My personal opinion on where medicine is headed. (An Editorial)

My practice has spanned 25 years as of August 1st.  That is a significant amount of time, almost half of my life, and it gives me some perspective on the problems we all face in health care. Here is a list of issues I believe are critical.

1.  Many Americans, maybe most, have relinquished to one degree or another their accountability to pay for their health care needs. It has been an insidious change and is a result of the insurance companies taking more and more of a role in determining where and what health care we should obtain. These insurance companies are not doing this to help us receive the best health care but to make money. That is why they are in business, to make money, not to provide health care.  So, as we have gone along over the years we default our decisions about tests to be run and treatments to be administered to what is covered.  The doctors, to a lesser degree, are guilty of the same. We have insurance and we get tests and treatments when we need them.  The problem is that often these tests and treatments are really not necessary.  There is so much waste and we cannot afford it anymore. The average family health premium will exceed 700.00$ per month and it will only get higher.  If the burden of paying for tests and treatments were to shift back primarily to the patient, significantly more thought and care would be used to make determinations and fewer and fewer unnecessary tests and treatments would be given.

2.  Contributing to the above problem is our societies general belief that if something bad happens somebody should pay.  In medicine that turns out to be the doctor or the hospital.  Therefore, many tests are run and some treatments administered to avoid any "misses", however unlikely they are to occur.  For example, 20 years ago when one went into the ER to evaluate abdominal pain, a careful history and exam were performed as well as a few simple blood tests. This history, exam and tests was usually sufficient to rule out an acute appendix, an ectopic pregnancy a kidney stone or an ovarian cyst.  Maybe less then one percent of the time a serious problem was missed and a delay in diagnosis occurred.  Now, a C.T. scan is routinely performed to rule out these problems at a cost of 7 or 8 hundred dollars simply for the test.  After all it is "covered" and expected and the doctor has no disincentive to order the test.  It is only getting worse and I'll say again "we cannot afford it"!

3.  So what is going to happen?  Each of is going to decide we cannot afford the premiums on our health insurance policies and we won't pay them.  The government is going to try to make us pay them either thru taxes or penalties or both but the simple truth is we don't have enough money.  As the system, "govt." goes bankrupt we will be left to our own devices on how to take care of ourselves which is how it should be anyway.  We will find a doctor who is trustworthy and capable, "not perfect" and consideration will be made carefully on what the problem is, what tests may be useful, what can we afford, and what if any treatment is needed.  Isn't it ludicrous that we have allowed the health insurance industry to take such a sizeable portion of our health care dollar (some estimates as high as 60%) to tell us who to see and what we should have or have not done.  I am looking forward to the changes coming that will happen whether we want them to or not.  SD

I'm in heaven on a pack trip!

This past week we traveled to the Bookcliffs just east of Green River.  It is called the roadless area of this small mountain range and is a secluded part of heaven.

I try and get in there 1 or 2 times per year and I am blessed to have gotten there this early this year.  We pack two mules and I ride a mule named Lucy.  She is a relative new animal to my cadre of horses and mules but she is special.  Really calm with good confidence and a brisk pace.  My favorite mule is a john named Cody. I have had him since he was one year old.  A good friend of mine named Diana Tibbets raised and sold mules and he was from her draft mare, (a Percheron).

One trip I was riding Cody on the Muddy River down near Hanksville. We got to a deep hole in the river and I decided to "swim him across".  Now I won't pretend I know how to swim a mule nor even if he knows how to swim but at the time I thought it was a good idea.  He and I sank like a ton of bricks.
If any of you are interested in pack, horse and mule stories, I have written a short book of those stories and I would love to send you a copy.

I am excited for our next pack trip which will be into the upper reaches of the Yellowstone River to a place called Hawks Rest.  It is 26 miles one way so most of our time will be spent riding which suites me just fine.  Have a nice day and happy trails.  SD

More Book Review

I have been blessed with a desire to read and it has brought me much joy.  I believe it has also added to a better outlook on life in general. Several books that I have read some time ago that have much to recommend are the following.

1) The Virginian by Owen Wister.  A true cowboy western that depicts the rough but "square" deal to be had in the old west if one is willing to work an honest day.

2) The Last of the Mohicans by James Fennimore Cooper.  This is a classic about the history of the indians in the great lakes region of our country and how time take a toll on all of us in one way or another.

3) Half Broke Horses by J. Walls.  This is a story set in the Arizona, New Mexico area around the turn of the 19th century.  It is about a tough woman who makes the best of her life and I believe is fulfilled.

4) I may have mentioned this already but also recommend the book "These Is My Words" a rough approximation of a diary by Sarah Prinn.  It is excellent!

                                                                    ENJOY!!

More books.

