Public Health System

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My telephone was cradled between my left ear and my shoulder, as I pounded the keyboard of the sluggish rural county computer with one of the requisite patient visit fill-in-the-blanks atrocities — er, I mean “reports.” Finally, I heard the person I was waiting for pick up the other end.
“Hello,” I said. “Is this doctor A…….(name unpronounceable to native speakers of English)?”
-“Yes,” he answered, “I am the only doctor here.”
“This is Doctor Goldstein. I am one of the psychiatrists at the county mental health clinic.”
-“Really? And you call me?” Read more on The County Mental Health Clinic’s Referral…

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I remember a supervisor from the past whom I never thought had the right personality to be a psychiatrist.  I mean, he was a little angry and domineering for my taste.  But heck — I gave him a “bye” since he worked in a prison context.

I was never attacked by a prison patient through my tours-of-duty through four (all-male) California state penal institutions.  I had a couple who ended up on their knees, crying, stroking my hands, or even asking permission to kiss me (denied, of course).

They said I was “nice” to them.  I guess I treated them like human beings — something pitifully lacking in the prison system where everything seems oppressive and depersonalizing. Read more on Assaults On Psychiatrists…

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My preceptor in child psychiatry at the University of Kansas (Wichita) was easily the most respected psychiatrist in the region. Former chief of the residency training program, he was not at all the fanatically-publishing academic type I would find in psychiatric departments elsewhere.

He was eminently practical. Nearing retirement and clearly at the top of his game, he was known to be someone who really did straighten out troubled kids.

Me, there were times he gently chided me because of my theoretical and academic concerns which were not always of practical use. Read more on Responsibility for Veterans…

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By every measure, America is hanging onto its first world status by a thread.  And even that is arguable.  We have been in slow decline toward third world status for the last 30 years.  And nothing speaks to this reality more than this country’s poverty rates. It is sad that poverty is measured in percentages and indices that are debatable at best.  As in many news stories, an effort is made to personalize — to render concrete — these elusive numbers.  The happiness of the person who found free fruit but could not afford it at Walmart, cited at the end of the article, is a touching story. These are the stories of real poor folks, who have seen me as patients, in rural northern California. Folks like the married couple, both of whom were on active army duty in both Iraq and Afghanistan.  They left their kids with their parents while they served.  They wanted to continue serving, but were informed they could not because of “military cutbacks.”  They asked for job direction from VA counselors who were no help, and finally both found minimum wage jobs.  Their new wages combined total less than 1/4 of their military salaries, but they still make too much to qualify for insurance.  They own some land — from the family – where they are living with their children in their parents’ houses.  They are wondering how they are going to pay for their children’s medical care. Like the young man who has impacted wisdom teeth and back pain from a serious accident at a saw mill.  Something ran amok and tons of wood fell on his back. He cannot pay for either dental care or an operation on his back.  His family has chipped in for medical marijuana.  He has no idea of how to do anything except stay home, in pain, depressed, and stoned. Or there’s the older woman on oxygen who cannot lift her tank and has a bag of pills she cannot lift either.  She needs me to hold her hand while she limps with great pain into my office.  She has a broken hip but until she is old enough for Medicare — a year or so — mostly her friends shop for her and bring her everything she needs.  What she really needs is an operation on her hip but has no idea how to pay for it.  I tell her to ask her doctor for some kind of a device to assist ambulation.  She says a cane is not enough and nobody will pay for a walker; certainly not for a wheelchair. Some people think Obamacare might help but have no idea what to do until then.  I have seen unemployed young people who are glad they are still on their parents’ health insurance. The kinds of things I am seeing are the kind of things that missionaries see in third world counties.  I know some physicians who have been discouraged from that kind of work, simply because people need basic food and shelter before they can be cured or managed.  From what the people above tell me, they do not seem to have these things, either. Hanging on by a thread to our first world status?  No.  The thread has broken and we are third world. Now.

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Hello health care system.  This is weird, to put it mildly.

