Blog Throwback from 2009 – Still Relevant – Blogs as a method of nursing education: Useful learning tool or immediate feedback need pandering



Still relevant and worth the discussion today –

As I have been teaching in an online format for post licensure nurses I have been researching and learning about the benefit of journaling and summative student self-reflection as a means for retaining and learning material. Born out of critical theory, self-construction of learning through journaling assists students in creating their own knowledge about information which assists them in not only retention but in application of knowledge to practical life situations. Where do blogs fit into the mix? The internet offers a mechanism for communicating with the world, a place where anyone can read a student’s hard work, even if it is not formally published by an academic journal. The internet also provides students with a voice for writing about what is important to them.

Nursing, a profession that many consider to be very ‘hands on’ has traditional held to strictly classroom and clinical learning methods for its students. Likewise, nursing faculty are frantic about teaching students to pass NCLEX licensure exams and thus provide numerous tests as a major source of evaluation within nursing curriculum. While teaching ‘skills’ such as IV placement and CPR,  teaching test taking ability,  and memorized content have been a large bulk of nursing curriculum… what about forming the essential skills of critical thinking and logical knowledge building? Within these two important areas, where does teaching nurses the art of logic through writing rate? How do nursing students learn to form their own knowledge and evaluate it? With the rapidly changing face of information, technology, and health care is learning critical thinking, logic, and self-evaluation more important than IV placement?

I recently came across a couple of institutions that encourage the use of blogging as a form of journaling, which forces the student to concentrate on grammar, condensing important information, and clear communication (all while offering a vehicle for personal summative evaluation). I found several good blogs on incorporating blog learning into the classroom. Several of them had basis in philosophy and Logical reasoning (all of which are critical to learned writing communication and building a clear argument). I have attached these below for your interest.

Using Blogs to Teach Logic –
Use of Blogs in Philosophy –
An educator speaks on using and grading blogs –
WikiEducator, how to use blogger –

However, in an instant gratification society (fast food, fast forward through commercials, 140 character personal updates every 10 minutes on twitter) is using a blog to track students journals and provide immediate feedback only adding to the need for immediate gratification? I am wondering, what do you think about the use of blogs as a means of educating nurses?


Back to writing…



Somehow I keep leaving this thing that I love… this outlet.  I may not be the best writer, but there are some issues in the world of healthcare, nursing, education, etc. that need to be discussed.
I also just need an outlet.

I would gladly take topic suggestions.

I would like to hear from NP educators on topics they are struggling with and how we need to get some larger movement on them.

I would like to hear from bedside nurses on why you are leaving the bedside for higher education and what you find there.

Or hear from any of my nurse, NP, or parent pals.  How’s life? What are you dealing with.

I know daily I am strugglig to raise young adults and teenagers, in caring too much about work, in letting go of wanting perfection in my work and in others (and self). I also am in a torid love affair with coffee and my swiffer mop.  I love them both so much… please never leave me either of you.

I promise to write more later… perhaps just about me and what I am learning in life (something new every day).

Hugs and compasion to each of you… we need more of that.



When the provider is the patient…


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Hi blog readers.  I know I have been remiss in the last month posting anything new.  I also owe you all a blog post on the researched and resulted benefits of coffee and that is in the works.  I just wanted to take a minute and share something recent.

It’s always amazing to me how being the patient for even a single appointment gives me much needed perspective and often prompts me to put down in writing my thoughts to remind myself about patient perspective.  Recently, I had a health issue arise that prompted further testing, biopsy, meeting with surgeon, and a plan for continued high risk monitoring moving forward.  I guess I should just be clear as to what my issue was up front… I had a bi-rads category 4 reading on a screening mammogram, with clustered micro-calcifications in one specific spot in one breast that were new and not seen, even after detailed diagnostic imaging, on last mammography.  I am not over 50, not overweight, exercise routinely, don’t smoke, and yet I have a paternal grandmother with no daughters and no sisters who died young after a 4 year battle with breast cancer. Needless to say, I was a little worried about the new finding. Luckily the biopsy was benign(ish), but all of this has brought the patient experience front and center to my practice and teaching.i

When a routine screening comes back positive
For all patients this is stressful, regardless of family history.  In my case, I watched a family member die after a long battle with the same illness.  The only thing I heard, as a single mom of three kids after the positive screening, was that my screening was positive.  No rational discussion, or ‘probably benign’ wording, resonated for me.

