Tag Archives: technology

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Clinic comedy

Yesterday was my second day in the third clinic in this system and the day went a bit sideways. I am in seeing a person with their spouse. We are all masked because this is a sick visit. I try to wear a mask for all the visits but occasionally take it off if someone really can’t hear me. I go to wash my hands. The sink is small and turns on by a motion sensor. It is supposed to turn itself off. It goes on but then will not turn off and is loud. I send a quick message to the clinic director after flailing at it a bit. Why a message? The cabinet under the sink is locked, so I can’t turn the water off. With my patient slightly deaf and masks and loud water, I finish the visit trying to yell things. Ridiculous and embarrassing but funny. The patient and spouse are older and know that things break. They are not upset. The clinic director arrives, has her try at flailing at the sensor, unlocks the cabinet and turns the water off.

I shake hands with my patient and they and their spouse leave. We are in room three. I go in room 4 to wash my hands, since my patient was blowing their nose, and guess what? Yes, the water turns on and won’t turn off. I get the clinic manager. “I broke the second sink. How about I go home now?”

She laughs. “I will put in a ticket for maintenance.” She unlocks the room 4 sink and turns it off. Now we have two rooms out of commission!

I am covering for Dr. X. “See, this just shows that I wash my hands and Dr. X didn’t.” Not really. Dr. X has been out for a month already.

“Maybe it’s because they haven’t been used in a month,” says the medical assistant. We shut down those two rooms and I go into room 2 with some trepidation. The sink does not break.

Maintenance show up early afternoon and replaces the sink sensor batteries in room 3 and 4. They work just fine after that. It turns out that there are two other sinks not working, but there are patient visits going on, so maintenance will come back. The alcohol hand sanitizer makes my hands itch, so I prefer soap and water.

Isn’t technology great? Except when it breaks. I felt silly and helpless, since I was in a brand new place and the cabinets were locked!

I admonish all the doctors, do wash your hands! Even if the sink batteries need to be replaced more often.

For the Ragtag Daily Prompt: admonish.

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Batter batter

Right now the nuisance in clinic is not a bat or a batter but a battery. I have a hospital issued laptop from last April. I had a day of orientation and one day that they walked me through the electronic medical record. I absorbed about ten percent of what they said. One day is silly, it should be broken up over the orientation, over three days or more, but places do not do that. Anyhow, Friday afternoon I was done and supposed to see patients on Monday, with support.

I wandered back from the IT office to the HR office. “Um, I’m supposed to have a laptop. Is it already at the clinic?” HR didn’t know. They called the clinic. Nope, IT was supposed to issue me one. We went to IT together. IT was in the middle of a massive update. No one had remembered that I needed a laptop. They “found” one and set up my program. This all took another hour.

Months later we were on the phone with IT and I had to say the name of the laptop. “Oh,” said the IT person. “THAT’S where my laptop went.” I was issued an IT one, not a provider one. I don’t care, do I?

Except, the battery is old. I guess the laptop is “old” too, but it works. So far. However, the battery won’t last even through a morning now. I put in a ticket to IT about a month ago and a battery is on order “because that’s an old one, we don’t have those in stock”. I plug it in to the desk top in the office, but we run two or three exam rooms and it’s awkward and a nuisance to plug in and unplug in each room. I leave the cord in one room and cross my fingers.

Yesterday someone from IT shows up right before my last patient and takes the back off my laptop. Except the battery he’s brought doesn’t fit. He has to put it all back together. I laugh, because it’s kind of ridiculous. He does leave me a second charging cord, so now I have ones for two rooms. The risk is that I will forget and walk away with it plugged in and drop it. Of course, then I might be issued a “new” laptop.

That is the present silly mildly annoying nuisance at work.

For the Ragtag Daily Prompt: nuisance.

The picture is from the Saturday parade, a tree on a distant roof.

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If I were your child

Living in a town of 9000, now 10,000, I did not feel that my children needed cell phones. They could walk home from school. It is reasonably safe, though I knew too much about local use of heroin and methamphetamines to believe that anywhere is completely safe.

I spoke to a friend from high school in the early 2000s. He asked me to text him my address.

“I’ve never texted.” I said.

“NEVER?” he said.

“Nope.”

“Haven’t your kids taught you how?”

“My kids don’t have cell phones.”

Long silence. Then: “If I were your child, I would run away.”

I laughed. My son got a cell phone when he headed for college and my daughter got a track phone, ten dollars a month, in high school. Calls and no texting. My son ran away the same way I did, as an exchange student. He went to Thailand at age 16 and was on the Maylay Peninsula, two years after the tsunami hit. His first comment calling home was, “Mom, the world is a really scary place.” Going off to be an exchange student is a fabulous way to run away, because you learn tons and come home.

