Well, I must confess my blog is coming in mighty handy right about now because a large portion of the folks that I communicate with also read my blog...
So, as of Friday after my nap, my computer has decided that it won't turn on. This is, of course, not the first time my computer has thrown fits, but the timing isn't so great this go around.
I just wanted to let folks know that I can check email in quick spurts from my mom's computer, but I can't sit here long enough to spend much time or write back. Sorry.
Honestly, if it had been any other week for this to happen I wouldn't be so irritated. But this week? Seriously? I had a 'staycation' planned, and part of that 'staycation' was to spend some much-needed time writing and blogging.
I'm even skipping a shot this week! So there is so much to write about, and now it really is just going to have to percolate in my brain.
Unless Scott or other computer experts work miracles. . .I'll be offline for a while and wanted to let folks know that's why I'm out of touch (more than my usual 'out of touch'). I can still read your news though, so that's a good thing. I do apologize to the folks who have emailed me with things that really do require a thoughtful and timely response--as I won't be able to write to you anytime soon.
And maybe, just maybe, I'm 'supposed' to spend even more time away from the computer than I had planned this week? Maybe it was 'supposed' to happen during my 'staycation'? I can't help but wonder if God had a different idea of this 'staycation' than I did and I'm really supposed to take a major break from the computer. Aaah, I should be better at this adaptability thing by now, but I'm a bit frustrated to say the least.
Knitting, books on CD, and other 'down time' activities. . .here I come!
Here's hoping I'll be back on my own computer soon! Okay, I'm out of 'upright' time here at my mom's computer, so I'll check back in via blog when I'm up and running again (computer-wise that is!) Keep your fingers crossed that my computer can be fixed!
Blessings,
Emily
P.S. I cancelled the family newsletter this week in anticipation of my 'staycation.' Funny how that timing worked out! I wouldn't have been able to get it done anyways!
Saturday, September 13, 2008
Tuesday, September 09, 2008
The Glass Ceiling Effect: Palin and Clinton
As always, I remind my readers who do not share my political views to realize that I'm not pushing anything on you...just sharing my own journey. And what a journey this year has been!
As I've explored the Palin 'story' with my friends and family (and oh my has it been heated!), I've realized how much I'm still trying to figure out and understand about women, choice, 'having it all', feminism, what we demand of men and fathers, the structural systems in place for women, how far we have or have not come since my mother's generation started the feminist movement, etc. I hope I'll be able to explore this topic more in-depth in a future blog entry, as I wonder how other women feel? For myself, this time has been one of intense personal reflection and I hope that my post reflects my continued effort to understand my own views on such topics. I will not, however, rescind my statement that Palin is unqualified!
First, let me state that I have tremendous respect for John McCain. I think he is a great American public servant. He is someone who has been bipartisan and who has fought for what he believes in even when it was not in his or his Party's best interest. He has been through tremendous suffering, he has endured, he has owned up to his mistakes, and he has gone on to be an upstanding husband and father. He is a man of strong character, integrity and values.
I saw my friends' jaws dropping when I admitted earlier that I was seriously considering voting for John McCain over Barack Obama in this election. How could I do that?
This political season has left me strained and stressed. I place great value on the importance of voting and in the power of our vote. Our country is in shambles. Who we choose to lead this country post-Bush disaster is not something I take lightly. I'm terrified of where we will go.
I watched both of the conventions, but even before the Republican convention, John McCain's choice of Sarah Palin for his vice-presidential nominee had pretty much cemented my decision to vote for Barack Obama in this election. No, I'm still not "Obama-ized", but more on that later some other time, some other post.
How did the Palin pick make my decision?
Shouldn't I be excited that a woman is in a position to possibly be vice-president of the United States of America? Shouldn't I be excited that, no matter who wins the election, we as Americans have finally put either an African-American in charge of the presidency or a woman in the position of vice-president? And how come we never mention that McCain is a person with disabilities? That should matter too.
McCain disappointed me by choosing Palin as his running-mate.
Did he really think that Hillary supporters would be more likely to vote for him because he chose Palin as his running mate?
Palin was chosen as his running mate for no other reason than a political gimmick, a political ploy. She was chosen because she is a woman, not because she is a qualified woman.
Surely there are qualified Republican women he could have chosen?
When I talked to my Dad about McCain's pick of Palin as a VP, he said to me something that I have not been able to shake.
He said it was a classic case of the glass ceiling effect. We had a qualified woman for the job of president of the United States, and we passed her up for the job. (Whether you like Hillary or not, whether you agree with her views or not she was qualified.) Hillary was also passed up by Obama for the vice-presidency.
Instead, now we have a woman being put in this high position--that of potential vice president--simply because she is a woman, not because she is qualified.
Let's face it. McCain is not exactly the picture of health. He's already had four bouts of melanoma along with his many war injuries.
Palin has literally been placed in a position where, if McCain is elected president, she is a heartbeat away from the presidency. That is terrifying. Where is this woman's experience to run a country!?
