So, teeth again. In a previous post, I discussed guidelines from the American Dental Association, when it comes to getting toothcare abroad. Sometimes overseas dental work is a matter of necessity and not choice–you’re soaking up the sun while riding a camel through the Moroccan desert, taking a swig of from your bottle of overpriced Evian water, and wham–a filling pops out. Or you’re kayaking around the Galapagos, and suddenly your jaw begins to throb. You may need to see a dentist sooner rather than later, and that can be especially difficult in a somewhat remote location. But even if you’re in a large, modern Westernized city, finding a dentist for an emergency or semi-emergency is more difficult and overwhelming than if you had pre-arranged your appointment.

Pre-arranged appointments, aka medical nomadism, is the deliberate travel to an overseas location to get your teeth whipped into shape. The defining motive is saving money, and the savings has to be enough to offset travel expenses and time spent on travel.

So Where Do I Go?

That is a good question. The ADA has some recommendations for finding a dentist abroad, which again, I describe in my other post. As for actual names and faces, well, that is a bit more difficult.

The best way is to get a word of mouth recommendation. Short of that, there are a number of agencies that have popped up, offering their services in helping you find a reputable and inexpensive dentist. If they’re reputable, they can help you navigate the system and hook you up with a dentist.

Americans have been covering the globe in search of quality and inexpensive medical and dental care. Countries on the list include Mexico, Canada, India, Thailand, Singapore, South Africa, and Eastern Europe. In particular, Costa Rica and Hungary have become particularly popular for dental care. In fact, you could say that Hungary is the new rising star, and some towns are becoming “dental meccas” and wooing tourists to come and have their teeth cleaned, filled, capped, implanted, root canaled, and whitened. And after the anesthesia wears off, you can go sail up the Danube….

Here is an interesting article in USA Today about rising dental tourism in Hungary.

Dental Care US is a company that specializes in finding you a Hungarian dentist. Their website says that they arrange every detail, from the initial consultation, review of any x-rays and records, organizing the travel plans and accommodations, providing the services, and are available for any customer service need that arises. I don’t know anything about them, but they do appear to be a legitimate company (with a real address!), and what I like is that they give you a full breakdown of what every type of procedure will cost you. Since they are located in the UK, they compare the cost to what it would be over there, but you can get the idea as it compares to US dental rates (hint–a lot lower).

Not sure about Hungary. Well, try dental care in Bulgaria. It’s in the same neighborhood, and you can get a root canal done for 53 Euros, which is roughly about $40. This is through Dentist-Bulgaria, and they list prices, the type of equipment used, the procedures they perform and even accommodations on their website.

Looking for a warmer locale and some cosmetic work? Try Bangalore, India. I found this very nice and polished website for a cosmetic dental clinic in Bangalore, which is also the high tech capitol of India. They say that they are “a premier ‘Cosmetic and Restorative Dentistry Practice’ in Bangalore, India. Our services include providing excellent dental care to our patients from all over the world. We are apt at providing you simple cosmetic filling or more sophisticated smile designing and complete smile makeover. We offer the latest in contemporary dentistry including porcelain veneers, all porcelain crowns, teeth whitening, crowns etc.” It is interesting to note that all of the models on the website are fair skinned and European looking, not Indian. So you can take a guess who this is directed at.

These are a few samples. I am planning to put together an e-book about dental nomadism, which will have an extensive list of websites and clinics (I’m not endorsing any, just providing the information out there in one easy place to find it), plus other important information if you plan to go overseas.

Take Responsibility

But as with anything, we all have to take responsibility for what we’re doing. Prior to taking any kind of dental related journey to a far off land, it’s important that you do your research thoroughly–even if you are working with an agency.

• Get your price quotes and estimates up front (most important!). You do not want to be shocked after the fact, and get into a haggling war.
• Ask about mode of payment–cash, check or credit card.
• Get details about the procedure. For example, does the dentist use local anesthetic, or are you going to be into la-la land? How soon will you be able to travel? How many days do you need to plan to be there?
• If you do not speak the local language, make sure that someone in the office speaks English. You want to be able to communicate any questions or concerns while there. It may sound silly, but this is something that you want to be sure of. Would you go see a dentist in the US if you couldn’t communicate?

Photo courtesy of the U.S. National Library of Medicine

Well, not quite. I was more talking about the heinous Bush “Conscience Law” which he scrambled to get into place before being booted out of office. Of course, the words Bush and conscience really repel eachother, as it is hard to think of George Bush as having a conscience. As I’ve written before, his idea of pro-life is defending fetuses and pre-embroys and in petri dishes, but not giving a hoot about anyone or anything already alive and breathing. Including the planet itself.

