Monthly Archives: April 2018

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birds and color

The first birds that we saw and heard on the beach two nights ago were these: black oystercatchers. The red beak stands out, but if they are standing still, they blend with the rocks! Listen to their wonderful call here: https://www.allaboutbirds.org/guide/Black_Oystercatcher/overview. When I hear the call, I know to look for them at the edge of the water.

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I for intent

My Blogging from A to Z theme is happy things. Three happy things with intent!

We took a beach walk two nights ago and the beach was full of birds. Three great blue herons, three oyster catchers, an eagle landed in the surf, crows, gulls and the flock of brant. There were various dogs being walked, who were not chasing any of the birds, hooray for that!

I love this great blue heron: so intent on fishing. What are you intent on? Intent, intention, attention, retention. So many tents….

I was intent in clinic yesterday. We had a packed schedule and I started thirty minutes early to add an extra patient and I had good intentions to run on time. I didn’t. By the last person I was running 20 minutes late, and three people were grumpy. No, four people were grumpy because I have to add myself to that. I had good intentions, but I can’t control what problems people bring to clinic and they don’t always fit in the time allotted!

Here is the eagle, also intent on dinner. I don’t think of bald eagles as surf birds, but this one had caught something and landed. We did not get close, not wanting to disturb things.

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The photographs are taken at the Port Townsend Bay beach below Chetzemoka Park. Happy blogging. 

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Mundane Monday 155: close color

Welcome to Mundane Monday #155. I will post a photograph and theme. If you add your pingback I will list you next week, and very happy Monday!

Last week’s gorgeous entries, theme color contrast:

https://klallendoerfer.wordpress.com/2018/04/02/mundane-monday-line-of-rvs/

https://bedressed.wordpress.com/2018/04/06/photo-challenge-one-mundane-day-last-may/

Have a good day and check out each other’s photographs!

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hipaa, health insurance, and health information

Blogging from A to Z, my theme is happy things. Letter H is for HIPAA and health insurance and health information.

H is for hipaa: the Health Information Portability and Accountability Act, from 1996. I’ve been thinking about HIPAA and I have a question: if the patient handouts are supposed to be written at the fifth grade reading level for patients, why doesn’t Congress have to write laws at the fifth grade reading level?

Ignorance of the law is no excuse, right? Everyone in the US is supposed to follow the laws. Have you read them? I am supposed to follow HIPAA, right? I am supposed to follow the Affordable Care Act, (also nicknamed ObamaCare). It is 3600 pages long. It is written by Congress and attorneys.

What about health insurance? Have you read your health insurance policy? It’s a contract. If multiple US citizens have difficulty reading, why isn’t health insurance written at a fifth grade level?

CMS too and triwest and medicaid. I do not have time as a physician to learn the language of their websites.  I run my own small practice. It is infuriating to try to read, understand and follow medicare, medicaid and Veterans Choice rules and they change every year. We ask why health care costs so much, and then there are over 800 different insurance companies, each with multiple insurance plans, and more and more people are hired to try to navigate and understand the rules. It’s ridiculous. We need a single payer system so there is ONE set of rules. Everybody in, nobody out.

At the UW Telepain telemedicine, I said that I show chronic pain patients the link to the Washington State Law about opioids and pain medicine.

One of the faculty said, “Patients can’t understand that.”

I said, “Well, I’m supposed to follow that law and I am not an attorney. ”

My patients are all smart in something. Some of them can’t read well. I have had two recently that I recognized a reading issue in the clinic room when I gave them a survey tool to fill out. I promptly said, “Let’s do this together.” I read them the questions and the answers. They are not stupid, but I am not sure that their reading skills were up to the form.

