Friday, November 30, 2012

Le sigh

My partner and I both have a newly pregnant (as in sperm cozied up to egg yesterday) patient who is driving us nuts.

I suggested a Xanax salt lick in our's going to be a looooooooonnnnnnnnnnnnggggggggggg 38 weeks for both of us.

Thursday, November 22, 2012

My FAVORITE holiday!

Thanksgiving. My favorite holiday. To me, it is when I need to sit back and reflect on how lucky I am.

I am thankful for my best friend, my husband. I don't what I'd do without him, and I never want to find out.

I am thankful for my two kids, who are growing up into kind and caring people. I have so much fun being their mom.

I am thankful for my health. I still have orthopedic issues, but overall it's good.

I am thankful for a job that I love to do and for an employer who understands that I only want to be part-time for now. And who just ordered me an iPhone. ;)

I am thankful for my dogs, who give us lots of love and slurps.

I am thankful for the roof over my head, the clothes on my back, and the (too much) food in my belly. I recognize that not everyone has the same opportunities as I have had.

I am thankful for my friends, who are wonderful people with big hearts.

Tuesday, November 20, 2012

Musings on billing

Nymeria is getting fixed today. I sorta wanted to watch, to see a dog hysterectomy. Yes, I'm a geek. I'm sure I could You-Tube it. Take it back, I just spent 15 minutes watching one.

Anyway, I was the one who dropped her off this morning. And of course, there's a consent form to sign...with options. Do I want bloodwork? EKG? IVF? Increased pain control? Laser during surgery? All of course, with extra fees, documented. BTW, I said yes to labs, IVF, and better pain management. No to the EKG & laser - they can use clamps and ties like I do, dammit!  ;)

But it got me thinking about my hysts. I do the majority of them either vaginally or lap-assisted vaginally. And there are all sorts of do-dads that I could use if I so chose. On my LAVHs and LSHs, I prefer the gyrus cutting forceps for mobilizing the uterus and dividing the pedicles. I hate the Ligasure (tissue slips out of it too easily), and have never used the Harmonic Scalpel, so I have no opinion on it. But these instruments are disposable - and costly.

But on my vag hysts, I am old fashioned - clamps and suture. Cheap as all get out (~$2.50 per suture used - most cases I use about 12-15). There are disposable instruments designed for vaginal surgery (my training program had them), but I find that the advantage they claim to bring - decreased OR time - hasn't been true for me.

But would people pay more for the new gadgets? My understanding is that the hospital gets paid a flat facility fee for the hyst, and if I can do the case cheaper, the hospital makes more money. I can just see the uproar if I charged more for better pain management.  ;)

FWIW, I'm employed by the hospital and salaried - I don't make more $$ by doing more work.

Wednesday, November 7, 2012

One and only post on the election

It's no secret that I am a liberal. I support LGBT rights and proudly call myself a feminist. I am pro-choice, pro-contraception, and pro-equality. As you can probably guess, I voted for Obama/Biden in yesterday's ballot.

I live in a battleground state, rural area. This county is very, very red. Most of the races on my ballot were uncontested Republican.

Here's why I voted for reelection on President Obama.

1. I have a daughter. I hate the fact that I know Lily Ledbetter's name. I hate the fact that my smart, funny, talented daughter still lives in times where she will need to be better than a man in order to be thought his equal. I hate the fact that there are Republicans out there ON RECORD as saying that women don't need the right to vote. Or to be educated. Or that money is not as important to women as to men. Slate had an article recently with quotes from the Taliban and some Republicans...and I couldn't tell the difference between them.

2. I have a son. He's still a decade away from registering with the Selective Service, but I see a Republican party all too eager to declare war, especially ones where I'm having a hard time seeing any upside.

3. Many of my friends are in the LGBT community. Some are single, some are in long-term relationships, some have been married in a few states. They deserve to love and to officially declare that love. They deserve the benefits that accrue to married folks - benefits, ability to visit in the hospital, children. My dearest friend from medical school is a lesbian, in a long-term relationship. They are raising 3 beautiful kids. That couple are my daughter's godparents & I am a godmother to their eldest.  THERE IS NO GOOD REASON FOR THEM TO BE SINGLED OUT LEGALLY.

4. I am an OB-GYN who feels her profession is under attack. Legislators saying what procedures I should be doing, churches saying what meds I should be using. FUCK THAT!!!!!!!!! I go into the exam room, close the door, and it's me and the patient. Nobody else is invited. The end. Lately, however, many politicians seem to think that they know as much about OB-GYN as I do.

5. Fiscal responsibility. Yes, the debt has grown - but much of it can be attributed to moving our wars from a shadow budget to the real budget. The Romney/Ryan tax plans were unrealistic according to nonpartisan groups - it would be LESS fiscally responsible.

6. ACA - It didn't go as far as I hoped it would. Having said that, I understand the political need for babysteps. I want people insured. I want people to have the ability to get worrisome symptoms checked out.

7. Social contract. I do believe that we are our brother's keeper. I want a social net. And no, private charity is not enough. If we are the type of person our dogs think we are, then we care for others. Period. Is there abuse? Of course there is...humans are involved. Having said that, I would rather waste a little bit of my $$ there than see pain.

Longish post.