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	<title>Comments on: Healthcare insurance but no healthcare access</title>
	<atom:link href="http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/feed/" rel="self" type="application/rss+xml" />
	<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/</link>
	<description>A blog from inside the emergency department</description>
	<lastBuildDate>Wed, 19 Jun 2013 05:14:04 +0000</lastBuildDate>
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		<title>By: rungirlrun</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-123941</link>
		<dc:creator>rungirlrun</dc:creator>
		<pubDate>Sat, 23 Feb 2013 16:00:21 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-123941</guid>
		<description><![CDATA[For every example of a misdiagnosis by a NP that you give me I can give you one right back of a misdiagnosis by a MD.  We ALL, whether we are NP&#039;s or MD&#039;s make mistakes occasionally--hopefully, rarely.  We also all know that there are good NP&#039;s and bad NP&#039;s and good MD&#039;s and bad MD&#039;s.]]></description>
		<content:encoded><![CDATA[<p>For every example of a misdiagnosis by a NP that you give me I can give you one right back of a misdiagnosis by a MD.  We ALL, whether we are NP&#8217;s or MD&#8217;s make mistakes occasionally&#8211;hopefully, rarely.  We also all know that there are good NP&#8217;s and bad NP&#8217;s and good MD&#8217;s and bad MD&#8217;s.</p>
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		<title>By: throckmorton</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121965</link>
		<dc:creator>throckmorton</dc:creator>
		<pubDate>Fri, 15 Feb 2013 18:55:51 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121965</guid>
		<description><![CDATA[One of the issues is what level of care are the NPs able to provide. Often, they do not want their practice restricted nor do they want to be held to same medical malpractice liability as MDs or DOs. We constantly get transfers from other hospital ERs where the patient is wrongly diagnosed by an ARNP.  Most recently, cardiogenic shock being mistaken for pneumonia and a thorasic aortic disection for pleuric chest pain.]]></description>
		<content:encoded><![CDATA[<p>One of the issues is what level of care are the NPs able to provide. Often, they do not want their practice restricted nor do they want to be held to same medical malpractice liability as MDs or DOs. We constantly get transfers from other hospital ERs where the patient is wrongly diagnosed by an ARNP.  Most recently, cardiogenic shock being mistaken for pneumonia and a thorasic aortic disection for pleuric chest pain.</p>
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		<title>By: Larry Sheldon</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121961</link>
		<dc:creator>Larry Sheldon</dc:creator>
		<pubDate>Fri, 15 Feb 2013 18:14:28 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121961</guid>
		<description><![CDATA[Back up-stream here there was an apparent knock on &quot;unqualified&quot; practitioners like Nurse Practitioners and Chiropractors.

The error regarding Nurse Practitioners is so obviously xenophobic that I can&#039;t be much help, on the issue of Chiropractors, I this to say:

I am nearly 74 and since I was quite young I have had no respect for Chiropractors.

Most of thirty years ago I developed pains in my arms and sometimes tingling numbness in my fingers.

The doctor diagnosed &quot;Carpal Tunnel Syndrome&quot; since that was the Malady de die.  I was given a script for Naproxen Sodium [side question--I am not supposed to eat salt, but all of ny many drugs seem to be xxxxx Sodium.  Why is that?] which I later decided had unpleasant psychological effects and sent to see a Physical Therapist who did some electrical mumbo jumbo along the nerves of my forearms and who taught me some posture hygiene and I was able to manage the pain for a long time.

A few years ago, the GP got tired of my whining about the increasing pain in a shoulder and sent to a PT (the earlier one had long sice retired) who did some ultrasonic and LASER mumbo jumbo along with some massage and traction stuff and genuinely did some good.  And apparently burned out my insurance support.

Last year the other shoulder developed pains that wore the worst ever--incapacitating.  (I was later able to tell a check-in-whatever-she-is at the GP shop that on her one-to-ten-pain-scale foolishness I knew where twelve is.)

Members of my family (athletes, most of them) insisted that I really ought to see a Chiropractor (my wife was seeing one that Kansas City daughter&#039;s DC had recommended here and had good results from longstanding back pains) and so I did.

