Big news for me -- I recently accepted a new job! I'll start working as a research assistant studying renal disease and hypertension (that's kidneys and high blood pressure, for my readers whose vocabularies do not favor the medical) at University of Colorado's medical center in mid-July. I started reading through the project descriptions for what I'll be doing today. I'm excited and apprehensive about this.
I'm excited because...
- I will get to use my brain so much more than at my current job. My mind is crying out to be challenged.
- The new job has better pay and kickass benefits.
- I won't have to deal with the rude patients anymore.
- Did I mention that I'm looking forward to an intellectual challenge?
I'm apprehensive because...
- I will not have a close-knit group of coworkers like I do at my current job - it'll just be me and my boss.
- I don't know much about kidneys or the vascular system yet.
- I think I may miss patient contact.
- The timing of me leaving my job is not especially convenient for them, and I feel kind of bad about that.
In the mean time, I am trying to figure out what to do career-wise. Main options include nurse practitioner, physician assistant, or Ph.D. in human medical genetics or molecular physiology. I'm not ruling out medical school or a master's in genetic counseling either. I sure wish I could figure my life out.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
22 June 2011
15 December 2010
OMT
Sometime in November, I decided to just take the many suggestions I've gotten that I apply to osteopathic (D.O.-granting) medical schools as well as allopathic (M.D.-granting). I've been open to it, but I just found a connection to a D.O. to shadow (which osteopathic schools really want you to do when you're applying). In the last month or so, I have been shadowing a doctor who actually does osteopathic manipulative treatment (OMT, the hands-on musculoskeletal manipulations that DOs learn which constitute the difference between them and MDs but that a lot of DOs don't do in practice) one morning a week to see what it's all about.
OMT is pretty cool. And a quick search of PubMed (a database of scientific studies) shows that it works better than placebo or physical therapy to treat some back pain, ankle injuries, and ear infections, actually (which I think is so weird!) among other ailments. With some patients, you actually see a difference in how they move immediately after treatment, which is awesome. It definitely seems like a great treatment option for musculoskeletal pain.
So today as part of my shadowing experience I decided to be the patient. I definitely have some occupation-related back and neck pain (sitting all day with a phone cradled against your shoulder while typing? It gets to you after a year or so) which makes me a good candidate for OMT. Plus, watching a doctor do it doesn't show as much as I would like, because so much of it seems to be small, slow, gentle movements rather than large or jerky movements that would make clear what's happening. To be honest, I sometimes wondered if anything was really happening. So I had my neck, back, and pelvis realigned this morning.
The doctor held my arms in weird positions while putting pressure on the muscles in my back that are always tight (this is called counterstrain, and if I remember right, the idea is that you stretch the tight muscles in the opposite direction). He cracked my T1 vertebra (the only cracking I've seen him do, actually - apparently unlike chiropractic, OMT doesn't involve a lot of that, but it sure felt good). He put pressure with his fingertips on points on my neck and my pectoral muscles. The med student doing a fellowship there had me squeeze my knees together and push them apart against resistance, put pressure on areas of my lower back, and had me move my legs around in a particular way. Very little of it hurt at all, it was not like a massage - they barely moved their hands, it was mostly slow, and it took about half an hour.
This afternoon and still somewhat now, I felt like I'd lifted weights for about two hours. I was SORE. And thirsty. But the good kind of sore - when I feel my shoulder muscles, they are much more relaxed than they have been. My upper back feels refreshingly loose and mobile. When I feel my spine from my shoulder blades up my neck, it actually feels and looks straighter.
OMT is pretty cool. And a quick search of PubMed (a database of scientific studies) shows that it works better than placebo or physical therapy to treat some back pain, ankle injuries, and ear infections, actually (which I think is so weird!) among other ailments. With some patients, you actually see a difference in how they move immediately after treatment, which is awesome. It definitely seems like a great treatment option for musculoskeletal pain.
So today as part of my shadowing experience I decided to be the patient. I definitely have some occupation-related back and neck pain (sitting all day with a phone cradled against your shoulder while typing? It gets to you after a year or so) which makes me a good candidate for OMT. Plus, watching a doctor do it doesn't show as much as I would like, because so much of it seems to be small, slow, gentle movements rather than large or jerky movements that would make clear what's happening. To be honest, I sometimes wondered if anything was really happening. So I had my neck, back, and pelvis realigned this morning.
The doctor held my arms in weird positions while putting pressure on the muscles in my back that are always tight (this is called counterstrain, and if I remember right, the idea is that you stretch the tight muscles in the opposite direction). He cracked my T1 vertebra (the only cracking I've seen him do, actually - apparently unlike chiropractic, OMT doesn't involve a lot of that, but it sure felt good). He put pressure with his fingertips on points on my neck and my pectoral muscles. The med student doing a fellowship there had me squeeze my knees together and push them apart against resistance, put pressure on areas of my lower back, and had me move my legs around in a particular way. Very little of it hurt at all, it was not like a massage - they barely moved their hands, it was mostly slow, and it took about half an hour.
