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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.

H

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.

goat

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.

G

goat3

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!

F

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

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Eeeeeee

My theme is happy things, though sometimes they are things where I am trying to find the perspective to love what is happening.

When my son was little, I had Dr. Suess’s ABCs memorized: Ear, egg, elephant, E, e, e!

My words today are everybody, embody and evening.

E for Everybody. Everybody in, nobody out! This is one of the calls for Healthcare for all, and I am still a Mad as Hell Doctor, working for single payer.

Our state representative was here a year ago and said that there is not a mandate for healthcare for all. I said, “I politely disagree. We already have a law in place that emergency rooms cannot turn anyone away. They cannot refuse to treat a person. This is a mandate for care. Unfortunately, the emergency room is the most expensive and inefficient care, unless you are about to die. The emergency room cannot do chronic care: it cannot help people stop smoking, help lower blood pressure, help people with chronic illness such as diabetes, do preventative care like pap smears and checking kidney function to stave off renal failure. We have the mandate: now we need the political will to change to a single payer system that gives good care. A patient can see me in my family practice clinic a dozen times for the cost of one emergency room visit.” S o, everybody in, nobody out. The law that insurance companies can ONLY keep 20 cents of every dollar does not comfort me: I want my dollar to go to health care for everyone and not 1/5 to profit!

Embody: what do I embody? What do you embody? Do you treat your body well? Do you thank it? What is it carrying?

I see people so fixed on success and progress and getting goals, that sometimes we don’t pay any attention to our bodies. We treat the body like a tool, like a hammer or a wrench, use and abuse it, try to make it conform to some idea of external beauty, get angry when it breaks down. Fix me back to where I was three years ago, when I could work 12 hours a day and never ever paid attention to my body. Bad food, tobacco, alcohol, marijuana, gallons of caffeine, energy drinks, sugar, illegal drugs, no exercise… and then we are surprised when it breaks down? Even exercise is seen as an inconvenient and necessary job, like buying new tires for the car. When people say get me back to where I was, I ask, “Back to working the 12 hours a day that caused this damage? Do you think that is a good idea?

And I include myself in that! I have had pneumonia with sepsis symptoms twice. The second time I thought, how dumb I am! My father died and I did not take any time off. I just kept working and added executor to my jobs and cried daily. Is it any surprise that after a year of that I became ill? Now my goal is to not do medicine for more than forty hours a week and to listen to my body and to take breaks!

Evening: the sunset. I am so grateful for the day, for the night, for the light changing and the world turning, for the stars and the moon and the sun and the glorious, gorgeous, generous world.

E

This is an evening photograph from Mauna Loa last week.

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view

For the Daily Prompt: churn.

This is not a churn. It’s a cat. This is Princess Mittens. Oh, I miss her, but she is gone. I was looking for a photograph of students with a churn. I have one, but I found this instead. It is from my old phone photos and I don’t think that I took it: my son, I suspect.

Churning the internet…. “butter wouldn’t melt in her mouth”.

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Big D, little d, what begins with D?

Happy things starting with D:

Discrimination, death, delight.

I am happy that slowly, slowly, it feels as if there is change in the world and a decrease in discrimination. It is NOT gone by any means, but I think it is slowly being eroded.

My parents had a party when I was two and they were both in college. The party was raided in Knoxville, Tennessee in 1963 and my father was taken to jail. My mother and I were left alone and she was afraid we would be lynched by the neighbors. The next morning the paper wrote about a MIXED RACE COLLEGE STUDENT PARTY possibly with orgies. My parents were both suspended from the University of Tennessee.

They were both reinstated after a hearing, because there were no drugs, no underage drinkers, and it was not illegal to have a mixed race party. My parents never touched marijuana ever and I think it was because of that party. I don’t remember it, but I still feel cautious at parties and in crowds. My mother refused to return to the U. of TN and eventually finished her undergraduate degree at Cornell. My parents were so notorious that we left Knoxville as soon as my father graduated.

I grew up learning protest songs and work songs and joke songs. My mother joked about the party and it was years before I found out how terrifying it was. My mother joked that they sat at the one liberal table at the University of Tennessee. I hate discrimination and I do not understand it.

Death: is death a happy thing? Death is as much a mystery as life, and we cannot have one without the other. How could we value life if it were eternal? And we’d also get awfully crowded. I have the privilege of caring for all ages in clinic, all genders, any race that comes in the door, age newborn to 104, what joy! I get to be present when someone is dying and try to help the person and the family. There is no single idea about death or about how to “do it right” and often families struggle with multiple opinions and ideas and feelings. Death is as intense as birth and I have had the privilege to attend both.

Delight: there are many things that I find difficult and depressing, but I find delight too! The latest morbidity and mortality report from the CDC on overdose deaths, up from 52K in the US in 2015 to 62K in the US in 2016: Overdose deaths involving opioids, cocaine and psychostimulents — United States, 2015-2016. We have to work harder to prevent addiction, why do we choose addictive substances, why do people think it won’t happen to THEM?

And yet, I still find delight, taking photographs of bird, seeing patients that I know well in clinic, we laugh often, finding joy walking outside, my family and friends.

D

The photograph is from Mauna Loa last week. It is not a giant dinosaur nest, it’s a cinder cone. At least, that’s what a geologist claims….