health care

Today, I was reading another physician blog, http://acountrydoctorwrites.wordpress.com/, in between seeing patients (my charts were calling but I ignored them for the moment). One of his recent stories was entitled, "Choices in Swedish Health Care." In it, he discusses the socialized system of medicine in Sweden, a system somewhat similar to other socialized ones. This topic has been on my mind lately, especially with the election looming in November. Perhaps I shouldn't use the word "looming," but I am very concerned that a president will be elected who has not even mentioned the word health care.





I spent one month working at a pediatric clinic/hospital in New Zealand in 2004, another country where everyone has basic health care. It is also somewhat tiered, in that there are some options for faster care through a private-payer system. One of the big problems there, as in Sweden, was waits. There is, however, a fairly strong medical tourism trade with Australia, especially for people needing radiation therapy for cancer; people who can afford to live temporarily in Australia are able to start their therapy more quickly. At the time I was there, these waits were being addressed by the government, so hopefully, things have improved.





However, as we all know in the US, many people go without health care due to lack of health insurance. And, even those with insurance risk bankruptcy with a diagnosis of cancer, or a chronic health problem. We spend the most on health care of any first-world country, yet we have the poorest outcomes. What gives? Is that our technology is so advanced that we try to save those who likely would die in other countries? Is that our fees in health care are completely out-of-line with the rest of the world that we are just simply paying/charging too much? Is it the fault of the drug companies who make enormous profits are drugs that cost too much? I suspect it's a combination of all these and other factors.



The bottom line, for me, is that if we, as a country, feel that health care is a right and not a privilege, we need to be willing to make sacrifices, to change how we as doctors are paid, and to change how we as consumers define health care.

change is in the air

I love this time of year. The sunlight is already beginning to have a fall quality to it, the air smells fresher, and the nights are cooler. Change is definitely in the air!

When I first started this blog, I had plans to start a new job this coming winter, however, due to circumstances largely outside of my control, I will be continuing to practice here for a while. As you may know from reading my previous blogs, I do primarily outpatient care; our local hospital is ill-equipped for inpatient pediatric care. I worked hard as a resident to learn hospital medicine, and I'm afraid I'll lose those skills. So, I've decided to do some prn work as a hospitalist in Albuquerque. I am very excited about this, which is a little surprising to me, since I was very happy to leave the hospital as a resident. However, now that I've been away from that environment for some time, I really miss it! I had an interview last week, and it just brought this fact home to me. I like the challenge of these patients, I love the newborns, and it will be enjoyable to be around other pediatricians and pediatric support staff for a change. I think I'll learn a lot, I will refresh my skills, and I'll bring a unique perspective to the group, coming from a rural setting. I'm ready for this change/challenge.

olympics

I have to admit, I've spent a fair bit of my free time watching the Olympics during the last couple of weeks. I love to watch and dream of being in the shoes of the athletes, pushing myself to get another gold medal. If only I had been a better swimmer or fencer or soccer player, I could just have been there!! Or not!! But I do feel like a kid again when I watch the games. And when I can myself out of bed in the morning to go for a swim before work, I imagine I'm competing, until I notice that I'm the only one in the pool and that I'm not exactly breaking any records. It's still fun though to think there are serious athletes who enjoy doing what I'm doing.


Doing my sprint triathlon a few weeks ago, it was pretty neat knowing that I was doing a miniature version of what an elite group of Olympians was doing on the same day. I was also frustrated when my time was slow...I should be faster, better than this, I thought, yet I didn't exactly train religiously! But, like the athletes, I too have spent some time training heavily to do what I do, and, to do it well, I continue to train reading journals, etc. I also enjoy participating in activities outside of work/training, like spending time with my husband, cooking, reading, traveling, and working out as I continue with my medal dreams! So here's a salute to all the regular working people who compete in their own Olympics every day, walking the balance beam of work and family, running 10000m of errands after work, doing a triathlon at work of seeing patients, completing administrative duties, and completing paperwork, etc...it's a silly analogy, but true if you really start to think about it! Now, if I could just get a set of abs like they all seem to have!!

kids with autism

Last week, I read an interesting article in the newspaper about a family with a child with autism who was asked to stay away from their local church's services. There were a variety of opinions expressed by parents of children with autism regarding this event. Some parents felt that this kind of behavior on the part of the church was discrimination, and particularly galling because of where it was coming from; some felt that it was irresponsible of the family to take their child into a setting which is known to be challenging.

