Dear Mr. Donald Trump

Two weeks ago I sent this letter to Mr. Trump and all of the presidential candidates. To date I have gotten a form letter from Mrs. Hilary Clinton.

Dear Mr. Donald Trump and all Presidential candidates:

Mr. Trump, I am a rural family practice physician, a woman, who owns and runs my own medical clinic. I take care of patients from age zero to 104. Currently my oldest is 98. I take medicare and most insurances, but not medicaid.

I am running into legal immorality across the board from health insurance corporations that are maximizing profits at the expense of my health care dollar, our taxes and my patients. I would like your advice.

For example, the Veterans Hospital contacted me in May of 2015 and asked me to accept Veterans Choice patients, veterans who live more than 40 miles from the nearest VA Hospital. I accepted. I have 6 veteran patients, who are very complicated. To date I have not been paid for one visit. Now, before you say this is the fault of our government, it isn’t. It is the private for profit government contractor Triwest who is not paying me. They have my notes and we have followed their instructions on how to submit bills. Would you advise me to drop these patients?

For example, my father died in 2014. I called the oxygen company to pick up 6 tanks of oxygen. Then I found 8 more. I gently inquired why he had 14 tanks. The company said that his medical orders said that he should wear it continuously, so they delivered it. “Medicare paid for it.” they said. Ah. Well, I kept the other 8 tanks, because it is my and my father’s oxygen in those tanks: the company can have the tanks back when they are empty.

For example, the head of the sleep apnea supply company came to see me. He said, “You are getting in the way of your patients getting needed equipment.” I said, “Really? How?” “You only allowed a refill of one of the 8 necessary pieces of CPAP tubing instead of signing off on the whole group so we can fill as needed.” “Ah.” I said, “Actually my patients are tired of you mailing them 8 pieces of plastic that are filling up their closets and they don’t want extra plastic crap.” He mails it at the interval allowed by medicare, never mind whether the patient wants or needs it.

For example, I called a patient’s insurance to get a prior authorization last week for a limited sinus CT. They no longer do prior authorizations. They will decide whether to cover the CT scan once they read my notes. I asked if there was ANY way to see if it would be approved. They offered to let me send a letter to a PO Box in Wisconsin. My patient was sick, Mr. Trump. What do you suggest the patient and I do?

This is all legal. But it is not moral. So, Mr. Trump, where do you stand? Is our country’s highest value free enterprise and profit at any cost, no matter how many of our seniors are legally ripped off? Or do we have morals that health care and our elderly are important and need to be protected from legal but predatory businesses.

Please let me know, Mr. Trump. I would rather stick with my small clinic in the United States. At this point I would be financially and emotionally better off working as a temporary doctor internationally. I am sure that there is immorality internationally, but I will be less ashamed when it is not MY country.

Thank you.

 

B is for bored

B is for bored? All of the emotions that I could pick that start with B, and I pick bored?

But I am going to talk about bored in the context of chronic pain: and suddenly it is not boring at all.

Welcome to 7 Sins and friends, a spectrum, a kaleidoscope, an ABC of emotions.

B

If you hear the same sound over and over, like a faucet dripping, can you tune it out? I can. I can tune out practically any noise and I have fallen asleep under bright light in a Casino room full of ringing and blinging and alarming machines.

You may not have quite that level of ignoring something, but you can certainly tune things out. I have been reading Jon Kabat Zinn’s books on Mindfulness Meditation and I have used his mindfulness CD. I was having trouble sleeping after my father died, and I would use the CD. However, I used it in the reverse of how it is meant.

I used the body scan. Dr. Zinn talks in a slow calm tone and has the listener move from body part to body part, just feeling what is there. Not tightening or releasing muscles, but just starting with the left toes. At the start he says, “This is to fall more awake, not to fall asleep.” And I fell asleep every time.

But what does this have to do with pain? If you have tried meditation and focusing on your breath, your mind wanders. It gets bored. It starts think about the grocery list, or that person who yelled at you or ….. anything but the breath. You keep returning your mind to the breath. One day I had a hurt knee and was trying to go to sleep and thought…. hmmm. So I focused all my attention on the knee pain. Really tried to get inside my knee. Felt the pain fully and entirely….. and soon I was thinking about my grocery list. I pulled my mind back to my knee. My mind was sulky: yes, it hurts some, so what? Can’t we do something else? I am bored!

We are taught that pain is bad and I see many people in clinic who are afraid because of back pain. They are afraid to move because pain means something is wrong. Only most of the time it means that they have injured back muscles. The back muscles cramp up to protect themselves. The muscles must be soothed and stretched and healed and to do that we have to both pay attention to the pain and move without hurting the muscles worse. Sounds a bit boring,  right? Bored is more important than we think….

I took the photograph at the Hoh Rainforest on the Olympic Peninsula Washington, in 2004. We were not bored.