Why healthcare isn’t just another commodity

If you are a person with a lot of choices, with a job that offers health insurance, with a social security number and a safe place to sleep and knowledge of where your next meal is coming from, I can see how you might think a market-based healthcare model is a good idea. You might be annoyed at your doctor, or the confusing bill, or the insurance company, but when something shitty happens to you, you aren’t really worried that you’re not going to be able to get help.

And I know that a lot of people in this position of privilege think (wrongly) that these basic pieces of a stable, comfortable life are accessible to anyone willing to work hard enough to get them. That everyone has basically good options but some people take advantage while others are lazy, entitled, or whatever other excuse might bubble up. This is infuriating because it is so, so wrong. It’s like that old adage of being born on third base and thinking you hit a triple. A lot of folks were born without even a bat to swing. Those folks are just as human as you are.

So imagine you are 58 years old, and your daughter just had a baby. Continue reading

Rx: Vacation. Stat.

Did you take a vacation this summer? How about last year? Did you really go on vacation, or were you checking email on the beach (oops). Were you relaxing, or were you feeling guilty? (yup, that too).

How did it get so hard to actually take a real vacation from work? Where is this coming from? It’s not like this everywhere, you know– the world won’t come grinding to a halt if we take a short, planned, and total break. I think it comes from a combination of workplace culture and career anxiety. And you know where it’s really rampant? Healthcare. We don’t even want to stay home when we’re sick.

This is total BS. You can’t pour from an empty cup, you need a full charge to give a jump start, etc. Healthcare peeps know this. We know about burnout and compassion fatigue, too. We preach the gospel of self-care and stress management. But then. . .  we freeze up. So here’s the rx: someone will cover for you for a week. You won’t check work email– you’ll have an out-of-office message up. You won’t respond to phone calls– someone else will be designated to handle urgent matters. You won’t feel bad about it, because you are entitled to vacation and there are systems in place to cope with your absence*. You will spend this week doing something that makes you smile just thinking about it.

me? i went on a road trip with my sweetie, slept in a cedar cabin, cooked on a fire, kayaked in caves, ran by the beach, drank wine, went to museums, and ate at fancy vegan restaurants. and, ok, i checked my email a few times. . . but i’m working on that!

*sometimes you have to build these systems. . . but it’s worth it!

Sound bite: Lifestyle measures

In medicine, “lifestyle measures”  is code for diet (DASH, or myplate) and exercise (20 minutes/day!) — not for sleep, for relationships, for stress management, meditation, personal growth. . .

Can these things be taught in 15-minute office visits? How can we move away from  the sound-bite advice and into meaningful change?


what I wish I could tell my patients

This stuff is the truest truth I know, but it’s hard to impart it 20 minutes at a time to people who want you to fix what’s wrong with them. My clinic is full of people– good, hardworking, courageous people who want to be healthy, and who have diabetes, high cholesterol, high blood pressure, or back pain. Or else they don’t feel good– they’re fatigued, they don’t sleep well, they just aren’t themselves. So we look for serious problems, we treat the symptoms. . . and then we talk about what kind of changes might help them. But so often, I just want to scream that all the blood tests and prescriptions in the world won’t make you well– you have to do that! So, to all the wonderful people who want to be well but don’t know how, I have this advice for you:

the truth about change

what is a nurse practitioner?

I work as a nurse practitioner. NPs are becoming much more common, more respected, and more understood, but I still often get questions about what being an NP means– questions from patients, acquaintances, even physicians. So I thought I’d go over some common questions here– both because you’ll understand me better, and because NPs will be integrally involved in the future of health care, and if you’re lucky, we’ll be involved in your care.

The NP will see you now.

The NP will see you now.

Q: What does it mean to be a Nurse Practitioner?

A: An NP is an advanced-practice registered nurse. We are educated in universities, and all NPs have a regular nursing license as well as an advanced practice permit. NPs must pass a certification exam before applying for the permit. NPs work in different roles, and the scope of practice varies by state– in some places, NPs practice independently like a physician would, and in others, they work only as part of healthcare teams. We can work in outpatient clinics, hospitals, or community settings. We practice with more autonomy than RNs, and are generally trained to diagnose and treat certain illnesses or injuries, which includes performing procedures and prescribing medications.

Q: How long do NPs have to be in school and how much clinical training do you get?

A: Currently, you need a master’s degree to get an NP license. That’s generally at least two years beyond the 4-year bachelor’s degree in nursing (although there are some programs that don’t do it quite this way). At least 500 hours of supervised clinical experience are required, but often more are included. There is also a doctorate for nurse practitioners, called the Doctor of Nursing Practice, or DNP. This degree is becoming more common and some organizations are calling for this to be required for entry to NP practice. It’s not without its detractors, but the idea is to strengthen competencies in translational research, evidence-based practice, and leadership. A DNP takes about two more years. There is no post-graduation residency required for entry to NP practice– this is one major difference from physician training.

Q: Why didn’t you just go to med school?

A: Not to bust out a cliche, but. . . apples and oranges. They’re both fruits, they’ll both fill you up when you’re hungry, but they’re not the same, and even though they overlap, they’re good at different things. You want an orange pie on thanksgiving? NPs and physicians both provide healthcare and they can both diagnose and treat many ailments. But NPs are trained with a different philosophy– we are taught to approach people as wholes, and to focus on peoples’ health in the context they live in. Some physicians may do this also, but this approach is really central to nursing practice. In my opion, NPs are typically very good communicators, educators and problem-solvers, and those skills are invaluable in promoting health. That said, if you have serious, complex health issues, like those that require surgery, having a physician on the team is important. There’s certainly a need for both practice models.

Q: Can’t I see the real doctor?

A: Probably, if you are willing to wait. But know that NPs have comparable outcomes, and often higher patient satisfaction*. If your problem is outside the NPs expertise, she’ll consult, or get you in with someone who can help ASAP.

Q: Where do NPs work? What do you specialize in?

NPs work in all kinds of healthcare settings. Certification is done by patient population: NPs may be certified as Adult/Geriatric acute care NPs, Adult/Geriatric primary care NPs, as family NPs, as psych/mental health NPs, or as pediatric NPs. There are not sub-specialty certifications, though NPs may receive additional training and experience and work in these areas, such as dermatology, GI, cardiology, or others. A lot of retail clinics and urgent cares are staffed by NPs (often family NPs). They often work as part of hospitalist teams or may work in specialists offices with more routine cases. Many (like me!) work as primary care providers.

So, folk, I hope this helps clear up some of the confusion!

*Some medical groups have tried to discredit the notion that NPs provide comparable care in certain clinical settings, such as primary care. It is my belief that such attempts are politically motivated and not directed towards achieving high-quality, high-value care. Arguments against NP use tend to be emotionally motivated rather than data-driven– e.g., claims such as “when you’re sick don’t you want to see a real doctor?” And “the fewer hours of training clearly mean NPs are not prepeared”. I made sure to include references here from both medical and nursing sources.

On getting what you need out of health care

I once read an article about calorie restriction and its potential to extend life. The author’s point boiled down to “sure, you could add 10 or 20 years to your life, but if you can’t eat, why would you want to?” This little anecdote illustrates a larger issue that is frequently overlooked: not everyone wants the same thing. On the one hand, duh. But on the other hand, look at the huge volume of writing and research dedicated to sniffing out THE BEST diet, or exercise program, or morning routine, or place to live, or anything else. The part that is all too often missing is “for whom?” or “for what”?

The confusion generated by this lack of clarity plays out on blogs, in magazines, in books, and even in scientific research. Continue reading