It was a rare spring afternoon last year when I was able to leave the hospital early when I made a very eerie discovery in the doctor's lot. It was an odd hour to be leaving, so there was no one else in the lot and it was quiet in a rather ominous way. All I heard was the breeze through the trees in the cemetery across the street (creepy in its own right) and the whirr of the cooling motor that runs on an Audi that has recently been shut off. As I left the building, I made a shocking realization. I looked out into a sea of almost exclusively German made cars, expensive ones at that- BMW's, Mercedes-Benz, Audi's, even a few Porsche's. There were a few slumming it in Volkswagen's and Mini Coopers but most went for the big guns. And in the corner, there was a pack of BMW 3-Series cars whispering amongst themselves, looking at me in a very suspicious way. I had never noticed such an enormous collection of precision engineering all in one place in my life. Considering that Germany contributes a relatively small percentage of automobiles that are sold in the US every year, the fact that this lot was occupied by well over 50% German based cars just did not seem right. Looking back, I realized that this was not the first doctor's lot that I had seen this situation happen and I came to a startling realization.
Contrary to popular belief, not all physicians come from wealthy families. Our backgrounds are surprisingly diverse. The somewhat homogeneous presentation they exhibit is part of a slow and laborious process that they themselves are not even aware is occurring. At some point in a physician's career, most likely early on, but sometimes a bit later, the victim finds him/herself driven by an uncontrollable urge to go out and test drive a German made automobile. Sucked in by seductive advertising, offerings of unique options that are sure to make the cover of Car and Driver (seen in most hip doctor's office's) and sponsorship of "intellectual" sports (skiing, European motocross, biking), their attraction is irresistible. Eventually the unknowing victim is drawn into the world of high performance, precision tuned machinery that can only be found in the world of the German automobile industry. Each victim finds him/herself pulled helplessly into the direction of one of the manufacturers, much like a naive college student drawn into a cult. One cannot just like German cars, one must favor one brand, be it Porsche, Audi, BMW, etc. The victim will with time, learn all of the specific advantages of his/her chosen line over the others and will mindlessly spout those statistics towards anyone who dares ask. With time, the process becomes so entrenched in their mindset, the victim ceases to exist as an independent thinker and is transformed into a mindless, non-thinking German Car Zombie. These poor victims roam the halls of the hospitals and medical offices staring blindly flashing enormous German Car key fobs, talking about needing to have their car taken in to have their oil changed with full synthetic oil and complaining about the price of high test gasoline loudly. They shuffle to their cars at the end of the day, arms outstretched, mumbling in a monotonous tone "must have high performance German technology." When their cars get old, they trade them in for the next level car of the same brand, never wavering from their blind obsession with their maker of choice. They will use words like "4matic", "Quattro", "Ultimate Driving Machine" with reckless abandon.
Having chosen a pet manufacturer, they will argue about the pecking order by which cars must yield right of way to one another on the Autobahn. They will be very fast to criticize any other manufacturer and quote specific reasons for their dislike of said manufacturer. They will talk about how the Germans put down said manufacturer, even if they have never actually been to Germany, which most of them have not. They park their cars in groupings, Audi's in one cluster, BMW's in another so as not to be infected by mechanical "cooties." They cluster in set regions of the lot much like the Crips and the Bloods have their turf wars and much woe will fall upon the unsuspecting Lexus that tries to breach that territory. The victims of such cults take on a certain paranoia about the "other" cars out there with time, as if those cooling engines one hears were more than just high tech devices designed to fail, so as to give the dealership more business at the service department. They are growling monsters set to pounce on anyone who dares to disrespect their clan.
Which leads me to my daily struggle. I never should have listened to the psych nurse on the unit who told me that the Germans called BMW's "Euro Trash". That only let me to the habit of making a point to every BMW owner that I met that Audi has moved ahead of BMW in the pecking order on the Autobahn, especially since the inception of the TT. But hey, my TT gave me some of the most fun I have ever had in a four wheeled vehicle, and besides, the new A4 did outrank the BMW 3 series in horsepower, acceleration and gas mileage. Besides, no one has ever beaten the Quattro all wheel drive system at road handling, especially those lousy BMW rear wheel drive transmissions, so HA! Beat that! Hey 3 Series guys, just try to catch me in a snowstorm! You will be stuck in a ditch in a heartbeat! I DARE you!......
...As ashamed as I am to admit it, I too, am a German Car zombie.
Thursday, March 25, 2010
Monday, March 22, 2010
The Doctor's Parking Lot Horror - Part I
Some would call me crazy, but I know I am being stalked by a gang of BMW 3 series cars that park in the physician's lot outside the hospital where I work. Since I work at the hospital full time, I get a good view of the cars that are parked there and they know me. They lurk in the corner of the lot when I walk to my car, whispering amongst themselves, plotting some unknown evil scheme that they will one day spring on me when I least expect it. My paranoia arose from a horrible realization that I made one spring day last year. It is the kind of story that Steven King novels are made of.
Doctors, as a general rule, drive one of two types of cars. One is the ridiculously overpriced status symbol which may, or may not have any real need to large/expensive/fast but they are that way nonetheless. Many are enormous gas guzzling POS SUV's that have no real purpose for existing. Sure, they carry all the kids, and they are all wheel drive which helps in the winter which is important. The fact that a Pontiac Vibe has all of those qualities does not count. It is not expensive, flashy and overloaded with all kinds of high tech gadgets that are bound to malfunction but look really cool and are sure to impress. Then there are the expensive luxury imports, usually German with all their high performance engineering, fast race inspired engines, gleaming chrome and sleek beauty. There are eternal arguments about which make is above which other in the pecking order on the Autobahn in the medical staff lounge. Not that it matters here but it makes one look really cool.
Second is the "I don't buy into that nonsense" doctors who drive decaying POS junkers that are usually missing a hub cap or two, part of the body molding, and blow black smoke out of the tale pipe. Some have black smoke coming from underneath the hood as well. These doctors are determined to drive their vehicles into the ground then will hopefully inherit a late aunt's old 1984 Crown Vic so to save them from have to actually deal with buying something new. Depending on the particular physician's leanings, their ride may bear bumper stickers declaring their support for very outdated political figures such as: Bush/Quail or stating "Bush (as in HW) lost, get over it." These guys are the ones who will have the audacity to park next to the most expensive car in the lot. The ones that even the standard issue expensive car owners will not park next to due to fear of being "not worthy." Every doctor's lot is going to have the occasional showing of the outlandishly expensive car- Bentley, Ferrari, Dodge Viper, Rolls Royce, etc. to make sure everyone feels inadequate. Except the for the POS owners. They are not impressed by any of this nonsense and are going to park next to these cars just to prove it. I wish I had that kind of gall, but I must confess, I am too much of a pussy. I have parked near a Ferrari just to get a look at it, but would never dare park adjacent to it.
