I was running a little late this morning, and I was hoping that upon my arrival I would see a vacant waiting room at Disability Physicals. Unfortunately, I opened the door to the office, and saw four unhappy faces staring up at me. So, not only was I late, but my 9, 9:30, 10, and 10:30 were already there. I nodded my head in a brief hello, they scowled back, and I ducked into my office. The first patient was a Air Force veteran who had hurt his knee while "shuffling papers on the job." He said that, aside from getting a total knee replacement, the VA wouldn't pay for anymore treatments, and since he was eight years too young to get a total knee, he was out of luck. In addition, he stated that he had been thrown out of the local homeless shelter since he was "trying to get all my stuff that everyone had stolen out of my bag," (I'm sure there was more to that story) and therefore was really anxious about the upcoming winter storm later this week. He stated that he "really needed that disability check now, so I can get a good motel or something," to which I unfortunately had to tell him, "it usually takes about another month after this visit to receive any benefits." That apparently made him really mad, because he jumped right up out of his seat, and stomped out of the room, kicking the door on the way out. Apparently his knee wasn't bothering him anymore.
The next patient said that he too had hurt his knee, but also complained of some shoulder, elbow and neck pain that he acquired after "falling through a four-story roof." He stated that he had hit "a bike, a bathtub and a big clock," on the way down, and therefore couldn't work. I questioned him a little more about his injury, and he admitted that "I wanted to go back to work that day, but I ate lunch instead and I got fired." Interesting... Now, I understand that his story by itself is not too strange, but this gentleman was one of the oddest people I've met so far. Throughout the interview he proceeded to hit himself in the knee, face, neck and ear with the reflex hammer, measure the circumference of his face with my measuring tape, and, after slamming his hand with the tuning fork, put the tool to his ear and said, "I've never heard a sound like this before." Not only that, but he kept trying to touch me, even after I moved away from him multiple times. Now, I normally don't have a problem with physical contact, but if someone obviously doesn't want you to touch them, maybe you shouldn't, you know? I was wearing my Med school scrubs, complete with stiched logo, and he kept trying to pull the logo off, making statements like "there's something on your shirt," or "I like your colored pants, can I have them." After a brief (very brief) physical exam, I bid him farewell, and he touched me once again, stating "you're really young to be a doctor, I bet I could be your daddy." I responded, "I'm older than I look, and have a good day."
The 10:00 patient was totally normal, no problems at all. Then came the 10:30.
He walked into the exam room, swaggering with his pants halfway to the floor. He was around 5'1", weighted approximately 250 lbs, and had his hair in beads, standing almost straight up in the air. He sat down, and the following conversation ensued.
"So, what keeps you from being able to work?"
"Well, I was working down in Dallas, at a daycare center run by my old lady. We was doing good, we had a couple of kids that were good, then I started doing the PCP, and we got shut down."
"Well," I said, "that could make running a daycare center pretty difficulty, so are you addicted to the drug now?"
"Oh hell no," he responded, "Now I teach kids to stay away from gangs and drugs and everything. You see, I came home from the job one day, and found my girl in the bed with another dude. We got into a fight, and I got shot six times, and stabbed in the belly. I was like 'hey, why you with my girl?' and he was like 'I gonna kill you fool!' Then he shot me!"
"Ah, so you can't work because you got shot?"
"Yeah, I can't feel my right hand - the bullet blew out my armpit. It got my left fingers, too, but they're ok. But my girl was like 'why ain't you dead, fool?' and I was like 'oooh, call an ambulance!' so she did, and I'm here. But I wanted my money, so I took on Ricky Lake for some justice, but Ricky found that I was cheating! But I ain't, I walked in on her!"
As you might imagine, I didn't really know what to say to this, so I just nodded, and proceeded to the physical exam. Wouldn't you know it, he had lots of scars, and couldn't move his right hand. As he was leaving, he said, "I hope y'all are better at figuring out the truth than Ricky Lake!" I hope so as well...
And after all of that, do we really need quotes of the day?
Until later,
-DD
Tuesday, January 26, 2010
Friday, January 22, 2010
Friday Night Quotes
Woohoo, Friday....you know what that means. It's time for Friday Night Quotes! Tonight's entry is a good mix of quips from both Disability and the Juvie, so I think you'll be entertained. So, without further ado...
Me: "Are you able to bathe and dress yourself without difficulty?"
Woman: "So sure, but if I take a bath, my husband has to watch. I think he likes it."
