Tag: healthcare woes

Doctor Certificate for Internet Self-Diagnosis
Thanks, Internet! Now I’m a doctor.

Thanks, Internet! Now I’m a doctor.

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So far this year I’ve diagnosed myself with hypothyroidism, magnesium deficiency, muscle wasting, metabolic syndrome, and pyogenic granuloma—just to name a few of the things I’ve been searching the internet for information on.  (Don’t even get me started on the things I am finding wrong with my children!) Googling for internet self-diagnosis can be dangerous in so many ways. A simple symptom can turn quickly into a “terminal diagnosis”, or  can lead to home treatments that aren’t appropriate and can cause more damage. Medical information gleaned from the internet can come from anywhere and anyone, and even if you are an expert to begin with it can be hard to choose the right advice.

Yes, doctors and other providers use internet searches to aid diagnosis. But this happens in conjunction with education and experience, as well as access to professional databases with evidence-based, peer-reviewed research.

People can spend countless hours, as I have, sweating on their couches looking at disturbing tumor photos and reading freak-out forum posts (from other couch doctors) to find out what’s wrong and to attempt at setting the gauge on their worry.

Why are people so attracted to browsing the internet for medical answers in place of visiting or consulting an expert?

“Am I bleeding from my ass or did I just eat too many beets?”—said more people than you would think

What’s wrong with me?

People want instant answers to their nagging questions and may prefer to test the waters of hypochondria from the safety of their own homes.  Discerning what warrants a call, a request for an urgent appointment, or an ER visit can be hard to do on your own.  If you are prone to dramatization it can be easy to feel stupid when calling the doctor in the middle of the night.  I have been told more than once, “Ma’am, this really can wait until your appointment next week.”

Even when you score an appointment you probably have to wait days, weeks, or months.   In an era of instant gratification this can seem like a travesty.  For those who don’t end up coming to the emergency room for everything, including their chapped lips*, a little sleuthing ahead of time can irresistibly lead you down a rabbit hole.

After you have finally seen the provider for 5-15 minutes of their “undivided attention” it may be anticlimactic and you end up with a sense of longing for more information, more direction on what to do, and a realization that no one cares about your health like you do.  Why isn’t anyone else interested in the connection between eating pickles and hair loss?  How has my physical therapist not discovered medical parkour?

Who else has this, and what happened to them?

Humans are social creatures, and the way of the tribe’s medicine woman is pretty much gone.  It has been largely replaced with drive-thru style impersonal cookie cutter medicine (think drop-in urgent care type visits).  We stop in to see someone who probably doesn’t know us very well and receive blanketed advice that has been handed to everyone based on regulatory recommendations and pharmaceutical agendas.

We want to know how the other guy turned out that had similar complaints.  Searching for personal stories and forums can give us audience to the more relatable dramas of others.  We crave that word of mouth advice from people who suffer similarly.  We feel entitled to the secret cures that doctors aren’t taking seriously but people are finding success with.  No one wants to be alone in their struggles, and reaching out into Internetland can abate that loneliness.

What can I do about this right now?

As a society we are impatient.  If it is 1:00 am and we have a rash we want to guess what it is and buy something for it tonight. We desire easy answers and quick solutions we can do at home. I call this “armchair healthcare”, where we would rather complain or pretend like we are making progress while not putting out any real efforts. People skim and choose the remedies that fit their level of motivation, and this gives temporary satisfaction.  It’s part of our conditioning as consumers of healthcare, where special equipment, apps, supplements, and over-the-counter medicinal salves can be purchased 24 hours a day, not interrupting us while we watch YouTube or eat chicken nuggets in our cars.

Should I feel guilty/worried/sorry for myself?

The popular culture pendulum swings between self-blame and victimization, and we’re unsure how we should feel about our ailments.  We want to discern if something is self-inflicted, random, or if we should sue somebody.  The internet helps us decide.  What does this have to do with me and who I am, or who I’ll be?  Maybe it’s all about ME, dammit!

Are there treatments I might have to go through that look painful, expensive, or that result in me being uglier, disfigured, or disabled? I might need to feel guilty about this, so I need to prep.  Either that, or get angry at someone.  Wait, what is the route of transmission? (Maybe I got it from a toilet seat?) Just tell me who I should blame!

Cowgirl's Internet Self-Diagnosis: Dying from secondhand chew
Even cowgirls get the second-hand chew blues

Don’t get me wrong—I do believe the internet is a valuable tool for my health and the health of those around me. It connects us to others, gives us access to helpful information, and lets us find resources quickly. Doing your own research can bolster your knowledge and empower you.  You can find inspiration and ideas and get the honest opinion of 1467 of your closest friends. You may truly be able to captain your wellness ship in ways that were impossible 30 years ago.

