportunities where I hope I make a small difference in someone's life during such a short encounter. And then there are those weird, crazy, and funny moments, some are as follow...
* A rule for parents: please do not bring your puppy to your child's doctor appointment. Even more important, do not weigh your puppy on the baby scale or use any other clinic equipment on your dog.
* Another rule for parents: Please do not steal soap from the rooms. That is just ghetto. Ghett-o.
* I do confess that there are quite a few parents who ,"do not present themselves well," as one of my friends would say. Sometimes they don't have to say a word and sometimes their kids will say it for them. I had one tot whose first words, according the parents, very closely resembled "shut up" and "stupid." The only response I could say was ,"Wow." I remember my program director in PA school very early on in our training teaching us the importance of the "thought bubble" - as seen in cartoons and comic strips - and keeping our potential reactions and thoughts inside that bubble. I have used my "bubble" often.
* I am often humored by "creative spelling" of kids names. I know with some of the parents English is their second language, and some parents are trying to be unique, but I can't help to chuckle when I see names like "Melony" and "Marical" and quite a few others. Plus, it makes me look a little foolish when I attempt to say their name after I read it off the chart.
* One of the important rules I learned in pediatrics: Teenagers will always take more time. Always.
* I love my Littman stethoscope. It has endured some trauma during this past month, but its durability has not let me down. On my one week anniversary working at the clinic, I came down with the stomach flu. Near the end of the day as I was observing one of the doctors start putting some sutures into the last patient of the day, my stomach could no longer keep my breakfast and lunch down. Before I bowed to the porcelain god, I threw my stethoscope off my neck and onto the floor. After I finished what I needed to do, I noticed that the chain was broken in the toilet. I removed the lid of the tank and placed it on the trashcan so that I could reattach the chain. As I was fiddeling with the toilet , the trashcan tipped over and with with a loud noise (enough to scare another staff member and have her knock on the door) the tank lid fell right on top of the bell of my stethoscope. Fortunately, the tank lid didn't break and the only damage my stethoscope received was a crack in the rubber no-chill ring. Sooo lucky.
Fast forward to yesterday. I had a three year old patient who was going through a major mood swing. After yelling at his mom and calling her some not-so-nice names, he grabbed my stethoscope, pulling it from my ears, bit down on it and pulled on it as hard as he could. After I kept my cool he calmed down almost instantly and with my constant praise for his good behavior, he was an angel for the rest of the visit. After sanitizing my scope with some alcohol, I noticed that there was no damage, no teeth marks even. Amazing! A vet student friend of mine commented on how her stethoscope has survived being stepped on by cows. Huzzah for Littman stethoscopes, Huzzah!!

That's it for now, I'm sure I'll have more stories from the trenches, in a HIPPA-protected sort of way. Stay tuned!

Bergen, Norway

After I arrived in Norway, I was ready to achieve another part of my dream. This was to walk the same narrow, cobblestone streets that my great-grandparents walked at the turn of the 20th century - my great-grandfather as a missionary, and my great-grandmother as a resident. Other than the satellite dishes, many of the streets looked as if they had not changed much. I enjoyed the harbor, especially in the evening with the street performers, my first-night downpour without my umbrella, walking through the fish market on a Saturday morning (except for the smell), and the lovely shops that have existed for more than a hundred years.

One of my stops on the trip was to visit the home of Norway's most famous composer, Edvard Grieg. His name may not sound familiar to most people, but his music is. What I like most about Grieg is his ability to transform the emotions of life's ordinary and extraordinary moments into beautiful music, as well as his ability to embody the inspirational and spiritual nature of his surroundings (i.e. the wilderness of Norway.) Not surprising, his composing hut has a beautiful view overlooking a tree-lined lake that undoubtedly inspired his music.

One of my mandatory sites in Norway was to see a stave church - the centuries-old wooden churches with unique architecture and design that, as a tool to convert former pagans to Christianity incorporated early Christianity with pagan symbols. Unfortunately the original near Bergen burned down in the 1990s, but it was rebuilt. A stone cross from the early years of Christianity still remains there. I also had a good conversation with a graduate student conducting a survey about churches as tourist spots in Norway and Europe. We talked about his study, the religious lifestyles of Americans and Europeans, as well as a little of my own beliefs.

One of my favorite parts of the trip was my journey to Flam and taking a little cruise around the infamous fjords of Norway. It was incredible! I would love to return again someday and maybe take a hiking/kayaking trip around the fjords just like the American girl I met at the laundromat.