Don’t tell patients not to look on the internet
The internet is where everyone, including health care providers, go for data. When we tell patients ‘not to look on the internet’, we’ve created an irrational and impossible command. Not only did two separate providers give me this directive,  the surgeon asked on their intake form how much I went to the internet for information. Why not instead give patients websites with sound advice or links to research? Gone are the days when the provider knows all and is all and the patient should only get information from him or her. We have to learn to work with the internet, not against it. To a patient, such advice sounds closed minded and dismissive of their own abilities or need for information.

Attempt not to be dismissive of their questions or condescending
Patients are our partners and the reason we have jobs.  We are not a gift to them. In fact, there are many days when healthcare providers may truly be an obstructive force. Recognizing that, I am going to be more mindful of my tone in speaking with patients.  For this event, from the first moment I entered the surgeon’s office, who did not have a nurse or an advanced practice provider in the office but is another topic entirely, I felt small and belittled. There was yelling of names and insurance co-pays into the waiting room and comments like “oh you must have a high deductible”.  The MA, then chastised me for wearing a dress to an appointment on a work day when no instruction to dress a certain way was given.  The specialist then was in and out in 5 minutes, I was not allowed to ask questions about procedure, family risk, or genetic testing, but was told several times that “my staff will explain everything”.  I also was told repeatedly the same fact, “80-90% of the time this is nothing”, which I know not to be true given my risk factors, the mammogram findings, and my professional training.  The surgeon was out the door quickly, only to stick her head back in after not reading my chart thoroughly and asking about two other key issues in my history that she had not read prior to coming into the room… then she left again, mumbling a repeat of her 80-90% statistic again. The visit was 5 minutes and cost me close to $200 out of pocket.

What I will change in my own practice – Clearing time each visit to ask the patient if they have specific questions.  I will not proverbially and condescendingly p’at the patient on the head’ with my words by telling them things will be fine and that this health concern of theirs is essentially nothing. To each person, no matter how routine their situation may be to us their diagnosis is personal in ways that run deep, whether it is simple contact dermatitis or an upcoming surgical procedure. Fear of the unknown and disruption of normal life is real to every single patient.

Talk to patients who are awake during procedures
I don’t do surgical procedures, but if I did… I would want someone to tell me to acknowledge my patient during a procedure. If patients are awake constant communication is mandatory and if general anesthetic or something that may affect recall is administered, to make time to talk to the patient and support person before and after any procedure. I spent 30 minutes face down on a mammogram table, with my breast in a vice clamp while a hole was drilled into my breast and repeated images taken. The surgeon never even let me know when she entered the room or left and did not speak to me once throughout the procedure. The radiology tech (again no nurse, no vitals, no assessment before or after the procedure) is the one who did my teaching, intake, and talked me through what was happening. She was very good. Kudos to the support staff who make the providers look better. (Side note – the cash price for the biopsy was 1/3 the cost of what I was charged  out of pocket to meet my deductible as the cost billed to insurance, but if I had chosen to pay the cash price it would not have counted toward my deductible.  The catch-22 of insurance.  #UnitedHealthcare— care to reply to this issue in billing?)

Providers, remember who is on the table.  Make time for them regardless of who they are.  Give the same care you would want for yourself or your family member.

Nursing was surprisingly absent
In all of my recent encounters nursing was surprisingly absent. I have some ideas as to why that was, but I am still alarmed.  Nurses are the assessors, protectors, communicators, educators, to the patient.  They are more benefit than cost.

