“What Do You Expect ME To Do About It?”

Under the heading of this blog, the main intent was to address things that make you do a double-take when you hear them. In that spirit, I have decided to quote physicians who practice what I’ve labeled “Karma Medicine.”

Karma, on a basic level, is the belief that, in each of your reincarnations, you do good things & bad things. Opening doors for people laden with packages/disabled/caring for children would be “good karma.” Deliberately slamming the door in their face (especially if you laugh derisively & show everyone how “funny” it is) would, of course, be “bad karma.” Good karma, to them, means you’ll never be sick; bad karma is what makes you sick.

Lord knows, if that were true, dictators & tyrants who make millions miserable would be deathly ill & would die, impoverished by the cost of their medical care. Yet, those creeps are usually in excellent health; if not, they’re never short on medical care or money.

Doctors who’ve adopted this relatively simplified version of karma have done so claiming an “openness” to CAM (Complementary & Alternative Medicine), including an over-emphasis on their interpretation of the “mind-body” connection. In fact, they rarely have much idea at all about CAM-just try getting them to give you consults to  CAM practitioners in various types of massage, meditation, aromatherapy, etc. They’ll roll their eyes the same way teenagers do when they’re going through one of their “parents just don’t get it” phases, & tell you the only consultation they’ll give you is to a good psychiatrist; that you’re a hypochondriac; & that you need to stay away from the Internet & quit feeding your obsession with proving that you’re sick.

This is especially true of chronic fatigue syndrome, fibromyalgia, Chiari, lupus, complex regional pain syndrome, trigeminal neuralgia, Behcet’s syndrome, & any number of illnesses that no one can see, & which therefore (in their eyes) must not exist. “But you don’t look sick! You’re the picture of health!” is often heard from know-it-all civilian & medical types, who then go on to give you unsolicited advice on stress management, diet, exercise, work-life balance, & their cousin who had this & got all better on supplements, some sort of weird diet, & extreme exercise.

The problem is, doctors charge you money for this “What do you expect me to do about it?” attitude.

Push a few buttons & you’ll hear all sorts of things about how you’ve somehow brought this on yourself, ergo, you don’t really deserve medical care. Your karma made you sick, that’s your mess to clean up, not theirs. Ask them, “For what, exactly, will you be billing me?” Why, they’ll respond, for setting you straight, stopping you from believing that you’re ill, setting you on the path to good mental & physical health, showing you how badly you need to clean up your karma.

It’s just as bad for those brave medical souls who believe that not knowing what a sickness is means you find out (vs. blaming the victim). You look for physiologic clues to unknown pathogens &/or metabolic dysfunctions. Lazy people don’t like being shown up as lazy. Instead of exerting their energy joining more industrious colleagues in their pursuit of information leading to treatments, even cures, they expend energy lambasting their colleagues who want to help patients. They discredit them; lie about & to them; make their lives a misery.

Since this question is posed by so very many lazy doctors, who’ve adopted a false definition of karma & the mind-body connection as an excuse to collect a fee while doing nothing, I’d like to answer it:

Your job, fool.

Doctor, you’ll expend far more energy blaming patients & blackballing your colleagues than you’d spend doing something constructive. You’ll make money in the short run, but the doctors whose response is, “Tell me what you’re experiencing,” & “I’ll try to find something to help,” will make more in the long run easing human suffering. All the medical advances that have made people well & doctors wealthy have come from those who said, “Let me help,” not the ones who say, “What do you expect me to do about it?”

So, are you going to collect your own bad karma from abusing patients & colleagues, or counteract it by doing something positive & garnering some good karma for a change? If the answer is the former, may your karma gather you the responses (& associated ripoffs) you’ve given so many others; may you always hear how your sickness is due to your own bad karma, followed by a large bill &, “What do you expect me to do about it?”

Ninja Bureaucrats on the Loose | Cato @ Liberty

Ninja Bureaucrats on the Loose | Cato @ Liberty.

This article makes pretty much anyone want to weep at about the same time they want to find someone & punch their lights out.

Under the so-called “Patriot Act,” however, if there’s anything to link you as an actual or potential terrorist, no matter if you’re totally innocent & someone has framed you, the Government can suspend your civil liberties, because they have promised the American people that, unless they do this, there will be another 9/11.

Ben Franklin had it right:

“Anyone who trades liberty for security deserves neither liberty nor security.”

We have a really great Constitution. But we’ve allowed our government, over the past century, to erode it, & now the erosion is speeding up. Homeland Security lists, as potential right wing terrorists:

• Our returning war vets from Iraq & Afghanistan
• Peaceful tax protestors
• Anyone carrying a copy of the U.S. Constitution
• Anyone who “passes along misinformation about proposed/actual healthcare legislation”
• And apparently anyone who disagrees with the current administration.

That means any of those people  could be:

• Detained without a warrant,
• Denied the right to know what charges are being brought against them,
• Denied the right to face their accuser(s)
• Denied legal representation,
• Denied that one phone call you’re supposed to get when you’ve been arrested,
• Arrested at any time & any place,
• Taken to a secret location,
• Denied access to a phone to advise their family about what’s happenning,
• Held indefinitely under those conditions,
• Interrogated for as long as their captors desire,
• Denied food & water,

And then, when the charges are dropped, be advised that if they tell anyone, or attempt to sue, that not only will no one believe them, but that they will be re-apprehended with no hope of release.

Does this sound like America to anyone out there?

Hear that sound? That rumbling in the distance? I think it’s 2 things:

1. The Founding Fathers are spinning so hard in their graves that it could trigger that East Coast earthquake that would be so devastating
2. There is a groundswell of people from all walks of life who are getting really fed up with Federal shenanigans & the erosion of their Constitutional rights.

We have a good Constitution. And a wonderful country. Not perfect – but for anyone who says, “What makes you think the U.S. is so wonderful?” I’d like to point to the sheer number of legal & especially illegal immigrants who come from countries with very strict laws against almost any kind of immigration.

If we’re so evil to those who come here to live, I have one piece of advice: GO HOME & MAKE YOUR OWN COUNTRY BETTER. Otherwise, SHUT UP.

Is a Federally-Enforced 40 Hour Workweek a Way to End the Recession and Provide Healthcare for Most Americans?

The short answer is yes.

Right now, you may be fortunate enough to work in a state that extends the pay-for-over-40-hours-per-week part of Federal regulations to salaried employees, forcing them to be paid straight time, even time-and-a-half, for hours worked over 40 per week. If you are, congratulations.

If you’re not, though, you might find yourself in a salaried position with consistent “business emergencies” that mean you have to work long hours on a regular basis. Your health is being compromised by lack of sleep; you don’t have the energy for exercise and you’ve put it off until the long hours stop; you’ve gone from cooking healthy foods to stuff you can eat in the car so you can go straight to bed when you get home. You’re probably too tired to find a different job, and you know if you changed jobs, you’d probably end up in the same situation anyway. Every time the boss fires someone, you’ve noticed it’s on trumped up charges that really aren’t valid, and you know you’ve likely made enough errors, due to fatigue, to qualify for the same treatment – a treatment that ensures you won’t be eligible for unemployment, and you won’t find it easy to get a good job – in fact, you’ll be lucky to get day work if you stand on the street corner. So you give them whatever they demand, while your family and friends become estranged by your inability to devote time to the relationships.

