A Virtual Reality Devotional

Stained glass window

The body lies prostrate

On the confessional floor

A weakened avatar

Your closed door

Heartbeat slowed

From afar

Fading finally

Into empty code

Mere tokens

Conquests

Meaningless and broken

Nothing of value

Can be taken

Only the memories of love

Gained and lost

And gained again

Virtual virtue

Virtually gone

And truth now clear

Life

Turned into fear

Death 

A final frontier

Hold your breath

It is not so painless 

As they wanted us

To believe

Take Me Higher

Entrance to St. Peter's Basilica at the Vatican.
The young woman glanced down at the distinguished, gray haired gentleman propped up on pillows as she hung the bag of potassium from the IV pole at the head of the bed. 

He was more handsome in person than he appeared on TV, she decided.

“This might burn going in,” she murmured. “The computer says your level was a smidge too low.” They were piloting a new AI program that made treatment decisions instead of doctors. It was said to be more effective and more reliable, better outcomes.

The patient looked up at her from his newspaper and nodded, winking. “Thanks for the heads up.” A great wracking cough rattled through his chest at that moment, leaving him gasping for breath. He sat down the paper. There was his face on the front page in an article talking about his admission to this very hospital for pneumonia.

“That sounds… better?” It was a statement and a question. She looked at him hopefully.

“Oh, believe me, I do feel better than I did yesterday.” He spit out the great glob of yellow phlegm that had caught in his throat, then wiped his mouth.

“On the mend, then!” She smiled down at her VIP patient. Her shift was approaching its end and she felt some degree of melancholia about that. Rubbing elbows with the rich and famous was quite fun.

Illness was the great leveler, after all.

She couldn’t wait to tell her fiancé! 

And her mom. 

And her best friend. 

Technically she was not supposed to tell anyone about this fellow, privacy laws and all that, but how could she be expected to keep a secret like this? She had really met him, spoken to him, touched him. The part she would not tell anyone about was the number in her pocket. He had slipped it to her after telling her she was beautiful and that he would like to hook up sometime. She patted her scrubs absently to make sure the paper was still there. Not that she would ever take him up on it, mind you.

Power was sexy…. but phlegm? Not so much.

She walked out of the room and back to the nurses station where she charted her activities of the past hour or so in the EHR. She caught sight of the man’s wife getting off an elevator and she found herself watching with envy. The woman was beautiful in a way she herself could never hope to be. His wife walked purposefully, a blue coat draped elegantly over her arm, a slight smile curled on her lips. No one at the hospital had ever seen her smile before. They were all warned to stay out of her way.

He must have called to tell her he was feeling better.

The nurse glanced back at the computer screen. There was a new order for another six bags of potassium for the fellow in room 432. 

How odd.

A quick check of the blood test results reassured her. His potassium level was indeed very low.

She checked her watch. It would be another 30 minutes before she could hang the next one. The next shift would be kept busy, that was for sure.

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

The papers and news stations all shouted about his death. Across every front page. Leading every news program.

He was dead.

She couldn’t believe it. How? He was getting better.

Then fear. 

Did she do something wrong?

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

The voice on the other line spoke a greeting in Russian. 

“It is done?” she asked.

“Da,” the voice said gruffly then hung up.

She smiled to herself as she dropped the burner phone into the crackling fire and poured herself a glass of champagne.

Yes. Of course it was done. A simple hacking right under their noses and no one would ever know. Cardiac arrest from a potassium overdose. In the hospital. They would do everything possible to keep it hidden if it were discovered. No one wants to be the hospital that killed someone like him…

It was a beautiful, elegant thing.

There would be no other women. 

Founders Keepers

There is a term in population genetics called the founder’s effect and I have caught myself thinking about it a lot lately.

