Category Archives: 7 sins and friends

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focus

For the Daily Prompt: cringe.

I took this on the ridge on top of Mount Zion yesterday. Absolutely gorgeous hike, with the rhododendrons floating among the tall trees and tons of wild flowers. Here are little wild strawberries…. we will have to come back in September.

Cringe: I cringe when I hear the discussion on the news being about health INSURANCEย  and not health CARE. We need to change the focus.

We HAVE a mandate that anyone in the US can have health CARE. That is, the emergency room cannot legally turn anyone away. But the bills can bankrupt you and take your house away. Not only that, but the emergency room is the most expensive and worst way to take care of people in the world. The emergency room cannot treat cancer, cannot treat hypertension, cannot help a person with depression, cannot do the long term chronic care that I do. Per person in the US we pay twice as much as the next most expensive country and they have universal care. What is the matter with the citizens of the US? We care more for corporations protecting their profits than we do for our citizens health. And I think this will bring our country down….. we will collapse.

I am a physician but I also run my own clinic. I am a small business owner. And I really expect that health INSURANCE will force my clinic to close.

Call Congress. Say we want health CARE not health INSURANCE.

 

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bye bye doctors

stop this healthcare bill… until there is transparency… or this will get worse.

 

I am grieving, watching doctors leave.

I have been in my rural county, 27,000 people, for 17 years.

Doctors are leaving. Wake up, United States.

The trend when I got here was that we had 14 primary care doctors and 5 midlevels. For years, we lost one primary care doctor a year. I would grieve and it would mean more work, every year. We would get a new doctor, but often there would be a gap… I made up a game to help cope with grieving. I call it “Local Doctor Survivor”. I would bet on the next doctor to leave and also on their trajectory. One of three: nice doctor, angry doctor, doctor labeled nuts. Burn out.

But…in 2015 it jumped. Suddenly we had 3 primary care doctors and two midlevels leave. Uh-uh. One was a husband and wife, doctor and nurse practitioner. One switched to being a hospitalist. Another left. And another midlevel. By then, we still had 14 primary care doctors, but the number of midlevels, nurse practitioners and physicians assistants had risen to 12. Ok, 12 plus 14 is 26. One fifth left. That is a bad trend.

In 2016 another physicians assistant retired. One of the best. I stopped counting who was leaving. Until another doctor announced they were leaving in February 2017. One of the best. That doctor said that a 20 minute visit generates 1 hour of paperwork. If one works “full time” the quota of patients is 18 per day, 72 in the four day week, and that is 32 hours four days a week of 20 minute visits. Generating 72 additional hours paperwork. That is 104 hours a week. Unsustainable.

The 2016 salary information is out for primary care. The “median” family practice physician in the US makes $168,000. Ok. But every doctor given as an example works 60-70 hours a week. Maybe that salary is not as good as you think. Because they are quitting.

Our neurologist retired, in about 2010. I was bummed. The county north of us has 75,000 people. They had two neurologists. Both left in the last two years. The county south of us has 350,000 people. They had five neurologists. Two have left, including my current favorite. For the first time in 17 years I have a neurology referral refused: and not one, but two. Send them to the big city, says one. The other just says no.

I call ENT and he bemoans that now they are down to three in the county. Another left. Three there, one on the county north of me, great, we have 4 for 450,000 people.

I get a letter from one of the two neurosurgeons in Seattle that I like best. In 2016. He is leaving to go do medical administration in another country.

Our three counties are down three dermatologists. One sent a letter. “I am quitting on October 1, 2016, unless ICD-10 is cancelled.” ICD-10 is the new manual of diagnostic codes. It was not cancelled so that dermatologist quit. We have to code every diagnosis. ICD-9 had 14,000 codes. ICD-10 has 48,000. I am memorizing the new ones. I10 is hypertension. E11.65 is type II diabetes in poor control. I used to be able to write a prescription for diabetic supplies, lancets and glucose strips. Now I have to include the ICD-10 code on the prescription and often the pharmacy cites medicare and demands that I fax proof that I have seen the patient and that the patient does indeed need the prescription. I frankly have better use for my brain than memorizing the ICD-10 codes, but whatever.

