Are there enough doctors?

December 21, 2011

According to this article, the largest concentration of doctors in the United States is right here in Massachusetts.  So then why am I having so much trouble finding one I like?

Keep in mind, this is based on a per capita count, so it’s about how many doctors there are for every 100,000 residents and not on how many there are total.  Compared to the national average, good old Mass. is going great.  Of course, this doesn’t tell us how many of these doctors are specialists and how many are internists or family practitioners.  It also doesn’t tell us how many of them treat patients full time versus focusing on research.  For example, I have one doctor, a specialist, who does research most days and only sees patients two days a week.  How would he be counted?

But more than any of that, my big concern is that this article speaks about the distribution of doctors as if that were the biggest problem with getting a doctor.  Let’s forget about money, because that’s a different problem altogether.  What bothers me is the idea that if doctors were distributed more evenly, everything would automatically work out better.  But has anyone checked to see if there are enough doctors in this country?  Sure, Massachusetts has more doctors per capita than any other state, but does it have enough doctors?  Does it have the right type of doctors?  I called many potential PCPs this year and was told by each that they weren’t taking on new patients.  That’s in line with what I have been reading about PCP shortages.

Now, maybe I just called the wrong ones.  Maybe there’s a shortage.  Maybe that was a temporary problem that was magically fixed the next week.  Regardless, we need to figure out how many doctors, and what specialties, are needed in order to properly care for our population.  I agree that we need to have an even distribution of doctors, but that only works if there are enough.

 

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Scary changes in healthcare

December 20, 2011

How much control do you have over your healthcare?

Now, many of us have limited control over our health, but we should at least have control over our healthcare, right?  I don’t know what the answer is, but it can’t be this.

I read this morning about a plan by a local health insurer to reimburse patients for choosing cheaper care.  Well, that’s the basic idea, anyway.  If my doctor sends me for an MRI at site X and instead I go to the cheaper site Y, then I’ll get $10-75 from my health insurer.

This troubles me in many ways.  To keep myself from rambling, here’s a quick bullet list:

  • Will the care be comparable?  Or will patients lose out?
  • People suffering financially may put their money ahead of their health.  I admit that this is their choice, but is it really a choice?  After all, premiums won’t be cut, so this is their only chance for relief.
  • This may make it harder for doctors to coordinate care.  When I get a test done now, all doctors in that hospital system see the results.  If I get a test done elsewhere, I’d have to get the results sent to all of my doctors, which is unlikely to happen, so the burden would be on me to bring the results of all tests with me to all appointments.
  • There are already health plans that only allow patients to be seen by cheaper doctors at cheaper facilities.  How much farther will this cost-cutting expand?  I don’t get to choose my health plan – my employer does.  If they choose one of these, I might have to change all of my doctors, and it has taken me years to build up a medical team I trust.
  • If cutting costs is so important, why doesn’t the health insurer cap reimbursement payments?  Wouldn’t that make more sense?  Why reimburse one site more than another?

Really, what upsets me is the direction of healthcare changes.  Health insurers and politicians are floundering to find a way to save money and stop the skyrocketing costs to patients and employers.  There is talk of a single payer system in my state.  While I love the idea theoretically, I have seen the way it has been put into practice in other countries, and I don’t trust it.  Really, do I want anyone involved in my government to decide if it’s cost-effective for me to take a certain medication or have a certain test?  No!  I trust them even less than I trust health insurers – I guess I trust the devil I know more than the devil I suspect.  If my health insurer chooses not to cover the cost of something, I can appeal within the insurance company and also to a state board.  If the state were in charge, who would I be able to appeal to?  Costs are too high.  People can’t afford care.  Those of us that can afford it, often pay so much that we must cut back on other things (like ever being able to afford to retire.)  This just isn’t working.

We need a solution.  So many of us are desperate for a solution.  If only I had any idea whatsoever what it might be.

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The medicine of a simple visit

December 17, 2011

Knowing that I’ve been stuck at home a lot, my parents came over for a visit today.  They don’t live very far away, but they rarely visit.  Usually when we see each other it is at their house, where I grew up.  Since I’ve been staying closer to home, they came over for a visit with their pooch.

