Category Archives: Hospital

So when I finally got the mail after the Great Snowstorm, there was a letter from a bill collector stating that we were very delinquent on a medical bill from College Medical Associates (CMA), the physician group from which we receive medical care. It was… odd. I am very aggressive about paying medical bills as they arrive. As soon as they arrive. Before I even see what the bill is for, as often as not. Medical providers are especially aggressive about turning things over to bill collectors because when they don’t get paid quickly they are abnormally likely never to get paid at all. And on the other side, if you overpay they are good about sending you back a check. so if it’s under a couple hundred dollars, and it usually is, we can float that.

So what happened? Did I miss one? I wasn’t sure, but I did what I always do and immediately paid the $89.44 the bill was for.

The next day I got a very stern letter from CMA asking me to please stop remitting overpayments, along with a check for $26.57. They made their case that I am ridiculous because here are the amounts of the overpayments you have been making. So for the love of god, please stop. Don’t pay anything further until you get a new bill.

And today I got a new bill! From CMA. For $26.57.

Which of course lead me to compare the bill to the bill collectors to the list of overpayments I’ve made. Wouldn’t you know it: $89.44.

Given their inability to actually keep track of such things and willingness to come down hard on the patients, I’m almost tempted to say “screw these people.”

I’d rather not, though, because CMA is my wife’s employer.


Category: Bank, Hospital

A hard coughing fit, the kind where you cannot stop and you cannot draw breath, is an overwhelming emotional experience for me that leaves me mentally drained.

I had severe asthma as a child. It wasn’t the debilitating non-stop puff-the-inhaler-between-every-word stereotype you see on television. I’ve never met anyone like that, and doubt there are many. I was very physically active, taking long bike rides through the country, playing countless hours of basketball in our driveway with my brother, and enjoying hiking and camping. I played trumpet and french horn in the band, which requires a bit of wind.

I have the kind of asthma that comes suddenly and leaves you frantically gasping to suck in air, and that can last for days or weeks. (more…)


Category: Hospital

When I first started using ecigarettes, it was a pretty big adjustment. It wasn’t all negative, as ecigarettes gave me a greater degree of flexibility to indulge in my rituals and habits. I no longer needed to worry nearly so much about lingering odors. I could do it indoors within certain limitations. I could punch things up with different flavoring. But there were other things involved as well. It was, contrary to expectation, more expensive than smoking. It was more complicated. But more than anything else, it was less satisfying. The brand I used at the time was so much less satisfying that, looking back, I am surprised I was able to jump that chasm. I believe I wanted to quit smoking more than I realized to be able to do it. (Just not enough to stop altogether – yes, I’d tried.)

Vaping was, and to a lesser extent is, uncharted territory from a health perspective. Few seem to really believe that ecigarettes are actually as dangerous as cigarettes, even if some make that argument. But how much safer? Are they safe? I came to the pretty early determination that they were not completely safe. While transitioning from smoker to vaper did leave me feeling better, it still… felt… like I was breathing in some stuff that wasn’t good for me. There was no more coughing through the night, and a lot less coughing in general, but some (albeit less) of the short-windedness was still there. But smoking is the motherload of all legal health evils, and once I still couldn’t quit after my daughter was born, I had practically resigned myself to being a lifelong smoker until I died from it. Things were that bad.

The science is starting to come in, and it’s presenting something of a mixed message. As I had hoped, so far nothing has arisen that makes me feel any differently than I originally did: I have made a substantial improvement to my health. As I had thought and feared, though, it’s not all good. Here are some of the areas of concern:

