What I want my children to see.

Have you heard about the sanctimommy?  It is a lovely species that inhabits the internet, mainly frequenting Facebook, various mommy blogs and parenting forums.  A sanctimommy is a mother who is doing it all better than everyone else.  Never fear, no matter what you're doing, she's doing it better.  More than anything else, sanctimommies are sad.  Why? Because their hearts are breaking for all the children who don't have it as good as theirs.  Tears well up in their eyes when they see a mom on her phone instead of hanging on her child's every action.  When they see a toddler tantruming in the grocery store, their arms ache to hold that neglected child.  When they see an infant being fed formula, they want to shove their own breast into the baby's mouth, rather then see it take in toxic "imitation breast milk." They shame women who work outside the home by saying that their children are being raised by other people.

You get the picture.

A post I read today was a fine example.  The title is "What Our Children Want Us to See," from the Hands Free Mama Blog.  In it, the author recalls, in rather hyperbolic terms, how when she was a teacher a child once told her that he wished she was his mom.  The reasons aren't that clear- apparently he said that he just wanted his mom "to see me."  Well, that's a rather deep and existential statement from a child.  Of course, her eyes fill with tears and she has to swallow past that lump in her throat as she tries with all her might to give that child everything that she assumes is lacking from his own mother.  She then goes into a litany of things that we should "see" about our wonderful, special children.

After reading the post, I could no longer see, because my eyes had rolled too far back in my head.   I'm blown away by the idea that anyone who actually has kids can take a statement like, "I wish you were my mommy" seriously.  Kids say stuff like that and it means nothing.  Not long ago, my son told me that he wanted to live with his friend's family from now on.  Why?  Was it because I don't "see" him?  No.  It's because his friend has a trampoline.  Kids say stupid stuff.  All. The. Time.  Get over yourself, Hands Free Mama.

So, here is what I want my children to see.

I want them to see that the world is a big place, filled with billions of individuals.  Most of those people will approach life differently from them.  Learn from them- don't judge them.

I want them to see that they've been born into a privileged life in a privileged country.  This does not give them the right to project their values onto others.

I want them to see that while they are the most important thing in my life, they are not the center of the universe.

I want my boys to see, and learn, that a woman's worth is determined by more than motherhood.

I want my children to see that it really does take a village, and they need to be a part of their community.


We're all just doing the best we can.  It's time to stop judging others.

Odd Stock Photo Choices

I have informational brochures in my exam rooms.  They are about common medical conditions, and they are put out by this company.  Overall, I think they're pretty good.  The information in them is accurate and easy to understand.  My patients seem to find them helpful.  I do, however, find the cover art of the brochures to be amusing.  Take this one, for example.

That guy looks awfully happy for someone suffering from gout.  Here's a picture of acute gouty arthritis:

Now, does that look like something to smile about?  I didn't think so.

How about this one?

Again, that is not what a child with an allergic emergency looks like.  A child with an allergic emergency looks like this:

And what is up with the picture on the bottom of the brochure?  Here's a close up:

What is that? Is it a bunch of kids trying to hit a piñata?  What does that have to do with allergies?  My office manager and I were trying to figure it out.  His suggestion was that maybe they were swatting at a beehive instead of a piñata.  I thought that perhaps the piñata was filled with allergenic peanuts and shellfish.

Anyway, this is my favorite:

Yup.  The face of chronic constipation, right there.  Happy, joyful, not a care in the world!

Boy, it's a good thing I went into medicine and not marketing.  The photos I would have chosen for chronic constipation would look nothing like that.

Oh, Joy.

I've written before about how I'm in the process of re-certifying my Internal Medicine Board Certification.  This exciting process has taken about 18 months, and it culminates next week when I take my exam.  The entire process has pretty much been a pain in the ass, and an expensive one at that, costing $1675.00.  That doesn't include review materials and the review course that I took.

One of the things that has kept me going through this process was the thought that it would be 10 long years before I had to do this again.

Until I checked my email this morning and read this email, with the subject line, "Coming in 2014: Important Changes to ABIM's MOC Program." My morning was instantly ruined.

Here are the important changes: basically, maintenance of certification is now going to have to be done on a yearly basis.  A certain amount of points will have to be earned every year.  The exam is still every 10 years.

Why are these changes being made?  Well, the Board claims it will help us "keep pace with the changes in the science of medicine."  Whatever.  I can firmly say, on the cusp of completing my most recent MOC, that it served no value to my knowledge base whatsoever.  I already have to do 50 hours of continuing medical education a year to keep my license, and in reality I do much more than that.  This is just busy work.  Oh, I get to pay $200 a year for the privilege of doing it.

Here's my opinion of the real reason.

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

There are roughly 250,000 ABIM diplomates.  Let's say that 10% a year do MOC under the current requirements (probably a good estimate, since you have to re-certify every 10 years).  At $1675 a pop, that's $41 million a year in MOC income.

Now let's charge all 250,000 ABIM diplomates $200/year for MOC.  That's an even $50 million.  Oh, look.  The ABIM just increased its bottom line by almost $10 million per year.  Just like that.  Over a 10 year cycle, they're up $100 million.

I wish I could make money by just changing the rules on people.

So, in summary, all I have to say to the ABIM is, "You suck.  Really.  Thanks for NOTHING."

AMA- Get out of my mailbox!

I'm not a member of the American Medical Association.  Never have been.  And I have no intention of joining.  Apparently I'm in good company- only about 25% of physicians belong to the organization.