I am thankful for in all of this is the chance to reflect on my own practice and to be nudged once again to patient and nursing advocacy.

Wonder, The Women’s March, Healthcare in the News and Other Random Thoughts…


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Hey there nurses, APRNs, and healthcare fanatics! This week’s post is just a conglomeration of what was on my mind.


My daughter passed along a book she was required to read for English this year.  Wonder, by R.J. Palacio is something I’m convinced all mom’s, kids, dad’s, and even nurses who deal with pediatric patients should read. I laughed, cried, talked out loud to the pages of the book, and overall thoroughly enjoyed this read on the journeys of a boy with facial deformities, his family, and his friends.  A quick read, I read it in three 1 hour sessions… find it here.

The Women’s March


I inadvertently ended up at the West Palm Beach women’s march a week ago and it was one of the most inspiring things I have seen my entire life.  All ages, genders, races, religions, of people came together in peace to improve the rights and healthcare access of women of all ages.  It was beautiful. It was peaceful. It was full of acceptance, love, open thought, and togetherness.  It was a place I found several nurses. Its definitely a place nurses need to be, not just on the day of the march, but every day. It gave me hope for the future for my daughter and my patients.

Healthcare in the News

This week the healthcare news was quite interesting from outbreaks to underestimates.  Here are a few important notes that you might have missed in all the political discussions/news:

2010 Writing Rehash: Independent Nursing Practice. Reality or still the ‘Physicians Hand’?

*I want to preface this re-post of something I wrote back in 2010 by saying the Future of Nursing report and much nursing research has helped push more educated and autonomous nursing practice forward at the advanced practice level primarily (24 states and counting). However, I feel that we are continuing to restrict bedside nurses from using the brains and education they have and thus we have created sometimes powerless new nurses who don’t know any better and fail to be proactive for patients precisely because we have not allowed them to make their own decisions in patient care. I could be wrong about that, strictly my opinion.

Years ago, when I went back to school to obtain a bachelor’s degree, I read a thought provoking book entitled “The Physician’s Hand” about nursing history from the paradigm of nursing culture and the dominance of medicine (strictly my interpretation). Even the author, placed nursing as ‘subordinate to physicians’.

Being the rabblerousing heretical feminist that I am, I have always sought to think of nursing as part of the medical ‘team’ where all professionals provide input to build the best care of the patient. I am beginning to wonder if my pie-in-the sky view and push to have nurses see themselves as independent professionals with a unique body of knowledge is accurate?

In one of the health systems that I interface with nurses can no longer document that they held a patient’s medications based on ‘nursing judgment’. Such an instance might be when a patient had hypotension from pain medication and thus the morning anti-hypertensive is held. Instead, they need an order from a physician to hold such medication. Further, something like ‘Tylenol’ on a patient’s medication record ordered for fever could not be administered by the nurse for a headache if the patient requested it because that would be ‘practicing medicine without a license’.  A nurse cannot order a social services consult, flush a urinary catheter should it become clogged, refer a patient for diabetes education, etc., etc., without an order from the supervising physician. Although we have been trained to recognize these things, we carry an independent license, sit for an examination to obtain that license, and have had years of education. Perhaps nurses really cannot do any of these things without a supervising physician to tell them?

Physicians, are critical components of the health care team there is no doubt, but why send a nurse to school and give him/her an independent license, scope of practice, and make them answerable to a board of nursing but then limit their usefulness?

I was reminded of this overriding ‘subordinate’ mentality when I spoke to a group of nurses this week and encouraged them, in light of the winds of health care change in the U.S., to consider starting their own business to increase access to preventative services. My suggestion was specifically that nurses should look at developing independent diabetic foot clinics at a lower cost. My thinking was, since Medicare is going to quit paying for these services, that hospitals will quit providing them, but this will in no way decrease the need for good diabetic foot care, monitoring, and preventative education. Nurses are primed to fill that gap.