Patient's written response to the question "Why did you condition stop you from working?"
"I didn't want to go to work because if I did, my legs started moving, and I don't like that."
Lady: "My knee arthuritis is so bad, it even keeps me from sitting at a table."
Me: "It wouldn't happen to be a round table, would it?"
Lady: "Oh no, it's square."
Me: "Ok, just checking."
Juvie kid: "I'm really allergic to poison ivy. Like this one time, I was running from the police, and hid in a bush...but the bush was really poison ivy."
Me: "That sounds terrible."
Kid: "Yeah, it was pretty bad, but next time I'm running from the cops, I'll know what bush to not hide in."
That same kid asked the question, "If you're asleep, can a dog smell you?"
Nurse: "Unfortunately, the test results show that you're positive for Gonorrhea."
Teenage male: "Are you kidding me? How is that possible?"
Nurse: "Have you been having sex?"
Male: "Yeah, but only with one girl at a time. I thought you couldn't get an STD unless you had multiple partners."
Nurse: "That's in total...not multiple partners at one time."
Male: "Ah crap."
Have a good weekend,
-DD
Me: "Are you able to bathe and dress yourself without difficulty?"
Woman: "So sure, but if I take a bath, my husband has to watch. I think he likes it."
Patient's written response to the question "Why did you condition stop you from working?"
"I didn't want to go to work because if I did, my legs started moving, and I don't like that."
Lady: "My knee arthuritis is so bad, it even keeps me from sitting at a table."
Me: "It wouldn't happen to be a round table, would it?"
Lady: "Oh no, it's square."
Me: "Ok, just checking."
Juvie kid: "I'm really allergic to poison ivy. Like this one time, I was running from the police, and hid in a bush...but the bush was really poison ivy."
Me: "That sounds terrible."
Kid: "Yeah, it was pretty bad, but next time I'm running from the cops, I'll know what bush to not hide in."
That same kid asked the question, "If you're asleep, can a dog smell you?"
Nurse: "Unfortunately, the test results show that you're positive for Gonorrhea."
Teenage male: "Are you kidding me? How is that possible?"
Nurse: "Have you been having sex?"
Male: "Yeah, but only with one girl at a time. I thought you couldn't get an STD unless you had multiple partners."
Nurse: "That's in total...not multiple partners at one time."
Male: "Ah crap."
Have a good weekend,
-DD
Doctor Thyself?
Well, I started working Saturdays this month...not something that I'm sure I will be repeating come February, but for the rest of January, I'm stuck spending part of my weekend seeing Disability claimants. I don't know if there's something special about people who would rather get a physical than do anything else on a Saturday morning, but it seems like the overall...sanity level of my Saturday claimants is lower than it is during the work week. The past two Saturdays I've seen multiple people that, using home medical resources (textbooks, WebMD, etc), have decided to doctor themselves for various ailments, and after their home remedies fail to fix the problem, feel the need to apply for disability. I mean, it makes sense to me...it's not like the now nine years of post-secondary education I've gone through means anything - the diagnosis of "tape worm and stomach cancer" you received from typing "diarrhea" and "vomiting" into some website is just as valid as my thorough history and physical, even though I just diagnosed you with gastroenteritis. One such patient presented last Saturday, stating that she was "oh so very tired (dramatic pause), and my leukemia is just getting so hard to manage."
Ok, as you might imagine, the "leukemia" got my attention. "What type of leukemia do you have?" I asked.
"Oh, I'm not sure if you're aware, but there are many different types of leukemia. I have one of them," she responded.
"Actually I am well aware of the different types of leukemia," I replied, "Can you recall what type you have?"
"Well," she stated, pressing a finger to her lip," I can't recall, I didn't bring my medical textbook with me, you see...but I know that it keeps me from making red blood cells, and that's why I'm on the iron I buy from Wal-Mart."
There were so many things wrong with that statement, that I felt the need to do a little educating.
"First of all, leukemia is a condition that affects white blood cells, not red blood cells" I said. "Secondly, leukemia is usually treated with, at the minimum, chemotherapy. Iron supplementation, especially if you're just getting it from Wal-Mart, does not really fit that bill. What you're describing sounds more like anemia, is that what you meant?"
"Oh no," she replied, "I'm sure it's leukemia. I spend a lot of time reading my medical textbook - you can never be too educated - and I'm sure that it told me, based on my symptoms, I have leukemia. I can go home and look it up, then call you, if you'd like."
