Work is being a bit of a difficult place. I think that if a clinic is has two new providers with one new medical assistant, there should be some formal support in place. Not the manager of multiple offices sticking their head in the room with the three of us at computers and saying, “Everyone happy?” Um, no. This came to a head two days ago. Then yesterday I am asked to write up what I said to the manager.
No. I don’t think that is appropriate. If they have formal evaluation forms, fine. If they want a biweekly formal meeting, fine. If I ran the zoo, I would be sitting down biweekly with the job description to say, “This area is going well, this part needs some more attention. What is going well from your perspective and how can we communicate better to help each other and the patients?”
In fact, in my very first practice in 1996, I asked for a meeting with my receptionist. They had one for each pod of 2-3 providers. She was so freaked out by it that she brought the office manager, much to my surprise. I didn’t care and just said, “What is going well, what isn’t, where are the communication gaps, how do we fix them?” The receptionist looked at the office manager, said she had been scared that I was going to yell at her, but since I wasn’t, she let the office manager leave. We were fine after that. I just want a well functioning team and I am happy to help build it.
So, after thought, I am going to refuse this write up and ask what their HR process is and say that I am not satisfied with the office support and that it is quite unreasonable to leave two providers new to the clinic to guide and train a new medical assistant.
The Ragtag Daily Prompt is honey pot. That bring up this delicious and quite naughty Taj Mahal song, ooooooo. As my mother would say, you catch more flies with honey than vinegar.
I am still thinking about Friday’s Ragtag Daily Prompt: failure. Now that I am middle aged (by my clinic definition, which put over 90 as older), I think the biggest failure of my generation is a peaceful world. For me, a peaceful extended family. I am good friends with my father’s family and my ex-husband’s family. But the maternal family, well. I have thought about that for the last two days: could I have changed that?
Yes, but at what cost? My sister followed the “family rules” on that side. She is dead from cancer. My mother also followed the rules and died younger than me from cancer. I can’t say that the rules cause cancer. But doesn’t our culture say over and over, be yourself? To fit in the family diaspora, I would have to play the triangulation game and gossip about others as they have gossiped about me. No, thank you, no. I don’t want to. They seem to need a family member to hate and have chosen me and labelled me and call me angry. I think they are silly and emotionally immature. At the very least, I would have had to keep my mouth shut and accept them gossiping about me.
The family failure and untrue gossip, with no one ever asking for my viewpoint, mirrors the US culture. Split and needing someone to hate. At this rate, we’ll need the hippies back, with flowers and joy and counter culture and dropping out. Someone fun, at least until the drugs wear off. Someone to say, we need joy back, we need friends, we need love.
It’s not just my failure though. The family failed. They make cruel choices and target people. It happened in my generation, my mother’s, my grandparents. I wonder if it is happening in my adult children’s generation. Who is the next target? Who will refuse to counter-gossip and fight with each source? My adult children are not part of it at all, because I had less and less interest in spending time with mean gossips and I did not want to expose my children.
Lies and drama and meanness and gossip. I hope my adult children’s generation does better. We went to Wicked on Thursday. I did not like it much. Too much drama. Why do we want drama? The world seems more and more surreal. Give me the lovely hike we did on Friday instead, Echo Canyon.
My friend M is twenty years older than me. A friend of my parents since college. When I went to college in Madison, WI, I got to know her and her husband and their two sons. I lived with them my third year of college and it was a ball! I loved the family.
I visited over the years and more often when her husband had lung cancer and died. She wanted me to come out for her younger son’s fiftieth birthday. Her daughter-in-law said, “It’s nice to meet the daughter.” Apparently M considered me a daughter. I was delighted, since both of my parents had died by then.
A year ago M was feeling less well. She started losing weight. A work up was done, finding no cause. She had a rare cancer that had been treated two years prior. But by July, she had lost thirty pounds.
Thirty pounds! As a primary care doctor, RED FLAG! Very high likelihood of dying, if that went on. She was eighty years old.
I flew out in September. We took a road trip, just the two of us, from Michigan back to Wisconsin. We visited multiple old friends of hers. She thanked me afterwards, because one friend had Parkinson’s and died ten days after our visit. We saw her sisters-in-law and we did a circuit around Madison.
Afterwards, she said that was her last time driving on highways.
By December, she had dropped another ten pounds. Then she had difficulty walking. The daughter-in-law called me. She was having trouble getting any medical attention. They had had trouble for a year! Over a week, M went from walking to not being able to support her weight or stand up. I flew up right after New Years.
Something was wrong, clearly. She’d carried her own bags in September. I was the out of state doctor. The daughter-in-law, B, was moving her from bed to chair alone. I couldn’t. I am 5’4″ and M was 5’10” and now my weight. B found a private practitioner.
On my third day there, M had chest pain. We took her to the Emergency Room. The Emergency Room did the usual things. Then the ER doctor came in. “She is not having a heart attack and she doesn’t have pulmonary emboli. So you can take her home.”
“No, something is wrong! She can’t walk! She could walk two weeks ago! We did a road trip in September!”
