Archive for the 'resources' Category

Repayment

June 29, 2014

I recently heard a story about a situation in which restitution that was supposed to be going to one person was actually being misaddressed to someone else.  That “someone else” was happily keeping it, either as a windfall or as misgotten goods (not to mention taunting the person who was owed the restitution), and the person making restitution could not figure out why the person they owed was still so frustrated with them.

Don’t know whether it suggests a plot of grand opera or of soap opera.

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What to post

March 22, 2013

I was writing a post yesterday about what happens when life’s excessive difficulties result in a person’s implosion or explosion instead of a “faith experience.”  I called it “Foxholes,” in reference to the old saw, “There are no atheists in foxholes.”  (I think there are.)  After reading David Brooks’s column about foxes and hedgehogs, I didn’t want to post something called “Foxholes,” even if I had written most of it before I read his column.

So I’m going to add a little here about my adventures Wednesday night with our medical system, which I mentioned in a reply to a comment to Timothy Egan’s column on The Five Guys restaurant and its relationship to health insurance.

I had been taking an antibiotic, and after taking a dose, a short time later I felt awful.  Waves of chest pain, nausea, retching, a red itchy rash on the back of my neck and shoulders, including a couple of hives.  The antibiotic was minocycline.  I think what I had was probably a side effect reaction, not what we call an allergic reaction.

I’ve had allergic reactions to other medications, as well as side effect reactions to both meds and vaccines (or their bases, or both).  I was once told by a Dr. Melchinger, who was an internist in New Haven Willy and I both used, that I apparently have a body that will eventually if not sooner react negatively to medicine, and that I should not take any unless absolutely necessary — to save my window of tolerating them for when it’s especially critical.  So I’m a veteran of medication reactions.

I would have called the pharmacy, but they were closed.  I called the prescribing doctor, tried to page her, didn’t hear back, made some other calls, one of which told me try a local hospital and that they should have a nurses line to advise me.  They didn’t.  I tried the nurses line on my health insurance card.  They told me to go to the ER as I might be having a heart attack.  I didn’t think I was, and I thought an ER visit was “overkill” and a waste of resources (including my time and energy).  I tried paging my doctor again, then eventually I went to bed.

At 6:34 a.m. the next morning my doctor called me in response to the pages.  (The second page had been at about 11 p.m.)  To make a longer story shorter, she told me to come in at 11:30 that same morning, at which time we agreed (for slightly different reasons) that I shouldn’t continue taking the minocycline.  She made a new diagnosis and gave me a topical medication.  When I went to fill it, the pharmacist chatted me up, and when he heard its relationship to the minocycline Rx he had filled for me before, he seemed to recognize the reaction as one associated with minocycline and said immediately that I should avoid the med in the future.  It helped to hear that from him.   (Of course, he and I are old chums after discovering our mutual affinity for the Stop & Shop Friday special on rotisserie chicken.)

I am underwhelmed by a health care system in which even when I have good insurance, I can’t get helpful advice in the situation I was in.

When I told my mother about my adventure the next evening, she said she thought the hospital ER would have gotten excited over the heart attack idea and run lots of tests and even insisted on keeping me overnight.  I hope they could have done a differential diagnosis better than that, but who knows.

I’ve had the opposite experience, though, which was even worse: knowing I was seriously ill and being refused an examination, despite multiple requests.  It turned out to be a post-partum infection and the consequences were terrible, both short term and long term.

So the other night’s adventure was, to be sure, unpleasant, but not horrible.  I write about it mainly to point out that we use the ER in inappropriate ways not just when someone is uninsured — it’s as if it has given us an “out” in all sorts of situations, kind of like that Life cereal commercial in which the older kids have Mikey taste it:  “I know, we’ll just send the person to the ER,” as if there were no downsides to that approach.  And I also wanted to point out that having good insurance may be necessary but insufficient to gain access to appropriate care when necessary.  The system does not work as advertized.  Some of it is less-than-stellar implementation, some of it is structural.  Paging systems break down, 24-hour “urgent care” is not available, a patient’s history does not produce adequate planning for pretty predictable negative outcomes, etc.

Instead of patient satisfaction surveys, the system needs a feedback mechanism to transmit more complex information from people with actual experience of the system.  Actual care providers may have this complex information, too, but I suspect both experts within the private system and policy experts in the public sector don’t.  I sometimes think they want to solve the problems they want to solve, not the real problems that actually exist.

Discrepancies

October 24, 2012

It was this time of year nine years ago that I began a long struggle to receive payment of the life insurance benefits on the policy Willy had had through his employer.  It involved, apparently, a discrepancy between the system of requirements the insurance company was saying it had and the requirements the employer had communicated to their employees.

Who pays when there is a flaw in the conduit and the transitive property in mathematics doesn’t work?  When it’s like a game of telephone and the original message arrives garbled when it reaches its destination after passing through links?  If there have been multiple links, how is responsibility attributed?

With the life insurance benefits, the employer and insurer settled, I received the benefits in dispute from the insurer, and the employer and insurance company parted ways.

With spiritual matters, there are other alternatives, even when the three primary parties won’t or can’t settle.  A fourth party with access to infinite resources can come in a say, “Not only will I pay the beneficiary the benefits in question but I will pay the life insurance company and the employer any profit they they expected to make.”

And then it’s over.  Any reopening is actually an opening of a new relationship among the parties, should they wish to engage with each other again.

A conduit can be flawed for many different reasons, but one that is not uncommon in spiritual matters is when the conduit as it were siphons off for personal use or gain some of what is being exchanged by the parties at either end.  That didn’t happen in my life insurance case, but I mention it because it is a pernicious flaw in spiritual cases because it produces one of those “death spirals” in which a small perturbation eventually downs the entire system as its consequences snowball.  Luckily there are folks who recognize the stupidity of letting it get that far and intervene gratis.

How happy should we aspire to be?

November 14, 2011

Someone I was talking with yesterday brought up the issue of how depression can be useful, and I got to wondering whether we think we should be happier than we should.  And whether, if that’s true, that maybe in trying to create what are essentially fairy tale lives for ourselves, we (try to, with varying degrees of success,) pull resources away from others, in order to feather our own tales.  And that that dynamic results in some people having an excess of adequacy (my apologies to Gordon Williams for misusing his concept; see his Tradition and Originality in Roman Poetry) of happiness (and resources), and others having a deficit of these things, and there being a lot of pushing and shoving over who will be in which group.  So, I am wondering if maybe we all reduced our expectations, maybe more people would be okay and feel okay, while there would be fewer people at the extremes.