the business of medicine in worker's comp: money is always the keyword

I have been working for almost three months now and I am already getting restless, drained and can't wait to leave this system.

I currently work in an orthopedic office specializing mostly in spine orthopedics and worker's compensation claims. How is it, you ask? I would rather go back to the craziness of PA school than work here. That says A LOT about how much I don't like this job.

I'm not generally a picky person, ortho was never my first choice but I took it anyway. Hell, I'm not a picky person at all I took the darn job in Bakersfield!! Don't get me wrong, I'm grateful I have a job during these hard economic times, but working for this system is exhausting.

I never knew how broken and inefficient our worker's compensation system is until I started working here. The idea of it sounds good, but the reality is far from it. Why? well, to start we have to get authorizations for pretty much everything in worker's comp: xrays, MRIs, medications, therapies, lab tests, referrals to other specialties, and of course the expensive procedures.


Countless times I tell my patients, "your insurance company is denying it," or " we haven't heard anything from your insurance yet"; I have seen patients wait for longer than a year to get back surgeries approved, or even a simple, relatively cheap treatment like physical therapy. I have seen real, legitimate patients suffer because they can't get treatment through worker's comp, and they either don't have private insurance or their private insurance won't touch their complaint since it's worker's comp. These patients are stuck; getting by daily with pain, unable to function, unable to live life to the fullest. Imagine living day in and day out in pain, no work and unable to do most of anything. That is a terrible life.

Then I get stacks of denial letters. These denial letters are pages long, typed in small fonts and in such a way that you don't even want to read it. The reason of the denial usually is never straight forward; they list all kinds of guidelines they used, and you have to search for the actual sentences that say the specific reason they deny a request. Sometimes they don't even exist. Sometimes the reason is beyond ridiculous. It's like they purposely try to frustrate you when you open that letter.

But not all the fault lies on the insurance company. The system is broken, because it's also being taken advantage of by the patients. I have also seen patients claiming heart attack, diabetes and hypertension through their worker's comp. I mean, that's stretching it a bit, don't you think? I have seen people lie and fake pain to get painkillers, because lots of times we provide meds in house, not through prescriptions.

Between the denial of treatments, people claiming diabetes caused by their work injury, people lying to get painkillers, delay of treatments and diagnostic testings, and 80 work comp patients a day, I finally read what is between the lines: MONEY. Money talks, money controls what can and can't be done, and money drives the huge volume of worker's comp claims we get. It is sickening, but it is reality.

I went to PA school because I want to do something to help people. I know you think, "that's what every medical professional say, but they really go into it because of the money"; well the money's good but that is not all the reason. I actually do want to help and do something productive to improve people's lives.

I have never felt so frustrated and so useless in my job (well, I've only worked  for 3 months now, but still...). I missed my clinical training days as a student in family medicine, in private practices and urgent care, where at least I still felt like I did something productive and helped my patients. But nowadays, medicine has become more and more controlled by money and medical treatments are getting harder to come by...

                                                    
                         “When morality comes up against profit, it is seldom that profit loses.”
                                                               ― Shirley Chisholm

~ josie

Chocolate Sprinkle Sandwich - A Dutch Legacy

It has been a while since we updated this blog. Jerrad is currently in Haiti, building schools and doing good for the world, while I am here working and getting drained by the non-sense and ridiculously broken worker's compensation system. Jerrad has all the exciting stories, but he has crappy internet there so the responsibility of updating our blog has fallen into my shoulders...


Thus comes the story of .... chocolate sprinkle sandwich. I know you feel sorry for me now, since I have such mundane and boring life that all I can write since the last 10 days or so is about some sandwich (that most of you probably think repulsive in some way), but don't!! I'm not, I'm excited about my chocolate sprinkle sandwich.

And I'm about to share it with you.

Chocolate sprinkle sandwich, as you have probably guessed, is made of two pieces of bread with loads of butter on them and topped with chocolate sprinkles. This is a Dutch thing, and the Dutch takes their chocolate sprinkles seriously.

