Now that we are past the age where the three martini lunch was an acceptable daily interlude, it is not acceptable for anyone to be under the influence of anything (other than a post-four hour meeting daze) in the work place.
Back in the late 70's and early 80's I worked in a restaurant that was a destination lunch place for a bunch of office park employees. We had cab company phone numbers next to the phone for those who could not safely drive themselves back to the office. Over the five years I was there, often working as a cashier, I watched the lunch checks go from three martinis to one glass of wine or a single Bloody Mary or other vodka based drinks. Times changed even then.
Later in the 1990's I worked for a British company and went to the UK regularly for week long trips. I was usually taken out to lunch at a local pub where I was expected to have a beer, or at least a half pint Shandy (lemon/lime soda with beer) with my meal. I usually declined because it would cause my jet lagged body to demand a post meal nap instead of working for the afternoon. In the US, I think its very rare that alcoholic beverages are consumed at lunch during the business day any more. I don't think any work place is immune to impaired employees but some of them have more long lasting implications than others.
When we go to the doctor we make a few basic assumptions, that they are trained and know what they are doing, they won't hesitate to consult their peers when they are unsure, and they are sober. While the majority of doctors would report their impaired colleagues, 17 percent actually have dealt with one. Um, do the math, that's one in six. I'm not picking on doctors and actually believe that they are probably one of the more conscientious industries. They are probably less likely to go out for fancy lunches to celebrate a business deal, or even have time to do more than grab a quick bite during the day. But when its my body and health that's being treated here, I would like the basics.
What astounded me about this article is that the numbers are so high. What it doesn't state is if the 17 percent reflects over their career they have dealt with impaired employees or over the past five years. We need a little more information here before becoming concerned. But I am already concerned. Should I start sniffing their breath?
Showing posts with label doctors. Show all posts
Showing posts with label doctors. Show all posts
Friday, October 23, 2015
Monday, October 19, 2015
Disillusioned Doctors
There has been a fair amount in the news recently on disillusioned doctors and the 'tell all' books on 'life behind the scenes'. Disillusionment is being deprived on illusions. So what were they expecting?
I guess I mean to doctors go to medical school expecting to save the world? I know the medical world has changed significantly in the recent decades and the focus has changed from caring about patients to caring about insurance costs and paying the hospital administrators. But as their world adapts, the medical professionals need to adapt.
Technology has advanced and made healing patients easier. Patient care now includes concerns with hospital and insurance costs. Its a fact. It doesn't mean its right but it must be worked with and adapted to. I am the first person to decry the weight an insurance company has on choosing my medical care. And I would value change to refocus care on to what the physician wants for the patient as opposed to what insurance will cover.
But I don't want a medical professional who is disillusioned and hating the system, to bad mouth it to me and be cranky. I still want the care where the carers do care. I want the bedside manner. I want the ability to talk and ask questions. I know the staff are rushed but it can be done with a smile instead of a frown.
To correct the system will mean more change so please do not resist the change and be grumpy and disillusioned to me the patient who is in need of care.
I guess I mean to doctors go to medical school expecting to save the world? I know the medical world has changed significantly in the recent decades and the focus has changed from caring about patients to caring about insurance costs and paying the hospital administrators. But as their world adapts, the medical professionals need to adapt.
Technology has advanced and made healing patients easier. Patient care now includes concerns with hospital and insurance costs. Its a fact. It doesn't mean its right but it must be worked with and adapted to. I am the first person to decry the weight an insurance company has on choosing my medical care. And I would value change to refocus care on to what the physician wants for the patient as opposed to what insurance will cover.
But I don't want a medical professional who is disillusioned and hating the system, to bad mouth it to me and be cranky. I still want the care where the carers do care. I want the bedside manner. I want the ability to talk and ask questions. I know the staff are rushed but it can be done with a smile instead of a frown.
To correct the system will mean more change so please do not resist the change and be grumpy and disillusioned to me the patient who is in need of care.
Saturday, May 23, 2015
Changing doctors...
I am not one to doctor shop or doctor hop. But I did make a change to my doctors yesterday. I see a psychologist and psychiatrist for depression and anxiety - how is your brain after all sorts of medical crap.
The PhD had recommended I see an MD a few years ago and she recommended one who was not available. So I went with Dr S instead. I was not impressed. She has no people skills. I stuck with her because I felt that I should give her a fair chance. A few years later I am not impressed still. So I bit the bullet and consulted with the PhD on who to go with. Now I'll be seeing a Nurse Practitioner instead.... I don't really care as long as my meds interactions are monitored closely which is my real problem.
My only real doctor concern these days is that one of them might retire and I will be forced to make a change...
The PhD had recommended I see an MD a few years ago and she recommended one who was not available. So I went with Dr S instead. I was not impressed. She has no people skills. I stuck with her because I felt that I should give her a fair chance. A few years later I am not impressed still. So I bit the bullet and consulted with the PhD on who to go with. Now I'll be seeing a Nurse Practitioner instead.... I don't really care as long as my meds interactions are monitored closely which is my real problem.
My only real doctor concern these days is that one of them might retire and I will be forced to make a change...
Sunday, April 26, 2015
Quick access to medical care
Do you see the nurse or the doctor (or the physician's assistant)? Back in the good old days, you went to the doctor and saw the doctor. A nurse might come in and take your vitals, bandage something up, or some other task that was below the doctor's capabilities. They were doctors and didn't do the basic stuff that would take away from their schedule.
Now you may see the doctor, the nurse, the nurse practitioner, or a physician's assistant or even someone else.... Does it make a difference? Not really. They all give out prescriptions, send you for tests, and diagnose and treat you. They all talk to each other if there are any questions.