It was a simple visit.  We talked, we took a walk, we had dinner.  I pet the dog.  I played with the dog.  I sat with the dog.  It was an easy visit.  Today was a good day, and I felt up to moving around, which was great.  Having company was fantastic medicine.

When you’re fatigued, in pain, or otherwise stuck at home, remind your friends and family that visits can help.  So many of us get offers of help, but the truth is, I don’t always need help with errands or cooking, sometimes I just need some stress-free, activity-lite time with loved ones.  We all need to be alone at times, but we also all need to be around the people we care about and who care about us.  Sometimes it’s just that simple.

 

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2 Comments | Educating, Expectations, Isolation, Kindness, Limitations, Medication, Pain, Raves, Support, Symptoms, Thoughtfulness, Unpredictable | Permalink
Posted by chronicrants

Getting back the unintentional smile

December 15, 2011

This past month has been a real bitch.  Fatigue sucks.

One of the hardest parts has been feeling so down all the time.  Sometimes I couldn’t tell if I was sad or tired or depressed.  I knew I didn’t have my usual pep.  I’m generally a happy, cheerful person, and that was definitely gone.

Today should have terrible.  I over-exerted myself last night and went to bed too late.  I was woken up very early by outside noise, and forced to get out of bed.  I should have been a mess, but I felt ok.  I actually felt pretty decent.  How odd.  It took me longer than it should have to get out of the house, but I tried not to pressure myself too much, and hey, at least I made it out before lunchtime!  I took a quick walk down the street to the library and CVS, then came back home for lunch.  And I wasn’t exhausted.  Weird….. Good… but weird.  Even stranger, I noticed random people on the street smiling at me.  A few made random comments (Good morning. Did you see what that driver was doing?)  I didn’t feel any happier, but I did feel that the cloud was starting to lift.  Maybe strangers saw it too?

I really needed to do something about Prednisone boobs, so after lunch I drove to a store I like that carries unusual sizes and tried on everything they had that was an option.  I should have been exhausted, but I wasn’t.  I was a bit tired, but ok.  I made friendly chit chat with the woman helping me.  Hmm… that feels more like me.  It felt good to be friendly and pleasant again.  And she was pleasant back.  And hey, I was smiling!

On the way home I stopped for groceries.  It was late afternoon and the store was getting crowded.  I took my time finding the right items, asking a clerk for help, trying hard to make sure I’m keeping a healthy diet (ugh.)  The clerk kept apologizing for taking so long to check in the back, for making me wait, for not having the item, and I kept assuring her it was fine.  I didn’t care.  I wasn’t in a rush.  Woah, it’s like the old me!  Not rushed (unless I had to be) and patient.  The checkout lines were long, but I was in no hurry (though beating rush hour would be nice.)  A new register opened up and the cashier asked me to come over.  I said not to worry, that I was fine waiting, and that the woman behind me with the very full cart and the obviously-bored child go ahead.  She looked incredibly grateful.  I felt good.  Hmm, I wouldn’t have done that a few days ago.  Ok, I couldn’t overlook that one, something was definitely different.

By the time I got home I was feeling it: I was tired.  Still, it wasn’t the fatigue I’ve been feeling lately, just the old kind of tired.  I sat and rested for a while.  I listened to an audio book.  I ate dinner and watched a movie and now it’s about time for bed and I feel… OK!  I FEEL OK!  I want to shout it from the rooftops.

This might not last.  Maybe tomorrow I’ll feel great, maybe tomorrow I’ll feel horrible.  I’m just so grateful for today.  These good minutes, hours, days, weeks, and sometimes months are such a gift and I’m so grateful for them.  Did I say that already?  Well it’s true.  Thank goodness for today.  I would have survived physically, but mentally and emotionally it was getting really tough.  I feel renewed.

I just hope it lasts.

And every day that this lasts, I will use it.  I will cross off items on my to do list, I’ll write, I’ll clean, and more importantly I’ll help others.  Maybe I can’t do volunteer work at a charity or help a friend move, but I can let someone cut ahead of me at the grocery store, and for now, that’s enough.

 

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Leave a Comment » | Expectations, Isolation, Kindness, Limitations, Raves, Symptoms, Unpredictable | Permalink
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