And it could all be solved by them hiring – or not firing – people so that there are enough for everyone to do the job, do it right, and do it without working much, if any, overtime.

Employing more people is what stops recession. More workers, more income, more spending, more business. Simplistic as it sounds, it works. And full time, as well as some permanent part time, employees usually obtain health insurance through their jobs. That means the more people who are employed, the more people who have health insurance.

Of course, there have to be some laws and fiscal incentives, some shifting of tax breaks away from exhorbitant CEO salaries and perks and towards providing real health insurance – not this $5000 a year deductible  stuff that never pays anything. Insurance  companies do need to stop with the pre-existing conditions clauses. The IRS needs to limit CEO salary tax breaks to an amount not exceeding 10 times the pay of the lowest paid employee. If the board still wants to pay the CEO way too much, the tax break won’t be there for them. Instead, the tax breaks will be there for providing all employees, regardless of FTE status, health insurance at one flat rate.

It might not be a bad idea to make it difficult for businesses to hire mostly casual and part time workers, then call them in and work them full time but not provide them benefits; perhaps a law that mandates a certain percentage of employees must be full time – perhaps 85%? And it might be nice if larger businesses were allowed to extend healthcare coverage to entrepreneurs starting small businesses, for the same cost the large company’s employees pay, forming an informal – or formal – co-op. Insurers would have more people paying in. We’d have more people with healthcare coverage from their jobs.

Medicare and Medicaid have huge administrative costs and arcane rules for reimbursement. They have steadily decreased compensation for hospitals and physicians, to the point where any hospital with most patients on Medicare or Medicaid (or both) are running in the red from the combination of decreased reimbursement, slow-pay/no-pay practices, denials and appeals, and the drop in privately insured patients due to the recession. Every time a private insurer cuts reimbursement or denies a claim, you can be certain Medicare and Medicaid did the cuts/denials first. So in essence, what’s ruining healthcare in the U.S. are the very federal programs to which so many point as a solution.

There are solutions out there that don’t involve socialized medicine. I’ve proposed one. Americans are the most creative, ingenious people on the planet; we can find something better than the broken socialized medicine programs of small countries overseas, programs that betray those who believed they would be a solution. No country does as much innovation or as much research into diseases and cures as does the United States of America. We are the only real game in town for most medical research. We can’t kill that and replace it with Medicare for all. We have to find a way to make the equation Private Insurance for All.

Employing more benefited people is the first step.

AMA Patients’ Action Network

AMA Patients’ Action Network.

So, Congress mashes 4 huge healthcare bills together into a document so huge it makes “War and Peace” look like a pamphlet.

And they actually think something that huge & internally contradictory is going to work? You know darned well they won’t even read the whole thing! NO ONE can read that much mind-numbing crud.

There’s a word for this: EPIC FAIL.

We all know the current system sucks, to be quite blunt. But we haven’t asked the most important question of all:

Why isn’t Congress listening to doctors, nurses, pharmacists, rehabilitation therapists, imaging professionals, laboratory workers, their assistive personnel, billing/coding/documentation specialists? Sorry, this group KNOWS what patients need! And they’ve had enough experience with federal programs to know the burdens of “cost saving” regulations cost more money than they save.

I will give you that epically confusing federal legislation does create jobs. Jobs where people with brilliant minds have to turn them to making a balky system work.

There’s a much better use for brilliant minds.

Like, helping Congress figure out what’s working, what’s not, and why, not to mention how to fix it.

Cutting what doctors earn isn’t a solution. Their fees are created to cover the cost of the human & materiel resources & follow-up necessary for the procedure or action taken to benefit the patient.

Doctors have to pay nurses, medical assistants, HIM (Healthcare Information Management, aka “Medical Records”) specialists, HIPAA specialists (including ones who obtain copies of your records for you), documentation specialists, denial and billing specialists, computer consultants to buy &/or maintain the electronic records systems (and the faxing system because none of these fancy computer systems talks to each other), someone to teach the systems. They have to buy or rent space, furniture, equipment, supplies. They have to hire temps if their regular hires quit or are overwhelmed or the practice grows. Their continuing education units cost a great deal of money. Annual costs for license renewal are very expensive. Add on the cost to repay 8 years’ worth of student loans (unless the doctor comes from a very wealthy family, scholarships along with loans, grants, & work-study/jobs were a big part of financing their education). Then there is the sheer amount of brain power it takes to be a doctor.

And now, the Feds, instead of saying, “Hey, after all that, if they make some money, they’ve earned it,” they say, “Let’s cut the doctor’s reimbursement to the point where, relatively speaking, they’re making less now than they’d have made 10 or 20 years ago.”

Do you think any elected or appointed government official would take a pay cut to do what they do?

I sincerely doubt it.

And here’s another, more important question to ask your lawmakers:

ARE YOU, MR./MS. CONGRESSPERSON/SENATOR, WILLING TO GIVE UP YOUR HIGH END COVERAGE AND TAKE WHATEVER YOU PASS FOR US, FOR YOURSELVES?

If your elected officials won’t take whatever plan they pass for us, and use it exclusively as their only healthcare option, then they shouldn’t pass it for the rest of us.

The AMA thinks we can do better.

So do I.

Follow the link to petition if you agree, & sign. Then get active. Ask your elected representatives, including President Obama, if they’re willing to use the same care they’ve sentenced us to use. If not, they shouldn’t pass it.

The Big Business of ?Dead Peasants Insurance?

The Big Business of ?Dead Peasants Insurance?

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Cybersecurity v. Censorship: Where is the Line Drawn?

I really hope the article to which I’ve linked, isn’t pulled. But I am afraid it might be, because it exposes the dangers of a so-called “cybersecurity” bill introduced by Sen. Jay Rockefeller, D-WV. It would give the President sweeping powers over the Internet – the power to shut it down completely being among them.

And what are the criteria that would allow President Obama to shut down all or part of the Internet?

His own perception of what constitutes a cybersecurity threat.

His.

Not Congress’s; not even the intelligence agencies; not the Department of Homeland Security.

His perception of a threat.

The article linked to this post discusses a rewrite of the original bill, noting what was changed in the bill.

It’s scary.

Please don’t give me the tired argument that terrorists could set up a private network and use it to orchestrate death and destruction. Of course they could. But if the US government’s spy agencies can avoid playing one-upmanship and defending their own turf long enough to do some detective work, they’ll likely find those networks, trace the terrorists, and shut down the entire thing. We don’t need censorship; we need solid intelligence gathering.

Would they need to shut down a network? Yes. What’s the difference? A group of intelligence chiefs, not one man. Still dangerous? Yes, potentially – but any group isgoing to have that one guy with a conscience, the one who blows the whistle.

The bill apparently does not define 0cyberemergencies that would result in a shutdown. They are entrusting that to one man.

I have a serious problem with that, and it’s not related to the current sitting president. I’d have a problem with it whether it was George W. Bush, his Dad, Bill Clinton, Ronald Reagan – you get the idea. It’s not who the current president is. This much power should never, ever be entrusted to one man.