  • Nicotine – While nicotine isn’t the worst ingredient in cigarettes by a long shot, there are still a large number of heart-related health concerns about it. While less worrisome than smoke, there may also be concerns about it being delivered as ecigarette vapor. I have myself been cutting the nicotine levels downs, but mostly to reduce and eliminate the addiction rather than from concern over my heart. Even so, this one is my doctor wife’s biggest concern. I should also add that, while I don’t know for certain, until I cut back nicotine levels I am pretty sure that my nicotine consumption had increased over smoking. Nicotine for tar is probably a good deal, but the inefficiencies of the delivery mechanism may mean (until technology improves, if it is allowed to) that more overall nicotine is consumed generally, without specific attempts to cut down and cut back. Another concern about nicotine levels is that some suppliers have been caught using more (or less) nicotine than their advertised level.
  • Formaldehyde – This is the one that scares the bejesus out of me because formaldehyde. Worse, some studies have suggested that ecigarettes have more of it than combustibles. However, those studies don’t stand up to scrutiny. They essentially burn the liquid at a temperature so hot that it creates, if not smoke, something close to it. These are not real-world circumstances, because when you do that, it tastes awful. When they used low voltage (3.3v) they found no formaldehyde; it was what they found when they used high voltage (5v) for extraordinarily long puffs that made the headlines. It is analogous to burning a Salisbury steak to an absolute crisp and finding carcinogens in the char. Which you would, but even people who like their meat well done wouldn’t burn it that much. Having said all of this, most voltage falls in between 3.3v and 5v (the one I use is 3.7v), and we don’t yet know at what point it becomes a problem even if you’re not burning it to a crisp.
  • diacetyl

  • Diacetyl and Acetyl Propionyl – While not as scary as formaldehyde because people haven’t heard as much about it, this is the most significant concern. While formaldehyde is generally only produced through burning, these chemicals are often in the eliquid itself. Potentially unsafe at any temperature, these chemicals can cause serious lung problems. A recent Harvard Study turned up a lot of D/AP and has gotten a lot of publicity. However, Dr Konstantinos Farsalinos – who has been investigating this a while and previously produced a study that had similar results – points out that the levels of D/AP found in the Harvard study were pretty low (lower than in his own study, in fact): below that of occupational safety standards and significantly lower than those found in cigarettes. Also noteworthy, like the formaldehyde findings, they had an unusually long draw (heating period) at eight seconds. One of my batteries actually has a timer on it and I rarely go above three and almost never above four. This may not make a difference because, while the formaldehyde is produced by the heat, D/AP is in the liquid itself. Even so, I find it noteworthy that they didn’t seem to use real-world conditions. (Either that or I am an atypical user. Which is possible, but I assume that I go in the other direction since I tri-puff when I drag. On the other hand, I don’t inhale.)
  • Other things – There are concerns about kids getting into the eliquid and getting nicotine poisoning. There are some misconceptions about this because articles seem to present the ejuice as something a child might drink. They wouldn’t. It tastes awful. Most come in containers that limit output so, with the right packaging, people shouldn’t worry about chug-a-lug. It’s cause to be mindful, and to childproof packaging, but not much beyond that. Also, some of the cheaply produced imports have batteries that don’t charge correctly and explode. That’s pretty scary, but fortunately pretty rare and fixable.

Now, let me let you in on a little secret. I am pro-vaping. I am skeptical of regulation, at least in the abstract. I would, however, welcome the right regulation in this domain. Pretty enthusiastically. While I might prefer everything be handled with labels and certifications, I’ll take regulation.

For effective regulation, though, we need to move beyond particular parts of the debate. (more…)


Category: Hospital

There are many things that Windows does that drive me crazy. One of which is the file copy. When you’re copying a lot of files, and it runs into a problem or a question, it stops everything in order to get an answer. So if you want to move 300GB of files and go to bed, you wake up and it’s moved 2GB and wants to know whether you want to merge the source and destination folder or skip, or whether you want to replace a file or leave the current one there. These are reasonable questions, but there’s no reason to stop everything while waiting for an answer. There are 298 more GB to move! And I wanted it done before I woke up!

It’s like having a secretary where you give him ten things to do and when you check in with him in the afternoon he had a question about the first one and did nothing. Such a secretary would be fired. But Windows file manager has persisted in this behavior for years and years. I blame unions.

