Concierge 

Gerber Daisies

“The letter said I had to pay $2400 each year to remain a patient because from now on he was going to be running a concierge practice. I would still have to use my insurance and pay deductibles and such. He’s a good doctor but I just don’t have that kind of money!” She said it in a way that made it clear the she hoped he would not hold it against her that she would have to find a new doctor. It wasn’t his fault. It was hers…

Trust me, honey, I know him. He doesn’t give a rat’s ass.

I get told all the time that I ought to go into concierge practice. 

But I won’t. 

Not ever. 

The fact is, I would feel like such a sellout, I wouldn’t be able to live with myself.

Why do I hate concierge medicine so much? 

I want to believe that it is because I think healthcare should be equally good for everyone, not better for those who can pay more. Concierge medicine smacks of elitism. Maybe, though, it is because I don’t understand people that have that kind of money, that kind of entitlement. Yes, I have assigned an unfair stereotype, haven’t I? 

Maybe I am simply jealous of them?

And then I wonder at what point do I actually become one of those rich, entitled people? Is it when I become willing to pay the retainer fee? Or some point before? 

Do I have to have gobs of money to be one of them?

Is wearing a large chunk of fake diamond on my finger selling out, too, in a way? I have had it for just over a year now. People treat me very differently when they notice the “rock” on my finger and I have to admit that I like it, I like the deference and I feel dirty because I like it. And then I ask myself WHY does that make me feel dirty and not any number of other things from my checkered past? 

And so I come back to some level of jealousy. 

I am not noble. I am eaten up with jealousy and having to face that every day would be painfully difficult.

That is why I cannot do concierge medicine. 

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The Overseers

Through a window at the American Museum of Natural History in NYC

I see your drones flying overhead,
Your truck driving by.
I know you are watching me,
Following my every move… 
Silently waiting 
For the proper time to strike. 
You know my internet searches,
The names of my kids. 
You know my habits 
And my darkest faults. 
Some days you know my secret wishes 
Before I can even get the chance 
To wish them. 
Always there, behind the scenes 
Your satellites measuring my level 
Of devotion. 
Well placed hints, strategic glimpses, 
All forms of intimidation
Meant to remind me that I am yours 
Entirely,
Forever subject
To your every whim.

*****************************************

If you want to see something fun, zoom in on the bottom left of the photo.

Thursday Thoughts From The Throne #4


Today’s’ thought is brought to you by my upstairs bathroom….

I am a huge fan of grandparents. I really love celebrating Grandparents Day. I do NOT, however, appreciate schools celebrating Grandparents Day by inviting everyone’s grandparents to come for some function or another. 

Here’s why:

  1. They are invariably disorganized.
  2. There are always a fair number of kids whose grandparents are dead or live too far away to come.

My kids are blessed that they have a grandmother who comes to these things but I have each year encountered the kids who don’t, who are stashed in a back room looking forlorn and left out. It tugs at my heart. 

This year my kids were supposed to write letters and make artwork for their grandparents. Earlier this year their PawPaw died. My son’s letter read like this:

Dear grandfather, I wish I could still speak with you. Even if I will not see you, I will always keep you in my heart.

He gave it to his Granny instead. 

It was good on some level, helping the kids work through their grief but I sure do wish the exchange could have been done privately instead of in front of the whole assembly, putting their grief and their grandmother’s grief on display. 

And that is all my butt has time for today!

The Twelfth 

World Trade Center

“Mommy, why are there so many police everywhere?”

I looked around. She was right. They stood on every street corner it seemed, decked out in bulky bullet proof vests. New York City, more than any other city in the world that I have visited, possesses a very visible police force. No longer simply protecting us from each other, they stood ready to protect us from them.

Did it make me feel safer? 

Yes. Yes it did.

I grabbed my daughter’s hand as we crossed the street with the crowd of other people. The Empire State Building rose up in the distance. 

“Are you going to take your kids to the 9/11 museum?”

They are six and seven.

“No. They aren’t ready for that yet.”

I’m not ready for that yet.

I dropped my purse and camera into a bin and wiggled out of my jacket, sending it and my ball cap through the scanner then stepped through the metal detector. The security guard nodded silently. We were free to move on to the next staging area. 

“Mom, why is it that everywhere we go here is like the airport?” my son asked.

In truth this was the forth scanner we had walked through on this trip. Long lines made longer by strict security. Stress. My kids felt it. So did I.

“Some years ago there was an attack on two tall buildings here in New York. They collapsed and thousands of people died. There are people who hate Americans and want to hurt them so the police and all of the security measures are trying to prevent something from happening like that again.”