And we’re all sitting on our hands.

If it weren’t for a few conservative watchdogs out there, most of this stuff would pass and we’d find out after the fact, unless we were glued to CSPAN and read the entire Congressional Record religiously.

The Internet is how our world communicates; it’s how most business is done; it’s proposed that this is the venue on which our medical records should be kept so that they can follow us from one place to another if necessary. You cannot shut down an entire private network without affecting everything else. If something is going to be shut down, it has to be only the place where the threat has been identified; there has to be concensus among intelligence agencies that it’s needed; it has to be done in a way that will minimize disruption of the daily business of life in America.

How did we get to where we accepted this as normal? I guess we’re all frogs.

It’s said that if you happen to like frog’s legs, you can’t just drop a frog into boiling water as you would a lobster to cook them. You instead put them in water about the same temperature as a pond, and put the heat on low. Gradually, the frog becomes used to the ever-increasing temperature, realizing it is in jeopardy only when death is imminent. Up until that too-late period when the truth dawns on the frog, it’s sitting there, happily ribbiting in its nice little makeshift “pond.”

Fellow frogs, I believe it’s time to jump out of the pot and start getting hopping mad.

I always believe that when the election’s over, you stick by the people who won and move on. Standing by your country generally includes respect for her elected and appointed officials, who are, we hope, trying to do their best to fulfill the obligations of office. No one is perfect, so you have to expect you’re not always going to agree with every move a sitting president makes, nor with everything for which your congressperson votes.

But I also believe you have to stay involved and let them know how you feel about pending legislation. Speak up when you disagree. Make your voice heard.

I believe that, at least right now, Mr. Obama believes roughly the same way. But I’ve never seen a president come away from his term(s) in office without a lot more gray hairs than they had when they first took the Oath of Office. It’s a tough job.

And it’s totally unfair to President Obama to put him in a position to close down pretty much every Internet activity if he feels there’s a threat. I know he has national security advisors, but as the bill stands right now, it’s his  call, not theirs. And one tired man can make a lot of mistakes.

Famous and powerful men have noted the  dangers of power. Lord Acton said, in a letter to a bishop: “Power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men.” William Pitt, founder of Pittsburgh, said, “Unlimited power is apt to corrupt the minds of those who possess it” The danger is clear, and to protect President Obama and this country, this bill needs to die a quick death.

Blame the Patient, Collect the Fees = the High Cost of Healthcare

I recently read a blog with which I can partly agree. (http://thesystemmd.com/?p=778) I agree with the idea that what is “free” is often misused or overused. That socialized medicine ends up being rationed; I’ve seen that happen. I know that people on Medicaid use ERs as personal physicians due to the long lines. I know many people are on disability because they’re substance abusers, they can’t get or keep a job due to the addiction, & are often involved in criminal activities that keep their potential earnings very low once they’re released from prison. After all, once you’re convicted of a felony, you can’t generally become licensed, certified, or bonded, even if you were at one time a highly paid professional with a license. But addiction isn’t a disability like losing a leg or having a disease that impairs your mobility & function.

I also know that chronic disease is expensive. It seems to me the way to fix this is to find definitive treatments & cures. Instead, we blame the patients, claim the disease is imaginary – & if the patient’s female, we have a whole bunch of other sexist things on which to blame their illnesses.

But while I agree with some of the blogger’s points, I disagree partly with how poorly physicians are treated. Yes, in some cases, they are. I have 2 excellent physicians who earn every cent they get paid 3 times over. Yet, they’re treated just like the ones who don’t give a patient the time of day. Or give them 5 – 10 minutes, & blame “slow pay, no pay” insurance reimbursement practices & denials for the reason why they cram many more people into the waiting room than they can possibly care for.

Maybe if doctors listened, assessed, & quit blaming patients for their illnesses, they would actually earn what they get, like my physicians do. Instead, the perception that doctors get rich for being lazy is “proven” in the public mind repeatedly by some of the practices I have listed below in my response to that blog. Unless the blogger has dropped my comments, you’ll see them on the link above.

I don’t say the blog isn’t worthwhile or that there aren’t valid points. But there is a heck of a lot that, in my opinion, that blogger missed.

And I am tired of letting people get away with that without calling them on it, especially since I am sure they’ll have no hesitation on calling this female on things I’ve said with which they disagree heartily. So here we go with an expanded/edited version of my comments. Just in case…

I made several suggestions for why physicians are often seen as part of the problem, especially by women.

1.  Physicians need to quit treating every illness for which they have no definitive tests, treatments, or cures, as if they are the fault of a lazy, good for nothing person who doesn’t want to work. Or that the patient isn’t ill but is instead a hysterical female. Or maybe, a “goldbricking” guy who doesn’t want to work. Or a malingering veteran of military action who wants to live on disability their entire life – and who had the unmitigated gall to enlist & serve in military action with which the physician disagrees.

Maybe some of  us would like to, oh, WORK with at least fewer symptoms (preferably cured)? Maybe that’s why we keep “bothering” your Royal Highhandednesses? You know, you could treat us so we can work…what’s wrong with that option? And by treat, I don’t mean put us in mental hospitals or send us to shrinks. I mean find the physical problem & treat it.

Unless, that is, your MD degree is also “all in your head” & therefore not real?

2. Before you get on the admittedly large “behinds” of obese patients, consider some facts: There are people in 3rd world countries, who can’t find one meal a day, who are obese & diabetic. How do you get that their obesity is the cause of sitting on the sofa with chips, soda, & candy, watching cable or satellite TV?  That being so, how about you find a REASONABLE cure for obesity? Try following the viral disease model for a while instead of ridiculing those researchers who do so. Maybe they’ve got something. Or the ones investigating gastric hormones (the pity in that is their new treatment is to excise the part of the stomach that creates the appetite/store food as fat hormone – but eliminating a hormone is not a good idea because it will cause an imbalance – that’s just common sense). 

3. Consider how “sucky” current so-called “treatments” for obesity have proven. We have pills. One of them makes people leak stool. Isn’t that a lovely picture? Would YOU take that? Then there are the ones who were removed from the market only after years of absolute proof that they ruin the heart worse than obesity would. Lovely. What is this, get thin or die time? 

Then there are the surgeries, again, “get thin or die” time. Oh, please…cut up your insides, cause massive dehydration & malnutrition that have to be treated with expensive supplements & special meals for years? Then, after 5 years of telling the public that we’re saving healthcare dollars because these people don’t have to take blood pressure pills that cost maybe $30 a month, or diabetes pills at about the same cost, we have people lining up for this. How about the truth- the cost of those supplements, the treatments for dehydration, the horrific morbidity (disease burden) – massive infections & seeping wounds that cost hundreds, sometimes thousands a month to treat, for example, plus sometimes IV tube feedings that cost hundreds a week, or even just the repeated hospital ER trips for fluids IV because the patient can’t keep food or drink down, can only drink an ounce at a time anyway, because they can’t stop throwing up & having diarrhea? This exceeds by far the miniscule savings for blood pressure pills & oral antidiabetic pills. And since joint replacements are going to be needed anyway, don’t even think to count that in the “savings” column. So far, the balance sheet is very much in the red.

