![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 39 to 63 of 68. Go back in thread:
Posted by Estella on August 8, 2006, at 20:44:16
In reply to Re: Yikes! I agree with Auntiemel » Estella, posted by Phillipa on August 8, 2006, at 20:28:58
> Tough one I agree and disagree. Yes to those being able to take courses and get a job to be proud of. No to those who are unable due to lets say ALS or something similar.
Yes I agree. I wasn't talking about people who are physically unable to work. But then there are different things that people who are physically disabled / sick are and are not able to do. Though sometimes... They don't believe they can do anything meaningful when their sickness / disability means they can't do what they used to do.
I was trying to comment on the 'lazy' notion. IMHO 'laziness' has another name: depression.
It is a social problem. Medical model locates the cause of blame and responsibility within the individual...
We evolved to live in close kin groups and I don't think we have evolved out of the need for social support just yet ;-)
Oftentimes I think that what is typically considered to be a problem within the individual e.g. they are *just* lazy is more a problem with society - what is it that society has done to show them that they *can* have a productive place in it?
social problems... need a social solution imho...
and it can be really really really really really very hard imho.
i don't really understand the volountary work structure in the US... i've heard someone say that they couldn't get volountary work. i don't really understand that one... i guess not as many people do volountary work where i'm from. it isn't a factor on applications or anything like that (though kudos to you if you do it off your own bat of course).
i don't know...
but if you are thinking of you...
what would you like to do?
i mean... you don't have money troubles - do you?
you are fairly close to retirement (so retraining can be much harder)
you were in a very high anxiety job...people should be able to retire at some point, shouldn't they?
and of course solo parents trying to raise kids... imho that jolly well *should* be paid work.
Posted by kylenn on August 8, 2006, at 20:56:08
In reply to Re: cost of drugs, posted by Estella on August 8, 2006, at 9:44:49
Again, you took me out of context.
I realize you put my "exact words" above your response, but you left some other paragraphs/ideas out.
I am not talking about the super-rich, anyway, but I DID say (look again) that LUXURIES should be SUPER-TAXED!!! That is the closest we can get to fairness in my world view as far as taxes go.
I am still thinking about the fining process in Finland, and I think I agree with it.
If it is money (and not time in jail) they are talking about, then the punishment should hurt everyone equally, (in order to be fair), so I agree that if an 18 year old minimum wage student has to chunk out 1/2 a paycheck for a fine for speeding, then so should the 22 year old heir of a billion dollar fortune.
If the 18 year old makes $500 every two weeks, and has to pay $250 for a fine then if the heir makes (or gets, because he may not work for it)
$50,000 every two weeks, then he should have to pay $25,000 for the same crime in my view.
And when they buy that 10,000 square foot home with a tennis court and a pool.
I said luxuries, excesses--should be taxed at what did I say? 20-25%? And sins even higher.
That would effectivley tax ONLY the super rich.
I wouldn't mind if they taxed luxuries like 40% and sins 50 or 60%!
whatever! and that would, as I said, tax ONLY the super-rich.
As I said (I am repeating here)
essentials like food, water, electricity, health care, shelter should not be taxed at all; houses over say 1500 square feet per person should be considered luxury houses and the square footage over what would be essential could be taxed as non-essentials.
Cars over say $25,000 should be taxed as luxury cars the same way.
I am a fair minded person.
As I have said.
But I will stand my ground when I say that hard work and ambition should NOT be taxed; at least the tax should not be HIGHER for a bigger paycheck.
If a person works for the money, it should be his money.
It is when he spends it on non-essentials that the government could step in and take a chunk of it.
As I said.
And criminals, who make a lot more money than you or I, all income tax free, well, they REALLY like to spend that money, don't they? The big, fancy cars with all the non-essential silly rims and lights and stereos, the hotel suites, the pretentious jewelry, the fancy high dollar restaurants (yes, eating out is a non-essential)
Then, it would be fair. The super-rich, the criminal element, all would pay for their excesses with high taxes, and it would be so much more fair.
I really, really, really do not understand why anyone disagrees with this.
Especially a grad student that has worked so hard to get where she is. When you are finally out there getting a paycheck of say, $65,000/yr, you'll know what I am talking about when you see what Uncle Sam has in store for you.