In the course of several weeks (during which I was told to expect things to get worse before getting better) the pain and tingly fingers went away and now 6 or so months later I am (with respect to arms, etc., pain free.

The Chiropractors in that office still have posters, comments, and TV pronouncements that I believe to be borderline fraudulent, I have to say that they were able to do more for me than translate &quot;arm nerve hurts&quot; to Latin.

Last year the pains]]></description>
		<content:encoded><![CDATA[<p>Back up-stream here there was an apparent knock on &#8220;unqualified&#8221; practitioners like Nurse Practitioners and Chiropractors.</p>
<p>The error regarding Nurse Practitioners is so obviously xenophobic that I can&#8217;t be much help, on the issue of Chiropractors, I this to say:</p>
<p>I am nearly 74 and since I was quite young I have had no respect for Chiropractors.</p>
<p>Most of thirty years ago I developed pains in my arms and sometimes tingling numbness in my fingers.</p>
<p>The doctor diagnosed &#8220;Carpal Tunnel Syndrome&#8221; since that was the Malady de die.  I was given a script for Naproxen Sodium [side question--I am not supposed to eat salt, but all of ny many drugs seem to be xxxxx Sodium.  Why is that?] which I later decided had unpleasant psychological effects and sent to see a Physical Therapist who did some electrical mumbo jumbo along the nerves of my forearms and who taught me some posture hygiene and I was able to manage the pain for a long time.</p>
<p>A few years ago, the GP got tired of my whining about the increasing pain in a shoulder and sent to a PT (the earlier one had long sice retired) who did some ultrasonic and LASER mumbo jumbo along with some massage and traction stuff and genuinely did some good.  And apparently burned out my insurance support.</p>
<p>Last year the other shoulder developed pains that wore the worst ever&#8211;incapacitating.  (I was later able to tell a check-in-whatever-she-is at the GP shop that on her one-to-ten-pain-scale foolishness I knew where twelve is.)</p>
<p>Members of my family (athletes, most of them) insisted that I really ought to see a Chiropractor (my wife was seeing one that Kansas City daughter&#8217;s DC had recommended here and had good results from longstanding back pains) and so I did.</p>
<p>In the course of several weeks (during which I was told to expect things to get worse before getting better) the pain and tingly fingers went away and now 6 or so months later I am (with respect to arms, etc., pain free.</p>
<p>The Chiropractors in that office still have posters, comments, and TV pronouncements that I believe to be borderline fraudulent, I have to say that they were able to do more for me than translate &#8220;arm nerve hurts&#8221; to Latin.</p>
<p>Last year the pains</p>
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		<title>By: Larry Sheldon</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121959</link>
		<dc:creator>Larry Sheldon</dc:creator>
		<pubDate>Fri, 15 Feb 2013 17:44:59 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121959</guid>
		<description><![CDATA[Since the medical center system installed their new geewhiz EMR system, all I see in most visits is somebody&#039;s back side and the screen they are attending.

With distressing frequency I see on that screen what looks to me to be a pop-up Google search window.

The only shops where this is not true is Physical Therapy (No computer&#039;s in sight except the Reception-Appointment desks where you might hear imprecations about being able to view a patient&#039;s appointment records, but not modify them.  ??!), Dermatology (which might not be on the system), the Wound Center I have not been there in a while--may be changed),the Nurse Practitioner from Cardiology who walks over from Cardiology to Physical Therapy or to the Wound Center to attend my Swollen feet and legs, and the ENT Doctor.  Audiology would not make an advance appointment six....make that eight or nine months ago because they didn&#039;t trust the changeover--and I have just now made an appointment so we will see.