I was enthusiastically speaking about this possible place nurses could exercise their knowledge to provide care to a group of people who need it when a woman to the side of the room raised her hand and said… “We can’t do that. We need a physician’s order to get someone’s toenails cut inside the hospital. Not anyone can just walk in somewhere and get services for foot care. I mean, if you did it wrong someone would come and take your license.”

Thus the mentality continues. Until nurses recognize their  knowledge set, research, health management skills, education, and license as their own then health care will never change and these big gaps in prevention and health maintenance will remain; so will the continued air of ‘hierarchy’ among health care professionals.

Become a certified diabetic foot care provider –

2011 Writing Rehash: Western Medicine… I Have a Pill for that

Funny how things I wrote 6 years ago are still relevant.  Working now some in a functional medicine clinic I see the benefits of alternative medicine even more clearly. Wonder why we call it ‘alternative’ and not just adjunct medicine?

*Prior to reading this post please be aware that I am not providing medical advice to anyone nor encouraging any lifestyle change or activity without consulting your primary health care provider.  In fact… I am really preaching to health care providers themselves :) (me included)

My most recent interest?…Reading and learning about nutrition and exercise.  As a nurse I have had some training in nutrition, which was required for my basic diploma degree, but no training in exercise physiology.  The world of nutrition, exercise, and alternative medicine have grown substantially since my white cap days.  I am by no means an expert, only scratching the surface of knowledge, but I thought I would share some opinions I have formed from my recent research.

My new found push to be ‘healthier’ (whatever that means) has evolved from several factors.  (1 ) I am aging and my mother had open heart surgery for complete blockage of a major artery in her early 40′s (you can’t change genetics).  (2) I have been doing some crossfit (*2017 Note here-I gave up crossfit for body pump… cheaper and easier on my joints and much better muscle development as a female… sorry crossfit).  (3) Most importantly, I am finding my patient population in primary rural health to be sicker, more obese, and needing more medications, but let me be frank… medications are NOT fixing their health.

All of this has lead me to seek out what can really benefit my patients and not surprisingly the answer is EXERCISE AND DIET!  Exercise appears to be the proverbial ‘magic bullet’ for numerous diseases including heart disease, Type 2 diabetes, depression, anxiety, osteoarthritis, fibromyalgia and reduces the risk of a host of other diseases including cancer.

Further, the implications of nutrition in the treatments of such illnesses, while not as widely studied as pharmaceuticals, is impressive.  The implications for a vegetable and fruit based diet in preventing and altering heart disease risk is impressive.  Good nutrition in itself benefits diseases like diabetes and decreases obesity.   The use of nutrition to improve memory, anemia, prevent migraines, improve mood and sleep, and a host of other uses for fruits and vegetables and vitamins, has shown promise and needs more research.  So far, this discussion does not even include current problematic treatment of chronic pain in this country and the alternative therapies, diet, and exercise that could benefit such patients (another post perhaps?).

Let’s be honest, medications are dangerous.  With current adverse drug reactions and drug overdoses claiming more than 100,000 American lives alone per year, clinicians need to find a safer and more permanent way to improve chronic health in this nation.  There has got to be a more adventitious way, a safer way, to improve the health and quality of life of a nation (and to reduce skyrocketing health care costs)!  There is…. nutrition and exercise.

Pills, Pills, Pills… do they create more ills? I am beginning to wonder if the toxic nature of long-term pharmaceuticals is an issue for my patients? Seriously, this is a legitimate question.  I am not trying to throw the baby out with the bath water.  Pharmaceuticals are good.  I am thankful for pharmaceuticals and for common life saving drugs, but for the long term treatment of chronic diseases that are all life style related… is our current practice of medical care in this country (acute care hospitalization and primary care medication pushing) working? Look, in a published report on vitamin adverse reactions and deaths in the U.S. in 2007 there were only 8 adverse reactions and 0 deaths.  Yet, I would honestly like to know the general health outcomes, quality of life improvements, improvements in mood/sleep/lifestyle, and what patients generally die from who are on long term pharmaceuticals for chronic problems? Longitudinal research anyone?

