How Satisfied Are You?

Chicago Sky“A diplomat is a person who can tell you to go to hell in such a way that you actually look forward to the trip.” – Caskie Stinnett

I was listening to a physician friend of mine a while back complaining about how the focus on patient satisfaction scores was forcing him to prescribe antibiotics and refer for procedures that would not otherwise be indicated.

Because he was afraid.

Of a piece of paper.

In fact, apparently, he is not the only one speaking up on this. Do a google search.

Quite frankly, I have very little patience for this sort of thing.

Are patient satisfaction scores always fair?

Hell, no.

I have been dinged because a patient didn’t like how much their MRI cost. Not my fault. That is an insurance benefits problem that I have no control over. Or there was the time someone wanted large quantities of a controlled substance I don’t ever write for prescribed to them for a questionable diagnosis. They didn’t like me saying no very much. At all.

I could go on.

To say that I don’t care what patients think of me is not really true. I care very deeply. Every negative survey really bothers me. I will tell you why.

Because I feel like a failure.

There is still art in the practice of medicine.

The art is earning trust.

I have people from time to time who are upset that I do not write antibiotics for their two days of upper respiratory symptoms.

More often they are appreciative when I explain that antibiotics won’t help them get better at this stage and that inappropriate use means that they or someone that they love may develop an infection down the road that we cannot treat with ANY antibiotics. We work together to treat their symptoms while their body fights off the infection, knowing that antibiotics are available if needed down the road.

Generally, patients respond very well to explanations.

For a doctor to say that they feel trapped by a patient satisfaction survey suggests they are are not really trying.

That being said, physicians who argue otherwise like to point to a fascinating article, The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality.

“Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”

Translated: If you are happy with your doctor, you are spending more on your care and are more likely to die.

Does that just mean we are all pansies? Do we believe patients are too stupid to understand? Are we pushovers who really think patients just want us to give them what they want?

Is that what patients want?

If we ALL use evidence based medicine, if we all consistently educate our patients to change their expectations about their care, can’t we improve care, costs, and patient satisfaction?

Maybe I am just being naive.

I Am Going to Beat it Out of You!

20140720-110326.jpg

I had a question the other day, about reconciling your past with how you discipline your kids. Specifically, the question came from a woman whose parents were angry people who severely punished for minor infractions and now with her own children she can feel that anger building up inside of her. She struggles with the spank or not to spank question.

This is a complicated, multiple issue question.

My own parents loved to spank. With belts, spoons, cutting boards, hands, tree branches, whatever they could find. The avoidance of pain is a great motivator. For them, it was a useful tool.

My father also had a terrible temper. He threw a slide projector across the room because it jammed. He broke a coffee table down the middle because of…hell, I can’t remember why. It was always touch and go to see what mood dad was in when he got home from work, particularly if you had been marked for corporal punishment.

Just you wait until your father gets home!

My mother yelled. A lot. Granted, she was a stay at home mom with a passel of kids. She had reason to yell, probably. But in response, we yelled. We yelled at her, we yelled at each other.

Our house was full of anger. To this day, none of us really like each other much.

My last spanking from my father was at age thirteen, with a belt, because I gave my mother a sour look when I was told I could only have one donut at church. I was never allowed donuts. I loved donuts, all of that greasy, glazed goodness. Just one more! There were dozens left that no one was going to eat!

After that, punishments were more creative. At the end of my junior in high school I had to write 1,000 times “I will listen to my mother.” This was because a good male friend of mine gave me a hug. He had graduated that night and was heading to the Naval Academy. We weren’t dating. We were just friends. But it incensed my mother. It took me a week because the sentences had to be legible to count. At least it wasn’t spanking. After a spanking, I seethed with anger and hate for days. This… I realized that I wasn’t angry so much about it, even if it was outrageous. And it was effective. You can bet I never hugged a guy in front of my mother again. I hugged. Just not in front of her.

Then I became a parent.

I decided that I would not spank my own kids. I wanted to try to teach them out of love, hoping to help them understand grace as they grew up. That was my plan.

Yet, one day my son pushed all of my buttons. He would not stay in time out. He was defying me at every turn. Yelling at him was not working. So I spanked him. I was so angry, I wanted it to hurt. It felt good for a second as he started to cry.

