A Day at the Office, and the Day of the Dead

11/8/14

My workday started yesterday with a lady who is nearing the end of her life. She has a good deal of dementia, and although she is still recognizable as the person I’ve been treating for years, she is not quite that person anymore, literally a shadow of her former self. Who is she now? This lady’s daughter gave the opinion that when her father died, her mother died as well. Where did she go?

The day ended with my empathically witnessing the very troubled birth of a child whose mother was the person actually lying on my table. The child has been having terrible nightmares and visions. Our working theory was that these distressing images relate to a disaster that occurred two generations back, before the birth of the child’s grandmother, because they seem to depict such similar images. Is this trauma still stuck in the psyche of the family group? Is the little girl a version of someone who was physically present at the event? Why is this child the one carrying the trauma?

All that plus an extra measure of fatigue and stress to scrape away my outer layers made me especially conscious of the continuity and connectedness of human life. It’s a few days past Día de los Muertos, and this year I have felt the thinness of the veils as never before. (As I wrote that, I felt a touch from Fryderyk at my right side.) Most years I hadn’t noticed anything special at that time, though I appreciated it and cherished it as my favorite holiday.

But most years I didn’t know so many on the other side personally. Within the past year one of our cats passed, then the patient and friend that I’ve mentioned, then two of my husband’s relatives, then my cousin. Very recently there were two I only knew vaguely but my husband knew better, someone prominent in the music community and an artist who lived down the street from us. A week ago I made an ofrenda in the dining room, with silk flowers and an Archangel Michael votive from my patient’s house, and put up pictures of those I could.

Late that night I suddenly felt strongly drawn into that room. I paid attention and pulled up a chair next to the ofrenda. There was an incredible sense of peace, and as I gazed at the photos in turn, I felt the presence of each of the deceased, especially my patient, and very much including the cat. As you know, for me to reach out to the dead is nothing new, but they had never reached toward me in this way before. It was a wonderful benediction and blessing. I didn’t want it to end.

altar 2014

The theme of this year’s Marigold Parade, the Día de los Muertos observance in Albuquerque’s South Valley, was water (“No Se Vende, Se Defiende!”). Nature went along by dumping rain on us, the only rainy, chilly day in a period of gorgeous fall weather. The energy was a bit lower than usual, but my enthusiasm for the holiday was way up.  Here’s my attitude:

From a calendar owned by my patient, artist unknown

From a calendar inherited from my patient, artist unknown

I’ve encountered a reaction of “ewwww” from some folks who aren’t in tune with this celebration of the dead. I don’t understand why. The dead are no more or less than the same people we loved when they were alive, and our relation to them doesn’t change in any fundamental way. Our ancestors may be gone from this plane, but their lives inform and nourish ours at every moment. There is nothing foreign or frightening about them.

The depictions of the dead dressing up in their party clothes, playing music, eating, drinking and dancing charm me. Why not have fun, free from one’s earthly cares? Because I know that there is infinite potential to keep learning, developing, loving, and appreciating, and I want others to know it too, I like this kind of reminder. The images of the skull and the skeleton also remind us that under the skin we are all the same, and that all of us are equal in facing death, no matter what our station in life.

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Filed under history, spirit communication, spirituality

An Invisible Patient

I thought I’d be writing Part II of my last health-care post at this point, but meanwhile something fascinating came up that I’d like to share with you.

More and more, I’m being called upon to do psychic work with my patients, although I never advertise or warrant that I can do that. They assume I can do it and trust me to come up with something useful, even when I don’t trust myself. Two weeks ago, on September 3, a patient asked me to help with something that seemed a bit outside my abilities. She, and the other person involved, have authorized me to tell about our experience.

The other person involved was my patient’s dear friend and business partner, who killed himself a couple of months ago after grappling with intractable mental and physical health problems and other frustrations. I’m going to call him G for Ghost, and his friend simply P for my Patient, even though in this case the patient was actually the ghost himself.

G has been in persistent contact with P since his death. Not in a frightening way, not any kind of possession, no attempt to control P, but he’s just always around. He’s talked with her often, with perfect clarity. He’s even commented on conversations she’s had with other people, which were not intended to include him, leaving her a bit peeved. When P asked if she could bring G to my office so that he and I could communicate, I didn’t understand what she wanted. Since she could hear him so well, and I likely couldn’t, why would it help for me to try to converse with him?

“He needs to talk with someone who isn’t me,” she told me firmly. The truth of this became obvious later when we had our meeting.

I’d already met G, briefly, at P’s last appointment. It’s not particularly unusual for spirit entities of various flavors to come in with patients, but finding myself nose to nose with a recently dead human being was still a little startling when it happened. I asked G if he had anything to tell us, and he hung his head and repeated, “Sorry sorry sorry sorry….” Poor guy, I thought. I tried to tell him that nobody was judging him and everything was OK now.

Later, P told me that G had been feeling terrible, both before and after his passing, about how much he had needed her to do for him, how much of her energy and resources he’d taken, and how he had hurt her by committing suicide. She said that the “sorry” message was very real and I had heard correctly.

It seems that G has been making every attempt to be helpful since, but his helpfulness may not be any more balanced or healthy than his guilt and shame. I wasn’t sure what to make of the message P relayed next, that G wanted to help me with my “balance of giving and receiving” because he felt that my patients were draining me. OK, I can somewhat see where he’d be getting that, but overall it’s not the issue he thought it was, and at any rate it wasn’t happening at the treatment he’d observed me giving to P.

I set up an appointment with P, and tried to prepare every way I could during the time leading up to it. I sent out repeated calls to Fryderyk, requesting his presence at the event; I had the feeling that things would be difficult, and I was hoping for backup. I got very little response.

P and I agreed that if nothing happened, we would just accept that and not worry about it. I set our chairs on either side of the treatment table, as if we were about to work on a physical patient who was lying there. On the table was the MacBook on which I’m writing now, with GarageBand open to record the session. We needn’t have worried that nothing would happen– as usual, G was right to hand.

G immediately reiterated his desire to be of assistance to me, and a moment later he was inside my body, trying to move my hands and look out through my eyes. This would have totally creeped me out if I hadn’t had such experiences with Fryderyk before; as it was, I stayed utterly calm. I didn’t think that G was any threat to me or that he had any ill intent, but still, this was exceedingly inappropriate. I told him in no uncertain terms that he was not allowed to use my body in this way.  It was useful that he made the attempt, though, because that showed me where he was coming from and what he was trying to do.