How about an option that doesn’t involve an expensive surgery which has good results for maybe 5 years, after which most of the doctors quit following these people? Those who do have found early osteoporosis, death of the cells in the hip joint (read: hip replacement), accelerated arthritis in all weight bearing joints (knee replacements, hip replacements, spinal fusions), & accelerated aging overall with resultant changes to the body’s organs (brain included). As their health goes down the toilet from rapid aging, what gets blamed Not the doctor, or the procedure. You see, you lose a max of 80% of your excess (not your total) body weight – and if you do the math for almost any weight, 80% loss usually means the patient’s still at least overweight, if not obese. Guess what THAT means? Yep. All that surgery & the patient’s still fat. And treated with the same disrespect with which they were treated before they had this “miracle” surgery. Not to mention, if insurance does pay for this 5 – 6 figure surgery & the complications, they also usually pay for the excess skin to be whacked off the belly at 10 figures’ cost. No place else but the belly, by the way - so the patient has all this heavy, excess skin hanging off their legs, arms, back, butt, etc. Attractive, huh? Unless you’ve got the cash for a lot of plastic surgery, you’re still gonna be ugly, so you’ll have to hide that now-thinner body so no one sees the droopy skin. So much for the beach…it’s gross, more so than the fat. 

So the fat person gets less fat, spends about 5 yr. sick, spends the rest of their life aging prematurely, & probably dies earlier than they would from obesity.

But the doctors are making a fortune on this racket. No way are they going to kill the goose that lays the golden egg in favor of finding the real reason for obesity! Just keep blaming everything on “weak willed, lying, cheating fat people” & the weight. Belittle the patient. Eventually they will wear down & beg you to do the surgery. Then you can go ahead & force them to diet for 6 months, exercise & ruin their joints more, blame them for failure or else say they’ve lost enough to prove they really could lose weight if they’d do as they’re told. Have the insurer pay for expensive counseling from the people you recommend (a clear violation of anti-kickback rules disguised as collaborative practice), who will always say the patient’s OK psychologically so they get their “cut.” I’ve seen people who have borderline personality disorder, who should not qualify for the surgery, who’ve been given it & have made life miserable for all around them. There’s no change to the central problem there. Go ahead & let the counselors blame them & belittle them more if they’re mentally stable to start with, so you can prove they’re really mentally unstable (sure, by now they’ve been convinced they’re terrible humans & their only salvation lies in this drastic option). Then have your billing people get the insurance to cough up (knowing how much more you’re going to be able to charge for complications & getting rid of the belly skin). Put them in special “bariatric” units where people treat them nicely to their faces (for the tiny amount of time they can stand to be by the fat person), then laugh &  make fun of them behind their backs. Ignore their complaints as “whining” until they come to the ER, nearly dead. Let’s not forget the free labor at home, provided by, usually, female family members – & the huge amount the insurance would have to pay if the person lived alone, for convalescent care. Blame them for their infections, vomiting, & diarrhea the same way you blamed them for the weight – obviously, they’re lying; obviously, they “cheated.” Yes, some did, but not all of them; most patients have one really bad bout of diarrhea or vomiting from disobeying the rules before they learn to do what they’re told. The only possible motive for obedience is the fear of being that sick again; they’re still going to be blamed for “cheating” when something goes wrong, so their motive can’t be pleasing the doctor. Don’t let anyone know that the dangers of a fat, malnourished weight loss surgery victim – yes, they’re victims – cause health problems that are far more expensive than the treatments the patient would get if they stayed obese. Keep that cost of healthcare high, and blame it on the problem instead of this half-baked “cure.”

And oh, yeah, make sure all those followup articles about weight loss surgery after 5 years are pulled unless they’re the ones who, rarely, support weight loss surgery instead of questioning it. I have seen more articles that question weight loss surgery claims disappear off Medscape than I care to think about.

4. Everyone says obesity causes diabetes. Well, I think it’s often the other way around; that diabetes does, in some cases, cause obesity, then manifests as a glucose metabolism disorder when what it causes (obesity) makes the body more dysfunctional. Here’s why: I know of a kid who was size slim, but in 1 year, without additional food intake or a reduction in activity, gained 2 sizes & went from slims to husky size. When he developed type I (not type 2, type 1) diabetes 6 yr later, the endocrinologist told his parents that he got diabetes that year he went up 2 sizes & from slim to husky in one year. That as the viral infection that triggered the autoimmune type 1 diabetes kept destroying his pancreas, it caused him to be unable to metabolize food & store it correctly, so he got fat. How about you follow THAT idea? What if type 1 AND type 2 diabetes cause obesity, not the other way around?

5. While doctors are all so compassionate about HIV/AIDS (which only happened after a lot of lobbying to get that changed around, by the way – most of it by nurses uniting with families & patients), remember that, with the exception of needlestick transmission & tainted blood, former Pres. Reagan was right: This the most preventable disease in the world. I don’t suggest abusing HIV/AIDS patients. But how about if you stop abusing  people who are fat, or who have things like chronic fatigue syndrome or fibromyalgia. of Gulf War Syndrome, as if they are lazy. Show them the same consideration.

6. Women are automatically labeled as hysterics because they come to see you BEFORE their conditions become serious, because unlike you men, we have to keep going; we can’t sit on our butts in bed or the recliner, whining about colds, expecting to be waited on hand & foot – often by a woman who’s taking cold medications, cough medications, etc., to keep going & serve YOU while she suffers through aches & pains. Hey, that’s OK for the children – but if you need that much care from Mom, wife, sister, girlfriend, then hand in your Adult License - & your “Guy Card.” You’re a bonafide sissy.  If you can’t take care of yourself with a cold without whining & being waited on, you should not be able to control the TV programming, drive a car, drink alcohol, or vote.

This abuse of women – and it IS abuse - is the reason why you don’t see men in your physician practice until they’re seriously ill most of the time - unless the wife hassles them to come in. You have built in servants/nurses in the women in your lives & theirs. Instead of being grateful, you’re a bunch of sanctimonious, sexist pigs – the doctors being the worst. Even female physicians, who can afford someone to care for their kids & elders, act as if their fellow female professionals in the workplace owe it to the world to work full time, take care of the house, & nurse everyone in their families to keep healthcare costs down – & not seek care for their own illnesses. When we get sick & need our share of the care, we get the bill, but not the treatment. We’re expected to nurse ourselves. Hey, news flash: If we nurse ourselves & everyone else in the family, we end up with chronic illnesses from stress & overexposure to untreated pathogens.

Women might as well wait until the last minute like the men do, though; we’re not really going to get the care for which we’re billed (as is our insurance - fraudulently, I might add, since you’re not doing a thing for female patients most of the time). We won’t get care until we’re dead or nearly so - & that’s provided we’re even believed at that time!  

No wonder you see slow pay/no pay. Women process the claims & they know what care those female patients likely are NOT getting.

Yes, there are a lot of guy caregivers. They’ll all tell you they’re way outnumbered by females. They also get a lot more help getting respite care than most women do.