I have multiple reasons for this.  The AMA, at its core, is really nothing more than a political lobbying group.  It exists to protect the interests of doctors.  That being said, their interests really don't align with mine.  The AMA is incredibly geared towards specialists.  They created the RUC, which works with the Center for Medicare Services to determine payment to physicians.  The majority of RUC members represent specialties, rather than primary care, and very few will argue that it is not responsible for the huge disparity in payment.  I'll take it a step further and say that we probably can thank the RUC and, by extension, the AMA, for contributing to the shortage of primary care physicians in the USA and the huge amount that we spend on healthcare.

Anyway, it is particularly galling to me that every month I get this in my mailbox:

Looks like a bill, right?  Even what's inside looks like a bill, at first.

Yeah, that's right.  These bozos want $420.00.  Sure.  I'll get right on it.  For good measure, they send me one at home, too.

It does such a good imitation of being a bill that my husband actually tried to pay it once...which is exactly what I think the good folks at the AMA are hoping will happen.  Luckily, I caught him before he mailed out the check.

If you look at what else is in the envelope, it becomes a little more clear.

OMG!  I can get a FREE subscription (valued at $250!!!) to JAMA if I join????  Oh, now I'm sold.  Except...this also came in the mail today.

Yeah, it's a copy of JAMA.  It comes every month, clogging up my mailbox.  I don't read it.  I get a great journal summary every month that I read instead.  I never subscribed to JAMA, yet they continue to send it to me.  Every. Week.  For the past 10 years.  That's over 500 magazines that I never asked for or wanted.  I've tried to get them to stop sending it.  No luck.

What's even more ironic is this leaflet attached to the cover of the magazine.

Renew today or they'll cut you off!!!!  Don't delay!!!  If only.  I never send the card back.  And yet, like clockwork, the cycle starts again the next month.

Sigh.

I think that $420 a year probably goes to postal charges.

Beacon Runners 2013

It's that time of year again.  The 9th season of the Beacon Runners is about to get started.

For the initiated- I started the Beacon Runners in 2005 as a way to encourage my patients to start exercising.  It's grown over the years...

2005

2012

Anyone is welcome to join- man, woman, child, dog.  All abilities are welcome- we've got an appropriate level for you, I promise.

The goal of the program is to complete a 5K race in May.

Group workouts are Saturdays at 9AM at the Red Hook Brewery and Tuesdays at 6PM at Jenness Beach.

See you there!

Watch an Insurance Company Try To Drive Me Insane- Algebra Edition

Wow.  Express Scripts/Medco must really HATE people who have herpes.  This is the second post in a row about trying to get proper treatment for this condition.  This time I wrote a prescription for acyclovir, a generic anti-viral.  The correct dose for suppression of herpes is 400mg twice a day.  That's what I wrote for.

Of course, they asked me to fill out a prior approval form for it.  Now, please note, acyclovir is CHEAP.  It's like, $30 a month cash.  It's the cheapest option for treatment.  But, again, like a good little soldier, I filled out their form.  And got back this:

Ok.  First of all, who the HELL figures out dosages like this?  80,000 mg of acyclovir every three months?  What????  So, I did a couple of quick calculations in my head.

400 mg x twice a day = 800 mg/day.  800 mg/day x 90 days = 72,000 mg.

So, this is what I sent back to them.

It'll be interesting to see what they say.  

Also:

80,000 mg per 90 days = 888 mg/day.  Acyclovir comes in 200, 400 and 800 mg tablets.  How do they expect anyone to take 888 mg/day?

Watch an Insurance Company Try to Drive Me Insane, Again

As you may or may not know, Express Scripts and Medco merged last year.  What are Express Scripts and Medco?  They are what's known as Pharmacy Benefits Management companies (PBMs).  Basically, they are a third party that processes prescription claims.  They are the ones who create the charming prior approval forms that I'm always complaining about.

Anyway, two of the largest companies, Express Scripts and Medco, merged. They made sure to reassure customers that they would continue to "receive the high-quality care you expect."  Well, my expectations were pretty damn low, and I'm happy to report that the newly merged company has more than met them.

Oh, I hope you enjoy my new Post-It notes that I've used to block out identifying information.  They eloquently express my feelings.

This saga started on January 8, when I received a PA form for valacyclovir, an anti-viral medication that is generic.

On January 10, I received a letter from Medco, stating that the PA was not even needed.  Please note, THE PATIENT HAD ALREADY PICKED UP THE MEDICATION ON JANUARY 8, THE SAME DAY I WAS MADE TO FILL OUT THE DAMN FORM IN THE FIRST PLACE.

Then the patient's pharmacy (CVS) called me asking, "Where the hell is the PA for this patient's medication?" despite the fact that they HAD ALREADY DISPENSED THE MEDICATION TO HER!

I faxed them the form form back saying that no PA was needed and faxed a copy of the letter to them.  They apparently didn't really care, because they sent me another request for a PA on February 5.

I faxed them a copy of the letter again.

Then, today, I received another PA from Express Scripts for the medication!  Two months into this saga.  Like a good little soldier, I filled it out again.

After I filled it out today (since I received it today), I got this fax, sent today but dated yesterday.

Apparently, they are unable to approve the medication that they have already approved.  Why not? Because apparently my evil twin withdrew the PA request.  So, Medco tells me it's not needed, Express scripts tells me it is, and hours of time are wasted.

Read what Express Scripts had to say in their press release about the merger:

"Our merger is exactly what the country needs now," said George Paz, chairman and chief executive officer, Express Scripts. "It represents the next chapter of our mission to lower costs, drive out waste in healthcare and improve patient health. We remain focused on formulary management, channel management and closing gaps in care, which will allow us to further improve the health of people with chronic and complex medical conditions.

Yup.  Tell me another one.

I can't wait to see what's waiting on the fax for me on Monday.