Back when I was young and athletic in the 80's and 90's, I used to go skiing with Club Med in Colorado (an awesome vacation every year for seven years). One year, I was put in a group of skiers which included several doctors, a nurse, a few others, and me. It snowed overnight so we went skiing in the back bowls to enjoy the fresh powder. This entailed a hike up over a ridge in loose snow at about 14,000 feet (gasping for breath), over the head wall singly, and reconnect as a group with the instructor last to clean up any debris (skis, poles, hats, gloves, etc) to ski down for a mile or two, take another lift back up to ski down the front side of the mountain.
All went as planned. Each of us went over the head wall and into the loose powder (and you say 'why is she telling this story' - be quiet there is a point here) and across the flats. Last came the instructor, schussing across the flats, until his ski hit a rock just under a thin layer of powder where the wind had blown off the other foot or so of snow. He did your basic rolling fall with equipment going everywhere (similarly to 'the agony of defeat'). We started back to help pick up everything and give him a lot of sass for it.
All jokes ended when we saw the blood pouring out of his face. In a rather inaccessible place in the mountains, he caught a ski pole in his face and ended up with an 'Al Pacino Scarface' injury. The doctors stood and gaped and said they hadn't seen anything like that since internship. The nurse ran to his side and started yelling for clean tissues, napkins, bandanas, anything to apply pressure and stop the bleeding. The nurse knew what to do. She fixed him up and rode the chairlift back up with him and went with him to the clinic where he got five stitches in his face. The doctors went to lunch.
So on that sunny day on a ski slope on the backside of a mountain in Colorado, the nurse was the winner.
Now when I go to see my PCP or oncologist, I often see a nurse practitioner. When I see my pain doctor, sometimes I see his physician's assistant. Its not that big a deal. Particularly with my PCP, if I have a new ailment and need a visit as soon as possible, I'll get one of the nurse practitioners. I could wait a week before seeing my PCP or see the nurse practitioner. I'm happy with the sooner visit.
Think of this as well. Do you remember going to the dentist and the dentist cleaned your teeth? Now a hygienist cleans your teeth and a dentist does fillings and other nasty things with drills and pointy things. When I go to the eye doctor a technician checks my vision and glasses prescription and the ophthalmologist checks my corneas.
All this is for quicker medical care and more use of specialized training in different parts of the medical world. I'm all for it - I want the quicker access to medical care.
Now you may see the doctor, the nurse, the nurse practitioner, or a physician's assistant or even someone else.... Does it make a difference? Not really. They all give out prescriptions, send you for tests, and diagnose and treat you. They all talk to each other if there are any questions.
Back when I was young and athletic in the 80's and 90's, I used to go skiing with Club Med in Colorado (an awesome vacation every year for seven years). One year, I was put in a group of skiers which included several doctors, a nurse, a few others, and me. It snowed overnight so we went skiing in the back bowls to enjoy the fresh powder. This entailed a hike up over a ridge in loose snow at about 14,000 feet (gasping for breath), over the head wall singly, and reconnect as a group with the instructor last to clean up any debris (skis, poles, hats, gloves, etc) to ski down for a mile or two, take another lift back up to ski down the front side of the mountain.
All went as planned. Each of us went over the head wall and into the loose powder (and you say 'why is she telling this story' - be quiet there is a point here) and across the flats. Last came the instructor, schussing across the flats, until his ski hit a rock just under a thin layer of powder where the wind had blown off the other foot or so of snow. He did your basic rolling fall with equipment going everywhere (similarly to 'the agony of defeat'). We started back to help pick up everything and give him a lot of sass for it.
All jokes ended when we saw the blood pouring out of his face. In a rather inaccessible place in the mountains, he caught a ski pole in his face and ended up with an 'Al Pacino Scarface' injury. The doctors stood and gaped and said they hadn't seen anything like that since internship. The nurse ran to his side and started yelling for clean tissues, napkins, bandanas, anything to apply pressure and stop the bleeding. The nurse knew what to do. She fixed him up and rode the chairlift back up with him and went with him to the clinic where he got five stitches in his face. The doctors went to lunch.
So on that sunny day on a ski slope on the backside of a mountain in Colorado, the nurse was the winner.
Now when I go to see my PCP or oncologist, I often see a nurse practitioner. When I see my pain doctor, sometimes I see his physician's assistant. Its not that big a deal. Particularly with my PCP, if I have a new ailment and need a visit as soon as possible, I'll get one of the nurse practitioners. I could wait a week before seeing my PCP or see the nurse practitioner. I'm happy with the sooner visit.
Think of this as well. Do you remember going to the dentist and the dentist cleaned your teeth? Now a hygienist cleans your teeth and a dentist does fillings and other nasty things with drills and pointy things. When I go to the eye doctor a technician checks my vision and glasses prescription and the ophthalmologist checks my corneas.
All this is for quicker medical care and more use of specialized training in different parts of the medical world. I'm all for it - I want the quicker access to medical care.
Friday, March 13, 2015
The cancer patient's interpretation of the doctor's advice
I came upon this article by a surgeon who has partnered with some cancer patients to come up with this advice when you are blindsided by cancer. While I agree with it overall, of course I have a few comments.
His advice is summarized as:
Own your cancer and your life. Don't just give up. Keep ownership of your life and take ownership of your cancer. Be a participant in the decision making process. Get a cancer buddy/caregiver to help you through this and hold your hand, bring your bowls of ice cream, and glasses of wine.
I think you should go to the internet for information with the caveat that you find out the good places to go for information on your cancer. Do not wildly Google your cancer and the words 'death rates' - you will only stress yourself out. But if you have information to direct you to where the information is about your cancer where you can learn the right kind of information which is not a pack of lies, aka a pile of hooey. My tip, if you do not know where to start, always start with the American Cancer Society.
I never really have selected my 'physician partners'. What I have done, is ditched any which I did not like. But I have never physician shopped or second opinion hopped.
Two critical features about your cancer are:
"First, you must learn how your specific type of cancer behaves, as each (breast, prostate, whatever) is unique. Second, you must understand your specific cancer stage."