Further, I have many patients who would benefit from yoga, massage therapy, physical therapy, acupuncture, and the like as supplements to their chronic pain management.  The majority of these patients have no health insurance or money, and if they do have health insurance it does not include coverage for such therapies… however, it pays for medications… an issue for another post.

With all of the empirical evidence as to patient improvements in disease through diet and exercise, why don’t we/health care providers (me included) use them more?  Wouldn’t we like to wean all of our patients off of their metformin, lisinopril, and lipitor? I know I would!

Several Bottom Lines: Bottom line number one, time constraints within a primary care visit, what ever they may be, and a culture of going to get a prescription for our ailments has lead us here.  It is a poor and pitiful excuse and I am not proud to write that I have fallen into the trap of both time and a patient’s desire for a prescription to fix instead of the hard work of lifestyle change.  I am confident though that health care providers can lead the charge to change how we practice and how we promote health in the U.S. and around the world!  We can do it in conjunction with athletic trainers, dietitians, exercise physiologists, and the like in cooperation.

Bottom line number two, the most common prescription we need to write is for diet and exercise.  However, will that make anyone any money?  As much as all health care providers hate it, money drives our system.  Of course, a patient being sick generally does not bring me personally any more revenue.  I would love to see healthy patients all day, or do something else if my patients were so healthy they did not need me (how great would that be!).  To cut costs, someone has got to stop making money.  Honestly,  if I could prescribe only two things to help almost every patient I had  in my practice it would be increasing fruits and vegetables in their diets and getting daily exercise.  (FYI- I am also going stop encouraging whole grains, because patients interpret this as bread and cereal and then eat processed cereal/bread and think they are being healthy.)

Bottom line number three, we have to help our patients get well through modeling. We have to start with ourselves.  No more should we as health care providers say… “well, I am going to eat this candy bar because I take my lipitor for it and I have to die of something anyway.”  No more cop outs.  No more excuses.  We can model the health we want our patients to have.

Now, go exercise or something…

Teaching the Next Generation of NP students

I am looking,  for feedback on this topic, either by comment or email.  Feel free to post links, your best advice, evidence, and thoughts on how to educate future primary care NP students.

We seem to have a lot of opinion, anecdotal evidence, and very small pilot studies out there with no real change.  We continue to teach in an antiquated model, but refuse to push students to the reaches that PA and MD programs do in the level and type of courses taken (physics, organic chemistry) nor in keeping them in class all day, not allowing them to work to engage focus, nor finding specific or prescripting clinical sites to them.
Before you write me about what I just wrote know that I understand that in all the large head-to-head research that NPs have done very well, if not better than our physician counterparts in many aspects of patient care and that NPs are nurses before they are NPs.  I get that we are doing many, many things right and that many bring very good clinical experience.  With the need for health care providers growing and the desire of many schools to enlarge programs both for profit and to alleviate the healthcare provider shortage that is no longer looming but present.  Here is what I am looking for:

  • Large scale (high level) research among NP students about what makes the best clinical thinkers/reasoners/etc.?
  • Advice from preceptors as to what you need? (Pay, more feedback, less responsibility?)
  • Advice from preceptors about where NP students are weakest or need the most learning?
  • Large scale evidence about what predicts success in a graduate NP program? (I.e. admissions criteria, English literacy, number of hours worked, years of experience as an RN (found one good study on this that said – no, but then a Georgetown study seemed this year to contradict this. Bottom line, not enough good, repetitive research in multiple populations to know.)
  • Teaching methods in the classroom that help NP students retain the most knowledge and information?
  • Factors that improve performance on certification exam for NP students?
  • How to tie pathophysiology into assessment, pharmacology, and treatment planning?
  • Whether NP students learn more or retain more in simulation experiences?
  • Alternate clinical ideas for experience?
  • How to gain preceptors and not lose them?
  • Generational or educational changes in NP students and how that may be affecting the downward trend in certification exam pass rates?
  • Does the DNP as primary education make a difference in any of the above with research?

