Wednesday, June 27, 2007

What's up, Sicko?

NewFNP and her Punjabi boyfriend hit the theater and checked out the new Michael Moore film, Sicko. NewFNP is hesitant to call it a documentary as it certainly was envisioned to do more than increase knowledge, but it certainly was not created solely to entertain its audience and therefore falls outside newNFP's definition of a movie.

Like the NYer, newFNP wishes that Sicko would have dealt more with the faults of insurance coverage and with how many Americans actually support universal health care rather than on some of the theatrics, but newFNP is a one-trick pony in this arena and her documentary about the subject would be boring as shit and would have had lots of swears and no one would want to watch it. Moore's film, on the other hand, showcased two very compelling stories about regular working folk who had HMO coverage and who died as a result of red tape and cheap, cheap, cheap decision makers who denied necessary care.

NewFNP is not wholly opposed to the idea of an HMO - an insurance designed in response to the over-consumption of medical care and the ordering of excessive tests in the fee-for-service system. However, who cannot deny that it is fucking rotten to have rewards for flat out denying care. And emergencies are emergencies - people need to get to the closest ED, not the closest in-network ED.

Shit, newFNP could make billions if she were just more of an asshole. She denies care on a daily basis just so that she can selfishly leave clinic on time instead of taking a walk-in pap test, but she never denies someone care, even at 5PM, if they really need it. So maybe newFNP couldn't make such bank after all. Damn, newFNP just shattered her own dreams of riches in the course of two sentences!

NewFNP dealt with her own "denial" moment today when an administrator at the clinic told her that she couldn't refer a patient to a partnering organization for post-partum depression because this organization wasn't a part of the right collaborative. What the fuck? There is exactly one resource in newFNP's area for uninsured women with post-partum depression and newFNP used it. No, this normally very with-it administrator was adamant that the patient wait and go through the referral process. Referral to where? The fucking Hubble Space Station? Disneyland? Buckingham Palace? The hospital that let a patient die on the floor of the emergency room?

NewFNP knows that universal health care isn't "the" answer, but it sure as hell seems like a better solution to what we have now and, call newFNP a leftie, but it seems like the ethically right thing to do. A wealthy nation should care for its people, should protect the health of the nation at the individual level as well as the community level, and should acknowledge that people cannot be productive members of society if they are unwell. For Pete's sake, newFNP is less productive if she has a fucking pimple! Imagine if she had pink eye! Or diabetes, hypertension and dyslipidemia.

So, anyway, after you all see Knocked Up, see Sicko. They both have to do with health care, in a way, so maybe you can get your popcorn reimbursed and call the time spent "continuing education."

Friday, June 22, 2007

Ah ah ah - stop right there

NewFNP has been slacking because all that has been occurring in her clinic is drama, drama, drama. It is exhausting. Save the drama for you mama is right!

Anyway, clinical telenovelas aside, newFNP's clinic has instituted this "new" practice policy of addressing just one concern per visit. It's not revolutionary, it's just that some of us (read: newFNP) have a difficult time adhering to it.

In newFNP's clinic, it takes about 3 weeks to get an appointment so newFNP can understand why a patient may want to kill you for saying that they need to schedule yet another appointment, for which they must arrive on time and subsequently wait 30-90 minutes to get seen. Would it kill newFNP to look in your ear when you're truly there for your pap results? Unlikely. Will you assume that this willingness to overlook the rules extends to each and every clinical visit? Definitely. Honestly, someone else needs to be the bad guy. There needs to be a triage nurse or some type of signage up in every room letting patients know that it's 1 - not 3, not 5 - concern per visit. No, no signage. All of newFNP's patients ignore the 'turn your cell phone off' sign, as well as the 'shoes off if you're diabetic' sign. No, newFNP's appointment needs a triage nurse that pins the real concern down.