My daughter had one friend who she would go to sleep over in her teens.

“I don’t want to sleep over any more.” she said after one night.

“Why?” I asked.

“She is up texting and by midnight she and friends are having arguments by phone and she cries. I want to sleep.”

Don’t leave the phone in the kids’ rooms, parents. And don’t have the phone in your bedroom either!!!

For the Ragtag Daily Prompt: texting. With music: https://youtu.be/hkmZGh9DQZ4.

The photograph is Studt’s Pumpkin Patch and Corn Maze again.

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The isolated working

I ran my own small clinic from 2010 to 2022, working somewhere else, got Covid, was on oxygen for a year and a half, did some healing and then came back to work.

There has been a culture change in medicine that feels very strange to me. I did not notice it because I was in a solo clinic and not “part of the system”.

All the doctors, providers, are more isolated. I got a compliment yesterday when I was doing a “warm hand off” of the most sick or complicated patients, three new diabetics, a person with cancer, a person with a genetic heart problem. The doctor who I was handing off to is in the same clinic but we have barely talked since May. I don’t know her at all. She complimented me on excellent care “and calling specialists”.

I thought, huh. But I think that is a dinosaur doctor thing. I think mostly people communicate through the electronic medical record email, send messages about patients. For the decade that I was solo, I had to call other specialists because I was on a different electronic medical record. The email didn’t connect. The hospital reluctantly gave me a “link” to their system, but it was only a link to look. I could not write or send anything.

About two months ago I got an echocardiogram result. I read it and thought, ok, it’s not normal but what does it mean? Outflow obstruction by the thickened heart wall. Hmm. I called cardiology and spoke to the cardiologist who read it. He sounded surprised and said, “Idiopathic hypertrophic cardiomyopathy, most likely. It’s a classic echo.” “So, what do I do?” “Send him to me.” “Anything that I should change meanwhile?” “Yes,” says the cardiologist. He had me stop one medicine and start another. “No vasodilators and the beta blocker slowing the heart rate should help decrease the outflow obstruction.” “Got it.” I said. He also gave me two more tests to order.

I referred the patient to cardiology but it was a month before he got in. The two tests were done and they ordered more. If the diagnosis is correct, he’ll be sent to a special clinic in Denver. I called my patient while we were waiting for the cardiology visit. The medicine change had not made much difference as far as he could tell.

I was also told when I got here that I would never get a local nephrologist to see a patient, they were two busy. However, I have called two nephrologists about two patients and both took the patient and again, gave me instructions.

Two specialties have been very difficult to contact: orthopedics and gastroenterology. I have no idea why they are so difficult.

I can see that email feels faster. But there is no human contact, asking follow up questions is difficult, I don’t get that bit of further helpful education: this is what you do next. I have learned so much over the years by touching base with specialists. Once I fussed at a patient to go to hematology oncology about their high platelet count. The patient didn’t want to. He came back and said, “Apparently I have this newly found genetic problem. They put me on two medicines, not expensive. And I feel better than I have in 20 years.” I asked the oncologist about it the next time I called. He lit up, excited, and told me about the JAK-2 mutation. It is so exciting to learn about new areas in medicine and my patient says, “I have to thank you for pushing me to see the oncologist. I feel so much better.” Wow and cool.

Clinic feels like I am mostly isolated, a silo, an island, rarely talk to the other physicians unless I go to find them. I think hospital administrations like this, keeping the physicians in line by having their schedule be so packed that they almost never talk to each other. What a good way to keep physicians from interfering in the money making production! Ugh, I think it is quite horrible and unhealthy for the providers and for our countries medical system in the long run. I was seriously less lonely in a solo clinic.

The prognosis for our current medical system is very poor. The patients say to me, “Why do my doctors keep leaving?” They aren’t attached, they are isolated, I don’t think the physicians know what they are missing. Colleagues. Not silos.

For the Ragtag Daily Prompt: prognosis.

The photograph is from the Fruita Fall Festival.

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Matter

If something doesn’t matter, is it anti-matter?

Lily’s person moved two days ago, much closer. Supposedly to a place where Lily the cat can go, but instead of a private room, there is a roommate. It took me a month to get Lily cat to let me pat her, so the roommate won’t work. We are all very very frustrated. And next week daily treatments for Lily’s person start, thirty minutes away, without enough warning to get volunteer drivers. So it will be me. I am tired. But I suppose it’s anti-matter, right? We were given 24 hours notice by the nursing home and by the physicians about both the move and the treatment and they wanted to start the treatment the same day that she was moving. Whether we can provide all the transport seems to be irrelevant.

The stealthie is from Whidby Island. Right, I’m just an irrelevant shadow as far as the medical dysfunctional machine is concerned.

For the Ragtag Daily Prompt: irrelevant.