I am looking forward to any engagement or open discussion on any of these questions as I prepare my own students and think about my ethical and professional responsibility to both students, their future patients, and the profession.


2012 Writing Rehash: From – A funny thing happened at the doctor’s office

A Funny Thing Happened at the Doctor’s Office

2012 August 2

There is often said to be a plague among health care workers… the plague of personal health care provider avoidance.  Although it sounds quite odd, it is true, that many of us just avoid our own annual physicals, screenings, and other primary care exams.  In the past two years I have unwisely put off yearly well woman exams, fasting blood work, and eye examinations.  This last avoidance recently became completely unavoidable, when after over 2 years I finally ran out of my 2 month contact supplies, mind you I had ordered enough for one year over 30 months ago…. Bad girl!

After the eye exam was finished my optometrist turned to me and gravely informed me that I now needed bifocals (not shocking, but still another one of those small annoying signs that my body is slowly making the down hill slide and my warranty has run out) and she quickly added that my optic discs were a bit too large in each eye.  I chuckled out loud when the optometrist told me and I informed her of the obvious fact that I am quite odd and having some freakish size to my optic discs was just like my body to do to me! She, however, did not think that this was amusing at all and immediately ordered me to the specialist the next week for further evaluation of possible glaucoma.  “Sure I’ll go”… I responded after her second attempt to evoke an oath of promise from me to keep the appointment, but inside I was sure that she was concerned over nothing, having no family history, exceedingly low blood pressure, and no other risk factors for glaucoma.

*On a side note the good doctor also did not find my aspirations for getting cataracts amusing, so that I could  get my HMO to pay for new lens implants and perfect vision (I think that my delivery of this message is hilarious, but note to self… do not joke about eye diseases with eye doctors…).

On the day of the appointment with the ‘specialist’, or ophthalmologist as they prefer… note to you… ophthalmologists hate it when you confuse them with optometrists, I arrived 15 minutes early as directed to fill out the notorious ‘paperwork’ – haven’t we moved to some other technology yet people??? The following is an account of what happened.

–  Wait 30 minutes to be called back (not bad), but called back by someone who had to be only 12 years old.  She was chipper, probably because she was looking forward to torturing me with blindness in just a few short minutes, and had no name tag. (I really like to know who people are and call them by their first name so this irked me a bit, but I am certain now it is because every patient who comes in there has significantly impaired vision when they come in and if they don’t they will have when they leave.)

– Chipper no-name takes me too a room, where she does not wash her hands, and then drops  a solution that she claims will numb my eyes into them, but it burns like acid.  She then drops in the second solution (the blinding solution I now affectionately call it) and says she will be back. Within 2 minutes I cannot see a thing and do not dare leave the chair she has put me in because it is up on a step and I cannot see the step to get off of it, I would hate to have stitches in the ophthalmologist’s office.

– 15 minutes later (not bad again) Chipper no-name returns and tells me to follow her down the hall for some tests.  She then opens the door and walks out.  I grope my way out of the chair and down a long hall with 15 closed doors that all look alike.  Luckily she left the door to the room she was waiting for me in open.  She quickly runs a scan of my retina (pretty cool I am sure if I could see it) and then tells me to go back to my room and wait for the physician.  Groping my way back down the hall I almost run into someone, but find the room, bang my foot on the chair, trip getting back in, but fall safely into the seat of the chair.

