Physician, heal thyself

One of the things that has been rattling around in my head is the prospect of savings in the healthcare field. I'm not a professional policy wonk, but I have had more than the usual amount of exposure to medical professionals, and how the healthcare field actually works. Here are a few of the things that I hope are addressed:

• Electronic records can and should be the norm. Electronic records allow for more efficient storage of greater amounts of information (not just patient notes, but digital X-rays, scans, etc.), provide greater assurance that the various bits of data will stay together (no more physically lost X-rays that wouldn't fit in the regular patient folder, for example), and make for easier transfer and sharing between various providers.
• Standardized documentation -- not so much for the actual medical documents (which seem to be pretty much geared toward the people that need them, anyway), but the support paperwork. I've seen, with my own two beady little eyes, the claim forms for three different insurance companies. All three of them asked for the exact same information, but used completely different forms to do it. This is a clear and compelling example of how and why electronic record-keeping would save money: using something called XML, insurance companies could have their own "unique" individual paperwork, but still make available a common base that would dramatically reduce the time and effort (and expense) of filing claims. It doesn't matter if you call a blank on a form "Home", "Residence", "Address" or whatever -- it's the place where I live, and I should have to provide it only ONCE for everybody treating me or paying for the care I receive.
• Defensive medicine is something that a lot of physicians feel the need to practice; it's the "policy" of ordering tests that aren't necessarily needed to establish a diagnosis, simply to ensure that they've covered ALL the bases in an effort to insulate themselves against a malpractice suit. This, of course, leads us to:
• Malpractice reform is something else that needs to be addressed. There are entirely too many people and lawyers willing to sue for any damn thing, and juries willing to slap heavy-duty lawsuit awards against doctors and other healthcare professionals for things that weren't the result of actual negligence. I mean, let's face it: no matter how much schooling they've had, or how long they've been in practice, doctors aren't immune to making mistakes. Sure, they should be making a hell of a lot fewer of them, but they aren't the life-giving Gods that people want to think they are (despite how some Doctors act). That being said...
• Physicians (as a community) need to be a HELL of a lot more open about their profession, and the people in it. By that, I mean that patients (consumers!) should be able to find out if a particular physician has a history of bad judgement, ineptitude, substance-abuse problems, or other factors a potential patient should be aware of. Similarly, it should be possible to get some idea of how experienced and proficient a physician is: if, for example, I'm looking at getting a knee replacement, I should be able to look up the names of doctors that do the procedure and see how many they've done, and how successful they were (including long-term results). Yes, some doctors take on "riskier" patients than others, and that can be noted and factored in; it doesn't change the underlying need for accountability and public awareness. I've heard of a lot of physicians saying that they can police their own; I say it's time they do just that -- police themselves, with the corresponding punishments and public accountability, just as the legal system provides.
• Individuals need to be a lot more active in their healthcare, too. As noted above, the title "Doctor" doesn't equate to "Divine Entity"; folks need to ask a lot more questions, insist on intelligible answers, and not give health care staff an automatic pass on things. By way of illustration, if I ever find myself in a hospital bed again, I fully plan to have a box of gloves and a big bottle of hand sanitizer next to my bed -- and if I don't SEE the staff cleaning their hands (THE most common means of infection transfer in hospitals), I'll insist they use one or the other before touching me so that I reduce my infection risks. Hell, be a pain in the ass, if that's what it takes -- it's your body, life, and health, isn't it?
• I'm going to suggest something that I think is new, here: a lower level of initial healthcare contact. By that, I mean we should maybe think of having an initial contact level of healthcare that serves as a "triage" point: let doctors and nurses in offices and emergency rooms deal with stuff that really needs people doing doctor stuff, and let this initial contact point serve to tell folks to put an icepack on their sprained wrist (minimal attention needed), they need to make an appointment with a doctor (more important, but not "critical"), or get them to an emergency room. Wouldn't it seem more efficient (and cheaper) to let an LVN/LPN wrap that sprained wrist or give a flu shot than the better-trained and more experienced RN or a doctor -- freeing them up to tend to stuff more appropriate to their knowledge and skills? I'd think that parking a mobile home outfitted as a first-care office in one corner of every schoolyard in the country would dramatically reduce the overloaded emergency rooms and doctors offices, and be cheaper to operate to boot.
• Insulate doctors (and other health care professionals) from the infrastructure. I can't imagine why a doctor (or nurse, or Physician's Assistant, or...) should even be allowed to have any financial interest in a drug company, medical technology company, or any other kind of product or enterprise that they have direct and immediate contact with. A doctor sending a patient to an MRI facility that he is a part owner of is inexcusable, just as it should be for them to prescribe a drug made by a company that they have stock in (or otherwise stand to receive any kind of tangible income or reward from). Granted that they may not be all THAT many doctors involved in such shenanigans, but I don't think there should be ANY. If doctors want to invest in such things, then it should be done as a "blind" trust -- the doctor(s) involved shouldn't have any idea of who, what, or where.
  