I give Palin credit on some levels. Yes, she's a mother of five children and being a mother is one of, if not the hardest, job in the world. I don't know how mothers do it, especially with five children! I'm always in awe of mothers. But the views she brings on motherhood, families, and women's rights are not going to pull Hillary supporters like me. Nor is her role as a working mother and Governor of Alaska enough to make her qualified to be vice-president or president of the United States.
Palin is going to have a lot of explaining to do as to her beliefs in conservative family values, trying to raise five children (including one who is special needs and one who is pregnant), trying to be the next VP, promoting abstinence-only education and having a 17-year old pregnant daughter. It doesn't add up for those of us with more liberal views on women. I wonder if it adds up for conservative women? I would like to know your thoughts.
I struggle with even mentioning the fact that she has five children as an issue. Would we question it if a man with five young children was running for president? We've never been in that position before. We've never put a president or vice-president in office with so many young children. I will make a note here that Michelle Obama discouraged her husband from running for president because she did not want that life for their young children. He chose career ambitions, in my opinion, over family, and to be fair I want to call him on that if I'm going to call Palin on what may also be perceived as choosing career over family. I think Obama could have waited until his girls were older, gotten more experience himself, and been more ready to be president. He champions himself as a present father, but how many days has he been home since he joined the Illinois state senate, the U.S. Senate, and started running for President? Compare this, for instance, to Joe Biden who after the death of his wife almost decided not to be sworn in as a Senator. How many nights was he home with his young children?
It should be each family's choice, not ours to judge, but in the end would this election season strike such a raw nerve if the issues of race and gender were not underneath the surface, sometimes the elephant in the room that everyone is thinking, but no one is going to mention?
But back to Palin. She's running on a platform of conservative family values. So, how does that part fit in? As vice-president she could be asked to serve, in a crisis situation, extremely long days and will likely work very long days on a regular basis.
I wish I could say that I believe women can have it all. But even someone like Elizabeth Vargas left her job as anchor of the ABC Evening News because she felt that she was short-changing her two children by working 12-hour days. She has the money and resources to have cooks, nannies, housekeepers, whatever. But she ultimately said, and has continued to say, that women have to redefine 'having it all.' For her, having it all meant giving up the anchor spot (historic in that she was a woman and is Latino) to do 20/20 instead, and spending more time with her children. She admitted that she hoped someday maybe she could go back to having a larger career, but she couldn't do it while raising two young children. Every woman is different in what they feel they can do and how well they can do it. Most of my friends feel overwhelmed most of the time--whether they are stay-at-home moms or also working outside the home. Can Palin do it all, and play all of her potential roles well? And uphold her belief in conservative family values?
This is where things get complicated--because a more liberal viewpoint would say that she can choose career first if the support systems are in place for someone else (i.e. her husband) to be the primary nurturer and caregiver of the children. We'd also be asking society to step up to the plate to make it easier for working women with children to do both jobs well.
My bottom line, my question aimed specifically at Sarah Palin, is this: How can you walk your talk? It's this part that I don't 'get' about Palin. My question is not how can you be a mother and be the vice-president. That is not my issue here. (Can you tell I'm afraid those who don't know me well enough are going to take this post the wrong way completely?!)
Oh, and did I mention that she's unqualified for the job she's been nominated for?
I got a piece of flair on Facebook the other day that pretty much summed up the whole Palin mess: "Yes girls, McCain thinks we're that stupid." Or as the Jon Stewart show said, but a little more bluntly, Palin is Hillary's complete ideological opposite but somehow McCain thinks we are going to vote for his ticket now simply because Palin's our 'gynecological twin'? I do love my friend who asked: "Who vetted her? FEMA?"
Whether you agree with Palin's ideological views or not (I obviously do not), it's scary to think of this woman being placed in a position of such power.
I want women to break the glass ceiling. I want them to be able to be mothers and to have careers. I want them to have equal opportunities. But I want them to earn those opportunities. I want them to be there because they are qualified to be there. Not because they are being used as a political ploy. I don't want to be insulted that way.
Sorry Palin and sorry McCain but both of you just showed us that the glass ceiling effect is still there and we still have a long ways to go. I thank Hillary for putting 18 million qualified cracks in the glass ceiling. And I'll pass up Palin as the one to crack that ceiling completely, because I'd rather wait for someone who earned the right to break the glass ceiling. Who knows, maybe someday Hillary will ultimately crack that toughest glass ceiling? :)
This continues to be quite the political year! Let me tell you how much fun it's going to be living in a battleground state for the next two months...ugh! At least Palin makes the VP debates 'Must-see TV' as my friend puts it!
Emily
P.S. A few new folks are reading my blog...and I'm afraid I may just have lost at least half of those folks by choosing to write a political blog first. I hope you'll stick around and see that most of my blogs are not just politics! This was the topic freshest on my mind.
As I've explored the Palin 'story' with my friends and family (and oh my has it been heated!), I've realized how much I'm still trying to figure out and understand about women, choice, 'having it all', feminism, what we demand of men and fathers, the structural systems in place for women, how far we have or have not come since my mother's generation started the feminist movement, etc. I hope I'll be able to explore this topic more in-depth in a future blog entry, as I wonder how other women feel? For myself, this time has been one of intense personal reflection and I hope that my post reflects my continued effort to understand my own views on such topics. I will not, however, rescind my statement that Palin is unqualified!
