{"id":46015,"date":"2014-05-04T16:00:41","date_gmt":"2014-05-04T20:00:41","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=46015"},"modified":"2014-05-04T15:56:11","modified_gmt":"2014-05-04T19:56:11","slug":"as-i-knew-it","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/05\/04\/as-i-knew-it\/","title":{"rendered":"as I knew it&#8230;"},"content":{"rendered":"\n<ul>\n<div class=\"small\"><font color=\"#200020\"><em>April is the cruellest month, breeding<br \/>      \t  Lilacs out of the dead land, mixing<br \/>      \t  Memory and desire, stirring<br \/>      \t  Dull roots with spring rain&#8230;<\/em><\/font><\/div>\n<div align=\"center\" class=\"small\"><font color=\"#200020\"><em>The Wasteland [1922] T.S. Eliot <\/em><\/font><\/div>\n<\/ul>\n<div align=\"justify\">Every year, I joke that rather than being a post-World War I lament about the burdens of hope, what Eliot was really writing about was Spring Pollen &#8211; that he was a fellow sufferer of seasonal allergies. But this year, it was more poignant, more like Walt Whitman in his 1865 eulogy to Abraham Lincoln:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><font color=\"#200020\"><em>When lilacs last in the dooryard bloomed, <br \/>     \t    And the great star early drooped in the western sky in the night, <br \/>     \t    I mourned, and yet shall mourn with ever-returning spring&#8230;<\/em><\/font><\/div>\n<\/ul>\n<div align=\"justify\">In the week after Easter, I lost my two best friends of some forty years duration [<a href=\"http:\/\/1boringoldman.com\/index.php\/2014\/04\/27\/in-memory\/\" target=\"_blank\">in memory&hellip;<\/a>]. We retired around the same time and moved to the mountains to grow old together, living within a couple of miles of each other. Beside being lifelong playmates, the two of them had more to do with shaping my values than any medical mentor, though they had nothing to do with medicine. Andy was a minister who, early on, left organized religion and lived it&#8217;s tenets rather than talking about them. Al was a decorated photojournalist who, among <a href=\"http:\/\/www.thetimes.co.uk\/tto\/arts\/visualarts\/photography\/article3851419.ece\" target=\"_blank\">other<\/a> <a href=\"http:\/\/www.nashvillescene.com\/bites\/archives\/2014\/05\/02\/al-clayton-noted-southern-food-photographer-passes-away\" target=\"_blank\">things<\/a>, chronicled the dark realities of the South and was instrumental in <a target=\"_blank\" href=\"http:\/\/www.amazon.com\/America-Photographs-Clayton-Introduction-Kennedy\/dp\/B003S9ZLCM\/ref=sr_1_fkmr0_1?s=books&#038;ie=UTF8&#038;qid=1399209476&#038;sr=1-1-fkmr0&#038;keywords=hunger+in+america+al+clayton\">showing them to the world<\/a>. This blog began life as <em><strong><font color=\"#200020\">3oldmen.com<\/font><\/strong><\/em> to keep up with our other shared friends elsewhere, but Andy and Al weren&#8217;t the writing kind. When I turned to writing about more weighty matters, my daughter rebranded it <em><strong><font color=\"#200020\">1boringoldman.com<\/font><\/strong><\/em> to protest.<\/div>\n<p align=\"justify\">But this is not a eulogy, it&#8217;s about my recent encounters with Medicine and its current practices during my friends&#8217; illnesses. The doctors were excellent except for the Emergency Room where some were okay and a couple were truly horrible. The best I can say is that I didn&#8217;t hit one of them [which says more about my restraint than his just due]. Which brings me to what I want to talk about. There were two  main forces at work in our hospitals and medical systems that are diametric antipodes &#8211; struggling with each other in every single medical encounter.<\/p>\n<p align=\"justify\">At multiple points along the way, each of them needed to be in the hospital for diagnostic reasons, but apparently that&#8217;s a poor use of hospitals these days so we had to haul these two very ill men all over hell and half of Georgia [literally] to get the tests needed for diagnosis as itinerant outpatients. And there were numerous examples of &#8216;we can&#8217;t do this test [we need] until we do this other one [that we already know the result of]&#8217;. The tentacles of managed care utilization review spreadsheets were everywhere, usually unnecessarily obstructive, and drove us all nuts &#8211; concretely interfering with decent care. Consults that could&#8217;ve been done in a few minutes took days to schedule and coordinate with others doctors. The impact of the forces of restraint in medical spending were certainly apparent every day, everywhere.