Basically, in a founder’s effect a small subset of a population is isolated from the larger population. For instance, maybe seven people went on a three hour boat tour but instead ended up stranded on a deserted island. The Professor and Mary Ann mate and reproduce, as people are wont to do, and several generations later the resulting population on that island looks very different from the larger population that it originated from. There is a loss of genetic variation and certain traits get reproduced at a greater rate than you would find elsewhere. Sometimes this is benign, like with a greater proportion of blue eyes or brown hair. Sometimes it is bad, like when you have a higher predisposition to develop colon cancer or maybe a higher rate of growing an extra leg out of your backside…

EPIC is one of the largest electronic health record in the US. It is highly customizable. Therein lies its power AND its weakness.

Keep in mind that I have only a small part of the picture and I am making certain assumptions, but here is what I have gathered:

When a healthcare system decides to go with EPIC there is a build out, or personalization, that occurs. The EHR that I see is very different from the one used by a physician in another healthcare system across town or in one across the country even though they are all called EPIC. 

From that initial build out, there are changes made as the product is tweaked. For instance, when we went live, we had to enter our password to log in but then had to enter it again with each and every note we signed, every single order we placed. Hundreds of times a day I was typing in my password. Now? I only type it in to log on. Good thing, too, as I was at risk of destroying expensive equipment.

I have staff in my clinic who have worked for three other major hospital systems in the area who also use EPIC. What they describe is much, much easier to use than what we have currently. In fact, they regularly threaten to leave and go back to those other organizations so they can feel at peace again.

How does that happen? 

How do they have such different products? 

Because they are all starting with a basic product. It is thrown out onto a deserted island with a few people making decisions and then everyone waits to see what you get down the road. 

The founder’s effect.

No one from the other hospital systems is sharing what works for them from what I can tell. There is no collaboration. So each one has parts that work well and other areas not so much. Why can’t we help each other?

THEN you have smaller islands. We are a small clinic in a huge system. We did not get support staff who came out to help us after going live until the following week and then only for two days. The bigger clinics? They had trainers there on day one. Some clinics never got anyone. Training classes done before had very little to do with the reality of the EPIC we were presented with on day one. So we have muddled through figuring out our own work arounds. Some good. Some bad. We need an infusion of fresh genetic material to correct our problems. 

That only works well when you have someone visiting your island to add to your gene pool and that only works if that person is genetically diverse themselves. Getting people to leave their islands is difficult. Distance to travel, time constraints, don’t know how to swim, etc… 

So we get this perpetuation of problems and errors… fractured systems. It has been really interesting to watch from my vantage point at the bottom, looking up. I wonder what this will look like in six months.

Impact: Chapter Six

Chicago elevated train.

I awoke to sunlight streaming in through the windows. I stretched lazily. There was nothing more blissful than waking up to bright, warm light on your face after a long shift. This was why I always opened the curtains before crawling under the covers. That, and there was something reassuring about waking up in the night to see the lights of the city outside. It helped with the loneliness.

My shift! OMG.

My heart leapt into my throat and I sat bolt upright in bed. I had picked up an extra shift. I was supposed to work today.

Why hadn’t the alarm gone off?!?!!?!?

I distinctly remembered setting the alarm. Did I do something wrong? The new phone lay on the empty pillow next to me. I snatched it up and after hitting the button over and over again found that it was dead. 

How? 

I checked the power chord. It was plugged into the phone and the wall properly. Last night should have been a clue when email wasn’t working, I realized. I picked up the land line phone beside my bed. I needed to call in but there was no dial tone. I punched a few numbers and clicked the receiver a several times. Nothing. I slammed the receiver down in frustration. 

Skidding to the bathroom, I flipped the light switch but no light. I tried every damn light switch in the apartment but none worked. The clock on the microwave was a black, empty space. The TV would not turn on. Soon it was clear that the power was off completely. 

There hadn’t been a storm, had there? 

I checked out the window. The streets looked dry.

The clock on the wall in the kitchen read 9:18. I wondered if it was right or not but remembered it was battery operated. I was so miserably late and this time I did not have a Good Samaritan excuse. They probably wouldn’t believe me about the power.