But enough of Bush. He is gone. And President Obama has taken the first move to get rid of that idiotic law.

The Obama administration has begun the process of rescinding sweeping new federal protections that were granted in December to health-care workers who refuse to provide care that violates their personal, moral or religious beliefs.

From the Washington Post:

The Office of Management and Budget announced this morning that it was reviewing a proposal to lift the controversial “conscience” regulation, the first step toward reversing the policy. Once the OMB has reviewed the proposal it will be published in Federal Register for a 30-day public comment period.

“We are proposing rescinding the Bush rule,” said an official with the Health and Human Services Department, which drafted the rule change.

The administration took the step because the regulation was so broadly written that it could provide protections to health-care workers who object not only to abortion but also to a wide range of health-care services, said the HHS official, who asked not to be named because the process had just begun.

And that was the main problem–the broadness of it. Under these loose laws, virtually anyone working in any situation remotely related to health could “claim” an exemption from doing their job. Even the cashier in a drug store could say it was against her morals to ring up condoms or pain pills (patients need to be stoic you know, says so in the Bible). Nurses working in the NICU could refuse to care for patients that wer the product of fertility treatment, because that type of treatment goes agains their morals (not natural!).

I think that workers and employers need to discuss these issues ahead of time, and then it is up to the employer to decide if this person is suitable. For example, a nurse who won’t participate in an abortion would be a moron to seek work at a clinic that performs them, and certainly, would be spending much of her day sitting around and collecting pay for no work done. Likewise, if a pharmacist feels that it is against his morals to dispense birth control pills, then he should not seek employment in retail store. Or should discuss ahead of time and be willing to pass the prescription over to another pharmacist to fill and keep his views to himself, and make sure that he was never on duty alone.

But with the Bush law intact, it might become impossible to fire people for refusing to perform their job (female nurse finds it morally objectionable to touch a male patient beginning with an infant) or to “discriminate” in hiring, ie, you’re not allowed to even ask what the person may find morally objectionable during the interview–you just have to wait for the surprises at work. It is against my morals and conscience to breathe in the same air as people with brown eyes…unless they are at least 1000 feet away from me..

This Patient Should Object

Talk about moral objections. It wasn’t so long ago the physicians didn’t seem to have any conscience when it came to embarrassing the patient, as judging from the photograph. This is from 1903-04, from the Chattanooga Medical College, and all these eager young bucks, ie, doctors to be, are staring at this poor woman who is about to give birth. I would imagine, judging from the time period, that they didn’t even ask her permission if 75 men could watch her give birth. Look at that delivery table–nice.

Okay, just a joke. The caption says that its a female mannequin. Better than having a live woman in labor lying on that wooden table, but can you imagine? This is how medical students got their obstetric training, by viewing a mannequin—um, I wonder if she actually had female parts, or were they too prissy for that?

A lowly nursing home doing one-upmanship over fancy academic medical centers? Well, seems that way. While some fancy centers may be cutting edge when it comes to equipment like the sharpest scalpel on the block, or the shiniest MRI machine on this side of the Mississippi, but when it comes to computer systems and electronic documentation–well, say hello to the 19th century.

But this sounds really cool, what they’ve instituted at a nursing home. It allows nurses to voice record in real time, rather than trying to squeeze in charting at odd moments, or hours after a situation occurred.

From the Pittsburgh Business Times:,

Since January, the Villa St. Joseph has been piloting a voice activated computer system called AccuNurse, which was developed by Wilkins-based Vocollect Inc. and guides patient care by documenting, in real time, all of the care being provided. Under the old system, aides and nurses would chart specific patient interactions sometimes hours after they occurred, increasing the likelihood of errors and omissions and, therefore, lost revenue through incomplete billings.

“It’s absolutely an opportunity to make sure we have the documentation,” Executive Director Mary Murray said. “There are many benefits to this system, and one of the biggest is that it frees nurses from pen and paper documentation, allowing them to spend more time with the patient.”

Seems like physicians and nurses are having a little spat, over who gets to be called “doctor.” All I can say is….uh, don’t you have anything better to fight about?

From NPR:

No one wants to badmouth Florence Nightingale, but a new degree for nurses is causing bad blood between doctors and their longtime colleagues. The program confers the title of doctor on nurses, but some in the medical profession say only physicians should call themselves “doctor.”

All I have to say is “yawn…., are we done whining yet, boys and girls?”

The subject of medical nomadism stirs up a lot of debris, anyway you look at it. You have the critics muttering about all of the risks that a person takes by heading overseas to find quality care at an affordable price, and they can always dig up a horror story to illustrate their point.