Since my friends on both sides of the political fence and everywhere in between have been emailing me and calling me to ask what I think of this whole "Palin thing," I wrote some of my thoughts several days ago, but have been too afraid to post this entry. Since folks are still asking me what I think I decided I might as well put it out there as I see it, eh? Here goes.
I'm shaking in my boots quite honestly!
First, let me state that I have tremendous respect for John McCain. I think he is a great American public servant. He is someone who has been bipartisan and who has fought for what he believes in even when it was not in his or his Party's best interest. He has been through tremendous suffering, he has endured, he has owned up to his mistakes, and he has gone on to be an upstanding husband and father. He is a man of strong character, integrity and values.
I saw my friends' jaws dropping when I admitted earlier that I was seriously considering voting for John McCain over Barack Obama in this election. How could I do that?
This political season has left me strained and stressed. I place great value on the importance of voting and in the power of our vote. Our country is in shambles. Who we choose to lead this country post-Bush disaster is not something I take lightly. I'm terrified of where we will go.
I watched both of the conventions, but even before the Republican convention, John McCain's choice of Sarah Palin for his vice-presidential nominee had pretty much cemented my decision to vote for Barack Obama in this election. No, I'm still not "Obama-ized", but more on that later some other time, some other post.
How did the Palin pick make my decision?
Shouldn't I be excited that a woman is in a position to possibly be vice-president of the United States of America? Shouldn't I be excited that, no matter who wins the election, we as Americans have finally put either an African-American in charge of the presidency or a woman in the position of vice-president? And how come we never mention that McCain is a person with disabilities? That should matter too.
McCain disappointed me by choosing Palin as his running-mate.
Did he really think that Hillary supporters would be more likely to vote for him because he chose Palin as his running mate?
Palin was chosen as his running mate for no other reason than a political gimmick, a political ploy. She was chosen because she is a woman, not because she is a qualified woman.
Surely there are qualified Republican women he could have chosen?
When I talked to my Dad about McCain's pick of Palin as a VP, he said to me something that I have not been able to shake.
He said it was a classic case of the glass ceiling effect. We had a qualified woman for the job of president of the United States, and we passed her up for the job. (Whether you like Hillary or not, whether you agree with her views or not she was qualified.) Hillary was also passed up by Obama for the vice-presidency.
Instead, now we have a woman being put in this high position--that of potential vice president--simply because she is a woman, not because she is qualified.
Let's face it. McCain is not exactly the picture of health. He's already had four bouts of melanoma along with his many war injuries.
Palin has literally been placed in a position where, if McCain is elected president, she is a heartbeat away from the presidency. That is terrifying. Where is this woman's experience to run a country!?
I give Palin credit on some levels. Yes, she's a mother of five children and being a mother is one of, if not the hardest, job in the world. I don't know how mothers do it, especially with five children! I'm always in awe of mothers. But the views she brings on motherhood, families, and women's rights are not going to pull Hillary supporters like me. Nor is her role as a working mother and Governor of Alaska enough to make her qualified to be vice-president or president of the United States.
I can't, in good conscience, support a woman who supports abstinence-only education (don't even get the sex educator side of me started on this topic!), creationism, is anti-abortion even in cases of rape or incest, and the list goes on...
Palin is going to have a lot of explaining to do as to her beliefs in conservative family values, trying to raise five children (including one who is special needs and one who is pregnant), trying to be the next VP, promoting abstinence-only education and having a 17-year old pregnant daughter. It doesn't add up for those of us with more liberal views on women. I wonder if it adds up for conservative women? I would like to know your thoughts.
I struggle with even mentioning the fact that she has five children as an issue. Would we question it if a man with five young children was running for president? We've never been in that position before. We've never put a president or vice-president in office with so many young children. I will make a note here that Michelle Obama discouraged her husband from running for president because she did not want that life for their young children. He chose career ambitions, in my opinion, over family, and to be fair I want to call him on that if I'm going to call Palin on what may also be perceived as choosing career over family. I think Obama could have waited until his girls were older, gotten more experience himself, and been more ready to be president. He champions himself as a present father, but how many days has he been home since he joined the Illinois state senate, the U.S. Senate, and started running for President? Compare this, for instance, to Joe Biden who after the death of his wife almost decided not to be sworn in as a Senator. How many nights was he home with his young children?
It should be each family's choice, not ours to judge, but in the end would this election season strike such a raw nerve if the issues of race and gender were not underneath the surface, sometimes the elephant in the room that everyone is thinking, but no one is going to mention?
But back to Palin. She's running on a platform of conservative family values. So, how does that part fit in? As vice-president she could be asked to serve, in a crisis situation, extremely long days and will likely work very long days on a regular basis.