This afternoon and still somewhat now, I felt like I'd lifted weights for about two hours. I was SORE. And thirsty. But the good kind of sore - when I feel my shoulder muscles, they are much more relaxed than they have been. My upper back feels refreshingly loose and mobile. When I feel my spine from my shoulder blades up my neck, it actually feels and looks straighter.
13 April 2010
A brief rant
I deal with ignorance a lot at work. Not bigotry, just lack of awareness about things. And I really don't blame people for it too much. But today I encountered a pretty ridiculous example, and I would like to share it with you.
A patient is having trouble getting her insurance to cover a couple of routine screenings and another test. She called about it today. Apparently the insurance company is saying they have the wrong diagnosis codes for the procedures she had done. So I called her insurance company to see if I could help her figure things out. Here is how the call went.
[Holds for 10 minutes.]
Customer Service Rep: Blue Shield of California, my name is [name]. This call is being recorded. How can I help you?
Me: I'm calling from a doctor's office, and I have a patient who is having trouble getting you to cover some tests we ordered. Can you please tell me what information you have on file for [date of service]?
Rep: Do you know how much the claim is for?
Me: Around $2000? I don't know exactly, I don't have the patient's bill in front of me.
Rep: It must be this claim for $2210. I show that the services were not covered benefits. Oh wait! It looks like we covered $220.
Me: And what was that for?
Rep: Diagnosis code V76.12 and procedure code 00403.
Me: Okay, V76.12 is "need for screening mammography." What is 00403?
Rep: It's the procedure code.
Me: What type? It's not a CPT code [standard procedure code]. It must be unique to your system. What does it mean?
Rep: Uhh... let me check.
[Puts me on hold for 2 minutes.]
Rep: Hemo- hemoglobin.
Me: Hemoglobin is not a procedure. There is no way that's right. The only procedure code that should go with the diagnosis code "need for screening mammography" is a procedure code for a mammogram.
Rep: Uh... hold on.
[Puts me on hold.]
[Disconnected.]
SERIOUSLY. WTF. This guy works in the health insurance industry and he doesn't know what hemoglobin is. It's the protein on red blood cells that transports oxygen. It is NOT a procedure. It's like saying "eyeball" or "toenail" or "skin cell" is a procedure. What a dumbass. I would like to say I can't believe insurance companies hire people who don't know anything about medicine or medical terminology, but I can. This guy was clearly not familiar with the word "hemoglobin" and he definitely didn't even realize the idiocy of what he was saying to me.
A patient is having trouble getting her insurance to cover a couple of routine screenings and another test. She called about it today. Apparently the insurance company is saying they have the wrong diagnosis codes for the procedures she had done. So I called her insurance company to see if I could help her figure things out. Here is how the call went.
[Holds for 10 minutes.]
Customer Service Rep: Blue Shield of California, my name is [name]. This call is being recorded. How can I help you?
Me: I'm calling from a doctor's office, and I have a patient who is having trouble getting you to cover some tests we ordered. Can you please tell me what information you have on file for [date of service]?
Rep: Do you know how much the claim is for?
Me: Around $2000? I don't know exactly, I don't have the patient's bill in front of me.
Rep: It must be this claim for $2210. I show that the services were not covered benefits. Oh wait! It looks like we covered $220.
Me: And what was that for?
Rep: Diagnosis code V76.12 and procedure code 00403.
Me: Okay, V76.12 is "need for screening mammography." What is 00403?
Rep: It's the procedure code.
Me: What type? It's not a CPT code [standard procedure code]. It must be unique to your system. What does it mean?
Rep: Uhh... let me check.
[Puts me on hold for 2 minutes.]
Rep: Hemo- hemoglobin.
Me: Hemoglobin is not a procedure. There is no way that's right. The only procedure code that should go with the diagnosis code "need for screening mammography" is a procedure code for a mammogram.
Rep: Uh... hold on.
[Puts me on hold.]
[Disconnected.]
SERIOUSLY. WTF. This guy works in the health insurance industry and he doesn't know what hemoglobin is. It's the protein on red blood cells that transports oxygen. It is NOT a procedure. It's like saying "eyeball" or "toenail" or "skin cell" is a procedure. What a dumbass. I would like to say I can't believe insurance companies hire people who don't know anything about medicine or medical terminology, but I can. This guy was clearly not familiar with the word "hemoglobin" and he definitely didn't even realize the idiocy of what he was saying to me.