– 70 minutes later the physician comes in (you read that correctly… where was he all of that time? An hour and thirty minutes after my appointment, you have to be kidding!  He and the obstetricians should be in practice together and serve snacks and have TV’s in their rooms, since cell phones are not allowed and I know this because neon green signs stating this rule are plastered on the front desk, the hall way, the back of the door of the small room I am in.  The least they could do is tell you to bring your own work or reading material because there is NONE in the room. )… Anyway, he saunters in without introducing himself or apologizing for my being stuck in a 7 by 7 room for over an hour and tells me I have ‘pre-glaucoma’ (translated out of medical language that means… “welcome to old age”) and to come back in a year.   No explanation of the disease, outcomes, what to expect, why I might have this new introduction into the second half of my life, why no treatment now, etc. is given.  He then tells me we are through and I can leave.  He breezes out.  He made well over $400 for our visit and we wonder why health care is expensive?

–  I grope my way back down the hall the other way to the front desk, find my prescription sunglasses (a previous sign of old age I was avoiding) to shove on my face and help shield me from all of the bright lights, pay my co-pay and leave with my designated driver, only to enjoy blindness for another 3 hours.

Funny it might be, but fun it was not.  Borrowing a line from a Tom Cruise 80′s movie, “I am sure we can all agree that this is a good example of what not to do… (if you are the staff of the medical office)”.  I am not going to tell you where the corrections should have been made, but perhaps with a chuckle you yourself can figure the areas of improvement out and apply them to your own practice.  As we like to say in education, this was a wonderful learning opportunity!

Am I Deserving of Healthcare?


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The answer probably should be an automatic ‘yes’, but…

I have been struggling recently, well… recently is not true as I have struggled my entire career as a nurse with this topic but more so lately.  The topic of whether people ‘deserve’ healthcare or not has again reared its head forcefully as politicians decide whether to dismantle the Affordable Care Act, which by the way is law. I’ve seen and lived both sides of this argument.  I have seen patients who have health insurance provided for them who take advantage of the system, but I have also seen patients who pay for their health insurance or who have no health insurance who do the same.  I have heard those who pay more for Medicare supplements and medications complain that they are paying more ‘only because they make more money’.  I have seen those who have no supplement struggle to fill daily medications.

After decades in healthcare questions continue to arise. I am looking for honest answers to these questions. They are not meant to be rhetorical in any sense. Please feel free to engage me on any of the following areas.

Discrimination against those who have Medicaid insurance

Have you ever been standing at a nurses’ station and heard from a healthcare professional of any sort make the following statement… “Oh they have Medicaid insurance and thus want us to do (blank) for them” and then either roll their eyes or let out an exasperated sigh? How did we become so jaded or so discriminatory against a group based on some identifying factor such as type of insurance?  Does having Medicaid insurance predispose providers to make judgements or to provide different care? Does the institution of Medicaid itself set up a class-system, in a country where how much wealth you have has always dictated healthcare access, type, etc.?  Is there a contrast for how a practice treats its VIP patients versus its Medicaid patients? Is this good? Should we allow it?

The truth is that being poor, and needing healthcare insurance may co-exist, but they are two entirely different things. Further, the reasons people need one or both is complex. Ranging from profound tragedy and loss of income or ability, to geographic location and opportunity, race, gender, education, or even twists of fate. Does this make persons who are poor, who need Medicaid, or who have no health insurance less human or less deserving of healthcare? Did our oaths and schooling teach us this? Did our culture? Did our parents? Did our religions? Do those of us who have the ability to pay for healthcare or have private health insurance always make the best choices? Which choices or attitudes should automatically exclude people from certain aspects of healthcare or access in its entirety? Should there be levels of deservability (not a word I realize, but one that is called for in this discussion) or access as we seem to now have? Should we continue these?  Should we shrug and say access to an ER or a community health center is enough for those without health insurance? Should we look the other way with a sigh and express that the problem is too big and that attempts to change it thus far have failed so why do it? Would the current levels of access available to those without insurance or with Medicaid suffice for those of us who have private insurance or can pay? Would we work to change the system if all we had was access to the ER and a community health center? Would we want the same for our parents or children?