Another clinic closed in the county north of us and our county. Then the main clinic closed in the county south of us. Within two weeks. 3500 patients needing primary care providers and refills and we can’t get old records because the rumor mill says it was a “hostile takeover”. That is, the person who owned the clinics quit paying the bills, so the electronic medical company won’t release the records. Great.

I have been absorbing about one new patient per day worked since March, but I am getting tired and will have to back off.

Meanwhile, our county hospital has been hiring specialists. Gynecology, new orthopedists, dermatology. Great, right? But currently most specialists won’t take a new patient without the patient having a primary care doctor. Why? Well, one of the new trends is that the specialist says the patient needs something but that I should order it. Yep. Had one of those yesterday. The specialist says I should order it. It’s a veteran. So I get to fill out the VA authorization paperwork with the ICD-10 codes and the CPT code for the study, fax that to the VA, call the patient and remind him to call triwest, because if the patient doesn’t call then triwest throws the authorization paperwork out. And the specialist makes more than 5 times the amount I do. Maybe I should retrain. I am a specialist: family practice, three year residency, board certified, board eligible. But….. I have little value in the United States.

We are seeing Veterans in spite of the extra paperwork. Triwest is sending us 5 from Whidby Island. They have to take a ferry to see me. Because no one on Whidby is taking veterans. My receptionist complains to triwest about all the doctors leaving the Olympic Peninsula.

“No,” says the triwest person. “Not just the Olympic Peninsula. The whole west coast of the US.”

 

http://www.aafp.org/news/government-medicine/20170620senatespeakout.html

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yielding

Y for yielding in Blogging from A to Z.

Again, the definition changes, from Webster 1913 to the present.

Webster 1913: yielding

Inclined to give way, or comply; flexible; compliant; accommodating; as, a yielding temper.

Yielding and paying Law, the initial words of that clause in leases in which the rent to be paid by the lessee is mentioned and reserved. Burrill.

Syn. — Obsequious; attentive. — Yielding, Obsequious, Attentive. In many cases a man may be attentive or yielding in a high degree without any sacrifice of his dignity; but he who is obsequious seeks to gain favor by excessive and mean compliances for some selfish end.

— Yield”ing*ly, adv. — Yield”ing*ness, n.

Dictionary.com is different:

adjective

1. inclined to give in; submissive; compliant:
a timid, yielding man.

2. tending to give way, especially under pressure; flexible; supple; pliable:
a yielding mattress.

3. (of a crop, soil, etc.) producing a yield; productive.

Crop yields are important! But is compliance or giving in, a feeling of yielding, something I am comfortable with? What about yielding to love or to grief or to joy?

Today’s poem:

yield

I am yielding to my family
to no more contact

though I think they see me
as stubborn angry argumentative

they do not love me as I am
they want a different person

who acceeds and yields to their ideals
I am the villain who won’t yield

and yet I yield
I send them love

I send them joy and peace
one said if you make me choose

I won’t choose you
pressure, sorrow, grief

acceptance: I will miss them
I do not know if they

miss me

 

I took the photograph at the Women’s March in Port Townsend. When should we yield? When should we fight? When should we reach out for mutual understanding?

 

 

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vulnerable

V is for vulnerable, in Virtues and views, Blogging from A to Z.

Is feeling vulnerable a virtue or a vice?

I don’t think feeling vulnerable is either a virtue or a vice. It’s a feeling. It is a feeling that our society puts pressure on adults, particularly males, not to feel. Or not to admit.

I read Robert Johnson, PhD, Owning our own shadow. He asks what three aspects of ourselves we are most proud of. For me, at that time, the triad was toughness, smarts and independent. He says that the opposite, or shadow, of that triad, is what we are most afraid of….

….oh, and he had me there. I look in my mirror and see someone smart, tough, independent, and terrified of being vulnerable.

