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“Assessment and plan”, something I still mutter to myself during tenuous decision-making, having overheard it so many times during my mom’s dictating. Her knowledge and experience was central to my early opinions regarding healthcare and primary care giving.

At 19 years old, I dropped out of college and spent nearly four years working in the admissions department of a small hospital, in a community I suspect has more Medicaid recipients per capita than of the rest of the state. I lost most all of my faith in humanity as I watched “repeat offenders” use the ER for everything BUT emergencies.

I became incredulous, self –righteous in my own “betterness”.

I am not an expert in our medical system, or any medical system. My knowledge of medicine is incredibly limited, and based mostly on anecdotes and recurring themes I have heard from medical experts I know. The 7 years I spent in medical billing did little to lift the cloud in my understanding of medical reimbursement.

I heard two things from my “left” news source this morning that angered and troubled me.

1^st– Republicans think that Medicaid expansion has contributed to the opioid crisis. The evidence is correlational not causational, and the increase is in prescriptions overall, as well as opioid-related deaths in Medicaid expansion states. Republican lawmakers are extrapolating evidence. Also, opioid users who aren’t physicians cannot write prescriptions for themselves. Should we address that prism of a problem before cutting the Medicaid lifeline?? Because CHILDREN are the primary recipients of Medicaid benefits, I will always be in favor of supporting and expanding coverage, even if that means more abuse.

2^nd– HHS has moved to protect healthcare workers with “a moral or religious objection” to providing treatment. The problems with allowing these types of objections seems OBVIOUS to me (and most of my readers), but just in case, a few potential concerns.

Physicians cannot currently refuse to treat patients based on ethnicity, race, religion, or sex, and in some instances ability to pay. What rights do they have to refuse treatment now?

What if I had a moral objection to your marital status, the number of children you had, your political views, your support of gun ownership or free speech, or your drug/alcohol use?

What about Emtala? Who can we refuse to provide life-saving/stabilizing treatment to now?

What if a woman is going to die if you don’t perform an abortion for her and you refuse? (aside from the problem that you are placing more value on the life of her unborn child than you are hers)

I am also deeply troubled by how often I feel the need to either rely on my mom to advocate for me, or to be my own advocate in our medical system. Even if you have a physician whose opinion and expertise you trust, there are so many instances in which patients should ask for clarification, or more information. Patients should ask questions not only because of the costs associated with these decisions, but also because many times there are what I will term “negative side effects” associated.

When a doctor orders a diagnostic test

When a doctor prescribes antibiotics

When a doctor prescribes opioids

When an OB schedules an induction or a non-emergent c-section

When a doctor recommends prolonging someone’s life where the quality of life has entirely diminished.

In my mind (a pretty backwards place) the lack of reliability and accountability in our primary care system (which I will not speculate on the causes of, nor solutions to) has led to one other health crisis (falling immunization rates). Unless you are immune deficient vaccines are ALWAYS an incredibly good idea. There is absolutely no evidence otherwise. How could a person of average intelligence and education know when to ask questions and when to trust and accept their doctor’s recommendations? It’s more repercussive noise from our litigious society.

 

 

 

I thought that being an adult meant I didn’t have to contend with other peoples’ absurdities, unless they were paying me to; that the only person who’s opinion of me I would constantly be watering would be my employer; that if somebody made me feel somehow less than him or her I could tell them off. The reality is I answer to more people and their opinions of me than I ever imagined possible in my naïve and buoyant youth.

 

If I had to create a resume where my Christmas Card mailing list was my character reference

 

My Family

Hannah is a woman full of opinions and ideas, but they are usually wrong. She is misinformed as to the value of these opinions, especially when it comes to attending to the needs of her own child. She has an immense sense of urgency, and can often be impatient and rude. She does not respond well to criticism. Hannah would be best served in an environment where someone monitors her work to assure there aren’t any errors.

 

My In-Laws

Hannah is very expressive and direct. When she says what she means it catches us off guard. She does not respond well to other women, and has developed a fondness for Pendleton. We are unsure if we can trust her as she does not mix her alcohol with sugar, nor her vegetables with ketchup. She thinks her cynicism and sarcasm are funny, but she is rude and offensive. Hannah would not work well in an environment where trust is built on permissive attitudes.

 

My Friends

Hannah who? Hannah lacks the discipline and flexibility required to manage her schedule. She often doesn’t respond to messages for days. It is difficult to communicate with her about events, opportunities and get-togethers. She does not initiate contact well on her own. She is all too pleased by her own cleverness. Hannah would work best in an environment where she doesn’t have to be around other people.

 

In good humor,

Your loving daughter/sister/wife/mother/sister-in-law/friend

 

~Hopefully I still have people in my life after this