Some thoughts about Thanksgiving…
PS- I can’t type much, but I can talk a lot…
Where have all the Blog Posts Gone?
I have been blogging for 6 years now. My first post was in November 2013. I posted a lot at the start, 2-3 times a week. I was unable to keep that pace, and slowed down to the point that for the last few years have been trying to post at least once a week.
That streak is ending. It has been 2 weeks since my last post, and it will be a while after this before I post again.
The surgery I had three months ago to relieve nerve pain in my right arm didn’t work. Although the doctor said he successfully unpinched the nerves during the procedure, it seems that things had been pinched too much for too long. The pain has not resolved, and the doctor now thinks it never will.
That is not to say there is nothing I can do. The pain increases with repetitive motion. The less I use my hands, the less it hurts. In order to minimize the pain I have decided to minimize how much I type. In the office I have hired a scribe to type for me. At home, I have decided to try and avoid typing altogether for a while.
This means I will cut back on the blog. I pray that it will only be temporary, that God will intervene to restore the health in my arm, but I feel I need to accept the situation for what it is. I may occasionally share a post, but the days of writing every week seem to be behind me.
Thanks to all who have shared the journey for the last 6 years.
Bart
A Tale of Two Addicts
“Is this a doctor’s office? Do you have a band-aid?
I was standing outside my office with some of the men from my weekly men’s group when the young man approached from the liquor store across the street. He was disheveled and dirty, his clothes the standard ground-in-dirt style common among the homeless. His face was dirty as well, making the gash on his forehead an even greater concern. It did not take long to realize he needed more than a band-aid.
The gash had an impact on me, for the wound helped me see him as a person in need and not merely as a man of the streets. His attitude as he approached also disposed of my preconceptions. He was polite and unassuming, even shy, as if he was embarrassed to approach me as he was by his request and his circumstances.
In response to his question I turned and unlocked the door to my office. “Come on in, “ I said, as I swung it open. He followed me into the office and down the hall. I grabbed a magnifying light and took a closer look. It was deep enough for stitches, but when he told me the cut was over a day old I decided not to apply sutures. The risk of infection from a dirty laceration that old was too great. I instead gently cleaned it and applied medical steri-strips, pulling the edges together as best I could.
As I did I asked him how he had ended up on the streets. He openly shared with me that he had a problem with drugs and alcohol, and that he had lived in a rehab house in town for a while. He had recently been put out of the house and had no where to go but to the streets. He was doing well at staying off of drugs, but was not doing well with alcohol. He said he was hoping to find a place to live, but he did not seem to have a plan that made his hope seem viable.
When I finished dressing his wound he thanked me profusely and made his way out of the office. I followed him outside and rejoined my friends. I watched him walk across the street and return to a spot behind the liquor store. There he took a seat on a low wall alongside some other homeless men. Although there was nothing visibly different about him, nothing to distinguish him from the others, after our conversation he seemed strangely out of place.
My interaction with him was starkly different than one I had with a different homeless person a few weeks later. He was a much older man I had seen across the street at the same liquor store several times. He had white hair and a white beard, in marked contrast to his darkly tanned face. He always had a bike with him, and almost always had a paper bag with a bottle of alcohol. He changed locations throughout the day, following the shade to stay out of the summer sun.
One day as I returned to the office from lunch, I saw that he had followed the shade to the trees in my parking lot. He was sprawled in the dirt, sound asleep as I walked up. “Excuse me sir,” I called to him, “but this is private property.”
He woke with a start. “Alright, alright, I’m moving!” He said with a grumble. As he gathered himself and his bicycle the expletives began. “I am sick and tired of all of this $%#&,” he muttered loudly, “it’s the same %$&#@ thing all of the time. People giving me $&@# over nothing!”
“There is a solution to this problem,” I replied, “you could get a job!”
“You can get a %&$%@# life!” he yelled as he rode off.
Two different men, both homeless, both trapped in addiction. One approached me in humility, as if he knew he was intruding and undeserving of help. The other responded in anger and arrogance as if he was entitled to make a home on my property. One inspired compassion, the other disgust. Together they reminded me of an important truth- we do not suffer from a homeless problem, we suffer from thousands of homeless problems, experienced by thousands of unique individuals. While they were both plagued by alcoholism, they were not alike.
I do not presume to know what society’s response to the homeless problem should be, but I am beginning to realize what my response should be. I must strive to see each person as an individual created in the image of God, and to respond to each person in a unique way appropriate to the individual circumstances.
Bart
So Long, Farewell, Insurance Changed Goodbye...
“Thank You” read the title of the message. As gratitude tends to make me happy, I opened the message with the expectation of good news. It wasn’t. A family that has been under my care for over 20 years, whose children I delivered, was leaving my practice for good. Their company insurance options had changed and staying with me would cost them over $2000 a year. With sadness and reluctance they signed up with Kaiser and send me the email thanking me for the care I.
A few days later a patient came in with a similar story. She was changing to a different HMO. Although I am affiliated with the hospital to which she was going to be assigned, the hospital contract with the insurance blocks her from seeing me. If she wants coverage, she has to enroll with them and see a new doctor.
