But Whyyyyyyyyyyy?

Here's more, this time from Respectful Insolence, on the lack of evidence that patient satisfaction is the best measure for health care, since the most satisfied patients do not necessarily have the best health outcomes.

Sadly, it appears that getting what we want, medically (tests, specific drugs), is not always the best thing for us.

Hm. It feels like a touchy subject, because nobody wants "just shut up and do as your doctor tells you" to be the right answer. Especially not medical librarians with our "here, let me show you how to locate reputable consumer health information, which will be totally the coolest thing you'll do all day!"

I think that the problem is partly the concern about that attitude, which of course ideally would not be the presentation at all. If it's more like "here's what I think is the best approach for your situation, and here's why," then it's less of an issue to take the advice of an expert.

But then we have all the problems with physicians not having time to actually talk to people and explain what they think is the best approach and why, so you probably do get patient-dissatisfying dismissals of concerns or requests for test that may be entirely worth dismissing, but the approach is just wrong...

Like so many things in life, it's really a lot about interpersonal dynamics, isn't it?

Getting Some Exercise

After a dreary yesterday of rain and snow, today the sun was out and the wind was relatively restrained. It was a nice day.

For a white wedding!!!

Um. Not sure where that came from. Anyway, a nice day for a white wedding, or a Walk For Choice, which was what we actually did. It was definitely cool, but basically a good day for walking. Only my fingers got pretty cold.

Much like a wedding, it was an occasion for a few hundred people in festive garb and accessories to get together and celebrate human hope and enthusiasm while shaking our booty to some rousing chants on the grand dance floor that is the Boston Common.

There were a few more signs than at the average wedding, and perhaps slightly more discussion of contraception, cancer screenings and abortion. Although I may just not be attending the right weddings. A few good signs might do wonders for a reception.

.

Go Where They Know You

GruntDoc explains why you're better off going to the same Emergency Department every time if you need to make repeated visits.

He notes,

Every ED has seen a patient, probably today, with “they saw me at the ER across town, but they didn’t do anything and I’m still sick”. While it makes some sense not to return to a restaurant that gave you a meal that wasn’t to your tastes, medicine is quite different.

The basic explanation is, if you show up at a new hospital for a continuing complaint, they're going to have to look at you as a complete unknown and may run tests or try courses of treatment that are redundant or have already been done.

Because the whole 'sharing of health records' thing is apparently not really off the ground yet at many institutions.

Repeated ER visits have happily not been a part of my life thus far, but I have made note of this advice, just in case.

.

What About UNDER the Counter Medication?

It is open enrollment time for benefits at my job, and I must decide how much to set aside for Health Care Reimbursement--that program where they take some money out of your paycheck pre-tax and give it back to you in reimbursement of authorized health-related expenses.

In past years such expenses have included things like prescriptions and office visit co-pays, but also over the counter medications like aspirin and so forth, so if you didn't use up everything you'd set aside over the course of the year, you could just go on a year-end shopping spree and stock up on painkillers and adhesive bandages. I owe almost the entire contents of my medicine cabinet to this fact.

But now, now they've changed the rules all of a sudden, and OTC expenses will no longer be eligible for reimbursement. I'm not totally happy about this.

It requires me to much more precisely calculate my expenses for the coming year, which is kind of tough to do, since you just never know when you're going to get hit by a car or develop a goiter or something that will involve medication and doctor visits. (And yeah, the car thing is covered by auto insurance, but what if it had been a hit-and-run?)

I think I'm just going to have to set aside much less money and assume that I'll wind up with expenses that I don't have anything set aside for, rather than set aside a larger amount and risk losing some of it at the end of the year.

Because I don't like losing money. No sir. I don't hold with it.

.

Learning Something New

Two posts on learning things previously not known strike me today.

Elisa at HealthyConcerns finds that you can use Flexible Spending Account money (those pre-tax dollars you can set aside to pay for healthcare needs) not only for things like doctor's office co-pays and prescriptions and glasses, but also for basic household health stuff like cough medicine and adhesive bandages.

I myself have been known to stock up on this sort of thing near the end of the year when I have money left over...and will have to do so soon. It then occurred to me that if I could only think of some way to present bandages and aspirin as appropriate holiday gifts, I could be in great shape!