On the other hand, you have the patients who might otherwise have to mortgage their house or sell their kids, in order to afford the same care here in the U.S. And these are often people with health insurance, but the insurer finds a convenient glitch in the policy so they don’t have to pay for the procedure, or the copay is beyond the means of the patient, and so on.

And as far as medical disasters, well, you don’t have to go far from home to find those.

The bottom line is the medical tourism exists because there is no acceptable alternative.  It would not have grown to this capactity if most patients had a viable alternative. The critics often criticize, but I’ve yet to see them offer a reasonable alternative, other than “we must reform health care.” Well, I can’t argue with that, except it doesn’t do much for someone who needs help right now.

Teeth, Anyone?

I thought I’d write about teeth, since I did post an article yesterday about a woman who went to Costa Rica to find a dentist. Teeth are an interesting topic because dental care tends not to be a top priority for many. It could be because of the pain associated with the dentist’s office, and many people (including myself) avoid dentists as much as possible due to traumatic childhood memories, but dental care is also expensive and poorly covered by insurance.

So if you decide to venture beyond US shores, how do you find a dentist? Well, the best way is the same way that you would go about it for any type of healthcare professional–a reference from someone you trust (and has nice teeth to show for it). But if you don’t know anyone who has actually gone abroad for dental work, or any other medical care, the only other way is to do some sleuthing.

So let’s stick with dentistry for now.  The American Dental Association has not offered a statement on medical tourism, but they do offer some guidelines:

– Check with the appropriate government agency in the destination country about its national dentistry guidelines.

– Find out what recourse is available if something goes wrong.

– At the dental office, look for infection-control procedures, including instrument sterilization and use of protective gloves, mask and eyewear.

– A traveler’s guide to dental care is available through the Organization for Safety and Asepsis Procedures at www.osap.org.

But Where Do I Find My Dentist?

While these are great tips, they still don’t tell you how to find a dentist. Well, there are a number of ways of doing that, and of course, no guarantees that you’re going to land one you love.  But for starters, the American Dental Association offers some practical tips on finding a dentist:

The International Association for Medical Assistance to Travellers, (IAMAT), maintains a network of medical personnel, hospitals and clinics around the world that have agreed to treat IAMAT members in need of care. IAMAT is helpful in referring patients to dentists. Any traveler can belong to IAMAT. There is no membership fee, although a donation is welcome.

For more information visit:

• www.iamat.org
  IAMAT
  1623 Military Rd. #279
  Niagara Falls, NY 14304-1745
  Phone: 716-754-4883
  info@iamat.org

If you are traveling in Europe, contact the American Dental Society of Europe (ADSE). The Society’s members–dentists who live and work in Europe–have completed a full-time course of study at a recognized dental school in the United States or Canada.

For more information visit:

• www.adse.co.uk
  The American Dental Society of Europe
  Dr. Alastair MacDonald
  62 Highburgh Road, Glasgow
  G12 9EJ Scotlan
  Phone: 011 44 141 331 0088
  Fax: 011 44 141 338 8109

Many countries have dental associations that can provide referrals. Here is a list of International Dental Associations.

A dental school in another country may also be an option. Check the FDI World Dental Federation Web site:

• www.fdiworldental.org

Dental referrals may be available from a hotel concierge, the American Consulate, or the American Embassy in the country you are visiting.

More tomorrow on dentists abroad…

Photo courtesy of Stock.xchng

Nurses were clamoring that one of their kind (or two or three or more) should be selected to head up healthcare agencies in the U.S. Afterall, healthcare reform does need nurses. Well, here we go. It’s a start and maybe we will be seeing more nurses moving into key positions.

From Reuters:

WASHINGTON, Feb 20 (Reuters) – U.S. President Barack Obama has named a University of North Dakota rural healthcare expert to head the federal agency in charge of improving access to care in the United States, the White House said on Friday.

Mary Wakefield, a nurse who heads that university’s Center for Rural Health, was chosen to head the Health Resources and Services Administration, an agency of the U.S. Health and Human Services Department, the White House said.

You may have reason to smile if you can get dental care done for a fraction of the price that it might otherwise cost you. As most of us know, dental insurance for the most part, well, sucks. I’ve had dental insurance in the past, and its not worth the premiums for the pissy coverage.  And many people do not have any dental insurance at all, and have to pay out of pocket to fix teeth.

But if you’re an adventurous health nomad, you may find that affordable and good quality dental care can be had south of the border. And what’s more, some employers now offer insurance that transcends borders.

