I'm Gonna Die...

... and college will surely be the cause. Week three of classes has just begun and already I'm running on caffeine, adrenaline, and despair.

So far, I've had three homework assignments, one exam (on which I scored a rocking C, due to my intellect's embarrassing defeat at the hands of a ScanTron sheet), and eleventy-gazillion pages of reading material.

Deep breaths. I can do this. In the words of... well I don't know who said it, "Failure is not an option." Really not.

I've got to get these things done and I've got to get A's on them, because, I don't want to be a biologist. I want to be a doctor and you don't get into med school with C's.

Success or Death!

***
In other news; I'm taking a Health Care Mega-Trends class, which is retarded.

I thought, first of all, that my proffessor would exert at least some, small modicum of effort to appear neutral, but no such luck.

Let me preface this rant with the fact that I know, without a shadow of a doubt, that our health care system is broken.

I'm just not entirely sure that Obamacare (I'm sorry, the Affordable Healthcare Act) is the best way to go. I'm certainly not going to go out on a limb and say that it's the only way to go.

The textbooks I've got to read for this class are unbelievably biased and one of them is out of print (Who assigns out of print books as textbooks anyway?).

But, the free market system won't fix our health care system, squeal my textbooks. We've tried that before and it didn't work!

No. We haven't.

First of all, we've never tried a free market system. You know, with price transparency and interstate competition for health insurance companies (among other things)? So don't tell me that we tried it and it didn't work.

Second of all, even assuming that a free market system wouldn't fix a majority of the problems in our health care system, how is the Affordable Care Act the only good solution? What about a single payer system (Eeek! Socialized medicine!) Hell, it works for a whole lot of other developed nations around the world. What makes us so different?

But they'll kill off our old people in giant concentration camps like the Nazi's! I hear you say.

First of all, that brings up opinions on certain end of life issues that I know I don't share with a majority of Americans (although none of them involve concentration camps for old people) so I won't get into that. Second of all, no. No they won't. Let's not be stupid. No one advocating for a single payer health care system is suggesting that you ship grandma off to the Old People Resort, Spa, and Death Camp (TM). Nor is any (sane) economic or political forecaster predicting any such thing. Do they kill off their elderly in Canada? How 'bout the Netherlands? Great Britain?

Seriously, lets get real for a minute here. Would there be some "rationing" of care? Of course there would. Rationing care is the only reasonable way to provide care for everyone. You fractured your tailbone (please note: this is only an example) and now, you'll have to wait a week or so to get it repaired. I'm sorry, the orthopedists in your area are busy repairing spines. Think I sound heartless? Think about how you sound, when you whine about that sprained knee that needs to be checked, to a person that's had to walk around (and go to work) for the last five years with a broken back.

But who would make the decisions about who gets care right now and who has to wait? You ask.

Doctors.

Yes, that's what I said. Get over it, all you whiny, mealy-mouthed, members of our public who scream about how our average joe is just as good as any doctor out there. They are fully as valuable, as people, but they are not on the same level professionally. Doctors are in a special position where they have acquired a vast amount of knowledge from specialized schools, training, and work experience in caring for people with medical conditions, that we, as the general public, are not. Don't like it? Take a shot at med school and practice for a few years. Then you can make your own judgment calls about who can and cannot (or should and should not) be treated and/or saved.

Doctors, not elected officials, not bean counting bureaucrats, would need to be the ones to make the calls. Heck, appoint, or even elect, a panel of them that the public can appeal to.

I don't see why this idea causes such a problem for some people. Most people don't do their own taxes, fix their own cars, or cut their own hair, so why the hell do they leave these matters to experts (who went to school to learn their trades) but expect to know better than medical practitioners about health care? I'd bet your doctor doesn't fix his own computer.

***

All right, I'm done for now (I think) although I'm sure there'll be more to come. I feel a posts about end of life issues and HIPPA coming on as we speak, but my Biology notes are calling to me so I'd better go.

Tort Reform -Why Doctors Can't Say They're Sorry

Lately I’ve been doing some reading about the myriad of things in our healthcare system that we could be doing much better and as always tort reform comes out close to the top.

Looking at it, the problem doesn’t only lie in our rising medical costs due to malpractice insurance and doctors practicing defensive medicine (ordering probably unnecessary tests and treatment out of fear that they might get sued). It also erodes the trust present in the doctor-patient relationship and the integrity of the doctors forced to practice in a litigious atmosphere.