However, there is so much information out there that if you read enough you may find contradictory information, your eyes just might glaze over, and you could possibly end up doing your own dental surgery or booking a leeching in a back alley clinic. User beware!

*Chapped lips. This is my favorite ER diagnosis ever.  Someone actually came into a hospital seeking care for this.  Seeing it in writing, up there on the patient information board, made me laugh and was an “aha moment”—people are crazy, and either don’t know how much an ER visit costs, or don’t care.  Maybe he should have googled “chapped lips” first, or called Kip to bring his chapstick to school….

 

Sick day guilt is hard for this sock monkey
The Art of the Sick Day

The Art of the Sick Day

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When I was a much younger and wilder me I used to call in fake sick to work at my retail sales job, claiming a maiming or exaggerating cold symptoms. I wouldn’t do this all the time, but when I needed a day to wallow on my futon, or sneak away on an impromptu road trip, it was an option I considered.

Fast forward 20 years to tonight, when my backup babysitter has awakened me from slumber to call in sick. (The regular babysitter has already been sick for a couple of days.)  I think I have bad sick day karma. This news came after I spent the better part of my waking hours trying to procure staff for the surging census at the hospital. Now I feel like a major jerk having to call in at work, and I know the day will be crappy for those left behind, including the people who kindly agreed to do an extra shift. I have major sick day guilt!

Barbary ape calling in fake sick on his banana phone. No sick day guilt?

Who cares for those who care?

Even though I’m not the one actually ill, I do have to stay and care for my little poopers (aka kids…is it bad to use feces in pet names?). I feel that insane pressure to NOT call in. What will they do without me at work?  I have major sick call guilt!

Why? The American workplace, for the most part, fosters abandonment of self care (or family care) for commitment to the company. We work frequently alongside colleagues who should be home getting better, or at the bedside of a loved one. There can be expectations to show up, sick or not, which actually contributes to more lost days as germs are spread and people don’t take time to fully recover. Worry over missing work further causes stress and illness.

I talked to a friend today that said she couldn’t take time off work to care for a critically ill brother in another state, because her workplace would not grant her the time. The federal Family Medical Leave Act sadly does not consider a sibling to be an immediate family member, so a leave of absence would be “unprotected” and could result in termination of employment. Even when an employer must grant leave because of federal or state protections, it doesn’t mean you can afford it or that you have enough paid leave hours or sick time.

It’s hard to stay home if you need to. I suggest people build safety nets around themselves and their finances to help soften the blow.

Don’t kiss your honey when your nose is runny. You might think it’s funny, but it snot.

Know the rules

  • Familiarize yourself with workplace policies on sick days, and understand what benefits you get, if any, such as paid time off or short term disability.
  • Read up on FMLA and your state’s medical leave laws, which can apply depending on the size of the company you work for. Sometimes intermittent leave can be used for chronic illness of yourself or a dependent.

Have the money to be sick

  • Keep an emergency fund for lost wages and unexpected medical or travel costs.
  • Don’t use up your paid hours for fake sick days at the beach!
  • Consider short term disability insurance to cover lengthy illnesses, injury recovery, or maternity leave.

Don’t get sick

  • Sleep well, eat well, love well and exercise!
  • Take planned time off. Burnout and stress will catch up with you.
  • Wash your damn hands and keep them off your face. Your eyes and nose can be more susceptible to germs than your mouth, so pretend there is a force field around them. Teach yourself to wash your hands properly with this Glo Germ kit. (I used it to train my kids).
  • Take care of your gut. A big part of your immune system resides here so give it props.

Plan for inevitable life emergencies

  • Set up work systems so someone can take over essential functions in your absence. Know who you will delegate to in an emergency.
  • Have alternate child/elder/pet care arrangements as back up.
  • Know what transportation options to take if your car breaks down or weather gets crazy.
  • Choose the right village. Surround yourself with people who support you at home and and at work, and support them too.