I have finished two books since I last made an entry.  They were both excellent!  The first was a book in the Jack Reacher series by Lee Childs.  Tom Cruise starred in a recent movie called Jack Reacher.  My wife and I saw it sort of by accident as the movie we wanted to see had already left the theatre.  It was excellent and we both enjoyed it.  It is a type of detective thriller. So, I was looking in Smith's for a new book to read. Just wanted a fictional novel for the pure enjoyment of relaxing while reading and I saw this series by Lee Childs.  There are 5 or 6 books about this fictional character named Jack Reacher who is an ex Army police detective.  They are very well written and exciting with a reasonable plot.  The book I just finished was called Echo Burning.  

The second book I would highly recommend is titled "These is My Words" by Nancy Turner.  It is the fictionalized diary of a western woman who helped settle the Arizona Territories in the 1880's and 1890's.  Marvelous and entertaining as well as educational.  You will learn to love Sara Prine who is the main character in the book.

Book Club

I hope the book club will interest some of you.  Let's write a summary of the book and why we liked the book.  Here are three I'd like to start with.

1) A Thousands Splendid Suns.  Hosseini.  This is the second book by this Afghanistan author, the first called The Kite Runner.  The Splendid Suns book is the story of several women living and surviving in Afghanistan during the height of the Taliban. The brutal conditions and suffering these women have to bear causes one to wonder about the cruelty of man and makes even more poignant the kindness and love we can show each other.  The heroine in the book (in my estimation) becomes a Christ figure.  One of my top ten books of all time.

2) The Bean Tree. Kingslover.  A story about a young woman setting out on her own to find out about the world and about herself.  The vernacular and colloquial writing style is pleasant and adds so much enjoyment.  It is also a great story.

3) The Education of Little Tree. Carter. A series of true stories written by the man who experienced them.  It is heartwarming and genuine with the visual imagery of the hill people and the simple but insightful wisdom that comes from living a good but hard life.  Again, the vernacular of these people is so pleasing to read and the stories are not only humorous but will bring tears to your eyes from the heart.

Our Facebook/Blog Contest Winner!

Congratulations to our contest winner Sherri! We will be starting our new contest in May 2013. Updates Coming Soon!

Where do I fit in? Part 2

Dr. Dewey: I have started thinking and pondering. Here is a quote that keeps coming into my head, “most men lead lives of quiet desperation and go to the grave with the song still in them”. Maybe we can learn much from those that have felt much and written much. That was a quote from Thorou, Henry David.

Alice: Thank you for your response. It doesn’t really help me know what to do though…me and my wild streak.

What do you mean by this statement? “I believe you need to examine carefully where you want to jump but that you do need to jump.” I agree that I need to channel these feelings, and I’m trying to do so in a way that isn’t going to damage me…too bad. I think you are totally right that through some pain and anguish we can learn and grow. I’m fine with my own pain…to a certain extent, but I’m trying to keep in mind that I have a husband, children and extended family that will be hurt if I act too rashly. Let me give you a little idea of what I’m talking about. We are considering opening our marriage a little. I think that Kevin has been thinking about it for a while. It’s fun and exciting. He and I are of the same mind that it is so intriguing and sexually stimulating, but we are wary that it might ruin us both. We’ve talked a lot about what we want and need. I’m having a hard time separating the two things. Do I really need to have attention from other men to feel good and sexy about myself…or do I just want it? He and I have always had a bit more loose lifestyle, but do I dare take it to the next level? I feel like I am becoming a shallow existence of the person I once was. I love being social and making people laugh. Now I find myself alone nearly every day tending to children and the duties of a stay at home mom. This isn’t a bad thing, necessarily, but I feel like I am being lost in it. It is very difficult for me to get turned on at the end of a hectic day. I know this is the case for a lot of mothers, and busy women. I am not one of those women that turn my husband away, and we have a quite active sex life. I’m trying to find a happy medium where I am happy with who I am, and I feel sexually satisfied.

Dr. Dewey: I am still thinking about where I would suggest you jump. Not an easy answer. As I think about your considering an “open marriage” it would be exciting but I believe very strongly casual sex is empty and leaves one feeling used and alone. The emotional connection needed to make physical intimacy meaningful would tend to lead to feelings of jealousy and possessiveness. It would hurt some or all at some point in time.

Alice: My husband is of the mind that a lot of things are okay as long as they are casual. He doesn’t want me to get emotionally involved with someone else. We’ve spent a lot of time discussing this…but still aren’t sure where we stand. Last night we were thinking we would bag the whole thing. Today…I was face-timing with a guy I met through a couples dating site. Obviously, we flop easily. We are going very slow. We don’t want to get caught up in the lust of it and do something rash.

Dr. Dewey: Alice, I have been thinking about your situation a great deal. You seem to feel there is more out there, that life is passing you by and there should be more meaning to your existence. You are bored with the way things are in many aspects and want a change.