And when he takes $22,000, and then you have your $750/month student loan payment (mine is over $1500 and from what I understand, that is just the interest--I owe about $165K which is about average for med school grads) and you have your $500-$1000/month rent (depending on where you live, could be more, might be less) and your$200/month gas bill, $200/month light bill, $350/month car note, $125/month car insurance, $100/mo phone bill, $65/month cable, (an non-essential, I shall admit, but I bet you have it),
$50/month cell phone bill, and $400/month food bill, you might start to realize that if you had an extra $22,000, you might be able to save for retirement. As it is, you won't. And do you think the government is REALLY going to keep up the welfare state that we already have? The Elderly SHOULD NOT have to worry about food, shelter, water, lights, transportation, and health care ESPECIALLY when they have spent their life working and EVEN if they haven't. I sincerely believe that after the age of 65-70, these worries should be behind you.
But, I would bet you money that Social Security, (which doesn't take away these worries by a long shot now) will NOT be there when I retire (I'm 44) and it WON'T be there when my daughter retires (she's 23) or my son (he's 21) or my youngest (he's 11). And I am not able to save ANY money for retirement at this point in my life; alot of that has to do with having had this depression to deal with.
When income tax was first put into action, there were approximately 15 workers paying into the system for every 1 person unable to work.
The same with social security.
Now, the ratio is about 3:1, and that was as of 5 years ago, I believe.
We are NOT making 5X more than our predecessors (inflation adjusted income) were making, check it out. Can people not see this is a disaster waiting to happen? The baby boomer generation is retiring. That is going to mean EVEN LESS workers to contribute. The ratio may go to 2:1.
It WILL NOT be possible to put enough income tax on the people to support the welfare state we have now.
I am certainly CERTAINLY not suggesting FOR A SECOND that the elderly and the disabled should all go to work!
I am saying INCOME TAX is not going to sustain it, and it is unfair, anyway.
People with more disposable income SPEND MORE, don't they???? And how much do you think they SPEND ON NECESSITIES? Not much more than you or I.
The rest is all cream, baby.
And THAT should be where we get the money for the disabled. THAT IS WHERE we should get the money for the elderly.
SIN TAXES like a 50% or higher tax on cigarettes and alcohol and gambling wins should be AUTOMATICALLY put towards HEALTH CARE.
LUXURY TAXES should be towards paying for the necessities of those who cannot afford them and are elderly or disabled.
Maybe LUXURY TAXES on things like VACATIONS IN ST TROPEZ (is there such a place?) should be earmarked for MENTAL HEALTH CARE for those of us who cannot afford to unwind on the white sands of the Caribbean!!
Taxes on luxury automobiles and first class plane tickets and cruises could pay for transportation for the elderly and disabled (notice I do not like to use the word needy, because to me there is a BIG difference between someone who is "needy" and someone who is elderly or disabled OR DIAGNOSED WITH SOME KIND OF HORRIBLE DISEASE THAT IS EITHER INCURABLE OR IS GOING TO BE PROHIBITIVLEY EXPENSIVE TO TREAT.
And you know what? I would even GO FOR a nationalized health care system if AND ONLY IF, they would do away with the income tax.
And, while I am spelling out my wish list, do away with all these stupid and pointless laws like HIPPA and these stupid DRGs that MEDICARE and other insurance companies use to pay for certain things like hospital stays (like if you get diagnosed with chest pain, the DRG says you can only stay for 24 hours max and then you have to be discharged, or medicare won't pay.) and HIPPA is a law that added OMIGOD so much paperwork to medical care for SUCH a stupid reason (THE ONLY PEOPLE THAT BENEFIT FROM THE HIPPA LAW AREN'T PEOPLE AT ALL: THEY ARE INSURANCE COMPANIES!!!)
All that paperwork they make you sign now at the doctor's office and at the hospital saying you have recieved the HIPPA paperwork which basically spells out your "RIGHTS" as a patient when it comes to your health care information.
