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Posts tagged ‘health care’

Trust Me

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A couple of weeks ago I asked my PCM for a referral to OB/GYN to replace the IUD that I had to surrender over the summer. She and The Guy and I have been talking for some time about the options and realities of having another child with my condition, and the answer we came up with is that we will wait for a little longer and see if I am still doing well with my current regimen.

Usually these things take weeks to schedule, but they called the next day, and I had my referral appointment on the second day. No matter what your history in the OB/GYN clinics you have to have counseling in order to get birth control through the MTF (all the ones in which I have been treated anyway), and the idea is that you get to talk to your OB/GYN about all of your birth control options, what you want from your birth control, take his or her advice, and decide on what is best for you. That is the theory, anyhow.

Some people (like me) have an idea ahead of time what they want or what is best for them. I, for example, due to my medical history and ongoing condition, am not able to use a hormonal birth control. Because of that I know that the copper IUD (ParaGuard) is the best option for me. Also because of this, I often read up on ParaGuard and IUD use in women, and try to keep abreast of any information regarding IUD usage, risks involved, etc. The IUD has such a bad reputation from so much misinformation that I feel the need to stay on top of this. Some would say this makes me a big smarty-pants-know-it-all. I say that sometimes a woman can’t trust that her doctor is going to take her word at face falue, and in the off chance that her doctor isn’t as awesome as mine she needs to be prepared. I am privileged to have information available at my fingertips.

I did not realize that my appointment would not be with my usual kick-ass OB/GYN, Dr. K, the same one who saved my fallopian tubes and life this summer and who promised to give me a shiny new IUD whenever I was ready for it. Not panicking when I saw the face of a woman I didn’t know I sat down as she introduced herself as Nurse Midwife V and told me that she had been looking over my file. Great. Maybe she was doing her background reading too, because I really tire of bringing every doctor up to speed constantly on my condition when it is right there on the computer screen for them to see. I don’t have a bunch of degrees and I can keep up with the required reading.

Before I had even the chance to say anything she told me that I was “not a candidate for an IUD” because of my ectopic pregnancy, and that she was not going to refer me for one. When I started to say that I understood that there were some risks she cut me off and told me that my pap was also past due and kept talking. I tried to assert myself past her obsession with people rooting around in my vagina, to let her know that I was aware that there were risks involved with the IUD, but that I knew that not only was what happened to me rare, but that I knew it was rare that it might happen again. But she wasn’t having any of that. She kept right on talking like I wasn’t even there.

I told her that my regular doctor had already said I was fine to have one. She responded by saying that it usually took weeks to get in to see him, as if this was supposed to deter me somehow. I also tried asking if the new ACOG regulations had been implemented yet, thinking this might distract her and get me closer to my goal (also, I am in the lag area none of them know what to do with, being 29, soon to be 30) and all she would say was that my pap was past due. Is it? I don’t know. I had a normal one in late 2008. I am in a mutually monogamous relationship…

When I left I told the front desk that I would no longer allow Nurse Midwife V to treat me. I am currently in the process of filing a formal complaint against her. What shouldn’t have happened here was having everyone from the desk staff to the NCOIC (that’s Non-commissioned officer in charge) tell me how nice Nurse Midwife V is and how everyone likes her so much, and that she is well known for being very good at what she does. That might well be true, great. My experience is that she was condescending and rude, and didn’t help me with my medical needs to my satisfaction. I think that people forget that sometimes, that doctors and nurses are also here to provide a service for us. I have a medical need, and she didn’t meet it. I shouldn’t have to settle for that. No matter how nice and great she is to work with. I also shouldn’t have my experience erased and dismissed by everyone in place to help me when things go wrong for me. That is not good patient advocacy.

I am rather privileged, however, in that I was able to make another appointment, and I saw Dr. K the next day. Had I been someone who had to drive a long way to a clinic, I might not have been able to. Had I had to pay out of pocket for this visit, or if my insurance limited the amount of OB/GYN visits or birth control counselings I was allowed per year, I would not have been able to. Had the travel cost me money I did not have, this would not have been possible. Had I not had the type of job I do where I set my own hours, I might have had to miss work. These are the kinds of things that women face when they come up against providers like Nurse Midwife V, providers who don’t want to listen to women, who won’t talk to women about their own bodies and medical histories. Providers who don’t trust women to be actively involved in their medical processes. Providers who can’t be bothered to involved women in the partnership that should be their own medical care, especially when it comes to their reproductive health. As it was, having to go back a second time was already taxing on my spoons, and stressful, because now I have be on my game. Suddenly I have to come in educated on something that my provider should have known the first time.