• Non-traditional medical "practices" should be subject to rigorous review and evaluation -- there has got to be a way to get rid of the pay-for-pills "pain management" offices, the whiplash-centric chiropractors, and the like. Not only do they give the rest of the medical profession a bad name, they directly and indirectly contribute to the associated costs the rest of us have to pay: increased insurance rates to cover inflated insurance claims, crimes associated with drugged "patients", waste and abuse of the medical infrastructure due to fraudulent claims, and more. I'm not suggesting doing away with pain management or chiropractic practices entirely -- only those that are patently engaged in fraud. If one office accounts for a statistically significant higher number of cases (lawsuits, crimes, etc.) than anyone else, it would seem pretty obvious that something untoward is going on.

No single ONE of these things is going to make a whole hell of a lot of difference by itself. But taken together, I think they'd be a damn good start on reducing the cost of healthcare, and the increasing rate that it's rising at.

Blended family

As mentioned in my last post, I've opted to take in a new co-owner. After spending the day with them, I finally settled on taking the cat formerly known as Sally Forth (the one with the white paws, a female). Here's a picture taken yesterday; in it you can see (click to make bigger) why I'm thinking about renaming her to "Radar" (because of the huge satellite dishes on her head), or possibly (because of the dark smudges around her nostrils) "Booger":
Of course there was a certain amount of displeasure from my current owner, Elf, expressed as growling and hissing at the interloper; and a refusal to even share the same room in my apartment with the little beast.

Happily, that has (mostly) passed by now. Elf isn't ready to become buddy-buddy with the new family member, but has at least gotten to the point that the complaints are mild and infrequent (usually when the nuisance gets too close). Here she is watching the newcomer beating the crap out of a ball in the kitchen:
I expect that once the two of them get used to each other, they'll get along fine, and keep each other company.

In the mean time, I've had a couple each of toes and fingers tested to see if they were edible (they weren't), had assorted body parts attackled while in bed, had my feet and ankles ambushed repeatedly, and (of course) been slept on.

New family member

I've been contemplating it for a while now, and decided to go ahead and add to my little "family": my cat, Elf, is getting a little baby brudder or sister today.

A friend of mine has a cat that had kittens, so I'm "babysitting" the two of them that haven't been spoken for today; the idea is to get some idea of which one will best fit in with me and Elf. Needless to say, Elf is considerably less than impressed with the idea -- she spent the first half hour staring at them while growling and hissing at them. Following that, she went off to sulk for a while.

The kittens are both gray longhairs; one has while front feet that the other doesn't. Both have a few random white splotches. One is female (named "Sally Forth"), the other is male ("Marco Polo").

It's been a couple of hours since I opened the carrier they were in, and both of them have pretty much gotten used to being in a new environment, and are actively investigating my apartment. As soon as I can, I'll get pictures of both to put up here.

UPDATE:
As promised, here's a photo showing the two fuzzballs...
clickenize to embiggenate

What he said...

I'm with Good Sir Jimbo on this one.

Housekeeping

This is pretty much how I schedule my housework efforts...

Public Service Announcement

I was just watching Wheel of Fortune, and I am forced to the conclusion that there are lot of people that don't bother to prepare for the game.

