Health Chaos

Until I was hospitalized 1 1/2 years ago for a perforated ulcer,  I was only on one daily Rx medication: the  one pill for keeping my hereditary “borderline” blood pressure under control. However, my “provider” felt she needed to add a calcium supplement to prevent osteoporosis and aspirin to prevent a heart attack and a decongestant, in lieu of just standing upright and blowing my nose. And then, during the hospitalization, Protonix was added (I can live with that). As was Norvasc which resulted in severe hair breakage and loss. I just dumped that one. And a bunch of drugs that caused fluid retention and more drugs to cope with constipation (which I never experienced). Lots of drugs prescribed; few that I took.

Now why did I need all these drugs, and even more that I just didn’t take? Well you know my bandwagon about the pill pushers in this country. And why did I even have a perforated ulcer? Too many inappropriate drugs prescribed for back pain., osteoporosis, nasal congestion!  (I have idiopathic scoliosis and a spinal fracture which didn’t bother me at all for many years when I lifted heavy  bags of books).

So now, without health insurance (yes; one of the 47 million Americans), I am trying more and more to reduce any of this junk, these chemicals, that I put into my body. Why? The side effects. And the cost!  Maybe it is my BP med that is making me a little tired , not the aging process? By the way, the insurance company DID NOT PAY FOR ALL OF MY HOSPITALIZATION AND MEDICAL CONSULTANT EXPENSES.  Surprised? I had to. After a “lay off” due to downsizing at work, with no income, and no insurance. (even though I had worked as a manager for a HEALTH insurance company!). Who pays for all these medications? I go to a local neighborhood clinic that is low cost, for the blood pressure med. But anything else? Well check into Partnership for Prescription Assistance (PPA). They have been most helpful with the drug that will prevent another ulcer.

 As a health professional, I have encountered patients/clients/members who are on as many as 21 medications each day. This is incredible. Who is monitoring this regimen? How can  people keep this straight? How do you do this? And what is really necessary? And what interacts with what other medications?   Contraindications? And what are the side effects? And who is helping to monitor this? No one. Does your doctor/provider/”prescriber” have time to do this? Of course not. And what if all these medications have the resultant side effect of confusion?

 Oh! The answer! Health insurance companies are now providing programs like healthy living support programs that  have nurse case managers who give advice to “members”. The nurse case managers are the gate keepers who help the “members” manage their medications (often from many states away) and keep costs down for the insurance companies (don’t go back to your doctor’s office! that will be a bill that the insurance company will be expected to pay). Just call me, your case manager. the nurse case manager  can talk with you after he/she enters your data into 47 computer  screens.

 So what to do? Think about who you vote for in the next election, and why. No; we don’t need another layer of bureaucracy. We need a WELL THOUGHT OUT PROGRAM FOR NATIONAL HEALTH INSURANCE. So that we can be as progressive as other developed countries. This is just one little step. Think about this.  Don’t just go along with a candidate who says she/he supports health care. You need to look way beyond that kind of statement. What is really in mind? What kind of program? Managed by whom? Who will be in charge? Who will do the oversight? THINK!

I am sure this article, and I will try to keep it brief and not too inflammatory, could really upset some folks. But I make my statements following 39 years in my profession, with a lot of observation, experience, and education.

There is nursing education, and then there is nursing education. I happened to be an undergrad student in nursing at one of the leading universities  in the country in the 60s. We worked at being professionals, taking courses along with med students. We wanted to be the best of the best. And those that didn’t succumb to organic chemistry and anatomy and physiology persevered. Our class diminished from 300 to 99 over four grueling years! But as the years have gone by, I have observed the disintegration of this professional education.

In the state where I now reside, continuing professional education for nurses is not even required. How embarrassing to the profession. Just send in your 50 bucks each year. It wouldn’t take much science to figure out where I live. Not that it matters. My first position in this state was to spend 2 months teaching maternal and child health, because if I had not been hired that summer, the students would not have been able to graduate in the spring. This was an LPN to RN program. I had 12 students (4 men; 8 women). I tried so hard to motivate them to look toward higher education, to think about what opportunities they might have in their careers. But their sole motivation seemed to just make a few more dollars in the hospital. I found this most disappointing.

And maternal and child health? I was to follow a rigid curriculum and monitor clinical practice. The curriculum was labor and delivery, with clinicals in the hospital. No curricula about maternal health. No curricula about child growth and development.

In my work since then, I have met some young nurses who are truly enthusiastic, motivated, wanting to grow professionally, hopefully into a specialty. I would do anything to help them, even if all it means is a great letter of reference and a lot of support. It is of interest that they came from major universities, but not in this state.

