Friday, October 14, 2011

not what she said...

you may remember a prior post on selective English T-shirt wording which patients sport unbenounced to the actual meaning of the wording.

Today, I saw another choice example of why an English-Spanich Diccionary may come in handy at your average San Francisco thrift store;

Walking on the corner of 19th and valencia, a kind tiny older hispanic woman was seen sporting a shirt reading "expert cougar hunter".... hmmm, something tells me the meaning is lost on her, and i expect her cougar hunting skills are minimal if at all existant :)

Not clinically related, but thought it was worth posting before the weekend to put a smile on a few faces!

Monday, October 10, 2011

resources shmescources

This NP was recently seen at a large conglomorate hospital in the area (think socialized albeit private quality medicine with a name that correlates), using insurance I have paid for through work although I waited over 90 days for it to "kick in", I was seen for a procedure (which luckily amounted in nothing abnormal, yeah!). The experience reminded this provider how broken our medical system is.

Patients are usually not seen in Community Health Centers by choice, and there is a reason why... understaffed, underfunded, with long lines and limited resources... (although to be fair; our spunk, drive, commitment to social justice/equality,creativity, and NHSC obligations are second to none!)... it's nothing like a trip to your friendly concierge service MD.

While a friendly radiologist inserted an uncomfortably long and shockingly low gauge needle into my neck, a friendly radiology tech followed instrutions on a quality ultrasound machine, and a very peppy tech complied with the provider's every need. Wow, posh... and it was only a relatively minor procedure.. I've put in hundreds of IUDs (a sterile procedure nontheless) singlehandedly without even an MA, so this treatment felt like a day at the spa (medical-resource wise).

Ok, I'm not saying we should all be signed up for some high priced, private HMO...and if you are a billionaire and want to use some of your wealth to pay for an ultra-private service, so be it... what I am saying is that every citizen, from the uber rich to the hoi polloi deserves basic, quality, accessable and appropriate health care as a human right... you can always pay extra to access your botox, fancy additional procedures, or brand name medications without generic equivelent, but there is something majorly broken when such huge disparity exists.

I don't have all the answers, but the basic starting point seems quite simple... it's broke, needs fixing... start at the beginning; basic affordable health care access for all.

Folie à deux

Folie à deux, "a madness shared by two"... not exactly a classic case, but remarkable nontheless...

Working triage today, a patient walks in requesting a medication refill... normally this involves review of a patient's medical record, but given he is a new patient, it would involve patient subjective history, a pharmacy med list, or prior medical records.

A list of common question/answers ensue; with one commonality... see if you can spot it;

"what medication" - not sure
" what for" - not sure
"who prescribed it" - not sure
"where was it prescribed" - not sure
"did you bring a list or the bottles" - no, I lost my backpack which they were in, not sure how or where
"how long have you been off the medication"- (no joke) one hundred weeks
"one hundred weeks is over a year..." - well, at least since August (August was two months ago)
"do you know the month/year today" - got this one spot on!

ok, so we were not getting very far with this questioning. A set of vital signs later ensured that the patient was at least not going to drop in the office, saving us some time for investigation.

"so", I commented "there seem to be a lot of details you aren't clear about, can I ask who helps you remember to take your medication?"

"Sure" he replied "my friend steve or my mom"

Excellent, this NP thinks to herself, I may be able to solve this case yet!

"Can you bring your mom or Steve to the next visit?" I inquire.

"no, they are REALLY crazy" our fairly confused patient comments... ahhhh... Folie à deux

Hopefully our lovely social worker will be able to make heads or tails of the case next week, as I called EVERY major pharmacy in the area, and no record of this kind patient exists.

gotta love the creativity of community health, and the opportunity to occasionally feel like your life is a strange movie that never ceases to somehow entertain...