I am not using the American Academy of Family Practice patient handouts much because I think they are too dumb. I use the Mayo Clinic much more. I direct patients to the CDC, to NIH, to the Mayo Clinic website. Sometimes my patients may not be able to read at that level, but I think everyone appreciates being treated with respect. I am also happy to go over and explain more about a topic. I also warn them that there are loads of crappy medical sites and pseudo scientific sites and misinformation on the internet. If they want to look something up, I want them on a decent site.

Now how are these happy things to think about? It makes me happy to question my own behavior and my own assumptions. It makes me wonder how our country can insist that medical information has to be at a fifth grade level but lets Congress write laws that I find nearly unreadable.

Now I am warning my patients that a federal law may go into effect in January 2019, about opioids, and that it will be different and override the state law. Change will keep coming.

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The photograph is from the beach last night: brant. What would the flock think about our health insurance? 

 

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G for give

My Blogging from A to Z theme is happy things: G for give and generous and goat!

Goat? Yesterday was the opening of our Farmer’s Market which starts with the March of the Goats.

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Give and Generous:

I went to a Rotary fundraiser last night.

I am in the Sunrise Rotary, and the fundraiser was put on by the noontime Rotary. We have three clubs in our county.

There was dinner and both a silent and live auction. The benefit raised $20,000 for a new kitchen for the Boiler Room. The Boiler Room is a youth coffee house, drug and alcohol free, and where people are welcomed and can volunteer. There was a video about three people who talked about how it helped them. The fourth was the director, who told her story from 18 years ago.

Additional funds were raised. I love the Rotary: it sustained me when I had to start my clinic and it does so many things. I am delighted that we are down to two countries with polio virus, the exchange students come from all over the world and go all over the world, the yearly Shelterbox that we buy will go to some disaster area and locally the third graders each get their own picture dictionary. And I get to meet weekly with a wonderful group of people.

I bid on a lunch with US Representative Derek Kilmer. I wish I’d gotten that, I would bend his ear about healthcare. I didn’t. But I came home with an odd ladle and I am signed up for a two day black smithing class at the Cedar root school. And my money will go to multiple projects.

Hooray for all the generous people and organizations working for and with people and the people working for and with them.

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Blogging from A to Z.

 

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conversation

Mordechai, our clinic skeleton, had such a wonderful time out at dinner last month. As you can see, she is still conversing about it. We’ll have to take her out more.

For the Daily Prompt: inchoate. I’m not sure quite how inchoate relates to this. My ideas are unformed. Where to take Mordechai next?

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feeling, farm, friends

My theme is happy things: feeling, farm and friend.

Feelings: I find our culture a bit bipolar about feelings. Love and friendship and joy are celebrated and other feelings are labelled “negative”. Grief, fear, anger, basic  grumpiness. I see posts about staying away from “toxic” people and away from people that are “downers”. But we all experience all of these feelings. Feelings are as important as thoughts. Feelings are quicker that thought, hormonal and electrical information in brain and body: we pull the finger out of the candle lightning fast, we jump out of the way of the swerving car, we feel the cascade of fear if someone is following us at night. The feeling is not always correct — we may feel threat from someone who is not threatening us.

In high school my daughter said that most of the arguments she noticed were someone saying something not well thought out or offhand as they left. It is misinterpreted, stewed over, discussed with other people and then  the person who felt that it was “at” or “about” them will react. The first person is shocked and doesn’t even remember or understand the trigger. Misunderstandings all the way.  We have to step back from feelings and have the courage to be vulnerable and ask, “What did you mean when you said that?” We all get grown up and over that after high school… well, I try.

Farm: I got my first local CSA box on Wednesday, lovely vegetables straight from the farm and tulips! I get an email each week and often with recipes.  I love my CSA box. I eat more vegetables too, because I don’t like to throw them out.

Friends: My  friends give me  such joy! I have an email this morning from friends in Berlin, Germany! I have not seen them for more that a decade but they are coming to visit this summer! What absolute joy!

And may your day be joyous too!

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Another photograph from Hawaii, my friend Patrick and one of the lovely green turtles. For scale….