Archive | June, 2017

Brother Chuck

26 Jun

I … am an only child with brothers and sisters.  My parents were both married before.  They both had children.  When I came along they were between the ages of 14 and 23.  Consequently, I don’t have a recollection of growing up with brothers and sisters.  (Yes, I know.  Technically, they are my half brothers and sisters while they are steps to each other.  But they’re all that I have.)

The family story included Brother Chuck.  He left school early to join the Navy.  I always heard that he was a Seabee and was headed for Japan when the atomic bombs were dropped on Hiroshima and Nagasaki.  I never heard how close he got to seeing action during World War II, but I do know that he made the acquaintance of a malaria-infected mosquito somewhere in his travels.

CE Fisher Navy

After being separated from the Navy, he joined the Air Force and became a military policeman.  Mother always thought that this would be his vocation until some incident occurred in England and Brother Chuck came home.

SSGT Charles Earl Fisher USAF

He had a variety of jobs.  He was a police officer for a while, then the trucking business, and eventually he owned a service station. He was active in the American Legion and the Jaycees.  I think he held offices in both organizations.

There were 23 years between us.  We didn’t have many conversations.  I do, however, remember one.  It was during Vietnam. It wasn’t a popular war.  There was draft dodgers … war protests … Kent State … civil rights demonstrations … riots … and the Democratic Convention in Chicago.  Brother Chuck didn’t talk about these things but about his military service and life in the United States.

Much of this conversation, I don’t remember.  I was 18 and knew everything; e was my brother from a different generation.  But one theme continued to repeat in my head.  He wasn’t philosophical; he just made a simple statement.

Brother Chuck mentioned the rights, privileges, and benefits of living in the United States and added that each of us are obligated to do something for the country in exchange for those rights, privileges, and benefits.

It got me thinking.  Eventually, I followed his lead and joined the Navy.  It continues to haunt me.

Today it seems that those rights, privileges, and benefits are taken for granted.  They are just freely given.

Just think about it!

Managed Health Care

4 Jun

I don’t think I like managed health care.

“Managed [health] care is any method of organizing health care providers to achieve the goal of controlling health care costs and managing the quality of care” (Tobin, January 1997).

It strikes me that the medical profession is no longer concerned about getting the patient well but rather managing the illness.  Each entity must get their “pound of flesh” (Shakespeare):

  • the doctors;
  • the physician assistants;
  • the nurse practitioners;
  • the billing networks because physicians, since the Affordable Health Care Act, have generally affiliated with health networks for billing purposes;
  • nurses;
  • technicians;
  • the labs;
  • the pharmacies;
  • the pharmaceutical companies; and
  • the health insurance companies[1].

The system encourages providers to keep patients within the system instead of getting the patient well.   I just don’t understand.  Perhaps the following examples will explain.

  1. An acquaintance had a mastectomy. Before she could be fitted for a prosthesis bra, she needed a prescription from her general practitioner and not the oncologist which, of course, required a visit to the general practitioner.
  2. An acquaintance is diabetic. The family doctor made a referral to a podiatrist because of some recurring foot problems.  The podiatrist recommended some special shoes for diabetics; however, the podiatrist could not write a prescription for the special shoes.  (Why not?  Who knows?) My friend returned to the family doctor for a prescription and referral to another podiatrist who handles the special shoes.
  3. I’ve had both knees replaced. Before the replacements would be approved, there were X-rays, MRIs, and CAT scans.  Anti-inflammatories were prescribed; blood work ordered.  Fluid drained.  Cortisone injected.  Fluid supplements to help lubricate and cushion the knee joint were tried.  Physical therapy ordered. I can’t recall how many appointments there were before the knee replacement was approved, but each and every one required a fee.
  4. I’ve had some reactions to medication. Fortunately, these reactions have just been minor irritants.  Instead of wanting to address the underlying problem, the physician was eager to write another prescription to address the symptoms associated with the drug reactions. Why take two medications when adjusting the strength of the first addresses the problem?
  5. An acquaintance had edema. A hospitalization addressed the condition but not the underlying cause.  After discharge, the problem reoccurred.  Now, there are four or five doctors involved.  They seem to admit that Lasix should have been continued when he was sent home from the hospital.  There seems to be no idea of the underlying cause as each doctor continues to poke, probe, and order tests.

Why don’t doctors work on getting people well instead of just managing the disease or condition?  Oh, I forgot, as they sang in the musical Cabaret “money makes the world go around” (Kirk & Mallinder, 1998).

Just think about it.

References

Kirk, R. H., & Mallinder, S. W. (1998). Money [Sang by L. Minilli, & J. Gray in the musical Cabaret].

Shakespeare. Merchant of Venice.

Tobin, C. (January 1997). What is Managed Health Care? AADE News.

 

[1] These are probably in inverse order since the health insurance companies like to call the tune.