I threw on some clothes. I had a habit of sleeping naked. It felt good to strip off all vestiges of the day and lie beneath clean sheets but now I felt terribly vulnerable. 

Exposed.

What was going on?

I would have to sort out everything later. The first order of business was getting to the hospital. 

Brushing my teeth helped. So did splashing water on my face. Quickly, I pulled my hair back into a ponytail. There was no time for make up. I shoved my make-up bag into the satchel next to my computer and headed out the door. Maybe I would have time later to apply something. I didn’t want to scare the patients…

Without my phone, I could not summon Uber. I was going to have to use the train. I zipped around other people as I ran two blocks to the nearest station. I flashed my card at the till but the light did not turn green. I tried again. 

Still red. I was getting frustrated and contemplated just hopping over.

“Hey, lady, do you think you could maybe go through or get out of the way?” The voice behind me was irritated. I turned to see a blond twenty-something in a light gray suit wielding his briefcase with an air of self importance. He glared at me. He was probably running late, too. So was the middle aged woman behind him and the older woman behind her.

“It’s broken.”

He rolled his eyes and reached around me with his card. The light turned green and he pushed past muttering obscenities under his breath.

The woman behind him did the same. I tried my card again but still got a red light. 

Fine.

The bodies behind me were pressing forward. I backed up from the turnstile pushing past the line that had accumulated behind me and did a quick visual search for a kiosk. 

Something was wrong with my card. Maybe I had lost track of how much was on it? I found one of the vending machines and attempted to load more money onto it but the message flashed that the card was invalid. I tried to purchase a regular ticket using my bank card but it said that card was invalid. Then I tried my credit card but received the same message.

Damn it!

Precious minutes were wasting! I fished out some cash and purchased a ticket that way, then made my way to the platform. 

I found a seat in the corner of the train and stewed. How could it be possible that all of my cards were dead? I watched the faces of the other commuters, wondering if any of them was experiencing something similar. No. They all seemed calm.

I decided to distract myself by putting on some mascara and lipstick.

At the next stop a woman settled into the seat next to me. She looked like a talker. I scooted closer to the wall and crossed my arms across my chest, hoping the body language would send the clear message to leave me alone. I couldn’t bury my head in my phone since it wasn’t working. I felt exposed again.

“Good morning!” 

Clearly, she had not gotten the message.

“Morning,” I muttered.

“You look like you are having a bad day.” 

I glanced over at her and raised an eyebrow. 

“My daughter, Cordelia, does the same thing.”

“What?” I was puzzled.

“Wrinkles her forehead like you do.”

“Oh.” I hoped the clipped response would shut down the conversation. 

It didn’t.

“I work in real estate as a paralegal. It is the most dreary office ever, so small you would think it had once been a closet. I feel the life sucked out of me a little bit each day.” My brain flashed to the scene in The Dark Crystal where the Skeksis drain essence from the Podlings, leaving them dessicated, mindless zombies. “Where do you work?”

“In healthcare,” I said carefully. Admitting that I was a physician always opened me up to awkward questions.

“Oh how nice! What exactly do you do in healthcare?” She smiled.

“I’m in housekeeping at the hospital.” It was sort of true.

She squinted at me, then laughed. “That’s funny! I would have put you in management. You just never know about people.”

I shrugged.

“I get off up here,” she said, digging her purse. She handed me a business card. “If you ever need to buy some property…” She winked as the train stopped, then was gone.

I tucked the card into my bag next to the accident victim’s card, shaking my head. What a 24 hours this had been. 

The rest of the trip passed in blessed silence. 

At the correct stop, I exited and ran the remaining few blocks to the ER at Northwestern. I stoppped at the nurses’ station to catch my breath and survey the lay of land. I could see they were fully staffed. There was Dr. Prick, I mean Dr. Waters, back again to make everyone miserable. There were three other physicians seeing patients but they and the rest of the staff pointedly avoided making eye contact. I checked the board. I was not on the list for today. Then I realized my name had been erased from the rest of the week, replaced with Dr. Waters’ name. A sense of foreboding came over me.

