A Spoonful of Sugar Makes the Diagnosis Go Down…

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The doctor came in and announced in front of the entire family, including numerous small children, that the patient had about six months to live. That patient was my uncle, who did die of lung cancer, but I have, since that moment, had a complete and utter distaste for that medical organization, and this was almost 30 years ago.

Gone are the days of the sympathetic bedside manner of the graceful country doctor. LONG gone. In its place are giant healthcare factories, some just a traffic lane short of a “drive-thru” window. Take a number, unless your bleeding is messing up the floor. I was actually told once, in the middle of an obstetrics exam, that I could dress and go down to the pharmacy, buy the device, come back upstairs, and they would place it. I felt like I was in a Pep Boys auto parts store, and Manny, Moe, and Jack were wearing white coats.

Recently I developed an unusual redness in my left eye, but didn’t think too much about it. Seasonal allergies, or a “cold in my eye” as I had heard once was possible. I awoke one morning to an extremely inflamed conjunctiva (the while part) and fear drove me to the Urgent Care while on vacation. The doctor there guessed a bacterial infection, gave me, and it seems everyone in the exam beds around me, an oral steroid. I’m not kidding – the kid on my left was hacking; steroid. The guy on my right had a rash; steriod. I was also given a prescription for some eye drops, and sent on my way.

A day later the inflammation was back, along with pain. Another optometrist visit decided that I was having a rather common reaction to the preservative IN almost every eye drop known to man! I was given another prescription for, you guessed it, a steroid drop. (I should be HUGE right now.) Yet the next morning I noticed on the box that that same preservative was in even this drop! The excruciating pain had convinced me there was something actually in my eye, though a second visit to the same doctor revealed still nothing. “Give it some time,” was the suggestion.

Well, my father, who had just been treated for sarcoidosis- a body response to foreign particles in the tissue- in the eye, went behind my back and made an appointment with his specialist. What I heard there was about the last thing I was expecting: possible benign tumor. In my eye?! The tear duct, actually, but he wouldn’t know unless he cut my eye open and we biopsied it. Fortunately, my trip was coming to an end, so the plan was to follow up with my eye doctor back in Colorado, and just continue to deal with one extremely red eye with the steroid drops.

Upon my return, my home-doctor studied the eye, and then leaned back in his chair in what I can only describe as “the lawyer pose” (Fingers laced on top of and behind the head) I had seen my dad do so often when things didn’t look good and he was devising a plan. He suggested another specialist and a biopsy. He called while I was at work from his personal cell phone later that night, asking me to call him the minute I got the message. Let me tell you, if that doesn’t scare you, nothing will. Although he assured me he wasn’t calling to scare me, his haste spoke volumes.

The sixth visit in less than two weeks, another pupil dilation, and the specialist leaned back in his chair and said he just didn’t “feel” this was something that needed to be biopsied yet. I was both relieved and exasperated as if this doesn’t work, then we start all over again?

So this is an exceedingly long story to get to this: how did we get from “infection” to “tumor” in a span of three days? Is this just to cover all possibilities so there isn’t a lawsuit? And if so, this isn’t the way to practice medicine when a patient’s mind is the most important thing in the entire healing process. And most patients will jump to the most terrible conclusions on their own, thank you very much. Those who do their Internet research are probably a doctor’s nightmare as absolute worst-case scenarios turn up every time. But to needlessly scare patients to cover your own behind CAN’T be doing anyone any good, mentally or physically.

I know that doctors in some institutions are practically timed with patients these days. Three or four minutes per patient, gotta go, bye. Like a quickie hair-cut, if one goes over their time limit, there is a whole new pricing put into place. I also know that doctors are less likely to misdiagnose a patient they know a little better. And a patient who actually knows and likes their doctor is more likely to follow care directives. A study was done where doctor were given a sheet on a patient to interpret their symptoms and provide diagnosis. When the simple act of placing a patient’s picture along with their sheet was put into place, the number of misdiagnosis declined. Ultimately, isn’t that what healthcare (not the Big Drug business) should entail? Healthier patients? Less time in the hospitals? Less paperwork to submit to insurance companies?

