Monday, December 28, 2009

Hope and reality for '10

Getting ready for the new year. Full of hope and vim and vigor. High expectations for that championship season, that break-through discovery, the new romance, new job,new child, maybe even a warm day.

Just remember, and this is nothing personal, incompetence is everywhere. It isn't malicious, it doesn't have to be devious, it's just lots of mistakes, poor performance, distracted workers, bad software, misinformed, badly trained, or just plain sloppy.

That's why electronic records will cause as many problems as they solve, the air-conditioning only breaks when it's hot, the roof only leaks when it rains,luggage gets lost, and Saab is going out of business.

Here is one of my favorite examples. I have been getting rejection notices for a claim to an insurance company for which I am not a provider, and never was. This rejection is for people I have never seen, and for a procedure I don't do, and I am not qualified to do, and therefore have never billed for. But, the best part, is that I have been receiving this rejection notice once a week, every week, for twelve years! Yes fans, you read that right, twelve years.

Every two or three years I have made an attempt to stop it, just to save the mailman, and save a tree. But it is impossible to stop. Once, someone told me I could get them to stop if I repay the money that I was never given, about $94.

I decided not to do that.

So these notices will continue to come, once a week, long after I have retired, long after I have died, long after the insurance company has gone out of business. The paper will be put in recycling bins and be recycled to come out as rejection notices for a procedure I didn't do on people I never saw, at a place I have never been.

Enjoy the new year, but don't count on getting that much accomplished.

Thursday, December 24, 2009

very quiet night

It's dark out now, and very, very quiet.

Very little light reflects off of the snow

Only a slight wind rustles the dry leaves and bare branches

Is that really all that is out there?

This year give me more of what I want and less of what I deserve.

Wishing you all:

Merry Christmas,

Happy Hannukah

Joyous Solstice

A Wonderous Winter

and most of all

A Happy, healthy, prosperous, peaceful, creative and fun new year.

"Let's hope it's a good one, withour any fear.

Friday, December 18, 2009

Health care -swept away

It is becoming increasingly apparent that Mr. Obama had too much trust in his own abilities and the political process. He had hoped that by letting everyone participate, and trying to give everyone a voice, including Republicans, insurance companies, pharmaceutical companies, all the interests that opposed the Clintons, that he could reach a compromise and a consensus. He didn't realize until recently that many people would oppose him no matter what he said, and that others were never going to move from a totally self-interested position.

Many had no reason to compromise, for they felt with enough time and enough money, and a few hysterical distortions, they could get what they wanted. Others feel that their corporate livelihood is at stake, and they could not see passed that for any greater good. It is difficult to ever see a bigger picture than your entire wealth and position.

This is not a surprise. Anyone who has been working in health care has been able to see the the big players, such as United Health Care, Humana, The Blue
Shields, and the other major companies, were really no more threatened than the banks were last year -- even less because they did not screw-up their own incomes. I have known things were going to be bad since my heart-throb, Sarah Palin began talking about 'death panels."

The health care companies have been spending an average of $1,500,000 a day lobbying Congress. I mailed in $50 once.

I try to explain this to my clients when they feel overwhelmed by how unfair life is. They are correct; they are getting screwed; hardly anyone beyond a few friends and family and me, cares.

But that's what makes it interesting. The best course of action is to keep on fighting against the tide. It is an invigorating, and noble endeavor -- even if it is, perhaps, useless. If that becomes tiresome, then find a a way to build a wall, or construct a shelter, fend off the evil-doers, enjoy your family and friends, put on some good music, and dance.

Tuesday, December 15, 2009

genetics too, and parents too

There is a good article in The Atlantic of all places by a science writer, David Dobbs. He writes about research done by Marian Bakermans-Kranenburg who worked with children who were way over on the sensitive/reactive/irritable end of the spectrum.

