Shut Up and Run

Yesterday, after running only twice since the triathlon in July, Jason and I ran in a 5K to support Christian Student Fellowship.  We had a lot of fun running together (which we haven't really been able to do together since kids), and obviously, we survived.

Another thing I liked about the race was the back of a few of my fellow racer's T-shirts.  My favorite shirts said "Shut Up and Run."  Obviously, they were more experienced runners than I because after the first 100 yards, I could read their shirts no longer.  But, the motto did make me smile.  And think.  

It made me think about a few patients I'd like to say it to.  "No, I do not have a magic diet pill for you.  Shut up and run."  "Yes, you can get off your diabetes meds if you'd just shut up and run."  Okay, so maybe I'd get downgraded on my patient satisfaction surveys and that might not be the most effective strategy for some people, but I may try it some day.

Really, though it made me realize that I should actually look in the mirror and yell, "Shut up and run!"  I blame it on time.  I blame it on work.  I blame it on travel.  I blame it on exhaustion.  I blame it on the boys.  I blame it on ...  But, the truth is, I should stop pointing fingers and shut up and run (or at least walk for heaven's sake).

I'd feel better.  I'd look better.  I'd eat better.  I'd have more energy, so I'd work better and I'd be more fun.  I'd be more confident.  And I'd only be out 30 minutes or less in a day.

Susan, come on.  Shut up and run.

Alphabet Soup

A1C, AAA, ACA, ACL, ACLS, ACS, ADHD, AI, AKI, ALL, ALS, ALT, AMA, AMS, ANA, AOx3, AOM, AP, APAP, ASA, BID, BKA, BMJ, BMP, BP, BNP, BRBPR, c, CA, CAD, CAP, CBC, c/d/i, CHF, CK, CKD, CK-MB, CNII-XII, COPD, CP, CPAP, CPT, CPU, CPR, CT, CVA, CVP, D/C, DEM, DO, DOA, DMII, DNA, DNR, DSM-IV, DVT, ED, EEG, EKG, EMR, ENT, EOMI, ESR, ET, FLK, FP, FROM, fT4, F/U, Fx, GAD, GC, GCS, GI, GNR, GYN, H&P, HCAP, HDL, HIV, HLP, HR, HRT, HPI, HTN, HOIII, h/o, I&D, IBD, IBS, ID, ICU, INR, IO, IRU, IUD, IV, L&D, LAD, LGA, LPN, LTCS, MAC, MCA, MD, MDD, MDS, MGUS, MI, MRI, MR, MRSA, MVA, MVP, NAD, NC, NG, NICU, NIPPV, NPO, NRP, NSAID, NSVD, n/v/f/c, O2, OA, OB, OCD, OCP, OU, OR, OSA, OT, OTC, PA, PALS, PAP, PCI, PCMH, PCN, PE, PEEP, PERRLA, PFT, PMH, PNA, PO, PR, PRN, Pt, PT, QID, RA, RF, RR, RRR, RLQ, RLL, RN, ROA, Rx, SCDs, Sig, SOAP, SOB, SQ, TBI, TID, TKA, TPN, TSH, TTP, UC, UGIB, UPJ, URI, U/S, UTI, VCUG, VRE, VS, VTE.

In other words...
PT/OT s/p Rt TKA 2/2 OA.
I&D by ID HOIII c VRE.  D/C PCN.
80WM h/o HTN, DMII, COPD, & CAD c MCA CVA on MRI is AOx3 in ICU after MVA.
Follow up for shortness of breath = ?

On Healthcare

Change.  Well, President Obama, congratulations, healthcare has definitely changed.  And it continues to change.  I'm hopeful, it's for the better, but I'm nervous it's not.  I'm anxious to see where we will be in the next 5 years.