“Dr. Benton!” It was the ER director, Dr. Boyack. Someone must have alerted him to my presence. “Why don’t you step into my office?”

Oh, god.

I followed him into the tiny office around the corner. He settled himself behind the desk, motioning to the chair across from him. The room was sparsely decorated except for an ivy plant by a window that looked out onto a brick wall and a framed illustration of a busty female robot stood on the corner of the desk. Eccentric was the word for him. He studied me for a moment, probably for dramatic effect, then leaned forward, steepling his fingers in front of his long beard. 

“We have decided to let you go, effective immediately.”

I let out the breath I hadn’t realized I was holding. A million panicked thoughts were racing through my brain. When I didn’t respond, he continued.

“You have excellent patient satisfaction scores. The staff loves you. But we need someone more reliable.”

Wait! I wanted to scream at him. This isn’t fair! But in his defense, I had a habit of running late. Getting used to the unpredictability of Chicago transportation had been difficult. If I had not already established a pattern of behavior, we would not be having this conversation. So instead I just nodded. 

I was not sure this day could get any worse but at least now I had time to figure out what was going on with my bank and credit cards and to try to get the power back on at my apartment. Oh, and the phone. That goddamn stupid phone that I had been forced to get after the men in suits had stolen my original. I fingered the cold screen in my pocket. I wanted to take the cursed thing out and stomp it to pieces right then and there. 

But I didn’t.

He pushed a long, white envelope across the desk. “Your last paycheck. I’ll need your badge and keys.” He smiled sympathetically.

I dug the items out of my bag and dropped them onto his desk, giving a satisfying clang as the metal and plastic hit the fake mahogany surface. I opened my mouth to speak but thought better of it, choosing instead to leave the office without a word. As I reached the door he called out to me.

“Hey, Dr. Benton?” I paused, looking over my shoulder. “Good luck. I have a feeling you are going to need it.”

Chapter One

Chapter Two 

Chapter Three

Chapter Four

Chapter Five

Embellished

img_3987

I used to be an author.

Every day I wrote two dozen or more short stories. 

Some were comedies:

“The pain in the right knee started after a snowboarding accident in Aspen two months ago during a spring break trip with friends. He swears that a tree suddenly jumped into his path and evasive maneuvers failed.”

Some were tragedies:

“The patient states that she learned last night that her husband has had a two year long affair with a coworker. She would like STD testing and something to help her sleep for a few days.”

Now I am supposed to point and click predetermined text to generate my note. It comes out something like this:

“The episode started two months ago. Pain is in the right knee. It is worse with movement. It is better with nothing.”

Where is the patient in that? Gone.

Then it is followed by a long list of smart text that generates an office note so full of crap that it is impossible to get to the meat of things quickly. I routinely get 4 page notes from specialists. I read the first paragraph and then the last page to hopefully figure out what is going on. The rest is meaningless drivel that is tacked on for billing purposes. I scan through hundreds of pages of documents every day. You know how I can read so many blog posts so quickly? Years of practice…

We are losing our humanity. 

Change the human body from a person to a machine.

Change the healthcare providers into automatons.

It is inevitable, isn’t it? Dehumanize the patient. Dehumanize the doctor. Dehumanize the nurses and medical assistants and other providers. Do it little bit by little bit. If you do it in one fell swoop, there will be rebellion. Whittle away at it in small bites so it is easy to swallow and then one day we will all look up in horror at what we have become but by then it will be too late.

Once you have done it to healthcare, do it to every other aspect of our lives. 

Little bit by little bit. 

I think, perhaps, it is already too late.

Homework assignment! Ask to read what your doctor writes about you next time you go in…. 

Virtual Perfection

img_2856

My new electronic health record (EHR) likes to be helpful. Very helpful. It is full of all sorts of suggestions to ensure that my care is better than best.