I told P what was going on, and added a bit about why I thought G was incorrect in thinking that he needed to save me from being drained by my patients.* P marveled that even after death, we can still project our own issues onto others. Well, as we discussed, we’re still ourselves when we die, and we don’t immediately become hugely enlightened, though I hope we can get a bit broader of a perspective even early on. G, it seems, had major issues with being able to ask for help and to feel OK about needing it. I can understand that, and it’s not foreign to me by any means, but as I told him, I get a great deal of help from both Earth-based people and the spirit world, and I’m very aware that I couldn’t manage without it.  Anyway, I thanked him for his offer, but made it clear that we would not be working together in that way, period.

It was becoming apparent to me that G believed he needed to work through a physical body, even though he had given up his own. I tried to convince him that he was far less limited in his present form, and could do whatever he might want or need to accomplish perfectly well. “I don’t even work in my own body half the time!” I exclaimed. But G looked to me (through my mind’s eye, not as a vision in the room) like a small, contracted, grey figure, not a powerfully glowing ball of energy, which is how I see a person in a healthy state. He didn’t look like he could accomplish much of anything, he was so closed up and shut down.

“Isn’t there anyone helping him?” I asked P. Normally, we all have our connections to current family, ancestors, guides and so forth, and we’re always told that when we die someone comes to take care of us and show us the ropes. I could not detect anyone or anything around G, and P couldn’t either. This seemed unimaginable, but my own vision, the messages P received, and her subjective experiences all said that G was completely alone except for his connection to his one friend. When I asked G about this directly, I heard the only verbal message I got from him that day, which was an impassioned, “I LOVE [P]!!!!”

Feeling perplexed, I set about trying to help G open up to the universe beyond the small area in which he’d confined himself. Right away, I sensed extreme resistance to this. Looking further, I discovered that G believed that if anyone out there saw him, any higher beings, they would immediately judge and reject him. I did my best to convince him that this was not the case at all, but he wouldn’t take that in. I talked about other messages I’d channeled and been told about, in which I’d heard how valuable and beautiful and precious an individual human personality is, and how loved we all are, as well as how much fun he could have in his new expanded state of being and how much good he could do. P and I kept up this encouraging conversation for a good while. At the same time, I kept doing energy work, as I would with a physical patient. I brought a column of illumination down into him (best I can describe that), and G began to expand and light up a bit. He still seemed extremely skeptical about what we were telling him, though.

At this point, I felt like I really needed some outside support. Unable to find anyone naturally connected with G, I sent out a plea toward Fryderyk, who I knew had done this sort of work before. I felt only a vague tendril of contact; it appeared to me that he and G reached their hands toward each other, but the connection felt tenuous, and I wasn’t sure anything was really happening.

Over an hour had gone by, and we were all beginning to feel that we’d said everything that could be said in that session. I knew that G still wasn’t the least bit ready to Go Toward the Light, but I had no more incentives to offer him. P reported that G was telling her, “She needs to go and have lunch.” I was feeling that way too. It was a day of 7 patients in a row with this in the middle, and I definitely needed a break.

When I checked my laptop, there was a message on the screen saying that GarageBand had crashed because there was too much data coming in too fast for it to handle. A simple recording of one track of ambient voices, with a lot of spaces between sentences– how could that be too much or too fast?

G left the room, and there was no question in my mind that he was gone. I didn’t feel that there was any residue left in my body or in the space. P felt him go, as well– giving her a little break! And the moment he was gone, Fryderyk was all over me, embracing me warmly, almost overwhelmingly. No words, but a feeling of “Good job! I knew you could do it!” He must have been observing the entire time. And really, I could do it. P and I were both completely capable of handling this sticky situation, and we both felt fine afterward.

But we didn’t succeed in helping G on to the next phase of his existence. When I saw P a week later, she reported that he was still around. All. The. Time. Her strategy at that point was to sit in her yard and meditate, expanding her own energy outward, trying to model this behavior and encourage G to do it along with her. It sounds like a reasonable response to the situation. This is all I know so far about the results of our session.

 

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

 

As you know if you’ve been reading my posts for a while, I am all too familiar with the feeling of a malign entity invading one’s system. (See “A Case of Possession.”) G isn’t like that, and I don’t mean to lay any blame on him, at least not much– he’s doing more than enough of that himself, after all. He’s just confused, as far as I can tell. When my other patient died at her own hand last year, she had become much clearer and in a way well by the time she passed over**, but G died in a state of great distress, as far as I know, and didn’t have a chance to resolve anything. I don’t know how typical this is of suicides, but I wouldn’t be surprised if it happens a great deal.

I am also familiar with the feeling of having an invisible friend hanging around for days on end. Now that I don’t get a lot of concentrated time with Fryderyk, I’m nostalgic about it, but early in our relationship there was occasionally almost too much togetherness. Sometimes, after it went on for a while, I would begin to wish for time to myself, like can’t I even go to the bathroom on my own for gosh sakes? It was not unpleasant in any way to have him around, and I didn’t experience any interference with my daily activities, but I would just start to feel like I needed a little more room to breathe. I can certainly empathize with P’s desire to have her own space again.

There is another close parallel with my experiences with Fryderyk: the form that my interaction with P and G took was exactly like the “afternoon teas” Mendy Lou and I used to have with him. In both cases, the other embodied person in the room was getting verbal messages and for the most part I was not, but I was clearly picking up emotional and energetic impressions. Combining our two streams of communication, we were able to put together vivid and complete pictures of what was going on. The similarity says to me that the type of communication I received from Fryderyk when we were with Mendy Lou was more related to my personal mix of abilities than to his specific way of interacting with us. I’m still much more an empath than a telepath, and still a pretty small medium, I’m afraid.

As I worked on this today, I couldn’t help but radiate wishes to spend some quality time with my dear departed, and apparently those got through to him. When I settled down to rest for a while, my wish was granted. I’d been hoping to ask him about a subject that had come up in the past couple of days, the types of keyboard temperament (tuning) in use in his time. I wondered what sort of tuning he had preferred. It was a fairly technical question and I didn’t know if a reasonable answer was possible, but I asked anyway. The first answer was that if an instrument could be competently and completely tuned in some temperament, any temperament, and stay that way for a while, that would be great! Yes, for sure…. So then I asked him, “If you had an ideal instrument and an ideal tuner, what would you ideally prefer?”

As so often has happened, he gave me a reply that came in from a totally unexpected angle. Showing more than telling, he conveyed this to me: If he could have had anything he wanted in terms of tuning, what he would have wanted was to sing, to be able to shape the intonation and tone quality of each and every note without limitation. I felt a huge rush of air and sound through my body, vibrating everywhere, tremendous power and freedom. It was exhilarating, and it was something I want as well and have experienced all too rarely.