So, as we used to say, &quot;with time to spare, go by air&quot;, it is now &quot;If it is not urgent, see the doctor.  If it is, try Google unless you are losing fluids, then see the Urgent Care office at the supermarket&quot;.  Doesn&#039;t rhyme but that is the best I can do.]]></description>
		<content:encoded><![CDATA[<p>Since the medical center system installed their new geewhiz EMR system, all I see in most visits is somebody&#8217;s back side and the screen they are attending.</p>
<p>With distressing frequency I see on that screen what looks to me to be a pop-up Google search window.</p>
<p>The only shops where this is not true is Physical Therapy (No computer&#8217;s in sight except the Reception-Appointment desks where you might hear imprecations about being able to view a patient&#8217;s appointment records, but not modify them.  ??!), Dermatology (which might not be on the system), the Wound Center I have not been there in a while&#8211;may be changed),the Nurse Practitioner from Cardiology who walks over from Cardiology to Physical Therapy or to the Wound Center to attend my Swollen feet and legs, and the ENT Doctor.  Audiology would not make an advance appointment six&#8230;.make that eight or nine months ago because they didn&#8217;t trust the changeover&#8211;and I have just now made an appointment so we will see.</p>
<p>So, as we used to say, &#8220;with time to spare, go by air&#8221;, it is now &#8220;If it is not urgent, see the doctor.  If it is, try Google unless you are losing fluids, then see the Urgent Care office at the supermarket&#8221;.  Doesn&#8217;t rhyme but that is the best I can do.</p>
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		<title>By: JJ</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121946</link>
		<dc:creator>JJ</dc:creator>
		<pubDate>Fri, 15 Feb 2013 15:35:55 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121946</guid>
		<description><![CDATA[I agree with WC, you don&#039;t know what you don&#039;t know (this goes for some MDs as well). In ophthalmology we have been fighting optometry about scope of practice for years.  In reality it is a very vocal minority that is pushing this agenda.  The problem with optometry is they are turning out many more optometrist than they need.  3 or 4 more schools opened in the last few years.  Private practice is a struggle and there are a finite number of Walmarts.  Consequently, they need to find new ways to pay off their 6 figure debt.  Hence the drive for expansion away from the eye and into more areas related to systemic disease.  I mean it already says doctor on their white coat, how hard can it be.]]></description>
		<content:encoded><![CDATA[<p>I agree with WC, you don&#8217;t know what you don&#8217;t know (this goes for some MDs as well). In ophthalmology we have been fighting optometry about scope of practice for years.  In reality it is a very vocal minority that is pushing this agenda.  The problem with optometry is they are turning out many more optometrist than they need.  3 or 4 more schools opened in the last few years.  Private practice is a struggle and there are a finite number of Walmarts.  Consequently, they need to find new ways to pay off their 6 figure debt.  Hence the drive for expansion away from the eye and into more areas related to systemic disease.  I mean it already says doctor on their white coat, how hard can it be.</p>
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		<title>By: DdR</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121933</link>
		<dc:creator>DdR</dc:creator>
		<pubDate>Fri, 15 Feb 2013 14:03:20 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121933</guid>
		<description><![CDATA[Doctors can be such arrogant @sses. While I get your point, I&#039;d rather have a competent NP who has the sense to refer me to a specialist when the issue is beyond him than an MD who believes he knows everything (so I should just shut up and take the prescribed meds - never mind that they don&#039;t address the actual problem, just the symptoms (typical).]]></description>
		<content:encoded><![CDATA[<p>Doctors can be such arrogant @sses. While I get your point, I&#8217;d rather have a competent NP who has the sense to refer me to a specialist when the issue is beyond him than an MD who believes he knows everything (so I should just shut up and take the prescribed meds &#8211; never mind that they don&#8217;t address the actual problem, just the symptoms (typical).</p>
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		<title>By: DefendUSA</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121930</link>
		<dc:creator>DefendUSA</dc:creator>
		<pubDate>Fri, 15 Feb 2013 13:34:23 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121930</guid>
		<description><![CDATA[WC...
I once took a practice Nursing Exam for licensing because I knew someone who could give it to me. The &quot;proctor&quot; said that it was too bad I couldn&#039;t challenge taking the test because of the results. I am still not schooled as an RN, but there are people out who could pass with flying colors...and they&#039;re not allowed to challenge the system. I was not degreed then but my Army training and experience is the only thing I can attribute it to. I could have been one helluva nurse....haa. 
Believe me when I tell you that I am stocking up on expendable medical supplies and brushing up on things I have learned because I am afraid it&#039;s going to get bad...I am even looking at finding a doc who will be my own personal go to guy for a chunk of change...I&#039;m not kidding. I will want to be under the radar if this gets worse.]]></description>
		<content:encoded><![CDATA[<p>WC&#8230;<br />
I once took a practice Nursing Exam for licensing because I knew someone who could give it to me. The &#8220;proctor&#8221; said that it was too bad I couldn&#8217;t challenge taking the test because of the results. I am still not schooled as an RN, but there are people out who could pass with flying colors&#8230;and they&#8217;re not allowed to challenge the system. I was not degreed then but my Army training and experience is the only thing I can attribute it to. I could have been one helluva nurse&#8230;.haa.<br />
Believe me when I tell you that I am stocking up on expendable medical supplies and brushing up on things I have learned because I am afraid it&#8217;s going to get bad&#8230;I am even looking at finding a doc who will be my own personal go to guy for a chunk of change&#8230;I&#8217;m not kidding. I will want to be under the radar if this gets worse.</p>
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		<title>By: Marilyn</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121882</link>
		<dc:creator>Marilyn</dc:creator>
		<pubDate>Fri, 15 Feb 2013 07:24:50 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121882</guid>
		<description><![CDATA[I am only half joking.  Dr. Google has helped me greatly if only advising me how to frame my questions.  I have too much respect for my doc&#039;s education and training; I don&#039;t presume to tell her anything, I DO ask her to tell me if my thinking is reasonable and if not, to point me in the right direction.  

