December 2, 2016

My impression is that doctors are leaving the Olympic Peninsula like rats off a sinking ship.

This is reinforced in the last week by four calls in one day from patients from Clallam County. Now, there is a really big clinic much closer to them. I said this to one of the callers.

"They aren't taking new patients." she says.

I don't believe her. I call the really big clinic. "We are currently not taking new patients." says the receptionist. "We might reopen for new patients in January."

I leave a message for a doctor that I know there. He calls back. "We've had some providers leave, so we've had to spread the patients out. We have three buprenorphine providers, but we are working our way through a wait list." It's not just buprenorphine patients. They are not taking ANY new patients.

Ok. We ramp up and get the folks in. The only other people who take insurance in my county are the hospital clinics: they are refusing to take Clallam County patients. Great. They can drive through Jefferson County to Kitsap... or use the ER and the Urgent Care... until the insurance goes away with the new administration.

My receptionist gets another veteran call. She bemoans to the triwest caller that the doctors are leaving the peninsula.

"Not just there." says the triwest caller. "The whole pacific coast. Doctors are leaving."

Rats.

I am trying to choose my continuing medical education for next year. I was thinking about the Scripp's Conference on alternative medicine. Or the adult medicine course in Portland. But at this rate I should go take the trauma/intubation/emergency crash course and brush up on my surgery skills.

http://www.ibtimes.com/venezuelas-medical-exodus-result-its-contracting-economy-spurs-fears-national-health-1885490 Can't happen in the US, right? We can just pay them more, right?

I don't think so. I think at a certain point money can't fix burn out. Money can't balance watching patients suffer and die because they don't have insurance or the insurance won't cover the treatment. We have patients that die even WITH the best treatment. Add more patients dying because they are not getting treated: screw this. Money can't fix ICD-10. Money can't fix a suffering heart.

http://www.centerforhealthjournalism.org/2014/03/10/whether-it%E2%80%99s-retire-or-flee-doctors-are-leaving-health-care
http://www.wnd.com/2015/11/mass-exodus-u-s-doctors-fleeing-medicine/This article blames the government. I disagree. There is massive paperwork for EVERY insurance company... and medicare and medicaid and triwest and disability and Blue Cross and they ALL have massive paperwork and the ALL change their rules all the time and do you have time to do passwords and learn to navigate 500+ different insurance websites to get prior authorizations? Are you looking forward to paying an employee to do that?
http://www.forbes.com/sites/dandiamond/2015/06/02/why-doctors-really-quit/#2e86d78b28f7 This one says it's EMRs. The EMRs suck too, but I can deal with it. In our area it's an EPIC problem, ha, ha.....
State by state: https://www.aamc.org/download/100598/data/

... and grief. The new person comes in and is grieving because their doctor left/is leaving... I am tired of grief...

So I've spent nearly all afternoon between work calls reading, studying, researching, and otherwise speculating on some E2 history.  Or more accurately, its oral lore and legends according to the public statements of longtime users.  Yes, that's right.  I've been combing https://ascorbic.net. 

First, some context...  I've been around here for a relatively long time.  Better than 15 years.  I started down this rabbit hole after following a Google link to Adventures in the women's bathroom : A male perspective and from there I was hooked on the neural nature of the soft links, the brash humor, and above all else the content.  Content and context are what sunk their claws in to me and kept me around here, and -- the relevant point --> not the more social aspects of the site. I lurked without a username for around 3 years, just READING nodes daily. 

Now I don't want to sound like a Judgy McJudgerson here.  I probably will anyway though.  I've never been very interested in socializing on a website with people I've never met in meat space.  Even in the days when I was something of a code geek and spent most of my time in front of a monitor, I still had a pretty busy social life outside of the internet.  Back then, I preferred to drink whiskey and fuck strippers and ride motorcycles when I wasn't busy coding. These days I prefer to do all those same things without the coding, but I digress.  So in those early days after I actually signed up, everytime I would have a peep in the catbox I was put off by a lot of the personalities.  E2's core user base in those early days always seemed to me like a bunch of sad nerds who couldn't get laid and didn't want to go out and meet new people.  I didn't fit in and I could FEEL it, so I continued to lurk for a little while soaking it all in.  Of course, I was 23 and way more of an asshole back then. 

My first foray into the catbox was a shitshow.  The result was something of a dichotomy.  It set the tone for my tendency not to be part of the social side of E2, but on the other hand it cultivated in me an immense respect for a user named Jet-Poop. 

The Short version:

I wanted to post a Dead Baby joke. The node was locked. I requested to add a writeup. I was told that an editor could add it to an existing writeup. I got pissed because in my 23 year old vanity I thought it was the greatest and most wowing dead baby joke of all time, and I wanted credit and my name attached to it. My request was denied. I created a new node, "The Greatest and Most WOWING DEAD BABY JOKE OF ALL TIME!!!!" and posted a 15 word writeup with no hardlinks.  It got nuked.  I got indignant.  I made a clown of myself in the catbox.

Nobody likes you when you're 23.

Feel free to go read it HERE.  It's funny as shit, and Jet-Poop ASSAILED me with sarcasm and derision and I appreciate it very much to this day.  More of my few C!s are from him than all others. I don't know if it's because he felt hope for me as a noder after that first absurd incident, or because he's a ching whore; because my writing is terrible.  But when I see that he chinged my writeup, it gives me some small sense of pride.  Back then, I used to be a person who needed validation.  That me is dead and gone, but even now I smile when I get that Cool Man Eddie message from the Poopster.

Anyway, I digress again.  The point I was thinking about is that there is a LOT of knowledge of the history and lore of E2 and I'm sure good old Jet-Poop and plenty of others could clue me in if I was friendly enough to seek out decaversary-type users and ask questions.  It's the history of PEOPLE that interests me so much after all.  There's so much MYTH and mystique about this website for me and I can't explain why.  But I want to know everything I can know about donfreenut's Butterfinger McFlurry.  And about DMan.  Who was Sensei, really?  Damn, I'll bet jessicapierce was hot.  Why did Senso get so pissed off at Alex about Donginger?  Did Ush really revenge hack the site?  So.  Many.  Questions. 

So I've wiled away the day, like an archaeologist brushing dust off old bones.  For me, that's as much fun or more even, than just asking.