It was something his small, struggling body could never have done, but somehow he deeply understands what it can feel like. Perhaps I should see if he and I can try it together.

 
*This strikes me as amusing in light of what my former friend and colleague, whose patients I inherited, said about me– that because of the “evil spirit” Fryderyk hanging around me, I was draining the energy of my patients and everyone near me. Here another “evil spirit” was seeing things exactly the other way around.

**I had been pleasantly surprised, when I encountered her after her death, to find that she seemed peaceful, not stuck or confused. http://elenedom.wordpress.com/2014/01/07/get-right-while-you-can/

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Filed under channeling, spirit communication

All Healing Is Self-Healing, Part I

A few weeks ago I ranted about one aspect of our dysfunctional medical system, prohibitively high copays. Since then I went to see my chiropractor*, and he mentioned that his patients have been telling him that they would be coming in more often if not for their recently inflated copays. He added that in the past, by this time of year, patients would virtually all have met their deductibles, but now deductibles are so high that 80% of them have not.

What amazes me most is that we are all putting up with this. But then, we’ve learned that we have no power within this system. Many of us have also learned that we don’t have much power over our own health. More than anything, that is what is going to have to change if we are to have any hope of getting health care on a viable and sustainable course.

Last time I gave you a link to a post by my friend James Rolwing, which he began with this crucial statement: “All healing is self-healing.” Please think about that for a moment. Does it sound true to you? Does it have exceptions? Does it feel liberating, or does it make you a little uneasy?

All any of us in health care can do, for any amount of money, is to aid the body’s and the mind’s own natural healing processes. Even in the case of the most drastic interventions, such as a joint replacement or organ transplant, the body must take what has been added and make it work, while repairing the tissue around the new portions. Surgery can remove damaged tissue or stitch it together, sometimes in truly ingenious and astonishing ways, but there is no force on this earth that can heal surgical incisions except the body’s own innate ability. We do what we can, and then we must wait.

But what about drugs, you say. Drugs make direct changes in body functions. Yes, but the body must metabolize and make use of the drugs, and individual bodies do that in individual ways.

When I do acupuncture I am acutely aware of the fact that all I can do with needles is to give signals to the body about what it needs to do to get back into balance. I can use needles to talk to the body through obviously physical means, engendering tiny electrical currents and stimulating the release of substances such as neurotransmitters and hormones, as well as the subtler energetic signaling that medicine understands less clearly. I can ask for increased circulation or for excess fluids to dissipate. I can ask for whatever I care to, but then the body will do exactly what it wants to do and is able to do, no more and no less.

This is not so much a limitation as a gift, though it can be frustrating to find the optimal way to get the body to respond. Most of the effort and cost in American health care goes to dealing with chronic and often very confusing conditions, and there is contention and controversy about how to treat them. If we say that we want people to have access to health care, what exactly do we want them to be able to access? What is our underlying belief system about how to deal with diabetes or fibromyalgia or cardiovascular disease or even simple aging? I think you have a pretty good idea of how things stand in the medical world at present. We do a lot of fixing but not a tremendous amount of healing, lots of sick care but not so much health care.

How do we find a path to health for ourselves as individuals and as a society? How do we take responsibility for our health in concrete ways? We know about fundamentals like nutrition and exercise (though even those are fraught with controversy), which in themselves could transform our lives if we would do what we know we should. There is far more that we can do, at least if we are fortunate enough to have access to the information we need and the openness to make use of it.

Here James outlines two possible ways of thinking about our bodily discomforts:

“Essentially, we have two choices of dealing with a symptom. We can drive it back below the threshold of our awareness (a suppressive approach) or we can participate with it (an expressive approach). With suppression a door is closed, and with expression a whole world opens up.

“Most of what is typically described as healing occurs as the result of suppressive mechanisms. Painkillers and antidepressants are obvious examples, but any type of therapy can employ a suppressive approach. It is often a fear-based strategy, as we unconsciously fear to examine what is underneath the symptom.

“Expressive healing describes the mechanism of self-healing, and views a symptom as an indication that something within us is asking for acknowledgement, most often trapped or repressed feelings and emotions. Relief or resolution occurs as the result of recognizing and giving expression to these underlying sources, because the symptom was only there to point us toward the deeper cause in the first place.”

http://rolwingjames.wordpress.com/2014/04/13/the-intervention-fallacy-part-i-how-it-starts/

While I was working on this post, my right arm and hand were giving me a lot of grief, impossible to ignore, just in time to help me think about how to apply what I was writing about. That was what sent me to the chiropractor. You might wonder why I needed to/chose to do that, since one’s physical structure ought to be able to right itself naturally. In fact, that’s an essential concept in chiropractic, the body’s innate wisdom and healing capacity. Well, I had been doing everything I could come up with on my own, and it wasn’t enough. I was still having disabling pain and dysfunction, and I needed this kind of assistance. (It’s OK to acknowledge that we can’t do everything alone; that’s not abdicating responsibility for oneself.) Getting my bones pushed back into place helped the acute situation quite a bit, though that also brought other aspects of the pattern to light, which I then needed to deal with. I still had to work with the emotional issues that had been stored in that area of my body; that is, I had to do expressive healing. It was very clear that I had to do that, and that the pain would not resolve otherwise. In the midst of it I went for an Alexander Technique session** to get some guidance in releasing the habitual tensions that were feeding into the problem and to help move the stuck emotional content. It all took a lot of time and effort, especially considering that most of it was a matter of simply letting go! I’m doing a great deal better now. Maybe I even know a bit more about how to avoid this in the future.
Here’s a case for you to contemplate:

A patient of mine who is disabled and on Medicare hit the “donut hole” recently.  A drug which has helped immensely with his diabetes will now cost him $295 per month. That will be the case for four months, one third of this year, even though he is insured— all the way till next year. (This would not happen in the same way with private insurance or with Medicaid, only with Medicare.) His family makes $1000 per year too much to get any kind of extra subsidy. He’ll never get out of the donut hole, because he won’t be able to pay out of pocket up to the amount where coverage would kick in again. They might as well ask him for $2950 per month— he simply can’t afford that $295. He’s already tried the other available medications, some of which are cheaper, and this one worked tremendously better. I could see a marked difference in his condition with it, and I’m sure his PCP was delighted to see what it was doing. So much for that.

If complications from his diabetes put him in the hospital for even one day, that will cost us all more than we would pay to cover his medication for the rest of the year. Our country is being financially stupid as well as cruel to this man. And our vaunted medical breakthroughs are meaningless if our doctors can’t get them to the patients.

