Fun And Games · Fun With Suits! · Pains in my Fifth Point of Contact

RANDOM THOUGHTS

RANDOM THOUGHT THE FIRST:

I had seen a soul for some malady or another, and had prescribed an antibiotic. In keeping with our usual practice, I had e-prescribed this medication, sending it off to the pharmacy the patient had identified as his preference.

An hour or so later, the receptionist received a phone call FROM THE PATIENT, asserting that the medication was not covered by his insurance.

I receive these calls frequently. Simply so that you know, the mere fact that any particular medication had been covered by one or another of the hundreds and hundreds of different health insurance plans that are out there, by no means establishes that this medication will be subsidized, today. In addition, each individual health insurance plan has it’s own “formulary”, or list of what medications it will subsidize, and to what extent. These formularies differ from Medicare (and among different medicare plans, as well), to Medicaid (and, again, among various flavors of Medicaid), to assorted flavors of private health insurance. Again, formularies vary from one private insurance plan (say, one particular form of Humana insurance), to another (like, one of the insurance products from Blue Cross).

Therefore, it is not uncommon for these calls to come in. Generally, they are from the pharmacist. Then, the pharmacist, who has access to the insurance company’s formulary, can suggest another similar medication that will be subsidized. I will request it, and we all go on about out lives.

When they originate from the patient, it becomes somewhat of a time sink. What, am I gonna tell the patient what the new medication will be, and the dosing regimen, how many doses to dispense, and so forth, so that the patient can communicate this to the pharmacist? (anybody ever hear about, ya know, PRESCRIPTIONS?)

Occasionally, when I have some sort of wild hair up my ass, I am tempted, briefly, to do just that. “Why, thank you for the call, Mr. X! Please tell the pharmacist that I am changing your prescription from Amoxicillin, and instead I will prescribe Mofeen, one pound, and you are to take ad lib and prn until the heat death of the universe! And, you have a nice day!”

My filter has,thus far, worked without fail. I have never told anybody that…out loud.

Instead, what I do, indeed, say, out loud, is “Please invite the pharmacist to phone me, and he and I can discuss it.”

The Second:

I had occasion to phone another physician’s office, in order to have my patient seen that very day. I generally make this sort of call myself, when I need a same day appointment for my patient, because I can either explain all the particulars of the scenario to my MA, who can then repeat it to the other office’s MA, and then have her seek me out when, inevitably, there is some question that I have failed to explain in sufficient detail, or I can do it myself, explaining things once.

I vote for “Once!”

So, TINS©, TIWFDASL©, and on hold/ignore. Eventually, the other office’s scheduler came on the line, and we had our lovely little conversation about my patient’s malady, and why I felt the burning need that this soul be seen TODAY!

Everything proceeded swimmingly, and I noted the time and address of the particular office my patient was to report to. The scheduler asked my name.

“Reltney McFee, PA.”

“How do you spell that?”

“R-E-L-T-N-E-Y, M-C-F-E-E.”

She read back her note: “R-I-A-L-D-M-A-I, M-A-K-A-S-E-E?”

I had not really slept all that well the previous night, and had several people in the waiting room, eagerly awaiting (DYSWIDT?) my attention, so that they could get on with their own days. I quickly calculated that I could get this chucklehead to properly spell my name on the scrap of paper that she would soon discard, or get this patient the hell out of my department, and on to Higher Level Of Care, sooner.

I (unsurprisingly, I wager) went with option “B”.

“Nailed it!”

The Third Random Thought:

My home state, The UnNamed Flyover State, legalized marijuana last year, for recreational purposes. I have spoken, previously, about my rapture at this development. While I have not, completely, cataloged every single way in which I think that this is a fail of epic proportions, perhaps I have revealed just a little bit of my lack of enthusiasm for this development.

A couple of times.

I have noticed in recent months the phenomenon of idiots (er, I MEAN, children of God) evidently wandering through the world stoned. I reached this conclusion because of the numerous folks who stop by my clinic reeking of reefer fumes.

I do not mean, “Hey! If I pay attention, I can detect a waft of a smell, as if of marijuana, somewhere about this person!” Nay, I mean “Dude! Are Cheech and Chong shooting another movie hereabouts?”, or, perhaps, “Is there some sort of Rastafarian festival in town?”