This will help you greatly to understand where you are and what are your options. You are putting a name on it. Which leads me to my personal requirement:
You cannot have an ailment or take a medication without knowing how to both spell and say it properly. This is another way you take ownership of your cancer and learn more about it.
Okay, so the patient came through with agreements and disagreements but I think we both can agree that cancer should not take you over. You are still you.
His advice is summarized as:
- Take a breath, seriously
- Own your cancer
- Don't run to the internet
- Select your physician partners
- Understand two critical features of your cancer
Own your cancer and your life. Don't just give up. Keep ownership of your life and take ownership of your cancer. Be a participant in the decision making process. Get a cancer buddy/caregiver to help you through this and hold your hand, bring your bowls of ice cream, and glasses of wine.
I think you should go to the internet for information with the caveat that you find out the good places to go for information on your cancer. Do not wildly Google your cancer and the words 'death rates' - you will only stress yourself out. But if you have information to direct you to where the information is about your cancer where you can learn the right kind of information which is not a pack of lies, aka a pile of hooey. My tip, if you do not know where to start, always start with the American Cancer Society.
I never really have selected my 'physician partners'. What I have done, is ditched any which I did not like. But I have never physician shopped or second opinion hopped.
Two critical features about your cancer are:
"First, you must learn how your specific type of cancer behaves, as each (breast, prostate, whatever) is unique. Second, you must understand your specific cancer stage."
This will help you greatly to understand where you are and what are your options. You are putting a name on it. Which leads me to my personal requirement:
You cannot have an ailment or take a medication without knowing how to both spell and say it properly. This is another way you take ownership of your cancer and learn more about it.
Okay, so the patient came through with agreements and disagreements but I think we both can agree that cancer should not take you over. You are still you.
Friday, January 30, 2015
Doctor's Orders
Do you heed your doctor's orders? (Do you floss more because your dentist asks?) Two-thirds of Americans do not take their prescriptions medications as prescribed. That would mean that most of us are screw ups.
Yes there can be the issue of cost of the medications but aside from that it is sheer laziness or ignorance. I'm not sure why.
The problem with not taking your medications as requested can result in life risking events - uncontrolled asthma or heart condition can result in an expensive Emergency Room visit or hospital stay. Even if its covered by insurance that adds costs to the medical system. And its 125,000 extra deaths each year.
I do my best to take my medications as requested by doctors. They make it damn complicated.
This is what I do:
Take this one daily, except Monday's when you should take 1/2 a pill.
Take these two pills weekly, 12 hours after your methotrexate injection.
Take this pill in the morning at least an hour after you take you first pill.
Take an extra pain pill at bedtime or at least 3 hours after taking evening pills.
And if I take all my evening pills at the same time I get a stomach ache so I need to split them up and take my vitamins later.
Every week there tends to be a little pile of vitamins that I missed at one time or another.... So I'm not perfect either.
Yes there can be the issue of cost of the medications but aside from that it is sheer laziness or ignorance. I'm not sure why.
The problem with not taking your medications as requested can result in life risking events - uncontrolled asthma or heart condition can result in an expensive Emergency Room visit or hospital stay. Even if its covered by insurance that adds costs to the medical system. And its 125,000 extra deaths each year.
I do my best to take my medications as requested by doctors. They make it damn complicated.
This is what I do:
Take this one daily, except Monday's when you should take 1/2 a pill.
Take these two pills weekly, 12 hours after your methotrexate injection.
Take this pill in the morning at least an hour after you take you first pill.
Take an extra pain pill at bedtime or at least 3 hours after taking evening pills.
And if I take all my evening pills at the same time I get a stomach ache so I need to split them up and take my vitamins later.
Every week there tends to be a little pile of vitamins that I missed at one time or another.... So I'm not perfect either.
Wednesday, January 21, 2015
Advice from a long, long time ago
Well back in 1981, I was told I had cancer the first time (and stop trying to figure out how old I am - I am 37 this year, I will be 37 next year, and was 37 last year.). I was the good patient. I went to see my doctors and had all the fun tests after surgery and learned to take my thyroid pills regularly (except today when I cant remember if I took it or not - most aggravating).
Then all of a sudden my doctor said 'You should be fine. Live a healthy life style, don't take risks, each right, and get plenty of sleep'. WHAT????? But I'm still in college. I don't want to live a healthy life style. I want to go to bars, dance to live music, stay out late, eat dessert for breakfast and breakfast for dinner and live on beer, coffee, and TAB (remember TAB?)
So after ruminating on this comprehensive advice for a few months, I decided that although I had been told I had cancer and would have a life of being dependent on a little bottle of pills, I was going to live my life on my terms. I wasn't necessarily going to play in traffic but I was going to do what I wanted.
I did do things like 18 months after cancer treatment, I went to Europe for six months to study. I survived that - being away from doctors and living my life as I wanted. I finished college, got a real job, started a career, and all that. I didn't implode. I had fun. And I am still here.
I may have had cancer again and my health may not be so great in a lot of ways, but I'm doing what I want for the most part and having fun. I don't think a cancer diagnosis, or two, should take all the fun out of life.
So my advice for the post cancer life is do what you want, don't play in traffic, and have fun.
Then all of a sudden my doctor said 'You should be fine. Live a healthy life style, don't take risks, each right, and get plenty of sleep'. WHAT????? But I'm still in college. I don't want to live a healthy life style. I want to go to bars, dance to live music, stay out late, eat dessert for breakfast and breakfast for dinner and live on beer, coffee, and TAB (remember TAB?)
So after ruminating on this comprehensive advice for a few months, I decided that although I had been told I had cancer and would have a life of being dependent on a little bottle of pills, I was going to live my life on my terms. I wasn't necessarily going to play in traffic but I was going to do what I wanted.