This gentleman is a superb energy healer himself, and he does everything as naturally as he can to take care of himself. He has had some success in the past with herbs to control his troublesome symptoms, and he is exploring herbal options again. After a period of being enraged with the system, he decided that the present situation might be an opportunity to find a better way to deal with his blood sugar. At least, he pointed out, he won’t have to worry about the potential side effects of the drug. He already does all the obvious things with diet and exercise, you understand, and with his mental attitude. We’ll see what else he and I can come up with.

Update!!!  My patient has been able to get his meds through a free sample program at Presbyterian.  It took quite a while before this happened, and when he first (and second and third) inquired he wasn’t told this was possible, but the system did come through for him.  He was already developing preventable problems while waiting, however.

 

*Terence Timm, DC. I’d refer you to him except that (waaahhh!) he is retiring very soon.
** with Karen DeWig. http://alexanderabq.wordpress.com/

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Filed under health and healing

Killer Copays

Most of us seem to enjoy complaining about our so-called health care so-called system, but not a lot of clear paths for improvement have been put forth. I have come to think that above all, we have a failure of imagination. We cannot envision another way of doing things, or at least a way out of the present situation, and so we continue to put up with a reality that is increasingly insupportable. We tinker around the edges, but nothing more. As Dr. Dean Ornish put it, “We spend so much time in medicine mopping up the floor around the sink that’s overflowing without ever turning off the faucet.”

Much of what I’m writing today will focus on a small aspect of the system, copays, and will not offer grand visions for the future, but I would like to drop this idea into your head so you can let it grow in the background: We created the present situation. We can create something else. What we have now is not ordained by God or nature. It hasn’t even existed for a very long time, only a few decades.

After you’ve read this post, please look up the 2012 film Escape Fire, which outlines just how completely screwed we are and what we can do about it. You can find it here:  http://www.escapefiremovie.com/  It’s also available through Netflix.

Escape Fire is based on a book by Donald Berwick, MD, the former head of Medicare and Medicaid. He wrote it early in the 2000s, and you’d think that a decade later we would have figured a few of these matters out, but as far as I know we haven’t made a single one of the changes he recommended. The idea of an “escape fire” is that if one is about to be overtaken by a forest fire, one can burn an area on purpose to provide a path to escape. The film recounts the story of a group of firefighters who were in this type of situation. Their leader dropped a match on the ground and burned a circle around their position, using up the fuels that would have fed the fire. He told the others to stay in the circle with him, but they took off, insisting that they could get out safely. Guess who survived. Dr. Berwick’s point is that we have obvious paths to escape right in front of us, but we refuse to take them, or even to see them.

Dr. Berwick pointed out that people within the health care industry do exactly what makes sense to them where they find themselves. It’s just that the system contains such incredibly perverse incentives that they often do things that have ill effects for the country as a whole.

Recently one of my elderly patients canceled her appointment for the next day. The reason was that she had to see her eye doctor, and the copay for that is $45, meaning that she wouldn’t have the money to pay even the extremely reduced price I would have charged her as a low-income senior who doesn’t have insurance that covers my services. This lady lives in a subsidized retirement apartment complex. Some of the people who live there have income of less than $1000 per month, and few have much more than that. A copay of $45 is huge for them, possibly even requiring saving up over a couple of months. These folks have Medicare and often other coverage, but strangely, it’s still quite possible to face daunting copay amounts.

A few weeks ago, an insurance company representative told me that high copays do not prevent access to care. Clearly, they do. Copays and deductibles* are both going through the roof. I wrote to her company, one of the major insurers in our area, one which pays only 2/3 of usual and customary fees for acupuncture, as follows:

“Copays keep increasing in general. I understand that at least in part this is caused by attempts to limit increases in premiums. What is troubling is that in many cases copays are equal to or greater than the amount insurers actually reimburse for a given service. As copays continue to go up, this situation is likely to keep getting worse.

“Within the ____ system, the most extreme case I’ve seen involves City of Albuquerque employees. They have a $55 copay for acupuncture, but ___ only pays $43.73 for acupuncture. [Your representative] said that she thought in this case the member would only be expected to pay the $43.73, but that is not how it works. EOBs show clearly that the full $55 copay is expected. And providers are not allowed to discount copays and can get into trouble for doing so.

“It is more typical these days to see a $40 copay for ____ members, and has been for a couple of years now. That means that much of the time ____ is paying a princely $3.73 for acupuncture, and the patient is paying nearly the entire charge. When you include the fact that ____ limits members to 20 treatments per year, the total paid for the year can be as little as $74.60, less than the price of a single appointment for most medical services.

“In both of these types of cases, the member and the employer (often through the taxes we all pay) are paying for coverage for acupuncture, but they don’t get anything that can really be called coverage, and in the case of the highest copays, they have a kind of negative coverage. It’s an advantage to me as a provider to have the patient pay a larger copay, but it’s still painful to see them treated so unfairly.

“I imagine that when the HR department or whoever set up these copays were in discussions about how their plans would work, the amounts sounded quite reasonable to them. Perhaps someone said, ‘I don’t know, what does acupuncture usually cost?’ and someone replied, ‘Well, my acupuncturist charges $70.’ It might not have occurred to them that $55 would be higher than the reimbursement amount.

“(After all, usual and customary insurance payments for acupuncture alone are in the range of $62-65, not counting any amounts for E & M codes or other services. ____ is unusual in paying only about 2/3 of that— an amount that has not changed for a number of years even as patients pay more and more. This exacerbates the issues with copays.)

“I don’t know about how other types of providers are affected. I do know that chiropractors have some similar issues.

“Copays are charged for us DOMs at the ‘specialist’ rate, but since we are not reimbursed at anything like the amounts cardiologists, etc. get, the copays are a much larger percentage of the price. I understand that PCP visit copays are kept lower because insurers want members to see their PCPs to try to catch problems early, but often the PCP can’t do anything and simply makes a referral anyway, meaning that the PCP visit is a waste. Visits to DOMs, DCs and PTs are relatively discouraged by the higher copays, even though we are saving insurers money by helping patients avoid more expensive interventions such as surgeries— not to mention helping the patients relieve their suffering and improve their overall health, which ultimately reduces costs as well as being worth doing in itself.

“[Your representative] said that members have far wider benefits than just acupuncture, which obviously is true, and a member who has a major health problem may end up with much more value paid in benefits than they pay in premiums in a given year. However, this does not change the fact that members with high copays for acupuncture are being sold a benefit that they don’t truly receive. It’s rather like going into a store to buy a shirt, and being told that although the shirt normally costs $45 and most people pay that or less, you have to pay $55 for it.”