Indeed, occasionally the smoke is eye wateringly intense, yet the purveyors of the fumes appear unaware of the air quality hazard that they present.

I have wondered about that. I suspect one of two things is in operation here. Either they are so stupid, either at baseline, or due to the deleterious effects of marijuana upon their mentation, (maybe, I should embrace the power of “and!”?) that they simply cannot realize what they are spreading in their wake, or else it is some sort of pheromone, at least in their minds, that attracts The Opposite Sex.

Although, to be honest, anybody who would be attracted by the olfactory cues these folks present, I would not romance with your johnston!

guns · Life in Da City!

Why Do People Get Shot In Da City? (or) A Tale Of Four Stupids

TINS©, TIWFDASL© in Da City, as a medic. (Kinda where this entire series of stories began, right?) Every night my partner and I would respond to somewhere around 12-20 runs in the course of a twelve hour shift, seven shifts in each two week pay period. Let’s call each typical night 12 runs. It makes the math simpler. Nearly every shift, there’d be one shooting, sometimes we would catch a couple or four shootings, occasionally no one would be shot among our patients.

So, after over 6 1/2 years, back of the envelope math reveals that I responded to something on the order of 14 000 calls, maybe 2 000 shootings. I developed my own opinions on why it is that folks get shot in Da City.

First in the list, most popular, if you have your heart set on being shot, is engaging in the unlicensed retail narcotics trade. If you prefer, in order to accommodate delicate 21st century sensibilities, we can refer to folks so occupied as “Undocumented Pharmacists”. These entrepreneurial souls were commonly among the shoot-ees in my ambulance. As regards their numbers among the shooters, well, I lack direct data, but it seems reasonable to conclude that these folks were not shot by the Amish, nor by employees of competing internet startups; for one thing, there was no internet in these dark times. Rather, it seems likely that the perpetrators of these shootings were attempting to dissuade competitors from marketing in what the shooters thought of as their markets.

Secondly are alcoholics or those who associate commonly with alcoholics. Patient census wise, this was also a “popular” option should one seek to be shot. Well, for certain meanings of “popular”, that is.

Third in line (and likely showing some overlap in our Venn Diagram of morbidity with the first two groups), are those folks who owe some third party sizable amounts of money, and have allowed this third party to have some lack of confidence in either the timeliness of repayment, the completeness of repayment, or some combination of the above. And, I do not mean MasterCard or Quicken Mortgages. They only shoot you in the wallet.

Next up in our list of popular triggers, so to speak, of being shot, is represented by Lotharios who romance somebody, that somebody else believes is THEIR love interest exclusively. That aggrieved somebody else may seek redress ballistically.

Last in measurable terms is the innocent victims of random violence.

An over arching theme among the above, is the report of the shoot-ee, that “There I was, minding my own business, and these two dudes, they shot me for no reason!” This is akin to the classic report by the family of deceased home invaders, immortalized in recent months on television news, as “He dindu nuffin! Ain’t no cause to shoot im! He just breakin in, dat ain’t no deaf penalty crime!” (checked for typos)

Also associated with this is the lament that the decedent was studying to be an aeronautical engineer, transplant surgeon, minister, or was studying music so that, once his rap career was successfully concluded, he could find a second career being a choir director, given his love for choir as a yout.

In summary, may I remind one and all of John Farnam’s dicta, which I repeat to my family ad nauseum. In my iteration, it is referred to as “Avoid the Four Stupids!”, or in more detail: “don’t go to stupid places, at stupid times of day, to do stupid things, with stupid people.” This includes by reference the mantra that “Nothing good happens after midnight!” Mr Farnam’s own formulation reads as follows:

(a) Don’t go to stupid places. (b) Don’t associate with stupid people.

(c) Don’t do stupid things. (d) Be in bed by 10.00pm (your own bed!).

(e) Have a “normal” appearance. (f) Don’t fail the attitude test! (http://defense-training.com/2018/where-is-safety)

 

(So, I suppose that makes for Six Stupids: “Don’t go to stupid places, at stupid times of day, to do stupid things, with stupid people. Don’t look stupid, don’t act stupid”)