GUESS WHAT? the HIPPA law made it ILLEGAL for a doctor to tell ANYONE IN YOUR FAMILY ANYTHING TO DO WITH YOUR HEALTH CARE INFORMATION AND THAT INCLUDES HUSBANDS/WIVES, ADULT CHILDREN/PARENTS, PARENTS/ADULT CHILDREN, SIGNIFICANT OTHERS, SISTERS/BROTHERS BUT GUESS WHO HAS TOTAL AND COMPLETE ACCESS TO YOUR HEALTH INFORMATION (AND SOMETIMES MISINFORMATION?) THAT'S RIGHT, YOUR FRIEND AND MINE, THE INSURANCE COMPANIES HAVE THE RIGHT TO YOUR HEALTH CARE INFORMATION IF YOU APPLY FOR INSURANCE.!!!!!! That's what the big money insurance companies spent most of their lobby funds in Washington on during the Clinton years. Think about it. UNLESS you give your doc specific WRITTEN permission to tell your wife, your daughter, your mother, your brother, your partner about your health (even if you are in a coma as a result of an accident, they can NOT, BY LAW, tell you what is wrong with your loved one if written permission was not obtained prior.
BUt, you can be if your son gets DDAVP for bedwetting at age 8 and then applies for insurance (not group insurance, right now that is a loophole. if you have group insurance HANG ONTO IT) applies for insurance on his own at age 24 after he opens his own auto-body shop, guess what? The insurance companies will jack up his premiums and AND refuse to cover ANYTHING THAT HAS ANYTHING TO DO WITH THE URINARY SYSTEM. And so that means, just because your son had a little bedwetting at age 8, if he develops, say diabetes at age 28 and then develops kidney problems from it at say, 38, he is SOL! The insurance companies knew what they were doing. So did congress. (I am really putting a BIG ASSUMPTION) on that one. BUT guess who did not have a clue??
That's right, you and me, bub.
I didn't just wake up one morning with all these opinions. I used to be a liberal democrat. then I was a repulblican. NOW, I am neither, because they are all FOS.
I thought about fairness long and hard.
It IS right and fair that the one of the big functions of govt (since we cannot do without it)
should be to look out for those unable to look out for themselves (UNABLE)
BUT, it SHOULD NOT PUNISH people who believed in the "AMERICAN DREAM" and worked their A##es off to attain their goals of breaking out of poverty (which, y'all, that is how I grew up).
Income tax should be done away with. ANd if it cannot be (and I truly do not know why it couldn't be) then it should be a FLAT TAX.
BUt I think that the Federal Sales Tax would be even better, bring even more money to the federal coffers, and truly be a fair tax, that the disadvantaged would be totally unaffected by.
Even if they work their a99 off for a few weeks of overtime, all the money they make, they keep.
And maybe Christmas won't be so sad this year!
Maybe people really can start saving for a "rainy day".
And the SUPER RICH and the CRIMINALS would finally do their part.
See, the thing about the Finnish system of paying a fine is fair.
Yes, the rich pay more because it is a punishment and the way it makes a person feel about their crime should be equal for the crime committed.
If a rich man pays a $200 fine, it is pocket change, I can see that.
Make it a percentage of a months pay or something, that is fair.
But DON"T make the same assumption about GOOD DEEDs and HARD WORK!!! THESE things should be REWARDED!! and they usually are, with higher wages. BUt, when the gov't nullifies that reward by just taking that much more in taxes, percentage wise, it FEELS like and is the EQUIVALENT of, a PUNISHMENT.
My employees all worked about 10 hours of overtime a few weeks ago. I was excited for them and they were excited. Guess how much more their average paycheck was? Less than $30 more than if they had worked NO OVERTIME. They were essentially paid LESS THAN MINIMUM WAGE for their overtime hours. WHY? BECAUSE THE STUPID INCOME TAXES TOOK SO MUCH MORE OF A PERCENTAGE SINCE FOR THAT TWO WEEKS THEIR INCOME GOT BUMPED UP A BIT.
noW, who thinks that is fair???????
I know they did NOT.
Posted by kylenn on August 8, 2006, at 21:27:29
In reply to Re: Yikes! I agree with Estella, posted by AuntieMel on August 8, 2006, at 14:48:24
You are right about the ERs being used as clinics. but as a person who has worked in ERs MANY times as a student, resident, and now as an attending, I have to point out that the ones who truly abuse the ERs generally (sorry, I have to generalize because I am aware that there are exceptions but public welfare systems run on statistics and statistics are, by definition, a way to find out, GENERALLY, what things are or how things are used, etc)
but generally, the biggest abusers of the ER for things like an earache for 3 days brought to the ER at 10p.m on Thursday night ARE folks that are taken care of by the system, and they DO have clinics they can go to during the day and they GENERALLY get better care, wait less, and have better follow up, if they go to their clinics.