Then he goes on to review other research to link these kids, in part, to a specific gene allele that was linked to the processing of serotonin. This is linked to a vulnerability to depression

What the article was mostly about was that some kids are genetically more reactive than others. It discusses how if these kids have a stressful childhood they often go on to have difficulties with anger, ADHD and impulse control in the rest of their lives. But the more surprising part seemed to be that if these kids were more nurtured and protected they often went on to not only do OK, they went on to be more crative, spontaneous and successful than others in many areas.

It is no surprise to me that people are made differently and that some of those difference can be helpful and exciting, but also, under different circumstances, the same qualities can get someone messed up.

What is new is that with new technologies we are finding ways to see more of what is interacting with what. We can watch the blood flows in the brain as the brain reacts to different situations and we can see gene patterns that emerge and are partly linked to personalities.

The implication is often that this can lead to new levels of treatment interventions that can be more specifically designed. However, at present, this is also very dangerous. Because what we are really seeing is that the mind/body/brain/environmental interactions are even more complex that we had conceived. These interactions are going on constantly, and thus the conditions are constantly changing and making new conditions. When you mess with two factors out of a thousand, you can't be sure of what you're going to get.

Interfering with this flow of events is really what I do. But I have to do it indirectly, by talking to someone. As I said a couple of posts ago, I can't get directly to the brain or the mind. But some some people are going to think that they can, and this will either be a great break-through or a real disaster.

I can imagine a time when knowing someone's genetic make-up could be helpful in designing a psychotherapeutic treatment plan. Some people are naturally more quiet and reflective. Others learn better from behavioral experiences. Do you think we will ever be able to tell who is which, just by looking through a microscope at a slide of someone's spit?

Thursday, December 10, 2009


I sat with Bob and we talked about how he has not sent his resume out. It has been six weeks. He almost did it. He is waiting for his girlfriend to review it. He knows he needs a better job. He's been stuck in this one for five years, going nowhere. He could probably get a better one pretty quickly too. He's good at what he does.

Alice should move out of Frank's apartment. They were roommates for a couple of years. Then they were kind of more than than. Then Frank met Betsy and she moved right into his room. Now Alice and Frank are kind of friends and everything is awkward. If she moved out she could see more of Paul, who was once Frank's friend, but isn't any more. But Paul likes Alice, so they meet at the coffee shop. If she wanted to she could move in with her sister....but she doesn't.

Me?? I've been doing the same thing for almost thirty years. Things are getting more diffiuclt, with all of the forms and regulations, and diminished reimbursemnts. Sometimes this almost feels like just a hobby.
I've been thinking I ought to do something else, or at least learn about something else. I've been thinking that for about eight years.

This week I signed up for a six week course. In six weeks my whole life could be changed.

In six weeks I may be a gastroenterologist.

No, that's not the title of the course. I'd better check-- but whatever it is, it's new and different.

Wednesday, December 02, 2009

new look

I had last seen her about three months ago. She had come in with her husband to give it one last try. They had come to see me over ten years ago to work out what was missing from their marriage. At that time the kids were young and she was struggling to hold it all together.

They came back last year with the same complaint, She said she knew he loved the family but he had never figured out a way to show it. She had raised the kids while he worked at his job and on the house. She had gone to work and made friends while he had gone to work and worked on the house. She had invited him out to do things but he worked on the house and watched war movies and The History Channel. She had gotten depressed, took several medications and went to bed and he worked on the house and watched war movies and The History Channel. Two years ago she went on the computer and found a Christian chat room. She began to talk to people who listened to her problems and encouraged her to work on her marriage. He worked on the house and watched war movies and The History Channel.

When they came back to therapy she had told him many things she hoped they could do together, including having sex. He said he loved her but didn't know if he could change and didn't like to be told what to do.

I didn't see either of them for three months.

She came to see me yesterday. She was at least twenty pounds thinner, had her hair done, put on some make-up and was colorfully, but appropriately dressed. She said she had been to a lawyer last week and was moving out after Christmas. She had lost weight because once she made the decision she felt elated, went off her anti-depressants and walked three miles a day. Without him she didn't need any medication to cope.

She was looking forward to her new life. It is clear that she won't have trouble finding it --- although trouble may be what she is looking for.

When you're done, you're done, and often a new look comes with it.