My wife is having some tests run regarding a potential sleep disorder. Two weeks ago, she had some tests taken and sent to be analyzed. In rural Arapaho, it takes 2-3 days for test results to come back. So no problem, right? Well, of the 16 tests they had to run, they had an equipment problem with one of them. So… they did nothing until they could get someone out to fix it. They didn’t run the other 15 tests or anything. So they did nothing. Including informing Clancy that there is any sort of problem. So Clancy calls and is told they are a couple of days away from being able to run the other tests. They didn’t want to send it to another lab because there were fifteen tests they could run. But they didn’t run them because they couldn’t run the 16th.

Which it turned out didn’t matter anyway. The next round of tests that they were going to run were canceled. The crafty insurance company declined to sign off on them. They had a few questions. But since the appointment, made a month ago, wasn’t until this week, they didn’t review it until this week. They didn’t send it out until the day before. Which nobody could do anything about in time to clear it. The result was that her sleep study was cancelled, and she won’t be able to do anything more about it until late January.


Category: Hospital

Chuck Schumer wants to change some regulation to “make eyeglasses cheaper.” Specifically, he wants to do three things:

  1. Require that optometrists give customers their prescriptions, so that they do not have to purchase their glasses from the optometrist.
  2. Require optometrists to verify prescriptions in a timely manner.
  3. Allow people to go more than one year without getting their eyesight checked.

Some of you may remember a story a while back:

In other news, my optometrist’s office apparently refuses to send my prescription to the Redstone Walmart because the optometrist is on vacation. I cannot for the life of me figure out why that matters and why they don’t have my prescription on file so that they can send it out. Meanwhile, Redstone Walmart won’t let me place an order with a prescription to be named later, nor will they let me order over the phone even though they have my frame preference on file. This is going to set back my glasses order by a couple of weeks, most likely. My glasses are getting scratched up.

Two Weeks Later The situation with the optometrist has not been resolved and has in fact gotten worse. When they finally send the prescription to Walmart, they sent a contacts prescription. I don’t need contacts, I need glasses. I haven’t been able to check with them in order to see whether or not they even have a glasses prescription or whether they were under the impression that it was specifically for contacts. I’m never going to get my new glasses. If I have to get a glasses prescription, I’m just going to go to the Walmart eye center. The most frustrating thing about all of this is that my vision hasn’t changed. This was confirmed on my last visit.

The situation did get resolved at some point.

It seems rather weird to me that I apparently let the optometrist not give mt he prescription. Maybe I lost it? Or maybe they would give it to me, but not in a form that Walmart could accept. Whatever the case, the inability to get it verified was certainly quite the hassle and #1 and/or #2 were to blame.

I’ve also long complained about #3, and of course did so in a post from long ago. I won’t blockquote it because my narrative is not especially clear, but to summarize I found myself in a position where an old glasses prescription was actually better than a new one and there was nothing I could really do about it because the only prescription I could get them to take was the new one.

So, three cheers for Chuck Schumer!

However!

This will actually do me no special good. I just got new glasses and contacts earlier this year. I had from the start intended to order them online, so I made darn sure that I had my prescription on paper (which they had no problem providing, despite imploring customers not to order glasses online). Now, because I did go to the doctor first, my prescription is no longer out of date. But as long as I can see, the online vendors don’t even look at the piece of paper nor do I have to refer them to the optometrist that wrote it, so… yeah, I can pretty much flout the regulation that Schumer rightly wants to relax.

Of course, I’m not supposed to do that, and I have to admit that a part of me worries that somebody, somewhere is going to make a big deal out of this regulatory hole. Someone like Chuck Schumer, come to think of it…


Category: Hospital

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There is a rather significant post up at Ordinary Times. It can’t easily be reproduced here, but you’re welcome to comment here if you are disinclined or unable to comment over there.