Generally, I try to stay out of the political battlefield.  It's ridiculous that opinions on policy turn friends into enemies, and I'd rather have a friend.  However, unfortunately (or maybe fortunately), because of the career I chose, I've been forced to pay a little closer attention lately.  I've watched more political news and read more on policy than I've ever cared to before.  And I'm still naive.  The more I hear, see, and read; the more confused and frustrated I become on the healthcare debate and on our political system in general.  Why can't it just be simple?  Doctors are expected to talk to their patients somewhere in a grade school level to avoid confusion, and although, we may not always be good at that, it sure beats a 2000 page document written by lawyers (no offense) that we are expected to be "for" or "against" when we vote or at least have an opinion about healthcare reform (whatever that means).  And forget trying to find something that just explains the main points because those cliff note versions are laced with bias and manipulation.  If you find a good "Dummies Guide to Healthcare Reform" let me know.

What I've come to conclude, is that healthcare is going to be different, but NO ONE knows what it will look like regardless of who wins the election and who is making the decisions.  It's just too big with too many cooks in the kitchen.  From my very, very limited view point here's my opinion on healthcare.

The Good:

• Refocus on the importance of primary care.  I'm not just saying that because I'm a family physician and hopefully will reap some benefit (trust me, we are not hurting for business the way it is), but really, it's only what makes sense if you are trying to navigate an ever complicated healthcare system; and not to mention, if you're a pencil pusher it's proven to control cost.
• Encourage efficiency.  This kind of goes along with stressing primary care and patient care management (and to a point implementing patient-centered medical homes).  There is honestly a lot of waste in healthcare.  For example: people coming in for appointments that could have been handled over the phone (i.e. one day of cold symptoms); repeating lab tests because you didn't know the resident physician ordered it 4 hours ago or you don't have access to it after hours; prescribing unnecessary medications; ordering CTs, X-rays, and the million dollar work-up because the patient requests it or we are afraid of getting sued; or keeping a patient in the hospital extra days over the weekend, because they can't get the study they need until Monday or they have to meet the 3-midnight rule to qualify for Medicare's nursing home coverage.  Trust me, it happens every single day, and to avoid it would definitely be a good thing.

The Bad:

• Loss of patient responsibility.  (This is my beef with the idea of a "Patient-Centered Medical Home.")  It's frustrating as a doctor after explaining the benefits of a medication, of losing weight, of checking blood sugars, or of stopping smoking to have a patient come back without doing anything or maybe not come back at all.  It's frustrating and annoying, but soon it's going to make me angry because my paycheck is going to be dependent on how well my patient does.  I will be penalized if their diabetes is uncontrolled, if they don't lose weight, or if they have to go back to the hospital.  Unfortunately, it may come to a point when doctors "fire" patients (and believe it or not, if we jump threw the hoops, we have that "right") for noncompliance because we literally can't afford to take care of them.  In my opinion, it's the physicians' job to diagnose accurately, educate well, and recommend appropriate treatment; but it's the patient's responsibility to do it.
• Entitlement.  I disagree with many of our leaders that healthcare is a right.  Healthcare is a resource, and a limited resource at that.
• Treating based on evidence while reimbursement is tied to patient satisfaction.  There has been a big push in our reimbursement model to follow "evidence based medicine."  For example, when a study of sinus infections finds that there isn't any statistical benefit to starting antibiotics in the first 10 days, then the standard is that we shouldn't prescribe antibiotics in the first 10 days.  That's fine and probably good to have some standards; but it also comes at a time when we are also being scrutinized on patient satisfaction.  So now, that patient with the sinus infection comes in to clinic on day 5 of their symptoms, pays their $35 copay and finds out I'm not going to give them the antibiotic they were expecting.  Their satisfaction with me probably isn't going to be that high; which also is fine and probably good to not be catering to patient's every whim, but ultimately the choice becomes to sacrifice meeting standards or sacrifice my bonus for patient satisfaction.  It's a no win situation.

The Ugly:

• EMR.  If you're in the business you know that three-letter naughty word.  Electronic Medical Records has been the thorn in our side.  Sure, it may be better in the long run, but it is painful!  It's like knowing that being a hundred pounds lighter is good, but exercising several hours every day really hurts (and takes a lot of time).  This is one of those things I'm hopeful we'll be grateful for in the future, but I'm nervous it may become a trap to keep payers' (i.e the government and insurance companies) eyes and ears in the exam room.  It also makes me nervous because of the genius computer hackers out there, but I'm trying to be anxious about that.