Then, I was horrified. I was a monster.

I had become my parents.

There are a lot of things to be said about spanking. Research shows a higher level of anxiety and a lower IQ in kids that are spanked. Many pro-spanking people want to dispute these things. Meh.

Bottom line, I found that spanking for me was not out of love. It was out of anger. It did not help my kids. They were not safer or happier or kinder as a result. It did not help me. It only made me more angry.

So I don’t spank.

We have behavior charts. They earn stars for tasks and behaviors and can cash those in for prizes. We use time outs for bad behaviors. I work hard to publicly praise them when they do something right or demonstrate a good trait like sharing or kindness. I don’t yell. I get down at their eye level and talk to them calmly when it is serious.

This is not because I am a fantastic parent who has read tons of literature on the subject. Oh, no. Everything I learned about parenting I learned from the TV show Super Nanny. Don’t laugh. It was a brilliant show.

So far, they are turning out well, these kids. They are respectful… most of the time. They behave and follow directions… most of the time. They are kind… most of the time.

Of course, they are not teenagers yet. It will be many years before I release my masterpieces on the world (hence the Sistine Chapel picture…I snuck it on my phone when the official shushers weren’t looking since they don’t allow photography and I never learned to follow rules despite the spankings…those paintings are rife with delicious irony!). I still may have screwed them up irreparably before it is all said and done. There is certain to be some delicious irony concealed in those little brains, just waiting to burst forth to pay me back. Only time will tell!

Medical Mommies

20140719-190954.jpg

When my kids are sick, I hear all of the time: “Your kids are so lucky their mommy is a doctor!”

Welllllllllll….. Let’s just say there are pros and cons to this.

We ARE blessed that I know my way around the system. But stay with me as I digress.

When I was pregnant with my first kiddo, I was told he had a kidney/bladder issue. We had to do a level four ultrasound with a neonatal specialist. Beforehand I had to listen to a genetic counselor telling me the likelihood, as an older mom, that this meant he had Downs Syndrome or some other genetic anomaly and how I needed to agree to an amniocentesis.

I refused.

I did not want to chance it being positive, having to spend the next five months worrying about all of medical implications of that. Kidney and bladder problems were enough for me, right then. I needed the possibility that he was perfect in every other way.

Then, I thought, maybe I am just being an overbearing doctor mom. Maybe I just need to chill and follow instructions. I don’t know everything, after all. So I decided to stop questioning, stop being difficult. I just did what I was told.

Before it was over with, we were having level four ultrasounds every two weeks throughout the pregnancy. I had to see a pediatric urologist before he was even born.

After he was born, when he was 2-3 weeks old, I was told he needed to have an MRI of his back to check for tethered chord, among other things. I wanted to argue that it was not necessary. He did not have the other signs. But I let it go.

He had to be sedated. I insisted that I was present in the room with him, though, even though they told me it wasn’t allowed. They made an exception because I was who I was and during the two hours that ensued the procedure had to be halted twice because of medical errors… I wondered if I would have been told afterward what happened to my kiddo if I had not been there. He survived. Maybe that was all I needed to know in the end?

Throughout this whole process, from the third ultrasound on, in the back of my mind there was this nagging thought:

Is all of this even necessary?

The truth of the matter was we were being over treated because I was a physician.

That might be a good thing, you might think, operating with an over abundance of caution. Don’t you get better care? No. It resulted in tons of wasted time and money and with the MRI, a significant amount of actual suffering on the part of my son.

So my days of being a compliant physician mom were over. It was my job to help protect my kiddo, I decided, and by golly I needed to step up to the plate.

After a while of this, I got tired of fighting everyone, arguing, asserting myself. It was exhausting. Want to see a physician get defensive? Ask if something is really necessary.

So I decided that I would not tell people what I do for a living.

However, I quickly learned that the problem with being a mom without a medical background is that no one takes you seriously.

Seriously.

You have to prove to people that what you say is going on is really going on.

I used to wonder why moms would tell me that the reason they had not given their kiddo anything for their fever of 103 before they brought them in (as the poor kiddo was shivering wracked with chills and absolutely miserable) was that they wanted to show me that it was really going on.