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Double standard: AI technology can take jobs but improving healthcare can’t

The United States could go to single payer healthcare, but one objection has been “People will lose their jobs with health insurance companies.” Yet no one seems to object to AI, Artificial Intelligence taking jobs. It’s technology so it’s fine! The wave of the future! Coming whether we like it or not!

One form of single payer healthcare is medicare for all. Expand medicare so that it covers everyone. At first, it only covered retired female teachers. Women were only considered for teaching jobs if they were single. A married woman was expected to work in the home. The teaching pay was low. Men were expected to be supporting a family, so they got more. Women were often supporting parents or children if spouses died or divorced or abandoned a family or were disabled. Early census information was a finagle: any male in the household was listed as “head” even if it was an elderly disabled father or a boarder or a teen. So the true numbers of women as head of households were obscured.

Single payer would improve healthcare. There would be ONE set of rules. Physicians would know if something was covered. Right now there are over 500 health insurance companies and they each have multiple different policies. Not only that, but the policies can change monthly in what they cover. Did you know that? I would get monthly postcards from multiple companies saying that I could go on line to one of the 500 different websites and see what they had changed and were no longer covering. I found little time to learn 500 websites. We spend enormous amounts of healthcare money on communication back and forth from insurance companies to hospitals and clinics. Trying to prior authorize CT scans, MRIs, surgeries, referrals, medications (even old cheap ones!) and then attempting to get the health insurance companies to pay for the care. Remember that the insurance companies are allowed a 20% profit: so for 1 million dollars of healthcare money, $200,000 can go to profit. The people and computer work is not in that profit, so what percentage of your healthcare dollar goes to attempting to prior authorize and get paid? How much of your healthcare dollar would you like to go to healthcare?

Medicare’s overhead is either 1.4% or 6%, instead of that 20% profit and the prior auth/collection effort. There are two different estimates (from here):

1. There are two different measures of Medicare’s administrative costs. One figure comes from the Medicare Board of Trustees’ annual report, while the other comes from CMS’ National Health Expenditure Accounts. According to the latest trustees’ report, Medicare’s overhead represented 1.4 percent of its total expenditures. According to the latest NHEA, Medicare’s overheard was 6 percent of expenditures.

2. The discrepancy between the two figures is due to Medicare Parts C and D. Mr. Sullivan wrote that the difference between the trustees’ measure of overhead and the NHEA measure “is due almost entirely to the fact” that the NHEA figure includes administrative expenses incurred by health insurers that participate in Medicare Advantage (Part C) and Medicare’s prescription drug program (Part D). In essence, the overhead associated with the private insurers involved with Medicare raise the program’s overhead by almost 5 percent, or $24 billion in 2010.

People worry about “socialized medicine” but really, the closest system to socialized medicine is the Veterans Administration. I don’t think anyone wants to take their healthcare away, and some of it is specialized depending on where they were deployed and what they were exposed to. I saw veterans in my clinic because we were more than 30 miles by car from a VA hospital.

What about medicare fraud? I saw way more fraud with the insurance companies. Companies will maximize revenue by sending equipment at the exact interval insurance allows (like sleep apnea equipment and diabetes glucometers). It doesn’t matter to them if it’s being used or not. After my father died, there were 16 full oxygen tanks full in his house. The company was happy to pick them up and no, they did not want to reimburse the payments. A biller told me that often the health insurance companies will pay less then the contracted amount. When challenged, they say, “Oh, that was a computer error! We will fix that!” She said, “I have never once seen the error in the physician’s favor.” When I had cobra insurance, they would not pay my bills and I had to call them every single time to force them to pay. It took enormous amounts of time and again they claimed, “Oh, computer error!” I finally called their counseling line and said, “I want to be counseled for your company refusing to call me back and screwing over this cobra policy, and by the way, I have a family member dying of cancer.” That finally made them fix it.

WHY is our culture ok with technology taking jobs, while improving healthcare can’t? Get rid of the health insurance companies! Medicare for all! If we all had secure health insurance, think of the work innovation in our country!

For the Ragtag Daily Prompt: finagle.

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Reblog: Desertification

I don’t want to argue about global warming. Let’s talk about deserts instead. Overgrazing, cutting down all the trees and losing topsoil: we have seen this in the United States, with the dust bowl. We have a lot of people in the world to feed, even after all the deaths from Covid-19. We need to take care of land.

Healthy Forest Project launched to protect Mongolia forests for future generations

Ok, I am lame, that is embedded, not a reblog. I will have to figure out the difference. Feel free to laugh at me. My problem with technology is that it is NOT intuitive. I was horrible with computers until I realized that they are linear and stupid. That is, they only follow the exact right command and they have very little capacity to guess what I mean. I decided that computers were glorified hammers and very very annoying and that the manuals are usually written by people who speak computer, not English. That made it much easier for me to work with computers.