Doctors aren’t allowed to say “I’m sorry”. It’s a malpractice thing, kind of like the warning on the back of your car insurance card that says, in event of an accident don’t apologize. Apologies imply guilt, you see, and guilt means you lose in court.

The strange thing is that, they found (in a study I can’t lay my hands on right now), that if the doctor had only apologized, most of these lawsuits wouldn’t have happened. These lawsuits are brought to court by people in pain. People that have just lost a loved one, or a leg. People who believe that the doctor should be made to pay for what they’ve done since they so obviously have no remorse.

Can you imagine? I’m sure it’s happened to most physicians at one point or another, whether as a near miss or a true tragedy. One day you screw up. You’re too tired and you make a mistake during surgery, you misdiagnose a condition because the alternative just didn’t occur to you, someone dies or is horribly disfigured. And you can’t say, “I’m so sorry. I was tired. I didn’t think. I was human. There’s no way I could ever make up for your loss.”

What does that do to them as people? Doesn’t it make them feel like a monsters to cause a tragedy by making a mistake and then have to consider something so ridiculously pragmatic as whether or not the family will sue? How hard is it to go against their first instinct to try and ease these people’s pain and lock it down so that they can pray they don’t get sued. It’s a challenge with a million dollar price tag if they fail.

What does it do to the doctor-patient relationship when there’s a bad outcome and you know that even if your doctor was in the wrong they wouldn’t tell you? It sure makes it easier to assume that there was a mistake and a cover up or even true malicious intent, doesn’t it?

How did we get here? To place where people in pain use the legal system to punish people in pain? Who can fix this, really? What can we do? I don’t have the answers to any of these questions. Maybe someday I will. But for now I think we need to start by asking the questions.

It's Hard To Get Into Med School

I’m shocked, aren’t you? It’d be more amusing except that really I am, kind of. I thought that all you needed were good grades (really good, like 4.0 good) and a decent score on your MCAT (the SAT’s of med school). It turns out that this is not so. You also need a good amount of physician shadowing, 500+ hours of volunteer work (yes over five hundred. Yikes!) in a clinical setting and “well rounded extra-curricular activities”.

So basically I have to get a 4.0 in a “well rounded” (not just sciences) degree, ace my MCAT, convince several doctors to let me follow them around for a while, offer myself up for ten hours a week of indentured servitude for a year, and join, ugh, clubs.

All I have to say, is that they must really want to make sure that you really want to be a doctor. And that you handle pressure well. As far as I can tell, the schedule imposed by the volunteer work plus school and school related activities (classes, homework, clubs, and work study) AND the care and feeding of my spouse and four children will leave me with approximately six hours a week of free time to do things like, you know, read a novel or poop. Did I mention that medical school and residency are supposed to be much worse than this? I think that they have about this same schedule only without sleeping during the week.

I’m glad I found the Flylady system which works uber awesome for me. It’s the only way I have a prayer of keeping up with school, getting my homework done and keeping my house from being condemned. I strongly suggest that everyone check it out. Just be sure to take some of the over-the-top sappy messages with a grain of salt. I, for one, can’t help but snicker at terms like, “weekly home blessing hour” (that’s when you do things like change your sheets) and quotes like, “Nothing says I love you like a clean toilet to throw up in!” You should definitely check it out, just don’t drink the Kool-Aid.

In unrelated news, my brother got married yesterday in a beautiful ceremony that just made me wish harder for one of my own. Fortunately my divorce (from a man I separated from nearly a decade ago) should be final by the end of September which means that I can finally marry the wonderful man that I cohabitate with, although I still don’t get a gorgeous ceremony or a pretty dress. Such is life I suppose.

I’ll post pictures of the ceremony regardless, because, well, I’m pretty proud of myself for finally having the courage to get divorced. It took me a long time. Heck, starting school, getting divorced, VBACing my fourth baby. This year seems to be all about courage for me. It’s certainly filled with new experiences.

Well, I should probably run along and put an end to the Wrestle Mania going on in my living room. Be sure to tune in… well, tomorrow to read about the awesome volunteer job I nailed over at our local hospital.

