her particular injury is a foot injury
I've been relatively healthy my whole life, so maybe I lack perspective. But persistent, chronic foot pain has far greater impacts than "can't go running," especially when you have to walk a couple of miles a day just for commuting purposes.
No, she specifically states that her injury is not super intrusive but she really misses being able to go running.
She also says she's in pain when walking her dog, which sounds intrusive since an un-walked dog will shit on the floor.
Second and more petty: this tone of surprise is invading everything and it's driving me crazy.
I hate that. It's the "act like you are learning along with the reader" pose. You see it a lot in science popularizations, too. The writer pretends they had the same common misconception they think the reader has, even if they have been reporting or researching this topic for decades.
Isn't the "surprised" tone the audio counterpart to the rhetorical devices of the Internet: e.g., the "I am not asserting this proposition with off-putting or arrogant confidence" question mark? That is, a prophylactic abdication of authority, superiority and/or knowledge. "I dunno, man. It's a crazy world, but did you hear about Donald Trump donating to this guy's campaign in Texas? Isn't that a #goodgovernment #fail? #squadgoals #onlyGodcanjudgeme"
4: You wouldn't like statistics instruction. They always teach three wrong ways to do something before teaching the right way. I figure about 95% of the time, the third wrong way is close enough.
I'm sort of taken aback by how her explanations of what would make life easier for her seem easy to generalize. Here, computer access isn't ubiquitous among the poor and neither are smartphones, so putting everything on the web is not necessarily more helpful than having things faxed around to people whose current plan has to be to show up in an office and wait or spend hours on the phone (ask me how I know!) to get care for themselves or their children. Part of the argument is that if this is how hard it is for people on the top of a system we already know is tiered and weighted, the bottom must be far worse.
4: Great minds. Great, cynical minds.
I was lucky that when I was navigating the system for my back injury I had my wife handling all that. Going through a complicated set of procedures without a wingman is hard. I managed to do it when I re-injured my back after the divorce, but the difference in my experience as a patient was striking.
It also seems to me that better coordination would reduce costs as well as improving outcomes and generally being the right thing to do. Perhaps there is a role for someone with appropriate training to be patient advocate and handle all that crap with a knowledge of how the system works. I'm willing to bet that the cost of the patient advocate would be covered by savings in efficiency. Even if it isn't it's still good for the patient.
I wonder if a patient advocate wouldn't just become another layer of administration for the patient to deal with. They have to be paid somehow and the whole issue of who pays for what is causing most of these problems.
10 -- What I didn't realise was that in America, they have to pay for their own doctors!
I mean, ideally "patient advocate" should be your GP!
Also:
Health Care Foot Print
The burden placed on patients is a huge impediment to actually getting people back on their feet again
I am disappointed by this because I feel sure you could have managed more than just two puns in this writeup.
this tone of surprise is invading everything and it's driving me crazy hopping mad, for example.
This is yet another argument for single payer vel sim. that doesn't gt enough airtime. In systems like the NHS you don't have to do this shit: the system does it for you once you're in it.
Does the article talk about "health care concierges"? Because that's a thing now, both within some health care orgs and as private businesses. An old friend of mine was starting one up last time I talked to her.
She also says she's in pain when walking her dog, which sounds intrusive since an un-walked dog will shit on the floor.
Oh, fair enough. I read the article a few days ago. Still, it's not like she felt too shitty to sit on the phone for a few hours.
12 provides the kind of constructive criticism that can help all of us be better posters and commenters.
Meanwhile, another example of the insanity of the system: I had PT for wonky knees this winter, all in-system for my insurance. Fees were minimal and reasonable; I have no complaints on that front. But in looking at the Explanation of Benefits, I see the "real" costs (which are of course inflated, and which nobody pays except for poor, uninsured suckers). And what's hilarious is that some of them were requested to be reduced, and then the request was refused, but I still didn't have to pay. That is, the right hand asked the left hand for $600, the left hand offered $400, but the right hand insisted on $600, which the left hand then paid. AFAICT it's all just balance sheet nonsense.
Charitably read, surprise can be a way to express moral outrage when the genuine article would be gatekept as shrill or opinionated.