I wish I could say that I believe women can have it all. But even someone like Elizabeth Vargas left her job as anchor of the ABC Evening News because she felt that she was short-changing her two children by working 12-hour days. She has the money and resources to have cooks, nannies, housekeepers, whatever. But she ultimately said, and has continued to say, that women have to redefine 'having it all.' For her, having it all meant giving up the anchor spot (historic in that she was a woman and is Latino) to do 20/20 instead, and spending more time with her children. She admitted that she hoped someday maybe she could go back to having a larger career, but she couldn't do it while raising two young children. Every woman is different in what they feel they can do and how well they can do it. Most of my friends feel overwhelmed most of the time--whether they are stay-at-home moms or also working outside the home. Can Palin do it all, and play all of her potential roles well? And uphold her belief in conservative family values?
This is where things get complicated--because a more liberal viewpoint would say that she can choose career first if the support systems are in place for someone else (i.e. her husband) to be the primary nurturer and caregiver of the children. We'd also be asking society to step up to the plate to make it easier for working women with children to do both jobs well.
My bottom line, my question aimed specifically at Sarah Palin, is this: How can you walk your talk? It's this part that I don't 'get' about Palin. My question is not how can you be a mother and be the vice-president. That is not my issue here. (Can you tell I'm afraid those who don't know me well enough are going to take this post the wrong way completely?!)
Oh, and did I mention that she's unqualified for the job she's been nominated for?
I got a piece of flair on Facebook the other day that pretty much summed up the whole Palin mess: "Yes girls, McCain thinks we're that stupid." Or as the Jon Stewart show said, but a little more bluntly, Palin is Hillary's complete ideological opposite but somehow McCain thinks we are going to vote for his ticket now simply because Palin's our 'gynecological twin'? I do love my friend who asked: "Who vetted her? FEMA?"
Whether you agree with Palin's ideological views or not (I obviously do not), it's scary to think of this woman being placed in a position of such power.
I want women to break the glass ceiling. I want them to be able to be mothers and to have careers. I want them to have equal opportunities. But I want them to earn those opportunities. I want them to be there because they are qualified to be there. Not because they are being used as a political ploy. I don't want to be insulted that way.
Sorry Palin and sorry McCain but both of you just showed us that the glass ceiling effect is still there and we still have a long ways to go. I thank Hillary for putting 18 million qualified cracks in the glass ceiling. And I'll pass up Palin as the one to crack that ceiling completely, because I'd rather wait for someone who earned the right to break the glass ceiling. Who knows, maybe someday Hillary will ultimately crack that toughest glass ceiling? :)
This continues to be quite the political year! Let me tell you how much fun it's going to be living in a battleground state for the next two months...ugh! At least Palin makes the VP debates 'Must-see TV' as my friend puts it!
Emily
P.S. A few new folks are reading my blog...and I'm afraid I may just have lost at least half of those folks by choosing to write a political blog first. I hope you'll stick around and see that most of my blogs are not just politics! This was the topic freshest on my mind.
Monday, September 08, 2008
Lost In a System Where Doctors Don't Want to Listen
I am always leery of how many articles or news stories to post related to health-care, Dysautonomia, or Lyme disease. The goal of my blog is simply to share my life story and information, not to push my ideas or beliefs on anyone. Yes, I may be a passionate Hillary supporter, but that doesn't mean that I expect you to believe the same thing. I share about it with you because it is such an important part of my life.
So, in that spirit, I have found a few articles here and there that I do think are deserving of being posted on my blog for those who are interested. I have a wide range of readers--some with greater interest in these sorts of topics than others. Remember, the delete button is always available in such cases when you are not at all interested in reading! :)
Sometimes I find an article that explains something better than I believe I ever could. And it touches on topics that I am both passionate about and that people often ask me about.
Jeannine passed this article on to me. I have over time, seen several articles discussing this sort of crisis in the health care system. But it also answers, in many ways, several of the questions that I am often asked:
Why did it take so long for anyone to figure out what was wrong?
Why did so many doctors push me out the door? Why did some completely refuse to even take my case?
Why did I have to see sooo many doctors before anyone listened?
Why is it so difficult to find a doctor willing to take my case? And why is this happening to so many of your friends on DINET?
What can we do to make it so that doctors have time to be doctors again? To have time for patient care?
What will happen when the doctors I have now, all nearing retirement age in the next ten years, are gone? What will we do to make sure patients like me continue to have quality health-care?
This article brings an often undiscussed part of the nation's health-care crisis to attention. And it also says hats off to those doctors that I have been so blessed to find--Dr. ANS and Dr. Lyme--who are willing to give me the time and attention my case requires.
Sadly, last summer I lost one of the key members of my health-care team--Dr. PCP--because he left the practice. He had been my PCP for five years and through the worst of my illness. He believed in listening. He told me that 80% of cases could be solved if doctors would just take the time to listen to the patient. I miss him. I'm still trying to establish a working relationship with my new PCP. When someone has not been witness to the course, the ups and downs, the extremes of this illness it is very difficult to 'teach' them. It's hard to lose the continuity of care I had worked so hard to find and been so blessed to have.
Blessings,
Emily
P.S. I only started this blog over a month ago! Oops!
