Flutters.

Today during church, as soon as Jeff started preaching the sermon, our baby started moving around. It was quite a good sermon. Apparently the baby thought so, too.

Maybe we have a little theologian in the making.

The pictures!

My first official ultrasound

We had our official anatomy scan on Wednesday. It was great.

First of all, I wasn't trying to crane my neck while simultaneously holding the probe and trying to get a good picture. There was actually a professional there for that. She was super nice - and quite good. She was able to find everything quickly and without any trouble.

Then there was the warm ultrasound gel. I've heard women talk about how nice it is, but having never had I couldn't personally testify. Now I know, though, and I'm going to petitioning our program to pick up a warmer.

Everything seemed to be in the right place and growing well. Our baby measured something like 4 days ahead - so he/she is growing right on track. There are sweet little feet, hands, back bone - everything looks good. Now that I'm feeling the baby move much more reliably and have had a good scan, my anxiety is slowly waning.

And no, we didn't find out the gender. We've been thinking all along we wanted to wait and be surprised. So everyone will just have to wait a little longer.

Pictures to follow soon!

Disjointed post.

I've been doing a bunch of sewing over the last two days - trying to finish a bunch of things and actually get caught up or maybe even a little ahead (!) on projects. After I got pregnant, I just didn't have it in me to sew for a long while - the fatigue combined with nausea just prevented me from doing it. It's nice to be back in the saddle. Or sewing room chair, as it were. With all the crafting going on, I haven't had much time to think about a coherent post. Here are some of the things floating around in my head.

1. I wore this shirt to work today, and I think it makes me look more pregnant than I really am since I got numerous comments today asking me when the baby is due. It's actually kind of nice. Yesterday, on the other hand, I wore a non-maternity shirt (obviously cut fairly loose) and one of my patients was really surprised that I was pregnant, and said that I wasn't really showing. (Trust me. I'm showing.)

2. The funniest thing anyone has said to me asking about being pregnant came at the urology office last week, where I'm currently rotating. (Incidentally, I was wearing the same shirt I am today.) An older black man, he looked me up and down with a twinkle in his eye and said, "How long you been in trouble?"

3. Speaking of the urology office.... it is a rather interesting place to rotate. Let's just say that patients have very interesting euphemisms to describe their various urological problems, and talk to their urologist about some interesting topics that I don't hear about much. Since I'm trying to keep this blog family friendly, I'll leave it up to your imagination.

4. We think Jeff felt the baby move yesterday. Hopefully more of that to come.

5. For the first time in a long time, I'm going to a baby shower tonight and am actually excited about it.

6. If old wives' tales are to be believed, our baby is going to have a LOT of hair. Even with medication, this heart burn is something else.

Baby steps.

I just bought some fabric to use in our baby's room.

It doesn't really sound like that big of a deal. But this is the first purchase I've made for our baby. We're nearly 5 months in, and until tonight I hadn't bought anything specifically for our baby.

I'm not sure if that's what happens when you are pregnant after you miscarry, or when you are pregnant and also a doctor who does OB care, or maybe just pregnant and have an overactive imagination. But I've just been too afraid to buy anything. Even though we've made it this far, I know I'm not guaranteed to bring home a healthy baby, and it's like I don't want to jinx it. I've been afraid that if I get some things and then something happens, then what will I do with it?

It is, of course, a ridiculous way to live. I cannot live in fear. And even though I'm a bit of a fly-by-the-seat-of-my-pants kind of girl, I need to prepare and plan. I need to let myself be more excited.

And I need to remind myself that the God I serve is good, and nothing happens to me that doesn't first pass through his hand.

And in case you're curious, here is what I got:

Part 3

And now it's on to the really, really bad ideas.

1. One way they plan on increasing primary care doctors is to give a 10% medicaid bonus for 5 years. As in, for 5 years after the bill passes. As if a bonus for only 5 years will really sway medical students, who have many, many thousands of dollars of debt, to choose primary care over a sub-specialty which might mean earning 2-3 times the salary of a primary care doc for their entire career. Medical students are pretty good at math, and this is not going to change anyone's mind. For more people to choose primary care, there must be a BIG change in how doctors are paid.

2. The other brilliant idea (and this is in all the drafts) to increase primary care docs is to take unfilled residency spots from subspecialties and redistribute them to primary care. This is idiotic for numerous reasons. The main reason is that there really aren't any unfilled sub-specialty spots. Dermatology, Radiology, Ophthalmology, ENT surgery - these all fill every single year. In fact, there are always lots more people who want to go into the areas than there are residency spots. Family medicine, on the other hand, only fills about half of their available spots with students graduating from US med schools. EVERY SINGLE YEAR there are tons of open spots in family medicine - these often go to foreign medical grads. Adding more residency spots to primary care will do nothing to increase primary care doctors. (And like I said first, these "spots" they want to redistribute are non-existent.) Apparently, they didn't talk to anyone who has graduated from medical school in the last 10 years when deciding to put this part in.

3. Then there's the abortion issue... There is nothing in this bill to prevent tax dollars from funding abortion. Yes, there are the current bans, but since there will be things that insurance will be required to cover, this will most likely include abortion. Catholic schools or other businesses who have religious or moral objections to abortion or birth control will likely have to cover it. The government should not be able to force someone into paying for something they find morally reprehensible.