7. Oh, while we’re at this: stop with the “hysterical mother” stuff when moms are worried about their kids. There are way too many tales out there of kids who died because their mothers were ignored or even accused of Munchausen’s by proxy in some cases. Or that we’re “enabling” kids to be sick so we can keep them dependent on us. PUH-LEEZE! Like we need more caregiving responsibilities? We’re already considered free healthcare for the entire system, from sick kids to sick spouses to elder care. The bill to the healthcare system if women refused to do all this caregiving would run in the billions of dollars. You all get a huge free ride from women. The least you could do is actually try to find out what’s wrong with our kids when we ask for help.

9. Here’s another revelation: Not everything that’s wrong with a woman is related to the phase of menstrual cycle from pre-menarchal to post-menopausal, either. I just love it when a doctor tells me I wouldn’t have bronchitis if I wasn’t having a period, or fat, or – believe it or not – doing too much caregiving or working too hard. Or if my parents hadn’t smoked (I never did, but when I was first diagnosed with 2nd hand smoke problems, I was called a liar for saying I never smoked).

10. The men & women of the military may or may not see combat, but they have joined to serve & are always at risk of being called up into battle. I don’t give a hoot if you agree with the conflict or not. If the conflict came to your fancy office door, or your upscale exurban home, you’d be glad to have them helping defend you. Their action in Iraq, you claim, is for oil – yep, the stuff you use to drive nearly 100 miles one way from your exurb in your big gas-guzzling SUV – the one that you have to have because you’re a doctor & the weather can’t be allowed to stop you from getting to work. Hence the Hummer or the Range Rover, Escalade, etc. But you too often treat vets like garbage, following the example of a lot of military doctors who’ll get in trouble if the servicemember gets disability. Especially if they get out & need medical help but can’t get a job – & thus have no insurance & no way to pay you much money except in small installments as they get something. Or else they’re forced into the ER, where you call them GOMERs (Get Out of My E R, for the uninitiated).  Jobless rates for vets are double digits; they’re worse than the horrid rates of unemployment & underemployment among the disabled. For all they’ve given us, we can’t even give them a job, we blame them for the conflict, & we kick them when they’re down.

In summary, you doctors have a lot to answer for before you start kvetchingn about fee cuts & socialized medicine/heatlhcare as a right. You are part of the reason for high costs, but NOT BECAUSE OF FEES – because you refuse to listen, to treat people (especially women) as if they are human beings instead of some sort of slave workforce for your pleasure. You bill for work you don’t do, & excuse it on the basis of slow pay/no pay. Because of this, & because you’d rather blame people for being sick instead of figuring out why, you are raising the costs of medicine sky high. Everyone knows preventing problems costs less than solving them. Take care of it early instead of blaming & the cost of medicine will go down.

I’m going to be harsh here, but it needs to be said. Quit kissing up to the AIDS lobbyists. Don’t ignore this terrible disease, but how about some research for some OTHER diseases? There are a lot of them. Like, oh, cancer? Heart disease? Lupus? Rheumatoid arthritis? Alzheimer’s? Parkinson’s? ALL of these diseases have had research dollars cut for decades, rerouted to AIDS research when the disease is mostly preventable. And diseases that have gone from being rare to being very common (Chiari malformation, chronic fatigue syndrome, fibromyalgia, & others) can’t get funding at all, or get a few thousand when the disease toll is costing the world millions per country. All in lost productivity.

Also, for all you embryonic stem cell lobbyists out there: Adult stem cells have done far more to treat these diseases. At last count, adult stem cells had helped 80 diseases. Embryonic stem cells, worldwide, have yet to cure even one illness, let alone ease the course of the illness & improve a patient’s quality of life. You’re not just blaming the patients, focusing on just one disease to the exclusion of others, but you’re also fixated on embryonic stem cells (which have a far higher risk of cancer as a side effect) when adult stem cells have far more documented proof they work. Thus, again, you are delaying an avenue that might treat, even cure, some of these diseases. After all, if the patient’s cured, where do you get money in a pay for sickness economy?

You’re right, Dr. Blogger, we pay for sickness & not health, but until you doctors are more vested in finding cures instead of blaming patients & collecting endless fees for doing so (as opposed to research for cures & treatments if cures aren’t available), you won’t change that.

Good health is both a right & a responsibility. When the body malfunctions, illness occurs. Blame doesn’t help; research, treatment, cures, those are what will help reduce costs & restore health.

Here’s one that everyone should hate: Quit blaming patients for getting cancer. You can blame almost anything: that they lived in the wrong place, had the wrong type of job, ate the wrong kinds of foods, didn’t have the right hobbies, worked in the wrong industry, stayed too close to people who smoked, cared for people with radium needle implants, worked doing imaging in a healthcare facility, served on a ship with asbestos…Cancer is caused by being alive, for Pete’s sake; quit blaming the patient. I’m a nurse. I’ve worked in many areas of endeavor, including oncology; I got so sick of hearing patients blamed for cancer I was ready to choke most of the physicians (as well as some of my nursing colleagues who blindly parroted the doctors rather than setting them straight), so I moved to another specialty. Remember the definition of stress: when the desire to choke the living crap out of some idiot who richly deserves it is overridden by ethical considerations (or the desire to avoid prison). There, I heard people who ran marathons &  ate a vegetarian diet blamed for familial hypercholesterolemia – called liars when they weighed maybe 140 lb at a height of 6 ft tall – accused of eating everything fried. I have seen people who eat french fried junk food who have a normal cholesterol, & while the medical community now claims to be “enlightened” about that, I still hear the occasional person I know who has all the right health habits, blamed as “cheating” on their low cholesterol diet. Why? Because doctors don’t really know why some people have high cholesterol on vegan diets while others have normal levels on french fried diets. It’s easier to blame the patient.

We all know about people who want to pig out, smoke (although the stench alone makes me wonder why), drink alcohol to excess (when it tastes horrid), use substances of abuse despite the risk of jail & disease – but we never ask why. We did find genes that are only in people with certain addictions, but that’s where it stopped. In other words, find the cause, then find the cure. And hopefully, test it so you don’t have to pull it a couple years later due to the death & disability the medication’s caused.

Because it’s easier to blame the patient.

A Nurse’s Life is No Bed of Roses

There are some hospitals where there are enough nurses to do the job and do it well, where the ever-increasing load of Joint Commission “Patient Safety” checklists can be completed thoroughly and not impinge on the limited time available to devote to each patient. A place where patient and family teaching proceed with sufficient time to have lots of practice and repeat demonstrations for those who are struggling with how to manage increasingly complex care at home. A place where orders are inputted into a computer by physicians who heed the warnings the computer gives them, or answer the calls by nurses and pharmacists who have discovered some issue that needs to be addressed. A place where no one is so rushed, with rare exception, that they can’t be civil to one another. A place where a nurse assesses each patient thoroughly, head to toe, reports findings to the physician, and is actually heeded. Where the nurse can be with each patient frequently enough and with enough serious time for evaluation, that potential problems can be caught early – and where, again, their findings are taken seriously when they are reported.

I just don’t know where it is.