HARD CASES
Lost in a System Where Doctors Don't Want to Listen
By Benjamin H. Natelson
Sunday, August 3, 2008; Page B03
I'd like to tell you about one of my patients. She's the kind of patient that I enjoy seeing but that many doctors go out of their way to avoid. This means that she's also the kind of patient I worry about most -- a patient who in the near future may be stranded without proper care as fewer and fewer doctors, constrained by time and the economics of our health care system, are willing to perform the fundamental task of diagnosing difficult or unclear medical problems.
My patient is a 37-year-old woman, a mother of two teenagers, with a busy career. She was in perfect health until July 2007, when, overnight, she came down with what her doctor said was a case of flu. This "flu," however, wouldn't go away. Her doctor assured her that she'd get better, but three months after her first visit to him, she was back in his office, still feeling ill. The doctor did a thorough medical evaluation, told her that he couldn't find anything wrong and again assured her that she'd eventually recover. A few months later, she was back again. This time, as she described it to me, the doctor sort of shrugged his shoulders and told her that maybe her problem was all in her head.
As you might imagine, the patient was put off by her doctor's dismissal, which set her off on a gyre of doctor-shopping. Over the next six months, she saw eight physicians, as well as a chiropractor and a homeopath, without getting a diagnosis or any real help. Finally, she did an Internet search and found me, a specialist in medically unexplained illness. All her tests were normal, but I listened to her and was ultimately able to make a diagnosis of chronic fatigue syndrome. We then launched into the treatment of her symptom-based illness, a slow process that unfortunately doesn't end in a cure but often leads to improvement.
The fact that this woman couldn't find a doctor to help her until she found me says a lot about where the U.S. health care system is heading. The economics of modern medicine have converted the doctor from Ben Casey to a factory worker on a conveyor belt, and those economic forces are driving more and more physicians toward specialties where they can spend less time with patients and earn more money.
Learning how to make a diagnosis is a critical part of medical education. It requires the doctor to listen to the patient describe the illness and then put it in a personal health framework by asking about other symptoms, previous medical problems (extending to the patient's family) and elements of the patient's life story. Doctors usually schedule an hour for these initial consultations, then 30 minutes for follow-up appointments.
Half an hour of a doctor's time is normally plenty for a straightforward health problem and more than enough for a cold with a runny nose or a cough with no fever. But what happens when your symptoms don't add up to a clear-cut diagnosis? Studies have shown that in more than 50 percent of cases, patient complaints don't have any diagnosable medical cause that can be determined by careful laboratory testing. Pain, fatigue, dizziness and trouble sleeping are among the most common symptoms, and doctors have problems with these because they don't point to any particular diagnosis.
When that happens, the diagnostic algorithm learned in medical school breaks down. The doctor's not sure what's wrong with the patient, and if he has a busy office, he won't have time to think through the patient's complaints to arrive at a coherent diagnosis. Very often, when all the tests are normal and time has run out, the doctor will conclude a visit, as my patient's initial physician did, by saying: "There's nothing really wrong with you. I'm sure you'll feel better in a few days -- or weeks."
Even doctors with time often prefer dealing with straightforward medical problems. I have a friend who's an allergist in private practice. When I asked him whether he'd be willing to work with some of my patients, he quickly said no. Why, he said, would he want to tackle difficult cases like that when he can take someone suffering from severe allergies and make them better in a day?
Doctors are being lured away from primary care by economic factors as well. Eighty percent of medical students have to borrow money for medical school. The expected median debt of this year's graduating class is about $120,000 for state medical schools and $150,000 for private, according to the American Association of Medical Colleges. At the same time, medical students face a candy store of career choices, all with widely varying earning (and debt-reduction) potential.
I, for instance, am a medical school professor with a practice devoted to patients with medically unexplained symptoms such as fatigue and pain. My patients often have complex medical histories and feel they're at the end of their rope. If a patient has Medicare coverage for disability caused by an illness, Medicare will reimburse me $196 for each hour of interaction with that patient. After expenses and other charges, I'll keep $86, a very good hourly salary.
But consider the neuroradiologist, who specializes in interpreting brain MRIs. Just a few years ago, it would take a radiologist a long time to organize and view many sheets of a patient's X-ray films, but today, thanks to computerization, the well-trained neuroradiologist can assess dozens of images of the brain in just a few minutes. He or she can probably read a patient's images and dictate a report in about 15 minutes. At my previous institution, the hourly reimbursement from Medicare was $492, and the doctor's take-home totaled $216, a substantially better salary than mine.
Physicians in a procedure-driven specialty such as neuroradiology -- and there are many others, such as cardiology and anesthesiology -- always earn more than patient-centric doctors. American medical students are aware of this as they make their career choices. And fewer and fewer are choosing patient-oriented medicine: In 1996, American graduates filled 76 percent of residency training slots in family medicine, while in 2002, they filled only 48 percent. We see similar shifts in general internal medicine. The remaining positions are filled by foreign-born and foreign-trained medical school graduates. They pass the same qualifying tests for licensure as American graduates, but cultural diversity and varying communication skills may affect their approach to patients and their ability to hear subtleties in their patients' stories.