I did do things like 18 months after cancer treatment, I went to Europe for six months to study. I survived that - being away from doctors and living my life as I wanted. I finished college, got a real job, started a career, and all that. I didn't implode. I had fun. And I am still here.
I may have had cancer again and my health may not be so great in a lot of ways, but I'm doing what I want for the most part and having fun. I don't think a cancer diagnosis, or two, should take all the fun out of life.
So my advice for the post cancer life is do what you want, don't play in traffic, and have fun.
Tuesday, January 20, 2015
Advice from a long, long time ago
Well back in 1981, I was told I had cancer the first time (and stop trying to figure out how old I am - I am 37 this year, I will be 37 next year, and was 37 last year.). I was the good patient. I went to see my doctors and had all the fun tests after surgery and learned to take my thyroid pills regularly (except today when I cant remember if I took it or not - most aggravating).
Then all of a sudden my doctor said 'You should be fine. Live a healthy life style, don't take risks, each right, and get plenty of sleep'. WHAT????? But I'm still in college. I don't want to live a healthy life style. I want to go to bars, dance to live music, stay out late, eat dessert for breakfast and breakfast for dinner and live on beer, coffee, and TAB (remember TAB?)
So after ruminating on this comprehensive advice for a few months, I decided that although I had been told I had cancer and would have a life of being dependent on a little bottle of pills, I was going to live my life on my terms. I wasn't necessarily going to play in traffic but I was going to do what I wanted.
I did do things like 18 months after cancer treatment, I went to Europe for six months to study. I survived that - being away from doctors and living my life as I wanted. I finished college, got a real job, started a career, and all that. I didn't implode. I had fun. And I am still here.
I may have had cancer again and my health may not be so great in a lot of ways, but I'm doing what I want for the most part and having fun. I don't think a cancer diagnosis, or two, should take all the fun out of life.
So my advice for the post cancer life is do what you want, don't play in traffic, and have fun.
Then all of a sudden my doctor said 'You should be fine. Live a healthy life style, don't take risks, each right, and get plenty of sleep'. WHAT????? But I'm still in college. I don't want to live a healthy life style. I want to go to bars, dance to live music, stay out late, eat dessert for breakfast and breakfast for dinner and live on beer, coffee, and TAB (remember TAB?)
So after ruminating on this comprehensive advice for a few months, I decided that although I had been told I had cancer and would have a life of being dependent on a little bottle of pills, I was going to live my life on my terms. I wasn't necessarily going to play in traffic but I was going to do what I wanted.
I did do things like 18 months after cancer treatment, I went to Europe for six months to study. I survived that - being away from doctors and living my life as I wanted. I finished college, got a real job, started a career, and all that. I didn't implode. I had fun. And I am still here.
I may have had cancer again and my health may not be so great in a lot of ways, but I'm doing what I want for the most part and having fun. I don't think a cancer diagnosis, or two, should take all the fun out of life.
So my advice for the post cancer life is do what you want, don't play in traffic, and have fun.
Monday, January 19, 2015
Prescription Dollars Wasted By 913 Doctors
This kind of thing really pisses ticks me off. Everyone in the country is trying to do their part to help reduce medical spending. Most people really do try. Patients get generics, are taking better care of themselves, doctors think about costs when suggesting treatments, hospitals are trying to manage their costs in many ways, insurance companies are managing and lowering their overhead costs.
Then we have a bunch of 913 loser doctors who prescribed name brand drugs without allowing for substitution by generic. Now I realize that some people need the name brand drugs because the generics are not the same for them. But some investigative journalism was done and found out about these losers.
Then we have a bunch of 913 loser doctors who prescribed name brand drugs without allowing for substitution by generic. Now I realize that some people need the name brand drugs because the generics are not the same for them. But some investigative journalism was done and found out about these losers.
A small portion of doctors nationwide is costing American taxpayers big time because of their tendency to prescribe name-brand medications through Medicare even when generics are available, according to an analysis by ProPublica, a nonprofit organization producing "investigative journalism in the public interest."
The biggest offenders are 913 practitioners who, thanks to disproportionately prescribing name-brand drugs, cost taxpayers an extra $300 million in 2011, say ProPublica's Charles Ornstein, Tracy Weber and Jennifer LaFleur. Each of these doctors wrote at least 5,000 prescriptions that year, according to the report.
$300 million a year is not chump change. And these doctors had ties to pharmaceutical manufacturers. So if you multiply 913 doctors times 5000 prescriptions (pause while I find a calculator because my brain is not that smart 5*3=15, carry the 1, 5*1 is 5 plus 1 equals 6, 5*9=45) equals 4,565,000 prescriptions each year.
And think of that year after year. $300 million and 4.5 million prescriptions times kickbacks which send them on fancy vacations and secret accounts in the Caymans at the expense of the American taxpayer through Medicare. Now you understand while I call them losers.
I am glad about this piece of investigative reporting. I hope those losers now get fined, lose their medical licenses and have to start paying back. I also hope Medicare fixes the loophole.
Changing doctors...
I am not one to doctor shop or doctor hop. But I did make a change to my doctors yesterday. I see a psychologist and psychiatrist for depression and anxiety - how is your brain after all sorts of medical crap.
The PhD had recommended I see an MD a few years ago and she recommended one who was not available. So I went with Dr S instead. I was not impressed. She has no people skills. I stuck with her because I felt that I should give her a fair chance. A few years later I am not impressed still. So I bit the bullet and consulted with the PhD on who to go with. Now I'll be seeing a Nurse Practitioner instead.... I don't really care as long as my meds interactions are monitored closely which is my real problem.
My only real doctor concern these days is that one of them might retire and I will be forced to make a change...
The PhD had recommended I see an MD a few years ago and she recommended one who was not available. So I went with Dr S instead. I was not impressed. She has no people skills. I stuck with her because I felt that I should give her a fair chance. A few years later I am not impressed still. So I bit the bullet and consulted with the PhD on who to go with. Now I'll be seeing a Nurse Practitioner instead.... I don't really care as long as my meds interactions are monitored closely which is my real problem.