<\/p>\n<p align=\"justify\">On the other side of the coin, the waste and unnecessary expensive medical tests took my breath away. It was worst in Emergency Rooms where CAT Scans and MRIs were ordered as if you had to have one or more just to prove you&#8217;d been there. It felt like a mixture of fee churning, CYA, and defensive medicine &#8211; more like the primary purpose of an ER was to generate revenue rather than tend to the sick. That was true in the hospitals as well. There are rigid protocols for everything perverted to drive up costs rather than contain them [their original purpose]. I&#8217;ve been mostly blessed with health, so my stint on the &quot;consumer side&quot; of modern healthcare was more up-close than it has ever been, and left me with a bad taste in my mouth &#8211; both the outside influence of managed care restrictions and rules and the outrageous waste, expense, and excesses of the hospital corporations\/PHARMA\/etc. I felt something between shame and rage much too often in this last month for my liking. There are other things that need feeling when you&#8217;re losing your friends.<\/p>\n<p align=\"justify\">I tried to keep what was going on in my life out of what I was writing about Integrative or Collaborative Care, but on rereading, I think I failed at that. What I read sounded like perverse systems theory drivel with people jockeying for position. Even though I was a reluctant soldier, the best  system of medical care I ever worked in by far was the US military on an  overseas base. Part of that was because it was a healthy population.  Part of it was because there were very few, if any, sociological  problems &#8211; by definition, everybody was employable and employed, pretty much on the  same level. But another piece was that it was genuinely <em>Collaborative Care<\/em>, <em>Integrative Care<\/em>, whatever you want to call it when there is a  team of medical personnel working together. We were all in a centralized  location, knew each other, ate lunch together, were paid the same, etc.&nbsp; If you needed some help, it was just down the hall. I was an Internist then, but the Psychiatrists were an integral piece of that system.<\/p>\n<p align=\"justify\">The  second best systems were the two megalithic City\/County Charity  Hospitals where I did my training [one now closed]. They were always on  the brink of bankruptcy, underfunded, chaotic, and staffed largely by  sleep deprived trainees. The patients were indigent and with a ton of  pathology, but the healthcare was good, including psychiatry &#8211; collaborative. I would include the charity clinic where I now work in that group, though services are limited.<\/p>\n<div align=\"justify\">The  worst, also by far, is the system I&#8217;ve dealt with the last months with  my friends, private systems with the best doctors and the most medical  resources. It&#8217;s because the regulatory forces, the intrusion of the managed care carriers, the phobia about hospitalization, and the carpetbagger profiteers have made one hell of a mess of things. I&#8217;ve left out the details because I expect most of you have stories of your own. I always said I didn&#8217;t want to age into one of those old guys who longed for &quot;the good old days,&quot; but this particular April, I was mourning more than the final days of my friends. I mourned the loss of Medicine as I knew it&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>April is the cruellest month, breeding Lilacs out of the dead land, mixing Memory and desire, stirring Dull roots with spring rain&#8230; The Wasteland [1922] T.S. Eliot Every year, I joke that rather than being a post-World War I lament about the burdens of hope, what Eliot was really writing about was Spring Pollen &#8211; [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-46015","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/46015","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=46015"}],"version-history":[{"count":27,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/46015\/revisions"}],"predecessor-version":[{"id":46042,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/46015\/revisions\/46042"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=46015"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=46015"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=46015"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}