For instance:

When I prescribe a birth control pill, a warning flashes up in the form of a red and yellow pop-up to remind me that it is contraindicated in pregnancy. Um. Duh? The patient isn’t pregnant. Not yet anyway. 

Similarly it wants me to know that metoprolol, a medication used for blood pressure and the heart, is contraindicated in chest pain. Well, Ok…

Dozens of commonly used medications have absurd warnings. What I am most afraid of is getting to the point where my brain blocks out all warning pop-ups because at some point I am going to get alerted about an allergy that I forgot about. I don’t want to automatically click through that alert. It would help if the medication allergies were listed on the same screen as the order entry screen. Wishful thinking, I guess.

The EHR wants me to add “Morbid Obesity” to everyone with a BMI over 30 and “Overweight” to everyone with a BMI over 25. For many of my patients, rubbing their noses in their weight is counter productive AND the bigger question would be is being overweight by BMI standards really a medical condition? I don’t think so. THEN it wants to suggest that I send the patient for nutrition guidance. That would be all well and good but when was that ever covered by a patient’s insurance company? Almost never. Even for diabetics, thank you very much. I have yet to have a patient volunteer to pay $1,500 for nutritional guidance with a dietician. I sure as hell wouldn’t.

Are you coming in for strep? Well, the computer wants to remind me that you also need your tetanus booster. Except that I already gave you a tetanus booster two years ago. You are good for another eight years, technically. In fact, the computer has that immunization in the shot record, it just isn’t giving you credit for it. Or me credit for it, apparently. I have to go through a complicated series of maneuvers to “properly” record that you had the vaccination. It cannot be easy. Oh, no.

Oh! I have patients that are finding their records merged with old records from when they saw an unrelated doctor in another part of the state over fifteen years ago. Kinda fun, except that their name is now reverting back to their maiden name or some other nonsense and I have to delete those ancient meds off of their current med list before anyone gets confused.

Speaking of the magical appearance of meds, do you have something you don’t want your PCP to find out about? TOO BAD! If you fill an antibiotic or any other medication at a pharmacy from another provider, I’m gonna find out. That has made for some awkward conversations with patients about their over utilization of teledoc services… I hate it when they cheat on me with another physician!

The EHR fills in quantity and refills on many of the meds I order automatically, except it often isn’t correct. For instance, a Z-pack (azithromycin) that it says to take two pills on the first day and then one pill every day thereafter, auto fills a quantity of two rather than six. Or amoxicillin three times a day for ten days sometimes auto fills a quantity of 20 rather than 30.

It is still early. We will see how this continues to shape up as I get more proficient.

Impact: Chapter One

Chicago skyline from Sears Tower
A sudden squealing of brakes and a dull thud caused me to glance up. Nothing…. at least so far as I could see through the two dozen heads waiting to cross the intersection with me.

Engrossed in my phone again, I checked a news app, scrolling through the stories. More election drivel. I gave up and slipped the phone into a pocket. There were a few seconds of dysphoria after I looked up as my eyes took in the surroundings again and my brain processed where I stood.

The corner of Harrison and State Street.

The light changed.

I started to walk. People parted ways ahead of me, some going right and some going left. Some stopped and stared. I kept walking until I finally registered that something blocked my way. A dark figure lay sprawled in the intersection, his right leg bent weirdly. 

Someone behind me screamed.

The man lay so terribly still on the asphalt. There was a bright pool of crimson growing around his mangled leg, a gory halo of sorts, offset further by the sliver of morning sunlight that crept between the skyscrapers to fall across the road exactly where he rested.

Damn it.

This was going to make me late for my shift. Again.

A man stood nearby with a 911 operator on speaker phone.

I could just keep walking. No one would know who I was…

Like I could do that.