I am still trying to make sense of this state that I have been living in for 3 years. Is it the education in this state? Is it the value system of this state? Or is it a more systemic problem that I have lost track of, despite my staying on top of professional literature. The political climate? At any rate, would you really, in good faith, encourage your child to study for the nursing profession? Is it even a “profession” anymore?

 Well here is my arm chair diatribe, and again, I would like to say, I have no intent of offending anyone, but I am very disappointed in most of my nursing colleagues. Which explains, to a degree, why I left 3 positions this year. I was embarrassed to work for colleagues that I could not respect.

To those of you who have read my blog, I apologize for repetition. But some issues just don’t go away.

I just heard an ad on tv for health insurance plans to supplement what medicare offers. First of all, just what does medicare offer? And what about the 47 million of us who have no health insurance and are not yet ready for medicare? The ad was about a certain supplemental insurance company, and it was recommended that you discuss this plan with your “doctor” who will help you decide if this plan it right for you. Yah sure! Since when do “doctors” recommend health insurance plans? Well, someone is getting a kick back here from an insurance company. You need to count on your friends and colleagues for this kind of advice: not your “doctor” and not the insurance companies!

All research must be taken with a grain of salt. I was recruited, years ago, for the Nurses’ Health Study. After filling out their questionnaire, I received a letter informing me that I was ineligible as a participant since I had taken steroids. I had  never taken steroids in my life! I didn’t write back because I didn’t have the time (full time working mom, grad student, with two little boys). So now I look at all health care research with more acute skepticism.

As for HRT (Hormone Replacement Therapy), I did that for about 5 years, then quit cold turkey because my gynecologist told me she could not in good faith prescribe it anymore. I have a friend who has been “tapering off” HRT for the 3 years I have known her. Tapering off HRT? No need to. Doing this will not affect your blood pressure and heart rate, and will probably do nothing except have you discontinuing HRT.  I can only suspect that her gynecologist is her age as well, and the looks of skin and hair are more important than the total health picture? Or maybe not? Maybe it doesn’t matter if we do HRT or not? Once again, conflicting conclusions from research.

There is a lot of spurious, and confounding, information in these studies…I am a medical professional, but also a skeptic. I have attended prestigious universities, have worked at prestigious universities. But that doesn’t mean anything. What is important is the integrity of their representatives,  their scientists, of their reporting of results of their studies. They need to be honest, not just writing what the public wants to hear.

So now we need drugs to fall asleep, drugs to stop restless leg, drugs to make us “regular”? Soon we will need drugs to wake up, get our legs going, and be able to use the bathroom normally?

Have we forgotten to eat a normal, well balanced diet, with fiber,  that would prevent some of these “problems” in the first place? Have we forgotten to just go to sleep to some nice music at 10pm after walking the dog in fresh air? And though I am lax myself about taking vitamins, popping a pill or two each day, if it doesn’t burn up your stomach (drink plenty of water), you won’t have legs that fly around or get stiff and achy, most likely.

As you have probably noticed, due to the constraints of health care costs due to the insurance industry wanting to make profits, health care providers have less and less time to spend with you: their patients, clients, members. The average time is 10 minutes or less. Can you have your questions answered? Your needs met? Maybe. Maybe not.  And thanks to the pharmaceutical companies and their agenda, it is easier for a provider to say “take this” and “take that” rather than LISTEN to you and discuss alternatives.

 I had the recent experience of going to a clinic. I left with 2 prescriptions. I ran out the door, prescriptions in hand, to avoid a parking ticket. When I got home, I noticed the prescriptions were for someone else…not for me. This means that someone else very likely received my prescriptions.

 What are the issues here? Safety and Privacy. Just suppose I wasn’t a health care professional myself and didn’t recognize the error. Just suppose I had taken medications not meant for me. Not to mention HIPAA VIOLATIONS.  Please see http://www.hhs.gov/ocr/hipaa/

And this all extends to our pet companions as well. I took my dog to the veterinarian this week. Her allergies were acting up. I was given the usual antibiotic and steroid to get this under control. I knew what the medications were. This was discussed with the veterinarian and stated in my bill. However, I noticed that the bottle of medications DID NOT give the name of the medication or the dosage. Danger! Just suppose my dog had a middle of the night emergency. Just suppose I grabbed her medications and ran out the door. Just suppose the emergency veterinarian asked what meds she was on. Just suppose I couldn’t remember at the time. I called my veterinarian, not to complain, but to express my concern. I believe this is a legal violation. You don’t dispense drugs without labeling the name of the medication and dosage. Sure, you could say, it’s just a dog. Oh well. Suppose my 2 year old grandson had gotten a hold of these?