But, they don't they go to the ER. At 10pm or 1a.m or 4a.m with their 6 year old who has had a sore throat for 5 days. I kid you not. Now, what was that kid doing on Monday, Tuesday? Wednesday, all day Thursday? I have EVEN seen them come in like that and actually say THAT THE KID IS FEELING BETTER TO DAY BUT THEY THOUGHT THEY SHOULD JUST GET IT CHECKED OUT!!! Guess what, I agree, but why the ER? why in the middle of the night? why not when they were feeling really bad? why not this morning? why not in a couple of hours? Why is your 6 year old up at 4 am on a school night?
Dont get started on Oh my God how can you say that?
Maybe the kid couldn't sleep! Maybe they thought it would get better!
and maybe monkees will fly out of my $%@!
Ok, for all of you who just can't take it,
THERE ARE exceptions. OF course I realize that.
BUT the majority just do not care.
They are awake, they have a ride, whatever, I just fail to believe that that many people really think that waiting until some ungodly hour (or during the day) and GO TO THE ER for something that IS NOT AN EMERGENCY are abusing the system, they know it, and they simply couldn't care less. They aren't paying for it.
(and I am not saying that they should)
but they might think twice if they were.
SELF PAY patients ( usually hard working lower middle class to middle class people) RARELY abuse the ER. BECAUSE THEY KNOW THEY ARE GOING TO GET A BILL AND THEY REALIZE THAT PAYING $2000 FOR A SORE THROAT AT 4 AM IS JUST PLAIN STUPID.
But, the folks on medicaid never have to pay. they never see a bill. AND I AM NOT SAYING THAT THEY SHOULD
But, they should be educated what constitutes an emergency (and my patients are, by me) and what an emergency room is meant to do (and I think most people are aware) and I think there should be a review of a situation when a person is repeatedly abusing the free healthcare in such a fashion and after education and understanding is performed and documented, repeated infractions should be fined. I am not saying make them pay the bill, I realize they could never afford it.
But, I am telling you, if they knew they were going to get docked $25 for every documented unneccessary er visit out of their SSI check, they would think twice. It would STOP. I virtually guarantee it. And, almost every health care worker I have ever heard discuss this very issue agrees. A few bucks at 4 a.m. for a sore throat vs free at 8 a.m. and they WILL wait.
(generally) :)
When I work the ER, I am very lenient on what I consider an "emergency" because I try to look at it through the eyes of the patient. But when I can see that it is just blatant abuse of the system. I realize new parents are frightened and nervous of every little sniffle! I know that a child that you thought would get better, but didn't and now it is three a.m. and you are REALLY getting worried that something is terribly wrong is an emergency. (Maybe not to a doctor or a nurse, because we might be more objective and realize the kid is ok, but you may not know that and it is our job to reassure--even at 4 a.m.--and be gentle about it.
But the abuse is usually so obvious, let me tell you.
Like a kid with "ringworm" in the ER.
When was the last time ringworm killed anyone?
or the rash for 3 days (like poison ivy)
or , the 4 a.m. sore throat that is a little better today and the kid is running down the hall chasing his big brother at 4 a.m.
That is wrong, and they know it, and if it is repeated after it is brought to their attention there should be some repercussions, and THAT is what will increase the efficiency of the ER and THAT is what will bring health care costs down in this one small slice of the pie, and THAT is putting personal responsibility back where it belongs. On the person; not the public.
ALL medicaid and medicare pts have clinics. They are assigned to doctors, and if they do not like the doctor for some reason, they can switch to another clinic, and it is all free.
And, that is fine, I am ok with medicaid for the poor kids and the truly disabled.
But the ones that don't have clinics are the ones that fall through the cracks. And, like I said, they rarely, if ever, abuse the ER.
It happens, I can think of a couple cases, and they get sent a big bill, and they can't pay, and they get mad, and they ignore the bill, and it goes to collections, and whatever, but I promise you, this is the exception to the rule of the patients that abuse the ER.
Posted by kylenn on August 8, 2006, at 21:50:29
In reply to Re: Yikes! I agree with Auntiemel, posted by Estella on August 8, 2006, at 20:13:18
I must with kindness disagree with Estella.
I do not think the reason why most people choose a life in front of the t.v. is because they do not think they can do anything meaningful.