I stepped forward and knelt by the body, checking for a pulse. It was thready. Instinct took over as I dropped my leather bag and worked to stabilize him. He was barely breathing. I ripped his gashed pants leg and found the artery in his leg that was severed, holding it tight with my fingers. He had a large gash over his left cheek that exposed the bone. His belly was rapidly distending, no doubt bleeding internally.

His eyes looked through me, unseeing. 

A groan.

Within minutes I could hear the sirens, though they were still far away. I looked down at my blood covered hands and then glanced up at the crowd of faces staring down at me. I saw shock, concern, hope…

But there was nothing more to be done. Not here in the middle of the street at least.

His eyes focused on me for a moment of lucidity, knowledge flickered across his face as he understood he was dying.

“Tell her….” The sounds came out barely audible as he formed the words around the blood bubbling over his lips. “Tell her it was the pearls in Paris.”

Wife? Girlfriend? Who?

“Sure, I’ll tell her,” I soothed. No further sounds came. His chest moved rapidly as his breathing quickened, getting more and more shallow as the belly expansion pressed against his diaphragm. 

I hope they hurry. He needs a hospital STAT…

I checked his pockets with my free hand after wiping it on what remained of his suit coat and found a wallet and phone. 

Why don’t I carry gloves?!?!!? 

No photographs in the wallet. No one ever carried real pictures anymore, did they? His driver’s license. Joseph Spellman. A stack of business cards. Mr. Spellman was a computer consultant. I slid a business card into my pocket.

There was the hushed whisper of a voice behind me, “Did she just steal his money?!?!” I turned my head to make eye contact and glared at the elderly man who had spoken. He hung his head guiltily.

All of a sudden the area was crawling with police and EMTs. I stood and stepped back as they took over, stretching. My knees hurt from kneeling on the asphalt. I looked around for something to wipe my hands on, then noticed that my bag was gone.

A man in a black suit touched my arm and pulled me back. “Ma’am. Could you come with me please?” His voice demanded compliance, his face stern. 

I needed to call the hospital to let them know I was going to be late. 

Very late.

“Wait. My bag…”

“I already have it.” He pulled on my arm again. 

“Where are they taking him?” The man shrugged. I turned to an EMT standing at the background. “Where are you taking him?”

“Northwestern.”

I nodded. My hospital. I could find out what happened to him later.

“Ma’am. You must come with me.” 

“Do you have something I can use for my hands?”

Dark Days

pond before a rainstorm

So how was it? The first day of the new EHR?

If you really want to know… It was a cluster F**K with a capital “F”.

I don’t want to bore you with all of the gory details but suffice it to say some clinics had staff so frustrated they were just walking out, quitting on the spot. 

My staff is all coming back tomorrow. I think. I’d like to believe that pizza and slushies and chocolate helped but I am not sure there was anything that really could have made it better short of an electrical fire. A devastating electrical fire….

Hmmmm.

There’s always tomorrow.

The End and The Beginning

Yesterday was the last day I had to use our old electronic health record. I hate that thing. Loathe it. In fact, I am not quite sure there is a word in the English language that would adequately convey the depth of my negative feelings about that thing. If I could physically place that EHR behind the wheel of my truck and roll over it back and forth until it was pulverized, it would be very gratifying.

However, as I closed it out for the last time, my virtual desktop completely empty, I felt an odd sadness that I had not expected. I spent nine years learning how to play that game. I knew how to navigate the system, work around its weaknesses. It was familiar to me. I was comfortable because I knew what to expect. I knew how many clicks X, Y, and Z required. If I couldn’t print, I knew I needed to log out and try to get hooked up to a new server. I knew how to phenangle clicks to get credit for preventive care, even if it was laborious. I knew lab orders and imaging orders could get lost, how we needed to utilize a back up plan. I knew that no matter how much I complained about the screen blanking out periodically, or the eprescribe function sometimes not working, the help desk would always say that it was a “known problem” and there was no ETA on when it would be fixed, if ever.