There are always a few outliers who do not fit into either category. Those that have the "practical" car, not too expensive, but well built and reliable. Usually they are noted for good reliability (Toyota used to be one of them), able to manage well in the snow, can carry a lot of cargo and have good fuel efficiency. In other words, indescribably boring. Some doctors have common sense, but they are by far in the minority.
With all of that said, this leads me back to why I am being persecuted by a group of rogue BMW's. Having been a bit verbose, I am going to pull a Quentin Tarantino and continue this story in my next entry.
Doctors, as a general rule, drive one of two types of cars. One is the ridiculously overpriced status symbol which may, or may not have any real need to large/expensive/fast but they are that way nonetheless. Many are enormous gas guzzling POS SUV's that have no real purpose for existing. Sure, they carry all the kids, and they are all wheel drive which helps in the winter which is important. The fact that a Pontiac Vibe has all of those qualities does not count. It is not expensive, flashy and overloaded with all kinds of high tech gadgets that are bound to malfunction but look really cool and are sure to impress. Then there are the expensive luxury imports, usually German with all their high performance engineering, fast race inspired engines, gleaming chrome and sleek beauty. There are eternal arguments about which make is above which other in the pecking order on the Autobahn in the medical staff lounge. Not that it matters here but it makes one look really cool.
Second is the "I don't buy into that nonsense" doctors who drive decaying POS junkers that are usually missing a hub cap or two, part of the body molding, and blow black smoke out of the tale pipe. Some have black smoke coming from underneath the hood as well. These doctors are determined to drive their vehicles into the ground then will hopefully inherit a late aunt's old 1984 Crown Vic so to save them from have to actually deal with buying something new. Depending on the particular physician's leanings, their ride may bear bumper stickers declaring their support for very outdated political figures such as: Bush/Quail or stating "Bush (as in HW) lost, get over it." These guys are the ones who will have the audacity to park next to the most expensive car in the lot. The ones that even the standard issue expensive car owners will not park next to due to fear of being "not worthy." Every doctor's lot is going to have the occasional showing of the outlandishly expensive car- Bentley, Ferrari, Dodge Viper, Rolls Royce, etc. to make sure everyone feels inadequate. Except the for the POS owners. They are not impressed by any of this nonsense and are going to park next to these cars just to prove it. I wish I had that kind of gall, but I must confess, I am too much of a pussy. I have parked near a Ferrari just to get a look at it, but would never dare park adjacent to it.
There are always a few outliers who do not fit into either category. Those that have the "practical" car, not too expensive, but well built and reliable. Usually they are noted for good reliability (Toyota used to be one of them), able to manage well in the snow, can carry a lot of cargo and have good fuel efficiency. In other words, indescribably boring. Some doctors have common sense, but they are by far in the minority.
With all of that said, this leads me back to why I am being persecuted by a group of rogue BMW's. Having been a bit verbose, I am going to pull a Quentin Tarantino and continue this story in my next entry.
Sunday, March 21, 2010
Have you ever tried to find a phone book that does not have an ad for an attorney on the back? I have travelled a lot of places in this country and always make a point of checking the back of the phone book to see. Most of the time, they are malpractice attorneys at that. So far, in my years of searching, I have probably checked over 100 different phone books in at least 15 states and have only found one phone book that did not, and that one was very out of date. The phone book we receive here even has a magnet of a malpractice attorney firm on the cover so one can put it on the refrigerator just in case one comes upon the emergent need to file a malpractice lawsuit.
Do not get me started on the class action lawsuit ads against every medication that has that possibility of have some unpleasant side effect. Many of those ads are targeting some of the very precious few decent medications that psychiatry has available to help people improve their quality of life. Realistically, the benefits of the medications far outweigh the risks of the side effects, which are at times extraordinarily rare and often cannot be proven to have actually been caused by the medication itself vs the fact that some people are going to get diabetes, weight gain, etc.
The problem is there are too many lawyers. Law schools do not do a good job at limiting the amount of new lawyers to the amount that the market is going to need. A lot of new lawyers are graduating with no job and $75,000 or more of student loans to pay off. Even when they do get jobs in a criminal or civil law firm, there are only so many criminal or civil cases out there. So they create work by drumming up malpractice cases, class action suits and social security disability cases.
Lawyers know there are too many lawyers out there when they enter the field. I have spoken to many of them who admit that it is very difficult to get by so I do not have a lot of pity on these guys. They knew what they were getting into when they entered law school. Like most doctors out there, there is not a lot of love lost between all those Social Security disability/malpractice/class action suit lawyers and me. The guy that did the closing on our home mortgage, he is okay. But he is not stabbing anyone in the back to pay his bills, either.
The debate has raged endlessly about putting limits on excessive malpractice suit payouts, and I, like most doctors support this, but I do not expect to see this happen anytime soon. For one, there are a lot more lawyers than doctors. Medical schools do not overproduce doctors, they try to use some common sense. Second, most of our legislators are attorneys and there are very few doctors elected to public office. My response to the whole thing is to at least stand up as a group and voice our dissatisfaction with the corrupt malpractice attorneys but designating an official:
Do not get me started on the class action lawsuit ads against every medication that has that possibility of have some unpleasant side effect. Many of those ads are targeting some of the very precious few decent medications that psychiatry has available to help people improve their quality of life. Realistically, the benefits of the medications far outweigh the risks of the side effects, which are at times extraordinarily rare and often cannot be proven to have actually been caused by the medication itself vs the fact that some people are going to get diabetes, weight gain, etc.
The problem is there are too many lawyers. Law schools do not do a good job at limiting the amount of new lawyers to the amount that the market is going to need. A lot of new lawyers are graduating with no job and $75,000 or more of student loans to pay off. Even when they do get jobs in a criminal or civil law firm, there are only so many criminal or civil cases out there. So they create work by drumming up malpractice cases, class action suits and social security disability cases.