So there you have it... lots of my thoughts on health care reform.
I'd say write/email/call your congressperson and tell them what you think. Bills like this make me wish doctors as a whole were more involved in the process. But I know I need to be doing more to let my voice be heard.

Any further thoughts? I'd love to hear what any non-medical people think.

Part 2

If yesterday was "The Good," now it's on to "The Bad..."

1. A big issue I have is that most of the bills do not exactly address how this will all be paid for. One major idea is to cut future medicare/medicaid payments to doctors. Patients who only have medicare and medicaid already have a difficult time finding a doctor, and cutting the payments will only cause more and more doctors to not accept medicare and medicaid patients. Furthermore, this will hurt primary care doctors even more than sub-specialists, worsening the already fairly severe shortage of primary care doctors.

2. One of the BEST ways to save money would be to pass some sort of tort reform. Only ONE of the several bills says ANYTHING about tort reform, and the bill that does say something basically says it will "consider" implementing some sort of "pilot program" to test the idea out. (Meaning: a snowball's chance in hell this will ever come to pass) The CBO recently estimated that tort reform would save $54billion over the next 10 years. But since lawyers write the bills and other lawyers give big money to the lawyers that write the bills, they don't like this idea. But it's proven that doctors order more tests because they are afraid of being sued.

3. The house bill especially seems to create a LOT more bureaucracy. Bureaucracy usually means that you have non-doctors telling doctors what to do. We are the ones who went to medical school, so we should be the ones making decisions about our patients. Not, as is suggested by the house bill, Katherine Sebelius, who has been a politician for a long time and lobbied for... you guessed it... trial lawyers.

4. The big plan to encourage people to get insurance is to give them a tax credit. But there is no tax credit for people who are already getting insurance. Furthermore there will be some sort of penalty or additional tax if you don't buy insurance. But you can apply for a "hardship waiver." I think that many people who currently don't have insurance are unlikely to buy insurance, figuring they'd rather pay the fee. Plus, if something bad happens, they can just go to the ER, where care is "free." (This is unfortunately the perception of many people out there.)

5. The house bill also has this section that will set goals for primary care residencies. On the surface, this doesn't sound like a bad thing. However, we already have the GME (graduate medical education) that does this. Plus the goals are things like: "training to work in non-acute settings." Um.... I'm in our outpatient clinic (non-acute setting) 4 half days just this week, seeing 12-13 patients at a time. "Coordination of care" and "Understanding the cost and value of diagnostic options" - yes, so that is basically what I already do every day. I do not need the government to come in and create even more red tape and paperwork to tell my program to teach me what it already does.

6. Penalizing hospitals with high readmission rates - now certainly we shouldn't discharge people too soon. But certain hospitals, especially those in inner cities that serve the indigent have lots of patients who just don't take care of themselves. Or are actively doing things that harm themselves. We can't send people home and physically make them stop smoking or drinking. Or even get them to take their insulin. This one might be more of a neutral, since it is good to encourage hospitals to take good care of patients, but hospitals, especially those that have residents, likely will have a high incidence of readmission just because of the population we serve.

Again.... this is a non-exhaustive list of many of the problems I see. Tomorrow, or perhaps Thursday (since I'm on call tomorrow) I'll write a little about "The Ugly."

A Doctor's Thoughts on Health Care reform: Part I

One of my classmates did an excellent lecture on the different health care reform bills currently in congress.

Mostly, I left the lecture depressed. But because I have lots of thoughts, I'd thought I'd put a several posts up about specific ideas the bills contain. One thing I did learn is that there are 3-4 different versions going through congress right now, several senate bills and a house bill. So all the bills contain things that are slightly different.

Today's post will be about the things that I liked. This will likely be a rather shorter post than further thoughts to come, but I don't have tons of time tonight for the more lengthy posts about things that I didn't like. So in no particular order:

1. Setting standards for what insurance has to cover - a big part of what is in the bills is going to change laws so that lots of basic stuff has to be covered by health insurance. Things like pap smears, colonoscopies, mammograms, maternity care now will have to be a basic part of what is covered. There is a good focus on encouraging people to get preventative care so that we can prevent or catch earlier some of the diseases that cause lots of problems. This is good.

2. Preventing insurance companies from excluding those with pre-existing conditions. - Even if you have health problems, you will be able to get insurance. Hopefully some of the people without insurance now who are very, very unhealthy will be able to get insured so they can see doctors regularly, and not just when they are in a medical disaster and come to the ER.

3. No lifetime limits on benefits - insurance companies will no longer be able to say, "Sorry, you've used up too much of our money, we aren't paying for anything else."

4. Encouraging some competition by creating co-ops and health care exchanges so people can shop around for the best plan for them. The idea of the exchange is that there will be a place people can look for a clear description of different plans. Hopefully this will mean less "fine print."

5. More funding for loan repayment for people doing primary care. Some of the bills also have increased funding for low interest loans for those going into primary care. Hopefully this will help encourage people to choose primary care specialties.

Well, they may have been a few other things I liked, but that is most of what I can remember right now. What do you like about the bills? Any thoughts?

And come back later for Part 2, and if the post gets too long, Part 3 - things that I didn't like and things that are just bad ideas.