"That's quite alright," I said. "Let's just move on to your fatigue."
While I do believe that one can never be too educated, I do think that knowledge in the wrong hands can be disastrous. The lady above is an obvious example of this. The emotional turmoil of being diagnosed with a chronic illness, especially something as scary as cancer, is a terrible burden to bear, and has long-term consequences that persist even if the disease itself is cured. If the untrained person gets on some website, diagnoses themselves with, leukemia for example, and actually believes that have that disease, they still undergo the same emotional scarring as the patient that is actually sick. Thankfully, most self-diagnosis websites put some disclaimer like" do not use this website to diagnosis yourself" in small letters on the bottom of the page, but let's be honest...how many people actually read the fine print. When these patients present complaining of "worsening leukemia unrelieved by iron pills," however, it then falls on us as physicians to not only try and explain to the patient that they don't have the "disease," but also to try and heal the emotional wounds that the "disease" left on the patient's psyche. Knowledge is power, there can be no doubt about that, but we have to make sure that that power is used to heal, and not to cause harm.
And now for the disability quotes of the day:
Me: "So why did you stop working?"
Dude: "I was working an on-call job, and they just stopped calling."
Me: "Using a 0-10 scale, with zero being no pain, and ten being shot, stabbed, lit on fire and run over by a truck - all at the same time - what would your pain be?"
Man: "That all happened to me once time, but they also threw me off a building. Yep, life is hard as a bum."
Careful what you read,
-DD
Ok, as you might imagine, the "leukemia" got my attention. "What type of leukemia do you have?" I asked.
"Oh, I'm not sure if you're aware, but there are many different types of leukemia. I have one of them," she responded.
"Actually I am well aware of the different types of leukemia," I replied, "Can you recall what type you have?"
"Well," she stated, pressing a finger to her lip," I can't recall, I didn't bring my medical textbook with me, you see...but I know that it keeps me from making red blood cells, and that's why I'm on the iron I buy from Wal-Mart."
There were so many things wrong with that statement, that I felt the need to do a little educating.
"First of all, leukemia is a condition that affects white blood cells, not red blood cells" I said. "Secondly, leukemia is usually treated with, at the minimum, chemotherapy. Iron supplementation, especially if you're just getting it from Wal-Mart, does not really fit that bill. What you're describing sounds more like anemia, is that what you meant?"
"Oh no," she replied, "I'm sure it's leukemia. I spend a lot of time reading my medical textbook - you can never be too educated - and I'm sure that it told me, based on my symptoms, I have leukemia. I can go home and look it up, then call you, if you'd like."
"That's quite alright," I said. "Let's just move on to your fatigue."
While I do believe that one can never be too educated, I do think that knowledge in the wrong hands can be disastrous. The lady above is an obvious example of this. The emotional turmoil of being diagnosed with a chronic illness, especially something as scary as cancer, is a terrible burden to bear, and has long-term consequences that persist even if the disease itself is cured. If the untrained person gets on some website, diagnoses themselves with, leukemia for example, and actually believes that have that disease, they still undergo the same emotional scarring as the patient that is actually sick. Thankfully, most self-diagnosis websites put some disclaimer like" do not use this website to diagnosis yourself" in small letters on the bottom of the page, but let's be honest...how many people actually read the fine print. When these patients present complaining of "worsening leukemia unrelieved by iron pills," however, it then falls on us as physicians to not only try and explain to the patient that they don't have the "disease," but also to try and heal the emotional wounds that the "disease" left on the patient's psyche. Knowledge is power, there can be no doubt about that, but we have to make sure that that power is used to heal, and not to cause harm.
And now for the disability quotes of the day:
Me: "So why did you stop working?"
Dude: "I was working an on-call job, and they just stopped calling."
Me: "Using a 0-10 scale, with zero being no pain, and ten being shot, stabbed, lit on fire and run over by a truck - all at the same time - what would your pain be?"
Man: "That all happened to me once time, but they also threw me off a building. Yep, life is hard as a bum."
Careful what you read,
-DD
Tuesday, January 19, 2010
Confessions
Well, the recent poll results showed that the majority of would like more disability quotes - and lucky for you, I've got tons of them, so expect to see more in the upcoming entries. Also, if you like Friday Night Quotes, please let me know. Likewise, if you like the series on Healthcare reform I'd like to know that, too. You can send me a message on the blog, or on our Facebook Page if you'd care to comment. Anyway, onto the blog.