Society has come up with a partial solution to the growing gap in primary care providers: "physician extenders." These master's level health-care professionals are trained to deal with commonly occurring, easy-to-diagnose problems: a flu, hay fever, a splinter, even severe chest pain. Usually, however, they haven't had enough training to give them the know-how to sort through a complex medical history to arrive at a diagnosis that isn't immediately evident. When they're stuck, they have to call the physician, and by then, the 30-minute visit is very often over. The patient is left hanging and disappointed -- on his or her own to figure out what to do next. The inevitable result: patients falling between the cracks of classical medicine.
There's one silver lining in this situation: the increasing number of women choosing medicine as a profession. Approximately 50 percent of most medical schools' entering classes today are women. This trend may work to offset a major patient complaint -- that doctors don't spend enough time listening to them. Research studies show that women in general and women physicians in particular are better listeners than men. Since the turn toward more women in medicine is relatively recent, I'm not sure which path the young female doctor will choose, but I can say anecdotally that quite a few of my own female students seem to be choosing primary care -- either family or internal medicine. I hope that in the next few years, their presence may help offset the dearth of U.S.-trained doctors in primary care.
Meanwhile, what are patients with an elusive diagnosis to do? If they're fortunate enough to live near a medical school, they can search the doctor list for generalists. Physicians in academic centers are encouraged to see patients as part of their duties, and they often have more time than their colleagues in the community. More important, patients can help themselves by knowing more about their bodies, how they work and what can go wrong with them.
But finally, patients will have to understand that finding a doctor who has the time to listen, diagnose correctly and then know how to treat them is going to get harder and harder. Reversing the trend away from patient-oriented and toward procedure-oriented medicine will require attention by legislators as well as medical educators. Reducing the debt of newly minted doctors who choose primary care might be one way of doing this. Cutting back on both the number of postgraduate training positions in procedural medicine and the salary paid such trainees, while raising the salaries of those in primary care, could be another.
None of this will happen, though, unless patients make their voices heard. Otherwise, they may just find themselves on their own the next time puzzling symptoms arise.
info@painandfatigue.com
Benjamin H. Natelson is director of the Pain and Fatigue Study Center at Beth Israel Medical Center in Manhattan and author of "Your Symptoms Are Real: What to Do When Your Doctor Says Nothing Is Wrong."
So, in that spirit, I have found a few articles here and there that I do think are deserving of being posted on my blog for those who are interested. I have a wide range of readers--some with greater interest in these sorts of topics than others. Remember, the delete button is always available in such cases when you are not at all interested in reading! :)
Sometimes I find an article that explains something better than I believe I ever could. And it touches on topics that I am both passionate about and that people often ask me about.
Jeannine passed this article on to me. I have over time, seen several articles discussing this sort of crisis in the health care system. But it also answers, in many ways, several of the questions that I am often asked:
Why did it take so long for anyone to figure out what was wrong?
Why did so many doctors push me out the door? Why did some completely refuse to even take my case?
Why did I have to see sooo many doctors before anyone listened?
Why is it so difficult to find a doctor willing to take my case? And why is this happening to so many of your friends on DINET?
What can we do to make it so that doctors have time to be doctors again? To have time for patient care?
What will happen when the doctors I have now, all nearing retirement age in the next ten years, are gone? What will we do to make sure patients like me continue to have quality health-care?
This article brings an often undiscussed part of the nation's health-care crisis to attention. And it also says hats off to those doctors that I have been so blessed to find--Dr. ANS and Dr. Lyme--who are willing to give me the time and attention my case requires.
Sadly, last summer I lost one of the key members of my health-care team--Dr. PCP--because he left the practice. He had been my PCP for five years and through the worst of my illness. He believed in listening. He told me that 80% of cases could be solved if doctors would just take the time to listen to the patient. I miss him. I'm still trying to establish a working relationship with my new PCP. When someone has not been witness to the course, the ups and downs, the extremes of this illness it is very difficult to 'teach' them. It's hard to lose the continuity of care I had worked so hard to find and been so blessed to have.
Here's to better days ahead for both the providers and the recipients of health-care in America.
Blessings,
Emily
P.S. I only started this blog over a month ago! Oops!
HARD CASES
Lost in a System Where Doctors Don't Want to Listen
By Benjamin H. Natelson
Sunday, August 3, 2008; Page B03
I'd like to tell you about one of my patients. She's the kind of patient that I enjoy seeing but that many doctors go out of their way to avoid. This means that she's also the kind of patient I worry about most -- a patient who in the near future may be stranded without proper care as fewer and fewer doctors, constrained by time and the economics of our health care system, are willing to perform the fundamental task of diagnosing difficult or unclear medical problems.
My patient is a 37-year-old woman, a mother of two teenagers, with a busy career. She was in perfect health until July 2007, when, overnight, she came down with what her doctor said was a case of flu. This "flu," however, wouldn't go away. Her doctor assured her that she'd get better, but three months after her first visit to him, she was back in his office, still feeling ill. The doctor did a thorough medical evaluation, told her that he couldn't find anything wrong and again assured her that she'd eventually recover. A few months later, she was back again. This time, as she described it to me, the doctor sort of shrugged his shoulders and told her that maybe her problem was all in her head.