Watching the towers collapse over and over again on the news feed at the clinic between patients, the world shifted. It wasn’t until the next day, as the dust was settling, that it became apparent just how much it had shifted. 

My kids seemed to take in the information and I braced myself for more questions, for fear, or even tears from my daughter, but there was nothing. 

Nothing.

This is their world. They don’t know what it was like before 9/11, a world where simply being American carried with it a certain degree of power and respect. They didn’t feel that shift. They will only know a September 12th world, a world where they are targets. 

Pumped Up

IMG_1233

“Well, you see… I was benching 300 pounds and felt something give in my right shoulder. It’s been hurting ever since.”

“How long ago was this?”

“Um.” He searched his memory. “Three months ago? Maybe longer.” He shrugged, then winced.

“Why the hell are you benching 300 pounds?” 

Did he really do that? Or was he maybe exaggerating just a smidge?

I mashed around on his shoulder, bringing on another wince, and walked him through some range of motion exercises to evaluate the joint further. This was his sixth injury from lifting in past 24 months. I had already told him he needed to back off a bit.

“I need to gain weight. I need more muscle.” 

He came from a long line of average height, thinly built people. He had already put on 25 pounds of muscle since the last time I saw him. Much more was going to be impossible.

“You are fighting genetics, you know. You are not going to be able to bulk up more than you already have without doing dangerous stuff.”

He look back at me, clearly horrified. “Oh, no, I’d never do that, Doc! But I’ve at least got to make my chest look good. That’s what the ladies want.” He puffed up his chest for effect.

“I’m a lady. That’s not what I want. I don’t think that is what most women want.”

He stared at me with a single eyebrow cocked up in disbelief standing out on his fresh-out-of-college face.

“So, what do women want, then?”

“Security. Respect. Love. Not necessarily in that order.”

He rolled his eyes and laughed. 

Had no one said this to him before?

“Sure, Doc….” His reply held a hint of sarcasm.

“Don’t get me wrong. I appreciate a man who takes care of himself, who stays fit. That in itself is an act of love, but having impeccable pecs is really not necessary. Pushing the envelope is really not necessary. A guy who says, ‘You need to carry the groceries in yourself, hon, because I can’t lift the sacks with my jacked up shoulders and I can’t walk with this bum knee,’ isn’t really sexy if he did it to himself.”

There was silence as I ordered an MRI in the computer. Thousands of dollars already spent treating his injuries, what was a few more?

Then he laughed.

“I guess you’re right, Doc.”

Damn right, I’m right.

“Just take it easy on your body. It has to last you the rest of your life…”

*****************************************

I have had several conversations like this over the past year. I talk a lot about how body image issues affect women but there is a ton of pressure for men, for boys even, and it is getting worse. A distortion and misrepresentation of what is possible and what is desired is being perpetuated by media, by people selling lies. 

Fight back, I say. 

Fight back.

Missing Out

IMG_1621
“Why can’t I go?” I held the paper clutched to my chest. I’d earned a trip to a church summer camp for free. My ticket out of my own little hell for two weeks. I needed this. Never had I been allowed to go to camp. Up to that point I had been led to believe it was a money issue.

Please let her say yes, God. Please, please make her say yes. I promise to go to South America to do mission work when I grow up if you will just let me have this one thing!

My mother stood silently, her face turned away. 

“Mom! Why won’t you answer me?”

Her body stiffened. 

Finally, her back still turned to me, she answered:

“Because I never got to do something like that.” 

And then it dawned on me. My mother, my own mother, was jealous of me. Jealous of this opportunity. Was there more to it? Probably. But there was an undercurrent of envy and that was what I latched onto.

I judged her harshly.

How can you be jealous of your own daughter? What kind of person does that make you?

It struck me yesterday, listening to my son and daughter practicing on the piano, that I am envious of them. I am jealous that they get the opportunity to have piano lessons from a real teacher. I am jealous of my son’s spelling and math ability, how easily music comes to him. I am jealous of my daughter’s artistic creativity, her ability to easily make friends, and her extensive glitter pen collection. What I could have done with even a couple of those glitter pens back in the day… 

Even now I don’t understand all of the reason behind my mother’s refusal but I did learn an important lesson. I learned I could survive without church camp. I also learned, and a great big wave of relief washes over me even now when I think about it, that God did not *want* me to serve as a missionary in South America. 

Whew.

So where am I going with all of this?

Envy was a surprising emotion to recognize in myself and I find it embarrassing to admit. It snuck up on me. Since I am not a particularly unique person and I am living on this planet with billions of other not so unique people, I expect this means that other parents also experience jealousy when it comes to their kids. I wonder how many?