Lawyers know there are too many lawyers out there when they enter the field. I have spoken to many of them who admit that it is very difficult to get by so I do not have a lot of pity on these guys. They knew what they were getting into when they entered law school. Like most doctors out there, there is not a lot of love lost between all those Social Security disability/malpractice/class action suit lawyers and me. The guy that did the closing on our home mortgage, he is okay. But he is not stabbing anyone in the back to pay his bills, either.
The debate has raged endlessly about putting limits on excessive malpractice suit payouts, and I, like most doctors support this, but I do not expect to see this happen anytime soon. For one, there are a lot more lawyers than doctors. Medical schools do not overproduce doctors, they try to use some common sense. Second, most of our legislators are attorneys and there are very few doctors elected to public office. My response to the whole thing is to at least stand up as a group and voice our dissatisfaction with the corrupt malpractice attorneys but designating an official:
National Give a Malpractice Attorney a Wedgie Day
During that time, all reasonable adults should be allowed to, without fear of repercussion, be allowed to give as many wedgies to as many malpractice attorneys as they like. It may not get anything done, but it would sure be a lot of fun and for once maybe these guys would know what it was like to be on the receiving end.
Friday, March 19, 2010
Thank God for Generics- part II
Returning to the issue of money buying happiness, and the endless debate about health care reform, the lines between money and happiness get blurred in this arena. It takes money to have health care, and it takes money to buy health insurance. I can think of a lot of situations where lack of money and, therefore, health insurance would have guaranteed certain suffering. The mere existence of health insurance brought a great deal of happiness into a person's life. Most people can probably think of a case in their own life of a friend or family member struck with a life threatening illness that would not have survived without treatment. Most people do not stop to think about the cost until they are faced with the bill and no way to pay for it.
In my own life, the happiest thing that ever happened to me came at a very great expense. It is very easy to criticize the enormous cost of Neonatal Intensive Care Unit (NICU) care until one becomes the parent of a child who is a patient in one. After that, there is no test, procedure or intervention that is too expensive if it was needed to help ensure one's own child's survival. I faced this situation four years ago, quite unexpectedly one winter day while eating lunch at work. Without warning, at 34 weeks pregnant, I felt my amniotic fluid leaking. Up to that date, everything had gone perfect, no problems, complications, the baby's size was good and I felt great. I did not smoke, drink, do drugs or abuse my body. I ate well, took care of myself, had good prenatal care, a supportive husband and so on. My only sin was advanced maternal age but no one else seemed too worried about this so neither did I. Until that day.
The series of events that followed were somewhat of a blur with a lot of panicked phone calls to my husband at work, a trip to the obstetrician and hospital and the eventual comedy of errors that lead to the birth of a somewhat distressed boy who was healthy for his age and able to breathe on his own, thankfully. He spent the next 31 days in the NICU and my husband and I spent our days going between our home and the NICU several times a day to visit him. I even returned to work part time so not as to burn up all of my maternity leave. I would dutifully see patients for two hours then hiking down the block to nurse him and return to see more patients. Neither one of us thought we could endure but one of the other NICU parents told us "you get used to it" and he was right. Eventually we learned the routine enough to endure until the magical day when he was finally released to go home. He wore oxygen by nasal cannula for several months and an apnea monitor for several more. The oxygen tanker that came every two weeks to fill up the big silver missile in our living room did tend to attract some odd looks in the neighborhood and it was hard enough being inexperienced parents without family nearby to help us learn how to care for a newborn as it was. We certainly could do without the hindrance of a 30 foot tube that he had to be kept tethered to 24 hours a day, but somehow we endured.
Today, our son is a perfectly healthy four year old who knows how to read quite a few words, asks questions like "how do Ipods work?", and loves to go to Preschool and swimming classes. No one would ever know how rocky his start to life was unless we told them. For all the torment we went through, I would do it all again to have a healthy child now. I was lucky enough to have health insurance to cover most of the bills, although I still had around $5000 out of pocket expenses to pay. Not a problem for a doctor, but the cleaning staff working at minimum wage might have a tough time stomaching this kind of bill. Imagine life for those without insurance. For those who do not want health care reform, think about those people and their children before rejecting the idea entirely.
In summary:
The total bill for the NICU alone: about $75,000.
The cost of the RSV vaccine he received every month for several months after discharge: $1600 per injection.
Apnea monitor:$350 per month rental fee.
Home oxygen and equipment:Your guess is as good as mind.
Having a healthy, happy child:Priceless.
Tuesday, March 16, 2010
Today was not a good day at work. The unit was full, a lot of the patients were angry about being there, and far too sick to be released and the staff's nerves were frazzled. These days will happen. They go in cycles and these are one of the more difficult times. It will get better sooner or later but after hearing a litany of profanities all day, being told about how incompetent I am and hearing repeated threats that I will be sued/arrested/killed, etc. it tends to get to a person. To make matters worse, it was a warm sunny day for the first time in months, and we were all stuck inside. Maybe that is why the patients were so agitated.
Either way, it was a good day to leave work which I did with a great deal of alacrity once I was able. I was a great day to drive with the sun roof open, and the satellite radio cranked. Too bad all of the cars in front of me did not seem to think that driving as fast as I like to drive was part of their way to have a good time driving home. For some reason, I have found that part of the best way to enjoy driving with the sun roof open and the music turned up is to do the same, only drive the car faster. People in this are drive slow. Real slow. It drives me nuts. The whole driving conservatively thing is one area that I admit that I have failed to be very Zen about, and probably always will and did little to soothe my frazzled nerves.
Despite my rather sluggish peers' attempts to reform me, I eventually did get home alive and well and was reminded of something that is far more important in life that the opinions of a few select individuals who struggle with illnesses that impair their insight. My husband and four year old son were in the front yard cleaning up the remnants of the wind storms that have torn apart the trees this winter and the gravel the township throws on the road to make it passable to get to work in the snow when I got there. The reception that my son gave me could not have been any more joyful if he tried. He immediately abandoned helping Daddy (a very important job, indeed) and came running up to my car shouting for "MOMMY!" loud enough to hear over the satellite radio and the gravel on the road. He was so excited to see me that one would have thought that he had not seen me in months. I have not felt so important in a long time. Money, prestige, respect, all of those things are nice perks of being a doctor, but their value pales in comparison to the love of a child. There are joys in life that are easily taken for granted, but can mean so much.