And while I’m sure a bunch of healthcare recruiters will, if they should read this, post tons of comments claiming they are the place I imagined above, I believe that, if you responded to their claims, and worked at their hospitals, you’d probably find the same thing that exists in every hospital out there:

• Mandatory overtime. Lotsof mandatory overtime, putting overtired personnel on duty for so long that the likelihood of errors of omission and commission are increased with each extra hour. But there is a nursing shortage, you know.
• Orienting agency nurses and wondering if the extra person will be worth the time it takes to teach them where things are, while the agency nurse is struggling to give decent patient care so you don’t complain about their performance and get them fired.
• Day shift patient loads of 8 or more seriously ill patients at a time when you’re supposed to be coordinating care with:
  • Social workers for placement, home health, Medicaid applications, etc.
  • PTs and OTs for maximizing function and planning post discharge follow up.
  • Case managers who ensure the patient gets all the tests nad procedures recommended on time, doesn’t have extra tests done that could be done later on an outpatient basis, and goes home soon enough to prevent infection by all the pathogens present in any hospital (regardless of how clean we try to keep hospitals, the sheer volume of sick people and their families/friends ensures a lot of germs).
  • Physicians and the specialists they call in.
  • And when you’re supposed to be helping to arrange home health care for the half or more of your patients who’ll be discharged, and filling out their discharge summaries so there are no questions by nursing homes/rehab facilities/home health agencies about what they need to do for the patient now.
  • While fitting in doing admission databases (20 or more screens long in some cases) for the admissions who’ll replace the discharges – and which will not be read.
  • And in between, having to find someone who can do 4 or more stat bed cleans for you and all the other nurses on the unit.
  • Trying to arrange a time to teach the patient and their family/significant others how to do the complex post-discharge care.
  • Addressing abnormalities in vitals and blood sugar levels, changing dressings, engaging in rounds for wound care, pressure sores, etc.
  • Sometimes, giving or attending nursing grand rounds when, no matter how educational they are, they’re cutting into oh, patient care?
  • And let’s not forget giving meds on time in between multiple trips the patients have to make for procedures – including sometimes having to chase the patient down at the procedure area to administer a medication on time to avoid a disciplinary write-up for something that is not your fault. 
  • And there are the endless beeping pumps; sometimes monitors that must be watched and their alarms that must be addressed – even if half the time, it’s because the patient ripped the leads off.
  • If you work on a stroke or cardiac telemetry unit, the care’s more intense but the ratio is the same as if it were not.
  • Meanwhile, education’s been sent up to give unannounced inservices – through no fault of their own since they were likely as surprised as you were to find that they had less than an hour to put together an acceptable presentation and go give it, getting as close to 100% attendance as possible.
  • Or being told that you have to go online and finish a certain course before the end of the day if you want a decent eval, or if you want to be able to work.

Phew! If reading that was tiring, imagine doing that!

Everyone knows about the nursing shortage. But other things complicate it. There aren’t enough nursing aides or patient care techs to do all the vital signs, so you have to pitch in. There aren’t enough unit clerks to take care of all the traffic and take off all the orders so you have to help. This is especially needed since, in way too many  hospitals, physicians are still allowed to scrawl illegible orders into paper charts before trotting off to destinations unknown, and they are allowed to become verbally abusive if you call and request that they tell you just what that twisting, loopy line created by a pen in the chart is supposed to say.Never mind Joint Commission can practically shut down a hospital if it finds illegible orders on a paper chart that aren’t clarified and cosigned; they’re still allowed to do it. You, the unit clerk, and sometimes, the pharmacist who’s just seen the faxed – yes, I said faxed – copy and can’t read it, either, have to suck it up and take it in hopes that after the rant runs down, they’ll actually clarify the order (if you’re not too deafened by being yelled at, nor too incensed by the accusations involving your ancestry, IQ, schooling, background, and personal habits to hear it).

And as you end up taking up the slack and wasting time clarifying orders – time that would have been saved by insisting the physician input orders into the computer himself/herself – you know you’re going to be in trouble for giving a “late” dose when there are 2 other people, probably , who can explain why, so you all have to document in detail about the issue – with time you don’t have but have to make – unpaid overtime, because “if you would just organize your day right, you’d be out on time.” Or so your clinical manager, who’s working a salaried 16 – 20 hours a day at times for the same reason, will tell you, based on the time when staffing was a lot better and patients were a lot less sick, and they got to leave on time.  

I have worked with both types of system; CPOE, as it’s abbreviated, (Computerized Provider Order Entry) is much more efficient, and providers need only be apprised of one of its many side benefits to be convinced it just might be a good thing for them to go ahead and learn it. I’d try and delineate that here, but I don’t think that content is best delivered in print. It’s best delivered live and, if necessary, “in their face,” so to speak.

While you’re going 20 different directions at once, someone’s going to call you on your documentation for that one note that didn’t save and that you haven’t gotten around to re-typing (often because the PC froze up and crashed), and make you wonder if you’re going to have your license revoked (not to mention making you want to choke Bill Gates for creating Windows). Or some physician, having not read the nurses’ notes, nor responded to the nurse’s call when the incident occurred, will go off on the nurse on paper (without being reprimanded for unprofessional behavior) and accuse the nurse of not knowing the basics of patient care. Who’s note will be believed, regardless of time and date? The physician’s, of course. Everyone knows nurses are all liars – except, it appears, the general public, who consistently rank nurses as the first or second most ethical profession, with doctors much further down the list. But in hospitals, nurses are seen as revenue drains. Physicians are seen as bringing revenue in, no matter how badly they perform. Sadly, until nurses can also bill for their services, that won’t change. And the chances of nursing being able to bill for what they do,  are about the same chances as a 600 lb female fitting into a size 000 dress.

Still, some nurses persist in their profession. Others, forced out by poor health, would dearly love to help in some capacity but cannot find a hospital that will let them in. The usual excuses that every nurse has to be able to lift that 600 lb patient, wouldn’t apply to someone who could still assess a patient on admission and fill out that 20+ screen database, but they put it in the job description nonetheless as “in an emergency,” effectively blocking handicapped nurses from participation that would free up the nurses’ time on any unit – provided you hire more than one for an entire hospital (given patient turnover times, a couple per unit would still stretch things out with those 20+ screen admission databases that no one reads anyway). But, you see, the disabled are more likely to use sick time, vacation, personal days, and healthcare benefits – and after a year of employment, FMLA time so that a flare up of their condition that requires a few days off does not result in being counseled for “excess absenteeism.” And that sort of cost, which might raise the employer’s overall benefits cost, does not sit well with people who might see leaner than usual bonus checks if costs go up. So, they’re not going to hire the handicapped if they can prevent it, and they can prevent it by claiming that a nurse who is essentially doing an assessment and documenting it, with the patient’s answers to the normal questions, has to be able to lift a 600 lb patient when that should never be in their job description because they’re not lifting patients, they’re inputting data from an assessment and patients’ responses.

