206) Adios La Alondra de la Frontera

January 17 2008

El Milagro:
Got here at 4:30… which was good since my chair wasn’t ready at 4 anyway. Carrie cannulates me and Monica the Nurse checks my chest and ankles. Monica is leaving the facility to move back to the west coast to be closer to her family, so I wish her well and say we’ll miss her. I watch Oprah and see Dr. Chistine Northrup discuss menopause and am glad I’m a guy.

I am pondering the Patient Advisory Committee meeting we had yesterday and writing up the report for the newsletter. The meeting was on the gripey side; with the members having issues with nursing assessments, staffing on shifts, patients bleeding too much, Suzanne’s picking up trash, Moritz the doctor's not coming around to visit with folks, Moritz’s bedside manner, and the doctors' ‘drive bys’ being billed to insurance as visits when they only
last a minute or so. The administration, represented by Suzanne the Administrator and Marilyn the Social Worker responded to all these ‘issues’ and the meeting ended on a positive note, but now I have to write up a politically correct report about it all for the newsletter, and that will be a challenge.

In at 76.9 Kgs and out at 75. Kgs.

January 18, 2008

El Milagro:
In at 4:15 for my 4 o’clock chair and the chair is ready. (I am here today so I can miss tomorrow for Mitch's House-warming) I ready my area by taking out my blanket, my pillow, and replacing the batteries in my radio. Carrie the Tech comes over to stick me again, saying, “Is it okay for me to stick you two days in a row?” I am okay with it and tell her so. As she is sticking me I notice that she changes gloves about five times during the process, so either she is a bit germ-a-phobic, or obsessive-compulsive, or really conscious about not spreading anything to patients… doesn’t matter to me, since I am the recip
ient of all her hyper-consciousness. The frugal me wonders how many boxes of gloves they charge to my insurance company.

As she is hitting me up and hooking me up, I am watching her, having these wonderings, and simultaneously listening to Latino USA’s remembrance of Lydia Mendoza*, the meadowlark of the border, who died in San Antonio just before Christmas.

I remember hearing her sing on the radio of my youth in El Paso and always liked her voice and guitar work even though I couldn’t completely understand the words. The un-named memory of her is one of those auditory anchors that is buried in the folds of my brain from long ago, and released when there is another playing of her songs… especially Mal Hombre, which stuck in the folds of my brain, probably since listening to KELP radio softly by my bedside back in 1958-59. Even then Mal Hombre was an “oldie” on the radio. The name of Lydia I didn’t remember until today, but the guitar and voice were etched in the folded blankets of my memories to be unlocked today with the sounds of her voice. Pretty cool!

There are not a lot of people here today. I count about 12 empty chairs and wonder if folks are skipping out for a Friday night out, or if this is the norm for this 3rd shift MWF.

I have been thinking a lot since the PAC meeting about the doctor, patient, dialysis center relationship. The center has to, seemingly, be subservient to the doctor’s needs and directives and yet the center can complain to DaVita central if they think the doctors aren’t being responsive to patient’s needs.
The issue (this time) is this: a patient tries to get the doctor to agree with him related to complaints of joint pain. The doctor responds (from the view of the patient) in a way that tells the patient that he is just griping and really needs to lose weight, and therefore the doc isn’t gonna do anything or give him anything for his pains. So, the patient goes to another doctor who wants to consult with the first doc about the patient’s joints and the first doc blows off the second doc and then acts even more rudely to the patient at the next meeting. The patient confronts the doc about this, and the doc treats him even worse (according to the patient). So, the patient sees as the only solution to change dialysis centers and change doctors. That is one solution. We in the PAC suggest he change doctors in the same office (CTKA) and set up regular doctor’s visits at the office, rather than using the dialysis center’s doctor’s ‘drive bys’ as his doctor’s visits. Suzanne the Administrator says she too will bring up the situation with the doc in question.

My concerns are several. For one thing, it irks me that the ‘drive bys’ that the docs do at the center, which are in no way confidential visits between a doc and a patient, are still billed to our insurance companies as doctor’s visits. They usually last about one minute and most patients tell the doc all is fine, which is an easy thing to say when you are in the middle of a dialysis session and have neighbors less than two feet away from you. That situation doesn’t lend itself to bringing up anything really intimate. Instead it is an opportunity, usually for the dietician, nurse and doc to compare notes about meds, diet, and the recent blood work, which all patients have in common and is readily discussable in the ‘drive by’ kind of situation. The facility's answer is to offer screens if the patient wants a confidential doctor's visit, but I have a hard time imagining patients doing that, because that too makes their visit with the doc stand out to everyone else.

For another (and one I have sent a complaint letter about) is the practice of docs transferring patients back and forth without telling the patient. They claim that this is for expediency in coverage of the different dialysis centers, but from my view it is an unethical practice to switch off a patient to another doc without even notifying the patient and giving them a say in the switcharoo.

BTW: I never did get a response to my complaint letter on this, and I just solved it myself by refusing to list the doc they gave me as “MY” doctor on my insurance stuff. This isn’t really a solution, although I have cleared my brain of it for the time being. I recommend that dialysis patients not think of the in-center drive-bys as their doctor’s visits! Patients should make an appointment to meet with their nephrologist every 6 months in the doctor's office. There you have the time and privacy to bring up all you are concerned about (make a list) and want to discuss with the doc. And the session is not rushed by being in a line of chairs that they are rushing by to get to the end. Enough said.

So, I hear Latino USA, doze, ruminate over the above, watch the news, and switch over to hear Gwen Ifel’s guests talk about the state of the primaries on Washington Week**. It is a great show for taking my mind off the above, so I am thankful to Gwen again. And so it goes this week at dialysis. This week my blog has functioned as whipping post and I appreciate my readers for wading through my grumbling diatribe.

In at 75.8 Kgs and out at 73.7 Kgs.

* Lydia Mendoza, interview on the Worship Guitars website, at http://www.worshipguitars.org/Interviews/lydiamendoza/index.html

**Washington Week, available online at http://www.pbs.org/weta/washingtonweek/thisweek.html

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