MM#209 / JapanJoyful#803
Amongst the highlights of 23 activities completed on Day III of GS’s spring break was (1) seeing a mountain goat down on the lower slopes of the lakeside cliffs, (2) GS telling DD that, “papo lets me do it” when DD told him not to climb so high up on the trailside granite rocks, (3) Papo getting sand in GS's eye when skipping lakeside rockes, (4) GS hitting papo in the stomach when skipping lakeside rocks, (5) GS making up for it by squeezing under the outdoor stair climbs to retrieve papo’s glasses, (6) GS seeing “Governor’s Office” sign in the Capitol Building and asking the next innocent state employee to walk by if he was the governor, , etc. .Mercifully, when we got back just after 5pm, DD said, much to GS’s chagrin, “it’s too late to go to the swimming pool.” YIPPEE. However, he’ll get to make up for that miss tomorrow. . ..
Just my 2 cents.
ps holly - your 2-cents is worth a million dollars.It’s too bad some of the providers can’t just can’t get it through their thick skulls that most of us who make it into our seventies and beyond are just fine in appreciation and accepting what’s happened to us so far and just fine with moving on if that’s the way it’s going to be. Save your saving for others so they can get to this stage too, . . . please.
"Enjoy yourself. Your younger days never come again." 100yo T. Igarashi to me in geta at top of Mt. Fuji (8/2/87)
ps holly - your 2-cents is worth a million dollars. It’s too bad some of the providers can’t just can’t get it through their thick skulls that most of us who make it into our seventies and beyond are just fine in appreciation and accepting what’s happened to us so far and just fine with moving on if that’s the way it’s going to be. Save your saving for others so they can get to this stage too, . . . please.
ps holly - your 2-cents is worth a million dollars.
It’s too bad some of the providers can’t just can’t get it through their thick skulls that most of us who make it into our seventies and beyond are just fine in appreciation and accepting what’s happened to us so far and just fine with moving on if that’s the way it’s going to be. Save your saving for others so they can get to this stage too, . . . please.
I agree 100%. Holly, your statement was right on. Unfortunately, some of that also happens to younger (not on Medicare, no dementia) patients, mainly because they blindly believe and follow their doctors because, as they say, "I didn't go to medical school, they did!" But there's still a case for healthy skepticism. Anyhow, it's a well known and publicized problem (excessive, wasteful care) in this country. I only hope that it'll get some legislative or regulatory attention in the near future, to the same extent that has applied to insurance companies/plans as to what they have to cover.
Ok, enuf of that. I guess I'm done.
8.1 miles tonight, found a bit too much ice out there but still a good run.
Rose Colored Glasses
Guess you didn't click on my link or maybe didn't care about it.
There is waste and greed in every profession. The majority of physicians I know are intelligent, honest, and have integrity. It is a shame when all one can see is the bad things that some people do and not the good.
I am not excusing the bad. That is why I posted the link. It is called value based medicine.
Of course every patient should have an advocate! My goodness, my mother had a simple overnight hospital stay and I spent the night in the room with her. Every patient should have an advocate.
Blindly following any advice is stupid. I question everything but not with skepticism, with interest in my own or my family member's health. Everyone should have this curiosity and interest in their own health or in their family member's health.
If there is no family member, then a professional advocate should be available.
And evidence based and value based healhcare is one answer.
"Anytime you see the word "inflation" in the news, replace it with "record-breaking corporate profits" and you'll get what's happening."
It is a shame when all one can see is the bad things that some people do and not the good.
Yes for sure. Same as the profession I ended up in, there’s no doubt about the bad apples impugning the good works of the rest of us. .Returning now over spring break to my home town community where doctors used to be the pillars of society and respect but where the seemingly over-prescribing of pain-killers, etc. to young athletes who turned to drugs is front page news, I can’t remember seeing an article about the other doctors who do so much good, e.g. two HS classmates who have dedicated their retirement years to public service, Doctors-without-Borders, etc. Fortunately, by this stage, most of us are lucky enough to know who they are. .Thanks to all for all the insight and new information, e.g. the idea about professional advocates I never heard about. You are the best.
No wonder I love running so much.
Thank you, tetsujin.
As for the over-prescribing of pain meds? I have a little trouble with this idea. It seems there are efforts being made to correct ths by having doctors prescribe a smaller amount of doses for post-operative pain. There are efforts being made to push for non-pharm pain relief, i.e. e-stim, massage, p.t. etc. These are good measures.
Butt. The pendulum must not swing too far in the other direction. There are patients who desparately need narcotic pain relief. They should not be stigmatized or looked at with suspicion. Each patient should be evaluated and counseled regarding pain medication. I was livid when a friend's loved one was almost denied an opiate for his pain management. He was in the end stages of cancer. Now is not the time to limit his access to narcotics.
There is an epidemic of overdoses and substance abuse. I wish we could stem this with prevention such as trying to figure out what drives people to become addicts. What can we do to help them before they take that first hit?