The bottom line, the important lines:

• Please be aware of what medications you are getting; check for your name and the name of the medications, and the dosage. While you are doing that, check the expiration date too. Medications, which are chemicals, can change  their composition over time. And some expire; check the date.
• Please make sure the medical record that is being reviewed, and recorded into, on a paper medical record, or on a computerized record, is indeed yours.
• Please make sure that your privacy is not being violated. When you are called from the waiting room, your first name is all that needs to be used.
• Please keep records, at home, of all of your transactions with health care providers and pharmacies.
• Please extend these reminders to your  family, friends, neighbors, colleagues. and to anyone else that you know is encountering the health care system. Which is everyone.  And don’t forget your pets’ veterinary records. (not long ago I had to have a very old dog euthanized. Never easy. The medical record showed that my younger healthy dog had been euthanized).
•  BE CAREFUL. YOU ARE YOUR BEST ADVOCATE!  AND YOU MAY BE YOUR ONLY ADVOCATE!

Language development: Have you noticed that you talk to your dog the same way you talk to a toddler? The difference is that toddlers keep maturing, and dogs get stuck at around the human age of 3. I find myself, with some embarrassment, saying to my dog “I don’t like that” or “this is inappropriate behavior” or “this is not acceptable”. Yeah; I am sure she understands!? Maybe she does. Dogs are a lot smarter than we give them credit for. Someday soon I am going to count up all the words my dog knows. It is probably around 200. About the same as my 2 year old grandson…Although he knows stuff he cannot express verbally. Just like my dog!

My new position lasted 9 days. I did not sign the contract. Why? Because the salary I was quoted in my interview was 20k more than what the contract stated. Not livable. And again the demeaning and accusatory attitude of persons who don’t have basic management/supervisory skills.  I asked to “think about” the contract for a day or two before signing, and was told “oh, you’ll sign today” but I didn’t.  And the next day I received a call from my manager who said if I did not sign by 3pm, she would have to find someone else. Okay. I was out the door. I felt bad about the sites that I was committed too. But I had to look out for me.

 All this is after I interviewed in August, but all the beaurocratic red tape didn’t allow me to begin work till the end of October! They are lucky that I bothered to show up at all. And I spent more than $200 just getting through the application and certification process, never to be reimbursed.

So this is the third health care position that I have quit this year. Who do I think I am? I am not independently wealthy. But I am no longer willing to work for persons that I do not respect.

 I have a friend who has been a free lance writer for years, who now is recently employed by an insurance company, and struggling with the politics. Here is my ongoing advice to her:

Keep practicing the mantra “let me think about it and get back to you.” Then it sounds like you are cooperative.

As for parties and holidays, “oh thank you for letting me know; I will do my best to be there.” Then do whatever you want to do with NO excuses. If they ask “where were you? why didn’t you come?” “Oh; I am sorry. But I had something come up.” Don’t provide personal/family information.  Be vigilant about who you trust. Maybe you had a deadline.  “I am sorry; I am really busy today.” Doesn’t matter what.  As for costumes and Halloween, come as yourself. So what.

 This entry is about orientation of new staff, etc.   The moral of this story: it is really important to ask all the questions, have a contract, and don’t do a thing, don’t commit to anything until you meet with Human Resources, which should happen on your first morning, if not before you start.  And, if you are a manager or supervisor, please spend your first week telling your staff (or providing them with) your history, their rights, their challenges, commonly used acronyms, an organization chart, a list of necessary phone numbers and email addresses, how to use the phone and the computer, the politics, not to mention introducing them to other staff, providing them with a CLEAN equipped working environment, and a vase of fresh flowers.

 I have had a week from hell. First week in my new position. The incompetence and the accusatory style of communication amazes me. The worst I have experienced in my 39 year career. I still don’t know what my salary is, don’t know benefits, don’t know about my 1 yr contract. Will find out at 3 on Halloween. Bad omen? Good omen? I SHOULD NEVER HAVE STARTED without knowing salary. Why can’t anyone tell me? Well, if it is not livable, I will just have to decide not to sign the contract and walk out the door. 

