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.

Health and teeth

For the Daily Prompt: toothbrush.

Here is a young rabbit. Their front teeth grow and get worn down eating. Their nails keep growing too and need to be worn down or clipped if they are pets.

In my county there are no dentists who take the state Medicaid for dental. And in some states Medicaid covers orthodontia for children but not in mine. Teeth are not covered on Washing ton State for my Medicare or Medicaid. And there are still battles going on about covering mental health including addiction. Is mental health not part of health? Are teeth not part of health? Why do we put health insurance profitable before basic life saving health coverage that covers all of us?

Health care should be like a toothbrush. We all need it. We all should have it.

 

Substandard

What comes to mind for today’s Daily Prompt: substandard?

As a rural Family Practice Physician, what comes to mind is the United States current health care system.

There is nothing substandard about our health insurance system: it does what it is supposed to, which is earn money for owners and investors. But it is frankly terrible at delivering health care, health care is not the goal, and we spend twice as much per US citizen as the next most expensive health care system in the world. And we do not have universal health care for our citizens and we rank below 30th in health care measures.

Wake up, US citizens. Let’s buy health care with our dollars, not health insurance. Single payer, one system, low overhead, clear rules and coverage and everyone in, no one out.

 

 

 

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 INSURANCE  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.

 

beach

I took this about a month ago, on an evening walk with my daughter. She is airborne: her feet are not quite touching. I have pictures of both my kids airborne at the beach. Water, wind, air, sky: I think that is their effect….

The new health care bill would cut medicaid by billions. That is our poorest Americans and most disabled. Is that how we make America great? Great for whom? Call Congress and say no….. Call again and again and again. They listen to money but in the end they need votes.

Sea

Nearing the end of a beach walk with my daughter at Fort Worden, the Strait to the west had a line of silver at the horizon. Gorgeous in all weather….

The vote today by Congress would remove the minimum services that insurances must offer in the US. Steps backwards, where cancer screening or hospital services or life flights or pregancy may not be covered. VOTE NO!!!!

And we still need medicare for all, single payer, so that 20% of every healthcare dollar is not going to insurance company profit…..Can’t they see?