relationship

Blogging from A to Z about happy things, the letter r. R for relationship, red and real.

I’ve been down to the same beach twice in the last 2 weeks, and both times there have been a trio of great blue herons. Two adults and a teen? I don’t know, but right before the second one wandered over, I took this shot:

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Caught something, hooray! And then the other heron comes to ask, “What did you catch? Tasty? Are there more?”

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I love walking outside, it balances clinic. I am just present and real. I don’t speak heron well enough to worry about their blood pressure. Time just to watch.

And red, my son is visiting.

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I for intent

My Blogging from A to Z theme is happy things. Three happy things with intent!

We took a beach walk two nights ago and the beach was full of birds. Three great blue herons, three oyster catchers, an eagle landed in the surf, crows, gulls and the flock of brant. There were various dogs being walked, who were not chasing any of the birds, hooray for that!

I love this great blue heron: so intent on fishing. What are you intent on? Intent, intention, attention, retention. So many tents….

I was intent in clinic yesterday. We had a packed schedule and I started thirty minutes early to add an extra patient and I had good intentions to run on time. I didn’t. By the last person I was running 20 minutes late, and three people were grumpy. No, four people were grumpy because I have to add myself to that. I had good intentions, but I can’t control what problems people bring to clinic and they don’t always fit in the time allotted!

Here is the eagle, also intent on dinner. I don’t think of bald eagles as surf birds, but this one had caught something and landed. We did not get close, not wanting to disturb things.

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The photographs are taken at the Port Townsend Bay beach below Chetzemoka Park. Happy blogging. 

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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!

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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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”.