That is not logical, because I cannot think of anything less meaningful (short of criminal activity, but we are talking about something good or useful) I cannot think of anything LESS meaningful than sitting in front of t.v. for the major part of every day of every week for the rest of your life.
Now, I think that they may actually think that whatever job they get is stupid and doesn't pay enough and they can make just as much sitting at home. THAT I believe.
But that is because they CAN make just as much, and have a much more lesiurely life, by just staying at home.
Any person, with all else being equal, would rather relax than perform menial tasks.
I know I would!
But that is the crux of the problem.
A person that sweeps the streets for a living should DEFINITELY be better off financially than the person who sits in front of the t.v.
and the person who sits in front of the t.v. should ONLY be doing so if he CAN'T work, not just because he has chosen not to.
And sifting through those who choose to and those who have no choice would be easier if the definition of disabled was better delineated and structured and that if the difference between a life in front of the t.v. and the life sweeping streets was enough to where a person may actually choose to sweep and only watch t.v. after work!
Less people unfairly getting disability would automatically mean more money in the pot for workers! And if we do away with income tax and put in a federal sales tax and tax the blankety blank out of luxury spending then the person sweeping the streets would have more money for the necesseties and maybe even some for the un-essentials, like going to the movies or out to eat which would be taxed, but not as much as luxuries and sins. (and these would be in black and white with no fuzzy definitions or loopholes)
A yacht is a yacht is a yacht.
No loophole. I don't care if it is your house.
No body NEEDS to live in a yacht.
Anything over 1500 square feet per person on the ground would be considered excessive and taxed accordingly.
These are just a couple of examples; but to be merciful, I'll stop there.
But the street sweeper and the t.v. watcher should not share the same amenities. I am NOT saying punish the t.v. watcher; just REWARD the street sweeper so he is not tempted to do what anyone would do if there was no difference in the amount of change in his pocket.
And don't tax his income.
That will help solve a lot of this.
I am sorry, I just do not think that they choose to "become disabled" or "get on disability" for some illness, real or imagined or faked, because they cannot do anything meaningful.
It is because they get the same amount of money and better health care if they don't work than if they do work.
That is the problem.
The able should work, and they should be rewarded.
The disabled should not have to work, and they should not be punished, their needs should be taken care of; they should not suffer.
The rewarding of the worker is essential
Like I have said.
National health care is OK as long is the money comes from some sort of federal sales tax, especially a sin tax, and not out of my medical assistant's 10 hours of over time that she didn't get paid more than $30 for because it was all taken out in taxes.
And not out of the money I COULD be putting towards an eventual retirement (right now, zero is how much I can afford to put back, but w/o income tax, I could to put back a tad more.)
The disabled should have their needs met; the street sweeper should have a little bit more.
Period.
Besides, I like a nice clean street, and to me, that is a very important, and meaningful job.
And so is working at McDonald's (I did) and so is a security guard. (I don't think telephone marketing is so meaningful, but I am sure they are meaningful to the companies who hire them!!
I admire them just for taking that job!)
Posted by Jost on August 8, 2006, at 21:51:45
In reply to Re: cost of drugs, posted by kylenn on August 8, 2006, at 20:56:08
Kylenn,
I disagree with most of your economic and moral philosophy, as well as your theory of government.
One thing I noticed particularly is that you have certain ideas about what are and are not luxuries, which you think the government should enforce.
If nothing else, that sort of governmental intrusion into personal decision-making at the level of specificity that you suggest, and along the lines that you suggest, would involve a very coercive society.
Much more coercive than just having a tax system with certain percentages for certain income levels.
Also, it's not possible to theorize about how to organize a tax system without a well-developed sense of the budgetary demands that you have, the promises you've made that people have relied on in making all sorts of decisions, and many other factors that I'm not sure you've considered.
Jost
Posted by kylenn on August 8, 2006, at 21:52:37
In reply to Re: Yikes! I agree with Auntiemel » Estella, posted by Phillipa on August 8, 2006, at 20:28:58
Of course someone with ALS should qualify (automatically) for disability.
That is what I am talking about.
THAT is a REAL disease with OBJECTIVE findings.
YOU CANNOT FAKE ALS!