Since the contestants win money by correctly guessing letters that might be in the puzzle, simply using the normal distribution of letters in the English language dramatically increases the chances of winning. I mean, there's a REASON that one has to 'buy' vowels: they constitute 5 of the first 12 most common letters.

For those that would like a quick and easy 'tool' to remember, the most frequent 12 letters in the English language are (in order)

ETAOIN SHRDLU

If you'd like to see the full distribution, you can either see it as a graph in alphabetical order, or in the most- to least-used order.

If anyone reading this should happen to find themselves on WoF, and win whacking great wads of money, you're welcome to show your appreciation by sending some of it to me.

Explanation, please?

I'm paying attention to all the fuss and furor over The One's health care reform program, and there are a few things that I'm not understanding. Now, I'm not a Republicrat or a Demolican, I'm not a spokesmodel for any interest group, nor a doctor, lawyer, or Indian Chief. I'm just a plain-old Mk I, Mod I human people. Perhaps some knowledgeable person could give me clear and definitive answers to a few things:

• A lot of what I'm hearing involves affordable health care -- so just what, exactly, does "affordable" mean? Is that going to be the same for me and the schmuck next door, or is it going to be dependent on income? If it's going to be income-dependent, doesn't that mean that some folks are essentially going to be underwriting (paying for) the care their less-fortunate brethren get?
• There's also a lot of discussion on a "public option", where "public option" translates into government-funded. If the government DOES get involved, how much would that involvement include? Simple transfer of funds from collection to disbursement? Or would the government start mandating policies, procedures, and a whole raft of other dictates? If the government IS involved in the decision-making process, what would the limits of that involvement be?
• His Obamaness (and the Democratic party) are pitching a fit that there's a lot of astroturfing going on by opponents to Health Care Reform, and that everybody should be supporting the reform program -- except that all we have at this point are two completely different bills, one in each of the Senate and House, that aren't anywhere near ready for Presidential signature. With no single implementable bill available, we don't have any details or particulars to consider -- just a couple of incompatible vague suggestions. So just what the hell is it that we're supposed to be supporting?
• I haven't heard any clear, definitive explanation of how all this reform is supposed to be paid for. Sure, there're a few billion here and there that can be saved via pooled drug purchases, increased efficiencies in medical facilities and practises, and so on -- but those are minuscule compared to the projected costs of the entire reform program. So where is the money coming from? Somebody is going to have to pay for all this change -- so who is it?
• I find it telling that nobody is addressing the issue of the efficiency of any administration of this reform. Since the government doesn't have the most stellar record of efficiency, the ability to quickly adapt to changing circumstance, accountability, or restraining program growth, why in the world should any of us believe that government involvement is going to be beneficial to the process?
• Something else that I haven't heard any mention of is what specific goals are going to be set, who's going to set them, and how we're supposed to know when they're achieved. Is this whole thing going to be turned over to a bunch of social-reformers, professional (non-government) administrators, or someone else? What, if anything, is going to be done to keep any über-progressives from inflicting their wishes and opinions on those that don't agree with them? What reason do we have to believe that any policies that are proposed will have the greatest effect for the least cost, versus targeting anything or anyone the policy makers don't like?
• Who's going to be in charge of this operation? What are their responsibilities, and how are they going to be evaluated? Who's going to decide how much of what should be done? How are those decisions going to be reached, and what recourse is there for those adversely impacted by the decisions?

I have to admit that I've got a deep, deep mistrust of any policy or program that is initiated, sponsored, controlled, or directed by our very own U.S. Government -- there are simply too many shining examples of gross incompetence, ineptitude, inefficiency, and flat-out dumbassery for me to view any kind of major proposal like health care "reform" with anything else.

Cat-speak

Cat Says
It means

miaowbu
Feed me.

meeow
Pet me.

mrooww
I love you.

Miioo-oo-oo
I am in love and must meet my amour outside beneath the hedge. Don't wait up.

mrow
I feel like making noise.

rrrow-mawww
Please, the time is come to tidy the cat box.

rrrow-miawww
I have remedied the cat box untidiness by shovelling the contents as far out of the box as was practical.

miaowmiaow
Play with me.

