I voted

…after I spent about three hours going through paper and throwing it out… ok, like a total numbskull I mislaid my ballot. Have you mislaid your ballot? FIND IT! VOTE!

” …that government of the people, by the people, for the people, shall not perish from the earth.

When I went across the country as a Mad as Hell Doctor in 2009, we talked to people everywhere. I joined the group in Seattle. I had never met any of them and had only heard about them two weeks before. But we were on the road, talking about health care, talking about single payer healthcare, talking about Medicare for All.

Some people said, “I don’t want the government in healthcare.”

We would ask, “Are you against medicare?” “No!” “Medicaid?” “No!” “Active duty military health care?” “No! We must take care of our active duty!” “Veterans?”  “No! They have earned it!”

…but those are all administered by the government. More than half of health care in the US. So let’s go forward: let’s all join together and have Medicare for ALL! And if you don’t agree… so you don’t think you should vote? Hmmm, I am wrestling my conscience here….

We need one system, without 20 cents of every insurance paid dollar going to health insurance profit and advertising and refusing care and building 500++ websites that really, I do not have time to learn and that change all the time anyhow. How about ONE website? How about ONE set of rules? We are losing doctors. It’s not just me worrying: it’s in the latest issue of the American Academy of Family Practice.

Vote. For your health and for your neighbor’s health.

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Physicians for a National Healthcare Progam: http://pnhp.org/

Healthcare Now: https://www.healthcare-now.org/

I can’t credit the photograph, because I don’t remember who took it…. or if it was with my camera or phone or someone else’s! But thank you, whoever you are!

the dark things in the world

When my son was about 12, a friend called and asked if he could babysit.

I froze up, silent.

He got it very quickly. “Um, we often come home really late, staying out until 3 am, so would it be ok if he stayed the night and we brought him home in the morning?”

“Yes,” I said, with relief.

What was I worrying about? Alcohol. I knew he and his wife drank far more than I approved of and the thought of them driving my son home drunk was NOT ok. I think that sometimes they took a taxi home. I hope so. I suppose they could send my son home in a taxi, but by having him stay the night, he would sleep too. Their children were five and six years younger than my son.

So I would take my son there, or they would pick him up, and he’d go to sleep when the kids did. I don’t know how late my son and the kids stayed up in that house. I do know the household reminded me of my childhood home, where the adults stayed up and partied. I did not party in high school at all. I didn’t want to. I was not interested in drinking alcohol illicitly. I could perfectly easily have drunk it at home: my parents were too tuned out by then to notice. I knew what people were like when drunk: why would I explore that with my peers? My father would break things in the house when he fell, there were burn marks in the floor from cigarettes, my parents would scream at each other at 1 am. I kept my head down and did very very well at school: I wanted out, even though it was not conscious. I loved my parents. Home was chaos and I escaped into books and schoolwork.

Parents need to think carefully about babysitting. Do they know the family? Do they need to drive their child to the house and pick them up? Once I went to babysit and the family had two enormous St. Bernards. The male growled at me. The owner said, “Don’t worry, he will attack anyone who tries to get in the house.” I was quite terrified of the dogs, and the male trailed enormous strings of drool into my lap. That night at 1 am I found Monty Python on cable and wondered if I’d wandered into another universe. We didn’t have cable, so it was surreal. I didn’t tell my parents about any of it. These were not people we knew: friends of friends.

Parents need to be careful as well to tell teens that adults can behave inappropriately and that a normally nice adult might behave badly when drunk. Many babysitting friends told me about the father of the kids they were sitting making sexual comments or putting a hand on their knee driving them home. This is not ok and teens need to be warned. They also should be warned about signs of drinking and inebriation and have taxi money or be able to call for a ride if they are not comfortable with the adult driving them home. And if the adult makes any sort of inappropriate remark or touch, they should NOT babysit there again ever. I would tell the offending adult why, though I think that would often get an angry or denial reaction.

I have various friends with 9 year olds. One parent made a comment that they don’t want their children to know anything bad about the world until they are ten. Another didn’t want their child to know what the term domestic violence meant.

I disagree. I would respond saying, “If your mother doesn’t want me to discuss that, then we will leave for her to talk to you about it later.”

How can we shelter our children with the magical childhood until ten and then send them to babysit at twelve? How can they recognize an adult is impaired or inappropriate behavior unless we talk about it? I have been asking adult smokers what age they started smoking for years: most of my older men started at age 9. The other day a woman said she’d tried cigarettes by age 7. Our children are not stupid, they hear things, they try to puzzle it out with each other: they deserve honesty from the start.