The Top Ten Worst Paying Jobs For Doctors

Was surfing the net the other day and found this at Forbes.com. According to the medical search and consulting firm Merritt Hawkins & Associates' 2010 Review of Physician Recruiting Incentives, the ten worst paying specialties are:

Neurology ($282,000)
Obstetrics/Gynecology ($272,000)
Emergency Medicine ($247,000)
Endocrinologist ($219,000)
Psychiatry ($209,000)
Hospitalist ($208,000)
Family Practice with Obstetrics ($200,000)
Internal Medicine ($191,000)
Pediatrics ($180,000)
Family Practice ($175,000)

Now, I find it odd but not surprising, that half of the specialties on that list are currently experiencing shortages across the country. After all, how can you practice medicine, even medicine that’s your passion if it doesn’t pay even a living wage? (The figures above are gross income and don’t include the $60-100,000 a year malpractice insurance charges, clinical overhead, such as lab tests and new equipment, or the $140,000 in student loans the average medical student racks up.)

So how did we, as a nation and a society, end up paying the doctors we’re most in need of the least money? So little, in fact, that even the medical students across the country that have a passion for family or internal medicine end up in other specialties simply because they can’t afford to do anything else.

A lot of the problem comes directly from the AMA (American Medical Association) which sponsors a committee charged with deciding how much a doctor's time is worth in Relative Value Units (RVU’s). These RVU’s determine how much Medicare will pay a doctor for a procedure. They also determine, in a roundabout way, how much your insurance will pay, since insurance carries take their cue from Medicare when deciding how much to pay. Basically, the more difficult a procedure is, the more it’s worth. By their reckoning, intubating a patient is more valuable, monetarily at least, than face to face time with a patient in the office for a fifteen minute check-up even though the first takes much less time.

This system leaves physicians in primary care making half the money of specialists in a lot of cases. Not surprisingly, less money means less PCP’s, and we need those providers. Thanks to a not very well thought out new national healthcare plan, the demand for PCP’s is set to increase exponentially while the supply will only continue to decrease.

Something’s gonna have to give.

Electronic Medical Records

So… more from the I’m going to college this fall and why does it have to be so complicated front, I turned in my immunizations at Student Health Services today in hopes that it would cause them to take the hold off my registration so I can pick up the one last class I’ve been wanting before classes, you know, start.

Turns out that they did, indeed get it the first time I turned it in but there are not “enough” immunizations on it. Not enough meaning there is only one MMR recorded. Now, I know for a fact that I received my second MMR when I was twelve because a.) I remember getting it and b.) they let me attend high school which (at least around here) they won’t if you don’t have record of two MMR’s.

So, how could this have happened? Electronic medical records, the newest brilliant brainchild of the medical establishment. Now, I’ll admit, that when I first heard of the movement towards EMR’s I thought it sounded awesome. In theory, it should make records more accessible, care more coordinated and errors less likely.

The problem is that they only works if you use them and use them all the way and all the time. In my case and at the clinic I’m at they didn’t. They started using the EMR system and didn't transfer any of the older files over. So, despite the fact that I’ve been getting my medical care in the same place since I was three months old, when I ordered my complete medical record, the immunization records weren’t there. Not only that, all of my (and my oldest son’s) records weren’t even AT the main clinic location. I finally ended up having to go to the separate file storage area at the satellite clinic where my doctor practices and have them go through my medical record page by page to find the record I needed.

Imagine my frustration when it turned out that the record we found wasn’t even the complete record. It was missing my first MMR and heaven knows where the record of that shot lives now.

So, in short, there’s no centralized records. The computers, as efficient as they sounded, don’t talk, even within the same clinic system. I have all my labor and birth records at the (associated!) birthing center, all of my E.D. records at the E.D., a select few of my records at the central clinic office (still in hard copy), my records from after 2005 in the EMR computer system, and the rest of them at the satellite clinic where my doctor actually practices (also still in hard copy). A far cry from the “centralized records” that were promised when they switched over to the EMR.

How did this happen? How did everything get so spread out? And what does it say about the coordination of care that most patients receive?

I’m generally healthy, so the inability to find my records is really nothing more than a minor annoyance, but what if I had a chronic condition? I’m pretty sure that there’s no way my records would transfer seamlessly between my primary care provider (the proposed “medical home”) and the specialists I’m seeing or vice versa the way that the EMR‘s were supposed to facilitate. As a matter of fact, I’d be lucky if they ever got transferred at all.

The only “coordinated care” I’ve ever gotten from the EMR system is a repetitive list of medications that I haven’t been on since 2005. So much for innovations in coordinated care. There has got to be a better way.

Waiting...

…With bated breath for school to start up. It feels like I’ve been waiting my whole life to do this and now that I’m almost there it’s taking forever. Only seven more weeks to go. I’m torn (aren’t I always) between wishing that school would just start already and trying to relish every single one of my last moments as a stay-at-home mom. Surely enough it’ll never be like this again.