I could go on and on and on.  And like I said, I'm not really into politics.  My opinions aren't because of my political affiliation, they are just that - my opinions.  Surely, I have a lot more to learn, but given how rapidly things are changing and how confusing it all is, I'm spending most of energy resisting the urge to just give up and wait and see what happens.

In a Pickle

My heart is heavy.  Have you ever felt that?  Words can't describe it well, but it is an unmistakable feeling.

Honestly, I feel like I made a mistake.  I big one.  I've been praying for something for years, and this past month I just gave up and decided to take it in my own hands instead of waiting on the Lord.  I mean it has been years - what is He waiting for!  Where's this "hope and a future" I was promised in Jeremiah 29:11? 

Now I regret my decision.  It just doesn't feel right.  And that feeling of loss was almost instant.  I feel like I've lost what God had been building in me through patience.  I feel like I lost whatever else was actually planned for me.

Nothing bad has happened, and maybe nothing will.  Maybe this is what God would have had me do anyway.  After all, the pieces were falling into place.  Slowly.  I just couldn't wait.  I couldn't stand the mystery.  My fear is that in my haste I traded God's plan for mine.  I traded His unexplainable provision for the security of the explainable!  And knowing how Good and Perfect and Powerful my God is, I want what he has planned.  At least that's what I say.  I sing "I will not fear.  His promise is true.  My God will come through.  Always."  But, I didn't live that.  I didn't put my trust or my fear there.  I trusted myself, and I feared my security.  Why are you fearful, you of little faith?  Matthew 8:26.

Now, I'm in a pickle - a really sour one.  Do I go back and gather the feathers I tossed into the wind?  Do I undo my decision?  How do I get back to the place of waiting for something better - waiting on the Lord?  There are other people involved now.  I have to confess and explain, and it won't make sense to them.  Heck, it isn't even something I can explain well to myself.  "I can't do what I promised, because I don't have a good feeling" probably won't go over well.  Or, do I fulfill this decision and my commitment and wait for God on the next one?

Photo Friday - Endless

This is almost too embarrassing to reveal.  Please don't think less of me.  Try not to judge.  But, yes, that is our sink in it's current state, and be thankful this isn't a panoramic shot.  It's awful.  I know.  This is an attempt to be honest and show that I clearly do not have it all together.  There is no good excuse for this disgusting pile, although I do have plenty of bad excuses: 

• no dishwasher
• it's Jason's job because we divided the painful chores - he does dishes, I do laundry (but don't ask about the laundry baskets)
• not enough time
• I'd rather blog; actually, I'd rather do anything!
• they're "soaking"
• the big pans at the bottom take up the whole sink, so it really isn't that bad
• maybe when Mom comes over she'll do some... Thanks, Mom!
• it's just a sign that I'm cooking more and we're eating out less, i.e. it's a good thing

Okay, maybe I'd better stop making the situation, and your opinion of me, worse, and get my elbows deep into some sudsy water.  It will be better tomorrow.  I promise.

Fireworks & Stuck

It never fails.  After a drought of blog topics and scratching the bottom of the barrel to come up with something as soon as I hit the "publish" button, great stories and great ideas flood in.  To avoid posting twice in one day and seeming pathetic - like I have nothing better to do - I "save them for another day" (which means I will forget or they don't seem nearly as brilliant or funny later).  Well, here's to throwing pathetic in the wind and here's post #2 for today thanks to an almost-more-than-I-can-handle-time-on-my-hands rotation at work.

*     *     Fireworks     *     *

On the menu tonight was BBQ Chicken Pizza.  It's not too difficult, but two boys screaming at your feet in a tiny kitchen makes boiling water difficult.  The oven was preheating, and I started cooking the chicken all the while ignoring the chaos beneath my knees and praying that a hot piece of chicken didn't fly out of the pan and onto a forehead below making for another awkward trip for me, a doctor, to the ER.