The ER doctor shrugged. “What do you expect me to do?”
“Figure out what is going on!”
“She is eighty.” he said. As if eighty meant we stop caring.
“No, we won’t take her home. It isn’t safe. We can’t move her. M, do you want to stay?”
“Yes,” said M.
The ER doctor looked annoyed. “All right. I’ll admit her for placement in a nursing home.”
The inpatient doctor was scarcely more interested.
“What do you expect me to do?” he said, knowing he was dealing with an annoying out of town doctor.
“Steroids.” I said, “Maybe it’s a weird form of polymyalgia rheumatica. She deserves a trial of steroids.”
He too shrugged, and started steroids.
The next day she was stronger, and the third day she could stand. It was SOMETHING, but not clearly polymyalgia rheumatica. The hospital was small and did not have a cancer doctor and did not have a neurologist. They were sending her out on steroids. Follow up outpatient.
We looked at a nursing home, but went to a private assisted living instead. The staff were minimally helpful. We took turns sleeping there. Physical therapy and occupational therapy were started. M was a bit better but not the miraculous return to normal that steroids cause in polymyalgia.
I flew home. The private physician saw her. M was set up to see the U of Michigan. B kept asking if it was lymphoma, because that can be a side effect of the treatment for M’s cancer. M’s cancer doctor said no. M got covid and the appointments were delayed two weeks.
In February she went to the U of Michigan. The neurologists came through and said, nope, not polymyalgia rheumatica, and not neurological. The cancer doctor came through. The GI doctors did an upper endoscopy and biopsied. Cancer. Lymphoma.
M said no to treatment. She was discharged to hospice. She died within 24 hours of reaching the hospice.
The cancer doctor sent an apology to B, who was right all along. This was a particular lymphoma that responds to steroids for a while. M had said that if it was another cancer, she would refuse treatment.
“These people who live a vigorous life to 70, 80, 90 years of ageβwhen I look at what those people βdo,β almost all of it is what I classify as play. Itβs not meaningful work. Theyβre riding motorcycles; theyβre hiking. Which can all have valueβdonβt get me wrong. But if itβs the main thing in your life? Ummm, thatβs not probably a meaningful life.”
Ok, so now some doctors don’t care once you reach 75. That’s it. They define everything as “useful and productive” and if you are not doing meaningful work, well, you’d might as well die. I hope that doctor does die. Slowly. And that everyone around him refuses to do any tests to see what is happening. And who the hell defines what is meaningful work? That can be helping raise grandchildren, like, hello!
I have another friend who is going through the same thing. She is failing and the medical community in my town is shrugging their shoulders. She should have a head MRI, says the cancer doctor. So that was a month ago and it still isn’t scheduled.
Some of this is pandemic fatigue and backlash. People refusing to get vaccinated, people refusing to believe that Covid-19 exists, doctors and nurses dying of Covid-19, people refusing masks. If everyone is exhausted, what do you let go?
Apparently people over 75. But NOT everyone over 75. If you are wealthy, you will get care. Our Senators and House of Representatives certainly get care after 75. It is the isolated, the rural, the poor, the ones who don’t have an advocate, who will be sent home to die.
I took my friend here to her primary. “What do you want me to do?” he says.
“Here is the Home Health paperwork and she needs disability tags.” My friend is falling, five times that week.
“Ok,” says the primary. “I will set those up.”
When Home Health arrived, she had fallen. She had been down for 15 minutes and unable to get up. Home Health called the fire department. The fire department helped and also came back to put no slip pads on the steps. If she can buy the wood, they will build a ramp for her.
And I will go with her to the cancer doctor and I will rattle cages. She lives alone, she has no children, she has a brother in Alaska. But she also has an advocate. One who knows the medical system and who is not in an ethical stupor.
One thing that makes me gloomy, as a Family Practice Physician: the only person who has read my medical notes from the multiple specialists is ME.
Since March 2021, I have seen Family Practice, Cardiology, Pulmonology, Infectious Disease, Immunology and Psychiatry. I am in a rural area, so this involves three different hospital systems. They all use the EPIC electronic medical record, but they won’t release information to each other. I have gotten two of them hooked together under ONE of my names and passwords but guess what: my primary care physicain can’t see the notes from the other sites. Only I can. “Proprietary infromation.” Hey, you stupid medical non-systems, this is MY healthcare, MY notes, and YOU SUCK.
My primary care physician COULD request the notes from my pulmonologist but she hasn’t. I find this incomprehensible. I have been on oxygen for over a year. I guess my doctor frankly doesn’t care. Has she farmed my lungs out to pulmonology and doesn’t have to pay attention any more? My goal in practice was to have all of the specialists’ notes. If that was five different specialists, I requested them. Ok, it is next to impossible to get psychiatry notes. I keep wondering if psychiatrists really write notes. The patients never seem to know what diagnosis the psychiatrist is using. One hundred percent of the people that I have seen put on an (addictive) benzodiazepine say that it is for sleep. Meanwhile, at the conferences, the psychiatrists say that primary care should not give the patients benzodiazepines for sleep. I raise my hand: “Even when you psychiatrists have started them? The patients all say it’s for sleep. We don’t know WHAT you have them on it for.” When I try to stop the benzo, the patient has a fit and says that psychiatry said they have to have it. And the psychiatrist has retired or left or changed the phone number and there are no notes ever.