My only real doctor concern these days is that one of them might retire and I will be forced to make a change...
Another case of the warm fuzzies
Now that we are past the age where the three martini lunch was an acceptable daily interlude, it is not acceptable for anyone to be under the influence of anything (other than a post-four hour meeting daze) in the work place.
Back in the late 70's and early 80's I worked in a restaurant that was a destination lunch place for a bunch of office park employees. We had cab company phone numbers next to the phone for those who could not safely drive themselves back to the office. Over the five years I was there, often working as a cashier, I watched the lunch checks go from three martinis to one glass of wine or a single Bloody Mary or other vodka based drinks. Times changed even then.
Later in the 1990's I worked for a British company and went to the UK regularly for week long trips. I was usually taken out to lunch at a local pub where I was expected to have a beer, or at least a half pint Shandy (lemon/lime soda with beer) with my meal. I usually declined because it would cause my jet lagged body to demand a post meal nap instead of working for the afternoon. In the US, I think its very rare that alcoholic beverages are consumed at lunch during the business day any more. I don't think any work place is immune to impaired employees but some of them have more long lasting implications than others.
When we go to the doctor we make a few basic assumptions, that they are trained and know what they are doing, they won't hesitate to consult their peers when they are unsure, and they are sober. While the majority of doctors would report their impaired colleagues, 17 percent actually have dealt with one. Um, do the math, that's one in six. I'm not picking on doctors and actually believe that they are probably one of the more conscientious industries. They are probably less likely to go out for fancy lunches to celebrate a business deal, or even have time to do more than grab a quick bite during the day. But when its my body and health that's being treated here, I would like the basics.
What astounded me about this article is that the numbers are so high. What it doesn't state is if the 17 percent reflects over their career they have dealt with impaired employees or over the past five years. We need a little more information here before becoming concerned. But I am already concerned. Should I start sniffing their breath?
Back in the late 70's and early 80's I worked in a restaurant that was a destination lunch place for a bunch of office park employees. We had cab company phone numbers next to the phone for those who could not safely drive themselves back to the office. Over the five years I was there, often working as a cashier, I watched the lunch checks go from three martinis to one glass of wine or a single Bloody Mary or other vodka based drinks. Times changed even then.
Later in the 1990's I worked for a British company and went to the UK regularly for week long trips. I was usually taken out to lunch at a local pub where I was expected to have a beer, or at least a half pint Shandy (lemon/lime soda with beer) with my meal. I usually declined because it would cause my jet lagged body to demand a post meal nap instead of working for the afternoon. In the US, I think its very rare that alcoholic beverages are consumed at lunch during the business day any more. I don't think any work place is immune to impaired employees but some of them have more long lasting implications than others.
When we go to the doctor we make a few basic assumptions, that they are trained and know what they are doing, they won't hesitate to consult their peers when they are unsure, and they are sober. While the majority of doctors would report their impaired colleagues, 17 percent actually have dealt with one. Um, do the math, that's one in six. I'm not picking on doctors and actually believe that they are probably one of the more conscientious industries. They are probably less likely to go out for fancy lunches to celebrate a business deal, or even have time to do more than grab a quick bite during the day. But when its my body and health that's being treated here, I would like the basics.
What astounded me about this article is that the numbers are so high. What it doesn't state is if the 17 percent reflects over their career they have dealt with impaired employees or over the past five years. We need a little more information here before becoming concerned. But I am already concerned. Should I start sniffing their breath?
Disillusioned Doctors
There has been a fair amount in the news recently on disillusioned doctors and the 'tell all' books on 'life behind the scenes'. Disillusionment is being deprived on illusions. So what were they expecting?
I guess I mean to doctors go to medical school expecting to save the world? I know the medical world has changed significantly in the recent decades and the focus has changed from caring about patients to caring about insurance costs and paying the hospital administrators. But as their world adapts, the medical professionals need to adapt.
Technology has advanced and made healing patients easier. Patient care now includes concerns with hospital and insurance costs. Its a fact. It doesn't mean its right but it must be worked with and adapted to. I am the first person to decry the weight an insurance company has on choosing my medical care. And I would value change to refocus care on to what the physician wants for the patient as opposed to what insurance will cover.
But I don't want a medical professional who is disillusioned and hating the system, to bad mouth it to me and be cranky. I still want the care where the carers do care. I want the bedside manner. I want the ability to talk and ask questions. I know the staff are rushed but it can be done with a smile instead of a frown.
To correct the system will mean more change so please do not resist the change and be grumpy and disillusioned to me the patient who is in need of care.
I guess I mean to doctors go to medical school expecting to save the world? I know the medical world has changed significantly in the recent decades and the focus has changed from caring about patients to caring about insurance costs and paying the hospital administrators. But as their world adapts, the medical professionals need to adapt.
Technology has advanced and made healing patients easier. Patient care now includes concerns with hospital and insurance costs. Its a fact. It doesn't mean its right but it must be worked with and adapted to. I am the first person to decry the weight an insurance company has on choosing my medical care. And I would value change to refocus care on to what the physician wants for the patient as opposed to what insurance will cover.
But I don't want a medical professional who is disillusioned and hating the system, to bad mouth it to me and be cranky. I still want the care where the carers do care. I want the bedside manner. I want the ability to talk and ask questions. I know the staff are rushed but it can be done with a smile instead of a frown.
To correct the system will mean more change so please do not resist the change and be grumpy and disillusioned to me the patient who is in need of care.
Quick access to medical care
Do you see the nurse or the doctor (or the physician's assistant)? Back in the good old days, you went to the doctor and saw the doctor. A nurse might come in and take your vitals, bandage something up, or some other task that was below the doctor's capabilities. They were doctors and didn't do the basic stuff that would take away from their schedule.