Category: Hospital

smoke-monster-lost-mr-echo

In a post about how he quit, Pascal Emmanuel-Gobry has one of the best descriptions of smoking that there is:

It’s a nasty habit, but not for the reasons non-smokers might think. Non-smokers don’t like the smell, but man, the smell of smoke is actually the most delicious thing. No, it’s a nasty habit because it’s a demon. A demon is a spirit who inhabits you, and takes ahold of the muscles and sinews of your mind, and twists and turns them to make you look more and more like him, and less and less like you.

Smoking is a nasty habit because, like all addictions, it turns you into a slave and a liar.

It’s slavery if you can’t enjoy a meal or drinks with friends without having to step outside several times. It’s slavery to have to push away your toddler because you’re hunched up against a window feeding your habit. It’s slavery if you can’t listen to the person you are talking to, or pay attention to the lecture or movie or concert you are attending, because you are counting down the seconds until you can get your fix.

Smoking turns you into a liar — to other people and to yourself. Don’t trust the smoker’s pride. Yes, anti-smoker prejudice in the West can sometimes reach ridiculous heights. It’s insane that there are places in the U.S. where people will run screaming from the room if you smoke tobacco, but offer pot like it’s orange juice. And don’t get me started about Bloomberg.

But anyone who tells you they smoke purely because they enjoy it, and who is blase about the link between cigarettes and cancer, that person is lying — either to you, or to themselves (sometimes both). I know, because I’ve been that person.

Moki_smokerThe truth is that I did sometimes really enjoy smoking. And I do enjoy vaping. It’s almost a bit goofy but the early restrictions on smoking making it more enjoyable, in a way. It made it so that you had to extricate yourself from everything, go outside, and… just be. Be alone. Stop whatever it is that you were doing. Soak up the environment.

But that’s really only a part of it. That’s the equivalent of the ad in the paper. The reality is creates a need for you to do so. An overwhelming need. And the time that it costs you starts racking up. If you’re working, you end up losing your break time, and part of your lunch, to the habit. Being around the house, I end up losing time that I could be writing posts or even watching TV to the habit. It’s made attempts to start exercising again more difficult, not because of shortness of breath but because of time. Most importantly, lost time with my young daughter at a special age that she is growing through very rapidly.

Though opinions still differ on the health gains of my transition, I am relatively confident that I am in a much better place now, health-wise, than I was two years ago. But that lost time? I’m still losing it. And while I am less worried for my health than I was, I find myself actually wishing to relieve myself from the puffing habit altogether. Or, if not of puffing, than the nicotine, and the psycho-physical need that comes with it. If I can get the nicotine down to zero, then maybe I would be more likely to be able to do it on my own terms, instead of on the terms of a beast that needs to be fed.

Or stop doing it entirely. But I’m not going to think about that. I’m going to remember that I no longer smoke. I’m going to remember that over the time I have been vaping, the nicotine level has already fallen my 2/3 (from 18mcg/ml down to 6). And I’m going to think about what it will take to get from 6 to 0.

When I made the transition, one of the things I promised myself was that I wouldn’t pressure myself into quitting altogether, either the nicotine or the vaping. Because I felt, and feel, if I could just stop lighting leaves and rat-poison on fire and breathing in the smoke, I would be that much better off. Whereas if I made it about ending the extrication, it would just be too daunting. And I didn’t want the perfect to be the enemy of the good. One step at a time.

And it’s progress that I’ve decided that I want to take the next step. I want to work towards getting to zero nicotine. Then maybe I can own the habit more than it owns me. There is a potential step after that, which I am not going to think about. Maybe I will down the line.n the line.


Category: Home, Hospital

Sarah Kliff and Vox believe they know why Electronic Medical Records in the US suck:

For patients, it would be great news if any doctor or hospital could access their medical history. They could turn up at any office in their city, maybe even in the country, and with the click of a button a doctor could bring up their various scans and tests and personal history. It would become way, way easier to get a second opinion or switch to a new provider.