Thanks to meloukhia’s indominatable Google-fu I took in the information I was looking for, backing up what I had already said, that an ectopic pregnancy did not preclude me from having an IUD (or, that a previous ectopic pregnancy was not a contraindication for an IUD). Dr. K was impressed that I was so prepared. He told me that he had heard that information, but he himself had been so busy that he hadn’t had time to read any of the journals for himself. He told The Guy (who went with me this time, because they like to banter back and forth in Korean) that I should come in from time to time to keep him updated on current women’s health, and said he wished more people came to him so informed. He said that whomever told me that I couldn’t have an IUD was wrong. I was prepared, but I shouldn’t have had to come in as if I was fighting a war.

Two weeks later I have my IUD.

Nurse Midwife V didn’t care to ask why, after having one IUD failure (as rare as they are, b/c they are pretty much the most effective form of reversible birth control out there, with a fail rate of less than one percent), I would want another IUD. She didn’t bother to find out anything else in my medical history that might affect my decision to make that very personal choice about birth control, like that I am on medication that might have contraindications with hormonal birth control, or that previous specialists had determined that hormonal birth control is a migraine trigger for me. She simply asserted her own opinion (as wrong as it turned out to be) and called it a day. But all of that information is in my medical record if she cared to look. The same record she said she reviewed when she made her initial judgment.

And now, I can’t trust her.

Michigan to impost referral law for Acupuncture

From bfp:

Because Michigan can never just leave well enough alone, can it?

I found out from my acupuncturist that the state of Michigan is considering requiring it’s citizens to get a doctor’s referral to go to an acupuncturists. So, in other words, rather than hearing from a friend that she went to acupuncture and that person deciding to give it a try too–Michigan wants to make it so that you have to go to a doctor first, and then, if the doctor is willing to actually give you the referral, you can go to the acupuncturist.

Many people who know about the history of midwives in the U.S. know why this is such an extraordinarily bad idea. But for those who don’t know that history–what this particular requirement would do is first and foremost, place an incredibly unfair burden on those people who don’t have health insurance. Those who are unable to afford a doctor would simply have yet another health alternative option removed from their already limited health arsenal.

If you do nothing else, please sign this petition to help keep this medical option available for people who would lose access to the only health care they afford without insurance.  With Michigan being hit as hard as it has been by this recession and the job loss as high as it is in the state specifically, people are desperate for health care.  Community Acupuncture is one of the few options available to them, and if the requirement is added to get a doctor’s referral, well, without insurance, they will lose that too.

My New Series

I have a series going at FWD/Forward on navigating invisible disability claims in the military and the VA, and some other inside perspectives on TRICARE and military/Veteran’s health care.

Shifting the Responsibility for Disability in Uniform:

Hir PCM might evaluate hir, refer hir out for tests with specialists, or set hir on a merry-go-round of treatments.  When the ride stops sie may or may not have any answers, and there may or may not be a Medical Review Board pending to tell hir the terms of the future of hir career.

This is where things get interesting.  By interesting, I mean kind of fucked up.  One, any or all of those specialists might have diagnosed hir.  Those doctors start treating hir accordingly, because while TRICARE (military medical insurance) has its flaws, it kicks a lot of arse, and sie gets the care sie needs, mentally and physically (until her PCM deploys, but that is another post altogether, just you wait!), all under the umbrella of hir diagnosis.  But then the Medical Review comes up, and all of hir doctors have to write these recommendations, and suddenly things change in terms of hir care.  In hir appointments hir doctors start getting vague about care plans, and start talking around the actual words for hir condition…sie might suddenly feel dismissed or as if hir questions are not being answered.

Read the rest here.

A Delayed Deployment of Care:

One of the most frustrating aspects of dealing with a chronic pain condition while under military care, as an active duty service member or a dependent is an inconsistency of care.  Something that I learned pretty early on is that my best bet for getting the best care is to have a regular doctor.

May I drop into a sports metaphor?

Your regular doc, or in my case, my PCM, should be the quarterback of your health care team.  Sie should be the one on the field, aware of all the other team’s members (your symptoms, labs, tests, etc.), the plays your team have available (medications, treatments, therapies you are trying/have tried), the other team members (other docs and lab techs), as well as the special teams coaches available (specialists).  The quarterback should be able to run the plays and call audibles as needed, because the quarterback presumably knows the team, is comfortable with the team and the plays, and has been doing this a while.

But if you are playing on a military team your quarterback gets traded.  A lot.  Often without you even knowing, in the dark of the night like Jon Gruden to the Buccaneers.

Read the rest here.

Enjoy!