So costs to consumers and the country at large keep going up and up and up. In what aspects of the system are those costs increasing so persistently? Let me tell you, payments to doctors are not the problem. We’ve been seeing flat or even decreasing rates of reimbursement. Medicare and Medicaid in particular squeeze providers, and as shown in a heartrending segment of Escape Fire, often the only way a clinic can stay in business is to pack in more and more patients. Again, providers are doing what appears to make sense from their perspective in their corner of the system. But not only is this compression of appointments terrible for patients, especially those with more complex needs, it can actually raise costs. Primary care doctors who don’t have enough time to figure out what’s going on with a patient are likely to refer that patient to a specialist, costing dramatically more, whereas with more time to think, the PCP might well have solved the problem and come up with a treatment plan without making a referral.* So reducing payments for primary care to absurdly low levels is classically penny-wise and pound-foolish. “There is no more wasteful entity in medicine than a rushed doctor.”
http://www.nytimes.com/2014/07/21/opinion/busy-doctors-wasteful-spending.html?contentCollection=opinion&action=click&module=NextInCollection&region=Footer&pgtype=article&_r=3

I would like to propose a simple rule that copays may not be more than 50% of the amount reimbursed for a given service. Period. I truly believe that there is more than enough wasted money, far more than enough, to make this happen. I would also like to propose that resources be redirected into primary care and especially accessible clinics for the most vulnerable portions of the population, like the ones being seen by the frustrated PCP in Escape Fire. Continuing to cut already-thin payments to practices like that makes no sense.

These of course would only be stopgap measures. Next time, I’ll take up some thoughts about self-care and our responsibilities toward our own health. Meanwhile, I offer you one more pithy post to chew on: 
http://rolwingjames.wordpress.com/2014/04/13/the-intervention-fallacy-part-i-how-it-starts/

*https://elenedom.wordpress.com/2014/02/04/health-care-access-and-why-pcps/

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I Could Have Gotten Out at Any Time

 

Getting near water was almost worth all of it.

Getting near water was almost worth all of it.

I’ve debated about whether to post this description of a rather embarrassing event that I shouldn’t have allowed to happen.  A while back, I was told, “Everything you need to know is in this story.”  Maybe you’ll learn something from it too.  I’m reminded of the lessons every day by the scars on my leg where it was torn by the wire of that chain-link fence.

 

On May 3, feeling exhausted but in need of exercise, I decided to try to do something good for myself and take a nice walk down by the river at the Rio Grande Nature Center park. It was an unusually warm day, and between trying to finish laundry and chores and wanting to miss the hottest hours, I went late. I knew that they closed the parking lot at 5 pm, but I never park there, not being interested in paying unnecessarily nor in having my car locked in, so I wasn’t worried about it. In previous years, it had always been possible to get in and out of the park on foot at any hour.

I went in through the front gate at about 4:50. An APD cop was cruising through the parking lot. He didn’t tell me that I ought to get out of there, which reinforced my sense that it was fine to be there– another great moment for our dysfunctional APD. Perhaps, since I was striding purposefully, he thought I belonged there. Another woman was also walking in the park, but in the opposite direction. I assume she got out before 5.

Well, you guessed it– the entire park is now enclosed with chain-link fence. It’s no longer possible to get in or out after 5. They don’t make any announcement when they close. They don’t walk through and check. They just lock the gates and leave. I was trapped.

I felt sure that there must be a way out. I walked all around the perimeter of the park itself, including the education building and the animal rescue center. It seemed like surely there must be a human being left in the place, but there was no one. There is a large expanse of open space next to the park, and I thought there ought to be a place to slip through somewhere. There wasn’t. They have tamed the whole thing.

I found a gate near the road that looked a little bit lower and more accessible. To get to that, I had to clamber over a low wire fence in some tall weeds. I started trying to haul myself up over the gate. It proved to be impossible. I just wasn’t strong enough. Analyzing the geometry of the situation in retrospect, I can see that even with considerable upper body strength, it would have been unlikely that I could have made it over. I was trying to fold the top of the wire mesh over a bit, but that wouldn’t have been enough. I couldn’t get my toes into the openings between the wires, and even if I could have gotten over the top, I would have been injured because of the wire ends sticking up.

Which caught in one of the openings in my shoe as I tried to get my left leg over. (What I would have done had my leg gotten all the way there, I’m not quite sure.) So then I was ridiculously hanging there with my right foot on a support in the middle of the gate and my left stuck on the top. I think that was when I got the most hurt. Eventually I was able to get my foot unstuck and land on the ground without a total disaster.

An older couple was biking along the road in my direction. I flagged them down and asked if they had any idea of a way out. They said I was probably doing the best possible thing already. The woman tried to encourage me when I said I wasn’t strong enough to get over; she said, “Of course you’re strong enough, if you get enough adrenaline going.” No, I wasn’t. I felt hopelessly weak, and more drained than ever. And stupid, of course very stupid. And in pain from the cuts and bruises I had managed to sustain. I never did figure out exactly how I’d gotten cuts all over my arms and legs.

I had my phone in my pocket, but I didn’t want to try to call the cops for a rescue because I figured they’d cite me with something. There was only one other thing I could think of– maybe the opening under the front gate was tall enough for me to get under. As soon as I took a good look at it, I could see that it was. I slipped underneath and out, reasonably gracefully and with no more damage except for the dirt, which added to my feeling of ignominy.

I could have gotten out at any time.

 

 

 

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Dead Doesn’t Have to Mean Serious

Death is profound, but being dead doesn’t have to be serious.  As a devoted follower of Swami Beyondananda and the fortunate friend of that famed comic actor Chopin, I am pleased to pass on this story of humor and lightheartedness from the beyond.

A teenage boy who I’ll call N was killed in a car accident late in 2012.  His family was devastated.  There is nothing funny about any of that, but his mother and his aunt have been telling me about the amazing and amusing lengths to which N has gone in trying to communicate with those he left behind.

N was in JROTC in high school, and had always been interested in shooting.  After his death, yellow BBs started showing up around his family’s environment.  It would be easy to say that there must have been some he had dropped or left lying around the house during his life, and they just happened to turn up over time.  However, they were placed much too creatively and implausibly for that to be the case, and in places where N could not ever have been.  Why BBs?  Well, it seems that N’s stepfather was always giving him a hard time for leaving them underfoot!

N’s mom went on a cruise and found a BB in her stateroom.  His aunt found one in her car.