I'd like to make a confession. I'm starting to get very frustrated with the majority of patients I see while performing disability physicals. I know that I talk all the time about "looking beyond the disease," "treating the person," and so forth, but the fact of the matter is that I have had a really hard time recently holding my tongue when dealing with some of these people. While I know that there are people who definitely should receive disability, I feel like telling everyone else to just "toughen up," and move on with their lives. I wrote a while back about a teenager who hadn't ever worked, but wanted disability because he was afraid that no one would hire him. At the time, I thought that that was simply a fluke. I've come to realize, however, that this is a fairly common occurrence, as just last week I saw at least one claimant a day (under the age of 20) who wanted disability because their "legs get swollen after standing for eight hours," or their job "won't give me medication to help me work," and other such banal reasons. I'm sorry, but my feet get swollen after standing for eight hours, too, and my job definitely does not give me medication (although I probably wouldn't turn it down), but you don't see me applying for free money. Aside from the physical "aliments," I've seen multiple people applying because they're depressed, and don't feel like working anymore. When asked if they're on medication, the majority say "no." When asked if they're undergoing counseling, the majority say "no," as well. I understand that many people don't have the money to purchase medication or counseling, but when they tell me that they're planning to use their disability money to, "play the lotto or something," I have a hard time believing that they would seek help, even if they could afford it.
In addition to the "I'd rather play the lotto than work," crowd, I'm seeing an increase in the number of parents trying to get disability for/from their children. As a preface, I will say that I definitely see kids that have real problems - bad cerebral palsy, developmental disorders and so forth. On the other hand, I see a large number of children whose parents think they should be on disability because "they yell at the teacher," are depressed (what does a five year-old have to be depressed about?) or, my personal favorite, "can't walk like their three year-old brother." Keep in mind that that the "disabled" child was two. I understand that times are tough, and people are just trying to get by, but do you really want to be paying money every year because Little Billy gets mad? I don't. I want to tell the parents to actually "parent," and not just flop the kid down in front of the TV and feed them McDonald's when they get pissed off. I'm sorry, but Bob the Builder is no excuse for a well-disciplined household.
I've been told before that I'm an idealist, and it's very true, especially when it comes to medicine. I really try to practice what I preach, and to use this blog as a source of encouragement, but even I fall sort of the ideals contained within. The unfortunate truth is that medicine is dirty, filled with pathos, and, in the current healthcare setting, a very frustrating profession to be part of. There is simply no way that someone could practice 100% of the ideals I put forth, and I realize that. That said, I believe that those ideals are good goals to strive towards, who knows, maybe if physicians did something as simple as really listened to their patients, healthcare could be an entirely different world.
And now, for the disability quotes of the day:
Lady: "I'm not diabetic, but they say I'm on the border between high and low sugar."
Me: "So you're normal."
Lady: "If you call borderline normal."
Patient's written response to the question, "Please write why you are applying for Social Security Disability."
"I need money, and this is the easiest way to get it."
Me: "Is there anything else you'd like to tell me about your condition?"
Man: "I once got hit by a welding solder, but I didn't scream. I don't know if that helped."
Live your life,
-DD
I'd like to make a confession. I'm starting to get very frustrated with the majority of patients I see while performing disability physicals. I know that I talk all the time about "looking beyond the disease," "treating the person," and so forth, but the fact of the matter is that I have had a really hard time recently holding my tongue when dealing with some of these people. While I know that there are people who definitely should receive disability, I feel like telling everyone else to just "toughen up," and move on with their lives. I wrote a while back about a teenager who hadn't ever worked, but wanted disability because he was afraid that no one would hire him. At the time, I thought that that was simply a fluke. I've come to realize, however, that this is a fairly common occurrence, as just last week I saw at least one claimant a day (under the age of 20) who wanted disability because their "legs get swollen after standing for eight hours," or their job "won't give me medication to help me work," and other such banal reasons. I'm sorry, but my feet get swollen after standing for eight hours, too, and my job definitely does not give me medication (although I probably wouldn't turn it down), but you don't see me applying for free money. Aside from the physical "aliments," I've seen multiple people applying because they're depressed, and don't feel like working anymore. When asked if they're on medication, the majority say "no." When asked if they're undergoing counseling, the majority say "no," as well. I understand that many people don't have the money to purchase medication or counseling, but when they tell me that they're planning to use their disability money to, "play the lotto or something," I have a hard time believing that they would seek help, even if they could afford it.