I think there are a couple of different issues here. The first is just the set administrative set of burdens that are avoidable. Even after that is removed, you will still have some people whose health care is extraordinarily complex and those people will be more likely to be the people least able to to deal with that kind of stress/complexity. I think my dad could write a treatise on Medicare Part D and haven't the slightest idea how to manage if he ever can't do that.
OP/4 seem pretty dead on to me: it's especially annoying in this case when almost everyone has had to deal with some version of this problem at some point or other* even if it was a minor one (except, I guess, people who just plain don't go to the doctor at all, or have somehow managed to have the same doctor their entire lives). What she was really doing was talking about how quickly the problem escalates and how easily it can get to the point where people just decide not to bother with medicine at all. None of that required acting surprised about it, though.
Everyone saying that this is the sort of thing that could be easily addressed by not letting insurance companies design your medical system is right, too. But that's the conclusion of like 90% of stories about problems with medical care in the US.
*In my case "Look I need you to refer me to them before I go to my appointment and yes they do f***ing exist because I have an appointment. That one ended with me just giving up and going to a different clinic entirely.
Also I think she said the pain was pretty variable, so sometimes walking a mile or so would be difficult to impossible but a lot of the time it was somewhere between fine and annoying. I'm not sure if that makes it more or less of a problem, though. Unpredictability is really, really annoying if you have to plan anything ahead of time, even when it's as little as "then after work I'll still have time to walk to the liquor store" or something.
Doctors hate people presenting with unpredictable symptoms too. Makes testing much harder. Sometimes they basically give up in despair.
Second and more petty: this tone of surprise is invading everything and it's driving me crazy.
I hate that. It's the "act like you are learning along with the reader" pose. You see it a lot in science popularizations, too. The writer pretends they had the same common misconception they think the reader has, even if they have been reporting or researching this topic for decades.
I do not have words enough to explain how irritating I find this. It's one of many reasons I can't endure NPR, but it's certainly not unique to there.
I think it's because it's so unbelievably condescending. "We think you're too stupid and insecure to keep listening to this story if it turns out the reporter already knows something you don't, so we'll force her to pretend she doesn't." ARGGGGGGHHHHHHHHH.
(Hi from enlightened topless Europe, by the way, where I am unaccountably amused that the hotel mistranslated the brochure as "Swimsuits not permitted" instead of "not required" after 10am. Regardless, I am not swimming.)
I mean, all her gripes and medical issues are completely legitimate. But she should have included people whose illnesses interfere with their ability to coordinate their care.
AIMHMHB, one of the huge reliefs of my cancer experience was that, for the most part, I didn't have to deal with this. My doctors, who were all in different practices, coordinated everything amongst themselves. They handled my insurance company for roughly 90% of everything. I wasn't expecting that at all, and I can't overstate what a relief it was.
"Swimsuits not permitted"
In the dining room? If in the pool, what do they envisage you wearing after 10 am? I don't know any bit of Europe that's that enlightened, even if they did mean 'required'.
23: A friend just ended a roughly 5 year attempt to find out what is wrong with her thanks to presenting with really weird and ambiguous symptoms. Her experience with doctors was horrible. Turns out she has a syndrome that's very rare (47 diagnoses last year in the US), which is similar to AIDS but without the HIV - it's one of the things AIDS denialists point to as evidence of HIV not causing AIDS. Her symptoms were weird because she was getting infections a good immune system would wipe out before they got anywhere.
27, 29: No, the "Wellness Center," which I have to assume is basically a pool+spa? (I only visited that floor one time when I was trying to find a place to do yoga and all of the doors were locked then).
Regardless, I have been people-watching looking at Dutch Masters and listening to a war crimes trial instead. Fun stuff!
I am unaccountably amused that the hotel mistranslated the brochure as "Swimsuits not permitted" instead of "not required"
Everything not compulsory is forbidden!
Maybe it's in the sauna or something?
Crossed with 30. Whose war crimes trial? Gbagbo?
(I should at this point plug the very good "Watchers of the Sky", a documentary about Raphael Lemkin and international law. Rent it now! It won a prize and everything!)
I guess Milošević was never topless in the dock, but some of his shirts were a little revealing.
Quite a lot of the defendants at Nuremberg ended up topless because the first hangman they brought in wasn't very competent and gave them too long a drop.