On N’s 16th birthday, the family gathered at their old house, which had been completely cleaned out and gotten ready for sale.  They held his party outside, but the went into the house for a little while to blow up some balloons.  They checked the floor carefully, because they had a baby with them, and they didn’t want to leave anything lying around that he could put in his mouth.  N’s aunt reported: “Then, my mom and younger sister went back into the rooms they had just checked and little BBs started appearing: 8 total. They stated they just started showing up, N was there at that moment putting them everywhere they looked.  It was trippy and funny at the same time.  My husband found the 9th one in the bed of his truck.  He happened to be in the bed looking for a jack.  He had been in that bed many, many times before and POOF there was a yellow BB.  So, my mom and younger sister gave each of us a BB because there were 9 total, one for each of us.”

You might still be thinking, “Well, those BBs probably just didn’t get vacuumed up when the house was cleaned, and they didn’t check as carefully as they thought.  The one in the truck bed had been there all along.  And the one in the stateroom had been stuck somewhere in the mother’s luggage.”  But how about this:  On another trip, N’s mom brought a bottle of medication straight from the pharmacy.  It had not even been removed from the bag, which was still stapled closed.  Yup, you got it– when she opened the bottle, she found a yellow BB inside among the pills.

This seems like incredible virtuosity to me, especially for someone who was very young and hadn’t been gone from this life all that long.  I’m wondering if N’s little cousin, B, who says that she sees him on a regular basis, might be helping to provide an opening for him to get through.

On the Valentine’s Day after N died, the little girl, now age 3, received one of those mylar balloons filled with helium.  Her mom, N’s aunt, told me that the balloon stayed aloft for months.  Every time it started to sink to the floor, it would magically reinflate and head for the ceiling again.  It would also follow B’s mom around the room, so that she laughed and told N that she knew he was there.  One night it somehow passed through three closed doors to show up in her closet, floating as usual.

Recently B was playing a board game with her family.  The game included cards with printed questions, and B appeared to be reading the cards.  Now, she’s a smart girl, but she’s still only 3, and she’s definitely not reading yet.  “Is N telling you what’s on those cards?” her mother asked.  B admitted that he was, and as she’s done many times, said he was right there.  I wonder if she’s mystified that other people don’t see him the way she does.  Her mom does her best to be open to seeing, but so far it hasn’t been possible.  At least no one laughs at the child or tells her that she’s making it all up.

In the midst of all this, N’s mother and grandmother went to consult with a medium.  They were still mired in grief, and we know that making contact with the deceased can help tremendously with the pain that loved ones feel after a death.  They received quite a few meaningful messages, and indeed this has helped them to feel better, although things are still very difficult.

One day N’s mother got a text message that simply said “Hi” and appeared to come from her son.  He had known another boy with the same name, so she asked if the message was coming from his friend.  The reply was just her son’s name again.  She didn’t know what to make of it.   At the next session, the medium reported that N was asking, “Did you get my text?”  I guess for a teenager, there could be no more natural way to communicate than to send a text.  (Could Fryderyk figure out how to do that?)  And it seems that N’s mom had received some other anomalous texts before that, starting about 9 months after the accident, which contained the letters of N’s name but didn’t make any sense.  Unsuccessful attempts, apparently.

[Ironically, as I write this, the sound system here at Annapurna is playing “Up above my head/There’s music in the air/And I really do believe/There’s a heaven somewhere.”  N’s aunt wrote, “I hear the songs we put on his memorial slide show for the funeral all the time!  I will be in yoga listening to their nature music and all of a sudden a song will play.”  I have often heard of songs showing up anomalously as apparent messages from the beyond.]

N’s aunt continued:  “My stepdad spends a lot of time at N’s and his spot (my parents’ land).  He has said that he will go up there and clean the land up from weeds, move rocks etc.  Every time he goes up there, all the things he has done with the rocks are back to where they were.  You see N used to make “ramps” out on the land to jump his bike and/or motorcycle.  During a time when his mom and my mom talked to the medium, N asked if Papa got his signs.  Also, a hatchet that N lost of my stepdad’s at the land miraculously showed up too.  Just sitting by the garage on the land as if it had been there the whole time, nice and clean too!

“N is aware that my dad is rebuilding his race car.  It was always N’s car.  They wanted to make it street legal so N could drive it when he turned of age.  My dad has been hard at work rebuilding it.  N knows about it and states that he sits there with my dad when he is working on it and can give details about it.”

N’s maternal great-grandfather has also gotten in on the act.  His daughter, N’s grandmother, had a terrible time dealing with his death a few years ago.  He has told her, through the medium, that he’s tried very hard to get through to her but that she hasn’t been open to his messages, including the pennies he’s put in front of her.  From what I’ve read and been told, spirits often express such frustrations.  It’s sad to think of that, but at the same time I’m giggling at the idea of N and his great-grandpa having so much fun thinking of new tricks to play on the family.  I wonder what they’ll come up with next.

Update, 6/3/14: 

Well, here’s what they came up with next.  Recently N’s great-grandmother died.  At the cemetery, when the mausoleum was opened to inter her body, dozens of yellow BBs came rolling out.  The family didn’t count them, but there seemed to be about enough to give one to each person who was present.  Of course it had been many years since this mausoleum had been opened.

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Health Care Access, and Why PCPs?

Grant's rainbow 2.2.14A friend posted this picture of a rainbow that appeared two days ago in our area, a most welcome sight since we had had no moisture at all for over 40 days.  The rainbow showed up just after her neighbor died after a long illness, giving its benediction to the family.  Last night we had a fair amount of rain and snow, and it feels like we will not dry up and blow away just yet.

I am trying to keep up some hope for our health care system as the conflicts over so-called “Obamacare” continue and costs keep spiraling upward.  There does seem to be some lucid thinking going on in at least scattered spots among those in the medical field and those making policy, and I want to encourage that.  There’s also a lot of the same old thinking that got us where we are today.  Here is my current take on some aspects of the situation, which I sent to the Albuquerque Journal today:

The Journal has published some useful articles lately on problems with access to health care, and I’d like to add my perspective as a provider out in the field.  There are three main issues with access to care for New Mexicans: distance, cost, and scarcity of providers.

I don’t have to tell you that for many of our residents, most everything is far away.  Even in our smaller cities, there are not a lot of services.  In Grants, where I see patients once a week, medical specialists come in from Albuquerque or elsewhere, as I do.  People who need VA services must go to Albuquerque, no matter how elderly or disabled they are.  It’s bad enough in a small city like Grants, but people who live in more rural areas, as some of my patients do, may be completely out of luck if they lack transportation.