Marathon Maniac #957
This is neither true nor fair. No one is denying the importance of value-based medicine, and we certainly don't mean to offend you. However, we are also entitled to form opinions about what is happening in our lives, in the lives of those we know, in our area of the world. Since I deal primarily with people with diminished capacity, elderly residents in nursing homes and assisted living facilities (and their families), I expect I see more people in situations where they are not always able to make informed decisions about what is happening to them, healthcare-wise, or to stand up for themselves in situations where they are being taken advantage of, and I admit I get upset about it when I see it happen.
Life is a headlong rush into the unknown. We can hunker down and hope nothing hits us or we can stand tall, lean into the wind and say, "Bring it on, darlin', and don't be stingy with the jalapenos."
,,,,,,am now mailing all posters some of my ''Peace Fudge'',,,,,,,,please do Not Drive, as it seems to be slightly sedating,,,,,,,
also
if you are Allergic to Tungsten,
check with your physcian before eating it
..nothing takes the place of persistence.....
I was never offended. You certainly are entitled to your opinion. And so am I. And I fear that you don't realize that we are on the same page, really. I have not refuted anything you have said.
I worked in a nursing home for 6 years, so I know a bit about that situation. As a registered nurse, I am a patient advocate.
This all started when Deez was sharing with us her situation in which she has to try to get her son's medical debts forgiven. And then this morphed into something entirely different. I felt like physicians were being generalized as greedy money-grabbers. My intent was to show another side.
I have observed that people who are steeped in what they deal with every day for 8-12 hours a day or night, they start thinking that what they deal with is the norm because they see so much of it. For instance, I have a friend who is a physician in the emergency department. He has developed a lot of biases against many segments of the population because he sees and treats SO much of the worst of people. He has little tolerance for obese people. He sees them as heart attacks, strokes, diabetic comas, etc. But as human beings, we should treat people with dignity regardless of their bad choices. Dignity, not condoning the choices but not compounding their issues with condemnation.
I have another friend who is an orthodontist, I am sure he probably thinks everybody's teeth are crooked!
On the other hand, I have a friend who works with CrossFit. He thinks everyone is fit and healthy!
Just kidding. But you get the idea. If we are surrounded by certain segments of the population, we start to think what we see day in and day out is the norm for all of society. When I worked in the nursing home, I used to think that all old people will either have dementia or alzheimers OR be bedridden for a physicial problem. After I got away from that, I became more aware of the older people who were healthy and active well into their 80's and 90's. And in Karin's supergran's case, 100's.
You see people in situations where they can't speak for themselves. And then you see other people making decisions you think they would not make. I imagine that is why you are in the field you are in. You want to help older people. The problem is that if these folks don't have adequate advanced directives, a healthcare provider is obligated to treat the patient. By law, the healthcare provider cannot withhold lifesaving treatments without an advanced directive. I understand you see fraud, I understand fraud exists. But. I am still going to stand by my life and career experience and say that the majority of physicians are intelligent, caring, and full of integrity. I have worked with physicians whose orders I had to question. Although the confrontation is uncomfortable, we had to discuss why I thought his orders were inappropriate for my patient and in the end, he allowed me to continue with my plan of care. The outcome was good.
So, you see. I am not disagreeing with you that fraud happens. That people get treated inappropriately. What I am saying is that there is more good than bad. I am not saying that changes should not be made. In fact, that is why I was trying to discuss the value based medicine that my SIL works with. Our healthcare delivery system is seriously flawed. As I said before, I don't think we can call it a system because it is so fractured. I was trying to show you that changes are being made. It's a big ship so it is tough to steer. But changes are in the works.
I didn't think we were choosing sides. I thought we were all discussing healthcare and it's flaws. I find it healthy to discuss these issues not just by providing examples of how awful things are but, also concrete ways to improve things.
So, yeah, since nobody acknowledged changes happening now, I figured you didn't read about it. It's a relatively new concept for reimbursement. But it is what Erika described. Getting away from fee for services and toward fees for outcomes.
For example, it was discovered that hospitals were spending a lot of money treating catheter related urinary tract infections in hospital patients. Instead of the hospitals being reimbursed for the treatment of the infections, they were penalized for having catheter related urinary tract infections. What happened? The hospitals investigated how the nurses were maintaining catheters. Nurses and staff were retrained in the proper procedures to reduce catheter related urinary tract infections. Guess what? Some local hospitals have had zero catheter related urinary tract infections for over a year. They got a financial bonus for this.
Another example is in the operating room, they too, went over their procedures and found ways to reduce complications. Everyone benefits.
There is a lot of work to do to fight fraud and negligence. Let's get started working on this.