Anyhow, I am counting up specialists. I had really bad strep A pneumonia in 2012 and 2014. Since 2012 I have seen 20 specialists. That is counting the three Family Practitioners, because Family Practice is a specialty too. I thought it was about taking care of the whole person, which to me means reading all the specialists notes, but not one of the ones I have been to has done that.
So the medical system is an abject failure. I blame the US citizens. We choose the system with our votes. We need medicare for all, single payer healthcare, and one electronic medical record for all of the United States. Right now, there is a push to privatize medicare and turn it over to For Profit. We need to fight this and we need to demand better healthcare. Hospital organizations should not be refusing to send my clinic note to my primary care doctor. It is stupid and bad care.
https://pnhp.org/ Physicians for a National Healthcare Program for more information.
The latest issue of Family Practice Medicine has an article on patient satisfaction scores.
I remember my first patient satisfaction score VIVIDLY.
I am in my first family medicine job in Alamosa, Colorado. I receive a 21 page handout with multiple graphs about my patient satisfaction scores. I am horrified because I score 30% overall. I am more horrified by the score than the information that I will not receive the bonus.
I go to my PA (physician’s assistant). He too has scored 30%. We are clearly complete failures as medical providers.
Then I go to my partner who has been there for over 20 years.
She snorts. “Look at the number of patients.”
“What?” I say. I look.
My score is based on interviews with three patients. Yes, you read that correctly. THREE PEOPLE.
And I have 21 pages of graphs in color based on three people.
I am annoyed and creative. I talk to the Physicians Assistant and we plan. I call the CFO.
“My PA and I think we should resign.”
“What? Why?”
“We scored 30% on the patient satisfaction. We have never scored that low on anything in our lives before. We are failures as medical people. We are going to go work for the post office.”
“NO! It’s not that important! It is only three patients! You are not failures!”
“Three patients?” I ask.
“Yes, just three.”
“And you based a bonus on three patients? And sent me 21 pages of colored graphs based on three patients?”
“Um…”
“I think we should discuss the bonus further….”
I did not get the bonus. It was a total set up and I am not sure that ANYONE got that bonus. Much of the maximum “earning potential” advertised was impossible for any one person to get. You would have to work around the clock. They got out of paying us by having multiple bonuses that each required a lot of extra work…. They were experts in cheating the employed physicians. That became pretty clear and I was 5th senior physician out of 15 in two years, because ten physicians got right out of there. I lasted three years, barely. I knew I would not last when an excellent partner refused her second year of $50,000 in federal rural underserved loan repayment to quit AND stayed in the Valley working in the emergency room. I called the CEO: “Doesn’t this get your attention?”
“She just didn’t fit in.”
“Yes, well, I don’t think anyone will.” I asked my senior partner how she stayed. “You pick your turf and you guard it!” said my partner. I thought, you know, I hope that medicine is not that grim everywhere.
Unfortunately I think that it IS that grim and getting grimmer. Remember that in the end, it is we the people who vote who control the US medical system. If we vote to privatize Medicare, we will destroy it. Right now 1 in 5 doctors and 1 in 4 nurses want to leave medicine. Covid-19 has accelerated the destruction of the US medical non-system, as my fellow Mad as Hell Doctor calls it. We need Medicare for all, a shut down of US health insurance companies, and to have money going to healthcare rather than to paying employees $100,000 or more per year to try to get prior authorizations from over 500 different insurance companies all with different rules, multiple insurance plans and different computer websites. Right now I have specialists in four different local systems. The only person who has read everyone’s clinic notes is ME because it is nearly impossible to get them to communicate with each other. Two of them use the EPIC electronic medical record but consider the patient information “proprietary” and I have to call to get them to release the notes to each other. Is this something that we think helps people’s health? I don’t think so. I have trouble with the system in spite of being a physician and I HATE going to my local healthcare organization. Vote the system down and tell your congresspeople that you too want Medicare For All and single payer.
I have had people say, but think of all the people out of work when we shut down insurance companies. Yes AND think of the freedom to start small businesses if we no longer have to fear the huge cost of insurance: Medicare for all!
rape victims
if they had done something different
not THAT dress
not that date
too many drinks
did she flirt?
THAT college has statistics
would not have happened
if if if
she is holding a spatula
riding the school bus
age 7, second grade
look at the other kids
the only girl
who is not a virgin
played with
the high school senior next door
she loved when he would push the swing
trade: lie down here
I won’t hurt you
she got scared “stop” ran
asked her mother what it meant
when boys
worries until the doctor
surely the doctor
would notice if she is pregnant
her sister is four
never ever go near
the boy next door
her sister cries
she keeps an eye on her
she’s different now from other girls
should have known
never speak to him again
the bacon burning on the stove
cry, throw the bacon out
radio: violence
is never acceptable
it is not the woman’s fault
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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