I actually agree with the point that we are certain to see many problems erupting &quot;unexpectedly&quot; as patients are pawned off on not-quite-doctors.  The government&#039;s approach is just absurd and getting more so all the time.]]></description>
		<content:encoded><![CDATA[<p>I am only half joking.  Dr. Google has helped me greatly if only advising me how to frame my questions.  I have too much respect for my doc&#8217;s education and training; I don&#8217;t presume to tell her anything, I DO ask her to tell me if my thinking is reasonable and if not, to point me in the right direction.  </p>
<p>I actually agree with the point that we are certain to see many problems erupting &#8220;unexpectedly&#8221; as patients are pawned off on not-quite-doctors.  The government&#8217;s approach is just absurd and getting more so all the time.</p>
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		<title>By: Matt</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121863</link>
		<dc:creator>Matt</dc:creator>
		<pubDate>Fri, 15 Feb 2013 04:12:46 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121863</guid>
		<description><![CDATA[&quot;Unfortunately, policies are being created by people who have little knowledge about the provision of health care and with no regard to the effects of those policies. &quot;

Actually, policies are created by lobbyists, who generally write much of the legislation and the spread the dollars around to get it enacted.  Physicians have a very powerful lobby in the AMA.  For some reason, though, the AMA signed on to Obamacare.]]></description>
		<content:encoded><![CDATA[<p>&#8220;Unfortunately, policies are being created by people who have little knowledge about the provision of health care and with no regard to the effects of those policies. &#8221;</p>
<p>Actually, policies are created by lobbyists, who generally write much of the legislation and the spread the dollars around to get it enacted.  Physicians have a very powerful lobby in the AMA.  For some reason, though, the AMA signed on to Obamacare.</p>
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		<title>By: WhiteCoat</title>
		<link>http://www.epmonthly.com/whitecoat/2013/02/healthcare-insurance-but-no-healthcare-access/#comment-121844</link>
		<dc:creator>WhiteCoat</dc:creator>
		<pubDate>Fri, 15 Feb 2013 01:48:24 +0000</pubDate>
		<guid isPermaLink="false">http://www.epmonthly.com/whitecoat/?p=9094#comment-121844</guid>
		<description><![CDATA[BTW - congrats on your blog :-)
You earned every one of those hits.]]></description>
		<content:encoded><![CDATA[<p>BTW &#8211; congrats on your blog <img src='http://www.epmonthly.com/whitecoat/wp-includes/images/smilies/icon_smile.gif' alt=':-)' class='wp-smiley' /><br />
You earned every one of those hits.</p>
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