Getting more New Mexicans insured is necessary and commendable.  However, this does not remotely solve all the problems with the direct cost of medical care to consumers.  As those who are shopping on the state exchange have no doubt noticed, many plans have deductibles in the thousands of dollars.  Also, with some plans patients pay as much as 90% of the cost of the service themselves, even after their deductible is met, because their copays are so high; they are paying for coverage that they don’t get. The ACA was intended to bring deductibles and copays into the realm of reason, if I understand correctly, but as it is, cost limits access even for those who are insured.

For those on Medicaid, at least, copays are low or nonexistent.  However, very basic and critically necessary care may not be covered.  For example, one of my elderly patients needs drops for an unusual and painful eye condition caused by her recent case of shingles.  The cost is low compared to most of her care, but Medicaid is not covering this medication, and on her extremely limited Social Security income, this lady can’t afford enough of it to last through the month.  For all the millions we spend as a state, we still can’t get people simple things that they need badly.  And while the myriad costs add up to so many millions, Medicaid and Medicare payments to providers are so unsustainably low as to keep providers out of the programs, exacerbating the access problems all the more.

Our state’s lack of health care providers has multiple causes, but it also has the potential for multiple solutions.  Making better use of mid-level practitioners, as many have suggested, is certainly necessary, and any efforts which will attract more health care workers are worth trying.  However, there are other available health care forces which are only partly being tapped.  One of your editorials did refer to “traditional community health workers,” by which I assume you mean people like curanderas/os and Native healers.  Encouraging greater use of their abilities would be a definite help– but how is that going to be funded?  For the most part our insurance system has ignored the existence of these valuable resources, as it has ignored herbalists, homeopaths, and those who do energy healing such as Reiki.  Most federal dollars will also bypass all those practitioners and the people who rely on them.

New Mexico has a formidable and growing health workforce in the members of my profession, Doctors of Oriental Medicine.  We too are being used far less efficiently than we could be, even though most commercial insurance in the state does cover our services.  Decision makers don’t seem to realize how much primary care we do– and we have not yet managed to get the word out to them sufficiently.  We are lumped in with “rehabilitative medicine” by insurers, but that is only one aspect of our medicine.  Patients walk in to acupuncturists’ offices with everything from flu to IBS to sciatica, and we treat them effectively.  We are well placed to help take the strain off of primary care MDs, and we are ready and willing to serve.  However, provider groups organizing “patient-centered medical homes” have generally not included us in their planning.

Medicare does not cover acupuncture, and under most circumstances Medicaid also does not, largely because the federal dollars are not available to make that happen.  Attempts to fix this in the state and federal legislatures have failed thus far.  So immediately a huge proportion of our population is left out of a major form of effective and cost-effective medicine.  And while our NM-based insurers do offer coverage, as I mentioned before, in many cases reimbursement is slim and patients are left to pay as much as 90% of the charges, so that this “coverage” is not very meaningful.  (Fortunately, there are also many plans with much better coverage, I must add.)  Yet, many patients do use us as their front-line care providers, and that could be expanded.

There are still other possible providers as well.  In some situations a chiropractor may be the best choice to see first, and access can be a bit easier than that for DOMs, with so many chiropractors available and a good number of them accepting Medicare.  For at least some conditions these practitioners could also help to ease the burden on primary care MDs.  Physical therapy is usually given limited coverage, and patients tend to be referred to PT only after they have failed to get better for a long period of time.  That is inefficient and leads to unnecessary suffering.  We could use PTs more as the first choice, go-to practitioners for injuries, back pain, and the like.

There is one access problem that would be very easy to solve, IF those who are in charge were willing.  That is the system of HMO and PPO networks.  It was unconscionable when Lovelace ended its relationship with ABQ Health Partners and tore hundreds of thousands of New Mexicans (including my family) away from the doctors they knew and trusted.  Now Presbyterian has stopped coverage to the UNM providers, again leaving patients in the lurch.  We could stop this kind of abuse, I expect, legislatively or perhaps through actions of the state insurance department.  I am not holding my breath, but as the provider crunch gets more and more serious, I hope access will be broadened across insurance networks.  There is no good reason for things to be this way; we all pay and we all deserve to have the best providers for our needs.  HMOs were supposed to reduce costs and improve health outcomes.  Neither has happened.  Time for a different approach.

And we do have a different approach waiting in the wings: the home-grown, NM-specific Health Security Act is still here and has been gathering more and more support over the years, though so far it hasn’t made it past all the Powers That Be.  In the next few years we will have the opportunity to improve upon the current health insurance exchange and enact this more efficient plan.  We can choose to do it– it’s just a matter of willingness.

 

OK, that’s what I sent off to the newspaper a moment ago.  Continuing:

Let’s say that a patient has jumped through all the hoops of distance and cost and gotten the coveted access to care, and is now sitting in the doctor’s office.  Now the main barrier is time.  The patient may have waited months for this appointment, but she is going to be very lucky to get more than 10 minutes of the doctor’s time.  And maybe even that pittance may soon be a luxury.  An editorial written by two local executives with Presbyterian Health care and published a few days ago stated that because of the pressures on PCPs, we have to find some alternative to the standard 15-minute appointment with the physician, such as group appointments for people with common conditions like diabetes.  Wait just a MRSA-contaminated minute here!  We pay more and more and more for our supposed health care every year, we are totally breaking the bank, we are stressing the whole country out trying to fix all this, and we can’t even get a measly 15 minutes with the Minor Deity?  Seriously?  (Meanwhile, the Deity is struggling to stay afloat in a world of shrinking reimbursements and greater pressures on his or her business.)

I must say that on the fairly rare occasions when I’ve gone to an MD, as for my yearly OB-GYN checkup, I’ve had more like a 25-minute appointment.  I hear that this is not usual, but it has been the norm for me thus far, perhaps precisely because I’m not there all the time– I’m having more than just brief followup appointments.  So I have a little bit of hope, but again, as the provider crunch gets worse, that hope is likely to evaporate.

(Appointments with me as the doctor, in contrast, are still normally scheduled for an hour or more.  My patients who have gone to community acupuncture or to other colleagues who see multiple patients in an hour tell me that they appreciate the difference.  I find trying to treat more than one person at a time very stressful, in addition to feeling that I can’t be as effective, and I have no intention of doing that on a regular basis, but the squeeze on insurance reimbursement may force me to change my ways eventually.  I hope not.)