Latest tale of health care stupidity- kid was having headaches and complained of blurry vision while we were camping this weekend. Called pediatrician, said to take him to hospital to get checked out by eye doctor. Being a Sunday, this means going through the ER even though it wasn't strictly an emergency. So that of course means you wait for hours in the ER until they've dealt with all the real emergencies. Get taken in to exam room only to be told, oh, there's no eye doctor on staff on Sunday, come back later in the week, but we'll do a standard workup now anyway since you're already admitted. Copay: $200.
It was too long. I couldn't finish it. The entitled whining put me of completely. Thorn is right. She should come back when she really does have something to cry about or find someone for whom this is a true issue.
I mean, all her gripes and medical issues are completely legitimate. But she should have included people whose illnesses interfere with their ability to coordinate their care.
Just as a note, while Sarah Kliff is a regular reporter for Vox, that particular piece is published under the Vox "First Person" label -- so it's explicitly flagged as being about her personal experience.
I thought it was good -- there were some moments when the tone didn't work for me, but overall I thought it was a good essay on an important subject.
My wife has been seeking mental health treatment lately - looking for both talk therapy and medication management - and has found this aspect totally dispiriting. Her GP heard some of this, and set her up with our heath system's "patient advocate" to get some of it done... but the advocate just said "oops, my phone isn't working today, sorry" and sent her on her way. Several different practices just turned her down or didn't return her calls. She's finally (after about six months of searching) gone completely out-of-network in order to get any care at all (good thing we have some money), and in short order both the therapist and the psychiatrist she'd found have had personal emergencies and had to cancel several appointments in a row. It is very close to making her give up, which is a bad result for someone with severe depression.
That really sucks - I'm sorry to hear about it. It wouldn't help with the therapist, but if you're pretty certain that the problem is severe depression rather than something else you could try lying to your GP in order to score prescriptions off of them.* (Yes that's unethical. But.) The early stages of medication/treatment for it are relatively standardized at this point, the first line medications are mostly interchangeable, and the biggest benefit to a psychiatrist at that point would be excluding other possible problems (thyroid hormones; undiagnosed bipolar spectrum; etc.). The GP can run tests for thyroid problems pretty easily, though, and the other ones are mostly diagnosed by looking at someone's reactions to the first line treatments.** As unnerving as it sounds "a bunch of internet research" can actually do a decent job here as long as you manage to stay clear of the "anti-depressants are all just placebos pharma is a scam try these herbs!" folks.
* "So I'm seeing a psychiatrist but because they're an (or 'a second level') out of network specialist prescriptions from them won't be covered by my insurance without special application and confirmation from my primary physician anyway, which is like a seven page form that I would have to get from you and fax to them every time I needed to get a refill. The psychiatrist said that normally patients visit them and then just ask their GP to write the prescriptions for them after getting a recommendation. Could we just do that?" I mean, it's not like doctors don't know full well how awful and random insurance companies can be.
**Not, like, subtle ones I mean but "did they suddenly experience a horrific dysphoric (constant anger/anxiety) mania". (That one would probably mean bipolar spectrum.)
If you enjoying lying to your doctor, that's fine. But you should be able to tell your GP the truth about being depressed and get antidepressants.
Maybe - but GPs throwing around antidepressants in cases that don't really warrant them, or even nastier psych drugs is a genuine problem. I mean, this is a case where I'm sort of pro-specialist because a lot of people end up getting SSRI prescriptions for things that they won't help with from GPs when they wouldn't from psychiatrists. But imperfect cases demand imperfect solutions.
If you are lying about seeing a specialist, you get very few of the advantages of specialist care.
Unless you're two-timing your specialist with another specialist. Unh! Double-up unh, unh!
two-timing your specialist with another specialist
Hot.
Oh, she was officially diagnosed with severe depression and has been on meds for a couple of decades now, and has been through six or seven SSRI's and friends. But things have gone downhill recently, and she hasn't been in active therapy, beyond med refills, for several years.
4 seems right, but I wonder if it would be less annoying in cases where the topic is less well known. I mind it less in science pop.
Also, I suspect the writer is dealing with plantar fasciitis so I'm less sympathetic about her woes. A pain, sure, and tricky to fix but Jesus take an Advil and try some stretches and insoles already. You have lots of time to haggle with insurance.