Now that my sick call to work has been made I shouldn’t waste my day…or should I?  Technically I’m paying for it, so it’s mine to use on lying in bed, which is what an afflicted person would do: watching tv, eating ramen, and not showering. I have to be careful with my sick day karma, and I wouldn’t want to upset the delicate balance of the universe. Bring on the Netflix!
I Know What it Takes to Be Non-Compliant

I Know What it Takes to Be Non-Compliant

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There is a tumor in my mouth.  It has been there since the end of November, and I have yet to have it biopsied or removed.  There are many factors involved, including:

  • Delay in referral TWICE from my dentist’s office
  • A referral to a provider that’s not accepting my dental AND medical insurance
  • A seemingly lengthy medical review process
  • Limited number of providers who can assist with my problem, creating a scheduling delay

In the meantime my tumor has progressed and what seemed like a simple situation has turned into one where I have tooth bone loss and an uncertain prognosis.  Already I have seen multiple providers and not all of them seem to know what they are talking about.

I happen to work in the healthcare field and know a thing or two about what it takes to get access and follow through with both preventative care and treatment for illness.  I understand the system, have good insurance, and know how to advocate for myself, but yet I feel the pain of trying to use the healthcare system.  There are reasons some people fall through the cracks or don’t do what their providers ask of them.  In healthcare we call these patients “non-compliant”, as in, “Jeff is non-compliant—he hasn’t seen the specialist we referred him to for his abnormal labs.” Or, “Susie hasn’t been taking her asthma inhalers as prescribed and has been non-compliant with the treatment plan.”  Yes, there is judgement involved.

As a nurse it is hard to always objectively see the obstacles to a perfect treatment trajectory.  Once we recommend something to a patient we like to sit and wait for them to do their part, to see the next specialist, take the next medicine, get the next test done.  We like to think we can only lead the horse to water, and can only reasonably convince so many horses under our care at once to drink with the resources we have.

But when I am on the other side of the exam table I get it—I really do know from experience—as a mother and a patient what those obstacles to healthcare are.  In order to improve health we have to have access to people and tools to help us, follow through on testing and interventions, and maintain new habits and routines.  The stars must align in the following ways:

Access

  • Provider Availability
    • Proper providers accepting new patients
    • Specialist referrals happen when needed
  • Affordability
    • Able to pay insurance premiums, deductibles, copays, coinsurance
    • Straightforward billing and payment options
  • Convenience
    • Location
    • Reasonable waiting periods for appointments
    • Appointment time slots available (minimizing lost time at work or school)

Follow Through

  • Open communication between provider and patient
  • Thorough education provided on what is happening and what to do next
  • Continuity in providers
  • Trust and rapport in the care relationship
  • Motivation of the individual—seeing value in therapies

 Maintenance

  • Incorporating new habits and routines
  • Long term monitoring for chronic or high-risk problems
    • Appointment reminders
    • Care coordination between providers, specialists, and therapists

 

When things go right there is a balance of “providing” (done by practitioners) and personal responsibility (of the patient and their caregivers). There is a dance of expectations by both parties, and many times those expectations are not met.  Sometimes it is the nature of the system that creates trouble, especially when it comes to access, but there are ways to help ensure you are getting what you need.

See the best providers available

Get recommendations from friends or screen online reviews. Don’t be afraid to ask for special permission if you are told that a provider isn’t taking new patients.  They may make an exception if you are related to or know a current patient. Find a different provider if you aren’t meshing well with the current one.  If you have a rare or hard-to-manage issue try to find someone who has experience with it.  Use your insurance company as a starting point to find providers in your area who fit your needs.

Understand the workings of your health insurance

What is covered and at what rate? Who do you call if you have questions?  Insurance companies can actually be very helpful in preventing costly mistakes—mine once helped me clear a $1400 charge that a hospital was wrongly trying to collect from me.  Sometimes insurance companies make mistakes too, and if you know your coverage specifics you can argue or appeal items not paid.

Contact billing if you are having trouble paying

Payment plans can keep you out of collections. Providers can end their relationship with you for non-payment, and if you aren’t hiding from your bills you will be more likely to follow through with appointments and tests.  Don’t forget to ask for itemized bills to ensure accuracy.

Maintain the care conversation

Call and call again if you have to. Ask for what you want and be open to negotiating.  Let someone know if you don’t understand or need more information.  Be honest with your providers and expect the same from them.

Keep your promises

To yourself and to others. Do your best to attend recommended appointments and tests.  Take responsibility for your health and the things you can directly control.

Don’t give up even if it seems near impossible to have health care without obstacles and glitches.  I anxiously await my appointment with the oral surgeon for my tumor. And I’m sure this won’t be the last point in a chain of custody for my health that will bounce back and forth between the sides of the medical court, me on one side and “the system” on the other.  (But wait…I’m part of the system.  Does this mean I am playing against myself?  Too deep for me today.)

Peer Into the Kaleidoscope