Painful

Recently we were shown a new pain assessment tool. It fills an entire computer screen with about 42 different numbers, adjectives, identifiers, what makes it better or worse, how often,....amazing, since I began using it, all of my patients have no pain. It is indeed, a miraculous tool. And of course, a new document means something new to be audited about.

Painful

An overemphasis on pain

By calling it a vital sign,

It's a normal response

And quite often benign,

But as a Medical provider

It's the first thing we ask,

There will be an audit reprimand

If we don't perform the task.

My wife thinks it's too stupid

When she has a medical visit,

They ask, “Do you have any pain

The number, what is it?”

Because for her, pain is not the reason

For the appointment with her Physician,

She thinks that's a perfect example

Of their stupidity condition.

Is it any wonder

Addiction is out of control?

Medical care, created this problem

Asking if you have pain

As if it's the whole,

Summation of your existence

From the moment birth arrived,

By putting that first, we foster an industry

A painful diagnosis, neatly contrived.

So, we under-treated pain

In the young and the old,

The sick and infirm

The hot and the cold,

Until we offered Oxycontin

And created a nation of thieves,

Where we now ask about your pain

But which one of us believes,

When you say it is a “10”

Watching TV with your brother Hank,

A ten, is like having a baby

Or being run over by a tank.

We are supposed to record what number you choose

And apply future treatment, on this arbitrary measure,

You can be as stupid as a fence post and figure this out

It's pretty damn easy to read the map to this treasure,

The golden prescription, to your favorite drugs

We made it so easy and fostered your addiction,

And now upper-management, wants to audit my assessment

Did I document exactly, triggers, therapy and restriction.

If we were to follow this pattern of describing in excess

With every medical discipline invited to play,

There would be no time to perform our procedures

Physical assessments would rule our entire day,

So, who is the driver of this fancy new boat

The Captain, who audits my charting,

I didn't describe pain with the 42 adjectives

And now they threaten me with early departing.

Fibril_late;

8/12/13

The Copay Blues

Many people, when they finally retire, have so many afflictions, requiring pills and potions, and multiple doctors visits, they have to really pinch pennies to even survive. They suffer from the Copay Blues.

Copay Blues

Now that I'm retired

Life has changed a lot,

I can go wherever I want

And get there on the dot,

The outcome of my income

Is a topic oft discussed,

If I spend too much, too quickly

My bank account will bust.

One of the biggest worries

Retired people have,

How to pay for medical care

The Doctors, pills and salve,

You really need insurance

For emergencies and such,

A surgery could bankrupt you

But let's talk about the crutch.

Each time you see the Doctor

For the crutch or pill or potion,

You have to pony up some money

Your hard earned dollars are in motion,

Moving rapidly away from you

For a diminishing return,

Theses are the Copay Blues, my friend

So listen now and learn.

Forget the stupid reasons

When you went to see the Doc,

You had sniffles and a headache

You wanted time off on the clock,

This required a Doctor's note

To get 3 days off or more,

Then they paid you to be sick

Paid time off, now that's a score.

You're not working anymore

The Doctor isn't free,

The crutch, the pills and potions

Could break the bank, you see,

Fixed payments on prescriptions

Percentages till you hit the cap,

And a million dollar hospital bill

Is always there on tap.

Are you worth a million dollars?

That could be more, than you ever earned,

Your Copay would be just a percentage of that

But baby, you'll still feel burned,

Yes, this is a story of retirement

Everything you own, you could lose,

Frittering away your money for medical

Oh, these are the Copay Blues.

Fibril_late;

7/17/13

A New Disease

Did you hear? Obesity is now a disease. Great news for all of us, right? Now that we got that out of the way, let's go find some other preventable, self-acquired thing, and call it a disease too.

A New Disease

Obesity and smoking

Now called a disease,

Next, I think allergies

Everything that makes us sneeze,

And why not divorce

It can really make you sick,

A thousand rads of radiation

Would get you over it quick.

When we label a disease

The scientists?, how they love it,

Discovering therapy and drugs

And new places to shove it,

Treatments and modalities

Expert opinions abound,

Pharmaceutical designers

Love the dollars, newly found.

Let's say my BMI

Is just below the border,

If I got a little fatter

There's a drug that I could order,

Because, finally I qualify

My insurance says it's so,

It's time for fourteen burgers

To McDonald's I must go

Every problem begs a solution

It's a market driving force,

If you want to win the Belmont

You must own the fastest horse,

We build an industry around it

Find supporters and their money,

Then we'll advertise Obesity

We'll get rich now, won't we honey?

Fibril_late;

7/15/13

Lapeer

In Michigan, I grew up in a small town, named Lapeer. The hospital there, (controlled by a regional conglomerate) recently decided to stop paying certain Nursing pay differentials. The nurses and the union fought back and won, earning a judgement for back wages. I read about this in the National Nursing press, and wrote the following:

Lapeer

Lapeer RN's

In the town where I was raised,

Hard working patient advocates

Deserve to be praised,

For standing up to management

And their dictator boss,

Now the hospital must pay

Back wages, their loss.

The boss and his board

With their dubious credentials,

Withheld Nurse compensation

Extra paid-differentials,

Without consulting the law

Or communicating their intent,

Now McLaren must pay

Under a shadow of malcontent.