And for the love of all that is holy, what is newFNP to do when her 50 year old patient with normal lab results tells her that his lower back is hurting? Should she even begin to ask about it? Should she punch him in the gut and ask, "Any less pain in the back now?" Seriously, once newFNP hears a complaint, she feels a little compelled to address it. What if his prostate is the size of a Buick? What if he has the horrifyingly freaky cauda equina syndrome? NewFNP would assume that over the counter Tylenol, even extra-strength, wouldn't touch that motherfucker!

NewFNP printed an article from the current issue of Family Practice Management entitled "How to Manage the Difficult Patient." It's pretty helpful and reminds newFNP that, no matter what, she should not be another problem on the already exhaustive chief complaint list.

Saturday, June 09, 2007

Hg free for you & me

At newFNP's clinic, Fridays are reserved for pediatrics and, more specifically, for well child checks. *Well* child. Physicals and vaccines. Sure, newFNP will treat your child's ezcema during the WCC. She, however, cannot solve your daughter's super-fucked up life in 15 minutes. NewFNP can generally survive one train-wreck on Fridays. But four? Well, four is just too damn many. Especially afternoon train wrecks. Isn't there some type of screening tool the front desk staff can utilize in order to schedule all of the emotionally exhaustive patients in the morning? Doubtful, given that newFNP continues to struggle with labels missing from a fair number of her charts.

NewFNP's first afternoon patient was a 15-year old girl, absoultely ridden with sour-puss attitude, who had missed school for a month because the pills she was taking for her abdominal pain made her sleepy. What was she taking? Lunesta? Oh, the attitude. NewFNP knows that she must have been somewhat like this girl oh-so-many years ago and it pained her to see that she may have been such an asshole. NewFNP generally likes teenagers, but she was considering advising this patient to go screw herself. NewFNP rose above the temptation, however. A smart move all in all.

Then newFNP had the walk-in depressed patient with the very chatty grandmother. Her patient was a very sweet young man and his grandmother was very concerned. However, newFNP does not need the anecdotes regarding the patient's anxious sister, grandma's 'nerves' and dad's relationship issues during the already tight walk-in schedule.

Then there were the sisters with the mercury exposure. Too much tilefish? Broken thermometer? Nope. In newFNP's mind, this is the epitome of a ghetto exposure story.

These sisters attended a baby shower in a house located next to a junk yard. Some kids were playing with a bottle filled with silver liquid that they found in the junk yard. Opened up the bottle and - voila! Millions of little silver balls! Please kids, please... don't play in junk yards. NewFNP doesn't even like to go to Ross, so there is no fucking way that she is going to a junk yard. Anyway, word got out that the house was subsequently quarantined as a result of the exposure so newFNP needed to evaluate the kids.

The only problem was that newFNP didn't learn about frigging mercury exposure in school. She just learned not to eat mackerel. So, off to the CDC website for some guidance. In short - assess for respiratory complications, draw their blood and do a urine, preferably a 24-hour urine but a spot urine will do in a pinch. Call the health department. Done, done and done.

Oh but wait, what do you do if one of the mercury kids had scooped up some of the pretty, shiny toxin and taken it to school, where she then threw it away? Well, then you call the haz-mat team and everyone gets an early summer vacation.

NewFNP thought that she was finished with the heavy metal when she received a call from our friendly neighborhood laboratory draw station. The attendant had the requisition forms from newFNP's patients, but apparently their mother and a whole other family was there to get their labs checked as well. NewFNP's patients truly do not know how the health care system works and newFNP spends an inordinate amount of time explaining things such as what it means to have refills on prescriptions and why patients need appointments. Now this poor lab worker was stuck doing the explaining as to why you can't just walk into a lab and order tests yourself.

Oh, community health. The hits just keep on comin!

NewFNP did, however, feel very proud of herself for acting as a public health practitioner today. Sure, all she did was call the toxics epidemiology department, but she sure felt good about doing it. It made newFNP realize how much providing individual health makes her miss public health. One day.... one day.