In addition to the "I'd rather play the lotto than work," crowd, I'm seeing an increase in the number of parents trying to get disability for/from their children. As a preface, I will say that I definitely see kids that have real problems - bad cerebral palsy, developmental disorders and so forth. On the other hand, I see a large number of children whose parents think they should be on disability because "they yell at the teacher," are depressed (what does a five year-old have to be depressed about?) or, my personal favorite, "can't walk like their three year-old brother." Keep in mind that that the "disabled" child was two. I understand that times are tough, and people are just trying to get by, but do you really want to be paying money every year because Little Billy gets mad? I don't. I want to tell the parents to actually "parent," and not just flop the kid down in front of the TV and feed them McDonald's when they get pissed off. I'm sorry, but Bob the Builder is no excuse for a well-disciplined household.
I've been told before that I'm an idealist, and it's very true, especially when it comes to medicine. I really try to practice what I preach, and to use this blog as a source of encouragement, but even I fall sort of the ideals contained within. The unfortunate truth is that medicine is dirty, filled with pathos, and, in the current healthcare setting, a very frustrating profession to be part of. There is simply no way that someone could practice 100% of the ideals I put forth, and I realize that. That said, I believe that those ideals are good goals to strive towards, who knows, maybe if physicians did something as simple as really listened to their patients, healthcare could be an entirely different world.
And now, for the disability quotes of the day:
Lady: "I'm not diabetic, but they say I'm on the border between high and low sugar."
Me: "So you're normal."
Lady: "If you call borderline normal."
Patient's written response to the question, "Please write why you are applying for Social Security Disability."
"I need money, and this is the easiest way to get it."
Me: "Is there anything else you'd like to tell me about your condition?"
Man: "I once got hit by a welding solder, but I didn't scream. I don't know if that helped."
Live your life,
-DD
Friday, January 15, 2010
Friday Night Quotes (FNQ)
Well, it's that time of the week again. I had an utterly...fantastic...afternoon today - the entire population of the world turned out, late as always, to enthrall me with their tales of woe and disability. Luckily for you all, however, it did give me quite a few statements for tonight’s entry. It is without further ado, therefore, that I present to you the top disability quotes of the day.
Patients written response to the question: "What type of employment did you have before applying for disability?"
"Fast foot clerk."
Me: "So you say you worked a lot of jobs in the past year. Was there something that caused you to get fired from those jobs?"
Elderly Black lady: "Well I was working at Japanese Steakhouse from January until July, but then they fired me because they realized I wasn't Asian."
Me: "So what keeps you from working?"
Muscle-bound teenage male: "Well, it hurts my back if I try and lift over 100 lbs."
Me: "Any problems lifting lighter objects?"
Man: "Nope, just really heavy ones."
Patient's written response to the question, "How does your disability keep you from doing things you used to be able to perform?"
"Both of my hands are unable to grasp real good, even though I can grip good with my right hand."
Me: "So tell me what's keeping you from working."
Middle-aged woman: "Well, I read a medical textbook, and it sounds like I have heart failure. So I put a 2-3 lbs weight limit on myself, and no one will hire me."
Have a good weekend!
-DD
Patients written response to the question: "What type of employment did you have before applying for disability?"
"Fast foot clerk."
Me: "So you say you worked a lot of jobs in the past year. Was there something that caused you to get fired from those jobs?"
Elderly Black lady: "Well I was working at Japanese Steakhouse from January until July, but then they fired me because they realized I wasn't Asian."
Me: "So what keeps you from working?"
Muscle-bound teenage male: "Well, it hurts my back if I try and lift over 100 lbs."
Me: "Any problems lifting lighter objects?"
Man: "Nope, just really heavy ones."
Patient's written response to the question, "How does your disability keep you from doing things you used to be able to perform?"
"Both of my hands are unable to grasp real good, even though I can grip good with my right hand."
Me: "So tell me what's keeping you from working."
Middle-aged woman: "Well, I read a medical textbook, and it sounds like I have heart failure. So I put a 2-3 lbs weight limit on myself, and no one will hire me."
Have a good weekend!
-DD
Catching up?
Well, I didn't post last night - didn't have much to say, and my recent change of job venues (working at the medical school most of the time) has really decreased my content material...at least temporarily. Now that I'm working on the weekends, however, I'll hopefully have lots of DD material for you come next week. On to the blog.