Thanks, MRM for making my day.
Love, Mommy
Either way, it was a good day to leave work which I did with a great deal of alacrity once I was able. I was a great day to drive with the sun roof open, and the satellite radio cranked. Too bad all of the cars in front of me did not seem to think that driving as fast as I like to drive was part of their way to have a good time driving home. For some reason, I have found that part of the best way to enjoy driving with the sun roof open and the music turned up is to do the same, only drive the car faster. People in this are drive slow. Real slow. It drives me nuts. The whole driving conservatively thing is one area that I admit that I have failed to be very Zen about, and probably always will and did little to soothe my frazzled nerves.
Despite my rather sluggish peers' attempts to reform me, I eventually did get home alive and well and was reminded of something that is far more important in life that the opinions of a few select individuals who struggle with illnesses that impair their insight. My husband and four year old son were in the front yard cleaning up the remnants of the wind storms that have torn apart the trees this winter and the gravel the township throws on the road to make it passable to get to work in the snow when I got there. The reception that my son gave me could not have been any more joyful if he tried. He immediately abandoned helping Daddy (a very important job, indeed) and came running up to my car shouting for "MOMMY!" loud enough to hear over the satellite radio and the gravel on the road. He was so excited to see me that one would have thought that he had not seen me in months. I have not felt so important in a long time. Money, prestige, respect, all of those things are nice perks of being a doctor, but their value pales in comparison to the love of a child. There are joys in life that are easily taken for granted, but can mean so much.
Thanks, MRM for making my day.
Love, Mommy
Monday, March 15, 2010
Thank God for Generics- part I
We have all heard at some point that money cannot buy happiness. I truly believe this as I have seen some very wealthy people who were still quite miserable people. The smart ass response "yeah, but poverty ain't so hot either" does make a valid point, however. Going without food/shelter/heat, etc is not a whole lot of fun either. But the over
all point, that happiness comes from within is all too easily forgotten, especially when one is bombarded with images of the "Cribs" of the stars, exclusive vacation islands of the wealthy and cancerous Manhattan penthouses owned by CEO's of large corporations.
Despite its propensity to drive people to greed and corruption, money is not all bad. $4.00 can buy you a month's supply of generic Prozac at many pharmacies. And $125,000 can buy you an Audi R8 so you can get to the pharmacy really fast and look really cool to boot. My husband does not understand this point, but I am fully of the belief that I could derive a whole lot of happiness out of an Audi R8. Not that I am not happy now, I am, but if I had a really bitchin' ride like that, it would be off the charts.
In stark contrast, lack of money has caused a definite level of misery that cannot be ignored. Now I am getting political as a warning. I realize that the whole health care reform debate is heated and has caused a lot of division in this nation, but I work in a system where probably 1/2 of my patients are uninsured. Struggle though we might to scrounge and get them Medical Assistance, this often falls through and a very common cause of readmission of patients is lack of access to care. It is heartbreaking to work with a patient to get him/her well and on the path to recovery to hear that a few weeks later the same patient is in the ICU on a ventilator after an overdose. Once stabilized, their stories often sound very familiar "they denied me medical coverage because I was working and earned just a few dollars too much" or "some piece of paperwork got lost in the mail and the shut of my Medicaid." The end result often is the same. The patient cannot afford to come in for outpatient appointments, cannot afford his/her medications and suffers a relapse of his/her symptoms. This especially bothers me in patients that are employed and trying to get by but cannot afford the $1000 monthly cost for (individual) medical insurance or do not qualify at all due to pre-existing clauses. Forced to make choices between paying the bills or coming in for appointments, they pay the bills, prescriptions do not get filled and they decompensate. True, some psychotropic medications can be bought for $4.00, but many of the newest ones with the fewest side effects can cost hundreds of dollars a months.
I am not going to say that a $4.00 script for Prozac can make someone totally happy, there is no true "happy pill" out there, but it is a good tool to help our patients on the road to getting well and solving the problems that got them depressed. Without the medications, relapse into the torment of depression or psychosis is almost certain. People do not like the idea of health care reform, but without some kind of change, a lot of people are going to continue to suffer and put a strain on an already overburdened health care system. Those people are not just numbers, they are real people with real feelings and deserve care just as much as those of us who are lucky enough to have jobs that provide health insurance.
I am not sure if the bill in front of Congress is the answer to our ailing health care system, but I do know that doing nothing is certainly not. Nor am I suggesting that reforming the entire health care system in a few months with a bill thrown together by a bunch of mostly attorneys is the way to go about reforming the system, but at least someone is trying to address the problem. If I had the chance to talk to the President, I would recommend he form a committee comprised of doctors, nurses and other health care providers, hospital administrators, and yes, even insurance execs and have them come up with a plan that makes sense for the American people. Attorneys need not apply. When they come up with a plan, present it to congress, put it up for a vote and fix this system before it bankrupts the country. Then I would let all the doctors of the country go out and kick the @%*& out of all those ambulance chaser attorneys who are driving up the cost of malpractice insurance and prescription medication by suing every pharmaceutical company out there because it gave someone a headache.
Now THAT would make me happy. But not as much as the Audi R8.
Next - Thank God for Generics - part II
all point, that happiness comes from within is all too easily forgotten, especially when one is bombarded with images of the "Cribs" of the stars, exclusive vacation islands of the wealthy and cancerous Manhattan penthouses owned by CEO's of large corporations.Despite its propensity to drive people to greed and corruption, money is not all bad. $4.00 can buy you a month's supply of generic Prozac at many pharmacies. And $125,000 can buy you an Audi R8 so you can get to the pharmacy really fast and look really cool to boot. My husband does not understand this point, but I am fully of the belief that I could derive a whole lot of happiness out of an Audi R8. Not that I am not happy now, I am, but if I had a really bitchin' ride like that, it would be off the charts.