This illogical (and likely unethical) way of saving people from what they don’t want to do is nothing new – lawyers are experts at this. And hospitals may poor-mouth when it comes to hiring enough nurses – or, worse yet, close open positions and claim they’re adequately staffed because their positions are all filled – but they can always afford lawyers to advise them on how, of all things, to cut costs when they’re paying a department of people who demand 6 figure salaries (and if the first number is a one, it’d better be a kid fresh out of law school and the next 2 numbers had best be higher than 8).

So no, a nurse’s life is not a bed of roses. Nor are the lives of the people who work with them and share their frustrations. But when it’s all said and done, most nurses, though they complain about all of this, still keep going back because, somehow, we know we’re making a difference even if no one else does. Besides, there are still a lot of people who say “thank you” at the end of their stay, to sweeten the deal.

The Problem With Computerized Forms in Healthcare

I promised in the last post that I’d explain the problem with computerized forms in healthcare settings. I’m going to add a few things – more than just forms that don’t translate well, there are some inherent problems with PCs and the way the programs for clinicians, specifically the part where provider orders, are put into the system. Last, there is the environment in which they are used.

Hospitals are especially prone to having difficulties with forms. They have too many forms for the same thing.They’re notorious for not throwing out any form, no matter how old, no matter it if has a half dozen more recent versions that were supposed to eliminate all the previous editions. At times, it seems that there’s nearly always going to be some argument for keeping them, no matter how silly.  A lot of delay in getting new computer systems up occurs due to a last minute rush to get rid of duplicative paperwork. The first thing any HIS (Hospital Information Systems) vendor will do is ask the hospital to make decision on what forms to use, and insist they also streamline them.

Unfortunately, bad forms still make their way into computer systems, making the system difficult to use. When that happens, healthcare workers often complain bitterly that they spend more time caring for the computer system than they spend caring for patients.

People also have unrealistic expectations of computer systems, as if by magic they can erase bad processes. Instead of erasing them, computers often seem to magnify bad processes.

In addition to bad forms, when hospitals decided they would either have nurses and unit clerks transcribe physician orders into a computer system, and/or have the providers do so themselves, they were not using a clinical system that thinks the way doctors and nurses think.  The programs had originally been written for billing and were kluged into clinical programs. They do serve the purpose of streamlining care and making sure that the hospital is paid for its work, but they don’t have a “clinician” feel to them in most cases. There’s nothing wrong with billing; if it’s not done, people don’t get paid. But the two professions have a different focus and thus a different feel. Anything that makes the computer feel more alien to a clinician decreases clinician acceptance – and that’s because of the environment in which the tasks are completed.

The finance department is relatively quiet. Hospital units, however, have been shown, in some cases, to have noise levels approaching a jet during takeoff. Phones are ringing off the hook as unit clerks try to answer 5 calls at once; harried clinicians try to stop and help; doctors call out for favors from those passing by to grab something for them; call bells are always going; visitors and patients are bellied up to the nurses’ station desk like barflys at last call; dementia patients are screaming as if they’ve not seen a human face for weeks when someone was just in there 5 minutes ago as visitors cast dirty looks at the staff because the dementia patients are yelling out for help; pagers and other communications devices are ringing or buzzing and no one knows for sure which one needs an answer first.  Although innovations are being made that quiet the area for patients – something anyone would applaud – the demands for healthcare worker attention have just moved to things that blink and buzz – and leave the poor healthcare worker still wondering which to pick up first. 

The challenges I’ve listed above don’t include the well-documented shortages of all healthcare professionals; the decline in physician compensation when their expenses are rising rapidly; the reduction in compensation for healthcare facilities at a time when care costs more than ever; nor the costs of dealing with the multiplicity of regulatory agencies that healthcare facilities must satisfy to stay in business. All of these have nothing to do with computers – but they do have a great deal to do with whether or not a clinician can give the necessary attention to a PC’s sometimes quixotic behavior and keep his/her equilibrium so that healthcare can move into the digital age more smoothly.

No One in Healthcare Reads Healthcare Documentation

OK, well, some might, but most don’t. Nurses do, some doctors do, but for the most part, physicians don’t read healthcare information provided by families and/or put into the computer by nurses. This one is a pet peeve of mine, and I can tell you right now, it hasn’t changed in decades.

As both a caregiver and a nurse, I find myself wishing we could find a way to quantify a carbon footprint for healthcare and government forms – I’ll bet that does more to perpetuate global warming than any other thing out there – including Hummers sitting in traffic on a 100 degree, 100% humidity summer day, with their AC freezing people’s toes off, not moving.

I have dealt with this medical form proliferation – and doctors especially asking you the same questions over and over – since I was a teen caregiver starting at age 13. And I’ve heard stories from my grandmother’s generation indicating this isn’t a new thing for hospitals especially.

Before my Mom graduated to Heaven, she was in and out of the hospital a lot, of course more and more as she aged. We tried to keep her in her own home as long as possible. It was a lot of strain on our family; I’d work a 40 – 60 hour week, drive 250 miles up to her place, do what I could for her, drive back, and repeat. When things went well, it was monthly; often every other week, and for a long time, every week. The hospital she used up there, she’d been going to since time immemorial. But they still kept asking the same questions over and over again. They’d have the old chart with them, but they wouldn’t just check what was put in on the last admission and see if it was still valid. Computerization didn’t change that at all, either. It’s pretty bad when, between your own caregiving and your illnesses, all the nurses and the doctors (who’ve sometimes taken care of most of your family) pretty much know you by name and ask about your family – then proceed to ignore the old record and ask you the same questions over and over.

When she’d come home, she’d have home health care – usually an aid, RN, and a physical therapist, plus meals on wheels. And pretty generally, the same personnel returned every time she had home health care. Every home health episode was the same – the same forms, same info, all on paper because the same Government that demands we computerize all our records also demands that most subacute and home health care documentation be done on paper, not on a computer. They can’t even put it into a computer, print it out, initial it, and sign it – it has to be hand written. Every folder ended up being filled with 2 – 4″ of redundant paperwork. You can’t get rid of the folders from the last time; you have to keep them. I have no idea why. They have the exact same forms and information, with maybe 1 or 2 changes. When we brought her down here, the same thing happened.

I love computers. Well, most of the time, but I think we all have times when we’d like to throw them out the window. But they can be a very useful tool, and I decided to use them to keep medical records on all of us, including Mom when she was with us. I update them every time there’s any change. There are tons of ways to save electronic information. For example, I have a PDA, a Palm T|X, successor to a Palm Tungsten E that died and left me bereft of what my son calls my “back up brain.” It has Documents to Go (c) by Dataviz on it. This allows me to put Microsoft Office files on the PDA. The PDA can beam documents and other files to any infrared printer. The problem is, there aren’t too many hospitals with an infrared printer. If that doesn’t work, files can be saved on a USB drive, a CD, a DVD, even a 3.5″ floppy disk!

And it is totally useless in electronic format.

They do not have a walled off PC (one that isn’t attached to the network that could be used for things like this), and they cannot print out the file from media that might have a virus or trojan. So they can’t insert any type of disk. It’s not like it’s rocket science to scan the thing for viruses before you open any files, but apparently, they can’t do that, either.

So, I printed out at least a dozen copies of Mom’s updated medical history every time we had to call 911 or go to a new doctor.

