My grandfather had a heart attack when my mother was in her 40s. She immediately cut salt out of her cooking, and i grew up not liking anything too salty. My dad was then diagnosed with diabetes a few years later, and she cut sugar out of her cooking. And now, I don't like things to be too sweet. I thank my mother every day for teaching me healthy diet choices as a kid. Most of it started because she was afraid of high blood pressure for herself.
On another note, I had a client once who was so nervous about her blood pressure readings that her blood pressure always increased to above normal levels just because she was haven't it taken! I borrowed a cuff to read it with her and walked her through a series of mindfulness exercises to calm herself before the reading, and it came out on the low end of normal.
It's so true that blood pressure fluctuates over time. and like anything and everything, a balanced lifestyle can address that. Bruce has so many things that could be causing the high blood pressure, and then his lifestyle habits only increased to contribute to the condition more, as is so often the case. Patients like Bruce are so blessed to have you, to patiently and gently educate them and keep their BP low as you talk with them!
I've had more than one patient who cannot check their own blood pressure because they get so worked up about it. These are patients I should refer to you to learn some mindfulness exercises! Another problem is the clinic visit is so rushed. We are supposed to have patients sit quietly for fifteen mintues before we check their blood pressures. We don't have that many rooms! And for some of our patients walking from the waiting room to the exam room is a lot of exercise (as was walking from the hadicapped parking place to the waiting room a few minutes before) so checking their blood pressure is like checking that of me after I've run around the parking lot ten times.
A long time ago, someone suggested that doctors make recordings of themselves for patients to listen to for relaxation purposes. I never did, but perhaps I should give it some thought. Perhaps if people associated me saying a particular phrase with relaxation, I could say it beofre I checked their blood pressure in the clinic for better results.
That’s brilliant! What if you made a 7-10minutes guided meditation recording that could be done while driving to the doctor! In your voice. That focuses on breathing and calming. I could write a script for you to use.
I'm not quite sure what you are asking. There is no eligibility requirement to go to an FQHC! We take all comers, regardless of anything! I am a patient at my clinic, as is my family. If you want to find your local FQHC, you could search for "FQHC near me."
If I didn't answer your question, please try asking it again. Thanks.
I volunteer at a free clinic for uninsured patients here in Georgia (office manager). Finding medication for people that sometimes have no income is some of the most time consuming jugging acts we do! We do have a state run Good Pill program that provides many medicines for $6 or $8 for 90 days. And, for more brand name medicines (think Tresiba or Ozempic) we apply to the manufacturer via their patient assistance programs which often gets the medicine for no cost. But it is a giant time suck on our part because those applications can be denied for missing a check box and it takes consistent follow up to be sure the application is processed. I often feel like doing a jig every time I get one approved!
It really is such a relief when someone gets approved for one of those programs. Generally, it seems once they get approved, unless something changes, they’re approved for life so that’s one med for one patient I will not have to worry about again. Definitely jig worthy!
We have a person whose job it is to shepherd those applications through the patient assistance programs. I have zero patience for that kind of stuff, so I very much appreciate her! Sorting out medication payment details is one of the no fun huge time suck parts of my job, too, for sure.
It can be hard! Sometimes the patient’s mood rubs off on me and I can’t be defeatist because I have too much to do. I really do consciously take a breath during the day or deliberately talk to someone who is reliably positive (like my assistant, thank heavens for her!).
It is really helpful to remind myself that Bruce is doing the best he can. That ability to find the catastrophe has served him well; he was a great insurance analyst, for example, and I know from watching my patients go through it that searching for a job for a whole year is very depressing.
I hope he doesn’t need blood pressure medications. Stay tuned!
I hear you on the cost of meds. My 8-years older sister had a heart attack late last year and went from one blood pressure and one diabetes prescription costing her about $15 every three months to a host of heart health drugs costing hundreds (a couple of them cost hundreds apiece), and she has good insurance! Thankfully, her deductible is almost paid this year.
I support three nonworking neurodivergent adults (daughter and grands) on my retirement income and realized I can’t afford a heart attack! I’m walking, cooking healthy meals, take my BP medication, managing my diabetes through diet (doctor agrees), and working on weight loss. I really relate to your article! Thank you.
Thank you! I'm glad you like them. It sounds like you have had lots of experience with the Surprise! factor at the drugstore. I had it happen to a patient on Friday (of course) for a medication that is very unpleasant to stop suddenly. She paid for 3 days out of pocket (think her insurance company is going to reimburse her for that? ha!) to give the prior authorization angel a chance to work her magic. If the insurance company refuses to pay for it, I will be examining the similar meds they *will* pay for, picking one, and doing calculations to find a similar dose. Think that's reimbursable? Think again! I have lots of free time and am happy to do this kind of thing for free. Also, I'll be doing my best to make the doses roughly equivalent, and if I am off a little or she does not quite match the equivalence tables? "We're sorry! We can't be responsible for individual results, but we did save our $0.07 on her prescription."
I'll jump up on the soap box over this issue time and time again.