Let’s put the human back into healthcare. Heck, let’s start calling it HUMAN care instead. If a doctor had simply asked me first, “What conclusions have you already jumped to?” and then assuaged my fears, a whole lot of heartache could have been avoided. “Medicine is not an exact science,” someone once said. Ain’t that the truth.

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Coupon Clipped!

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I am one of those people who can happily clip coupons for an hour, then leave them in my car or at home, along with my reusable grocery bags. I really would like to save money, but somehow the effort put into collecting the coupons is trumped by my haste to get the shopping finished.

So when I do remember the coupons, I find it extremely annoying that there are limitations in the fine print on said coupons. And it is almost always on the specific items I would like to purchase. The first time this happened, I intended to buy a make-up item, but naturally the brand I wanted was listed in the fine print as being among those where the discount did not apply.

The second time a nice coupon from being a member of some loyalty program came along, that same thing happened. I went to purchase the item, happy that I was getting a 50% break on the marked-up price, only to find out that said item was not included in the discount. “That just figures,” I snapped. I felt as though I had been duped again, lured into the store with what appeared to be something great, and then leaving angry.

Retailers, listen up! Either offer a coupon that applies to EVERYTHING. or do not offer one at all! Consumers join your loyalty programs left and right, only to discover that their savings are extremely limited, or their VIP coupons do not work on everything they wish to purchase. Lord knows you’ve already jacked up the prices to cover untold costs and still ensure a profit, so why limit what is supposed to be a reward? And you restaurants? Ditch the “buy one/get one half off as long as you buy two drinks” deal too! Every consumer out there knows your soda fountain syrups only cost the restaurant pennies! Why continue ensuring profits but losing customers this way?

Remember the rule: it costs you seven times more money to land a new customer than it does to keep a happy and returning customer.

Businesses simply need to stop toying with coupons and discounts to ensure they actually stay in business. And isn’t that what a business dreams of in this unstable economy? The next time you are about to offer a coupon, make sure it is genuine and all-inclusive, and then sit back and watch your customer base grow.

The Miss/Mrs./Ms. Debate Researched

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It has always driven me wild when a married woman signed her name on correspondence as “Ms.”. All my daughter’s female teachers did this, and even my name-badge was printed “Ms.” when I clearly indicated I was a “Mrs.” I had to get this annoyance off my chest, so I naturally turned to Facebook to vent. Little did I know this post regarding the use of the title Miss/Mrs./Ms. would spark such a debate. I had stated, “One more time, from the top: when one does not know the marital status of a female, use ‘Miss’. ‘Ms.’ is for a woman who is no longer married. The ‘Mr.’ is gone. Get it?”

I received an earful from friends and others about this, from “I did not know this. Interesting….” to a lengthy post stating very politely, “I appreciate what you are saying but I disagree. Mrs. does refer to married and Miss can refer to single woman. Any woman, according to 1978 edition of, Amy Vanderbilt’s Complete Book of Etiquette states that a woman regardless of marital status can elect to use Ms. rather than Mrs. or Miss.

Because I was now curious when this title evolution took place, a little research was merited. I first stopped by the website www.ecenglish.com, but quickly noticed no one had remarked on it since 2009. Still, the same question was there; when to use Miss/Mrs.//Ms. A few of the comments confirmed my Facebook post thoughts, and a few were more along the lines of Amy Vanderbilt’s rules.

My second stop was an English language learning website, www.eslcafe.com. If you don’t think English is the most difficult language on the planet to learn, what with all of our homonyms and rule-breaking “i before e except for weird” exceptions, please let me know. (Having now taught it for 15 years I couldn’t explain some of these things if my life depended on it.) Author Dan Oliver stated Ms. should be used neutrally like Mr. is for males both married and unmarried.

Ms. is used for three occasions, he continues, those being for a woman in a position of authority, like a teacher; if one does not know the woman’s marital status; or if the woman is the addressee’s age or older. Tell me that isn’t going to get someone in trouble trying to guess!

It is a matter of choice when it comes to a divorced woman still using her ex’s last name. She can still be Mrs. What-Was-I-Thinking? if she wants to be. Mrs. can also be used by widows. My head was starting to spin, and I was born here!

For years I have taught a book in my English classes where a much older woman, a teacher, went by Miss. When the father, talking to the son about the problem with her, addresses her as Mrs., he is corrected by the son stating “It’s Miss.” The father snidely replies, “That figures.” The meaning is clear – no one had ever asked her to get married because she was so nasty.