So how bad an idea is it to lie to a therapist or doctor about heavy drinking during depression? The motivation would be to keep from having alcohol issues from taking over the therapy, but it still sounds like a bad idea. I can't help thinking that if you need to lie to your therapist you should find a new one.
Are there ways to find therapists who are cool with heavy drinking? Some sort of yelp guide?
48: I understand that it doesn't really take much time out of your day to deal with medical care for plantar fasciitis. As near as I can tell, medical treatment doesn't work. It's been over two years and I still haven't completely gotten rid of the pain even though I stopped running, stretch daily, and have taken enough Advil to literally* fill one of those foot bath things.
* in a metaphorical sense.
49: A good therapist would not press you if you didn't feel like dealing with it yet? I mean, they might say "It sounds like you're self-medicating, let's look at the underlying triggers" which is maybe less annoying. Do you think you're self-medicating or just a straight-up soak?
Also, I suspect the writer is dealing with plantar fasciitis so I'm less sympathetic about her woes.
She describes the original injury as a stress fracture.
the unhealed stress fracture showed up, bright white, in the blurry [MRI] scan. Still, this is an injury I've had for about five months now. It hadn't turned up on two sets of X-rays.
49: This seems like a moment for some fairly intense introspection about how heavy your drinking is. You're pretty sure that if you don't lie about it, it'll take over the therapy. Are you sure that it shouldn't take over the therapy? That is, is the drinking heavy enough to be an independent problem?
My flip advice is to wonder if you can cut back to a level that you don't think will worry a therapist. If you can, then I would surmise that (a) the drinking isn't an independent problem and (b) the therapist won't freak about it, even if you tell them the truth. If you can't/don't want to cut back that much, then maybe having a therapist focus on it isn't a terrible idea.
49: There are drug interaction issues, so you probably want to be honest enough that you aren't prescribed something that would be contraindicated.
My flip advice is to wonder if you can cut back to a level that you don't think will worry a therapist.
Tangent: I am three weeks into a "dry month" (excluding two glasses of bubbly) and it's crazy how much longer than three weeks it feels. I was concerned that the drinking was turning into a sneaky, unconscious every-night habit and had had good results from breaks in the past. So far so good, even if time crawls, and I'm willing to take the hit to cardiovascular health, which I bet I can offset somehow.
I think if you're candid about not wanting to talk about drinking, or wanting to deal with other stuff first, a good therapist won't push you too hard on it. It is in the nature of psychotherapy to get to the bottom of why you don't want to deal with things, though, so even a good therapist will hassle you about it. That's all in the game. (A bad therapist will do it in a stupid, non-therapeutic way.)
drug interaction issues
Wellbutrin, an excellent drug, is a crazy multiplier for booze, although not 100% predictably. I had a glass of wine and then a cocktail over several hours while on it, and I barely made it out of the bar. So, bottom line: if you can get a prescription for a multiplier-effect drug, you can save money on alcohol and otherwise live as you like. What therapist could possibly object?
50: fair. Having dealt with it myself I have to say dealing with insurance was really minor, mostly because doctors weren't helpful. (Eccentric calf raises, orthotic inserts, and spending time barefoot worked for me, or at least they made me feel like I did something while it healed.)
I think the calf raises are partially to blame for my Achilles tendon problems, but I do have much more definition in my calf muscles now.
55.1: So far so good meaning it's not difficult for you or you're feeling better or something? I've been essentially dry since January for non-health-related reasons and am totally over it and would love a glass of wine right now.
It's probably been good for me in that I don't need extra depressants in my life, but I'm not sure even that makes much difference. Sorry, Franklin, since this really doesn't speak to your situation. I suppose you could ask around bars in your area?
58: Meaning I don't feel bad/especially different, don't have too many cravings. It's about like quitting smoking, which took me a while but was oddly easy compared to many people's experiences. That said, I probably should find something in the long run to counteract this feeling of being cranked up all the time by caffeine and medication.
In the interest of full disclosure, however, this has been a run-of-the-mill shitty day that would be greatly improved by a glass of wine. Here, let's share one of these.