And on the way to work on Tuesday, I could not avoid some metal debris on the freeway (typical highway shlocky maintenance where I live) and blew out 2 tires and bent a rim. For almost $1000. Didn’t report to insurance cuz my deductible in 1k. So I hear “you were late!”. Yah; well I am alive! Went out to my car for 5 minutes one day to change my contact lens and was told “you never came back”. What!?  And the week before I even started I was asked by my “mentor” how I planned to allocate my time between my job sites.  What? I didn’t even know what sites I would have assigned to me. Most staff have 1 or 2 sites. And I already get the picture. They “drive” between their sites, presenting the fiction they are working when indeed they are not. I was given 17 sites! I will spend 2 days a week at an ethnic academy. Was told they are hard to work with. Nice intro, huh? But I find them VERY pleasant. Cuz I am not naive. I have been around the block a few times. I think THAT site will work out fine, if I ever get paid.

Are you expected to use your personal cell phone and not be reimbursed for mileage? I will just keep my cell phone off. Why should I pay for this service for them?

Take care of you, because often your employer will not….

Thankfully the democratic party candidates are in tune with the fact that we have 47 million Americans without health insurance, sometimes due to job elimination, like myself. And health insurance is not affordable without assistance from an employer, except for the very wealthy, and those that have spouses and domestic partners whose insurance they can tag on to.

And why is health insurance beyond our reach? Obviously, the insurance industry wants profits by driving up rates. And I believe that the pharmaceutical companies are creating diagnoses, and recommending drugs, that we all “need! “Just ask your provider,” whoever that is…

And who are two strong lobbies: the insurance industry and the pharmaceutical companies? And who is helping to finance most of the presidential aspirants?

What on earth is a “nervous breakdown”? why can’t people sleep at night? what is “restless leg syndrome”? Where did this stuff all come from? We should all be taking 21 drugs each day? Oh, and you need a stool softener, and laxative for breakfast that may make you “regular”. And a daily decongestant, whereas just being in a vertical position and blowing your nose in the morning may work just fine. Why? Why not choose a healthy lifestyle instead?

Why not jog or walk your dog (you would both benefit), stretch, swim, eat properly i.e. a diet rich in fruits, veggies, grains? Try to avoid anything but the essential drugs that you really need to stay alive.

All of these drugs, too many drugs, interact with each other, and can kill you. Less is better.

A national newspaper printed an article today about health care issues, including HRT.   All research must be taken with a grain of salt. I was recruited, years ago, for the Nurses’ Health Study. After filling out their questionnaire, I received a letter informing me that I was ineligible as a participant since I had taken steroids. I have never taken steroids in my life! I didn’t write back because I didn’t have the time (full time working mom, grad student, with two little boys). So now, even though public health is my love, I look at all research with more acute skepticism

As for HRT, I did that for about 5 years, then quit cold turkey because my gynecologist told me she could not in good faith prescribe it anymore. I have a friend who has been “tapering off” HRT for the 3 years I have known her. Tapering off a relatively innocuous drug? I can only suspect that her gynecologist is her age as well, and the looks of skin and hair are more important than the total health picture? Or maybe not? Maybe it doesn’t matter if we do HRT or not?

There is a lot of spurious, and confounding, information in these studies…I am a medical professional, but also a skeptic. I have attended prestigious universities, have worked at prestigious universities. But that doesn’t mean anything. What is important is the integrity of their representatives, their scientists, of their reporting of results of their studies. They need to be honest, not just writing what the public wants to hear.…

Finally, after a lay off happened to me in October of 2006, my applying and interviewing has paid off, or just about. Looking for work can be harder than working. I have been offered two positions: one with a great salary, a 2 year contract, with NO benefits; the other with a lower salary, with a 1 year contract (open for renewal) with great benefits.

Which one do you think I decided to accept?

 Since last October, I have been one of those Americans with no health insurance, a very precarious and scary place to be, especially as I am getting older. Maybe that would be okay if I was 21 and in my prime. I have no major health problems, am not old enough for medicare, don’t have a spouse whose benefits I can share, and suppose someone decides to run me over as I cross the street? Or shoot me? A real possibility in this city where, from my observation. drivers do not seem to know the rules of the road. (they speed through yield signs, brake going up hill, lose track of the width of lanes, have no clue what to do if two or more cars come to an intersection at the same time) So I liquidate all my assets to pay medical and dental bills, and ask my sons to buy me a shopping cart for Mother’s Day!

 This is an issue to think seriously about in our next presidential election. I have worked as a health professional for 39 years, paid my taxes, paid into social security. It seems like I have a right to a relatively comfortable life, with health insurance. Or don’t we have rights anymore? I might do better moving to a foreign country where there is national health insurance. We are LONG OVERDUE for this here.

 When I was an undergrad student in the 60’s, I had a professor who said that we would have  a national health insurance program by the time we graduated in 1968. What a dreamer…I hope, if she is still teaching, that she has become jaded and doesn’t say this anymore…