Since the writing of that book, though, the feminist movement has declared that Ms. can be used for any mature woman’s title. The website www.womeninbusiness.about.com goes into a discussion about the former use of the word mistress when it was still the feminine version of mister and not something tawdry. Definitely one of the English language’s smarter moves. Author Lakle Wolfe concurred that the word has been compressed to Ms. for married or unmarried women.

The only thing that is clear is Miss and Mr. can easily stand on their own if when addressing someone and one does not know his or her last name. For example, “Excuse me, Miss?” “Hey, Mr.?”

So I stand corrected, but I still don’t like it. Fortunately, with our hasty speech these days, the address is likely to come out “Mizz” anyway. Either way, etiquette fans, you’ll be safe.

It Takes A Village… But the Village Doesn’t Want to Get Involved

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I am not a parenting expert. An etiquette expert, yes, but not a parenting expert. Then again, is ANY parent, besides the Duggars, a parenting expert? I didn’t think so. There is no other employment one could have that provides constant on-the-job training that still does not make the person in the position an expert.
Really, all we know about parenting for certain is what NOT to do. Don’t hit, don’t forget to feed them, don’t leave young kids alone… Even then there are more questions; does spanking count? What if you only feed your kid fast food day in and day out? What age is okay to leave a child on his or her own? *sigh* It is never-ending, and no matter what you do, there will be someone, somewhere, ready to tell you that you are doing it wrong. But sometimes someone should be ready to step in and tell another someone they are doing it wrong.
On a recent trip, my family ended up in an airport food court, waiting in line for, I’ll admit, fast food. A young woman was loudly berating her very small daughter, and the lines of people around her stood silent. “If you don’t knock that off, I’ll beat your butt right here in front of everyone,” she barked. As far as I could see, the little girl was doing nothing wrong, save existing in this, I hesitate to say “lady’s”, world. The volume and tone of her voice seemed to be expecting the people around her to approve of her being a tough parent and putting a four year old in her place.
Every fiber of my being wanted to speak up, but I, like the rest of the people around this depressing scene, was afraid of the stability of this young mother. The little girl looked soulless, empty, and too familiar with this type of proceeding. If I stepped in and said, “I know travel is frustrating, but this little girl doesn’t deserve this kind of treatment”, would the woman go off on me? Would she have a weapon? Would a miracle happen and she would thank me for pointing out the error of her ways? What if I stepped in and the woman snapped and said, “Fine, you take her,” and left? Then what? That little girl couldn’t be any worse off.
Clearly, everyone hearing this was thinking all the same thoughts. It is nothing to be proud of, but all of us chose to avoid involvement.
Malcom Gladwell writes of this very same phenomenon in his book Blink. A crowd of people assumes someone else will step in and therefore individuals do not step up.
The woman retrieved her food and stomped off, the forlorn little girl following in her dark wake. The crowd relaxed and went about their business. I felt ashamed, said a prayer for the little girl, and let the scene haunt my memory. What will I do differently next time? Because there will be a next time, sadly. Do I do like the public safety ad where a woman approaches another mom in the parking lot during a meltdown and asks, “Can I help?” Yes. It is disarming enough of a question that it is truly the best way to do something. I vow to do this as it is practicing what I preach; that when you make someone aware that others are aware, there is more likely to be resolution.
Other ideas to stop an out-of-control parent are welcomed. In the meantime, I have come up with a few, from the over-the-top, “You ought to be ashamed of yourself, talking to a child like that!” to a variation of the PSA; “You appear to be really frustrated. What can I do to help?”
I vow to do better, as should everyone who is afraid to get involved. Though I am desperately hoping not to have to practice, I will say something if there is a next time. Stay tuned.

Courtesy in Medicine? “Inconceivable!”

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So I had an accident yesterday. A fall, actually. It was my own fault; I should not have been standing on the dresser to dust the top of the mirror. My “ladder” was the footboard of the bed, and the rest is history. As you can imagine, I ended up getting pretty badly hurt. X-rays were taken of my hip and wrist, but thank goodness nothing is broken. Well, mostly my pride as I have some great scrapes on my face and a hole in my lip.

