After Lou Carreras commented on my write up on autoimmune disease, I thought I would do more research. The article above https://theworlddata.com/autoimmune-diseases-statistics-in-us/ shows an enormous increase in autoimmune disorders in the last twenty years. Also, I canβt tell if they include fibromyalgia, chronic fatigue, long covid and the encephalopathies. The first three can be ANA and ESR negative. To me that means that we have not found a good inflammatory marker for these disorders. It is certainly not that they do not exist.
The data is a bit overwhelming and horrifying. I know too many people with connective tissue disorders and those were very very rare when I was in medical school (1989-1993). Not nearly as rare now and all the people I know are young.
I stand by what I wrote and this reinforces it: as a culture and world we have to back off from the high sympathetic nervous system fight or flight.
And today, Formula One racers are driving around the mall and Washington, DC. So what do I think of that? Imbecilic, toxic, dangerous. Which egotist set that up?
I am done with my third Grand Junction travel doctor assignment and packing to go home. I don’t think much of my temp company at the moment. I had to nag them for two weeks regarding the travel plans. I had to call both airlines (one hour 18 minutes and one hour 38 minutes) to be sure that taking Sol Duc on board the plane is arranged (it wasn’t). I called the hotel for the day between planes and they do not take pets. I called the company that takes me from the airport the last two hours home and they DID know about the cat. One out of four. They finally switched the hotel on Friday, the last day of work.
Then at 5:18 pm I am sent an email saying I have to vacate on the 19th. The first plane is on the 21st. It was sent by the rep who is covering me and knew the travel arrangements are for the 21st. I am glad that I pay way more attention to detail as a physician than they do to my travel and housing. They frankly suck. And I am not vacating until Monday. They may charge me at which point I will say they need to pay me for spending more than 5 hours fixing their travel screw ups.
I did say to the rep on Friday, “Well, if it’s not arranged today, I will just call the emergency travel line at 5:01 pm. They will help me.” The emergency travel folks cost them more money. That apparently caused them to do the last arrangements. I am doing the travel in two days because otherwise my cat would be in the carrier for 12 or more hours. That is not reasonable.
I am done except for travel home. Today I finish packing and cleaning.
The photograph is Sol Duc in front of our rental house yesterday. I think she will miss the heat here. She seems to quite enjoy 90+ degrees.
“Are you free?” Dispatch always sounds so disinterested.
“Yes, I’m free.” I try not to sound annoyed. I am too good at my job. I’ve given up on dating. This frees me up for the Agency.
“Room two.”
Room two has a woman who looks frozen. I introduce myself, a stranger, her previous person left.
“Are you sleeping?”
“No. Well, I fall asleep but then I wake up. Nightmares and my heart beats so fast. Then I can’t go back to sleep.”
“Did something happen?”
Her face tightens all over. She wants to tell me but not let the emotions out. “A scam!” Now the dam is cracking and falling apart. The story comes out bit by bit. “They opened an account in my name! Took out a loan! I am so scared. And ashamed. We could lose the house.” Not many tears. She won’t let them.
“Ok, I think this is a PTSD reaction. The not sleeping is really common. Can you talk to your husband?”
“I’ve snapped at him! We never fight! Forty two years!”
The monsters are visible now. Clinging to her, but some are coming to cling to me. Fear, shame, grief, anxiety, fatigue. They aren’t really that big, because she has been a careful person, a wise person. But this has cracked her open because she never expected it.
“Have you contacted the authorities?” We talk about what she has done, the practical bits. She has already made wise moves. It’s the feelings that are upsetting her.
We pick something for sleep, a low dose, not one of the newer addictive ones. An antidepressant that will hopefully make her sleepy. Close follow up is even more important, to be sure that she is starting to comfort the monsters. Many of the monsters are crying for her. I think they will be ok.
She is more comfortable before she leaves. She brought the feelings out and I was not horrified and I did not shame her. They weren’t so bad after all, when she brought them out in the light of day. It’s when they are fighting to be felt and heard that they feel so dark and dangerous and frightening.
I leave the room. She will be back in a week, sooner if she needs to. One of her monsters smiles at me tremulously as it clings to her. I smile back and nod. I think they will be ok.
The United States could go to single payer healthcare, but one objection has been “People will lose their jobs with health insurance companies.” Yet no one seems to object to AI, Artificial Intelligence taking jobs. It’s technology so it’s fine! The wave of the future! Coming whether we like it or not!