The train ride down into the Flam Valley was impressive and throughout my whole fjord journey I saw numerous cascades flowing down the deep green, and sometimes snow-topped, fjords. I also enjoyed seeing the beautiful little towns scattered throughout the fjords, from the deep valleys to the high peaks. The envy toward those Norwegian shepherds continued to grown inside me...

I enjoyed a sunset at the Bergen fortress one evening and it was very beautiful. My favorite sunset of the whole trip was enjoyed at the top of a hill overlooking the whole city and harbor of Bergen. I was able to take a tram up to the top and stayed until 11:30, just enjoying the view.


This pretty much wraps up my Scandinavia trip. Hope you enjoyed the ride. I would love to take this trip again, but I'm afraid it's going to have to wait for a very long time. I guess it's back to more diverse blogging.

Oslo, Norway

This was it. This was my gateway to achieving my 17 year dream of going to Norway and now I had achieved it. I had only one day to explore Oslo. Oslo is a beautiful city, lots of statues, clean streets, (except for the section of downtown that was torn up for construction), fountains, a mix of old and new architecture (the majority still had the antique feel) and lots of flowers.


My first stop in Oslo (after a much longer than anticipated trip the day before from Copenhagen) was the Akershus fortress and castle. Much of the building dates back to the late 13th century. This was a great place to take some pictures and get a view of the city.



















My second stop in Oslo was the National Gallery. So many wonderful works of art and masterpieces that were centuries old from different Norwegian artists. My favorite part was the room dedicated to the most well-known artist, Edvard Munch. I am fascinated by how he is able to convey such intense and personal feelings, philosophies, and experiences into his work. He is most well known for his painting of "The Scream", which I have a parody on the left side of my blog. It was fascinating to learn about how this painting was inspired by a personal experience of his. This particular version (he made multiple "Screams") was stolen a few years ago and recovered earlier this year. The restoration efforts, due to some defacing it underwent, were amazing. I was also able to enjoy the beautiful "Madonna" painting that was also recovered this year. Another painting that I was fascinated by was "The Sick Child" which was a work he painted at the age of 22 and was inspired by the death of his own sister. Despite the harsh criticism he received for his style and technique, I thought it was an excellent work. If I had more time, I would have visited the Munch Museum in Oslo, but I felt like I did get a good introduction to his life and works.

After an afternoon visit to the Royal Place and gardens, I spent the evening in Frogner Park and the Vigeland Sculpture Park.












The theme of the Vigeland Sculpture Park is the Human Condition and the cycle of life. Over 200 bronze and granite statues were designed and created by Gustav Vigeland during the early half of the 20th century. One of the highlights of the park is the Monolith, a single, carved piece of stone consisting of piled figures that look as though they are struggling to rise to heaven. This work is said to represent man's desire to become closer with the spiritual and design. It is suppose to portray a feeling of togetherness as the humans embrace one another as they are carried toward salvation. Another interesting point about the Monolith is that the humans at the top are children and babies, those who are closest to heaven and all that is divine. There was something about the range of human affections, emotions, and relations portrayed in all of the statues in the park that I found intriguing. The essence of the human soul and its basic relationships- parents, children, friends, siblings, lovers, enemies - all depicted in stone and bronze; giving life to the lifeless. It was a very memorable experience.

My day in Oslo ended with a trip back to the hostel on the tram, just in time to barely miss the beginning of a thunder and lightening storm. I wanted to see it, but it was quite late and I had a morning train ride to Bergen. Plus, risking electrocution when one is alone in a foreign country may not be a good idea.

Some other random observations about Oslo:
* I've never been to a city where street performers are dressed up as famous natives (well, maybe the exception of the Ben Franklins in Philadelphia). In Oslo's case , it was the playwright Ibsen.
*There were a lot of Spanish-speaking tourist in Norway. I would have never thought...
*I finally caught on about the true value of the recycling redemption value of plastic water bottles. A refund of a krone (probably about 20 cents) is a krone more to spend, especially in a country like Norway. I finally gave up buying bottled water in Bergen anyways.
* I did take a couple breaks from walking all over the city to watch some children play in the city's fountains on a hot, summer day. I was tempted to join them, but I refrained.


It is safe to say that Oslo was the cultural highlight of my trip. Stay tuned for more Norwegian beauty and adventures...