"Fireworks, Mommy," Owen reported as he looked in the oven.  I figured he saw the red hot coils glowing as the oven gathered its heat, so I just patted his fuzzy head and continued to shield Griffin's from the chicken above.  Owen moved along with his business.  By then it was time to bake the crust, so I opened the oven door.  Once my eyes stopped burning from the gray cloud of smoke that puffed out, I saw what Owen had noticed minutes before.  Fireworks!  The coil on the bottom of the oven was red, hot, glowing, and popping just like a July 4th sparkler.

I slammed the door closed to smother the fire (okay, so it wasn't exactly a fire but humor me), and pushed every button to try to remember how to shut the oven off.  With it off, I peaked through the hazy window (there was no way I was going to open that door... didn't you see Backdraft).  It was still glowing and when I saw a second spark I used my super-human strength to move and unplug it from the wall.  This time, the redness cooled and the oven again when black.  Slowly, I opened the door again; it was quiet and fireworks free.

It's even more funny because this is the 3rd oven we've had in our house since we moved just over a year ago.  Two of them have been gifts, and in all sincerity, we really appreciate the generosity!  But, maybe this is a sign that baking is not my spiritual gift after all.

*     *     Stuck     *     *

I'll keep this one short, because I do have to get up for clinic tomorrow.

Because we have the two cutest boys there ever were, it is difficult to not go in and just stare at them while they sleep.  Therefore, it's our habit to go in and hover over their beds and smile at least once before we go to bed.

Tonight, when I got home from Bible Study we did the routine.  Owen needed to be moved from the floor back to his bed, but he just rolled over, grabbed Oof-Oof, and went back to sleep in the most adorable way possible.  Then we opened Griffin's door.  He is not a peaceful sleeper.  With the sound of the door opening he flips and flops.  Sometimes he'll even sit up, all while totally asleep.  Tonight, he started to flip and flop, but he seemed a little restricted.  As I walked around his crib I saw his chunky thigh poking between the bars.  I expected him to pull it back in as he rolled around, but it didn't budge.  When I went to gently slide it back through, I realized it was really really stuck.  It took both Jason and I a few minutes to figure out how to manipulate his well insulated and now tomato red leg back into the crib where it belonged.

Needless to say, he didn't sleep through that.

Toy Box

We had a garage sale back in April, and honestly, we probably could stand to do another.  I am always finding things in my closet, in the boys' toy box, in the kitchen, in the garage, and in the basement that I completely forgot we have and that I realize we probably don't need.

 

Eventually, we will need to move, and how annoying is it to pack and then unpack a bunch of stuff you don't need?  What's even more crazy is that there were (okay, honestly, still are) some things I've kept because I've said to myself, "Well, I should keep this because when we have a bigger house, I'll need to have something to fill it."  Seriously, what am I thinking?  I guess it hasn't occurred to me that I could either not buy that big of a house, or I could put things in that house that I actually like and would use.

 

Today, my clutter frustration was targeted at the boys' toy box.  Who knew how many toys could accumulate in two and a half years?!

 

I'll admit that we are not good about making the boys pick up their toys that have been tossed throughout the house before they go to bed, and once they are asleep and it is quiet, the closest place to the toy box for all of those trucks and blocks is a pile outside of their closed bedroom doors.  Now that just seems pointless, so usually they just end of staying strewn about the house.

 

The other frustrating thing about the toy box, is that the toys don't even fit.  It takes a small feat of engineering to balance the last ball on the top of the pile.  Also, now that Owen thinks the toy box itself is a toy, it takes just one second for the whole thing to get dumped out and him to be curled up inside.  For some of the toys stuck at the bottom that is the only chance they have to see the light of day.

 

Well, today, I went through the toy box and made the tough decisions to evict a few of its inhabitants.  The broken, the duplicates, the boring, and the choking hazards all into an old moving box.  Somehow the cardboard box that was bigger than the toy box is full.  The toy box still has plenty of fun in it, and I'm confident that the boys won't even notice.  Actually, I'm sure they'll enjoy being able to find some of their favorites a little easier.
 

FYI:  Chuck the Truck and a few other had never been able to fit until now.