Recently there was article being linked to on Facebook by a few of my coworkers titled “Patient Satisfaction is Overrated” written by Dr. William Sonnenberg. Here’s a link to the article. A few years ago we were called to staff meeting and some changes being made to how Medicare reimburses hospitals and doctors were explained to us. Basically, Medicare is now holding back a portion of what they would normally pay to a hospital or physician for a certain hospital stay or procedure. The hospital or doctor can then earn back that percentage of payment by having high/good patient satisfaction scores. The reasoning is that Medicare wants hospitals and physicians to provide not just mediocre, decent care but quality care. They want health care providers to not just do their job, but to do it well. I can understand that reasoning and in theory completely agree. Hospitals and doctors who skate by and provide just the minimum level of quality of care considered adequate should be told they need to improve. But as with many theories, putting it into practice has a few problems. The biggest ones were hit on perfectly by the author of this article. By being essentially forced to bend over backwards to give the patient exactly what they want and keep them happy, we’re not always giving them the best care we can. Sometimes not even the appropriate care they need, in the case of overprescribing antibiotics when they’re not necessary. It ends up putting the emphasis in the wrong place. It takes the emphasis away from patient teaching and preventative medicine and places it on what amounts to customer satisfaction. While listening to our patients and their needs is definitely a positive thing, making what they think they want and are asking for such a priority is not. It ends up creating frustration in doctors, nurses, and others directly involved in patient care. I’ve seen changes come and go over my years as a nurse. I hope this change goes… the sooner the better.
I have a guilty pleasure when it comes to television… True crime shows! I find them fascinating for one simple reason. As Mark Twain said, “truth is stranger than fiction.” Watching these shows, I realize just how very true that is. I could not possibly make up some of the stories I’ve seen profiled on these shows. (Maybe all that proves is I should stick to being a nurse and not a novelist.) At work I also get to see this statement proved correct. A few coworkers and I were recently discussing the fact that if the general public was told some of the stories about what we see and do and hear in a shift, they would think we were making it up. Things patients do and say are sometimes almost unbelievable, and probably wouldn’t be believed by the general public. There happen to be some pretty significant laws in place to protect patient privacy that prevent us from sharing these stories, but trust me when I say these stories are sometimes sad, sometimes funny, sometimes shocking, and always interesting. Just one more thing I love about being a nurse! There is truly never a dull moment.
Oliver meows like he’s going to visit an executioner when I have to take him to the vet… or to the groomer. But every single vet or groomer visit, they tell me what a well behaved cat he is for them. Once his vet called him her best behaved patient all day. The office vet tech tells me “We love him here.” What’s puzzling about that is he is NOT as well behaved at home. Nope. Recently I had to give him a pill a day for a month. I lived with scratches on my hands and forearms for a month straight. Try to trim his claws? He cries and fights and acts like I’m trying to torture him. So why, exactly, is he so well behaved for others? At his last vet visit, his vet and I discussed that. My theory is that it’s similar to the concept that toddlers will act up for mom and dad more so than for other people caring for them because mom and dad are “safe.” (I know that’s a huge generalization, but let’s just go with it…) They can act up and know that mom and dad will still love them. Could he know I offer him safety and he can act up with me and I’ll still love him? Or am I giving a cat far too much credit? Hard to know for sure, of course, but his vet thought I might be onto something.
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A shot of mom’s fish pond I took a few weeks ago… Can’t believe how big the koi are getting! She’s had them for several years now and takes great care of them.
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So, I’m sitting at home today not feeling well and bored out of my mind so I was just perusing some websites to kill some time. I came across a link on aol.com that caught my attention… a link to an article titled Why Does the U.S. Overspend on Health Care? One Simple Reason. (Here’s the link to the article should you want to read it yourself: http://www.dailyfinance.com/2013/10/19/health-care-why-america-overspends/) As a nurse, I am interested in different observations and opinions about our health care system. So, of course, I wanted to read the article. And it was definitely interesting. In a nutshell, the author theorizes that the amount of money we spend on end of life care, trying to buy a patient more time when they are going to die in a matter of a short time anyway, is how and why we’re overspending on health care. He writes “The U.K.’s National Health Service, for instance, is known to practice “denials of costly treatments for life-threatening diseases” toward the end of patient lifespans — a decision necessitated by “resource constraints.” But that’s not necessarily a bad thing.” I’ve worked with dying cancer patients, dying patients who’ve had terribly debilitating strokes. And yes, sometimes the aggressive treatment the medical community uses to prolong their lives is futile. They are going to die with or without the treatment; it’s just a matter of how soon. And sometimes that probably isn’t the best use of our resources and health care dollars. Sure, it’s easy for me to sit here saying that as it’s not my family member or loved one we’re talking about. I guess I’m saying, in theory, I understand and even agree with what the author of the article is saying. But I’m admitting I may very well feel differently if it were my family member or loved one we were discussing treating aggressively. I think the ethical problem that comes into play is already touched on when it comes to organ transplants. We only have so many resources to go around and who exactly gets to make the decisions about how those resources are allocated? Who gets to make the final decision about when a patient should be denied costly/aggressive treatments towards the end of their life? (That’s provided we know the patient’s wishes and they would want the treatment, of course. Otherwise it’s a moot point.) Those are the kinds of decisions that are incredibly delicate ethically speaking and letting the wrong people make them could be a very slippery slope. But who, exactly, are the “right” people? Not an easy question to answer at all.