Photo of the Day

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Representative John Lewis of Georgia speaking at the Washtenaw County Democratic Party’s Annual Dinner about how health care is in fact a civil right.  I have nothing else intelligent to offer, just that this picture of a man who has been beaten, and jailed over 40 times for his views and actions concerning civil rights, speaking on behalf of health care as a civil right blew me away.  Humbled me, a little, actually.

Photo by Anne Savage.  Story at Eclectablog, via Pam’s House Blend.

I want to live in her fantasy world…

Only on Planet Couler (via Crooks & Liars, click over there to watch the video):

O’Reilly: But every problem wouldn’t go away. The one thing that I would like to see the federal government do is strict oversight on the insurance companies when they hose people. I mean, I don’t think they should be throwing you, Ann Coulter, off the rolls if, God forbid, you get MS or something.

Coulter: That will not happen. But Bill, that will not happen under competition. Look — [Crosstalk] — no, no, let me make this point. No it will not. The government was regulating, the SEC was closely watching Bernie Madoff. Government regulation doesn’t stop that sort of thing. What stops it is, people knowing you’re investing with this guy at your own risk, and then all these private organization develop. Competition is what enforces that.

O’Reilly: Yeah, well, I don’t believe that. I think competition can drive the prices down, but it cannot make an insurance company honest. Only a federal oversight committee that says if you don’t do it, we fine you.

Coulter: Yes it can. Yes it can. Otherwise, what about the SEC with Bernie Madoff?

O’Reilly: No, Bernie Madoff got away with it because the SEC, under a Republican, Christopher Cox, simply wouldn’t investigate him. That’s why he got away with it.

Coulter: That’s the government regulation! Why do you keep thinking a different regulator will be better? Government regulation does not solve these problems, competition does.

Because if I belonged to a health-insurance company that threw me off when I got sick, people would hear about it. There would be magazine articles. And I don’t mean to be me, I mean people —

I don’t suppose she’s heard of a Congressman named Bart Stupak?  Who deals w/ insurance companies doing this very thing to literally thousands of people every day?  She is either a moron or intentionally obtuse.

I want whatever she’s drinking.

The Pain of House

house-caduceus_lI am a pop-culture junkie.  If you have been playing along at home long enough this is common knowledge.  I have been a big fan of House, M.D. since it’s poorly lit pilot.  I am simultaneously appalled and amused by his crass behavior.  Even the best feminist in me laughs and fairly inappropriate moments.

I have seen and read plenty of critques concerning Dr. House and his manner.  I have chewed out my share of doctors for acting like him as if it makes them seem clever.  He is a character that is worth critiquing on many levels and for many reasons from many points of view.

What I haven’t seen is a lot of criticism of the characters assembled around House.  From Dr. Wilson, or Dr. Cuddy, or the myriad staff members he has had around him (yes, even Dr. Cameron-Chase) I have watched for nigh on five seasons now as all of the people who claim to care about him have done little more than chastize and concern troll his life.  Most notably, his addiction to Vicodin and his chosen method of pain management. (more…)

5 docs, 3 years, 2 psychs, 1 day in the life of…

Moderatrix’ note:  I wrote this on 16 November, 2008.  For some reason I thought I had written it here and I did not.  I am sharing it now, because I want to show how disability and medical care intersect with Military and Veteran’s issues.  Something I want to bring attention to is just how difficult it is to get continuity of care as a Veteran, and the challenges involved in getting disability from the Military or the VA.  If I had a way to work in the system to improve it I would take the opportunity.  For now, I will work on bringing awareness to the topic.

Thursday I met w/ a new Primary Care Manager.

This is my fifth official PCM in about three years. I have also had several other general practitioners b/c each of those PCMs was either retiring, deployed, or otherwise unable to treat me. The most I have seen any of them is about five times. I have also in that same amount of time been seen by two Psychologists, one Psychiatrist (b/c it’s all in my head, yo!), a Chiropractor/Kinesiologist, a Physical Therapist, two Neurologists, a Rheumatologist, and a Dietitian (b/c if only I wasn’t a big fatty I would feel better!).

I have been on Vicodin, Oxycodone, and at least three other narcotics over the last three years, no less than five sleeping medications, two allergy meds (for inexplicable rashes), three different anti-depressants, two anti-convulsants, any analgesic that is available, and five medications that hadn’t been available for more than a month.

I have been over medicated, under medicated, drugged out of my mind to the point where taking all of the pills in my cupboard sounded like a good idea (but I didn’t, I flushed them and got help instead), tried herbal remedies, vitamins, supplements, diets, and countless other suggestions. I have tried hypnotherapy, electroshock therapy, heat therapy, cold therapy, and physical therapy.

(more…)

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