This is from the State.com:

Sheila Liner spent years suffering from piecemeal dental work that led to sinus infections and a swollen face. But she didn’t have the money – an estimated $14,000 after insurance – for the nine crowns, three root canals, deep cleaning and partial dentures she ultimately needed.

At her boss’ suggestion, the 49-year-old customer service representative got in touch with a subsidiary of her insurance company and traveled to Costa Rica, where the work cost her $3,600 out-of-pocket. Even after spending $1,700 on the nine-day trip, including hotel, meals and sightseeing, she still came out $9,000 ahead.

And of course there are critics who point out all the potential problems, but then, healthcare isn’t risk free in the U.S. either. And critics tend to skim over the most important factor–why the patient went overseas in the first place. Liner wasn’t looking for sun and fun, but for a way to fix her teeth. If healthcare in the US was more affordable and if people had better insurance, medical nomadism wouldn’t even be an issue.  And that’s the bottom line. People are willing to take the risk.

The research firm Deloitte Center for Health Solutions reported that 750,000 Americans traveled abroad in 2007 for some form of medical care. Deloitte analysts estimated that number could increase to 6 million next year and projects the number will continue increasing. Other experts say the trend is growing, but perhaps not as rapidly.

The draw for patients seeking dental work, surgery and joint replacements are the discount prices for those who have high-deductible insurance plans, make flat-rate payments, like Liner, or have no coverage at all.

That’s a lot of people. I tend to think that 6 million may be an overestimate, but then again, with people losing jobs and insurance, it may be the only way to get needed healthcare. On the other hand, if Barack (yes, we are on a first name basis!) does something quickly about healthcare, it may become more accessible and affordable sooner rather than later, and health nomads may decide to opt for staying home.

Photo courtesy of Stock.xchng

Okay, so we’ve heard about the nursing shortage. Now it’s time to pick on another group of healthcare workers–physicians.

Apparently, several parts of the country are facing physicians shortages, or will be facing them. And it seems to be mostly primary care doctors. Gone are the days of Marcus Welby, who not only was always at work, but didn’t seem to have to concern himself about reimbursement, insurance, malpractice (now who would dare to sue Marcus?), cost cutting, etc. In fact, Marcus seemed to have all the time in the world to stick his nose into other people’s business.

But 10 articles popped up on Google news this evening, about physician shortages, and in places as widespread as Hawaii, Santa Cruz in California, Muncie in Indiana, Japan, Australia, Texas, and Grand Junction in Colorado.

Interesting but not all that surprising.

The Union that is. The California Nurses Association, one of the strongest and most aggressive (and mostly in a good way) unions is merging with 2 other unions, and will be heading into anti-union territory. Seems like Texas is one of the targets, and I sure hope that they head to Florida.

From the Dallas News:

Three of the nation’s largest nursing unions on Wednesday announced a merger to ramp up unionization efforts across the country, including North Texas.

The group already has paid union boosters based in Dallas but now will add more, according to the union’s chief regional negotiator. He would not disclose how many paid organizers are currently living in the Dallas-Fort Worth area.

The three unions to merge are the United American Nurses, California Nurses Association/National Nurses Organizing Committee and the Massachusetts Nurses Association. Their new, 150,000-member association will be called the United American Nurses-National Nurses Organizing Committee.

“We have an aggressive organizing program throughout the state of Texas,” said Fernando Losada, the union’s collective bargaining director, who is responsible for Texas. “We think this new uniting of nursing organizations will help us do that even more so.”

Or we can say, they never learn.

I just wrote about a pseudo surplus of nurses the other day, in several regions of the US. There are a number of reasons for the lack of jobs in some areas, but rest assured, it will be business as usual when the economic climate becomes more robust. That is the point when frustrated nurses will quit hospital jobs or nursing altogether, and vacancies will start cropping up. And according to a labor expert that I chatted with today, for an article I’m writing, a number of hospitals are using the economy as an excuse to work short. We can’t afford to hire more nurses, cries the medical center with more endowments than they can spend over the next 200 years. This is in one of the areas where nurses are having a hard time finding jobs, and some of the facilities cutting corners and stretching staff are doing so–just because. An excuse to increase nurse/patient ratios, and they’re gambling on the fact that since the economy is a bit sucky right now, most nurses aren’t going to quit.

Which brings me to this silly article about Idaho. From the Idaho Statesman:

One of Idaho’s hottest jobs will cool by 2012, according to a new report.

A 22-member nursing council appointed by Gov. Butch Otter said the supply of RNs statewide would meet the demand at hospitals and other places in three years if nursing programs continued to expand as expected.

The council’s report is a turnabout: Health officials for years have said the state is short on nurses.