One form of single payer healthcare is medicare for all. Expand medicare so that it covers everyone. At first, it only covered retired female teachers. Women were only considered for teaching jobs if they were single. A married woman was expected to work in the home. The teaching pay was low. Men were expected to be supporting a family, so they got more. Women were often supporting parents or children if spouses died or divorced or abandoned a family or were disabled. Early census information was a finagle: any male in the household was listed as “head” even if it was an elderly disabled father or a boarder or a teen. So the true numbers of women as head of households were obscured.
Single payer would improve healthcare. There would be ONE set of rules. Physicians would know if something was covered. Right now there are over 500 health insurance companies and they each have multiple different policies. Not only that, but the policies can change monthly in what they cover. Did you know that? I would get monthly postcards from multiple companies saying that I could go on line to one of the 500 different websites and see what they had changed and were no longer covering. I found little time to learn 500 websites. We spend enormous amounts of healthcare money on communication back and forth from insurance companies to hospitals and clinics. Trying to prior authorize CT scans, MRIs, surgeries, referrals, medications (even old cheap ones!) and then attempting to get the health insurance companies to pay for the care. Remember that the insurance companies are allowed a 20% profit: so for 1 million dollars of healthcare money, $200,000 can go to profit. The people and computer work is not in that profit, so what percentage of your healthcare dollar goes to attempting to prior authorize and get paid? How much of your healthcare dollar would you like to go to healthcare?
Medicare’s overhead is either 1.4% or 6%, instead of that 20% profit and the prior auth/collection effort. There are two different estimates (from here):
1. There are two different measures of Medicareβs administrative costs. One figure comes from the Medicare Board of Trusteesβ annual report, while the other comes from CMSβ National Health Expenditure Accounts. According to the latest trusteesβ report, Medicareβs overhead represented 1.4 percent of its total expenditures. According to the latest NHEA, Medicareβs overheard was 6 percent of expenditures.
2. The discrepancy between the two figures is due to Medicare Parts C and D. Mr. Sullivan wrote that the difference between the trusteesβ measure of overhead and the NHEA measure βis due almost entirely to the factβ that the NHEA figure includes administrative expenses incurred by health insurers that participate in Medicare Advantage (Part C) and Medicareβs prescription drug program (Part D). In essence, the overhead associated with the private insurers involved with Medicare raise the programβs overhead by almost 5 percent, or $24 billion in 2010.
People worry about “socialized medicine” but really, the closest system to socialized medicine is the Veterans Administration. I don’t think anyone wants to take their healthcare away, and some of it is specialized depending on where they were deployed and what they were exposed to. I saw veterans in my clinic because we were more than 30 miles by car from a VA hospital.
What about medicare fraud? I saw way more fraud with the insurance companies. Companies will maximize revenue by sending equipment at the exact interval insurance allows (like sleep apnea equipment and diabetes glucometers). It doesn’t matter to them if it’s being used or not. After my father died, there were 16 full oxygen tanks full in his house. The company was happy to pick them up and no, they did not want to reimburse the payments. A biller told me that often the health insurance companies will pay less then the contracted amount. When challenged, they say, “Oh, that was a computer error! We will fix that!” She said, “I have never once seen the error in the physician’s favor.” When I had cobra insurance, they would not pay my bills and I had to call them every single time to force them to pay. It took enormous amounts of time and again they claimed, “Oh, computer error!” I finally called their counseling line and said, “I want to be counseled for your company refusing to call me back and screwing over this cobra policy, and by the way, I have a family member dying of cancer.” That finally made them fix it.
WHY is our culture ok with technology taking jobs, while improving healthcare can’t? Get rid of the health insurance companies! Medicare for all! If we all had secure health insurance, think of the work innovation in our country!
I was pricing health insurance in case I get well enough to work more. I can get an $800 a month with a $8000 deductible or a $1435 a month with a $2000 deductible. I would very much like to work part time treating Long Covid. But, ironically enough, looks like I can’t afford health insurance. It costs more than the malpractice would. Ironic, huh? It’s not like we need doctors. (I do not have a medical release yet anyhow, but time to do research. It’s making me gloomy.)
You know, if we do get Artificial Intelligence, it will take one look at the United States Medical non-system, decide we are insane, and wipe us out.
And honestly, when I was working for the hospital clinics, I thought the most brilliant person in our office was the woman who could extract a prior authorization from so many insurance companies. I would send the referral to print and half the time she would have it authorized by the time the patient got to the front desk. And why do we waste all that brilliance on giving health insurance companies a profit of 20 cents out of every dollar? That is $20,000,000 out of $100,000,000. Looks worse with bigger numbers, doesn’t it?
The latest spam email I have gotten is “to order Covid-19 tests”. WATCH OUT FOR THAT ONE! I am sending hate thoughts to whoever sent that one out, predators trying to get information or lock up the computers of vulnerable people.