Posted by Estella on August 8, 2006, at 22:04:50
In reply to Re: Yikes! I agree with Estella, posted by kylenn on August 8, 2006, at 21:27:29
> but why the ER? why in the middle of the night? why not when they were feeling really bad? why not this morning? why not in a couple of hours? Why is your 6 year old up at 4 am on a school night?
have you asked them?
> I just fail to believe that that many people really think that waiting until some ungodly hour (or during the day) and GO TO THE ER for something that IS NOT AN EMERGENCY are abusing the system, they know it, and they simply couldn't care less. They aren't paying for it.
have you asked them why they do this?
maybe they haven't really thought about it...> When I work the ER, I am very lenient on what I consider an "emergency" because I try to look at it through the eyes of the patient. But when I can see that it is just blatant abuse of the system. I realize new parents are frightened and nervous of every little sniffle! I know that a child that you thought would get better, but didn't and now it is three a.m. and you are REALLY getting worried that something is terribly wrong is an emergency.
Right.
> Like a kid with "ringworm" in the ER.
> When was the last time ringworm killed anyone?Do you think the people who come in to the ER know that their kid has ringworm and know that it won't kill them? You are the doctor, remember.
> That is wrong, and they know it, and if it is repeated after it is brought to their attention there should be some repercussions, and THAT is what will increase the efficiency of the ER and THAT is what will bring health care costs down in this one small slice of the pie, and THAT is putting personal responsibility back where it belongs. On the person; not the public.
I see. You good patient doctor... They bad poor and abusing the system.
Sorry you are overworked... Sounds to me like... You are overworked.
What concerns me about this is the knowing that the person is poor -> thinking they are likely to be abusing the system inference.
I mean... Suppose some wealthy and dignified businessman comes in at 4am with the sore throat thing. If he was paying... Would you consider him to be abusing the system. Is it that these people aren't paying?
I'm sorry you feel so strongly about this.
But this reminds me of how people have made assumptions about me all my life. Poor therefore... And you wouldn't believe what people come up with. If you want people to 'abuse' the system then the fastest way to get them to do that is to... Begin with the assumption that they will.
I don't think people tend to think they are abusing. I mean... Doctors are on duty whether people go or not - right? Maybe they can't get time off work during the day. Maybe they think that there will be less wait at night. Maybe their kid couldn't sleep and they did feel worried.
If you think they are abusing the system... Well then I guess you aren't going to be feeling so sympathetic to them.
I'm sorry you are stressed.
But I still don't condone judging a group of people based on their income or lack thereof.
Posted by Phillipa on August 8, 2006, at 22:14:49
In reply to Re: Yikes! I agree with Auntiemel, posted by kylenn on August 8, 2006, at 21:52:37
Kylenn go back and read your original post . I don't believe you said heath care was a basic right but you are now. Love Phillipa
Posted by kylenn on August 8, 2006, at 22:36:09
In reply to Re: Yikes! I agree with Phillipa, posted by Estella on August 8, 2006, at 20:44:16
Yes, I also think Laziness in many cases is depression in disguise.
If we could get the diagnosis, and they would accept (and respond to) treatment, that would help.
Depression is a tough, tough, tough thing to get over.
If you ever even do.
I realize that it is not a diagnosis with OBJECTIVE (not really) findings.
You can (IMHO) fake depression. (at least maybe when you are in front of the examiner)
It would be very hard to fake it 24/7 because when I was really at my worst I could barely bring myself to get up to go to the bathroom when I didn't have to go to work.
But now, if I had to lay around like that, it would be very difficult, and I do not think I could pull it off.
Work was hard, but I put myself on "auto pilot" when I was working; emotionless/robotic (functional, and even good, but empty inside, just a thinking and decision-making machine)
but when I was at home, I let my kids go, I let my house go, I let my bills go, I let my looks go.
I hated life. I hated the sound of my own voice.
Sleep was my only escape from the misery of my waking existence. And existing was all I could do.
I am VERY scared that I could fall back into that abyss.
If I bend over a bit and look down into my psyche, I can see the pit.
I don't look long.
I understand depression. I know it is a true and debilitating illness, because I have it.
Thank the LORD my depression (but not my dysthymia, which is not even close to being as bad as major depression) is in remission. May I never go into that dark, lonely, scary place again.
I worked while I was depressed, but looking back, I should have taken a leave of absence. Not because I was not competent to do my job; I was. But because I was so, so miserable. If my profession was less biased towards mental illness, I believe I would not have felt so ashamed; so much like a failure; that I just could not allow myself to admit to myself, let alone my peers, how bad off I was.