In stark contrast, lack of money has caused a definite level of misery that cannot be ignored. Now I am getting political as a warning. I realize that the whole health care reform debate is heated and has caused a lot of division in this nation, but I work in a system where probably 1/2 of my patients are uninsured. Struggle though we might to scrounge and get them Medical Assistance, this often falls through and a very common cause of readmission of patients is lack of access to care. It is heartbreaking to work with a patient to get him/her well and on the path to recovery to hear that a few weeks later the same patient is in the ICU on a ventilator after an overdose. Once stabilized, their stories often sound very familiar "they denied me medical coverage because I was working and earned just a few dollars too much" or "some piece of paperwork got lost in the mail and the shut of my Medicaid." The end result often is the same. The patient cannot afford to come in for outpatient appointments, cannot afford his/her medications and suffers a relapse of his/her symptoms. This especially bothers me in patients that are employed and trying to get by but cannot afford the $1000 monthly cost for (individual) medical insurance or do not qualify at all due to pre-existing clauses. Forced to make choices between paying the bills or coming in for appointments, they pay the bills, prescriptions do not get filled and they decompensate. True, some psychotropic medications can be bought for $4.00, but many of the newest ones with the fewest side effects can cost hundreds of dollars a months.
I am not going to say that a $4.00 script for Prozac can make someone totally happy, there is no true "happy pill" out there, but it is a good tool to help our patients on the road to getting well and solving the problems that got them depressed. Without the medications, relapse into the torment of depression or psychosis is almost certain. People do not like the idea of health care reform, but without some kind of change, a lot of people are going to continue to suffer and put a strain on an already overburdened health care system. Those people are not just numbers, they are real people with real feelings and deserve care just as much as those of us who are lucky enough to have jobs that provide health insurance.
I am not sure if the bill in front of Congress is the answer to our ailing health care system, but I do know that doing nothing is certainly not. Nor am I suggesting that reforming the entire health care system in a few months with a bill thrown together by a bunch of mostly attorneys is the way to go about reforming the system, but at least someone is trying to address the problem. If I had the chance to talk to the President, I would recommend he form a committee comprised of doctors, nurses and other health care providers, hospital administrators, and yes, even insurance execs and have them come up with a plan that makes sense for the American people. Attorneys need not apply. When they come up with a plan, present it to congress, put it up for a vote and fix this system before it bankrupts the country. Then I would let all the doctors of the country go out and kick the @%*& out of all those ambulance chaser attorneys who are driving up the cost of malpractice insurance and prescription medication by suing every pharmaceutical company out there because it gave someone a headache.
Now THAT would make me happy. But not as much as the Audi R8.
Next - Thank God for Generics - part II
Friday, March 12, 2010
The Best of the Worst
The best part about working in psychiatry is that the stories we take home are a whole lot more interesting than the ones that our colleagues in other specialties do. Surgery may have a great deal of prestige and responsibility, but when it comes down to it, an appendectomy is an appendectomy. In my work have have met God, the Antichrist, top CIA operatives, and people important enough to be monitored by the Navy and aliens. I know people who have spend hundreds of thousands of dollars in a day (literally) that were not top execs for a Fortune 500 company. I have heard elaborate delusional systems that took years to put together. Now that is interesting. With that, I leave you with some of the "Best of" stories I have collected through the years:
1)Best excuse given for the need for an early refill of Xanax: "Shamu ate my Xanax."
2)Most cars bought by one person in a weeks time (who was not an auto dealer):15.
3)Most extravagant purchase that a patient that I have treated has ever made: a strip mall.
4)Most extravagant purchase that a co worker's patient has ever made: a Boeing 747.
5)Largest testicles I have ever seen: about the size of a soccer ball.
6)Best delusional system devised to explain having testicles the size of a soccer ball:"It's the beta rays that did it."
N.B. Real reason for testicles being that large: severe untreated congestive heart failure. They returned to normal once he was treated.
7)Most memorable question asked of a male family practice intern sent to suture up a gash in the eyebrow of a middle aged female patient with schizoaffective disorder:"Will I still be able to have intercourse with these in?"
N.B.-Advice to intern- "Just ignore that question and keep sewing."
8)Worst mislabeling of a patient's diagnosis: schizodefective disorder. Correct Dx: schizoaffective disorder.
9)Strangest thing I have ever been accused of being from a delusional patient: a member of the Freemasons.
And finally....
10)The most unpleasant piece of information I have heard imparted from one nurse orienting a new nurse to the unit: "You'd be surprised how many people in (our town) don't wear underwear."
1)Best excuse given for the need for an early refill of Xanax: "Shamu ate my Xanax."
2)Most cars bought by one person in a weeks time (who was not an auto dealer):15.
3)Most extravagant purchase that a patient that I have treated has ever made: a strip mall.
4)Most extravagant purchase that a co worker's patient has ever made: a Boeing 747.
5)Largest testicles I have ever seen: about the size of a soccer ball.
6)Best delusional system devised to explain having testicles the size of a soccer ball:"It's the beta rays that did it."
N.B. Real reason for testicles being that large: severe untreated congestive heart failure. They returned to normal once he was treated.
7)Most memorable question asked of a male family practice intern sent to suture up a gash in the eyebrow of a middle aged female patient with schizoaffective disorder:"Will I still be able to have intercourse with these in?"
N.B.-Advice to intern- "Just ignore that question and keep sewing."
8)Worst mislabeling of a patient's diagnosis: schizodefective disorder. Correct Dx: schizoaffective disorder.
9)Strangest thing I have ever been accused of being from a delusional patient: a member of the Freemasons.
And finally....
10)The most unpleasant piece of information I have heard imparted from one nurse orienting a new nurse to the unit: "You'd be surprised how many people in (our town) don't wear underwear."
Wednesday, March 10, 2010
The Third Sign of Spring
The third sign of spring is probably the most predictable, and requires the most patience, but these can also be the most entertaining. That is the Floridly Euphoric Manic Patient Who is Just Thrilled to See You! By the way, is your friend over there married? He seems to be a bit young, but I just LOVE green eyes and men in Levi's and did I tell you about the guy that my daughter was dating who wore Levi's three years ago? Boy, he was a catch, she should have never let that one go, but well, he did not want to move when she got that promotion and it was a good opportunity and I guess that I cannot blame her because she has dental and that is hard to get now, besides........
Manic patients have always traditionally be thought of in popular culture as euphoric, happy-go-lucky types that are full of energy and life. In reality, they rarely show up this way, and certainly not on a psychiatric unit. They are more often angry, labile, demanding and can be quite dangerous. There is NOTHING wrong with them and they DO NOT want to be in the hospital and they are not going to be nice about telling you this. They really do not want to take any medication that slows them down. The fact that the patient was just fired from a minimum wage job for threatening to kill the supervisor and just bought a brand new Dodge Viper is not a problem. He has just written a rap lyric that he is quite certain he plans to sell to Eminem and make millions and being in the hospital is just an impedance in doing that. The patient is in a hurry too. That first payment for the Viper is due in a week and $125,000 is a lot of car loan to pay off.