Now let’s think about what actually happens during that 10, 15, or possibly 25 minutes.  What are primary care physicians for, and do they fulfill that purpose?  One of the main things they do is to prescribe and authorize refills of medications.  In the case of chronic illnesses, they should be able to help the patient maintain well and deal with any changes in their condition that come up.  Well, last week one of my patients, who has been taking Synthroid for decades since she had thyroid surgery, went to see her new PCP, who had been forced upon her by the issue I mentioned above, Presbyterian ending its relationship with the UNM system.  Her last PCP had reduced her dosage, and she had done extremely poorly until she figured out the problem– herself– and started taking the higher dose again.  She explained all this to the new guy, but he flat-out refused to consider prescribing the dose she needs.  Total failure both at paying attention to the patient and at delivering the treatment.  Especially at paying attention!  I wish I could say this was unusual, but it’s what I hear from patients over and over and over, and it seems most common with regard to thyroid issues.*  In this case, there was an out– I sent the patient to a colleague of mine who specializes in endocrinology and can prescribe natural thyroid extract.  Not everyone has such an alternative, and many patients go without effective treatment.

The other main thing a PCP is “for” is to be on the lookout for problems and do something about them before they get worse.  Often they really shine in that role.  A few weeks ago we got my mother’s PCP appointment moved up because she was getting markedly weaker and often short of breath.  The PCP (Ann Jones, MD, about whom I have few complaints) didn’t like the way my mom looked either, and sent her for extensive testing at the ER space across the parking lot.  They didn’t find much, but my mom came home– after an exhausting 9 hours– with a clear diagnosis and a prescription that has been noticeably helpful.  That’s more or less how things should work.**

On the other hand, a patient who has recently entered the Medicare age group went for her first ACA-mandated Medicare yearly wellness checkup around the same time.  This lady has had a chronic cough and severe fatigue for months, following a period of extreme stress, and although she’s improving, no clear cause has been found and the problem has been hard to treat.  The idea of these yearly exams for Medicare is supposed to be to give the patient a thorough going-over so that any problems will be found and dealt with appropriately, keeping them from getting worse and causing more cost and suffering.  My patient reported that the appointment lasted less than 10 minutes, she barely had the opportunity to ask any questions, her main complaint was not really addressed, and no treatment was suggested.  And this is a very assertive and articulate patient.  So it didn’t seem like the purpose of the exercise was fulfilled at all.

The PCP is often the most accessible and cost-effective person for performing minor, in-office surgeries.  And of course the PCP can order tests, which will either show that there’s no problem or perhaps guide the path to more specialized care.  When I had that health scare back in August, I ended up with Bob’s PCP, Oswaldo Pereira, MD, who had no more idea what was going on than I did, but could send me for further testing.  We ruled out a number of possibilities, and that was helpful and quite necessary; I needed to know that I didn’t have a cardiac issue, for example.  However, Dr. Pereira never came up with either a diagnosis or a treatment.  Since we couldn’t find anything dire, and since I was gradually getting better, we both dropped the matter.

I had the most significant improvement with a structural approach, under the care of my friend Christine Dombroski, PT.  Dr. Pereira, thoughtful and knowledgeable as he is, would never have thought to send me there, and didn’t really understand why this helped.  It’s just not part of the way MDs are usually trained.

I love the PCPs of the world and feel sympathetic toward them, but the more I consider all this, the more I think our typical use of them is a bit misguided.  I’d like to end with some fairly obvious statements about when to head for your PCP’s office, and how to use that system appropriately.  First, please do not see the PCP when you have a cold!  You will accomplish nothing except to waste time and money, tire yourself out when you need to rest, and spread viruses around the office.  Even a run-of-the mill case of flu is not a good reason to go to the PCP, unless you have an underlying condition that makes it more dangerous; all they can do is give you Tamiflu, which works poorly if at all, and tell you to rest and drink fluids, which you already know.  (Do feel free to see me or my colleagues, as we can actually treat you!)

Do head for urgent care or the ER if you have severe unexplained pain, trouble breathing, or other scary symptoms that are not resolving in a reasonable way at home.  And of course if you are having any signs of a possible heart attack or stroke (I should write another post on those), you should call 911 as soon as you can reach the phone.

 

*It doesn’t have to be that way.  Both my last PCP and my OB-GYN tend to dose thyroid replacement on the basis of symptoms rather than strictly by blood test results.  They are not unique, fortunately, just not the rule. 

**Update, later in the day:  This morning my mother saw Dr. Jones again, and she is leaving most medication issues up to the specialists.  So I ask again, what is the PCP for?  It’s not easy for 89-year-olds to get to appointment after appointment, nor for their families to get them there.

 

As I was writing this, I came across a great Medscape article by a doctor who has a vision of what a true health care system could be like.  You may have to sign up with Medscape to read it, but if you have any interest in medical matters, it’s well worth it.
http://www.medscape.com/viewarticle/819947?nlid=46863_1521&src=wnl_edit_medp_wir&uac=167278MR&spon=17

Here the author imagines an idealized school health teacher:
‘”She sat down with all of the physical-education, biology, and health-education teachers in her system, and together they outlined a plan to change the curriculum such that health education starts in kindergarten. In their system, by the time children reach the 12th grade, they know which side hurts when their appendix is about to rupture. They know the warning signs of a heart attack. They know when to start screening for colon cancer, and they know when it’s appropriate to access the doctor’s office, the urgent-care clinic, or the ER. They understand the basic dangers and positives of over-the-counter medications. In other words, by the time someone puts a high school diploma in their hands, they are as well equipped to take care of their bodies as they are to find their favorite iPhone app.

“They understand the difference between a carbohydrate and a fat and which foods fuel their systems to fight cancer, heart attack, and stroke. They are not going to be obese because they know to exercise at least 150 minutes per week. Mrs J’s students are going to cost us less and live longer. They will live better with more money in their pockets, because they won’t have to buy a laundry list of prescription medications every year until they die prematurely from a preventable illness.’

And here’s her imaginary doctor who figured out a fix for electronic health records:  ‘Then, there’s Dr P [for practical]. Although we acknowledge the necessity of electronic health records [EHR], our earliest efforts have failed the patient. A doctor’s daily work has ground down to a snail’s pace. Patients complain about the basic lack of eye contact during an office visit because the doctor is focused on a screen. Dr P revolted against that practice. He designed a system where there are shorter updates at each visit and there is a symptom-limited entry into each subsequent visit. You don’t have to go through 900 reviews of systems that have nothing to do with why this particular patient has come to see you. He does only a positive review of systems. He took the time away from his EHR and gave it back to his patients, and his patients are more satisfied and better taken care of because of it.’

All this could happen.  There’s no reason why it couldn’t.

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