Now you may see the doctor, the nurse, the nurse practitioner, or a physician's assistant or even someone else.... Does it make a difference? Not really. They all give out prescriptions, send you for tests, and diagnose and treat you. They all talk to each other if there are any questions.
Back when I was young and athletic in the 80's and 90's, I used to go skiing with Club Med in Colorado (an awesome vacation every year for seven years). One year, I was put in a group of skiers which included several doctors, a nurse, a few others, and me. It snowed overnight so we went skiing in the back bowls to enjoy the fresh powder. This entailed a hike up over a ridge in loose snow at about 14,000 feet (gasping for breath), over the head wall singly, and reconnect as a group with the instructor last to clean up any debris (skis, poles, hats, gloves, etc) to ski down for a mile or two, take another lift back up to ski down the front side of the mountain.
All went as planned. Each of us went over the head wall and into the loose powder (and you say 'why is she telling this story' - be quiet there is a point here) and across the flats. Last came the instructor, schussing across the flats, until his ski hit a rock just under a thin layer of powder where the wind had blown off the other foot or so of snow. He did your basic rolling fall with equipment going everywhere (similarly to 'the agony of defeat'). We started back to help pick up everything and give him a lot of sass for it.
All jokes ended when we saw the blood pouring out of his face. In a rather inaccessible place in the mountains, he caught a ski pole in his face and ended up with an 'Al Pacino Scarface' injury. The doctors stood and gaped and said they hadn't seen anything like that since internship. The nurse ran to his side and started yelling for clean tissues, napkins, bandanas, anything to apply pressure and stop the bleeding. The nurse knew what to do. She fixed him up and rode the chairlift back up with him and went with him to the clinic where he got five stitches in his face. The doctors went to lunch.
So on that sunny day on a ski slope on the backside of a mountain in Colorado, the nurse was the winner.
Now when I go to see my PCP or oncologist, I often see a nurse practitioner. When I see my pain doctor, sometimes I see his physician's assistant. Its not that big a deal. Particularly with my PCP, if I have a new ailment and need a visit as soon as possible, I'll get one of the nurse practitioners. I could wait a week before seeing my PCP or see the nurse practitioner. I'm happy with the sooner visit.
Think of this as well. Do you remember going to the dentist and the dentist cleaned your teeth? Now a hygienist cleans your teeth and a dentist does fillings and other nasty things with drills and pointy things. When I go to the eye doctor a technician checks my vision and glasses prescription and the ophthalmologist checks my corneas.
All this is for quicker medical care and more use of specialized training in different parts of the medical world. I'm all for it - I want the quicker access to medical care.
Now you may see the doctor, the nurse, the nurse practitioner, or a physician's assistant or even someone else.... Does it make a difference? Not really. They all give out prescriptions, send you for tests, and diagnose and treat you. They all talk to each other if there are any questions.
Back when I was young and athletic in the 80's and 90's, I used to go skiing with Club Med in Colorado (an awesome vacation every year for seven years). One year, I was put in a group of skiers which included several doctors, a nurse, a few others, and me. It snowed overnight so we went skiing in the back bowls to enjoy the fresh powder. This entailed a hike up over a ridge in loose snow at about 14,000 feet (gasping for breath), over the head wall singly, and reconnect as a group with the instructor last to clean up any debris (skis, poles, hats, gloves, etc) to ski down for a mile or two, take another lift back up to ski down the front side of the mountain.
All went as planned. Each of us went over the head wall and into the loose powder (and you say 'why is she telling this story' - be quiet there is a point here) and across the flats. Last came the instructor, schussing across the flats, until his ski hit a rock just under a thin layer of powder where the wind had blown off the other foot or so of snow. He did your basic rolling fall with equipment going everywhere (similarly to 'the agony of defeat'). We started back to help pick up everything and give him a lot of sass for it.
All jokes ended when we saw the blood pouring out of his face. In a rather inaccessible place in the mountains, he caught a ski pole in his face and ended up with an 'Al Pacino Scarface' injury. The doctors stood and gaped and said they hadn't seen anything like that since internship. The nurse ran to his side and started yelling for clean tissues, napkins, bandanas, anything to apply pressure and stop the bleeding. The nurse knew what to do. She fixed him up and rode the chairlift back up with him and went with him to the clinic where he got five stitches in his face. The doctors went to lunch.
So on that sunny day on a ski slope on the backside of a mountain in Colorado, the nurse was the winner.
Now when I go to see my PCP or oncologist, I often see a nurse practitioner. When I see my pain doctor, sometimes I see his physician's assistant. Its not that big a deal. Particularly with my PCP, if I have a new ailment and need a visit as soon as possible, I'll get one of the nurse practitioners. I could wait a week before seeing my PCP or see the nurse practitioner. I'm happy with the sooner visit.
Think of this as well. Do you remember going to the dentist and the dentist cleaned your teeth? Now a hygienist cleans your teeth and a dentist does fillings and other nasty things with drills and pointy things. When I go to the eye doctor a technician checks my vision and glasses prescription and the ophthalmologist checks my corneas.
All this is for quicker medical care and more use of specialized training in different parts of the medical world. I'm all for it - I want the quicker access to medical care.
Saturday, January 17, 2015
The impact of the decision.
The doctor makes a decision but do they stop and think about the impact? We hope so. But not always.
Here's the story of a 51 year old man who was admitted to the ER with liver and kidney problems. He needed to be stabilized before they could do necessary surgery. Stabilizing was not easy and not even sure that it could be done. He was in intensive care. Two internists stopped by to see him and in less than ten minutes decided what he needed was comfort care and not intensive care. So they moved him out of the ICU and into a regular ward where he died the next day.
What went wrong? Several things but the main one was the decision by the two internists to move him to a general ward for comfort care. A patient with multiple organ failure needs ICU if they are expected to survive. But to the younger interns, perhaps he was an older patient where he was ready for the end of life? But if he had been young, would more effort been made?