You see, not all sprinkles are created equal. The sprinkles used for this sandwich is known as Dutch chocolade hagelslag, which consists of at least 35% cacao in it. If it's less than that, it ain't no chocolade hagelslag. And yes, these sprinkles taste better than your average joe sprinkles found in the regular supermarket. Here, to find one of these chocolade hagelslag, you usually have to venture to an asian supermarket... (why? I'm not sure..but probably because we Indonesians are also crazy about the chocolate sprinkle sandwich). One famous brand is this one:

Another proof that the Dutch takes their chocolate sprinkle sandwich seriously: just click here.

As far as us Indonesians, why on earth would we be so crazy about these weird sandwiches anyway?
Indonesia was colonized by the Dutch for 350 years, from the 1600s to early 1940s, before the Japanese invaded and ended the Dutch rule. And...the world history lesson ended here, folks.
Chocolate sprinkle sandwich is the Dutch legacy left behind long after the Dutch ended its ruling power. Everybody in Indonesia at some point or another has probably had some chocolate sprinkle sandwich in their lifetime (well, okay, I might exaggerate a bit, but I'm sure the majority of us have). I used to have this for breakfast every morning and for school snacks as well (health enthusiasts, please don't lecture me on the nutritional value of these sandwiches... I had a good childhood, thanks in part to this sandwich).

I made my husband tried it, and he didn't vomit. He responded pretty well actually, and confirmed that these Dutch hagelslag is better than the regular sprinkles. So, I would recommend you to try it as well. I mean, what's not to like? Bread...good. Butter...yumm. Chocolate...HECK YES!!! Look at all that goodness:

photo credit: theeatenpath.com

~ josie

marriage 101: "let your partner grow"

When my husband asked me if it was okay for him to go to Haiti to volunteer for All Hands, my instant and immediate response without thinking was, "No! Of course not!"

Then I thought about it for a few seconds, and I told him.... the same answer (which in my head was more like, "you must be nuts if you think I would be okay with you going and doing something cool on your own and leaving me here in this shithole Bako-town by myself!")

Now let us examine this response carefully.
First of all, All Hands is a non-profit organization with minimal bureaucracy and politics, it creates projects and sends volunteers in needed areas to do real work in the community, to educate that community and help them rebuild their infrastructure. It is an awesome organization, and you can find a link to their facebook page or website through our facebook page. We both wanted to volunteer with them, so .... obviously, he can't do it alone because I want to do it too! * little voice of reason: sounds like you're being a little selfish, josie!*

Also, if he leaves me for 3 weeks, that means I'll be by myself with two dogs in the house. If I have to leave them 8 hours or more a day to work, that means I have to WAKE UP EARLIER to walk them before work. In the wintertime when it's pretty chilli in the morning?!?!?! I don't see myself doing that...

Then my little voice of reason kicked me in the butt big time. Your husband is about to do something super awesome, and you wouldn't let him go because you didn't want to wake up at 6am to walk the dogs?!?!?! What kind of a selfish human being/wife are you?!?!?!?!

Here's life lesson number one on being married: it's not just about you anymore. The same thing with being a pet owner: you have responsibilities to take care of your pets, including.... waking up early to walk them before you leave them inside the house for 8 long hours.

Another thing I read somewhere about life lessons on being married is that you have to support your partner and let your partner grow. Well, I guess this means if my husband wants to go to Haiti by choice to help the locals there and do something good for the humanity, I should be proud of him and support his decision.

So if you are following our blog or facebook, you would've probably guessed what the conclusion of this story is. If you haven't figured it out yet, he's gone. This is day 2 without the husband and there are 20 more days to go. It's not so bad, we ( me and the dogs, that is) mss him but we are proud of him (okay well, I don't know about Daisy and Gidget, but I am).

As far as the dog walking at 6 am, well..... I'm still working on that one.



~josie

Thanksgiving Holiday Trip part 2 : 17-Mile Drive

Part II: 17-Mile Drive

The second highlight of our trip would be the 17-mile drive along the shores Pebble Beach on our way to Carmel. Carmel itself is a very cute town lined with shops and trees, unfortunately we did not have time to walk around town. That is for next time.