The state has about 11,200 registered nurses, and thousands more are expected to join the work force by 2012. So many people applied to Idaho nursing programs for the 2007-08 school year that 900 had to be turned away for lack of space.

So again, we have the assembly line nurse thinking, as I call it.  Meaning, they think that all they need to do is churn out nurses, and that will take care of their shortage.  As the nurses graduate, they all remain in Idaho, all fill in the current vacancies (regardless of job type, pay, benefits, shift), and then are “glued” into place. Then as the nevt wave graduates, they too are glued into place. So in 3 years, all the new grads are glued into place and the shortage ends.

Of course, they never question why this strategy has not worked for the past several decades. Certainly, Idaho has been churning out nursing grads, and surely if it was that simple, there would be no shortage. In fact, there would have been a surplus decades ago. An overflow of nurses, miles of white caps for as far as the eye can see.

In this nonsensical reasoning, issues such as work environment, pay, desire to move ahead, dislike of hospital nursing, moving into a new career, leaving the state for whatever reason, etc, never fit into the equation. And nursing and health related jobs always do well in economic downtimes. But as the economy picks up, and new industries and technologies develop, just watch the exodus out of nursing. It always happens.

Some news stories are reporting that the nursing shortage is as dire as ever, but yet some nurses are reporting being unable to find a job. Especially those fresh out of school

These seems to be particularly true in some parts of California, where the nursing shortage is supposed to be most acute, and where hospitals were complaining that they could never find enough nurses to meet the nurse;patient ratio law.

I graduated from a SF nursing school in December and just found a job in April. My friends and I were totally unprepared for the competitive job market for new graduate nurses in the Bay area, thankfully it sounds like you have a heads up before you are out of school.

This isn’t just one isolated comment, but a chorus of people who are having problems finding nursing jobs in the Bay Area. I did a quick search and looked at job openings in at UCSF and Marin General. There were virtually no jobs at UCSF, and Marin General had a handful–all per diem and part time except for one. I tried to take a look at Kaiser, but their website is down for an upgrade this evening.

Hmm, strange times. In Florida, however, hospital are still screaming for warm bodies, and there seems to be a lot of opportunity in Texas as well. But across the map there also appears to be layoffs and hiring freezes, due to the economic downturn, at the same time the media is shouting that we have a nursing shortage.

What is a nurse to think? Or a student in school who anticipates entering a vibrant job market?

The new catch word in nursing is no longer competent care, skills, intelligence, a valid license, or even the ability to read and write. Nope, by golly, it is customer service!

When I was in nursing school, the instructors tried their hardest to convince us that the sick, injured, dying, mutilated, and insane folks lying in hospital beds were our clients, and not patients. How they ever came up that, I’ll never know. Undoubtedly, it was customer service in its infancy. Most of the students continued to use that evil word “patient” as it just seemed too bizarre to think of hospitalized people as some sort of clientale–like they had shown up on my doorstep asking for my services. Lawyers have clients, mafia dons have clients, doctors and nurses have patients.

But it seems that a growing number of hospitals have this customer service bug up their ass, like they’re running a 5-star hotel and not a hospital. This is not Nordstrom’s or Neiman Marcus. Yes, it’s nice if patients are treated well and respectfully, and if the place is clean and there aren’t any roaches running up the sides of the bed, but the bottom line is that they’re here to be treated. Not pampered or kowtowed to. And nurses are busy enough without having to be spoon-fed customer service drivel.

But sadly enough, administrators are now hoping for “repeat customers” which is really a little perverse when you think about it. A repeat customer means that the patient will once again have to be admitted to a hospital, which implies that they are sick or injured. But service with a smile is now what nurses are supposed to be doing, and maybe to add to that, we should start encouraging patients to stop taking care of themselves. Who needs that medicine? Better to spend your money on something fun, like cigarettes. Obesity is good for you, fruits and vegetables bad news. Oh, and seatbelts are such a waste of time.

Now that should step up repeat customers.

What brought this topic to mind was an ad I saw for a large regional medical center. It’s in a state that is hurting badly for nurses, for a number of reasons, and ads like this certainly don’t help matters. I actually worked there a few times through a registry, and it sucked pretty bad. Seems like times haven’t changed.

Full Time Eligible 72 Hours per pay period. Every Other weekend. 7pm-7am. Completion of a nursing program from an accredited school of Nursing. Current State of XXX Registered Nurse. BLS card required. Nursing experience in an acute healthcare or other related setting required. Must have excellent customer service. The professional registered nurse is accountable to plan, coordinate, provide, intervene and evaluate the care of assigned patients based upon the treatment plan, nursing standards, nurse practice act and individual patient needs.