I spent a summer working at a camp for people of all ages and abilities with autism. I also worked in a group home for five men with autism and did some research on the topic. Having experienced the enormous range of abilities or disabilities, I was wondering what I would have done in the above situation. My gut reaction would be to find a church that had a service that was perhaps adapted to my child, and such a church was mentioned. I think I would be hurt that my family was rejected. Then again, some of the behaviors associated with autism can be very challenging to handle in public. And, they are not always predictable. I remember very clearly on a Saturday taking one of the group home residents to see a children's movie, an activity he loved and had worked hard to earn. When we got to the theater, there was a line to buy tickets, and my friend/charge absolutely went ballistic, throwing himself on the ground in the parking lot, swearing (fortunately he was very difficult for most people to understand!), and kicking. This was completely unexpected. I was able to calm him down eventually, get him to come with me to the car, and we came up with another outing where an outburst would not be quite so embarrassing. However, he was allowed to earn another outing to a movie and did quite well. All of us at the group home would have been very sad to take this activity away from him.

I loved my time working with this challenging population of people, and I still enjoy the children with autism that I have in my practice. But I have to admit that it is one of the most difficult diagnoses to deal with as a physician, as an early interventionist, as a caregiver, and I'm sure as a parent.

border medicine

A few weeks ago, I had a new patient in my office for a routine sick visit. I heard a significant murmur that was worrisome to me. When I questioned her mother about it, if it had ever been evaluated before, she said she knew nothing of a murmur in her daughter. The rest of her exam was normal, except that she was a bit small for her age, but both her parents are somewhat short. After doing a chest xray and ECG, I decided to send her to see a pediatric cardiologist for further evaluation. No problem, I thought, since UNM conducts an outreach clinic only 75 miles south of here once or twice a month. I was all set to have this appointment made, when I remembered that I needed to ask the family if they could travel south. You see, there is a border patrol check point between my office and Las Cruces. I don't keep track of which of my patients and/or families are here illegally, but at times like this, I have to be careful. Needless to say, this family did not want to travel south; they would rather travel twice the distance north to avoid the check point. Unfortunately, that isn't always safe either as there is a border patrol station north of as well, although it is only open on rare occasions. Happily, on this occasion, they were able to drive to Albuquerque and back without incident.

What a situation for this family to be in!! Both parents work, and their children go to school and do well in their classes; they are contributing members of society and the economy. But they live in constant fear of being deported and separated from their children who are all legal citizens. Yet, the parents did enter the country illegally, breaking the law. And so, some might say, they deserve to live like this, constantly watching their backs. I have very mixed feelings about the whole immigration issue, and, living here, it is something that is frequently on my mind. There isn't an easy, pretty solution. We rely heavily on this population for the work that they do. Mexico relies on the enormous amounts of money these workers send back home. Our economies are intertwined beyond repair. Will building a wall from California to Texas fix the problem? Doubtful. Do we offer citizenship to all immigrants who have already come here and are working? Not likely to happen. Maybe the official guest worker program that Bush suggested would work, although it too is very complicated, expensive, and unlikely to be adhered to. I really don't know. I do know that Mexico is an incredible country with many natural resources, a strong tourism industry, and a strong textile industry. Perhaps Mexico will continue to try to clean up it's house so that it is a more desirable place for it's citizens to live, so that they will not be willing to undertake the incredible risk and often the incredible financial cost to cross their northern border seeking a better life. We don't see Canadians crossing illegally, do we?

dental care

I have to brag today. I work in a remote area with few healthcare providers. BUT, we have a dental clinic associated with my clinic with two full-time dentists, two hygienists, and a few dental assistants. Because we are a federally-funded community health center, we accept all insurances, all medicaid plans, and we have a sliding fee scale for those without insurance. In addition, our dentists here can refer children to a pediatric dentist 75 miles south for care.

The other day (actually more like a month ago), I had a little girl come in to see me with poor weight gain, decreased appetite, and overall grumpiness. She had indeed gained very little weight in the past year, and I couldn't argue with the mother about the grouchiness! I did a full exam, and the only thing I found was obvious dental caries. On further questioning, she did complain of pain with eating sweets and cold foods. I called the dental clinic, and they worked her in immediately. Two weeks ago, she had dental surgery under anesthesia. I saw her on Monday, and not only had she already gained weight, but she was so happy. Needless to say, her mother was thrilled. And she immediately took the bottle away from the fourteen month old who was still drinking milk at night from it; I had been begging her to do this for months, but to no avail. What a relief! I really feel like I made a difference to one little girl and to her little sister!!

a first for me

I just finished my first triathlon! Hooray! It was a sprint triathlon, but, nonetheless, I did it. I'm proud of myself because I'm not an earlier riser, and I had to train for this before work because of heat and monsoon rains in the afternoon. Not only was it fun, in a painful sort of a way, but I had the chance to talk to some interesting people. The lady in front of me for the swim and also at my bike rack was a 63 year old woman who appeared to be in excellent shape. All I know is she finished before me, as I saw her back multiple times...There was also a kids triathlon before the adult event, which was a blast to watch. Oh, the race faces they put on, so intense and focused, I would have loved to take any one of those little athletes home with me. I may see if we can arrange for one of those around here next summer to give the kids a goal to work towards; I know that helps motivate me.
Anyway, I'm pretty tired, and I think I'm still a bit dehydrated, so off I go to my water bottle and to dreams of faster races...