Why did we not have time? Well, that is because we spent all the time we had absorbing the great beauty of the 17-mile drive. To start this drive, it took us a quick drive from Monterey along Highway 1 South to reach one of the entry gates. The fee is $9.50 per car. There are a total of 21 points of interest and 4 golf courses along this drive. Once you pay the entry fee, all you have to do is follow the red marks along the road to reach the points of interest. It is an easy drive with lots of signs along the way so no need to worry about getting lost or taking a wrong turn.

We did not stop at every point of interest for the sake of time, but here are some locations that we did stop at and enjoyed tremendously:

Shepherd's Knoll

Spanish Bay

The Restless Sea

Point Joe

another view of the Restless Sea

The Lone Cypress

It took us about 2 hours to do the drive and quickly enjoy/take pictures of some of those locations we stopped at. It was quite unfortunate that we did not have enough time to thoroughly enjoy all the spectacular views. Not only that, I also killed the batteries in our camera at the aquarium. So... we used an iPhone to take pictures, which came out pretty good, but our camera would've done a way better job. (note to self: next time, bring extra batteries).

We would recommend you to actually have the whole day available just in case you want to take a walk along the available paths or have a picnic or just sit and enjoy the waves for a while. We would also highly recommend you take your dogs along the drive because there are plenty of nice trails along the shores for you and your pet companion.We took our dogs Daisy and Gidget; MAN!!! they were super excited about this trip. They both couldn't stop whining in the car because they know they are near the beach (which is their favorite place on earth). I know they are thinking the same thing I'm thinking: we wish we were there longer.

~ josie

Thanksgiving Holiday Trip part 1: Monterey

We took a short trip to Monterey and Carmel for Thanksgiving holiday and these are the highlights of our vacation.


Part I: Monterey Bay Aquarium


This truly is a fantastic place to visit for a number of reasons. First off, their exhibits are pretty impressive ranging from the big mammals and birds to the colorful fish to the tiny invertebrates. Also, every exhibit is accompanied by little educational signs about the habitat and characteristics of the organism shown. They have several different touch tanks areas for us who want a closer look at these animals, as well as numerous educational programs and animal feedings that you can watch. Information on simple things we all can do to help the environment and the ocean animals are also found throughout the aquarium. 

Their current exhibits include the open sea, the giant octopus, the kelp forest, the sea otters, the secret lives of seahorses, the world-famous jellyfish, the penguins, and the rocky shore. As always, you can always go outside to their oceanview decks and use a telescope to observe directly the animal activities in the Monterey Bay. 

kelp forest exhibit

giant octopus

sea pen

big skate

sea nettle jellyfish

moon jellies

copperband butterflyfish

seahorse - the only animal on earth where the males bear children

Visiting this place always reminds us how majestic nature is and how diverse the ocean inhabitants are. We literally can spent hours at this place.  This is a place that everybody, from young to old, can enjoy and everybody can learn one or two new things about animals and the environment. We also like that this place helps to promote  the idea of sustainable living and responsible eating. It was worth the $29.95 entrance fee for the day (if you are staying for a few days, lots of hotels in the area offer a two-day-for-one ticket price). If there is one thing we did not like about this place, it is the cafeteria/restaurant food. It is mediocre at best, and we would definitely GO SOMEWHERE ELSE to eat and come back for the rest of the day.

For more info, you can always visit their website at http://www.montereybayaquarium.org and navigate from there to plan your visit. We highly recommend it.

~ josie

Gidget - Mischief (Almost) Managed

"We need to get a friend for Daisy."

"She's very lonely and sad when we leave her alone all day at home."

So we did. There she was, Gidget. An Australian stumpy tail cattle dog, small for her breed but feisty like no other (probably because the previous owners named her Gidget). She was...different than Daisy, she was quite a handful.

We thought they were going to accompany and play with each other when we were not in the house, but Gidget had her own idea of fun. She chewed up their plastic bowls, the couch, the trash, the socks and turned Daisy into a rebel dog as well. So it shouldn't come to a surprise when we had to do some damage control with Gidget.