Springtime manic patients are not always very nice either, but there are always a few that come in looking like they have been in hibernation for the past three months and have saved up all those thoughts and are going to tell you them in the next 1/2 hour. Then they are going to set you up with their son, find themselves a new husband, buy new cars for everyone on the unit that does not have one, open up a new stock portfolio, negotiate world peace, and so on. They need to get to that NOW because they have a bunch of stuff to get to tomorrow, also. They are best kept away from classified ads and younger men. I recall a patient several years ago who came upon a much younger man, pulled up a chair and announced loud enough for the whole unit to hear "Well, aren't you just the most handsome young hunk of meat I have ever laid eyes on!" I was not sure if she was talking about a side of beef or the patient. Lots of fun, these guys. Sometimes they can be a bit verbose and it can be hard to get them out of your office, especially when they are talking about their grandchildren or some rude store supervisor at the mall that they had a run in with, but they do add a lot of color. Once they show up, I know that the bright colors of Spring are sure to show up soon, too.
Or at least a lot of bear poop in my back yard.
Manic patients have always traditionally be thought of in popular culture as euphoric, happy-go-lucky types that are full of energy and life. In reality, they rarely show up this way, and certainly not on a psychiatric unit. They are more often angry, labile, demanding and can be quite dangerous. There is NOTHING wrong with them and they DO NOT want to be in the hospital and they are not going to be nice about telling you this. They really do not want to take any medication that slows them down. The fact that the patient was just fired from a minimum wage job for threatening to kill the supervisor and just bought a brand new Dodge Viper is not a problem. He has just written a rap lyric that he is quite certain he plans to sell to Eminem and make millions and being in the hospital is just an impedance in doing that. The patient is in a hurry too. That first payment for the Viper is due in a week and $125,000 is a lot of car loan to pay off.
Springtime manic patients are not always very nice either, but there are always a few that come in looking like they have been in hibernation for the past three months and have saved up all those thoughts and are going to tell you them in the next 1/2 hour. Then they are going to set you up with their son, find themselves a new husband, buy new cars for everyone on the unit that does not have one, open up a new stock portfolio, negotiate world peace, and so on. They need to get to that NOW because they have a bunch of stuff to get to tomorrow, also. They are best kept away from classified ads and younger men. I recall a patient several years ago who came upon a much younger man, pulled up a chair and announced loud enough for the whole unit to hear "Well, aren't you just the most handsome young hunk of meat I have ever laid eyes on!" I was not sure if she was talking about a side of beef or the patient. Lots of fun, these guys. Sometimes they can be a bit verbose and it can be hard to get them out of your office, especially when they are talking about their grandchildren or some rude store supervisor at the mall that they had a run in with, but they do add a lot of color. Once they show up, I know that the bright colors of Spring are sure to show up soon, too.
Or at least a lot of bear poop in my back yard.
Tuesday, March 9, 2010
The second sign of spring
The second sign of Spring to arise is more understandable, often comedic, but sometimes not very pretty. Apparently Daniel Craig, of James Bond fame is not bipolar, or if he is, is controlled enough that he does not get ragingly manic every Spring. No one with his build ever seems to either, for that matter. The Second Sign of Spring is the inevitable manic patient brought in by law enforcement running naked through the streets. Mania and springtime go hand in hand, and when it has been below freezing for weeks on end, once the thermometer rises above 40, some people apparently interpret the weather downright balmy.
There is some scientific explanation to the onset of manic symptoms in the Spring, much of it having to do with increasing length of day and the effects this has on the brain and sleep patterns. Were it not for artificial lighting, we would all sleep less when the days are short and more when the days are long. When bipolar patients sleep less, they get manic. When people get manic, they sleep even less. A lot less. I have had patients go for a full week without sleep and they still are not tired. Their spouses/significant others/people they are trying to negotiate world peace with are. They are not. And their houses are VERY clean.
Which brings me back to sign two. The days are getting longer, the temperature is rising, and love is in the air. Sooner or later, someone is going to have an unfortunate "out of clothing experience" that is going to raise the eyebrows of the neighbors and 911 is going to get a call. Eventually they are brought in to the ER, and hopefully the police have been kind enough to have found something to cover these guys up with before frostbite sets in. Of course the whole need to "strip and search" the patient ritual is rather abbreviated, although I have seen this documented in the medical record. Not that when you joke with the intake staff about exactly what they were stripping or where they were searching on a naked patient, do they ever get it. Maybe if Daniel Craig were to be brought in naked they would not be so tense about the issue.
I mentioned love being in the air, but in this case love never seems to have anything to do with any of these particular cases. So far most of the patients I have asked have been at a loss as to why they were running around naked. Usually the answer is a "it just sounded like a good idea at the time" type of response.
This has happened without fail pretty much every year for as long as I can remember, this year being no exception. By now, we have had several warm days, quite a bit of snow has melted and there are enough black bear paw prints and droppings in our back yard to be certain winter is on its way out by now, but prior to the neighborhood bear's decorations, the third and final sign appeared at work.
Next, the Third Sign of Spring.
There is some scientific explanation to the onset of manic symptoms in the Spring, much of it having to do with increasing length of day and the effects this has on the brain and sleep patterns. Were it not for artificial lighting, we would all sleep less when the days are short and more when the days are long. When bipolar patients sleep less, they get manic. When people get manic, they sleep even less. A lot less. I have had patients go for a full week without sleep and they still are not tired. Their spouses/significant others/people they are trying to negotiate world peace with are. They are not. And their houses are VERY clean.
Which brings me back to sign two. The days are getting longer, the temperature is rising, and love is in the air. Sooner or later, someone is going to have an unfortunate "out of clothing experience" that is going to raise the eyebrows of the neighbors and 911 is going to get a call. Eventually they are brought in to the ER, and hopefully the police have been kind enough to have found something to cover these guys up with before frostbite sets in. Of course the whole need to "strip and search" the patient ritual is rather abbreviated, although I have seen this documented in the medical record. Not that when you joke with the intake staff about exactly what they were stripping or where they were searching on a naked patient, do they ever get it. Maybe if Daniel Craig were to be brought in naked they would not be so tense about the issue.
