Archives for posts with tag: e-patient

“That which we call a nose,
By any other name would smell as sweet.”

Or “sweetly,” depending which way the wind blows.

Apologies for mixing poets, metaphors and verb forms, but that’s just the kind of summer it’s been. It’s a time of mourning with lots of loss, sickness, life changes, and now my nose. It’s no longer the nose I was born with, thanks to heredity and youthful stupidity on sunny beaches years ago.

My nose has been called many things over the years. Ski slope. Kitty. Pug. But I always loved it, small and turned up as it was. When I was four years old, we were in Philadelphia getting off a city bus to see a tourist site. A woman stopped my mother and said, “If I had that little nose, I would hold it up in the air as high as I could.” To her, it was the perfect nose and deserved to be worn proudly.

With biopsies and band-aids leading up to the surgery, my secret sorrow has been on display for several weeks. But on Monday at the surgical center, grief took center stage. When the doctor began the numbing shots, I let out a wail and commenced braying like a stuck donkey while hyperventilating my way through sheer mortification. How perfect to be in the first treatment room, kitty corner to the front desk and adjacent to the waiting area. Do you apologize? Laugh it off? Keep crying? I tried a combo approach.

But wow did those shots hurt, way worse than the ones for the biopsies. My second round of weeping began after the tissue analysis. The good news was, the first two Mohs samples had removed all the cancerous cells. The bad news was, as I looked down at the diagram she drew of the recommended reconstruction, I could see the two bloody pits where nose used to be! Eeesh.

I was on board with the reconstruction plan, but then again — how could I not be? Who am I to argue with the woman who holds my hope for a complete, healthy nose in her talented grasp? Since my teeth were aching and we definitely didn’t want me braying again, it was time for more shots.

Incisions were made, tissue tugged and placed, and two rows of stitches completed for each closure. The first round of each suturing made a clicking sound; the second was good old-fashioned needle and thread. Somewhere along the way I asked if they could please just hit me on the head and knock me out, but that wasn’t an option.

As the final step in each phase, the smell of cap guns filled the air as the surgeon cauterized “for a better cosmetic result.” She was aghast at my comment but I thought everyone of a certain age had owned a cap gun as a kid. The technician agreed with me: caps, which definitely beats thinking about what we were actually smelling!

By the time I was waxing poetic about the complete Laura Ingalls Wilder series to keep myself distracted, the surgeon began sawing off my ear. Not really, but it sure sounded like it. As she cut the graft to fill in the left side of my nose, her assistant cranked up the best hits of the 1930s and ’40s. (Note: cardiology and skin cancer offices cater to a similar demographic.)

What an ordeal — for us all! I feel so fortunate the philosophy of the Skin Cancer Surgery Center is very caring, hands on, and patient centered. (But I really do wish they had knocked me out; actually, they probably wish they had too.)

I talk a lot about post traumatic stress disorder in SCAD patients, and do believe it plays a role in our recovery and future health care experiences. It was so comforting that the surgeon took time to hear my feelings about earlier scars from open heart surgery. Her reassurance that she will do whatever it takes to heal my nose successfully is heartening. At 48, I plan to have several decades left to wear my nose proudly through life.

I just hope I don’t sneeze for another year or two.

For more on the various forms of skin cancer, symptoms, and treatment, check out: Skin Cancer

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The boys and I went to a movie on Friday. And it was so efficient!! And I kept thinking, “if AMC theatres can do it, why can’t Carefirst Blue Cross Blue Shield?”

Our “appointment” with “Wreck-It Ralph” was arranged electronically. In a very harried 15 minutes on my computer at home, I activate our frequent movie viewer card (we don’t see all that many) and purchased our tickets online. The frequent viewer card allowed me to waive the processing fee. It also allowed me to show up at the Swamp Fox 22, bypass the day-after-Thanksgiving lines, swipe my card at a kiosk to generate tickets, and proceed to the snack area where I received YET ANOTHER privilege in reduced prices. And then I enjoyed a movie on top of it all.

So my proposition is this: Carefirst knows everything about me; I even have a Carefirst debit card that can retrieve my high-deductible info in micro seconds.

Explain to me why Carefirst and my health care providers require me to repeatedly explain myself and my health care information to them? Why can’t it all be on my card (since most of it is already)? Just think: one swipe, and your medical history, benefits info, and payment summary could be transferred.

You’d receive efficient, appropriate care, and still have time for a movie.

Today’s theme is “I want to change THIS about healthcare…”

The word that first came to mind for me was disconnect. At a time when the greatest effort ever is being made to involve patients, integrate specialties and improve the health care process for all Americans, I still can’t help but feel there is a giant boulder in the way. Or some kind of undercurrent — like we’re buzzing along under the impression that all is well but not quite recognizing a key factor to success.

As always, it’s the little things that make me feel this way. My primary doctor, who technically should be my gatekeeper to care and coordinating my health, will no longer write prescriptions for drugs he isn’t doling out. I was so proud of myself for scheduling an annual visit where I could streamline care and not “over inflate” my copay use by seeing specialists. But my primary would not write refill prescriptions for me. Plavix? “Well, you’ll have to ask your cardiologist about that.” Eye drops? “Oh no, that’s up to your ophthalmologist to refill.” And so on.

Whatever happened to coordinating my total care? The primary doc’s role now seems truly to be “concierge” in the guest services capacity. My visits now consist of blood work followed by his recommendation to see a laundry list of specialists.

So if that’s the way it’s going to be, my primary doctor now holds only one purpose in my life: antibiotics for the occasional sinus infection.

Because I get the sense we don’t have a partnership any more. Rather than waste a copay on him telling me to see a specialist, I’ll just ramp up more health care costs for Carefirst BC/BS by seeing specialists at my own discretion. I’ve met my astronomical deductible, so what the heck — why not?

It’s a shame. We may have a hard working team of health care providers, insurers and advocates, but without a good coach, we can’t win. We need engaged, appreciated primary care physicians to lead patients to victory — even the smallest ones — in health care.