My life seems pretty uninteresting right now compared to what’s ahead. I have to keep reminding myself to stop, breathe, be present with my children. They’ll never be this size again and I know a time will come when I‘ll really miss all these long crazy days. Part of me, I think, is hoping that maybe, enough love and attention and time now will be enough to get them through the next few months until the semester ends. Months when I may not have the kind of time and attention available to give that I have now.

So, with that in mind, I didn’t do anything today. (Well, I cleaned my house. That’s always a pretty major accomplishment.) The kids had their lunch picnic style in the front yard, I made silly faces with our two-year-old, I nursed the baby, we all sat around and ate popcorn before bed, and I sat around waiting and waiting...

A Lazy Saturday

Lazy days are sweet. You know those days, where you never once get in the car (or sometimes even out of your pajamas). Where you get the dishes done early and get to play some board games (or video games) with the kids. I must have read seven board books today and I loved every moment.

I sometimes feel as if I don’t get enough of those days anymore. Not that I’m complaining, really, but, contrary to the popular belief that being a stay at home mom makes you feel trapped and lonely, I miss the times when I could go three or four days without ever leaving the house. What can I say? My kids are good company.

We did go to the grocery store today, something I was hoping to avoid. There’s nothing like a refrigerator decked out in nothing but condiments and moldy cheese to provide a bit of motivation for an outing. It was good though. Not one of those four hour long, everyone’s cranky, exhausted and homicidal by the end of it, marathon shopping trips. I actually hadn’t known until today that a family of six could get into and out of Wal Mart in under two hours.

I wonder how many of these lazy days I’ll have when I start school. Won’t it only be worse when I’m in med school or, god forbid, residency? Maybe that’s what “they” meant when they said you can’t parent children and become a doctor without neglecting them somehow. I worry about it. I worry that they’re going to miss me, that they’re going to miss out, on video games with mom, on bedtime stories, on home cooked food for almost every meal. These are all things I’ve always taken pride in providing, as a stay at home mom and wanna be June Cleaver. It’s kind of hard, I guess to reset my priorities from just being the “perfect” mom, wife and housekeeper to being pretty good at those things and getting strait A’s too.

To be honest, I don’t think they’ll end up mistreated or ignored, but I do think I’m really going to miss those lazy days.

Bigger Better And Exhausted

…or at least seriously worn out. I’m sure it’ll only get worse once I start college next month. College. Pre-med. At twenty five years old. With four children under the age of ten. What the heck am I thinking?

I always wanted to be a doctor. Seriously, always. When I was five years old I had a toy stethoscope and actually looked forward to going in for my shots. Because there were doctors there. But, well, like they say “Life is what happens while you’re busy making other plans”. I got pregnant just after my sixteenth birthday. Tragic, huh? Well I wouldn’t go that far. It’s not like I didn’t know how babies were made. But of course, having a baby in my mid-teens meant that I couldn’t possibly ever make it through med school. Right?

I thought so. I have to say, I spent the last seven and a half years since my son was born, embarrassingly convinced that, while having a baby before you were old enough to vote didn’t mean your life was over, it did put some of the bigger dreams a bit too far out of reach. Besides, I never really wanted to be a doctor anyways.

I’m sure I could make a novel length drama out of the years between then and now but memoirs are quickly going out of style, so what would be the point? A wonderful husband, a pretty satisfying life, and three more beautiful babies later, a blazingly obvious question finally occurred to me. “Why not?” My husband was convinced we could make it work and, once I was willing to be persuaded, convinced me too. So I applied to the college here in my hometown and was flabbergasted to receive a letter of acceptance despite the fact that, as I already knew, all you needed to get in were student loans and a pulse.

The ball had started rolling. I picked my major, a B.S. in biology, took my COMPASS test (a test for those of us who took the “get pregnant and drop out” career track to make sure that we can read) and met with an advisor to actually pick out classes. Like a real college student and everything!

Trust me, I’m excited. Elated. Terrified. Because you can’t go through medical school while still being a parent to your children. That’s what I’ve always been told. Because you can’t manage homework, and a family, and a household. Something’s got to give. I’m sure of it.

That’s why I’m glad there are blogs. I found some wonderful blogs written by doctors and nurses and even med students and residents. They’re all doing it. They’re all managing it just fine (or at least with a minimum of tears and anxiety). If they can do it, then maybe there’s more than a glimmer of hope that I can too.