I mentioned love being in the air, but in this case love never seems to have anything to do with any of these particular cases. So far most of the patients I have asked have been at a loss as to why they were running around naked. Usually the answer is a "it just sounded like a good idea at the time" type of response.
This has happened without fail pretty much every year for as long as I can remember, this year being no exception. By now, we have had several warm days, quite a bit of snow has melted and there are enough black bear paw prints and droppings in our back yard to be certain winter is on its way out by now, but prior to the neighborhood bear's decorations, the third and final sign appeared at work.
Next, the Third Sign of Spring.
Sunday, March 7, 2010
The signs of spring
Having been buried under three plus feet of snow for weeks has made it rather difficult for us to imagine that the Earth was ever going to return to life. Winter in PA has been worse this year than usual with long periods of dreary days being the only reprieve from yet another snow storm coming to bury us even deeper. I used to fight winter, choosing to complain incessantly about every cold day until the first blessed day when the thermometer hit 70 and it was warm enough to wear shorts. The years have taught me to approach the winter in a more Zen fashion. To me, it is cold because it is supposed to be cold, and when it is not, it is a sure sign of global warming and I am more likely to worry then. Rather than complain, I accept that winter is cold and dreary and there is nothing I can do to change it. So I have a car with all wheel drive, a manual transmission and as many "cute" snow boots as I have "cute" shoes (Carrie Bradshaw would be so proud). I have plenty of reason to be happy with my life despite the snow and I enjoy it.
And I patiently wait for the inpatient unit signs of Spring.
I have seen a pattern of admissions that occur with rather consistent regularity every year on the inpatient units I have worked on that let me know that Spring is on its way. They may come early, they may come late, but they come. When they do I know that sooner or later the daffodils will be pushing up from the soil and the mountains in the distance will no longer be gray and dreary. There was still three feet of snow on my front yard when we got our signal this year, so it was a real boost to weary souls.
The First Sign of Spring: The Sale on Crazy: Some things that occur in psychiatry are predictable. People get depressed in the winter and fall. They get manic in the Spring. College freshmen get admitted in the early fall. There are causes for this that are easily explained. This one does not have an obvious explanation, but it happens, and it happens first. I do not know why, but I welcome it, nonetheless. For some reason, in the late Winter or very early Spring, there always seems to be a huge influx of admissions of really psychotic patients. The ones who think they are some form of Deity, carry on conversations with the fire extinguisher more than live people or who think that there dog is part of the FBI and is trying to kill them. There will always be a few schizophrenic patients being admitted to an average psychiatric unit here and there, but it is unusual to have 5,6 or even more really psychotic people on the unit at one time. These are the ones that really need treatment and providers actually enjoy treating as they are the one who inspired us to go into the field in the first place. They are far more interesting than the guys who pawn their wives' jewelry for crack, come home and beat them up and then expect us to feel sorry for them when they end up homeless. The delusional patient who thinks he has worked for Special Forces for the CIA and we are trying to assassinate him is much more interesting to work with. He may not really like us considering we are trying to kill him in his mind, but it is important to remember this guy is really very tormented and needs our help. Sure, the phone calls to various federal agencies do tend to cause some, well, complications. Like visits from the Special Service, which can be rather inconvenient, but it is a lot more interesting than doing paperwork and dictating discharge summaries.
Once we get about 5 or 6 of these guys on our unit, I start thinking about breaking out the Spring wardrobe. They are only the first sign, but I know better times are soon to come.
Next post.. The Second Sign.
P.S. For those of you that have not have had the privilege of a personal visit from the Secret Service, yes, they do dress like the guys from Men in Black. Minus the pug of course.
And I patiently wait for the inpatient unit signs of Spring.
I have seen a pattern of admissions that occur with rather consistent regularity every year on the inpatient units I have worked on that let me know that Spring is on its way. They may come early, they may come late, but they come. When they do I know that sooner or later the daffodils will be pushing up from the soil and the mountains in the distance will no longer be gray and dreary. There was still three feet of snow on my front yard when we got our signal this year, so it was a real boost to weary souls.
The First Sign of Spring: The Sale on Crazy: Some things that occur in psychiatry are predictable. People get depressed in the winter and fall. They get manic in the Spring. College freshmen get admitted in the early fall. There are causes for this that are easily explained. This one does not have an obvious explanation, but it happens, and it happens first. I do not know why, but I welcome it, nonetheless. For some reason, in the late Winter or very early Spring, there always seems to be a huge influx of admissions of really psychotic patients. The ones who think they are some form of Deity, carry on conversations with the fire extinguisher more than live people or who think that there dog is part of the FBI and is trying to kill them. There will always be a few schizophrenic patients being admitted to an average psychiatric unit here and there, but it is unusual to have 5,6 or even more really psychotic people on the unit at one time. These are the ones that really need treatment and providers actually enjoy treating as they are the one who inspired us to go into the field in the first place. They are far more interesting than the guys who pawn their wives' jewelry for crack, come home and beat them up and then expect us to feel sorry for them when they end up homeless. The delusional patient who thinks he has worked for Special Forces for the CIA and we are trying to assassinate him is much more interesting to work with. He may not really like us considering we are trying to kill him in his mind, but it is important to remember this guy is really very tormented and needs our help. Sure, the phone calls to various federal agencies do tend to cause some, well, complications. Like visits from the Special Service, which can be rather inconvenient, but it is a lot more interesting than doing paperwork and dictating discharge summaries.
Once we get about 5 or 6 of these guys on our unit, I start thinking about breaking out the Spring wardrobe. They are only the first sign, but I know better times are soon to come.
Next post.. The Second Sign.
P.S. For those of you that have not have had the privilege of a personal visit from the Secret Service, yes, they do dress like the guys from Men in Black. Minus the pug of course.
Thursday, March 4, 2010
The science geek connection
Many do not realize this, but psychiatrists are nothing more than ordinary physicians that use a lot of psychobabble terms like "therapeutic process" and "object relations" and know a lot more about prescribing Prozac and Clozaril than other physicians. And before physicians were physicians, most of us were ordinary college students majoring in fields that would have earned us the title "science geek." I was no exception, at one time being a biochemistry major, which is a fancy way of saying I liked to work with radioactive elements in my lab experiments more than do math.