I am much less terrified now. I am a physician: everyone is sick sometimes, vulnerable sometimes, everyone does dumb things sometimes, and dependence will come as well as death. I needed to bring that fear out of the shadow and make friends with it. Bringing those shadows forward is hard work! I don’t want to! But I can and I like to work and I am good at working. Small steps daily on a path with love and thought and care…..

Dictionary.com vulnerable

adjective

1. capable of or susceptible to being wounded or hurt, as by a weapon:
a vulnerable part of the body.

2. open to moral attack, criticism, temptation, etc.:
an argument vulnerable to refutation; He is vulnerable to bribery.

3. (of a place) open to assault; difficult to defend:
a vulnerable bridge.

4. Bridge. having won one of the games of a rubber.

So we ALL fall under the first definition! ALL OF US!

Our culture derides and conflates vulnerability with weakness sometimes. Don’t let it. Stand up. Speak out. Do not let fear stop us….

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ugly

The letter U in virtues and views.

U for ugly.

Is ugly a feeling? Have you felt ugly? Is that a virtue or a vice? Why? If vanity is a vice, then is feeling ugly a virtue? Is beauty virtuous and ugliness the opposite, an indication of evil?

From Dictionary.com: ugly

adjective, uglier, ugliest.
1. very unattractive or unpleasant to look at; offensive to the sense of beauty; displeasing in appearance.
2. disagreeable; unpleasant; objectionable:
ugly tricks; ugly discords.
3. morally revolting:
ugly crime.
4. threatening trouble or danger:
ugly symptoms.
5. mean; hostile; quarrelsome:
an ugly mood; an ugly frame of mind.
6. (especially of natural phenomena) unpleasant or dangerous:
ugly weather; an ugly sea.

I wrote the following poem before 2009, when I was thinking that there are people that I think are just beautiful, but it has nothing to do with surface beauty. It has to do with love and trust. The makeup books in the poem are Face Forward and Making Faces, by Kevin Aucion.

Beauty

Beauty is not on the surface in people

People that I love are beautiful to me
They shine
It doesn’t matter how they look
In fact, scars make them more real
More human
Intimacy is knowing what this scar is from
And that
Knowing their stories
That they trust me to tell me
People that I love are beautiful

I have been wearing makeup
I never cared before really
Until a book by an artist
Showed me his vision
The beauty that he sees in everyone
I call it my paint by numbers makeup book
Because he is a true artist
Who believes that art is for everyone
And so he includes instructions for each picture
So that I too can dabble in his art

I will wear makeup at my family summer lake
I do not think my family will approve
Nor do I think they will understand
They may comment
I will say that I am trying to catch a new man
This will confirm their disapproval
I will break the rules by wearing makeup
Which is exactly the point
But I am also celebrating beauty
The beauty that the Beloved sees
In everyone

 

I took the photograph in 2014 from a train….sometimes we talk about ugly weather, but watching the land and weather change from the train was glorious. I hope you feel beauty in your life.

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temperance

Temperance: for Blogging from A to Z, the letter T. What does temperance mean to you? Do you ever say “I feel temperate.” Do you call someone else temperate? Is it a virtue to you?

Temperance is one of the four Cardinal Virtues which go back to the Greeks, Aristotle and Plato. But it meant self control then, not abstinence from liquor. Self control, self-restraint, moderation…I think we could still value that but our culture of drama and advertising and self-promotion and stardom doesn’t very much.

dictionary.com temperance

noun

1.moderation or self-restraint in action, statement, etc.; self-control.

2.habitual moderation in the indulgence of a natural appetite or passion, especially in the use of alcoholic liquors.

3.total abstinence from alcoholic liquors.

But… let’s look at the word origin:

Word Origin and History for temperance

n. mid-14c., “self-restraint, moderation,” from Anglo-French temperaunce (mid-13c.), from Latin temperantia “moderation,” from temperans, present participle of temperare “to moderate” (see temper ). Latin temperantia was used by Cicero to translate Greek sophrosyne “moderation.” In English, temperance was used to render Latin continentia or abstinentia, specifically in reference to drinking alcohol and eating; hence by early 1800s it came to mean “abstinence from alcoholic drink.”