Who do I know who wants a pack of cough drops?


And Jodi Jacobson at RH Reality Check reveals that the North Carolina Constitution basically bars atheists (and arguably people practicing non-Abrahamic religions, though I suppose that would come down to how you define 'Almighty God') from holding public office.

As quoted from Article 6, Section 8:

“The following persons shall be disqualified for office:

First, any person who shall deny the being of Almighty God.”

Wow. That's pretty definite.

Article 6 goes on to also bar:

Second, with respect to any office that is filled by election by the people, any person who is not qualified to vote in an election for that office.

That one sounds reasonable.

Third, any person who has been adjudged guilty of treason or any other felony against this State or the United States, or any person who has been adjudged guilty of a felony in another state that also would be a felony if it had been committed in this State, or any person who has been adjudged guilty of corruption or malpractice in any office, or any person who has been removed by impeachment from any office, and who has not been restored to the rights of citizenship in the manner prescribed by law.

Yeah, OK, that makes sense too.

But obviously the most important thing is that you attend the right place of worship. Treason is also bad, but denying Almighty God, well, that's one step away from selling state secrets to the highest bidder anyway, right?

There is, naturally, some discussion on whether or not this is binding law given that the U.S. Constitution prohibits requiring a religious test as qualification for office (another Article 6).

Interesting.

.

It All Works Out

Recall how I decided to watch New Moon instead of Money-Driven Medicine last Wednesday?

I lamented the necessity of this difficult choice, on account of I really wanted to see Money-Driven Medicine, which is relevant to my professional as well as personal interests, but all is well! I have just seen on The Health Care Blog that the film may be viewed online this month at the Money-Driven Medicine website as part of a nationwide Watch-In.

I'll have to give it a look! I love it when things come together.

.

Guiding Lines

Everyone is surely riveted to the kerfuffle around the recent change in the U.S. Preventive Services Task Force recommendations on mammograms.

I must say that my own immediate response was one of pure delight. I can wait until age 50 to be squashed and x-rayed?! That's much farther in the future than 40! Win!

But apparently I was missing some of the details, since there are plenty of people who are pretty perturbed about it.

I was filled in by some fine posts on the subject, to which I here give full credit:

Orac at Respectful Insolence has a well-reasoned post explaining the new guidelines, and another addressing some of the objections to them. (It's actually partly due to reading Orac's previous posts on the often-fuzzy issues around preventive screening that I reacted so casually.)

Christine C. at Our Bodies Our Blog also covers the new guidelines in a clear, straightforward way.

And finally, if you need any more, Naomi Freundlich at Health Beat has excellent details.

Something all of these posts explain is that  no one is telling women they can't get a mammogram before 50 if there's a reason to think they may need one. The new guidelines are just saying that in general, if there are no risk factors calling for increased watchfulness, you don't need to feel you're neglecting your health unduly if you wait.

After doing this reading up, I can say that I personally remain comfortable with the idea of forgoing the mammogram until age 50, unless something about my circumstances between then and now suggests I'm at increased risk of breast cancer and should do it sooner.

I'll be totally cool with it if that doesn't happen.

.

Reading Other Peoples' Mail

Maggie Mahar at Health Beat has the first of a promised series of letters from people in other countries sharing their personal impressions of their health care. This one is from Canada.

It's interesting to get a personal take on another system, to add to impressions we may have gained from other things we've read and heard. I like that Maggie Mahar interjects her own comments at some points to clarify numbers or other points, making this a nice mixture of anecdote and data.

The best of both worlds!

There's something inherently interesting to me about comparing other peoples' experiences to my own--that sort of "so that's how it works in Canada?" thing--and of course with the current debate over health care in the U.S. this is a good way to see some different approaches to the issue and think about which aspects of various systems might be nice to have, and which send us reeling out of the room clutching our stomachs in an attempt not to vomit uncontrollably.

In my case, it's the plans that force everyone to ingest high-powered emetics that do the latter. I can live without those.

.

Spread the Outrage

Cara at The Curvature has a post up called "All Denials of Coverage For Pre-Existing Conditions Deserve Equal Outrage."

It talks about how a lot of people find it weirdly wrong that, say, domestic violence or a prior cesarean section delivery can be considered 'pre-existing conditions' and therefore reasons to be denied health insurance.