Whether our interests were in biochem, physical chem or organic, we all liked to do side lab work, the kind not actually sanctioned by the university or actually intentionally included in assigned lab course work. Often referred to as "stupid shit", basically, we liked to blow things up. Some of my past endeavors included the manufacture of gunpowder in the chemistry stockroom while our supervisor was at lunch and igniting a crucible-full in the fume hood. There is also the non-intentional "stupid shit" that can be just as fun. Like my biology major friend who exploded a glass test tube of elemental sodium by being none too careful adding a reagent, sending glass shards and some unknown organic substance flying throughout a ten foot radius of organic chemistry lab. Although I was not witness to a second event, rumor has it he was responsible for causing the mass evacuation of the entire second floor of the Physical Sciences Building due to the accidental creation of a huge sulfur dioxide cloud in the very same lab.
Truth be told, science geeks love to do stupid shit. Why? Because we can, I suppose. When we got three feet of snow a few weeks ago, I know my husband had in the back of his mind my fantasy to build a snowman, lob a huge lump of elemental sodium into it and watch it burst into flames. Not that I have access to elemental sodium, but it would be SO FREAKING COOL to watch that display that I cannot help but to think about it.
That is why I got so frustrated when I saw some show on some unnamed educational science-type cable network doing a show about collisions in outer space and blatantly showed some astrophysicist type doing a supposed "scientific" demonstration and what he was really doing was stupid shit. His way of demonstrating the results of a collision between two planets was to run an explosive wire through a watermelon at various depths to show the extent of damage that it would do. Somehow this would correlate to the damage done by the collision of different sizes of planets. The deeper the charge was placed, the more damage done. The intent was to illustrate the results if different sizes of planets were to collide with planet sized watermelons, or planets that were composed of watermelon type material at least. Supposed to illustrate this event. What I saw was an astrophysicist and his assistant blowing up watermelons in the desert and most likely having a laugh when the cameras were not rolling. They were probably getting paid to do it, too.
Personally, I have treated Jehovah, the Antichrist, people being bombarded by "beta rays", and helped women who have PTSD from being raped by aliens, but exploding watermelons is not a sanctioned activity in my job profile. It might violate the fire code, for that matter and would probably get me in heat with the medical staff office, my medical director, JCHAO, etc. So interesting though my job may be, it lacks the mischievous element of the science geek life.
Which sounds more fun? I will leave that with the reader.
Whether our interests were in biochem, physical chem or organic, we all liked to do side lab work, the kind not actually sanctioned by the university or actually intentionally included in assigned lab course work. Often referred to as "stupid shit", basically, we liked to blow things up. Some of my past endeavors included the manufacture of gunpowder in the chemistry stockroom while our supervisor was at lunch and igniting a crucible-full in the fume hood. There is also the non-intentional "stupid shit" that can be just as fun. Like my biology major friend who exploded a glass test tube of elemental sodium by being none too careful adding a reagent, sending glass shards and some unknown organic substance flying throughout a ten foot radius of organic chemistry lab. Although I was not witness to a second event, rumor has it he was responsible for causing the mass evacuation of the entire second floor of the Physical Sciences Building due to the accidental creation of a huge sulfur dioxide cloud in the very same lab.
Truth be told, science geeks love to do stupid shit. Why? Because we can, I suppose. When we got three feet of snow a few weeks ago, I know my husband had in the back of his mind my fantasy to build a snowman, lob a huge lump of elemental sodium into it and watch it burst into flames. Not that I have access to elemental sodium, but it would be SO FREAKING COOL to watch that display that I cannot help but to think about it.
That is why I got so frustrated when I saw some show on some unnamed educational science-type cable network doing a show about collisions in outer space and blatantly showed some astrophysicist type doing a supposed "scientific" demonstration and what he was really doing was stupid shit. His way of demonstrating the results of a collision between two planets was to run an explosive wire through a watermelon at various depths to show the extent of damage that it would do. Somehow this would correlate to the damage done by the collision of different sizes of planets. The deeper the charge was placed, the more damage done. The intent was to illustrate the results if different sizes of planets were to collide with planet sized watermelons, or planets that were composed of watermelon type material at least. Supposed to illustrate this event. What I saw was an astrophysicist and his assistant blowing up watermelons in the desert and most likely having a laugh when the cameras were not rolling. They were probably getting paid to do it, too.
Personally, I have treated Jehovah, the Antichrist, people being bombarded by "beta rays", and helped women who have PTSD from being raped by aliens, but exploding watermelons is not a sanctioned activity in my job profile. It might violate the fire code, for that matter and would probably get me in heat with the medical staff office, my medical director, JCHAO, etc. So interesting though my job may be, it lacks the mischievous element of the science geek life.
Which sounds more fun? I will leave that with the reader.
Wednesday, March 3, 2010
Freud needed a vacation.
It is not my place in life to criticize one of "the Great Ones" but the past psychoanalsts did tend to be a rather somber crowd. It was Sigmund's daughter Anna Freud who actually formulated the idea of the defense mechanism and she did have the forethought to list humor as a mature (ie, healthy) defense mechanism, so whether or not our forerunners actually DID laugh, they did not think there was anything wrong with it.
I have learned through the years that life cannot be taken too seriously, or it will eat one alive. Too much worry has a way to driving people to be morose, irritable and depressed. It also tends to drive people to become unpleasant charachters such as lawyers, surgeons and CEO's of large financially unstable financial institutions. It does tend to ensure psychiatrists like me do not have to worry about finding work, though.
So, although many would say my defense mechanisms are more consistent with neurotic ones than mature ones, I do try to keep laughter high on my list of daily activities. I hope that I can help someone else out there not take life so seriously, too.
Dr A
I have learned through the years that life cannot be taken too seriously, or it will eat one alive. Too much worry has a way to driving people to be morose, irritable and depressed. It also tends to drive people to become unpleasant charachters such as lawyers, surgeons and CEO's of large financially unstable financial institutions. It does tend to ensure psychiatrists like me do not have to worry about finding work, though.
So, although many would say my defense mechanisms are more consistent with neurotic ones than mature ones, I do try to keep laughter high on my list of daily activities. I hope that I can help someone else out there not take life so seriously, too.
Dr A
Tuesday, March 2, 2010
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