Perhaps I am naive, but I believe people. I didn’t really understand this mentality. Why would someone lie about their kid’s fever? Or anything else for that matter? Who really wants to spend money and time taking their kid to the office or to the ER? Are there really physicians like that out there?

Then I lived it. Several times.

At the ER with my son, as he was having issues with his breathing the other night, I worried about which tactic I should use.

I opted for the nonmedical mom approach.

I found myself trying to convince the triage nurse that my son was in actual, true distress. He was breathing fast, he had retractions and was using accessory muscles. I knew that his oxygen saturation was low, that he was not responding to treatments, that things were going to get worse quickly as the albuterol treatment I just gave him started wearing off again, but my kid was a trouper and he was smiling, playing, trying to be sweet to the nursing staff.

Look sick like you did in the car on the way over, damn it!

They did not believe me until I said, “Hey, look, I am a doctor.” Then, they finally lifted up his shirt and stuck the monitor on his finger to measure… things started to move very quickly.

At one point, a woman showed up to tell me what my portion of the charges would be, based on my insurance info. $950. With insurance. That was before the transfer to the children’s hospital by ambulance. Cleverly, she also presented my son with a coloring book and a teddy bear so I would be less likely to tell her to go away and come back when he was stable. Yes. Yes, I believe I will take that teddy bear. Doctors really don’t get professional courtesy anymore… It costs us as much as anyone else.

Where is the happy medium in all of this?

I just don’t know. I haven’t found that place for myself yet. For now, I will agree that we are blessed. But not in the same way people may think. I can at least afford care for my family. Many cannot.

Wraps Me Up Like a Warm Burrito

IMG_6366
“The Poets have been mysteriously silent on the subject of cheese.” – Gilbert K. Chesterton

Think about it. This is true!

Now, I understand that not everyone is as enamored with cheese as I am, and for some very good reasons, but when I need comfort food gooey, stretchy, warm cheese is cheaper than therapy.

If you can recall a poem that discusses cheese, I would love to hear it!

Emergency

20140717-232700.jpg

I picked my son up from daycare this evening. On the way home, he was subdued. He wouldn’t talk. He refused to eat a snack. He refused juice.

By the time I got him home, he was breathing super fast, wheezing.

He has never done this before.

I took him to my office for a nebulizer treatment. His oxygen level was very low (86%) but he perked right up after the treatment. Wheezing gone. Back to a normal oxygen level and his normal silly self.

By the time we got home, he was bad again.

And for a bit, I panicked. I lost my head.

This is MY baby we are talking about here.

But I worried about taking him to the ER.

What will they think?

I sat in the dark in the local ER parking lot for a while after I drove around the neighborhood… actually debating if he was sick enough.

He is sick. Very sick.

We are being transferred to the big children’s hospital.

Sometimes being a doctor sucks.

Denouement

IMG_2658

Well, I survived. So did everyone else.

It is amazing how much better one little tiny positive thing can make you feel about your entire life.

Sometimes I skip doing the little things for people around me.

It’s too little to make any kind of difference.

I won’t neglect that so much anymore.

Hope.

Hope is a very powerful thing.

Tutu on Tatooine

It drives my son absolutely bonkers to have his Star Wars, Avengers, and Justice League figures dressed in princess dresses.

His sister, however, does not care about that.

Not one bit.

To her, they are princesses. Any other role they have in this universe is meaningless. Inconsequential. Irrelevant.

She is unwilling to see the big picture, not interested in the possibility that they may have some other purpose. Like destruction.

My son is not able to see beyond the square peg and the round hole. “These are BOYS’ toys, mommy!”

So there is this rage that plays out, back and forth, each one disrupting the other’s vision of a perfect world.

Pink princess clothes on.

Pink princess clothes off.

Temper tantrums galore.

I am in the middle trying to teach tolerance and compassion and respect for each other.

And then I catch a glimpse of myself in their mirrors.

Sometimes I am the same. “I don’t like other people touching my things!” Cue flying spittle bits and crazed gleam in the eye. “Put it back the way it was and back away, slowly.”

There are certain things that are sacred. They shouldn’t be messed with, right?

Until you see Luke Skywalker in a tutu. Then you realize that was meant to be.

Maybe change isn’t so bad after all.

20140714-205840.jpg