18 January 2010
How I feel about drug reps
So the office I work for is visited regularly by pharmaceutical company reps. Before I started working there, and when I first started, I was pretty unilaterally opposed to that. I tended to think that offices that barred drug reps from their doors were providing better patient care because they weren't under the influence of the drug companies' bullshit. Now that I've worked there longer, I have mixed feelings about it. For one thing, the providers I work for have told me that they take everything the reps say with a few giant chunks of salt -- they're not passive listeners. For another thing, some of the drug reps are in the business to help the patient/consumer -- you can really tell the difference between reps who are in it for the money only and reps who do truly want to help get good treatment to patients.
But my mixed feelings are primarily because letting drug reps into the office provides samples, and those samples can sometimes be lifesavers for patients.
For example, we have a patient who is an insulin-dependent diabetic. He has private insurance, but not very good coverage. I don't think insulin comes as a generic, and it is expensive. One brand of insulin pen, for example, costs around $200 out of pocket for about a month's supply. We give him his insulin -- via samples -- on a pretty regular basis. It's a similar situation for a lot of patients on anti-osteoporosis medication, testosterone gel, sleep aids, and several medications for acid reflux.
Another thing is that insurance companies are ridiculous and, as you know, enjoy denying coverage as much as possible. One thing that you may not know about is the "prior authorization." It works like this: You go to the doctor for, say, acid reflux. You have already tried a bunch of OTC medications and they're not working for you. Your doctor prescribes Nexium, AcipHex, Prilosec, etc. or their generic forms (which are not on the $4 list). The pharmacy runs the prescription through your insurance and they receive a message that says "Requires preauthorization."
This means that insurance will not pay for the medication your doctor wants you to have unless the doctor's office calls the insurance company and convinces them to cover it. It is usually the same deal for MRIs and CT scans. This call takes about 20 minutes for most insurance companies and sometimes takes up to 2 weeks for the insurance company to decide (Medicaid and TriCare are the easiest -- they have one-page paper forms and reply in 1-2 days).
During this time, what are you supposed to do? Your chest is burning, you can't sleep, and you're at your wits end. Answer? Get samples from your doctor.
To me, it's clear that the real problem here is our fucked-up private health insurance system. It would be awesome if there were a national healthcare system that did not "come between doctor and patient" as we hear pretty frequently these days. Even if that system did continue to require prior authorizations, the government model works much, much better than the private model as it stands (and Medicaid and TriCare approve most submissions).
However, since over half the country insists that socialized medicine is Satan incarnate, we're going to keep having evil insurance companies that refuse to cover necessary medications, and as long as that's the case I think it's good medicine to provide patients with samples. Remove the insurance industry and the need for samples it generates, and there's no need for drug companies to insert themselves into offices. And then the drug companies take a big hit too. Everyone wins.
But my mixed feelings are primarily because letting drug reps into the office provides samples, and those samples can sometimes be lifesavers for patients.
For example, we have a patient who is an insulin-dependent diabetic. He has private insurance, but not very good coverage. I don't think insulin comes as a generic, and it is expensive. One brand of insulin pen, for example, costs around $200 out of pocket for about a month's supply. We give him his insulin -- via samples -- on a pretty regular basis. It's a similar situation for a lot of patients on anti-osteoporosis medication, testosterone gel, sleep aids, and several medications for acid reflux.
Another thing is that insurance companies are ridiculous and, as you know, enjoy denying coverage as much as possible. One thing that you may not know about is the "prior authorization." It works like this: You go to the doctor for, say, acid reflux. You have already tried a bunch of OTC medications and they're not working for you. Your doctor prescribes Nexium, AcipHex, Prilosec, etc. or their generic forms (which are not on the $4 list). The pharmacy runs the prescription through your insurance and they receive a message that says "Requires preauthorization."
This means that insurance will not pay for the medication your doctor wants you to have unless the doctor's office calls the insurance company and convinces them to cover it. It is usually the same deal for MRIs and CT scans. This call takes about 20 minutes for most insurance companies and sometimes takes up to 2 weeks for the insurance company to decide (Medicaid and TriCare are the easiest -- they have one-page paper forms and reply in 1-2 days).
During this time, what are you supposed to do? Your chest is burning, you can't sleep, and you're at your wits end. Answer? Get samples from your doctor.
To me, it's clear that the real problem here is our fucked-up private health insurance system. It would be awesome if there were a national healthcare system that did not "come between doctor and patient" as we hear pretty frequently these days. Even if that system did continue to require prior authorizations, the government model works much, much better than the private model as it stands (and Medicaid and TriCare approve most submissions).
However, since over half the country insists that socialized medicine is Satan incarnate, we're going to keep having evil insurance companies that refuse to cover necessary medications, and as long as that's the case I think it's good medicine to provide patients with samples. Remove the insurance industry and the need for samples it generates, and there's no need for drug companies to insert themselves into offices. And then the drug companies take a big hit too. Everyone wins.
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