We're taught in medical school that pain is one of the most common complaints that causes patients to visit their physicians. In fact, for most men then only thing that will motivate them to visit their doctor more than pain is some problem with their genitals. I recently attended a lecture on neuropathic pelvic pain, taught by one of the national pelvic pain bigwigs and it really made me think about how we as a society view "ouchies." We're taught from a very young age that pain is bad. If you do something, and it hurts, you probably shouldn't be doing it. Obviously that's very true - pain does a much better job at educating than most professors. What we don't often think about, however, is the complications that chronic, uncontrolled pain brings. There's at least one patient per day that I see while performing Disability Physicals that lists pain as the main thing that keeps them from working. Additionally, the majority of the other applicants usually have pain listed somewhere in their file, even if it's just an "oh by the way," type of complaint. The complications of these "pain syndromes" are immense. Think about how many days of work, jobs, or even lives are lost because people are unable to manage a microscopic neuronal impulse from the brain. Throughout this plethora of pain, however, we've somehow come to the conclusion that life should be pain free, and that every little ache and ouch is an "I need Lortab, now!" type of symptom.
Who is to blame for this mentality? Is it the media? Sure they've done a great job promoting pain-relieving medication and services, but I feel they're just making said services known to the general public. Granted, knowledge is power, and according to some recent facts I read, there are many more people using "generalized, chronic pain," and "fibromyalgia" as reasons why they cannot function from day to day, but you can't (usually) blame the messenger for the message. What about drug companies? They make a nice profit off of medications, therapeutic "rubs," and one-trick ponies (Head-On, anyone?). Once again, however, they're just acting as suppliers to our collective needs. I think that when we boil it down, we as a society are to blame for the pain epidemic.
We've passed the point of viewing pain as your body's way of saying "something's wrong, fix me!" In fact, we have empowered pain itself - changing it from a symptom, to a disease. Amazingly, we've created an entire medical specialty, appropriately named Pain Management, to treat this "new disease," (personally, I don't really understand this - the specialties of Vomitology and Nose-bleediatrics have yet to be created, but who knows, maybe they're next?). The problem with this management approach is twofold. Number one: we're focusing so much on treating pain itself, that we tend to forget that if we treat the root cause of the problem, the pain will go away on its own. We're more than willing to throw Lortab at patients like candy, but asking most doctors to refer to physical therapy, perform manipulation or even do a thorough exam is like pulling teeth. Secondly, we as a nation expect to be pain free. Oh sure, it might hurt if you cut off a toe, but otherwise, you shouldn't be in pain. There's a book called, "Pain, the Unwanted Gift," that chronicles an Orthopedic Surgeon's experience with a leper colony. In the book, the author talks about how the lepers almost embrace pain, because if nothing else, it lets them know that they're alive. Now, I'm not saying that we should hold hands and sing Kumbayah every time we stub our toe, but remember, at least you have a toe that can feel pain.
The purpose of this entry was not to upset anyone that deals with pain daily. Therefore, if you are offended by what I said, I apologize. I simply was trying to state that physicians should try and fix the problem, and not just give medication to fix a symptom. Pain is, unfortunately, a fact of life - there's nothing we can do to escape that. If we acknowledge that fact, however, maybe we can better deal with it when it comes our way.
And now, the disability quote of the day:
Me: "So you say that your carpal tunnel made you depressed, and now you can't work?"
Man: "Yeah, I had a great job. I would move the mouse, and my friend would type. But then I got carpal tunnel, and we both got fired. So now he's mad at me, and I'm depressed."
Until next time,
-DD
We're taught in medical school that pain is one of the most common complaints that causes patients to visit their physicians. In fact, for most men then only thing that will motivate them to visit their doctor more than pain is some problem with their genitals. I recently attended a lecture on neuropathic pelvic pain, taught by one of the national pelvic pain bigwigs and it really made me think about how we as a society view "ouchies." We're taught from a very young age that pain is bad. If you do something, and it hurts, you probably shouldn't be doing it. Obviously that's very true - pain does a much better job at educating than most professors. What we don't often think about, however, is the complications that chronic, uncontrolled pain brings. There's at least one patient per day that I see while performing Disability Physicals that lists pain as the main thing that keeps them from working. Additionally, the majority of the other applicants usually have pain listed somewhere in their file, even if it's just an "oh by the way," type of complaint. The complications of these "pain syndromes" are immense. Think about how many days of work, jobs, or even lives are lost because people are unable to manage a microscopic neuronal impulse from the brain. Throughout this plethora of pain, however, we've somehow come to the conclusion that life should be pain free, and that every little ache and ouch is an "I need Lortab, now!" type of symptom.
