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.
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.
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.
So, it’s been 7 months now since my diagnosis. And boy, has my life changed. But for the better. Absolutely for the better. I’m healthier and stronger feeling than I’ve been in years. I’m down to a weight I haven’t been in eight years, at least. I can’t seem to stop bragging to my friends and family about my weight loss. I’ve lost 40 lbs and am only 2 lbs away from my BMI going down from the “obese” category to the “overweight” category. I do still have about 30 to 35 more lbs to lose, but since I’m already over halfway there the rest is all downhill from here. That does not mean I’m getting complacent at all. I’m eating better than ever and doing great with my regular exercise. In fact, this week I increased my number of workouts from 4 days to 5. I whine a bit (ok, a lot) and drag my feet about working out, but I’m always so glad when I do it… It just feels so good afterwards! Sure, my main reason for doing it is to make those insulin receptors more sensitive and help control my blood sugar. But the fact I’m losing a decent amount of weight while I’m at it is certainly a nice bonus. My blood sugars have been in great control and at my last doctor’s appointment she even let me cut back my oral diabetic med from twice a day to once. I’m feeling pretty confident right now about my health, my body, and my ability to stay on top of this disease. That doesn’t mean I’m going to get lazy about it. I know I need to work hard every minute of every day to stay on top of it. But I’m feeling like it is doable. I can do this! I may not want to, but I can. And it turns out that this nasty disease has actually been a blessing in disguise. Without it, who knows when I would have found the motivation I needed to make the lifestyle changes I needed to.
If it’s possible to have a perfect day, today has been one. In so many ways and on so many levels. Where to start? I went hiking this morning up a butte near my house. It’s about 2,500 feet high and really beautiful. A year .. and 35 lbs… ago I attempted this butte and made it halfway up before I had turn around and come back down because I was too short of breath to continue. Today I went 3/4 of the way up before I chickened out and turned around and came back down because the trail was too muddy. It’s a very steep trail. But 3/4 of the way up I wasn’t short of breath at all! What an improvement over a year ago. And then the sun continued to shine instead of the rain starting which had been forecasted. And I found some new sweats that are ridiculously soft and comfortable. And I’ve been eating good food choices all day … which has kept my blood sugar absolutely perfect all day long. This evening I’m going to hang out with my oldest niece. That should be a fabulous way to end a perfect day. I’m just feeling so happy and healthy today that I wanted to share that. :)
Diabetes sucks. That is a fact. I have diabetes. Also a fact. And lately that’s really been bothering me… frustrating me… making me mourn the days I could eat whatever I wanted whenever I wanted without having to give a single thought to my food consumption. Those days are gone… and ain’t never coming back. What is also a fact is that it is in my power how I choose to deal with this. I can choose to be in denial, eat poor food choices, and eventually (probably sooner rather than later) have to pay the price for that. But as a nurse, I’ve seen up close the price that not controlling your blood sugar costs. And that is one high price. I’m not willing to pay it. So, that only leaves doing the best I can to control my blood sugar. That is what I am choosing to do. It’s helping me to think of it in terms of it being my choice rather than something I’m being forced to do. Just ask my mom… I don’t particularly like being told what to do. :) Speaking of my mom, I had an interesting conversation with her the other morning that was probably more helpful than she realized. I was venting about not being able to eat whatever I want, whenever I want. She said “So, do it.” I replied something to the effect that that’s just not an option if I want to stay healthy. So she pointed out the only option left is to accept it. My mom really does have a way of getting to point. She wasn’t being cruel or unkind. She was helping me see I do have a choice. So I’m feeling a renewed motivation to make good food choices. This morning my fasting blood sugar was 95 (and that was after only 2 hours of sleep in the past 24 hours) and after I ate my healthy breakfast my blood sugar was only 101. So I was pleased about that. I’m back to feeling like I really can get the hang of this. It’s also helped to think of terms of nothing being completely verboten. I can still eat any thing I want. It’s the portion I need to change. I just need to fit it into my total carbs for the day. That’s helped me not feel so restricted. And I realized I need to give myself time. It’s been 5 months since my diagnosis. This is a lifelong disease. It’s ok to have up and down days… as long as I move on from the down days and learn from them. So that’s what I’m trying to do. Today is Easter and it’s fitting that I’m feeling this way today. Easter, to me, has always meant a time of renewal and fresh starts. I wish you all a blessed and Happy Easter and thank you for listening to my rambling, as always.
So, several people at work who see me frequently have mentioned I really look like I’ve lost a lot of weight. Always nice to hear, of course. And a few weeks ago I did go buy some new scrubs for work in 2 sizes smaller than I was wearing. That felt amazing. I called my mom as I was walking out of the store and I was giggling in delight as I told her about it. The last time I weighed myself a few days ago I’m down 33 pounds since my initial diagnosis of diabetes on November 3rd… so in not quite 5 months. I’m only 4′ 10″ so that 33 pounds really does make a difference. I went through my closet this evening and realized that practically none of my clothes fit me anymore! Except for the scrubs I bought for work recently, all of my clothes are TOO BIG! It feels absolutely wonderful to see the weight loss in real terms. Since I see myself in the mirror every day, it’s hard to see it come off slowly. But now that it’s enough to notice and to have my clothes not fit, it feels terrific! I’m even considering having my picture re-taken for my name badge at work… I have about another 30 pounds to lose so I don’t want to go spend a lot of money on clothes that aren’t going to fit me in another 5 months or so. So I’m thinking over the next few days off work I will go make the rounds of second-hand stores in town. I expect to have to dig through a lot of stuff I would never wear but I should be able to find some great deals, too. This is fun! And it’s amazing how good I feel. My energy level is better than ever and I feel healthy and am sleeping well and just feel good. I like this feeling and plan to keep doing the right things to keep feeling this way. I’m feeling very motivated at the moment. :)
I read a news article recently about a study conducted by the National Institutes of Health regarding weight loss. They proclaimed the “key” to weight loss is… wait for it… here it comes… cutting calories and getting exercise! Well, DUH! I’ve said for years now that weight loss isn’t magic. It boils down to simple math. Burn more calories than you take in. And now a study conducted by a reputable organization has proven me right. Don’t I feel special? The part I find most laughable (or sad, maybe… pick one) is that grant money was spent and time spent to determine a “key” to weight loss that is simply common sense. Does this seem like a waste of resources to anyone other than me? Let’s research a cure for cancer or diabetes, or research ways to clean our environment and keep it that way. Those would be more worthy causes to use the resources on. Sure, obesity is a huge problem in our society. (Yes, pun fully intended.) It costs us hundreds of thousands of health care dollars to care for the many chronic health issues associated with obesity. I’m not diminishing the severity of the issue. I’m just saying it’s pretty much common sense to figure out that eating less and getting more exercise is going to take bring weight off. Yet someone felt the need to spend who knows how much money and manpower proving this? That just seems like reinventing the wheel… in other words, completely unnecessary.
I was embarrassed today to discover just how out of shape I am. I went to a local hiking trail near my house to walk. I had my new camera with me and wanted to go to the summit of the butte to get some photos. From the bottom of the trail at the parking area to the summit is only 0.6 miles… not so far at all, really. But it’s steep. I mean REALLY steep. Add that to the fact I hadn’t eaten anything in at least 12 hrs and… well… I didn’t make it to the top. I made it about 2/3 of the way and turned around and came back down the trail. I’ll try it again in a few more days and make sure my body has fuel before I go. And hopefully then I’ll have some pictures to show you. For now I just have this shot I took along the trail. It’s one of my first shots with my new picturer and I was pleased with it.