In any event, looking for more in life is a common issue and I think a good thing. It is just important where you expect to find it. As exciting as it might sound, casual sex in a meaningless relationship, is not going to do it. It will do just the opposite and leave you empty and feeling used. You for sure need to find something “meaningful”.

Here is part of a poem I found, “A critical point of this life, it surely seems to me, is to create and not destroy, it is without question a key. Whether it be a building, a painting, or a piece of pottery; these temporal things can add immensely to who we are, and who we come to be. As I sit here and ponder this idea of creation, (a garden of peas, an orchard of trees, the fresh mown grass as it blows in the breeze), all add to the joy that builds within our being, and yes it’s true that it does seem to please.”

Exponentially greater then these examples I’ve shared, is the meaning that comes forth when two people are paired. Two souls in the cosmos as we travel along can sometimes come together from the midst of the throng…

What this is suggesting is creation is the key. It may be temporal things that you do that will lead you to peace. These are certainly safer then creating new human relationships, but I believe it is also true that it is the human relationships that bring the most meaning. When two people build a deep emotional connection it is “creating” but in the wrong circumstance or when it is based on superficial selfishness it will be destroying.

I am interested in how you feel about the current dissatisfaction in your life and what it will take to satisfy. Do you know yet? I sense it has to do with creating and needs to have substance. What are you thinking regarding this? Maybe you should build a library?

Alice: I feel like a very unsuccessful person right about now. I should be totally satisfied. I have everything anyone could ever want in life. Right? I’ve been thinking about the creating thing. I just don’t know what I would create. What do you mean build a library?

Dr. Dewey: Building a library was sort of a joke, but would satisfy a desire to create temporally (the building) and intellectually (the books or the intellect contained within the books). You are creating now, look at the children you are continuing to shape and mold, look at your body that you are continuing to improve.

My suggestion is you continue in those wonderful and fulfilling endeavors and then add a serious intellectual pursuit. Get a degree in English literature, become an RN, study religions of the Far East. Start an in depth study of Mormonism and its history.

Set a goal to become a president of a clothing company or an on line gourmet food store.

What interests you? Getting to know another man would be exciting and fulfilling only if you could really get connected mentally but that would lead to frustration because of the other issues such as time restraints, money, sex, kids, etc. Life is so interesting and exciting and challenging and there for the taking. All we need to do is reach out, put forth the effort and gather it in. Easier said than done. Most of us have had our share of relationship challenges and know firsthand all of the frustrations that come from unfulfilled emotions and jealousy and time constraints, etc… I know for me  patience has been a huge source of peace and now for me, peace is a far more preferred emotion then happiness. The more patient I am, the more peace I have found in my life.

Alice: I think that I have been very self-absorbed. Unfortunately all the worrying about me has just added more chaos and turmoil to my household. The main job I have in life right now is to be a wife and mother…neither of which am I doing very well currently. I feel like things have spiraled out of control .I thought that other relationships, especially sexually charged ones, would make me feel good about me. I was wrong. Years ago when I was a younger mother I started reading about an organizational guru name Marla Ciley. She is better known as the Flylady. She is all about routines. While I found the majority of what she says to be cheesy and ridiculous, I liked the routines. It made me feel in control, and successful. Running also does this for me, it has made me learn to control my body. I feel like I’m losing the life that I have worked years to set up. I’m ashamed. I eat more. I sleep less, and the anxiety is getting bigger. I think that you are right. I need to find something else to help me feel fulfilled. I’ve always valued the relationships I have with my friends, but am often disappointed when I “love” them more than they “love” me. I realize that sounds quite melodramatic, but no one wants to be in a relationship where they are always the pursuer. I have quite a few friends that confide in me and want me to help them through issues they have. But then when the roles are reversed, I feel like I don’t have a lot of confidants in return. This week I’m focusing on getting my family organized and having our home flow better. I think that’s a good start for me. I started my focused training for my first marathon in May. After I feel like I’m not running in circles trying to clear the haze I’ve created in my mind, I’m going to find something to do that’s just for me. There isn’t a lot that doesn’t interest me…so it should be easy to find a serious intellectual pursuit. I hope I can learn to be more patient and find peace that way.

Dr. Dewey: I agree with what you are saying about some routine and our understanding what our primary responsibilities are at any given time in our lives. Yours is to be a wife and mother first.  Mine is to be a husband, father, grandfather, provider and to improve those relationships. Another major “job” for me right now is to come to know God more intimately. That sounds corny but it is how I feel. I am not always doing all the church asks of me but I am accepting my weakness and transgressions and honest feelings and still seeking that closeness to Heavenly Father I feel is there.

Balance is elusive and personal fulfillment should include a healthy physical self and all the running and working out that entails. It is also about intellectual improvement and spiritual improvement. My relationships with others are for the most part fulfilling, but I often want to be closer.