That’s exactly why interoperability is bad business for hospitals: it makes it easier for patients to switch providers and take their business elsewhere. Hospitals with interoperable records would be taking away all the friction that’s associated with switching providers in the current health-care system.

There are other incentives pushing hospitals to make electronic medical records that do talk to each other. One is patient satisfaction: if other hospitals offer a better experience, with portable records, patients might vote with their feet and head elsewhere. So far, though, the figures above suggest that hasn’t been enough of a driver to force widespread adoption.

Maybe a little? But not really. At least, not in the way presented. It can definitely be said that interoperability is not a priority and this affects whether and how EMR is adopted. But while I am familiar with some of the things that hospitals do to enhance their financial picture, this one really doesn’t register. Not the least of which because most hospitals aren’t hugely worried about losing business. And when I have seen or heard of a battle for patients, it’s been between physician groups within the same hospital. And from what I have gathered, the real money is not in attracting patients so much as maximizing the revenue per patient. So it’s an extremely low priority to make things work across hospitals, I have seen nothing to believe it is something actually blocked.

So why, then, does the state of affairs described in the article exist? I would say that there are two parts to that question.

The first part is why adoption has been so slow. A lot of that is on the doctors themselves. The above scenario would rely on hospital directors making the decisions about EMR, but I haven’t really seen it work that way. They tried doing that in Arapaho and the doctors, never an organized or collective voice, revolted. While hospitals have some leverage, and while they tend to believe that they have more leverage than they sometimes do, the typical employer/employee dynamic isn’t the same when it comes to physicians. If you try to give doctors an EMR system that they don’t want, and they revolt, you can’t as easily say “If you won’t do it, we’ll go and find somebody who will!”

Which means that, at least at the places Clancy has worked, the physicians themselves have been given latitude to choose what EMR system to implement. Some portion of them don’t want to implement anything, and so there is some foot-dragging. There isn’t much of a consensus among the rest. There isn’t a whole lot of information out there. Two hospitals Clancy has worked at have been burned by bad programs, adopted and almost immediately aborted. The order of the day is not profiteering, or even outright hostility, but simple inertia.

The second part is why, once adopted, there isn’t that much interoperability. As mentioned above, I believe that’s a matter of prioritization. And to some extent, the market fragmentation that exists out there. It rural hospitals and urban hospitals and health clinics are all using different things, it takes some effort to get everyone to talk to one another. Which, without motivation, is not effort that will be extended.

Which are real problems. Collective action onse at that, since the costs of the action and inaction are being borne out by others. As loathe as I am to say it, there is a good chance this is going to going to require a top-down solution if it is going to get resolved. Or, more likely, we’ll still be asking ourselves some of these questions ten years from now.


Category: Hospital

In response to a subthread in a post from Oscar, a few weeks ago Saul Degraw wrote a piece about erratic work scheduling:

Gillian White has more thoughts on unpredictable schedules at City Lab. 17 percent of American workers live on erratic scheduling according to White’s article. New York’s Attorney General is trying to wage a campaign against the practice because “such practices take a toll on workers and prevent employees from securing childcare or pursuing other job and educational opportunities.” There are a variety of local and state ordinances which seek to help employees but they seem to be few and far between. White also points out the Unionized shops are less likely to have erractic schedules. Macy’s employees in and around NYC have their schedules set months in advance according to White.

I may not be Mr. Labor on a lot of things, but scheduling is one of those things I am sensitive to. Troublesome Frog framed it from an economist perspective:

Having a pool of people who could work two jobs or work and go to school but can’t because they don’t know in advance what their schedules will be is an insane waste of human capital. It would be like factories that use oil buying and using one barrel of oil and then being allowed to throw away 2 barrels without paying for them.

I would have framed it more from the perspective of abuse, but TF actually touches on why – of all the indignities of modern-day work – that one sticks in my craw. It’s incredibly wasteful, and the wasteful party isn’t paying for the waste.