For a small child, that may mean a very simple explanation. My mother died of cancer when my daughter was two years and six months. By age four she had processed it to where she asked me “How old was grandmother Helen when she died?” I said that MY grandmother was 92 when she died, but grandmother Helen was 62. She asked, “How old are YOU?” I said, “I am forty. I hope to live as long as my grandmother, but none of us know how long we will live.” She studied me for a while and then went off.

They say that small children can’t process death. Clearly my daughter could! Maybe children can’t because we do not talk to them about it. We aren’t respectful. We try to hide all the dark things in the world, we try to keep them in a fairy tale. I feel angry on behalf of our children. To me it feels like parents lie: they will not tell their children what is going on. It’s not okay. And how can they handle the dark if no one will discuss it until they are ten?

 

Adults can be pretty weird sometimes, right? The photograph is from this year’s Kinetic Sculpture Race.

community health

For the Ragtag Daily Prompt #69: community.

The photograph is from 2010, when the mad as hell doctors toured California to talk about single payer health care, medicare for all.

Small communities rolled out the welcome:

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In this community, every table was sponsored by local health groups: clinic, the health department, mental health, addiction treatment. In small communities everyone knows someone who has lost their health, their health insurance and/or their job and home.

Here we are setting up for another program:

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People asked questions:

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And they listened and responded:

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The health care industry has money. The insurance companies are for profit and make enormous profits. But in the end you and I have VOTES. When we stand up as a nation and say that we want medicare for all, Congress will listen. Stand up.

The mandate for health care already is a law: no one can be turned away from an emergency room. But as things stand, we do not take care that the person in the emergency room has care after the emergency room. The hospital may take the person’s house. We already have the government doing no profit care for over 50% of the care in the US: Medicare, Medicaid, active duty military and the Veterans Association. It is time to shut down the for profit insurance companies that refuse medicines, refuse care, refuse to answer their phones, tell me on the phone “we don’t have a fax”, the parent company tells me a medicine is covered and then the part D drug coverage still refuses: it is BEYOND TIME TO SHUT THEM DOWN.

Is the goal of health care profit? Or is it care for our citizens, support for families, works like the police and the fire station: we all support each other. Stand up, shout and VOTE.

 

 

Why can’t I just call for a referral?

Why, you say, do you need to SEE your doctor for a referral? It’s so stupid!

Multiple reasons:
1. Triage.
2. Scarce resources.
3. Your primary care may be able to handle it.
4. The specialist only wants to see people that they can help.
5. You may think that you and Dr. Google have it figured out, but Dr. Google sucks.
6. For physical and occupational therapy, it has to do with caution and malpractice insurance.

Let’s go through them backwards.

6. People call for a referral to physical therapy. I say I need to see them. No, I can’t make a diagnosis through the phone. Arm hurts is rather vague. The person says their insurance does not need a referral. But then the physical therapist wants one: why? Well, my malpractice outranks the physical therapists, so to speak. If the therapist sees you without your doctor examining you and something happens… yes, things have happened.

5. Dr. Google. You’ve read extensively and you know exactly what is going on and you just need the referral. No, you have not gone to medical school or residency. Every quack who can say anything even faintly convincing now has a website. Dr. Google sucks. There are very very rare exceptions to that…

4. The gastroenterologist does not want to see your bladder problem. The neurosurgeons hate seeing the people that will not benefit from back surgery, but they have to because the back pain patient doesn’t believe me, so the patient has to hear it from the surgeon. The patient thinks I am “gate keeping” them from the specialist. I’m not.

3. Primary care learns to handle a lot of things. One frequent referral is a postnasal drip, to the Ear Nose and Throat specialist. I recommend trying an acid blocker first. The person doesn’t believe me. “I don’t have heartburn.” I sigh, and do the referral. $450.00 later, the ENT has put the scope through their nose and put them on an acid blocker.

2. Scarce resources: We had 8 neurologists on the Olympic Peninsula for about 450,000 people. We are down to two. I called one for a complex stroke-that-wasn’t and had to do a series of MRI/MRA studies looking for specific things. It was a vertebral arterial bleed. Rare. I called the neurologist back and he said, “Send them to the other one. I am swamped.” He is in the larger population area and two others quit. The rule is sickest is seen first…

1. Triage. What is wrong, what are we worrying about and how sick is this person? If they are really sick I will call the specialist to ask for recommendations, or which test to do, or see if they need to be seen within a short time. I am not going to interrupt the specialist unless I think it’s really necessary! That would burn through my carefully built credit with them! And I have had a person come in for a new patient visit for a “lung problem”. I call the specialist, get him seen and he has a heart bypass….

0. And I am a specialist too. I am a Family Practice physician, board certified and board eligible, three year residency. The internist, the pediatrician, we are all specialists and all special.