And even though you will be working chronically short staffed, we still expect you to do all that–with a great big cheery smile on your face! Remember, the customer is always right.

Yes, you. If you’re a nurse or physician or other healthcare worker who is currently living in the U.S. on a temporary visa, that visa can turn to citizenship in just a matter of six months. The only catch is that you have to join the military, but it might not be a bad trade-off if your goal is to settle permanently in the U.S.

From the NY Times:

Military officials want to attract immigrants who have native knowledge of languages and cultures that the Pentagon considers strategically vital. The program will also be open to students and refugees.

The Army’s one-year pilot program will begin in New York City to recruit about 550 temporary immigrants who speak one or more of 35 languages, including Arabic, Chinese, Hindi, Igbo (a tongue spoken in Nigeria), Kurdish, Nepalese, Pashto, Russian and Tamil. Spanish speakers are not eligible. The Army’s program will also include about 300 medical professionals to be recruited nationwide. Recruiting will start after Department of Homeland Security officials update an immigration rule in coming days.

I almost forgot to mention that today is Valentine’s Day, and I wish everyone a happy and loving V day.

And here are my two favorite Valentine’s:

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The two most spoiled faces ever to roam planet Earth!

I got a cute little note from the California Board of Nursing a few days ago. When a letter arrives from them, and it’s not time for the obligatory renewal, you always have to brace yourself for the unknown. As in….”what the %&?%! do they want?”

You have to expect bad news, as in wanting to suck more money out of license holders, or adding new requirements to getting a license or renewing it. In this case, I was right on target. The California BRN has now decided that all nurses must be fingerprinted, as a safety measure.

I can see if this was a new ruling for nurses who are first obtaining a license in the state. That would make more sense. But no, they want everyone to be fingerprinted, even if you were first licensed during the California Gold Rush!

And what’s more, the fingerprinting is done at your own expense (of course), which according to the BRN, runs about $5-$45. And then the BRN will charge each nurse a $51 “processing fee.” Phew, do you smell scam? I can smell it all the way up north in Washington state.

The Dumbness of it All

I have often criticized our current licensing system, as it is set up primarily to provide income to the state and not to improve patient safety or maintain the highest levels of competence.

According to the BRN’s website, the cost of fingerprinting is $51. How they came up that as a processing fee taxes the neurons. Is this the right amount they need to make up for possible cutbacks to their budget? Did the nice girls and boys at the BRN not get their Christmas bonus this year, or are they going to have to postpone gettin their office bathroom remodeled?

As to how many nurses this involves–I don’t know. According to a fact sheet from the California Healthcare Association, there are about 275,000 RNs with active licenses in the state. Many were probably were licensed before 1990, so it is safe to sayIs this just a ploy to help the poor beleagured state of California balance their budget, by requiring all nurses to suddenly get fingerprinted? California began to require fingerprinting in 1990, so there are definitely quite a few who will be forced to pay this fee if they want to keep an active CA license.

On the other hand, it may be an impetus for nurses no longer working as such, but who just maintain an active license, to say, “The hell with you. Hasta la Vista, baby, take the license and shove it.”

Second, what’s with the retroactive bit? I’ve been licensed in California for over 20 years, have no infractions against my record, and indeed, my nursing record is spotless. Would requiring my fingerprints suddenly make the world safer for humankind?

According to their website, the BRN says that the reason they collect fingerprints is:

Why are registered nurses being required to be fingerprinted?

The mission of the Board is to protect the health and safety of consumers by promoting quality registered nursing care in the State of California. The Board fingerprints licensees as one way of ensuring that registered nurses are safe and competent practitioners.

Fancy words, but fairly meaningless. It may help weed out people who have a criminal record in California, and help keep nurses out of work environments where they should not be–ie, like a nurse arrested for drug dealing should not be in charge of the narcotics cabinet.

But because there is no national database of nurses, and every little Board of Nursing holds fiercely onto their turf and turns their nose up at the dreadful thought of a national license, there is no way of checking the record of nurses who enter CA from out of state.

Yes, the BRN, who claims to want to protect the public, does not want to lose their status and allow for true public safety. I’ve written on this before, but here is an example of how inept and dangerous the situation is.

I took my licensing exam in Wash DC, and was subsequently licensed. I went on to obtain a license in Virginia and in Florida, at the same time that my license was still current in DC. Now suppose I had killed a patient in Virginia, or was arrested in Florida for beating up my supervisor? And even served jail time?