Who is to blame for this mentality? Is it the media? Sure they've done a great job promoting pain-relieving medication and services, but I feel they're just making said services known to the general public. Granted, knowledge is power, and according to some recent facts I read, there are many more people using "generalized, chronic pain," and "fibromyalgia" as reasons why they cannot function from day to day, but you can't (usually) blame the messenger for the message. What about drug companies? They make a nice profit off of medications, therapeutic "rubs," and one-trick ponies (Head-On, anyone?). Once again, however, they're just acting as suppliers to our collective needs. I think that when we boil it down, we as a society are to blame for the pain epidemic.
We've passed the point of viewing pain as your body's way of saying "something's wrong, fix me!" In fact, we have empowered pain itself - changing it from a symptom, to a disease. Amazingly, we've created an entire medical specialty, appropriately named Pain Management, to treat this "new disease," (personally, I don't really understand this - the specialties of Vomitology and Nose-bleediatrics have yet to be created, but who knows, maybe they're next?). The problem with this management approach is twofold. Number one: we're focusing so much on treating pain itself, that we tend to forget that if we treat the root cause of the problem, the pain will go away on its own. We're more than willing to throw Lortab at patients like candy, but asking most doctors to refer to physical therapy, perform manipulation or even do a thorough exam is like pulling teeth. Secondly, we as a nation expect to be pain free. Oh sure, it might hurt if you cut off a toe, but otherwise, you shouldn't be in pain. There's a book called, "Pain, the Unwanted Gift," that chronicles an Orthopedic Surgeon's experience with a leper colony. In the book, the author talks about how the lepers almost embrace pain, because if nothing else, it lets them know that they're alive. Now, I'm not saying that we should hold hands and sing Kumbayah every time we stub our toe, but remember, at least you have a toe that can feel pain.
The purpose of this entry was not to upset anyone that deals with pain daily. Therefore, if you are offended by what I said, I apologize. I simply was trying to state that physicians should try and fix the problem, and not just give medication to fix a symptom. Pain is, unfortunately, a fact of life - there's nothing we can do to escape that. If we acknowledge that fact, however, maybe we can better deal with it when it comes our way.
And now, the disability quote of the day:
Me: "So you say that your carpal tunnel made you depressed, and now you can't work?"
Man: "Yeah, I had a great job. I would move the mouse, and my friend would type. But then I got carpal tunnel, and we both got fired. So now he's mad at me, and I'm depressed."
Until next time,
-DD
Tuesday, January 12, 2010
Healthcare reform - the second problem
The following is the second in a series of blogs about healthcare reform.
We talked last week about how part of the current issues in healthcare reform stem from the fact that politicians and lawyers are making decisions about who receives healthcare and who doesn't. I also mentioned last week that (albeit briefly) that some of that "medical decision making" is coming from insurance companies, largely in the form of Pre-Authorizations. I figured that since said insurance companies are at the forefront of some of the new healthcare developments coming out of Washington, it would be a good time to discuss that aspect of our healthcare problem.
As a nation, the USA spends more on healthcare per capita than almost any other country in the world (we're neck and neck with East Timor), with the majority of that expense going towards paying premiums for our health insurance programs. As an industry, health insurers make over $340 billion each year, with the majority of that going towards paying physician and hospital bills, right? Wrong. Physician reimbursement accounts for around 7-10% of all health insurance costs. Hospital bills, while more expensive, still do not put a large dent in net profits. In fact, the total amount of consumer benefits (how much your insurance plan pays if you get sick) accounts for around $170 billion annually. Let's see...$340,000,000,000 in income minus $170,000,000,000 in benefit payments = $170,000,000,000 in profits. Sure, there will be other expenses (every CEO needs a yacht, right?), but nothing that will bring that number down too much.