Anyhow, plant a tree. Blessings and peace you.

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Civility is not dead

I am attending parts of the online Collective Trauma Healing Summit, led by Thomas Hubl. This morning I listened to two speakers, each about an hour long. The first was by Rev. angel Kyodo Williams, an African-American buddhist teacher and the second is by Tristan Harris, who is the co-founder of the Center for Humane Technology.

Mr. Harris gives me hope about humans learning to live with social media without continuing to be polarized and angry. He speaks about the way that many platforms work. We tend to click on things that worry us and that we are traumatized about, and the platform immediately starts feeding us more of that. In a way, Facebook and other platforms gas light us: the algorithm figures out what makes us upset and agitated and promptly feeds us more of it.

He advocates moving to more humane platforms, that aren’t built on feeding us trauma, and especially for schools and parents to do this collectively with children. He co-hosts the podcast “Your Undivided Attention” each week, so I will be looking in to that.

However, I have a second reason to be hopeful about social media. I am in more than one group now that has rules and that has administrators that enforce them. Kindness. An insect group that forbids people saying “squash it”, because it’s a group of people that are interested in insects. A physician mom group. A pacific northwest rock group and a women’s pacific northwest rock group. I am now one of the administrators for a local group and am fine with it.

Even though Facebook is still feeding us more trauma and horror if that is what we click on, people are starting to see through this and refuse. They are forming groups where insects and people aren’t squashed. Rural farm groups. Music groups. In these groups I feel that people are coming together and are working to be supportive and help each other, identifying rocks, discussing child behavior, singing together.

Each time that technology makes the world smaller and more connected, we have to relearn how to get along. With our family, then our small tribe, then a larger tribe, then cities, countries and now we can see each other the world over. If all we see is what we fear and what horrifies us in our feeds, then we need to turn it off, breathe, and look for something to calm us down. Knit. Silly cat pictures. Flowers. What gives you a feeling of peace and hope? Whatever it is, do more of it and share it.

Blessings and peace you.

I don’t know who the person in the tintype is. I think that it came from a box from my Great Aunt Esther Parr, when I was in my early teens. My sister and I divided the tintypes and used them as portraits in our china doll houses.

For the Ragtag Daily Prompt: obituary.

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cancer pen

A patient told me about the “cancer pen” yesterday. I promptly pictured  Star Trek’s Bones holding his device over patients, but no, this has to touch tissue…aka a piece of you…and do a chemical evaluation. It is to be used during surgery.

Here: http://www.bbc.com/news/health-41162994

This is neat new technology… but. I can hear my sister saying, “Uh, so what about PREVENTION?”

This is technology to remove cancer after it’s already grown. And presumably metastasized. So this is stage II, stage III, stage IV cancer.

Cancer deaths are the second biggest cause of death in the US. Around 23% of yearly deaths and that does not count the people who survive cancer. At present we do not have many screening tests for cancer: pap smears continue to evolve, and now the recommendation is an HPV test or pap smear every five years AND we have a vaccine for the high risk HPV.
We can screen for colon cancer.
Mammograms for breast cancer.
The screen for prostate cancer sucks.
We can do skin checks.
The screen for lung cancer is now a low dose CT in a certain population that is high risk, that is, smokers. The recommendations have not addressed smoking marijuana.
Recommendations in the US are here: https://www.uspreventiveservicestaskforce.org/.

There are lots of cancers that we don’t have screens for…. yet.

Proteomics is on the horizon. Genomics is looking at the genes, but it turns out that lots of cancers and infections and other illnesses have particular protein patterns. There is TONS of research in this area. Someday we may have protein tests: put a drop of blood or urine on it and say, “Hmmm. Looks like you have a positive test, probable lung cancer.”

That in turn creates problems. Initially we may be able to diagnose a cancer but not FIND it. Also not know how to treat it. The first big study trying to set up lung cancer screening had over 600 worrisome CT scans out of 1000. How many lung cancers did they find? Nine. And half of the nine had symptoms and could be found on chest xray by the time they did repeat CTs. Think of the anxiety of the 600 people who might have cancer and “We will repeat the CT scan in four months. Don’t worry too much.” Also there were complications from biopsying the lungs, like bleeding and pneumonia….

The best bet to avoid cancer is still living in a healthy way: don’t smoke anything, avoid addictive substances, eat good food, exercise, have friends and loved ones, work for yourself and your community, do some things you love…..

 

I took the photograph of my sister in 2011. She died of breast cancer in 2012. Her blog is here: butterfly soup.

For the Daily Prompt: strut. Struts support things: airplane wings, cars, things that move. How do we as a culture support people to live healthy lives?