As far as anyone seems to be able to figure out what happened, this 38 year old nurse killed five dialysis patients and “assaulted” five others by putting sodium hypochlorite – bleach — in their dialysis tubing.

She had some problems with domestic violence and public intoxication and such.  But according to the relevant statements, that was all resolved before she did this.

Jurors have convicted her of capital murder, but she is not going to get the death penalty.  Mostly, this is because she is deemed to be of no further danger if she’s kept out of health care.  Her daughter seems to be taking it hard.  This is an indication for counseling, but not a change in Mommy’s sentence. Read more on When Nurses Kill…

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California is known as “The Golden State” and some have called it “The Land of Milk and Honey.”

The Beverly Hillbillies noted that it was the home of “Swimming pools – Movie stars.”

That should be encouraging for people like my 27 year old, freckled, red-headed patient.   After all, he had a pool cleaning business. But he was nervous — really nervous.

He did not have full-blown panic attacks, though he certainly fit the criteria for generalized anxiety attacks. Sometimes he did get a “heart in the throat” kind of feeling; something which some people would have called a “truncated anxiety attack.” But he had a lot of them and they really didn’t cramp his style very much.

He did not sleep very well, confessed that concentration was poor, and had great difficulty trying to find any interest in collegiate academics. As a result, his grades suffered considerably. And while I could potentially chalk this up to him falling into a category of males who may be better equipped for trade school than an actual 4-year college (based on patience; not necessarily intelligence), I didn’t believe this to be his case at all.

This guy was anxious. Read more on Stuck On The Treatment Treadmill…

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Stories about children having children are no longer the stuff that tabloid news is made of. They are everyday occurrences, although not usually as dramatic as the ten year old reported recently, in a cultural setting where such things are accepted — a cultural setting of gypsies that transcends usual divisions of governments and countries. I remember from my French medical education, how whenever a person of that group needed medical care, we were told that the person in question was in the family of their “king,” and special favors were requested as such.  I remember encampments in hospital parking lots, and very seductive young women dancing around for coins.

They reminded me of what Esmeralda in the “Hunchback of Notre Dame” ( the classic novel by Victor Hugo) must have looked like.  I stopped romanticizing them when someone who ran away quickly, and was allegedly one of “them,” tried to rifle my purse outside the hospital. All anyone has to do is open their eyes on the streets of the large cities of southern California, to see people who look like children (at least to Golden Oldies such as my husband and myself) who are pushing carriages full of babies and surrounded by tiny children orbiting the vehicle like satellites.

The question is — what is going on, and why. Read more on Early Puberty Causes — Chemical And Social…

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Some of the most vivid and memorable lectures I sat through in medical school were about bacteriology.  Our professor was a woman who was a consultant to the World Health Organization and who returned from assignments with dramatic first person stories about how she had collected trachoma samples from children in darkest Africa, and would thus help prevent their blindness.

She told us about Cholera, a horrible disease that killed quickly by diarrhea and subsequent dehydration.  A disease of poor hygiene that was found where people lived in congested settings and hygiene was tough to maintain. Did not even need antibiotics to save most of the lives; just hydration and electrolytes.  An illness apparently easy to prevent; there were pills to sterilize the water, simple public health interventions. But none of us were likely to ever see it.  We would all practice in civilized countries, like France. Vive la France. Read more on How Cholera Showed Up In Haiti…

She was 32 years old and a child of the streets.  I wondered if she were a Down syndrome — what we medical types call the mosaic (partial) trisomy 21 — the chromosomal abnormality some still call Mongolism.  This was purely an intellectual exercise, as the county health service would surely not pay for the expensive study, so I would probably never know.

Homeless person sleeping on a park bench.Previous doctors had prescribed anti-psychotic medication, but she did not tolerate any of the various brands available through the county clinic. I had her try a little Abilify (arapiperazole) and it did seem to help when she remembered to take it.  Or when she slept somewhere it would not be stolen.

Read more on Public Medicine — Cheap Is More Important Than Quality…

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