This is the health system our society has chosen. Large hospital systems are committed to capturing every dollar they can and to do that they are affiliating as much as possible with medical groups they own or subsidize. These groups employ doctors who are contractually obligated to send every patient they see to that one hospital for any needed test or x-ray, maximizing revenue. These hospitals then sign exclusive contracts (at discounted rates) with large employers, contracts that give patients no choice but to sign up with them. The end result is that long term physician-patient relationships are cast aside.
Complaining is futile. Under the current system, patients have almost no say when it comes to choosing their coverage. These decisions are made by VP’s of Human Resources who negotiate with providers for the lowest possible price. No consideration is given to the savings associated with long-term relationships, of the value that comes from a doctor who knows his patients well.
This seems terrible at first, but the reality is that many doctors don’t know their patients well. Some hardly at all. This because when physicians rush through annual visits and refer all sick visits to urgent care there is not much of a chance for relationships to develop. When after hours calls are handled by call centers, emails are answered by other providers, and it can take weeks to schedule routine visits, strong relationships seldom develop. In such a world the value of a personal physician is minimized.
I wish I could change the system, but past system-changing efforts have proven to be disastrous failures. In conversation after conversation I have learned that the majority of Primary Care Providers are more interested in going home on time than they are in building relationships. When given the choice of staying a few minutes late or punting care to someone else, most choose the minutes and go home. My exhortations that there is joy in relationships are routinely ignored and met with disbelief.
Electronic records have made things worse by limiting the amount of time physicians can spend talking with their patients. It seems that doctors spending more time clicking the mouse than they do listening to their patients. In addition, many doctors don’t type well, and most struggle to use electronic records efficiently. I know many doctors who routinely spend 2-3 hours at home each night finishing up their work for the day. Such overworked physicians cannot see a reasonable way to invest more time in getting to know the patients they serve. Most have given up on ever having the time to build relationships.
I can’t control them, but I have decided to not give up. I cannot control what happens in the future but I can control how I spend my time today. I haven’t given up on loving and serving the patients God brings to me. Every day brings the joy of relationship, the knowledge that I have made a difference in someone’s life.
Even if that means shedding a few tears when we say goodbye.
Bart
PS- If your insurance had changed, there may still be a way to continue seeing your doctor. If you have changed to a high deductible PPO, you will likely be paying cash for office visits anyway. Your doctor might be willing to see you at a discounted cash price, and your out of pocket costs may be the same as if you saw an in-network provider!
Cheap Faith
It happened again this week, more than once. Single patients told me about their strong commitments to their faith and then followed their professions with requests for Viagra prescriptions. As is almost always the case their requests were made unaware of the contradictions they represented. I am always tempted to ask, “How is it that a devout single man such as yourself finds himself in need of Viagra?”
I see such inconsistencies almost every week. I see “Christians” who abuse alcohol, cohabitate, work under the table to avoid taxes, or get divorced for no other reason than “I’m unhappy!”. It seems that our culture has embraced a new kind of Christianity, a kind that does not cost a person anything.
I was discussing this phenomenon this week with some friends and one of my favorite Bible stories came to mind. It can be found in 2 Samuel 24. In the passage King David is following God’s instruction to raise an altar and offer a sacrifice at a specific location, the place were a man named Araunah threshed his wheat. One can only imagine the surprise when Araunah looked up from his labors to see King David and his entourage approaching!
Upon hearing of David’s mission, Araunah responded as a faithful servant should. Araunah offered to give David his own oxen for the sacrifice, as well as their yokes for the firewood. David’s response is priceless, “No! I insist on paying you for it. I will not offer burnt offerings to the Lord my God that cost me nothing.” David understood there was no such thing as a free sacrifice.
It seems that too many nowadays are into offering things to the Lord that do not cost anything. It is as if some are saying, “Faithfulness? Fidelity? Moral Purity? No way, God! Those things are costly. How about I give you a few Sunday mornings a month and put a few bucks in the plate every once in a while?”
The truth is that God does not negotiate the terms of our obedience. As Jesus said, “Whoever wants to be my disciple must deny himself, take up his cross and follow me.” Self-denial is not optional in following Christ. It is mandatory. It is essential.
While many professed Christians do not seem to understand this truth, I think most non-Christians do. They understand that the genuineness of our faith is measured by the consistency our actions, not by the passion of our words. When they see people living lives that are the same as everyone else, they appropriately conclude that for many church is little more than a religious social club.
I want to be better. I want to follow God with my whole heart, whatever the cost. After over 40 years of pursuing my faith I have learned that this is indeed an expensive proposition. Hardly a day goes by that I am not saying “No” to something I initially want to do. I am constantly challenging myself to be patient and kind, to bite my tongue, or dismiss a malicious thought. It can be exasperating. I have such a long way to go and so much work to do.
There is a tremendous amount of energy I need to invest in denying myself and following God. True faith is indeed costly.
It is costly, but I have also come to understand that in the long-term, the return on investment is AMAZING.
Bart