Wow, My wife a trauma surgeon who's worked in the same level 1 ER for 20 years, read this and said: " I'd hire her. she would fit in comfortably with our team "
From reading all your writings it seems that you are always collected 😁!!!
And I finally got a hold of my wife who's "hardly working" this weekend in San Antonio. She said she would be very comfortable and confident to hand off any patients to you in the SICU, which says a lot because once they leave her trauma unit they're always her patients no matter where they go.
So glad to hear FQHCs haven't been impacted. I know many clinics serving poor people have been. Between being targeted for DEI, supporting Trans folks and immigrants many have been slammed and are losing staff. Can you say something about that Dr. B?
So far, FQHCs have not been impacted financially by the cuts (in general, of course). We are not federal employees so the DEI and trans rules do not affect us as an organization. My understanding of the ICE rules is that we are allowed to have private areas of the clinic and ICE can only go there with escort from the clinic. There has not been any ICE in medical facilities in NH (knock on wood) as far as I know. We mostly lose staff (irony alert) because our health insurance is terrible and people cannot afford to work for us. The next most common reason is people move. In general, people who end up working at an FQHC are there because we love the mission and we love the mission regardless of the rest of what’s going on in the world.
Your clinic sounds pretty amazing. For the first time, I've searching, with the help of my Dr's office, for cheaper meds from Canada. Except, the prices have gone up since the tariffs were started. How insurance companies charge is like a shell game. Last time the med was refilled it was $33. Now they want $900. As a retiree, just can't do it. I'm not destitute but it's still hard.
Sing it, sister! Yes, the prices of medications change constantly for no apparent reason. The pharmacy sometimes doesn't have the most up-to-date information, especially for our patients who may get their meds on different programs. Some meds are important to take every day, but miss a day of some meds and you might die. And now that med costs $15/day with no warning. You can afford $45 while we get it sorted out, can't you? You have a jar of peanut butter and some crackers in your kitchen, don't you? The constant changing of meds provides absolutely no value to anyone but the PBM and costs patients and clinics where we have nurses talking the patients down from their panic, admins doing their emergency prior auths, etc a pretty penny.
Better put this soap box away before I get going any more.
My grandfather had a heart attack when my mother was in her 40s. She immediately cut salt out of her cooking, and i grew up not liking anything too salty. My dad was then diagnosed with diabetes a few years later, and she cut sugar out of her cooking. And now, I don't like things to be too sweet. I thank my mother every day for teaching me healthy diet choices as a kid. Most of it started because she was afraid of high blood pressure for herself.
On another note, I had a client once who was so nervous about her blood pressure readings that her blood pressure always increased to above normal levels just because she was haven't it taken! I borrowed a cuff to read it with her and walked her through a series of mindfulness exercises to calm herself before the reading, and it came out on the low end of normal.
It's so true that blood pressure fluctuates over time. and like anything and everything, a balanced lifestyle can address that. Bruce has so many things that could be causing the high blood pressure, and then his lifestyle habits only increased to contribute to the condition more, as is so often the case. Patients like Bruce are so blessed to have you, to patiently and gently educate them and keep their BP low as you talk with them!
Thank you for your kind compliment.
I've had more than one patient who cannot check their own blood pressure because they get so worked up about it. These are patients I should refer to you to learn some mindfulness exercises! Another problem is the clinic visit is so rushed. We are supposed to have patients sit quietly for fifteen mintues before we check their blood pressures. We don't have that many rooms! And for some of our patients walking from the waiting room to the exam room is a lot of exercise (as was walking from the hadicapped parking place to the waiting room a few minutes before) so checking their blood pressure is like checking that of me after I've run around the parking lot ten times.
A long time ago, someone suggested that doctors make recordings of themselves for patients to listen to for relaxation purposes. I never did, but perhaps I should give it some thought. Perhaps if people associated me saying a particular phrase with relaxation, I could say it beofre I checked their blood pressure in the clinic for better results.
That’s brilliant! What if you made a 7-10minutes guided meditation recording that could be done while driving to the doctor! In your voice. That focuses on breathing and calming. I could write a script for you to use.
That’s a great idea! Thank you!
Thank you for sharing this! Really good to know. Is there a national database of clinics with eligiblity requirements?
I'm not quite sure what you are asking. There is no eligibility requirement to go to an FQHC! We take all comers, regardless of anything! I am a patient at my clinic, as is my family. If you want to find your local FQHC, you could search for "FQHC near me."
If I didn't answer your question, please try asking it again. Thanks.
You did! Thank you 😊
I volunteer at a free clinic for uninsured patients here in Georgia (office manager). Finding medication for people that sometimes have no income is some of the most time consuming jugging acts we do! We do have a state run Good Pill program that provides many medicines for $6 or $8 for 90 days. And, for more brand name medicines (think Tresiba or Ozempic) we apply to the manufacturer via their patient assistance programs which often gets the medicine for no cost. But it is a giant time suck on our part because those applications can be denied for missing a check box and it takes consistent follow up to be sure the application is processed. I often feel like doing a jig every time I get one approved!