We all want to believe that we are somehow better than our parents, though, don’t we? 

And yet we aren’t.

I expect that maybe even more than my kids’ glitter pens and the piano lessons that I am most jealous of their youth…. those unexplored futures, the potential looming ahead of them. I wonder if this is simply because I am an older parent, or if younger parents feel this acutely, too.

Ultimately, I don’t intend for jealousy to motivate my saying “no” to things in the future… except maybe if my daughter wants to go out for cheerleading.

Needled 

Door of St. Patrick's Cathedral in New York City

“Your mammogram shows an area the radiologist is recommending that we biopsy. I am going to put in a referral for you to see a breast specialist to get that done.”

“Um. I already have the biopsy scheduled. The radiologist said they could do it. It has been approved by my insurance and everything.”

I glanced at the time stamp on the mammogram report. She’d had the mammogram done just that morning. The report summary said “suspicious calcifications concerning for malignancy….”

“I would really rather we get you hooked up with a breast specialist to do this.” 

Silence.

Who do they think they are, scheduling my patients for procedures that I have not even authorized yet?

“I’d rather just get it done. It’s already scheduled for next week.”

“Look, I can get you in with the specialist in just a few days. This is not going to delay care in any way.”

Suspicion began to creep into her voice. “I really don’t want to,” she said firmly. What exactly had they said to her? 

How do you say, “I think you might have cancer,” without causing panic? How do you remain professional when you are seething inside?

If it were me, if it were my mother, I would want to have the biopsy done by a breast specialist, not a radiologist. They have surgical training but more importantly, they know what to do if god-forbid-it-turns-out-to-be-cancer. Instead of waiting to see someone that can take the next step, I would be already plugged in. I have seen it too often. The panic, fear… the rage… 

My patients deserve the same care I would get, the same care I would demand for my loved ones.

I knew how it was going to go, though:

“If you don’t stop doing this, I am going to stop sending my patients there for mammograms.”

The manager laughed at me through the phone. “You have to send patients to our facilities. We are in the same system. You know they track that sort of thing.” 

And she’s right….

The suit squinted at me from across the table.

“So, in analyzing the data from your mammogram referrals we see that you are sending about 52% of your patients to outside facilities. Care to elaborate on why that is?”

“Is it required that I send patients to only system facilities?”

“Oh, no. No. It’s not required.” 

That would be illegal.

“So why are you here talking to me about this again?” I could feel the pricks of anger rising under my skin.

“We can’t require you to do that but in the interest of managing costs for patients…” He trailed off. 

In the interest of keeping more money in the system…

I held back a laugh. 

It was an interesting thing, how much more frequently my patients getting mammos at system facilities seemed to end up getting biopsies compared to those facilities outside the system that did not do biopsies as part of their services. Did they track that, I wondered? Was my perception about this correct or merely a projection, tainted by the animosity I felt? I resolved to start keeping a tally.

“While we are on the subject, your referrals to system specialists is below the system average for primary care. Why?”

“The why depends on the patient. Some prefer to stay in the area. Driving downtown is a hardship for a lot of them, not to mention the cost of parking. Some need a physician with a certain set of skills or a certain personality. Some have experience with a physician through a family member or have been seeing this specialist for years and need a referral each year because of their insurance.” 

Why am I justifying this to you?

A month ago they added a button on external referral orders that requires me to provide an excuse so they can better track such things. If there was a “bite me” option on the choice list, I would use that. 

Previously they had only loaded the contact info for physicians within the system. If they were not a system specialist they had to be loaded manually by filling out a form that went to the practice manager then to a practice administrator and then to a VP and then to someone to add them in. It took weeks.

Provide us with a list of the specialists you would like to use and we will contact them to try to get them to join the system.”

“I’m not doing that. I’m not letting you use my name to convince them to join anything. If they want to join, they can look you up. Meanwhile, I will continue to refer in a way that keeps the best interests of my patients as a priority.”

Technically they could pull those names from electronic health record. Maybe they already had.

“Oh, we always want you to keep the interests of your patients as a priority. We would never ask you to do otherwise.”

Except that is not how it feels…

Thursday Thoughts From The Throne #3

Black and white Gerber daisies

The nice thing about your loved one continuing to ignore your advice about going to the ER for their severe right lower quadrant abdominal pain until their appendix eventually ruptures is that in a few weeks when it is clear they will live and the post op pain subsides (you have to be nice to them until then) you will have ammunition to use for the rest of their life… if you are the kind of person who does that sort of thing.

*wink*