Sharing

A patient made me cry today.

Not that she meant to. But nonetheless it happened.

I was seeing her for Graves' disease. And when we went over her family and social history, she disclosed that she is a widow, at the young age of 35.

I was taken aback, especially hearing that she has 2 young girls, which only made me think of my kids. And so she shared her story of how her late husband, a firefighter, was diagnosed with an aggressive form of cancer in the prime of his life. How, knowing the odds, in his last few months he made an effort to ensure his kids will forever remember him long after he's gone. She talked about the things they did. How, 2 years later his girls still remember him whenever they see a butterfly.

Somehow, we went on to talk about losses. And knowing I had a cancellation after her and was not rushed for time, shared my story of Buddy.

And we talked about love, life, coping. And I couldn't help but imagine how things would be if I suddenly left this world and my wife and girls.

And while she talked about her loss but yet how they try to remember her late husband, at one point she started to tear up, and the tears came rolling down. And unexpectedly, my tears came right out too.

We were both a bit embarassed when I grabbed the box of Kleenex and we both took a couple.

But sometimes, it's unexpected but yet beautiful when patients share these touching stories with me.

Broken System

No patient should ever have to say: "I couldn't afford to come see you, doc. That's why it's been a year since my last visit".

In the meantime, they've been profoundly hyperthyroid, or their diabetes has been uncontrolled.

I saw several of these patients this week, and it was frustrating, and made me sad. To realize that the system is so complicated, so broken, that we encounter episodes like these.

And who ultimately suffers?

Our patients.

When naive medical graduates first take the Hippocratic oath, pledging to help humanity, none of us knew then the complexities of practice. Medical economics, bureaucracy, medical insurance, medical malpractice, cost of pharmaceuticals.

We just wanted to heal the sick. Simple as that. Not always cure as we do not have divine powers, but always to heal.

But when situations like these arise, truth be told it makes me feel instead that I've signed a pact with the devil.

In the case of my Graves' patient, she looked frankly cachectic, and has lost 40 lbs off her already lanky frame. And while the labs are pending, I know she's going to be thyrotoxic still.

And so, I made her promise that should finances ever become a barrier again, to call me. If I can't treat her in clinic, I can treat her over the phone. And we can minimize the need for labs once we get her levels stabilized.

But it's such a broken system.

Wii Fit

After a long lapse, we finally dusted off the Wii Fit and put in batteries. The girls were having cabin fever so I was looking for an activity to do with them.

Except I was unprepared for what came next.

"Oops, it has been 1445 days since you were last here..."

I could swear, I heard a tinge of sarcasm and a snigger when he said that. And the little prick wasn't very nice about my weight gain, either. Apparently, he found the increase to be a bit too much, and he wasn't shy saying it.

And so, ladies and gentleman, I'm officially overweight. Barely, but per BMI criteria, alas, I am.

So, I'm pledging to:

- Hit at least 8,000 steps a day on my pedometer

- Skip the chips at lunch (damn the doctors' lounge and their free chips!!)

- Run 5 km a week (I know, but it's a start...)

- Sell my Wii Fit on Craigslist

Girls vs Boys

Difference between girls and boys, best seen today at daycare dropoff.

Alli and friends: "Oh, I like your pink sweater...".

Boy (holding a toy helicopter): "I call this my Hell-copter. Because when they die, they don't come back...".

I think I'll stick to toenail painting and tutus, thank you very much

Bureaucreatic Nonsense, Part 2

I'm sick.

Sick and tired of this bureaucratic BS, really. So consider this Part 2 of my previous post about Bureaucratic Nonsense.

Today, kids, we will talk about formularies.

Formularies are types of medications that are preferred by an insurance carrier, usually for cost reasons. They have been prenegotiated and because of a discount for the carrier, these tend to be preferred for their patients.

Except, many of us wonder if these were made up also for the insurance companies' personal entertainment.

Every new year, we often get calls from patients, sometimes faxes from the carriers, that this year, Insulin X is no longer preferred, and the patients will need to be on Insulin Y. Or statin A versus statin B.

Never mind that they may have been on said medication for years, and well controlled. Never mind that they might have a reported adverse reaction (if you didn't document a good reason, if this occured when under the care of a different provider). Otherwise, they end up paying for this out of pocket.

And so, it's a cat and mouse game when every year, the insurance changes their preferred medications, and we have a barrage of calls from patients or pharmacies requesting alternatives.

And if it isn't a headache enough, this year, several insurance plans have been rasing the headache bar up a notch for clinics: I've been getting letters stating that Medication A is not preferred, with no reference to what an alternative might be. One of the carriers suggest that providers visit the website to look up alternatives. Which takes you to a nonsensical website that asks half a dozen questions about the insurance plans, group number etc.

Which leads me to my suspicion that health insurance carriers really aren't there to help the patient, but to try to discourage patients/physicians from utilizing resources in order to minimize their expenses.

Another phrase that our medical assistants have come to hate, is "prior authorization". PAs are more bureaucratic nonsense that the pharmacy/insurance carrier requires before they approve the medication. And this often takes multiple phone calls, filling of more paperwork, faxing, and waiting sometimes weeks for them to send a letter or approval or denial. And sometimes, PAs are required even if a medication is ON formulary.

Which brings us back to the F word.

Formularies.

Yeech.

Fairy Dancing

I just had to share this. We took this video of the girls dancing in their tutus to their favorite fairy show.

Though I grumble about it in public, the truth is it's fun being a dad to girls, and having all this girly stuff around. And I'm getting pretty good at painting the toenails, too!