Wednesday, August 26, 2009

You say Verrucous, I say Varicose

We have wonderful staff in our office. I wouldn't trade any of them. Our reception ladies are friendly and efficient and attentive to details. They know how to use the computer and answer the phones and file and schedule tests and do all sorts of things that we couldn't run an office without.

They aren't, however, trained in medicine.

Most of the time they get it right, but sometimes it makes for some interesting appointments on our calendars.

I was thoroughly impressed one day to see that my partner had a "thymus" biopsy on her office schedule. The thymus is a gland that lives behind your breast bone, right next to your heart. It's pretty small by the time you're grown up. It's not the sort of thing we typically stick a biopsy needle into in our office. I asked her about it later. Turns out it was actually a "thigh mass" biopsy. "Thymus". . . "Thigh mass". . . Close enough.

We had one receptionist who regularly scheduled people to be seen for ambilical (not umbilical) hernias (I always wondered if an ambilical hernia could walk) and verrucous (which means wart-like, although I'm pretty sure she meant varicose) veins.

Sometimes it's fun just to try to guess what the problem might really be before you actually get to talk to the patient. For instance, tomorrow I have a patient scheduled to be seen for a "breast rupture." I'm not sure exactly how that would happen, but it doesn't sound pretty!

The mystery just adds an element of excitement to the job.

Friday, August 14, 2009

I have a theory. . .

I think that babies must prefer chubby mommies. I don't know exactly why. Maybe it starts with wanting more padding while they're on the inside. Maybe it makes them feel more secure. Then once they're born, who wants to snuggle with someone bony? Cushy is probably preferable to those little ones.

Whatever the reason, they have a master strategy to meet their goal. It starts with the whole pregnancy weight-gain thing. Cravings, swelling, etc. . .

Once they're born they cause chronic sleep-deprivation. That slows Mom's metabolism and helps her keep on those pregnancy pounds.

Sitting down to enjoy a meal becomes a thing of the past. It's more a matter of grabbing what you can when you can and shoveling it in. It's hard to remember what or how much you ate like that - not exactly a healthy diet strategy.

Exercise? Are you kidding?! There is definitely some sort of sensor in babies that alerts them when Mom gets near the treadmill or the exercise DVD. It causes them to wake up and scream, or spit up, or overflow their diaper, or otherwise derail Mom's plans for calorie-burning.

So, hey, if you're hanging on to a few more pounds than you'd like since you've had your babies, don't feel bad. Wear them as a badge of honor. You're just doing what your babies want.

Wednesday, August 12, 2009

Let's disagree over things that are real, indeed!

In a recent town hall meeting in New Hampshire, President Obama decried his critics' "wild misrepresentations" of his proposed health care overhaul. He denounced their efforts to "scare and mislead" people and urged, "Where we do disagree, let's disagree over things that are real."

The President should take his own advice.

I don't know whether he is intentionally misrepresenting the facts or if he is really that poorly informed on the issue of physician reimbursement. Either way, it's frightening to see this from the man who has taken it as one of his major objectives to "reform" our health care system.

The amount a surgeon gets paid for performing an operation isn't a hard number to come up with. The President's advisers could find that out easily enough if they wanted to. Here, I'll help them: In 2009, Medicare allows $695.80 for performing a foot amputation.

That includes the physician's evaluation of the patient prior to the surgery, the operation itself, and all the care provided to that patient for the next 90 days in the hospital and in the office. Healthy people don't often need amputations. No, patients who need amputations tend to have a lot of medical problems. Things like diabetes, heart disease, high cholesterol, high blood pressure, a history of smoking, or sometimes all of the above. That means they're more likely to have complications after surgery like wound healing problems, heart attacks, strokes or other things that require a lot of time and care from their surgeon. All that care is included in the $695.80.

Furthermore, $695.80 may be what the surgeon gets reimbursed, but it's certainly not what he or she "takes home." Before anything is taken home, money comes out of that to pay for office space, staff, supplies, medical liability insurance, continuing medical education, and so on.

No one gets rich amputating feet.

I wouldn't imagine that the president makes up numbers like that off the cuff in the middle of a speech. Surely that was something he had prepared ahead of time to use when the moment was right. If anyone in the press bothered to call him on it, I'm sure he'd claim he "misspoke." Just like he did after he asserted in this same speech that the AARP endorsed this bill. They didn't. A slip of the tongue would be hard to believe in this case, given the fact that just a few weeks ago he asserted that surgeons cut out children's tonsils just to pad their pockets. No, he really intends to vilify physicians - particularly surgeons - in order to muster support for his health system overhaul. As if taking your child in for an operation isn't stressful enough, now you have the president telling you that surgery is probably unnecessary and your doctor is a greedy crook.

For the past two decades, Congress has been trying to control health care costs by trimming physician reimbursement. So much so, that many procedures done today reimburse less than they did 15 years ago. I don't mean when adjusted for inflation. I mean in actual dollars. Adjust for inflation, and they're worth even less.

If physicians, and particularly surgeons, were all the money-grubbing charlatans that the President would like you to think we are, there wouldn't be many left. There are a lot less stressful ways to make a lot more money than your doctor makes. (Take being a CEO of a health care-related company, for instance. Now, there's where some serious savings could be found! But I digress. . .)

The vast majority of physicians are compassionate people who do what they do because they love to help people. Which is a good thing. Or there might not be any left when the current administration gets done with their "reforms."

Sunday, August 2, 2009

The Dentist

J had his first trip to the dentist last week. Yes, I know it's a little late to be starting that, but we tend to follow the "If it ain't urgent, it ain't happening" principle around here much of the time.

When I told him I was going to take him, he was very excited. He wanted to go right then. It was a big letdown when he found out we had to make an appointment. He could hardly wait until the big day arrived. I wasn't quite sure what to make of that. I was glad he was excited and all, but didn't know if he really understood what was coming. There was the time, after all, that he begged for a shot at the doctor's office. I had assured him in advance that there wouldn't be a shot at that particular visit. He was so disappointed. When the doctor suggested he get a flu shot, I said, "No, I promised him he wouldn't get any shots this time." After J and I went through a couple rounds of "Please, Mommy!" and "Are you really sure you want one?," he got the flu shot. It apparently wasn't what he expected. He hasn't asked for one since.

So, anyway, I was a little afraid it was going to be a repeat of that: excited about going to the dentist, a little ticked off once they start poking around in his mouth with sharp or noisy instruments.

It wasn't. He was absolutely the most charming little dental patient you could imagine. He hopped up in the chair, picked out his flavors of polish (bubble gum) and fluoride (mint), and opened wide. They had told me ahead of time that they would just do as much as he would tolerate - anywhere from just showing him around the place to a full cleaning. He didn't flinch through the whole exam, so he got the full treatment.

Despite our late introduction to the dentist, he got an A+ report. His teeth are completely healthy and his alignment is good. That last part was a big relief. After allowing him to keep his pacie for more years than I'm going to admit in writing, we had concerns about what it might have done to his teeth. Apparently our fears were unfounded. H can keep hers until she's 18 now for all I care.

I got a couple of surprises out of the experience. Turns out he's officially growing up. He has his "six year molars" in. I had no idea, since he never complained about that hurting at all. But then, he never seemed bothered by cutting teeth when he was a baby either.

We also learned that he has 2 loose teeth. That was pretty disappointing news. I've always thought that's the thing that ages a child the fastest. They lose all their "baby-ness" once those big teeth start coming in. He's only 5, after all. I was a late bloomer in that area and didn't lose my first tooth until I was 7 (second grade). I had hoped he would keep his baby teeth longer too, but alas, my baby's growing up.