My timing was pretty good as there is a new medical office in my neighborhood and I was able to visit them two times this week. (The first time was for record-breaking hay fever.) The best part was the personal care. Really. Eye contact. Genuine concern. Giving names first. Infused “spa water” in the reception area. Even the administrative assistant pronounced my name correctly.

What I can’t express enough was the joy I was feeling, banged-up as I was, after experiencing big-box medical care for the last two years. Seriously, the giant, not-to-be-named-ever-again-in-my-presence healthcare facility felt like that scene Beetlejuice when the main character goes in to get some case-work forms filled out. Take a number, we’ll get to you, stand behind that line, take a place between the lower portion of the sawn-in-half woman and the witch-doctor.

This is what worries me: healthcare is becoming more and more complicated. There doesn’t seem to be any way to get around that. The human touch that is so important in the healing process will be lost in the parade of cases seen day in and day out. Human beings, especially Americans, are growing too adept at compartmentalizing their empathy for their fellow beings, and what happens from there is the very real tendency to overlook conditions. There have been studies done proving that doctors, when presented with a plain file on a patient, rushed and misdiagnosed described symptoms. However, when the patient’s picture was attached to the file, the amount of misdiagnoses declined.

Remember the business adage, “People will only do business with people they know, like, and trust.” Your body is your business, so you want people you know, like, and trust handling it. This is where the relationship-building all business people are taught comes in, and doctors need to pay attention. Patients are people at their most vulnerable and that trust factor has to be present. Why medical professionals, for the most part, cannot grasp this concept is beyond me. Stop being “owned” by the drug companies, and start listening more to your heart. I mean, that is why you became a doctor in the first place, right? You wanted to help people, not help patients. And the bonus is these people will be better patients if they know you truly care.

Oops! That may empty the hospitals if people start taking better care of themselves, which may lower healthcare costs, but isn’t that what we want? (For more on “Putting the ‘Human’ Back in ‘Human Resources'”(TM), go to www.courtesybootcamp.com.)

It seems when we relate to one another as nonhuman, put some label on them, that’s when the problems occur. The incidents of malpractice, the school shootings, the road rage, the crimes against innocent people just going about their business. Apathy for our fellow man has grown exponentially as we withdraw into our own selves to avoid getting too involved with each other. But ironically we check in on Facebook and 90 times today to see what other people are doing. Studies prove, though, that we do this to compare our lives to theirs, and then start feeling bad about ourselves for not living as excitingly as other people do. (As if everything that can be read online is true.)

There is good news, and that is that we were all born with empathy. We just lose it somewhere along the way in the name of being “professional”. The prescription then is to start practicing it more. Wave to people. Look each other in the eyes. Acknowledge that person on the sidewalk approaching you. Pick up litter that is blowing around just to feel better about yourself. There is a reason that good news websites are so appealing; people are looking for the good in the world, and there is nothing, absolutely nothing, stopping you from being it.

Now according to doctor’s orders, and because I like her and want to be a good patient, I have to get back to icing my bumps and bruises.

 

Since Public Education is Being Privatized Whether I Like it or Not….

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It’s happening all over the country – public education is getting privatized. There is no use fighting it anymore, I guess. Teachers are nearly voiceless, their unions are almost powerless, and everyone from government to big industry thinks this is the way to go. Kids behave like widgets, don’t you know. They will robotically perform on big money-backed tests, and meet and exceed state expectations without fail, showing perfect growth curves every single time. It’s going to be great.

As I pondered this now-for-profit turn in education while out walking, I happened to spot the infamous green straw on the ground. Everyone knows where it came from – no other company has cornered the market on green straws like this one has. An idea struck me since teachers are going to be “fined” in the salary department for their students not performing as expected; why not fine the big money corporations for their consumers also failing to meet expectations? I mean clearly the consumer of this most likely caffeinated beverage was not performing as expected. This consumer was expected to happily consume the beverage, and when finished throw the straw in the trash. He or she instead carelessly threw his or her straw on the ground. What if the company behind the green straw was fined thousands of dollars for the carelessness of its consumers? This sounds only fair to me, a teacher, who more often than not can’t get her “consumers” to perform perfectly on state- and government-mandated tests.