Now, suppose that I lost my license in Virginia and/or Florida. Well, no big deal because I am still licensed in DC. And using my DC license, I can go back to work there, and never say a word about my tawdry record in Virginia and Florida and no one will ever know.

And I can take my spotless DC license and use it to apply for a CA license by reciprocity. Never mention that I previously had a license in Virginia and Florida.

How can that be, you may wonder. Well, the only way a BRN knows what states you’ve been licensed in is if YOU TELL THEM! How dumb is that? If they wanted to check my record, they would have to contact the boards in every state, to see if my name came up. Because we have no national database! And as well all know, no nursing board is going to do that.

So they think that by forcing all nurses now to submit fingerprints, they are going to make the public safer. It is really pathetic.

Now, it even gets better. The California Board will not accept fingerprints that you had done for another purpose, even if they were taken in California.

I was fingerprinted by my employer, school, or other state agency. Do I need to be fingerprinted for the California Board?

Yes, by law, fingerprint records are specific only to the requestor and results cannot be shared with others. Therefore, you must submit fingerprints to the Board. Although it may be inconvenient to submit fingerprints to multiple agencies, it protects your interest by ensuring that you know and authorize your records being sent to the requesting entity.

Whew, now doesn’t it sound like they are looking our for your interests? I mean, how dumb do they think people are. No, they are listening to the “ka-ching,” the money that will need to be forked over. What a scam, requiring repeated fingerprinting over and over again. Well, people do what they gotta do in hard times, and I guess this is Arnold’s revenge on all those nurses who won their case to keep the nurse=patient ratio law intact.

“You pay up or you die,” says the Governator.

So What Will I Do?

Well, when I first looked at it, my initial reaction was, “Yeah, and I’ve got swampland to sell you.” Like am I going to waste my time getting fingerprints, and pay for it no less? Just to help California get out of a money jam, created by corrupt and total mismanagment?

My next reaction was, wait! I already have been fingerprinted, as I worked for the military in California. But no, those prints are no good. The BRN only accepts “nice fresh prints” that are done exclusively for them.

So, I was going to write them a nasty-nice note, telling them that I could understand this is if it was part of a national nurse database, but the current system sucks and is dangerous.  A national license would eliminate the need for full fledged BRNs, and instead require just a small satellite in each state. So since the BRN in its present form exists just to support itself, they do not support national licensing. Which means that they don’t support public safety and this whole thing is a charade.

But then I saw that fingerprints are not necessary if the license is renewed on an inactive status, which mine is. I guess they’re not totally insane, as they are aware of the lost revenue of people like me who would just putting those inactive licenses in the shredder.

You see, CA charges you the same hefty fee ($85) whether the license is active or inactive, and it is actually less work for them to maintain inactive licenses because they don’t have to worry about continuing ed credits. So they love the inactive people—same price for less work.

Talk about scams…

Anyway, requiring the inactive folks to stick their fingers in ink would cause their revenue to plummet, because most of us would just tell them to take a flying f##k and to shove the license up their butt.

So the conclusion is that I will keep my inactive license, not get new fingerprints, and maybe seriously consider getting involved in making national licensing a reality.

Here is a link to the CA BRN’s schtick on fingerprinting:

Fingerprint Requirement for License Renewal

And yet for another year, nurses have been voted the most trustworthy profession. I don’t have the original link for this, but it came from allnurses.com. You can click over there and read the discussion about it as well.

But the bottom line–what good is all this “trust” when the public still treats nurses like their private servants? Or worse? Supermarket checkers get treated with more respect than nurses, on average.  And these comments by the ANA president are even more nauseating.  A proud day for nurses and nursing? That proud day will come when nurses are treated like valuable members of a healthcare team. It would be just a little helpful if the ANA acknowledged this discrepancy between the so-called great trust that the public has in nurses, and the way they are treated in the workplace, by that very same public as well as by administrators.

SILVER SPRING, MD- For the seventh consecutive year, nurses were voted the most trusted profession in America in Gallup’s annual survey of professions for their honesty and ethical standards. Eighty-four percent of Americans believe nurses’ honesty and ethical standards are either “high” or “very high.” “It’s a proud day for nurses and for nursing,” remarked ANA President Rebecca M. Patton, MSN, RN, CNOR. “The fundamental principles of nursing are compassion and respect for the individual patient. They are what inspire each nurse to strive to promote health, prevent illness and alleviate suffering. It’s gratifying to see those principles recognized by the public we serve.”

Since being included in the Gallup poll in 1999, nurses have received the highest ranking every year except in 2001, when fire fighters received top honors. Results were based on telephone interviews with more than 1,000 adults.

Is it? That’s the question that was put forth to 12 experts in an article from NationalJournal.com.