Then it points out that there's something uneven in the way that only some pre-existing conditions get this attention and are seen as unfair, as if the whole idea of using pre-existing conditions to winnow out expensive customers weren't kind of weirdly wrong on its own from any sort of "let's do good for people" standpoint. Of course it's not about doing good for people, which I guess is part of the disconnect.

I mean, we should all have known better than to have ever gotten sick before if we wanted to be able to afford health insurance, right? What could be more equitable than that?

It's an interesting system we've got here, all right.

.

Sad News from the Old Home State

Since I was born in Montana, this post on 4&20 Blackbirds had a certain familiarity that makes it, I guess, especially sad. Not that it wouldn't be sad no matter where it was, but when you have a sort of connection, no matter how slight, it feels a little closer.

It's the story of a woman about to lose her home because of healthcare bills. We've heard the like before, but that doesn't make it any less disturbing.

.

Hospital Gowns Optional

Rebirth had an interesting point about nakedness in health care, specifically in the delivery room. 

The post describes a labor nurse's complaint about a woman who wanted to be naked during her labor and after the birth. It made the nurse a little uncomfortable. 

And yes, I can imagine that one feels a little weird having a completely naked person there. We're used to there being a certain level of concealment between doctors and nurses and their patients. They see a lot, but not all at once...I imagine it's easier to deal with the sort of compartmentalization you have to do in healthcare, if you only look at the parts of people that you're interested in right then.

But does it really matter if women in labor want to take off all their clothes? I mean, they're pretty darn exposed anyway--if they're more comfortable without barely-concealing hospital gowns flapping around them in this intense time, shouldn't they be able to go with that, without having to worry about bothering the nurses?

I'm with the post's author: let it go.

Of course, if a woman had rather not be completely naked in front of strangers, I totally understand and support that too. Give her some draperies! It may not be much, but a little fabric provides the idea of clothing, meaning that you don't have to feel completely exposed.

I think I can understand both preferences. So if you're looking to me for validation of your choices, you have it. Go forth, my legions of followers, and give birth in the state of nudity with which you are most comfortable!

Come to think of it, one could make a similer argument for health care in general. Well, maybe not otorhinolaryngology. 

Go Work in Health Care

The Health Care Blog has an interesting post on the economy, noting that the health care sector is one of the only places jobs are not being lost at the moment.

Especially libraries, right? Everyone needs libraries! Well, they're not specifically mentioned, but it does say that "hiring remained robust at the nation’s hospitals, physician offices, diagnostic labs, nursing homes, and home health care agencies." 

I'm going to assume that this will spill over to libraries, just to comfort myself.

Anyway, the post observes that while it's good to have robust hiring somewhere, this could also mean less impetus for controlling those out-of-control healthcare costs we hear so much about. After all, if people are making a living with the system the way it is and jobs are being lost all around in other industries, do we want to mess with something that's sort of working?

There's more information in the Health Care Blog post, which details some of the complexities of the situation.

Finally, Plain English Healthcare!

The Common Craft folks, whom we might remember from such straightforward and funny online videos as their explanations of blogging, wikis, and zombies, now have one up to explain Why is Healthcare So Expensive?

This actually might be an older one, since I don't see it on their website. Nevertheless, Science Roll found it on YouTube, and I'm all over it.

Other Peoples' Vacations

Despite supposedly being on vacation, Maggie Maher at Health Beat has a fabulous monster of a post about a Census Bureau report on "Income, Poverty and Health Insurance Coverage in the United States, 2007."

She discusses details of the report's findings, historical context, implications for health policy, etc. I can't begin to do it justice. You must check it out!

In other news, so far I feel about being a librarian a lot like I felt when I'd just started library school. I'm tired, but it's great!

There's a lot to learn, lots of things to piece together. Some stupidly basic things I already learned way back when, like (hypothetically) that monographs typically have call numbers but serials do not. (Ahem.)

Some things specific to this library, like where, if people get paged, they can find a telephone (right over there!).

Some things specific to this library but certainly transferable, like what resources go well with which subject guides. Subject guides are way cool.

So yeah, I'm librarian-ing it up and life is good.

Now I suppose tomorrow will be the day everything starts to go downhill and I become filled with bitterness and unfocused rage. Watch this space for further updates!