—-

Though on a very different caliber than those at the bottom of our economic latter, we have ourselves been surprisingly feeling a bit of a pinch. You wouldn’t think that physicians would have to worry about this sort of thing much at all. And up until here, we didn’t.

The way that the schedule for her works is that she has an “on” week, where she is theoretically working 65 hours, and an “off” week, where she is theoretically working 15. (I say “theoretically” because it’s closer to 75 and 30.) We thought that this would be a convenience because it would mean that in the off week, she would be able to do a lot of those things that people who work banking hours always have trouble with.

It hasn’t turned out that way at all.

The assumption is that you get that time, which means that trying to get out of work during an “on” week is really frowned down upon. Which totally made sense. The problem arises when there is a hiccup in the schedule. What happens then is that the on weeks and off weeks switch. So up until last week, she was working “odd weeks”… but then, hiccup, now she’s working “even weeks.”

Which wouldn’t be a huge problem, except that we have months of various appointments that we specifically scheduled for even weeks so that she would be able to participate. We have some child development specialists looking at Lain and we wanted Clancy to be a part of that, but now she can’t. An appointment that we had to make two months in advance for her to see a fertility doctor is now up in the air. A new appointment could push things back another couple months, at which point she may be working odd weeks again. We just don’t know. I need to see a physician myself, but it’s hard to make the appointment without knowing when Clancy may be able to look after Lain (ultimately, I am probably going to just have to arrange childcare.

Some of this ties in to the problem that we had in Arapaho where hospital directors seem to approach physicians as typical employees where you can expect typical employee stuff. Except that there is a shortage on, of course, and typical employees don’t work the sorts of hours that she is expected to because she is a physician.

And while I’m kvetching, in her off weeks they still have her working at the nursing home doing the very clinical work that we moved across the country and endured another fellowship to get away from. She’s not even the low person on the totem poll anymore. Rather, they asked the newer person to do it and the newer person said absolutely not. Since Clancy agreed to do it “temporarily” last year, she seems to be obliged to do it until they can find a replacement. The result of that, of course, is that she’s going to be very reluctant to ever agree to do something for them “in a pinch” that could turn out to be “for months on end.” Though she did successfully draw a line when they had her pinch-hitting at a psych ward and she basically told them there is just no way that they can do this.

It’s starting to look like some of the problems we saw in Arapaho are more wide-spread than we previously supposed.


Category: Hospital

Clancy had a really rough last week. During what is supposed to be her “down week*” but where she is having to attend a nursing home until they find someone, she was called on to man the psych ward in Millsburg. Clancy has an undergraduate degree in psychology, and has been to medical school, but has no specialized training. But either she did it or the entire ward would have to close for the day. So she did it. And because she was doing it for the first time, she was there very late doing it.

But this video helped a great deal:

If you’re not familiar with the story, two llamas escaped from a flatbed in Sun City, Arizona, and city officials chased it around. Hilarity ensued. The video above is set to “Yakety Sax” (a tune you’re familiar with, even if like me you didn’t know it’s name). Very well done.

Unfortunately, the next day she found out that she lost her next down week, and lost her weekend because the doc with the “on week” had to attend a funeral. So she lost her weekend, lost part of next week because she’s going to have to make up for the time she wasn’t at the nursing home this week (because she was at the psych ward), and that will be followed by 21 straight days of working.

And for the second straight evening, she didn’t get to to see Lain.

Unfortunately, I had no llama video for her to help her come to terms that, yet again, she seems to have taken a job that is not actually the job she signed up for.

* – Her job is structured that she works 7 on and 7 off. The 7 off is the “down week.”


Category: Home, Hospital

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Greetings from Stonebridge a fictitious city in a fictitious state located in a tri-state area in the interior Mid-Atlantic region. We're in western Queenland, which is really a state unto itself, and not to be confused with Queensland in Australia.

Nothing written on this site should be taken as strictly true, though if the author were making it all up rest assured the main character and his life would be a lot less unremarkable.


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