In speaking to a friend (a U.K. citizen) about this article I was informed that the U.K. National Health Care System is very focused on preventative medicine and treatment of diseases rather than maintenance. That focus makes sense on many levels. First of all, it makes fiscal sense. It’s much cheaper in the long run to prevent a disease than to treat, cure, or manage it. And it just makes for a healthier society to prevent diseases so they’re not spread through the society. I don’t necessarily know if I think a national health care system is the right answer for the U.S.; but I do think there are some positive things about having one in place.
Recently I had the opportunity to spend a week visiting and working at Deborah’s House. That is a shelter for women and children coming from domestic violence situations located in Tijuana. I want to share with you the biggest lesson I brought home with me from that trip. I have a new definition of the word strong now, of what it means to be strong. The women staying there have suffered violent, horrific, awful circumstances. I don’t know many specific details of their stories, but I do know enough that the circumstances they’ve come from are unimaginable to a caucasian woman from the U.S. with a middle class upbringing like mine. The fact they’ve lived through these circumstances is testament enough to their strength, but they’ve gone on to survive those circumstances by coming to Deborah’s House and learning to make a better life for themselves and their children. Some inner strength gave them the power to keep the hope alive that they could have a better life. I can only begin to guess at the amount of strength that takes. And they don’t even realize just how strong they are. They probably also don’t know that they will forever now define that word for me. But they will.
For a variety of reasons, I’ve been a bit introspective yesterday and today. That lead me to do some searching online for Turner Syndrome forums and message boards. The literally dozens of comments I came across from women with T.S. talking about never quite feeling like they fit in at school or with groups of coworkers amazed me. I never really felt like I fit in at school… always felt like I was just on the fringe of each clique or group of students. As an adult I’ve felt the same way at work with groups of coworkers. And I just chalked it up to a fairly normal dose of insecurity. But wait a minute… I have every reason to feel a bit different. I DO have something about me that makes me very different than most of the women in the world. I was diagnosed with Turner Syndrome at the age of 13. It only occurs in 1 in 2,000 to 2,500 females. In a nutshell, it’s a chromosomal abnormality that leaves a female with one of their two X chromosome either partially or completely missing. The hallmarks of it are short stature and infertility due to the lack of ovary development. There are also a whole host of other possible symptoms but I’ve been fairly lucky that the only one I have is some hearing loss. Well, that’s what I thought until today. Is it just possible that the feelings of not quite fitting in are part of the T.S.? Very possible, especially if the few dozen women I read comments from online today are any indication. And there have been many times when I’ve had a vague feeling someone just doesn’t really like me, but couldn’t quite put my finger on why I thought that. I couldn’t give any specific example of anything the person had done or said to make me feel that way. And do you know what I read today? On the MayoClinic.com website I read the following listed as a symptom of T.S.: “Difficulty in social situations, such as problems understanding other people’s emotions or reactions.” Wow. There could be an explanation for my feelings other than insecurity? Today is the first time in my life I’ve ever considered T.S. as being a cause of those feelings. It’s definitely an interesting … and refreshing… thing to consider. From the time of diagnosis at age 13 until my mid 20′s my life seemed to be all about the T.S. for the most part. Learning to accept what it meant to me, doctor’s appointments to try to get the hormone replacement therapy doses just right, doctor’s appointments to make sure my heart and kidneys were fine, and so on. But after that, for about the past 20 years, I’ve more or less ignored it. I’ve just accepted it is something I have and will have the rest of my life and there’s no changing it. Now I have 20 years more life experience and wisdom to use to go back and reassess what having this syndrome means to me.
This is my very first crochet pattern… and a very basic, simple one. It’s actually a variation of a pattern my mom came up with for a hooded cowl.