The worsening economic situation and the withdrawal of the Daschle nomination appear to have slowed down momentum for health care reform. Do you think there still is enough time to complete health care reform this year? If not, how likely is action in 2010? Does health care reform have to be bipartisan in order to move forward?

Does it still make sense for the next nominee for HHS secretary to also head the White House Office on Health Reform?

The asnwers vary, but they generally agree that not only is health reform still “possible,” it should be a priority. I don’t know who they’re talking about when they write that the momentum for health reform has slowed. Americans are just as anxious for health reform as before the election, and yes, there are a few challenges but nothing has slowed down. The nomination of Daschle was just one peg in the puzzle, and doesn’t mean that everything has to come to a complete stop. The secretary of HHS does not control healthcare in this country on a day to day basis, so all else can proceed.

How about passing some laws that prohibit insurers from denying insurance to people with a pre-exisitng condition, and/or charging them an exorbitant premium? That would work wonders as a starter in health reform.

I think that Sen. Max Baucus (D-Montana) who is on the Committee Chairman Finance Committee, said it best. My thoughts exactly:

Health reform is not only possible in 2009, it is imperative.  Without health care reform, our economy cannot recover, grow, or remain competitive around the world.  And without health care reform, costs will continue to grow at a skyrocketing pace, crushing American families and forcing more and more Americans to go without health insurance.  This is a trend that cannot continue.

That’s the problem. Some of the talking heads are separating healthcare from the economy, putting it aside as a separate issue. Medical costs are the primary source of bankruptcy in this country. Reforming healthcare will help build up the economy, not add an additional burden.

And everything doesn’t have to happen at once, but we need to start somewhere and start right now, building upon what is currently in place. How difficult is that?

This is the first post for my new nomad section. Nomads can be either patients or healthcare professionals, who wander far from home in search of care or a job. The trend is becoming more common than people think, especially on the patient side of the equation. The search for affordable medical care in foreign lands is only going to grow, unless something changes dramatically in the U.S.

For cosmetic surgery, the world beckons. Why pay zillions to a fancy New York plastic surgeon, when you can slash that cost by 50% by heading to Argentina. This was an ad that I across:

Cosmetic Surgery – 50% less than in the United States.
Argentina provides highly skilled physicians and medical facilities equipped with the most modern technology. Argentina has the needed infrastructure and the professional qualifications for offering high quality cosmetic surgery to patients from the United States and other countries.

Cosmetic surgeons operating in South America, particularly Brazil and Argentina, do have quite a brisk business. And what I heard from a plastic surgeon living in California, who was heading down to a conference in Brazil, is that they perform techniques that aren’t quite available North of the border. Good or bad, hard to say, but a lot of innovation is stifled here, without really improving safety.

I thought that this ad was interesting because it shows how this practice of nomadic medicine has evolved. The website has a form to fill out, and you can receive a travel quote and free consultation. Just 30 seconds to  fill out and voila, you’re on your way.

Photo courtesy of National Library of Medicine

When I saw this article in the NY Times this morning, entitled “Can Nurses Care Too Much?”, my first reaction was to move on. Oh no, I thought, not another one of these sugar coated diabetes inducing sagas of the angel nurse–the angel of mercy who gets so involved in her patient that her “caring” boomerangs and causes more harm than good.

But the title is misleading. Very much so. This is not about a nurse who cares too much, but one who had the right amount of compassion and professionalism. She became attached to a cancer patient over time, but not in an inappropriate manner, or a way that interfered with professional behavior or judgment. It’s really quite a nice story, and she sounds like the type of nurse that I would like assigned to me if I ever had to go into the hospital.

Refreshing, is the best word to describe the article. But I wish the editors would change the title, because its bound to repel would-be readers.

I’m sure that by now we’ve all seen the story about the octuplets, and are familiar with the assorted controversies arising from it. I really don’t want to rehash it, but just to say that if there was ever a call for regulating the fertility industry, this is it. And let the doctor who implanted those 8 embryos be responsible for supporting those kids and paying their medical bills because I’m not interested in my taxes footing the bill.

Although, the same can be said for other areas of medicine. Regulations are weak, rules non-existent in many cases. While too many rules can stifle innovation and prevent new therapies from being developed and tried, at the same time, a Wild West approach isn’t conducive to public health either.

This is a very good commentary about the octuplet mess, that appeared in the Seattle Times. Needless to say, the birth of octuplets, conceived by artificial means, is not heroic or miraculous, or the proverbial “8 little blessings.” It is a medical nightmare, and the physician responsible should be relieved of his or her license to practice.