Webster 1913 from everything2.com: temperance

1. Habitual moderation in regard to the indulgence of the natural appetites and passions; restrained or moderate indulgence; moderation; as, temperance in eating and drinking; temperance in the indulgence of joy or mirth; specifically, moderation, and sometimes abstinence, in respect to using intoxicating liquors.

2. Moderation of passion; patience; calmness; sedateness.
[R.] “A gentleman of all temperance.” Shak.

He calmed his wrath with goodly temperance. Spenser.

3. State with regard to heat or cold; temperature.
[Obs.] “Tender and delicate temperance.” Shak.

Temperance society, an association formed for the purpose of diminishing or stopping the use of alcoholic liquors as a beverage.
___________________

I want to take words back and use them again and expand them back to previous meanings. Why is Webster 1913 more elaborate and subtle in definitions than Dictionary.com? Have you used the word temperate? Try it today…I will be temperate in my emotions, temperate in eating, temperate when driving…what will you be temperate about today?

I took the photograph from Marrowstone Island… the colors used to paint the sky are not temperate at all, are they?

 

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shy

This is for Virtues and views, Blogging from A to Z, the letter S.

There is more than one feeling that the fog could raise: shy, sneaky, subtle, sleepy. Scary if I am in a sailboat and the fog slides off Marrowstone Island and reaches fingers towards my boat. If I am smart, I am prepared with charts and radio and GPS and radar and I know that the ferry comes through and I will stay out of it’s way.

From dictionary.com: shy.

1. bashful; retiring.

2. easily frightened away; timid.

3.suspicious; distrustful:
I am a bit shy of that sort of person.

4. reluctant; wary.

5. deficient: shy of funds.

6. scant; short of a full amount or number:
still a few dollars shy of our goal; an inch shy of being six feet.

7.(in poker) indebted to the pot.

Yet these all seem negative. Can’t shy be a positive feeling? From everything2.com and Webster 1913:

The embarrassed look of shy distress
And maidenly shamefacedness.
Wordsworth.

That isn’t what I want either, that women should be shy and retiring.

No, I am thinking of the shy delight and mystery of the fog lying over Marrowstone Island while it’s clear on the water. And wondering shyly if the fog will expand as the tendrils reach down to the water… or will it dissipate slowly to a bright clear sunny day?

My shy and secret delight at the beauty of the world.

 

 

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reflective

This if for Blogging from A to Z, the letter R. Virtues and views, feelings….

When do you feel reflective?

What does reflective mean to you?

I took this picture thinking of photrablogger’s Mundane Monday Challenge, now #106. The photograph is from Fort Worden, one of the gun emplacements on the bunkers. But it is returning to moss and green and the sun was out and sky reflected.

Here is Dictionary.com reflective:

adjective

1.that reflects; reflecting.

2.of or relating to reflection.

3.cast by reflection.

4.given to, marked by, or concerned with meditation or deliberation:
a reflective person.

Reflections can be beautiful. Not always, though. Thinking of reflection brings this poem up:

Reflections

Sometimes the growing pains
Are hard
Sometimes when you move on
It hurts
Put away childish toys
Friends have gone other ways
Even family
You love them
Still
You’ve changed

They resist
Don’t like the evolution
Upsets the plans
Changes the rules
Don’t you love me
As I really am?
The authentic
True
Real
Me?

Or only the hazy
Image
You had in your head
Of who you thought I was
Friend, daughter, cousin
Suddenly I am eight feet tall
Ogre
Threatening
Stunned by silence
Abandoned by your withdrawal

But my skin is shed
I spread my hood
And rise
And flick my tongue
Not to threaten
But to smell
To taste
Your curious presence

When you rear back
In alarm
I am startled

I see a cobra
Reflected in your eyes

(written about 2002)