RANT ON- ...rose//......we now have DataBases for watching Narcotic Useage, and pharmacists are required to check prior to dispensing the abuse is so extensive, I only filled for my Regular Customers (in Tennessee) and turned down customers from- Cincinnatti, OH,,,,,,,,,,,,,,,,, (who claimed he would drive down here to have his Rx's Filled,,,,,,which was cute, or he thought I was as Stoopid as I must look) Northern Ky bordering Ohio various parts of Florida various parts of Georgia ...............we kept track and turned down 8-12 Out-Of-State Narcotic Rxs PER DAY my GrandPrizeWinner>>>>>>24-doctors, 20-pharmacies................ my Second Place PrizeWinner>>>>>>>> #280 Time-Release Morphine 160mg tabs (yes, 160mg is not a typo) back in the 90's the makers of OxyContin were REALLY pushing docs to prescribe their med,,,,,,,at one CE they had, they actually claimed unless you BROKE THE LAW to obtain your med you were only ''Physically Dependent'' not ''Addicted'' ,,,,,,,,I told them that was the ''Most Embarrassing Presentation I had ever heard'' and refused to take their CE Credit the sad part is, because of these Druggies, the people who actually need Pain Meds for Legitimate Medical Use are subjected to needless hassles RANT OFF-
RANT ON-
...rose//......we now have DataBases for watching Narcotic Useage,
and pharmacists are required to check prior to dispensing
the abuse is so extensive, I only filled for my Regular Customers (in Tennessee)
and turned down customers from-
Cincinnatti, OH,,,,,,,,,,,,,,,,, (who claimed he would drive down here to have his Rx's Filled,,,,,,which was cute,
or he thought I was as Stoopid as I must look)
Northern Ky bordering Ohio
various parts of Florida
various parts of Georgia
...............we kept track and turned down 8-12 Out-Of-State Narcotic Rxs PER DAY
my GrandPrizeWinner>>>>>>24-doctors, 20-pharmacies................
my Second Place PrizeWinner>>>>>>>> #280 Time-Release Morphine 160mg tabs (yes, 160mg is not a typo)
back in the 90's
the makers of OxyContin were REALLY pushing docs
to prescribe their med,,,,,,,at one CE they had,
they actually claimed
unless you BROKE THE LAW to obtain your med you were only ''Physically Dependent'' not ''Addicted''
,,,,,,,,I told them
that was the ''Most Embarrassing Presentation I had ever heard'' and refused to take their CE Credit
the sad part is,
because of these Druggies, the people who actually need Pain Meds for Legitimate Medical Use are subjected to needless hassles
RANT OFF-
One woman's story
Tomwhite,
I am well aware of all of this. My brother-in-law is an independent pharmacist in West Akron. This epidemic is tragic for everyone. I doubt there is any family that doesn't have someone affected by drug addiction.
Yes. I am aware of drug manufacturers marketing practices, too. What an awful presentation you had to witness!
As for your "sad part". Yes, these "Druggies" (your term not mine) have triggered the need to change our policies and procedures regarding the dispensing of pain meds for legitimate medical use, there are ways of dealing with people with dignity and respect while subjecting them to "needless hassles". I can't call them needless hassles if you are truly trying to prevent those abusing the drugs from obtaining them. Again, the manner in which you cautiously dispense the medication should be adequate. And my friend was not treated with dignity or respect. I have another pharmacist friend who works for a big chain. A few months ago, in broad daylight a sad looking guy came into the store and handed my friend a note saying he had a gun and to give him specific drugs. My friend complied and the perpetrator left and no one was harmed.When asked how he felt about that, my friend said, "I feel sorry for people in his circumstances."
A few weeks later the perpetrator was caught in a York County chain pharmacy trying the same crime. He was caught. Now let's hope he gets treatment.
Awesome post! Many points to ponder here, and I don't have time to address, but thank you - well said!
No one is saying the doctors are money grubbing etc, but it seems the way the insurance system is set up, they have those incentives. In Canada, of course, things are much different. Doctor's have no incentive to prescribe, order tests, anything. A patient can come in and say, I think I need this new drug - doctor will just say, no, no you don't. An American friend of mine was shocked that if you are obese, you cannot get approved for gastric bypass surgery and are sent to the gym and nutritionist instead. No, you cannot just demand certain tests and procedures there, the same way I feel you can here in the US if you have a good insurance plan that will cover it.
In other news, I ran 5 miles today! Woot! It was windy, a bit unpleasant but I got it done! Last steep hill, I ran up that sucker without stopping.
About the addicts - I feel really sorry for them. Once you take that shit - it is extremely hard for some people wean off it. I mean, it is extremely physically unpleasant - you have no idea. Proper withdrawal should be supervised somehow.
"During a marathon, I run about two-thirds of the time. That's plenty." - Margaret Davis, 85 Ed Whitlock regarding his 2:54:48 marathon at age 73, "That was a good day. It was never a struggle."
Oh, and one other thing I just remembered. My friend's DIL was going to have a baby. Her first. She told the doctor, months ahead that she wanted a C-section, she did not want to give birth naturally. And so that is what they did, a C-section. Zero attempt to say no to her request. This country performs far more C-sections than anywhere else, over 30% now of births. Are the women in the US any different?