Do you always “deserve” the level of heathcare access you have? Even when you used that nail gun without safety glasses? Or set off that firework in your hand? Or were texting while you were driving?  Or didn’t show for the last two appointments you had with your specialist? Or didn’t complete that round of antibiotics as directed? The truth is there are many different ways we can chalk up ‘deservability’ of healthcare. Are we going to say financial access and wisdom with which care is used are the way we judge? Is healthcare like car ownership, the more money you have the better yours should be? Those without enough money to own one… well… it’s just their own fault for making poor decisions to get there?

Does not having access to care affect health outcomes? Of course the answer to this question is yes, proven repeatedly in research.  If we know this to be true and we know that the health of people affects their ability to work, to have quality of life, pain control, functional ability, and even life relationships… then why on earth would we say that those who probably need the most assistance in these areas should in fact get none? What do we value as a society?

I fully realize the topic is much more complicated than my seemingly never ending stream of questions and that the currents of business, gross domestic product, jobs, wage earning, shareholder profits, and more is wrapped up in this.  However, this conversation is just for those of us who chose to be healthcare providers.  What does that mean to you? Why did you start? Do you believe in treating all people differently based on anything (Gender, sexuality, religion, criminal history, ability to pay, etc.)?  Resources are finite and we are all clearly human.  In a healthcare culture that is the most expensive, with the poorest health outcomes in the westernized world, we are all going to have to sacrifice something to make things better. What are you willing to sacrifice?  What ethical values and personal principles are at play for you when you treat patients? Would having healthcare access for all fix anything? Would making our population as a whole healthier by treating everyone with the same access do anything for our moral, financial, health, and economic stability as a nation?

I guess the bottom line is… when I contemplate the judgement I have seen and even handout out to others myself over the years for providing healthcare to those that have somehow been deemed less worthy, whether by finances, immigration status, addiction, criminal activity, gender identity, lifestyle choices, or whatever else we choose to identify them as… I then have to look back at myself.  Am I deserving of the healthcare I have? What makes me more worthy than anyone else? What am I willing to do to help change the current state of healthcare access and healthcare outcomes in this country? What can one healthcare provider do? How do I reach my current students to engage them in the same critical discussion? How do I create a new generation of healthcare providers, in a day and age of narcissism, which helps to answer these questions in a more effective way?

How do I look at myself in the mirror every day and then go to work and get paid within an industry that I do not work to make better or change? What one thing can I do each day to improve access, affordability, and equality in healthcare?

The Beginning… again… and again… and again.


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I couldn’t stand it. I need to write, even if I am no good and in fact precisely because I am no good and have failed before.

I’m writing again! Thank GOD I am writing again! How good that feels to type!!!!

I’m writing not because I think what I have to say is particularly meaningful, but because I have my own crap to work out… because I need answers from you who have experience, wisdom, thoughts, and are open to dialoging with me… because 140 characters is not enough… because there are many things that deserve my thought and attention in a patient and pensive way… because I need to work on being open… because I need to explore, create, and expand, while learning to be thoughtful and parsimonious… because words continue to woo me with their light, malleability, power to affect both the heart and mind… because there is too much fake news and too much anger in the world and I just need to find that there is still kindness, humanity, and peace out there… because learning to love yourself and learning from failure are important, albeit difficult… because the click of the keys as I type is intoxicating, soothing, and yet meditative.

I’ve failed at many things. I have learned more from failing than succeeding. Those of you who followed I thank you. The tragic story of the blog’s end is one that will stay where it needs to be, locked quietly away with the other journals, letters, cards, and writings that any person makes. Perhaps some of the better posts will show up again here. Perhaps not. Either way, failure will be guaranteed in some form and from that I will continue to learn. Will you join me in failure? In learning? In the journey?