Now, this problem isn’t limited to paper overloads in home health or the hospital. Do you know what happens if you hand a printout of the latest information to a new doctor’s receptionists? They tell you that is very nice, very sweet of you, but you have to fill out this form.

This form, you tell them, asks for the same information that is in the printout. It’s right here. Just take this.

Oh, but you’re told, the good doctor can’t read it in your format. He or she has to have it in his or her format.

But, you argue, it’s the same information. It’s even organized in roughly the same order.Too bad. It’s not close enough, and it’s not on the nice little lines in the nice little boxes on the doctor’s form. You have to fill out the form. So, you sit down, fill out the form that asks for the same information in about the same order. It’s not as legible as the printed information. The form is usually crooked; it’s a copy of a copy of a copy of a copy from so long ago that Columbus probably brought it over on one of the first voyages he made. And once you fill it out, they ignore that, too, and ask you the same questions again in the office.

I think medical forms are how we were able to subjugate the Americas. We made all the natives fill out forms until they died because terminal writer’s cramp messed up the bow and arrow fingers so that they couldn’t shoot straight enough to save themselves from the encroaching Northern European Menace. And I also believe the real reason the natives attacked the colonists was to try and stop the proliferation of all the medical forms. Hey, you remember your history, the stamp act? The British government made money by charging people to stamp their forms as approved by the government, and you couldn’t do business unless your forms were all stamped, so they made sure there were a lot of forms to fill out so they could tax people and make a lot of money. When they got medical care to the Native Americans, they got thoroughly disgusted and tried to burn things up, hoping to purge the land of medical forms. I’m sure of it. History doesn’t say that – because they hope no one else ever gets the idea to burn all the forms. But I have this ancient conspiracy theory about this. I’m betting if we could get into a time machine, we’d find out that’s what really happened. Hey, don’t knock it, conspiracy theories are fun, creative, and you can do them without triggering your implants or wearing your tinfoil hat.

Well, what about the computer systems, you ask? Don’t they eliminate all these extra forms?

Nope. We wish, but nope. There are a lot of reasons why they don’t, and maybe I’ll actually get around to putting those down in this blog, but for now, just take my word for it.

In fact, if a form’s on a computer, most clinicians are going to print it out.

On top of that, when they’re done, they’re not always near one of those locked metal or wooden boxes that are emptied by companies that make a living shredding stuff. And if they’re not near that box, they’re not always going to hang onto it and toss it later. It’s probably going into the nearest trash can.

So much for HIPAA…

As for those printouts I created, because they won’t let you put the information into the computer for them for security reasons, they go into the chart, and the nurses come in and ask you the same questions. You refer them to the printout, they ooh and aah, and ask you the same questions. In ERs, they generally are all scribbling and scrawling illegible notes, regardless of profession. On top of that, the admitting people come in and ask you the same questions. Then a PA (Physician’s Assistant) or NP (Nurse Practitioner) often comes in and asks you the same questions. And these people often don’t work on the inpatient units; they work in the ER – most hospitals outsource ER management to one of several companies who do nothing else, so if the patient’s admitted, these providers are not going to be taking care of them again. Then several doctors come in, one for each condition, and ask you the same questions. Generally, they also only work in the ER, so they won’t be taking care of the patient if they’re admitted, either. When the patient has to go for an X-Ray or a CT or other procedure, you answer the same questions for them; the only good part is that they’re more likely to be the same people if you have to repeat the test during a hospital stay. Then you go to the inpatient unit, and the maybe half dozen printouts that you’ve given all these people, that they’ve pushed into the chart while they ask the same questions despite your protests that the answers are already in the printout, go missing. You end up repeating the same process on the inpatient unit – and if your doctor is on vacation or not on call, you’ll be giving one to the covering physician and the attending physician.

Each time I’d encounter one of these personnel, I’d hand them this printout that has wise use of white space, bolded headings, bulleting, and I’d tell them the answer to all their questions is on the paper. No one reads that lovely print out that I created. Except the EMTs, that is. They read it and thank me profusely. But no one else bothers.

It seems that when it comes to families and patients printing out current medical history forms that have allergies, medical history, surgical history, any medical devices like pacemakers, etc., etc., the staff are all thinking like the obnoxious doctor on the TV show “House” (aka Medical Fantasy Island – the day you have 3 doctors sitting around doing the procedures as well as discussing them and providing direct patient care, you’ll know you won the Mega Millions Lottery). You know, patients and their families are all liars. You have to catch them. I have even been told by physicians that the reason they don’t take those forms and insist on redoing the history and physical over and over again is to catch people lying. I know they do, often enough, but it really doesn’t take quite that much work if you’re any good at smoking out liars and tripping them up.

But you’d hope that when the nurses put information in the computer system, that at least then, the doctors who are coming in to see the patient would read that first. Nurses are pretty good at catching liars, and we spend way more time with the patients than the doctors do. Used to be that doctors relied on nurses to “bust” lying patients. But they still don’t read it – with the exception of the regulatory agency or state inspectors and the quality improvement department, that is. And if they find something missing, Heaven help the nurse who neglected to document it.

All these scrawled notes have their drawbacks, and they do NOT catch many liars. What they do is mess up the patient’s chart. Quality audits are very targeted, and they don’t generally look to see if all the information scribbled in by various physicians matches either the nursing database or, if supplied by the family, the medical history print out (assuming it’s in the chart). And they don’t check to see if the entries match each other. When I did quality reviews, I was curious and I did look. I found in one chart, 4 dictated notes on the same patient – one referred to the patient as a 76 year old African American male, another as an 83 year old Caucasian female; another note referred to the patient in the first paragraph as an 87 year old white male, and 3 paragraphs down, as a 72 year old African American female; the last note had the patient listed as a 92 year old Asian female. I have no idea who this person is, but they must be the oldest X-Man alive (keeping in mind the X-Men, for those of you unfamiliar with superhero stuff, were of both genders). Other notes were a bit better – if you could read them – but the confusion about age, gender, and ethnicity/race kept showing up. Sometimes, the age variances ran from 42 – 84 as an age for one patient. Another patient must have had yo-yo dieting to a fine art; they went from emaciated to obese to underweight to overweight in mere hours.

How did this happen? Scrawled, illegible notes on multiple patients, with the doctor interrupted so often during the dictation process that he or she cannot keep track of the person on whom they’re dictating the note. And please, don’t even think about asking physicians to type – no one will give up the QWERTY keyboard, with its mixed up letters, for the Dvorak keyboard, where letters are in alphabetical order – or one that switches. Dvorak keyboards would probably be easier for physicians to use, and we might have a chance that more of them would just type in their own notes. And you have to ask how a medical transcriptionist could miss that one note where the patient’s age and sex changed in the space of 3 paragraphs! Or were there reports ignored? Questions about medical errors in the presence of overkill safety regulations for just about everything can generally be answered by auditing all the handwritten notes.

Nurses have to be asking why they bother…they are, after all, the ones who usually have it right. In fact, after those notes, if you’re not sure who the patient is, look in the nursing database. You’ll have more than all the information you’d need.

At least the EMS people appreciate the effort.