Also, was he a terminal patient? Or did he have a terminal disease? Could he have survived with the proper care?
The author concludes with:
"Perhaps what bothers me most is less the fate of our patient than the memory of those two doctors, both so young, efficiently dispatching a complicated decision in a matter of minutes, then dancing off without looking back. They knew a lot about the cost-effective deployment of intensive care. It would have been good to see them spend a little time struggling with the limitations of their analysis."
This is what bothers me - are we raising a new generation of doctors who don't think about the impact of their decision?
Here's the story of a 51 year old man who was admitted to the ER with liver and kidney problems. He needed to be stabilized before they could do necessary surgery. Stabilizing was not easy and not even sure that it could be done. He was in intensive care. Two internists stopped by to see him and in less than ten minutes decided what he needed was comfort care and not intensive care. So they moved him out of the ICU and into a regular ward where he died the next day.
What went wrong? Several things but the main one was the decision by the two internists to move him to a general ward for comfort care. A patient with multiple organ failure needs ICU if they are expected to survive. But to the younger interns, perhaps he was an older patient where he was ready for the end of life? But if he had been young, would more effort been made?
Also, was he a terminal patient? Or did he have a terminal disease? Could he have survived with the proper care?
The author concludes with:
"Perhaps what bothers me most is less the fate of our patient than the memory of those two doctors, both so young, efficiently dispatching a complicated decision in a matter of minutes, then dancing off without looking back. They knew a lot about the cost-effective deployment of intensive care. It would have been good to see them spend a little time struggling with the limitations of their analysis."
This is what bothers me - are we raising a new generation of doctors who don't think about the impact of their decision?
Thursday, January 15, 2015
Trust
Most people you meet, you generally don't share lots of private information until you have gotten to know them. Your doctor is different. You go see a new doctor for whatever reason and then you start spilling your guts on the state of your gut and other body parts.
If you think about it they are a stranger. I sometimes have to scrape doctors off the floor when I start telling them about my issues and allergies - they all love the fact that I am allergic to benadryl. I have had them start laughing too - with me, not at me.
But it is all about trust. How much do you really trust a stranger?
I think we believe doctors are ethical and honest human beings, with the best interests of the patient in mind. Personally I believe people are honest and ethical for the most part and don't start to lose trust unless I feel betrayed.
I don't mind if my doctors talk about me together in order to figure out how to best treat me. But I would be really upset if my doctors were trying to scam me. You hear the horror stories. I have blogged about a few of them as well. Here's a story with some more but also some good advice:
If you think about it they are a stranger. I sometimes have to scrape doctors off the floor when I start telling them about my issues and allergies - they all love the fact that I am allergic to benadryl. I have had them start laughing too - with me, not at me.
But it is all about trust. How much do you really trust a stranger?
I think we believe doctors are ethical and honest human beings, with the best interests of the patient in mind. Personally I believe people are honest and ethical for the most part and don't start to lose trust unless I feel betrayed.
I don't mind if my doctors talk about me together in order to figure out how to best treat me. But I would be really upset if my doctors were trying to scam me. You hear the horror stories. I have blogged about a few of them as well. Here's a story with some more but also some good advice:
- Research your doctor.
- Make sure your doctor isn't practicing outside his/her field.
- Be cautious of doctors who advertise too much.
- Ask a nurse or other hospital support staff.
- Get a second opinion.
Tuesday, January 13, 2015
The cancer patient's interpretation of the doctor's advice
I came upon this article by a surgeon who has partnered with some cancer patients to come up with this advice when you are blindsided by cancer. While I agree with it overall, of course I have a few comments.
His advice is summarized as:
Own your cancer and your life. Don't just give up. Keep ownership of your life and take ownership of your cancer. Be a participant in the decision making process. Get a cancer buddy/caregiver to help you through this and hold your hand, bring your bowls of ice cream, and glasses of wine.
I think you should go to the internet for information with the caveat that you find out the good places to go for information on your cancer. Do not wildly Google your cancer and the words 'death rates' - you will only stress yourself out. But if you have information to direct you to where the information is about your cancer where you can learn the right kind of information which is not a pack of lies, aka a pile of hooey. My tip, if you do not know where to start, always start with the American Cancer Society.
I never really have selected my 'physician partners'. What I have done, is ditched any which I did not like. But I have never physician shopped or second opinion hopped.
Two critical features about your cancer are:
"First, you must learn how your specific type of cancer behaves, as each (breast, prostate, whatever) is unique. Second, you must understand your specific cancer stage."
This will help you greatly to understand where you are and what are your options. You are putting a name on it. Which leads me to my personal requirement:
You cannot have an ailment or take a medication without knowing how to both spell and say it properly. This is another way you take ownership of your cancer and learn more about it.
Okay, so the patient came through with agreements and disagreements but I think we both can agree that cancer should not take you over. You are still you.
His advice is summarized as:
- Take a breath, seriously
- Own your cancer
- Don't run to the internet
- Select your physician partners
- Understand two critical features of your cancer
Own your cancer and your life. Don't just give up. Keep ownership of your life and take ownership of your cancer. Be a participant in the decision making process. Get a cancer buddy/caregiver to help you through this and hold your hand, bring your bowls of ice cream, and glasses of wine.
I think you should go to the internet for information with the caveat that you find out the good places to go for information on your cancer. Do not wildly Google your cancer and the words 'death rates' - you will only stress yourself out. But if you have information to direct you to where the information is about your cancer where you can learn the right kind of information which is not a pack of lies, aka a pile of hooey. My tip, if you do not know where to start, always start with the American Cancer Society.
I never really have selected my 'physician partners'. What I have done, is ditched any which I did not like. But I have never physician shopped or second opinion hopped.