The clue for me is the email address of the sender. If I hover over the address and get a string of weird things, it is spam. I am fast at deleting it now.
Old fashioned and very strong curses against the people sending out this spam.
But I did write another verse for the song SAVED. It might not be the one that comes up on the You tube search. I learn it as a teen from side B of Moondog Matinee by The Band.
I sang it to my father. He said, “Where did you learn THAT?” I didn’t know and did an internet search. I forgot what album I leaned it from. It was his album, that I recorded on tape before I went to college.
Here is my new verse:
I used to Tweet, I used to Twerk, I used to Tweet, Twerk, I was such a Jerk
I used to tweet and twerk, tweet and twerk and I was such a jerk
But now I’m standing on the corner, it was too much work
That’s cause I’m saved, that’s cause I’m saved
People let me tell you about Kingdom Come
I’m saved, I’m saved, I’m going to preach until you’re deaf and dumb
I’m in the Salvation Army, beating on the big bass drum!
_____________
Who else sang it? Laverne Baker! She is the earliest I’ve found. Recorded in 1960, though the videos are later.
I did a porch call a bit over a year ago. It’s like a house call except on a porch.
A friend/patient asks me to see a long time friend of his. The friend has multiple chemical sensitivities. We meet, the three of us, on his porch.
My friend has had me as a physician but he has not seen me at work with someone else.
I ask a lot of questions and then launch into an explanation of the immune system and how antibodies work.
My friend states, “He can’t understand that.’
I smile at his friend. “Oh yes he can. And you followed what I said, didn’t you?”
His friend grins back and said, “Yes, I did. Most of it. Or enough.”
All of my patients are smart. One day in clinic I think how blessed I am, that ALL of my patients are smart and fascinating people. Then I think, how could that be? And, how lucky am I?
And then I think: everyone is smart.
They are not all educated in the same way I am. They may not be well read. They may not have my science background or my geeky fiction and poetry and song brain. But they ALL are smart.
Some are brilliant at mechanical things. I have a patient who is an expert in restoring church organs and is working 3000 miles away in New York City. “They are driving me crazy.” he says. “You have to have the approval signed off on over 20 groups, historic preservation, the fire fighters, etc, etc, to remove one board from the church. The organ was covered over by bad repairs over the years. We’re trying to get it back. After this I will put in new organs, but this is my last restoration.”
Veterans, teachers, attorneys, physicians, retired computer engineers, car mechanics, marine engineers, parents, grandparents. They are all smart, men and women.
We finish the porch visit with some options and the friend of my friend says he will think about what I said and try some things.
A few days later my friend calls. “I couldn’t believe he was following your science talk, but he was. He got it. He remembers it and understood it.”
“Of course he did,” I say.
“I am actually impressed,” says my friend. “It was really interesting watching you do that.”
That may be one of my weird skills. To be able to listen to the person thoroughly and then respond in language that they understand and a bit more. An assumption, always, that they can follow a complex and intricate idea.
I do not know if they always follow what I say. But they always respond to the assumption that they are smart and that they can understand and that they are an equal. I am explaining from my expertise, but I know they can understand when I explain it correctly.
And I have not seen this in the physicians that I have seen. Out of 22 physicians since 2012, four were excellent and met me and explained as an equal.
The rest did not. They dismiss me. They talk down or avoid me once they realize that they do not understand why I keep getting pneumonia. They are afraid to say “I don’t know.” Four are not afraid and recognize that it’s something weird and say, “We do not understand this and we don’t know how to fix it.”
Four out of 22 have my respect. And that is a sad number. Medical training needs to change and physicians need time to listen and need to learn how to listen.
Meanwhile, all of my patients are smart. And I am so blessed.
I had a friend during the pandemic. A very close friend. The friendship developed over a year.
It ran into trouble. I got my fourth pneumonia. He said, “I need to return to my real life.” I should have walked away, but he had promised. “We will always be friends.”
The adult part of me knows that always and never are lies. But the small child connection to the Self wants to believe, oh so badly. The adult notes “That is a lie. You are lying to yourself, because I don’t believe always or never.”
The child has eternal hope.
A year later, abandonment. The adult is cynically unsurprised. The small child part weeps.
And my church is melting down. Me too. I wrote a peace poem and promptly got into a fight. Devil’s fall up to angels and then they fall down again. A peace poem sets me up to fail. The ends don’t justify the means and I may resign from the church.
The fallout from the pandemic is only starting. Everyone is grieving, everyone is hair trigger.
Peace you and anything you have lost in this Pandamnit.
Discover and re-discover Mexicoβs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - FlΓΌchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflΓΌchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
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