As you might imagine, the patient was put off by her doctor's dismissal, which set her off on a gyre of doctor-shopping. Over the next six months, she saw eight physicians, as well as a chiropractor and a homeopath, without getting a diagnosis or any real help. Finally, she did an Internet search and found me, a specialist in medically unexplained illness. All her tests were normal, but I listened to her and was ultimately able to make a diagnosis of chronic fatigue syndrome. We then launched into the treatment of her symptom-based illness, a slow process that unfortunately doesn't end in a cure but often leads to improvement.
The fact that this woman couldn't find a doctor to help her until she found me says a lot about where the U.S. health care system is heading. The economics of modern medicine have converted the doctor from Ben Casey to a factory worker on a conveyor belt, and those economic forces are driving more and more physicians toward specialties where they can spend less time with patients and earn more money.
Learning how to make a diagnosis is a critical part of medical education. It requires the doctor to listen to the patient describe the illness and then put it in a personal health framework by asking about other symptoms, previous medical problems (extending to the patient's family) and elements of the patient's life story. Doctors usually schedule an hour for these initial consultations, then 30 minutes for follow-up appointments.
Half an hour of a doctor's time is normally plenty for a straightforward health problem and more than enough for a cold with a runny nose or a cough with no fever. But what happens when your symptoms don't add up to a clear-cut diagnosis? Studies have shown that in more than 50 percent of cases, patient complaints don't have any diagnosable medical cause that can be determined by careful laboratory testing. Pain, fatigue, dizziness and trouble sleeping are among the most common symptoms, and doctors have problems with these because they don't point to any particular diagnosis.
When that happens, the diagnostic algorithm learned in medical school breaks down. The doctor's not sure what's wrong with the patient, and if he has a busy office, he won't have time to think through the patient's complaints to arrive at a coherent diagnosis. Very often, when all the tests are normal and time has run out, the doctor will conclude a visit, as my patient's initial physician did, by saying: "There's nothing really wrong with you. I'm sure you'll feel better in a few days -- or weeks."
Even doctors with time often prefer dealing with straightforward medical problems. I have a friend who's an allergist in private practice. When I asked him whether he'd be willing to work with some of my patients, he quickly said no. Why, he said, would he want to tackle difficult cases like that when he can take someone suffering from severe allergies and make them better in a day?
Doctors are being lured away from primary care by economic factors as well. Eighty percent of medical students have to borrow money for medical school. The expected median debt of this year's graduating class is about $120,000 for state medical schools and $150,000 for private, according to the American Association of Medical Colleges. At the same time, medical students face a candy store of career choices, all with widely varying earning (and debt-reduction) potential.
I, for instance, am a medical school professor with a practice devoted to patients with medically unexplained symptoms such as fatigue and pain. My patients often have complex medical histories and feel they're at the end of their rope. If a patient has Medicare coverage for disability caused by an illness, Medicare will reimburse me $196 for each hour of interaction with that patient. After expenses and other charges, I'll keep $86, a very good hourly salary.
But consider the neuroradiologist, who specializes in interpreting brain MRIs. Just a few years ago, it would take a radiologist a long time to organize and view many sheets of a patient's X-ray films, but today, thanks to computerization, the well-trained neuroradiologist can assess dozens of images of the brain in just a few minutes. He or she can probably read a patient's images and dictate a report in about 15 minutes. At my previous institution, the hourly reimbursement from Medicare was $492, and the doctor's take-home totaled $216, a substantially better salary than mine.
Physicians in a procedure-driven specialty such as neuroradiology -- and there are many others, such as cardiology and anesthesiology -- always earn more than patient-centric doctors. American medical students are aware of this as they make their career choices. And fewer and fewer are choosing patient-oriented medicine: In 1996, American graduates filled 76 percent of residency training slots in family medicine, while in 2002, they filled only 48 percent. We see similar shifts in general internal medicine. The remaining positions are filled by foreign-born and foreign-trained medical school graduates. They pass the same qualifying tests for licensure as American graduates, but cultural diversity and varying communication skills may affect their approach to patients and their ability to hear subtleties in their patients' stories.
Society has come up with a partial solution to the growing gap in primary care providers: "physician extenders." These master's level health-care professionals are trained to deal with commonly occurring, easy-to-diagnose problems: a flu, hay fever, a splinter, even severe chest pain. Usually, however, they haven't had enough training to give them the know-how to sort through a complex medical history to arrive at a diagnosis that isn't immediately evident. When they're stuck, they have to call the physician, and by then, the 30-minute visit is very often over. The patient is left hanging and disappointed -- on his or her own to figure out what to do next. The inevitable result: patients falling between the cracks of classical medicine.
There's one silver lining in this situation: the increasing number of women choosing medicine as a profession. Approximately 50 percent of most medical schools' entering classes today are women. This trend may work to offset a major patient complaint -- that doctors don't spend enough time listening to them. Research studies show that women in general and women physicians in particular are better listeners than men. Since the turn toward more women in medicine is relatively recent, I'm not sure which path the young female doctor will choose, but I can say anecdotally that quite a few of my own female students seem to be choosing primary care -- either family or internal medicine. I hope that in the next few years, their presence may help offset the dearth of U.S.-trained doctors in primary care.