Miaowmioaw
Have you noticed the shortage of available cat toys in this room?

mmeww
I believe I have heard a burglar. If you would like to go and beat him senseless, I shall be happy to keep your spot in the bed warm.

mioawmioaw
Since I can find nothing better to play with, I shall see what happens when I sharpen my claws on this handy piece of furniture.

raowwwww
I am not amused by your shenanigans. Cease at once!

mrowwwww
I am now recalling, with sorrow, that some of my private parts did not return with me from that visit to the vet.

Roww-maww-roww
I am so glad to see that you have returned home with both arms full of groceries. I will now rub myself against your legs and attempt to trip you as you walk towards the kitchen.

gakk-ak-ak
My digestive passages seem to have formed a hairball. Wherever could this have come from? I shall leave it here upon the carpeting.

mow
Snuggling is a good idea.

moww
Shedding is pretty good, too.

mowww!
I was enjoying snuggling and shedding in the warm clean laundry until you removed me so unkindly.

mroow
I have forced my body into a tiny space in order to look cute. How'm I doin?

Miaow! Miaow!
I have discovered that, although one may be able to wedge his body through the gap behind the stove and into that little drawer filled with pots and pans, the reverse path is slightly more difficult to navigate.

Mraakk!
Oh, small bird! Please come over here.

ssssRoww!
I believe that I have found a woodchuck or similar small animal. I shall now act terribly brave.

mmmrowmmm
It is certain that the best tasting fish is one you have caught yourself.

mmmmmmm
If I sit in the sunshine for another hour or so, I think I shall be satisfied.

Mreoaw
I do believe that you are failing to pay sufficient attention to me.

Mreeeow
Do you serve catnip with that?

Miaooww! Mriaow!
Since you are using the can opener, I am certain that you understand the value of a well-fed and pampered cat. Please continue.

Ling and Lee

I dunno, maybe it's me, but with all the happiness and joy over the return of Laura Ling and Euna Lee from North Korea, there seems to be one wee little technical detail that hasn't been fully explained...

How the fuck did the North Korean authorities get hold of them?

If they did, in fact, sneak across the border then what the hell made them think that they were somehow going to be immune from NoKo rules, regulations, and laws? Just because they were "journalists"? Why should that could for anything? I've spent no small amount of time travelling around while in the Navy, and I can't think of ANYPLACE that would tolerate anybody violating local laws, no matter who they are. If those two did sneak across the border into a totalitarian military-controlled regime, I figure they got off damn lucky with only 140 days in the clink; it would have served them right if they'd had to serve half the sentence before getting out for good behavior...

Terrorist strikes at McD

Every now and then, I give in to the temptation to enjoy the fine dining at McDonalds -- I'll admit that there are a couple of things on the menu that I actually like.

This morning, I stopped in for breakfast. Being a Troublemaker, I like to order what I want, versus their default manufacturing process. Accordingly, I wanted a quantity of TWO Snausage McMuffin sammich meals -- except that instead of two small cups of coffee, I asked if they could just put them into one larger cup.

Now, you might think that my request was simple and straightforward, but such was not the case. You see, McDonalds doesn't apparently grasp the concept of customer convenience or doing anything outside their Established Procedure.

From the reaction from the counter-person (something like an anti-person, I'm thinking), you'd have thought I asked him to solve a twelve-variable calculus equation in his head. After much brow-furrowing, he had to ask for help in trying to enter my request into the picture-screen. It wasn't working, and they finally had to get a blue-shirt to supervise. Before all was said and done, I was half-afraid the computers at McD Corporate were going to asplode.

I did get my one large cup of coffee, but it necessitated that they enter the order as:

• ONE meal with no drink
• A large coffee
• A separate Snausage McMuffin sammich
• A separate hashbrowns

Whereas two Snausage McMuffin meals would have cost me $8, the order they had to enter ended up costing me $8.40. That's right, folks -- I paid MORE money for LESS food (instead of 2 12-oz coffees, I got 1 20-oz; they "saved" 4 oz of coffee).

This is why jobs that require no thinking ability are referred to as McJobs, methinks...