On Monday, I will log into a completely different system. A better system. As I drove home yesterday I realized that I now felt more professional, more grown up, more like a “real” doctor. I felt taller in my seat, somehow.

Now I have a grown up EHR. 

Then a black cat sauntered across the street in front of me at a stop sign, mocking with his bright green eyes….

Seriously. It was eerie.

The reality is that I don’t know what the hell I am doing in the new system. The training sucked as all EHR training does. I don’t know what to expect. I don’t know where the holes are or how the work arounds need to function. I don’t know how to get credit for preventive care. Heck, I’m not even sure I can construct a coherent office note and we will be taking a hit financially due to the switch since the new system is more expensive and we have had to operate at reduced capacity due training requirements.

What is the future going to be like in my virtual world going forward? 

Hmmm…

Black cats aren’t really bad luck, are they?

Leaning to the Left

Chicago skyline from a boat in Lake Michigan

“They denied it again.”

“WHAT?”

I had, no joke, completed various permutations of that paperwork half a dozen times and I was done. DONE, I tell you. The faxed rejection notice included two pages of suggested changes to be completed before resubmission, all things I had already taken care of.

Four months of this back and forth. I was trying to get diapers, pads, wipes, and barrier skin cream for a patient with cerebral palsy via Medicaid.

Initially, I had completed the form just as I had for years. However, I found through subsequent denials that I could not use just cerebral palsy as the diagnosis code. Nor could I just use the code for incontenance or neurogenic bladder. I had to use ALL of them together. But that was still denied.

Then I wrote a letter of medical necessity, as Medicaid said the paperwork forms were not enough. The letter I wrote said, “This patient has cerebral palsy and incontenance and needs diapers, pads, wipes, and skin cream.” Seriously, it was exactly the same thing the forms themselves conveyed, only I wrote it in sentence format on a letterhead.

After the letter, they said they would cover everything except the skin cream. 

Take a guess why.

Because I had to say the skin cream was to be used as a barrier.

I rewrote the letter, adding the phrase “for barrier to prevent skin breakdown” after the skin cream mention.

Finally, it was approved. 

Two months later everything had expired. So I meticulously rewrote the forms and the letter with the exact same codes and phraseology. I even placed the periods and signature flourishes in exactly the same places.

It was denied.

You know what? I will play whatever damn game they want me to play but I need to know the rules. Changing the rules randomly without warning and without explanation is absurd. Sure, it wastes my time, but the real issue here is the patient needs the covered supplies and the state is doing its darndest to make sure that doesn’t happen. Not on their dime, at least.

These are the games we play.

Meanwhile, skin breakdown and ulcerations….

Kerfe at Method Two Madness asked, “Do you have a solution for remaking the way medicine is practiced in the United States? I know our politicians don’t consult either doctors or patients when they write their laws. But let’s pretend they will listen and do the right thing…what would you suggest?”

My list of biggest desires is this:

1. A simple EHR and an end to the litany of stupid ways that I have to prove to the government that I am using it *wisely* or demonstrating that I am providing a “patient centered medical home” or any other inane acronym/phrase they come up with.

2. No more silly game changes like the paperwork situation above. There would be a simple rule book that does not change on someone’s whim without notice.

3. Controls on the costs of medications.

4. Universal healthcare coverage that is shared by all politicians. This scares me because I have seen the government muck up almost everything it gets its hands on and healthcare is too important to screw up any more than it already is, but I don’t know how else to do it. I have watched as even people with insurance cannot afford needed care with the high deductible plans now provided by employers. It is a sad state of affairs.

5. A salary cap for healthcare, insurance, and pharmaceutical company CEOs.

6. Better security for the IT part of healthcare. I have read that stealing healthcare data is much more valuable than stealing a credit card number. I don’t doubt it. We have rushed into the technology without adequate safeguards. 

To be honest, though, I am probably the last person who should be fixing things. I have very little knowledge in the areas of politics, policy, and government finance. If you relied on me to take care of things, we would probably have a collapse of our economy…