Let’s go a few steps further. Let’s start fining real estate agents when the houses they are showing do not pass inspection when an unforeseen mold problem appears, or the foundation cracks. Let’s fine doctors when their patients do not take the medicine they are supposed to be taking and they don’t heal. How about mechanics when they don’t get our cars fixed properly the first time we bring it in? What about clothing retailers when our clothes don’t fit? (Wait- never mind; we are already suing fast food places for making us fat.)

How about fining the fitness studios when we stop showing up to exercise? I am not getting any thinner, so it must be their fault. What about fining libraries when people fail to read the book they checked out? How about fining movie theaters when we don’t enjoy a movie? What about fining an amusement park when we didn’t have a good time? How about fining the musicians because we don’t like their music?

We could fine the garbage collectors because it was kind of stinky when their trucks drove by. We could fine pet stores and animal shelters every time our pets threw up on our carpets. How about fining cities because we didn’t have fun at their events? How about fining newspaper companies when we fail to open up the newspaper and read it?

If you are starting to figure out that the human (or animal) end of the consumer chain is where things break down, good for you. I only wish governments could figure this one out when it comes to the very real, very human nature of education. It never has been, nor will it ever be, a fail-safe enterprise where kids perform consistently. There are far too many factors to list that make students, and, ultimately, people, the wildly unpredictable, flesh-and-blood free-will creatures that they are. And all too often they throw their straws on the ground.

Service People, We Are at Your Mercy!

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I’m sitting here trapped in the “Two-hour Window”. It feels more like a window-well too deep for me to escape. I know this is a far cry from the six hour windows we used to suffer, but two hours these days feels like an eternity. Think of all the things we COULD be doing!! Checking email! Returning calls! Mailing stuff! Writing a blog! Wait… I’m doing that.

I await a new energy-efficient washer/dryer set. The fact that I am rather excited about this would lead to a blog post of a more psychological nature, but what I’d rather address is service people. I recently had a nine-foot sliding glass door installed, and naturally that day the temperatures dipped and snow moved in, much more snow than the weatherman predicted. But faithfully the installers arrived and removed the old door that I had once witnessed actually allowing snowflakes to blow IN to my house. Blessedly, the wind stopped while I had a nine-foot hole in my house, and the new door went in without a hitch. I was so troubled by the adverse conditions in which the men were working I made them hot chocolate. With marshmallows. I think they looked at each other and whispered, “Mom.” That is fine – I’d rather that than have them freeze to death trying to spare me a few bills in energy costs.

A few days later, I received a call from the “home store” asking if I would take a survey regarding the process of the installation. I complimented the gentlemen on their speed, efficiency, and clean-up of the debris, and of course threw in the part about the hot chocolate. The survey conductor laughed like I am sure he had not laughed all day. “Service people enduring a blizzard need to be treated well!” I remarked. I know I wouldn’t be so quick to stand out in temperatures like that.

Which brings me to the point. I have a healthy respect for service people. You should, too. Would YOU do their job? Probably not. Freezing temperatures, broiling heat, wind, rain, traffic, not-so-nice pets, high voltage, gas lines, wild-life, politicians (same thing)… These people endure it all. My brother is a lineman for the electric company in California and he will not even tell me some of the things he has seen because it would cause nightmares. I couldn’t do his job, not in a million years.

I couldn’t do the job of the men (hopefully arriving soon) who are about to take away my old appliances and replace them with new ones weighing a couple of hundred pounds. I fully admit I am not physically capable. I couldn’t hook them up unless I opted to study some YouTube videos or something. I do not possess that kind of knowledge, and I know I am at their mercy for it.

But this is how society works – those who do not possess the know-how are at the mercy of those who do. We have delusions of being self-sufficient, but think back to the last time something broke in your world. Could YOU have fixed it? Probably not. I know I just drive my car. If something goes wrong, I will happily fork over the money to fix it because I can’t do it. Same thing with ANY of the technology I use, even down to my washing machines.

This symbiotic relationship we have with service people who can help us keep our lives on track is a thing of beauty, if you really think about it. They know they make money off of our learned-helplessness; we know we keep them in business by not being self-made Renaissance men and women. We get back to our buzy-ness, and they make a comfortable living.

And so it goes. We call them to fix our broken worlds. We call them at all hours of the day. We call them in all kinds of weather. And they arrive in a two-hour window.