Meanwhile, what are patients with an elusive diagnosis to do? If they're fortunate enough to live near a medical school, they can search the doctor list for generalists. Physicians in academic centers are encouraged to see patients as part of their duties, and they often have more time than their colleagues in the community. More important, patients can help themselves by knowing more about their bodies, how they work and what can go wrong with them.
But finally, patients will have to understand that finding a doctor who has the time to listen, diagnose correctly and then know how to treat them is going to get harder and harder. Reversing the trend away from patient-oriented and toward procedure-oriented medicine will require attention by legislators as well as medical educators. Reducing the debt of newly minted doctors who choose primary care might be one way of doing this. Cutting back on both the number of postgraduate training positions in procedural medicine and the salary paid such trainees, while raising the salaries of those in primary care, could be another.
None of this will happen, though, unless patients make their voices heard. Otherwise, they may just find themselves on their own the next time puzzling symptoms arise.
info@painandfatigue.com
Benjamin H. Natelson is director of the Pain and Fatigue Study Center at Beth Israel Medical Center in Manhattan and author of "Your Symptoms Are Real: What to Do When Your Doctor Says Nothing Is Wrong."
Sunday, September 07, 2008
A Sunday Afternoon Drive...
Every Sunday afternoon Dad and Abbie go for a drive through the countryside of Pennsylvania, stopping somewhere along the way for a rootbeer float (Dad) and some ice cream (Abbie). (Yes, I'm trying to get my Dad to break this addiction!).
Today, I decided I hadn't kept my committment to going on outings, especially since increasing my Lyme meds. I certainly gave D and A both a suprise when I called their cell phones asking if I could tag along for a ride. So, I got to pick where we went.
I took a zillion photos and this is still only a handful of them. I arrived home exhausted, but happy to have gotten out.
It was a very perfect day in our valley. So many of my friends have never been to see where I live and I wanted to share these pictures of a beautiful day in Pennsylvania. We think it's pretty nice here. :)
Enjoy and Happy Monday! :) (Britt, that 'Happy Monday' part is especially for you!).
First stop: The lookout.
And yes, Asher came along for the ride too and is quite tuckered out from all of the sightseeing.
The lookout is just about a 15 minute drive from our house partway up one of the mountains (we live in a valley). I have not been able to go here for years and have been longing to go.
You can see the entire valley from here. This is a shot of the more rural areas.
Me, Abbie and Asher hanging out! :)
Note: To view the collage in full, subscribers will need to go to my blog itself rather than stay in email. Left click anywhere on the collage and it will enlarge.
The Valley from "The Lookout"
Here are a few more photos of the view from "The Lookout". I have no idea what, if any other name, is used for this location. I have always known it by this name, and if you say "The Lookout" to any other townie, they know exactly to where you are referring.
The rural areas to the left...
The whole valley view...
The town to the right of the rural area. Yup, we live somewhere in the town part. There are more rural areas on the other side of town, but they can't be seen from the lookout.
Next Stop: A Farm in the Valley
After we went to the lookout, we drove through the rural areas and farmland that can be seen in the view from the lookout.
We just stopped at one of the farms along the way to get some pictures of what I think are absolutely classic pictures of Pennsylvania. The images I've posted remind me so much of Pennsylvania. I love the contrast of the mountains and valleys--the mountains as a backdrop to the farms.
Although the landscape is a bit different than that in Iowa, I sure did miss Iowa and my family there even more when we pulled into the driveway to this farm.
Sadly, so many of the farms in this area are being bought and developed. I have trouble getting used to how much things have changed over the past 30 plus years! Our house used to be surrounded by cornfields on all four sides! Now, there are none.
"Classic Pennsylvania"
Yes, in order to get his 'artistic photo' Dad made me crawl through the alfalfa field!
Mountains, barns, silos, alfalfa fields, cornfields, a gravel road, and a pretty sky...what more could you ask for?
Another bit of classic Pennsylvania scenery--with the trees along the edges of the fields.
The corn and alfalfa fields.
Blessings,
Emily
Saturday, September 06, 2008
Nap Time!
I'm not sure where the idea came that crates for dogs are 'mean.' All of our dogs have loved their crates. And Asher is no exception...
Dogs are such creatures of habit it's remarkable. Today, at precisely 3:30 Asher decided to head for his daily nap in his crate without even being told 'Go take a nap.' I hadn't headed to nap myself yet, but his internal clock knew it was nap time.
Usually I say, "Asher, go take a nap." And off he goes to his crate. I've also trained him to open the crate door if it is closed. He's always very proud of himself when he I tell him, "Open" and he gets the door open by batting at it with his paw.
His neck has been hurting him lately, so he has his nice little pillow to rest his head on. I couldn't resist taking a couple of pictures of Asher's nap time. :)
Speaking of nap time...it's time for MY nap!
Blessings,
Emily
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