The public and the media

Understand this dirty dealing,

All those hospital billboards

Are no longer so appealing,

And here I sit in California

Reading about my hometown nurses,

In solidarity, we must stand

While clutching our purses.

Fibril_late;

7/15/13

Auto-Flush

Hospital equipment purchasing........who decides what to buy? Who vetted the products? How were they tested, before being bought and placed into use? Shrug; I don't have any idea. I doubt if there is a single department for that, but I think, that at least there ought to be some qualified Mechanical Engineers on staff, to carefully scrutinize machines.

Take our new Auto-flushing toilets with their light-sensor switch. I don't know if it is infrared or just a motion activator, but newsflash, they aren't very reliable. In my careful observations, I'm betting on 50% success. Sometimes they flush, during the deposit, but not afterwards. Or, no flush at all. There is no fall-back handle, just a black, rubbery thing, that looks like a button. But, it isn't labelled, so one has to use a little intuition, to figure it out. I'm thinking of asking the public folks (when I do a "Discharge Phone Call) not only if the Nurses were sweet and friendly, did you get all the education you needed, and, by the way, when you used the bathroom in the hallway, was the toilet bowl flushed and clean when you got there. Odds are, they were too embarrassed to mention, that our public bathrooms often look like a post-apocalypse bathroom in Kathmandu. Quite frankly, that's what I would remember, when I got home. (of course, I'd remember the sexy Nurses too, after all I'm sorta normal).

And the term, "Discharge Phone Call", takes on a whole new meaning!

Auto-Flush

The automatic

Flushing toilet,

You don't even

Have to oil it,

Greased before

It was put together,

It operates

In any weather.

Sit right down

Or lift the lid,

Do your business

Like they did,

The Engineers

Who took a fling,

Designing this auto-

Flushing thing.

Does it work

After every expulsion?

Or do future users

Face revulsion,

When they discover

Prior remains,

After Billy-Bob

Crapped out his brains.

That's the dilemma

When adopting new tech,

If you believe the hype

From the Salesman, oh, heck,

He was a nice young fellow

Honest and sincere,

With the always-flushing toilet

The hottest thing this year.

These devices never work

As advertised,

Seven times a day

Someone is surprised,

With left-over remnants

From the last user,

Another irate customer

Acting as accuser,

Looking for the perp

Who left his smelly poop,

While the purchaser is to blame

But they're out of the loop.

We nearby nurses

Can't ignore,

So we call Housekeeping

That's their chore,

To clean up toxic

Spills and such,

Though I am betting

They don't like it much.

I suspect

The Hospital Buyer,

Wasn't a thousand

Flusher-trier,

To check if this device

Would really function,

And now we have crap

That needs extreme unction.

Luckily, Sister Euphemia

Hasn't lost her skills,

She knows everything

About flushing pills,

And wadded napkins

Always sanitary,

Though sometimes what's left

In the bowl is really scary.

She says a prayer

And calls, “Oh, Father,

Could you come to

4-East, if it's not a bother,

Because we need an Exorcist

To straighten out this mess”,

Sister Euphemia snickers

Knowing she might have to confess,

That she's overwhelmed

With this toilet disaster,

And she's merely dumping it

On the local Headmaster.

Didn't these new toilet flushers

Arrive with the latest C-E-O?

Is there some correlation

Underneath it all, that might show,

Where this organization is heading

Down the tubes, and such,

There's no way to say for sure

But we don't like it too much.

Fibril_late;

7/8/13

Big as a Barge

Three hundred eighty pounds fella, with new-onset Atrial Fib. Unsure how long he's had it, as his Left-atrium is enlarged, and his ejection fraction is only 40%. He thought the arrhythmia was due to stress at work..........a salesman / broker for multiple Nurseries. He did admit, that he and his wife, do love to eat (she's 200 pounds plus, herself). He was shocked (cardioverted) twice, and got back into Sinus Rhythm. He'll take some meds for a few months and see if he stays in rhythm. I'm betting he doesn't diet, but I'm the perpetual cynic, aren't I?

Big as a Barge

A BMI of forty-eight

Admit it now, that's too much weight,

To carry around on your skeletal frame

Regardless if you're a guy or a dame.

It's really such a case of denial

A thousand excuses in your personal file,

Categorically, ignoring the fact

You are obese, don't call it an act.

It's bad for your family

When you're as big as a barge,

If your kids eat like you

They too, will get large,

Adult-onset Diabetes?

There's a childhood rendition,

Thanks Mom and Dad

For promoting this condition.

Your sleep is disturbed

Because you snore all night long,

Fat throat, heavy tongue

Makes the apnea song,

Like a snorting Bull Moose

With his mating call of Spring,

A slew of comorbidities

Is the song you will sing.

Insulin resistance

And Atrial Fib,

Yeast infection colonies

Where you once had a rib,

At the seventeenth fat roll

Down south near your gut,

And you can't even speculate

What happened to your butt.

From the front, you're a bulldozer

From the back, a Mack Truck,

At a distance you're a blimp

And in the doorway you're stuck,

But once you were a baby

No more than 12 pounds,

Now you're three times my size

Which is out way of bounds.

So, today we shocked your heart

From A. Fib to Sinus,

But I guarantee it won't stick

Until your weight becomes a minus,

And your cardiomyopathy

Will only worsen, unless you change,

Curtail your gluttonous eating

Or drop dead on the driving range.

Fibril_late;

7/10/13