Like the time when I got the phone call from my husband:

"I think you need to put some stitches on Gidget." WHAT? Apparently the girls have gone wild; a play turned into a fight and Gidget got a deep cut right on her chin.

I just finished my ER rotation, so I was able to do laceration repairs (on humans, at least). Armed with my suture kit, supplies of benzocaine topical anesthetic gel, gauze pads, and benadryl pills, we attempted to stitch up Gidget's cut.... It didn't work. She was too scared to even get remotely drowsy with the benadryl, and the topical anesthetics wasn't doing it. And honestly, I was too emotionally attached to her to even attempt to stitch her up without any numbing meds/sedatives. What's our solution?

 

Yup, that's right. We super-glued the cut. It turned out really well, actually, better than I expected. You couldn't even see a scar on her chin.  SUCCESS!!

But Gidget wasn't going to stop there.

Two days ago, we found a nasty lump around her rear right leg. It was an abscess... a pus-draining abscess. Didn't know how it got there, but I'm sure it got worse really fast because she probably licked it like crazy. I refused to do an I&D (incision and drainage) but my husband was going to try anyway, mostly because we were worried of being stuck with a huge amount of vet medical bill that we couldn't really afford.

So here we were again, at a local drugstore, getting supplies. We had a scalpel (from my suture kit), more benadryl, more benzocaine, more gauze pads, a box of dog treats, and some saline spray. We then lured her into the bathroom, closed the door and started the I&D.

It worked.. in the beginning. Made a small cut and yellow/brownish, foul-smelling, pus started oozing out of her wound (note: next time, do this in a more airy room, or at least turn on the vents in the bathroom for goodness sake! the nasty smell started saturating the whole room). Then it stopped. No pus came out but we knew there was still a lot in there. After a few more failed attempts, and poor Gidget was shaking now, we stopped.

We took her to the vet the next day (I thought she would probably need a course of antibiotics anyway, and I didn't have that handy with me). They did a "clip and clean" there (which we assumed is a less-scary term of I&D), gave us some antibiotics and ibuprofen to take home. Oh, and of course the collar...

Poor baby, she must be miserable wearing that thing. She didn't even know what it is, or what it's for. But she wouldn't be the Gidget we know if this silly little thing was going to dampen her spirit at all:

That's the Gidget we know. Feisty little thing, mischievous and all, but we love her to death (and Daisy too, of course).

~josie

Intro

I never thought that I would be blogging, since I've never liked writing anyway, but here I am... writing my first blog. It took me probably close to one hour just to come up with the first few sentences, and probably a whole Saturday night to write a whole entry. So why am I doing this?

When you asked me ten years ago about what I want in life, I would've most likely given you the most generic and predictable answer that many other people give: to have my career, settling down, living in my own home, etc, etc, kinda like what everybody else is doing. That was what I envisioned for my future, not because that's what I really wanted in life, but because that was what everybody around me is doing. It seemed to me that that was what life is: you go to school, then college, then get a job and start a career, then get married, settled down, buy a house, live like everybody else. It does sound kind of boring... but that was okay, because I'm not much of a thrill-seeker anyway.

But then I got married... to someone who doesn't settle with a boring life. After two years of marriage, we started to envision what we want in our lives together, what we want our lives to be, and we don't want it to be boring.

This blog is to document our journey of marriage together. Long story short, we want to live the life we want, fulfilling in every aspect, and (hopefully) along the way give something back to the community we are living in. Oh, and we also want to live here:

That is the US Virgin Islands. We are planning to move there hopefully in 2013, that way we have about a year and a half to plan the move and save money to start over. I will continue to work as a Physician Assistant there, hopefully in a primary care community clinic setting serving the locals, while my husband will work in the tourism industry starting his own business. We also want to volunteer, help the community and maybe even one day start a local non-profit program there.

So that is the plan for now. We will write about our life in the meantime: living in a crappy town, working hard to save tons of money and getting ready to make the move to paradise. But it is Saturday night, it is time to relax and enjoy the weekend in our crappy town, so maybe I'll have one of this...

~ Josie