It really is such a relief when someone gets approved for one of those programs. Generally, it seems once they get approved, unless something changes, they’re approved for life so that’s one med for one patient I will not have to worry about again. Definitely jig worthy!
We have a person whose job it is to shepherd those applications through the patient assistance programs. I have zero patience for that kind of stuff, so I very much appreciate her! Sorting out medication payment details is one of the no fun huge time suck parts of my job, too, for sure.
Just reading of the patient’s negative attitude about every suggestion made me depressed, too.
It can be hard! Sometimes the patient’s mood rubs off on me and I can’t be defeatist because I have too much to do. I really do consciously take a breath during the day or deliberately talk to someone who is reliably positive (like my assistant, thank heavens for her!).
It is really helpful to remind myself that Bruce is doing the best he can. That ability to find the catastrophe has served him well; he was a great insurance analyst, for example, and I know from watching my patients go through it that searching for a job for a whole year is very depressing.
I hope he doesn’t need blood pressure medications. Stay tuned!
I hear you on the cost of meds. My 8-years older sister had a heart attack late last year and went from one blood pressure and one diabetes prescription costing her about $15 every three months to a host of heart health drugs costing hundreds (a couple of them cost hundreds apiece), and she has good insurance! Thankfully, her deductible is almost paid this year.
I support three nonworking neurodivergent adults (daughter and grands) on my retirement income and realized I can’t afford a heart attack! I’m walking, cooking healthy meals, take my BP medication, managing my diabetes through diet (doctor agrees), and working on weight loss. I really relate to your article! Thank you.
Thank you! I'm glad you like them. It sounds like you have had lots of experience with the Surprise! factor at the drugstore. I had it happen to a patient on Friday (of course) for a medication that is very unpleasant to stop suddenly. She paid for 3 days out of pocket (think her insurance company is going to reimburse her for that? ha!) to give the prior authorization angel a chance to work her magic. If the insurance company refuses to pay for it, I will be examining the similar meds they *will* pay for, picking one, and doing calculations to find a similar dose. Think that's reimbursable? Think again! I have lots of free time and am happy to do this kind of thing for free. Also, I'll be doing my best to make the doses roughly equivalent, and if I am off a little or she does not quite match the equivalence tables? "We're sorry! We can't be responsible for individual results, but we did save our $0.07 on her prescription."
I'll jump up on the soap box over this issue time and time again.
Wow, My wife a trauma surgeon who's worked in the same level 1 ER for 20 years, read this and said: " I'd hire her. she would fit in comfortably with our team "
- All her team is calm, cool and collected! 😎
That’s a lovely compliment! I’ve always admired the trauma surgeons although I’m much more interested in what happens in the SICU than the OR.
I do pretty well and calm and cool most of the time, but I sometimes fail at collected.
From reading all your writings it seems that you are always collected 😁!!!
And I finally got a hold of my wife who's "hardly working" this weekend in San Antonio. She said she would be very comfortable and confident to hand off any patients to you in the SICU, which says a lot because once they leave her trauma unit they're always her patients no matter where they go.
Aw, thanks! I can tell she's a kindred spirit. There is definitely a shortage of docs who feel that way, but I can tell we'd like to work together.
Will FQHCs survive the current administration “cutting waste and fraud” tactics?
So glad to hear FQHCs haven't been impacted. I know many clinics serving poor people have been. Between being targeted for DEI, supporting Trans folks and immigrants many have been slammed and are losing staff. Can you say something about that Dr. B?
So far, FQHCs have not been impacted financially by the cuts (in general, of course). We are not federal employees so the DEI and trans rules do not affect us as an organization. My understanding of the ICE rules is that we are allowed to have private areas of the clinic and ICE can only go there with escort from the clinic. There has not been any ICE in medical facilities in NH (knock on wood) as far as I know. We mostly lose staff (irony alert) because our health insurance is terrible and people cannot afford to work for us. The next most common reason is people move. In general, people who end up working at an FQHC are there because we love the mission and we love the mission regardless of the rest of what’s going on in the world.
I hope so! So far, so good.
Your clinic sounds pretty amazing. For the first time, I've searching, with the help of my Dr's office, for cheaper meds from Canada. Except, the prices have gone up since the tariffs were started. How insurance companies charge is like a shell game. Last time the med was refilled it was $33. Now they want $900. As a retiree, just can't do it. I'm not destitute but it's still hard.
Sing it, sister! Yes, the prices of medications change constantly for no apparent reason. The pharmacy sometimes doesn't have the most up-to-date information, especially for our patients who may get their meds on different programs. Some meds are important to take every day, but miss a day of some meds and you might die. And now that med costs $15/day with no warning. You can afford $45 while we get it sorted out, can't you? You have a jar of peanut butter and some crackers in your kitchen, don't you? The constant changing of meds provides absolutely no value to anyone but the PBM and costs patients and clinics where we have nurses talking the patients down from their panic, admins doing their emergency prior auths, etc a pretty penny.
Better put this soap box away before I get going any more.