From a corporate standpoint, it's brilliant, and it's no wonder that even in this bear economy, the insurance industry is posting record profits. When asked about how they have managed to profit in such a poor economic situation, insurance companies have turned to capitalism as a defense, stating "we're just giving the consumer what they want." Now let's think about this for a second. Do I really want to pay over $300 a month for health insurance? No, I don't, but neither do I want to be one of the millions of Americans applying for bankruptcy because a freak accident caused me to go hundreds of thousands of dollars in debt (well, hundreds of thousands of dollars more in debt, thank you very much, medical school). In addition, if this really was a capitalistic venture, shouldn't consumers be flocking towards plans with the lowest premiums, thus making other companies lower their prices in order to compete for business? Well, that makes sense, except that prices are, for the most part, fixed, regardless what plan you choose. I don't know about you, but that sounds a little like price gouging to me...shouldn't there be an anti-trust law or something against that? Oh wait, insurance companies don't have to abide by anti-trust laws. Let me repeat that again. Insurance companies don't have to abide by anti-trust laws. Don't believe me? Check this out: Health Insurance and Anti-trust regulations. Something is definitely rotten in the state of Denmark.
What I've said tonight just touches the basics of this healthcare conundrum. There are many resources out there that can provide a lot more insight than I can, and if this really interests you, you owe it to yourself to check them out. Like I said last week, these entries are rather heavy, so I'm trying to say what I think needs to be said in the shortest blog possible. If you're interested in hearing more from my perspective, send me message, and I'll post some more in the upcoming weeks.
And now for the disability quote of the day:
Me: "So what made your back start hurting?"
Man: "Well, it started after I got in a fight...when I was in prison."
Me: "Oh, what did they put you in prison for?"
Man: "Falsifying information on my worker's comp documents. I said I was disabled when I really wasn't."
Me: "...So about that back pain..."
Have a good evening,
-DD
We talked last week about how part of the current issues in healthcare reform stem from the fact that politicians and lawyers are making decisions about who receives healthcare and who doesn't. I also mentioned last week that (albeit briefly) that some of that "medical decision making" is coming from insurance companies, largely in the form of Pre-Authorizations. I figured that since said insurance companies are at the forefront of some of the new healthcare developments coming out of Washington, it would be a good time to discuss that aspect of our healthcare problem.
As a nation, the USA spends more on healthcare per capita than almost any other country in the world (we're neck and neck with East Timor), with the majority of that expense going towards paying premiums for our health insurance programs. As an industry, health insurers make over $340 billion each year, with the majority of that going towards paying physician and hospital bills, right? Wrong. Physician reimbursement accounts for around 7-10% of all health insurance costs. Hospital bills, while more expensive, still do not put a large dent in net profits. In fact, the total amount of consumer benefits (how much your insurance plan pays if you get sick) accounts for around $170 billion annually. Let's see...$340,000,000,000 in income minus $170,000,000,000 in benefit payments = $170,000,000,000 in profits. Sure, there will be other expenses (every CEO needs a yacht, right?), but nothing that will bring that number down too much.
From a corporate standpoint, it's brilliant, and it's no wonder that even in this bear economy, the insurance industry is posting record profits. When asked about how they have managed to profit in such a poor economic situation, insurance companies have turned to capitalism as a defense, stating "we're just giving the consumer what they want." Now let's think about this for a second. Do I really want to pay over $300 a month for health insurance? No, I don't, but neither do I want to be one of the millions of Americans applying for bankruptcy because a freak accident caused me to go hundreds of thousands of dollars in debt (well, hundreds of thousands of dollars more in debt, thank you very much, medical school). In addition, if this really was a capitalistic venture, shouldn't consumers be flocking towards plans with the lowest premiums, thus making other companies lower their prices in order to compete for business? Well, that makes sense, except that prices are, for the most part, fixed, regardless what plan you choose. I don't know about you, but that sounds a little like price gouging to me...shouldn't there be an anti-trust law or something against that? Oh wait, insurance companies don't have to abide by anti-trust laws. Let me repeat that again. Insurance companies don't have to abide by anti-trust laws. Don't believe me? Check this out: Health Insurance and Anti-trust regulations. Something is definitely rotten in the state of Denmark.
What I've said tonight just touches the basics of this healthcare conundrum. There are many resources out there that can provide a lot more insight than I can, and if this really interests you, you owe it to yourself to check them out. Like I said last week, these entries are rather heavy, so I'm trying to say what I think needs to be said in the shortest blog possible. If you're interested in hearing more from my perspective, send me message, and I'll post some more in the upcoming weeks.
And now for the disability quote of the day:
Me: "So what made your back start hurting?"
Man: "Well, it started after I got in a fight...when I was in prison."
Me: "Oh, what did they put you in prison for?"
Man: "Falsifying information on my worker's comp documents. I said I was disabled when I really wasn't."
Me: "...So about that back pain..."
Have a good evening,
-DD
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