Having dealt with it myself I have to say dealing with insurance was really minor, mostly because doctors weren't helpful. (Eccentric calf raises, orthotic inserts, and spending time barefoot worked for me, or at least they made me feel like I did something while it healed.)
I haven't dealt with it myself, but my sense as an NBA fan is that stress fractures are not a predictable injury and that the recovery process can be very different for different people.
I'm in a HMO network (Kaiser Perm.) that's sort of like it's own contained single-payer thing where your medical history is available to all the doctors you see on the same system, which can be accessed online. (You can see also all the prescriptions you have from different doctors online and order refills online.) This is convenient for trans* health care because it means I don't have to run from endocrinologist to psychologist to surgeon with documentation---they all know what's going on, and there's someone who coordinates trans* issues. However, their mental health system sucks and has meant that I've gone without mental health care since I took this new job. I picked Kaiser insurance only because of the good trans* care.
I'm sorry to hear that about Kaiser's mental health care. That was one of the things that a combined system like that was supposed to, in theory, be better at.
50.
seems like it's a permanent thing, with me. the only way to get rid of it is to stop doing what aggravates it. that may be as simple as getting better shoes. i won't wear anything with a big arch anymore. mine seems to be related to tight Achilles tendons so flat shoes and standing on my toes in any situation is right out.
I have a plastic boot to wear at night and stretch my tendons. I did stop wearing Doc Martens, partially because I figured different shoes might help but mostly because they are really heavy.
55
You might have said before, but how long have you been on Wellbutrin? I've been on and off (mostly on) for about 5.5 years now, and the kind of manic feeling went away after about 8-10 months or so. I also don't seem to have problems drinking, although every once in awhile I'll get the "two beer hangover," which I mostly blame on getting older.
Healthcare coordination seems to be a big thing now with Obamacare. My medicaid company is constantly trying to assess what level of help I need coordinating my health care, to the point they call me every few months just to make sure I'm not suddenly higher need. I'm currently "low-need," which means I do most of it myself. It's fine, except I mainly go to the student health clinic, and they generally refer me to doctors outside my network. The last referral I just put off and then called my other health clinic to set up an appointment when the issue didn't resolve on its own, and the one before that was for PT for my neck and shoulders, and according to the "find a doctor" website the only in-network PT is a gunshot rehabilitation specialist about 10 miles away from me. I ended up buying a new pillow and doing free yoga at the campus gym instead.
The bigger problem is most doctors don't accept medicaid, which is annoying. Also, state-based healthcare is really stupid and assumes poor people never travel or move. When I had an ovarian cyst out of state last year, I first had to call my insurance to confirm my condition would be considered an emergency, and then had to call a bunch of urgent care centers before I found one that would take my out of state medicaid. I did all of this while lying curled in the fetal position on the floor.
63: they ration mental healthcare. In urban centers the really good mental health providers don't even take insurance.
Also, I work for a big fancy hospital system. Our Medicare and Medicaid ACO model is pushing mental health onto PCPs, because the psych dept has an access problem. To save money, they want to do online behavior therapy.
the one before that was for PT for my neck and shoulders, and according to the "find a doctor" website the only in-network PT is a gunshot rehabilitation specialist about 10 miles away from me. I ended up
I was hoping that this sentence would not continue "shooting myself in the neck".
When I was last in NY I found myself involved (at the request of the police on the scene) in the case of a guy who'd had some kind of fit, and needed a) medical attention and b) a French-English interpreter. I asked the coppers if they were able to provide medical assistance, and they said something like "not really, we only get first aid training for, like, people who've been shot." And it was on the tip of my tongue to say "well, could you shoot him, and then give me a hand?" but I thought that might have been in poor taste.
The bigger problem isn't poor taste. It might have seemed like a good idea.
70 At the risk of VSOOBC, if situations like that recur with uncanny frequency I would begin to worry that someone in unexpectedly close proximity was beginning to rub off on you.
"not really, we only get first aid training for, like, people who've been shot."
Sounds like my agency. I've yet to do a CPR class but I've had practice sessions applying a tourniquet.
The irony is that I, too, have pretty much only had first aid training for, like, people who've been shot, but AT LEAST I KNOW HOW TO TAKE A PULSE YOU DUMB FLATFOOT PALOOKA hashtag nineteenfortiesinsults.