Two critical features about your cancer are:
"First, you must learn how your specific type of cancer behaves, as each (breast, prostate, whatever) is unique. Second, you must understand your specific cancer stage."
This will help you greatly to understand where you are and what are your options. You are putting a name on it. Which leads me to my personal requirement:
You cannot have an ailment or take a medication without knowing how to both spell and say it properly. This is another way you take ownership of your cancer and learn more about it.
Okay, so the patient came through with agreements and disagreements but I think we both can agree that cancer should not take you over. You are still you.
Wednesday, January 7, 2015
Professionalism expected
No matter why we end up in a medical facility we expect professionalism in return as we bare our bodies and medical secrets to receive care. We expect zipped lips and snicker free countenances.
I know I have been a moron at times when really stressed and at an appointment. I am sure there have been those who struggle for a straight face in front of me. And then I hope they store those moments in the memories of ridiculous patients and not share them....
I also know my doctors talk about me. This I do not mind. I like it when my doctors compare notes on me because my ailments are overlapping and due to some of them, and toss in a few medical allergies and sensitivities, I am not eligible for other treatments and doctors are forced to be creative in my care at times.
However at all times, I expect professionalism. I expect to be treated as a human being with respect as any other human being.
Then I hear these stories. A study done on hospitalists in Chicago showing unprofessional behavior and 2/3s were guilty of it. Did you know that every time a doctor orders a test as urgent when it isn't, that is unprofessional? Everyone needs to wait their turn except when it is truly urgent. This is a note to all who have benefited from jumping line.... If all tests were urgent, none would be.
The unprofessional behaviors fell into four larger categories, which accounted for 76% of survey variance:
But what if it happened to you, they made fun of you? What about this story of this woman who worked at the hospital and went in for surgery. Look what happened to her while she was sedated.
They painted a mustache on her and added yellow tears down her face. If that was me, I would actually file a lawsuit. Something I have never done before.
Professionalism is one of the most important things we expect from our doctors. Its right up there with a good bedside manner and a knowledge of your ailments.
I know I have been a moron at times when really stressed and at an appointment. I am sure there have been those who struggle for a straight face in front of me. And then I hope they store those moments in the memories of ridiculous patients and not share them....
I also know my doctors talk about me. This I do not mind. I like it when my doctors compare notes on me because my ailments are overlapping and due to some of them, and toss in a few medical allergies and sensitivities, I am not eligible for other treatments and doctors are forced to be creative in my care at times.
However at all times, I expect professionalism. I expect to be treated as a human being with respect as any other human being.
Then I hear these stories. A study done on hospitalists in Chicago showing unprofessional behavior and 2/3s were guilty of it. Did you know that every time a doctor orders a test as urgent when it isn't, that is unprofessional? Everyone needs to wait their turn except when it is truly urgent. This is a note to all who have benefited from jumping line.... If all tests were urgent, none would be.
The unprofessional behaviors fell into four larger categories, which accounted for 76% of survey variance:
- Making fun of others
- Learning environment (for example, texting during conferences or not correcting a patient who mistakes a student for a doctor)
- Workload management (for example, celebrating a blocked admission or coming to work sick)
- Time pressure (for example, backing up a resident's note without being confident about the content of the documentation)
But what if it happened to you, they made fun of you? What about this story of this woman who worked at the hospital and went in for surgery. Look what happened to her while she was sedated.
Professionalism is one of the most important things we expect from our doctors. Its right up there with a good bedside manner and a knowledge of your ailments.
Tuesday, January 6, 2015
Stress
I have a favorite coffee mug these days. It says "I didn't survive cancer to die of stress".
It is true. I try to avoid stress at all costs these days. Ten years ago I was working downtown with a relatively high pressure job where my boss believed yelling at people and making people cry would motivate them. I didn't like that, nor did I like the way my commute aligned with my new husband's - he was home an hour and a half before me. I found a new less stressful job which was shortly followed by a highly stressful cancer diagnosis.
Since then my health has been less than ideal and I have to live with the constant stress of new medical twists and turns every week (this week is an MRI and potential knee surgery). Stress started having a way of taking over my life as I focused on each stressor.
I learned to develop some support systems through support groups, online communities, writing (my blog), therapy, exercise and more. I try to do what relaxes me. I think while I am certainly not healthier, I am happier and less stressed.
Now doctors are catching on and prescribing stress management to patients and developing stress management practices. New research shows that 60-80% of ailments are caused by or exacerbated by stress. That is a scary number. I don't feel that my health issues were caused by stress but I do know if I am having an overwhelming day of stress, my aches and pains increase.
Medical centers are looking at offering everything from counseling, nutrition, meditation, yoga, tai chi, and more to help patients get their lives in balance. Everyone could try this by themselves, give yourself a five minute time out when stress starts taking over to close your eyes and relax and clear your mind. Or take a ten minute walk. Or join a gym, start a new exercise plan. Something besides sitting there and stressing.
Since then my health has been less than ideal and I have to live with the constant stress of new medical twists and turns every week (this week is an MRI and potential knee surgery). Stress started having a way of taking over my life as I focused on each stressor.
I learned to develop some support systems through support groups, online communities, writing (my blog), therapy, exercise and more. I try to do what relaxes me. I think while I am certainly not healthier, I am happier and less stressed.
Now doctors are catching on and prescribing stress management to patients and developing stress management practices. New research shows that 60-80% of ailments are caused by or exacerbated by stress. That is a scary number. I don't feel that my health issues were caused by stress but I do know if I am having an overwhelming day of stress, my aches and pains increase.
Medical centers are looking at offering everything from counseling, nutrition, meditation, yoga, tai chi, and more to help patients get their lives in balance. Everyone could try this by themselves, give yourself a five minute time out when stress starts taking over to close your eyes and relax and clear your mind. Or take a ten minute walk. Or join a gym, start a new exercise plan. Something besides sitting there and stressing.
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