Using a size K hook and medium/worsted weight yarn, loosely chain 165 or 175 stitches, depending on how long you want the scarf to be. You want to chain these loosely so this row is the same length as all the following rows. Slip stitch this chain row together. You can either keep it straight or twisting it if you want a twist in the scarf. Chain 2, double crochet in each stitch around. Slip stitch to 2nd of chain 2, double stitch in each stitch around, and keep repeating until it’s the width you want. If you use a lighter weight yarn, change the chain to chain 1 and use a half double crochet instead of double. I hope this makes sense. Feel free to contact me with any questions.
I first wrote this post on the 5th anniversary of the terrorist attacks on September 11, 2001. I’m reposting it today on the 10th anniversary.
I think every decade or two has an event occur in history that is so momentous that virtually anyone who was alive during that time can tell you exactly where they were when they heard that news. The terrorist attacks on September 11, 2001 were that event in history for the current decade.
I was at work at approximately 6:30 that morning PST in a hospital in Spokane, Washington. I was walking down the hall and glanced into a patient’s room and noticed our charge nurse standing there staring at the television with a stunned expression on her face. This is a nurse who has 30 plus years of experience dealing with life and death situations every day. The fact that whatever was unfolding was stunning her scared me before I even knew what was unfolding. I glanced up at the tv in time to see the second tower of the World Trade Center crash to the ground. As I heard that this was the second tower to fall the charge nurse and I glanced at each other and almost at the same time said “This was no accident.” The patient grabbed my hand and all three of us in the room had tears either in our eyes or streaming down our cheeks. The last hour of that shift until I got off work at 7:30 was the quietest and most somber I’d ever seen the floor I worked on. Staff were concerned about a co-worker of ours who was due to fly back from Boston that morning. Some patients had family and friends in the NYC area and were frantically trying unsuccessfully to reach them. As the day shift staff came in it was apparent right away many of them had been crying recently. At least one staff member was crying as she said she’d tried to reach our co-worker stuck in Boston for the past hour and not been able to reach her cellular phone. All of us expressed feelings of shock and sadness. More that one of us used the word surreal to describe how the whole situation felt. As I left work that morning the news announcer on the radio was announcing it was just becoming clear just how many people were presumed to be dead. I drove home with tears streaming down my face.
Later that morning my mother and I drove to Airway Heights, Washington near Fairchild Air Force Base. The base was locked down, of course. We were approximately three or four miles from the base entrance and within a five minute span saw no less than six local police patrol cars. The fact that the perimeter of the base was being patrolled so closely really made it seem more real to me because that hit so close to home. I went home and cried myself to sleep. I can’t think of a single day in my life when I have shed so many tears in one day. Each year on September 11 I can’t help but remember exactly where I was and how I felt when I heard the tragic news. I imagine that I, like many, many others, will continue to remember that for a very long time.
Several years ago when I was in nursing school I had an experience with an Emergency Room doctor that was less than positive. In fact, it was downright hurtful because of a just plain wrong assumption he made. It was the operating room rotation of school and I was spending half of the term observing in an operating room. I had been watching a surgery standing on a small stool so that I could see over the surgeon’s shoulder. I was fascinated by what I was watching and standing very still… unfortunately, with my knees locked. I stood too still for too long and the circulation to my legs decreased and my blood pressure dropped. Any guesses what came next? Yes, I fainted. I landed flat on the floor and the next thing I knew one of the OR staff members was waking me from my nap. My instructor arrived and I was taken to the ER to have a doctor make sure I was alright. The doctor who came in the exam room to see me wasted no time in jumping to the conclusion that because I was 20 to 30 pounds overweight I must have skipped breakfast and that was what lead to me fainting. And he told me this conclusion he came to not terribly politely at all. I insisted that yes, I know I am overweight and yes, I am attempting to lose weight but I did not skip breakfast. I had, in fact, had a snack of peanutbutter and crackers just before going into the OR to watch the surgery. My instructor and one of the OR staff tried to explain to him that I had been standing with my knees locked on that stool for at least an hour. He chose to completely ignore the perfectly valid physiological reason for my blood pressure to drop. Instead he continued to harp on the issue of my weight. I remember being very angry, hurt, and offended. I shed a few tears of anger, hurt, and humiliation later that day. But now I’ll share the humorous part of this story. Before our OR rotation the instructor had told all of the students that if we were going to faint, do not fall into the sterile field. Very sage advice. Well, my first words to her after I was awakened was “I didn’t fall into the sterile field!” She got a grin on her face and began to chuckle at that.