I felt like I had failed somehow. That the macho world of hard core modern day medicine was just too much for poor little me and who did I think I was kidding and on and on.
When I took one of the dozens of tests in the midst of my depression after my SA (and henceforth the awful and humiliating repercussions administered by the very peers who proclaim publicly that mental illness is just that, an illness, and should be treated as such.
Ha what a laugh., but anyway, I digress, which I am wont to do)
I took many tests, and one was an intelligence test.
I was so stressed out when I took this test; I had just come from the "bad cop" shrink.
I think in some forensic psych evals they employ the "good cop/bad cop" deal, only with shrinks.
Anyway, I was so destroyed by the "bad cop" that I could not stop uncontrollably sobbing throughout the intelligence test, which of course, made me even more stressed out since my whole life my intelligence was the one thing I was proud of and expected of myself, and I just could not bear to miss even one question; I HAD to ace this test. But, how could I? I was a complete emotional mess, I was so, so sad and hopeless.
Anyway, I really think I could have done better on the intelligence test.
And when they had their little group summary meeting at the end of the week with me, they told me that I was smarter than 99.9% of the population. Well, that figures, I thought.
I could have done better. What a loser I am.
Then they told me that one of the reasons that they thought I had PTSD (which I do not have, go figure) was because I was so hard on myself when I missed questions during that part of the testing!
And I was proving their point by being disappointed in my score! I wanted another chance at the test when I wasn't so stressed out, I told them. It wasn't fair to administer the test right after I had been literally emotionally destroyed by the "bad shrink".
They, of course, did not admit to (and I hadn't really thought about it and come to that conclusion at that point about the good shrink/bad shrink ploy, but I 100% - well almost- think that is their M.O.) they did not admit to that good shrink/bad shrink thing.
They were just amused at how much I was beating myself up over not doing better on that test, and congratulating themselves for being "right about me."But, back to what I started out with.
Yes, anyone could have interpreted my inertia and my messy house and the pizza delivery place having my kid's favorites memorized to me being lazy.
I am quite certain I was accused of laziness more than once; and still am.
And, my middle child, I believe, is depressed.
He plays video games nearly 24/7 and hasn't had a job for more than 3 months since he was old enough to work; and he dropped out of/flunked out of school after his 3rd time in 9th grade, then flunked out of/dropped out of three GED programs.
He is an excellent XBOX live player. He is always bragging about his "ranking".
I have tried to get him help
(he also has dyslexia and ADD, and I could have signed him up for SSI when he was a kid, but I didn't, because I was determined that he would not go "on the dole" and that he would overcome.
Now, I worry that I may have done him a disservice. He is definitely having trouble with living a self-sufficient life. Trouble? No, he is not having "trouble" living a self sufficient life, he just isn't doing it.)
Now, is it laziness (he stays up all night playing video games; he sleeps most of the day) is it depression (he is a candidate; mom has it)
or is it both? It is a chicken and egg dilemma.
I expect him to be personally responsible for his livelihood. I have given him a deadline to get a job, and I have driven him around and called in favours to get him jobs. I am really, really worried about him. He is my son.
I have tried to get him to take anti-depressants, but he will not. When he was a kid, he refused to take Ritalin. But, hey, the kid likes to smoke pot and drink alcohol and smoke cigarettes.
I do not get it.
I know he probably is "self-medicating" with the booze and the pot.
The self-destructive behavior is a big red flag for depression.
I know I felt inertia when I was severely depressed, and still it is one of my lingering symptoms. But, what do I do with a 21 year old Man living in my house that stays up all night, messes up the kitchen, plays video games and cusses so loud I can hear him outside when some thing in the game doesn't go his way (around my 11 year old son and my 2 year old grandson)
and won't get up to look for a job, and when I take him and introduce him, he slumps over, wears his lip ring, and generally acts disinterested, and he has done this since he was 14.
He has had one car repoed and the one he is in now, my mother helped him get, and it is about to be repoed too.
For 7 years, I have taken him to shrinks, counselling, inpatient, social services, private tutors, Sylvan Learning Centers, The Reading Center, indulged his hobbies (skating and gaming) as ways to make his life more enjoyable as I also assuaged my guilt over his problems being somehow my fault either genetically or socially or both.
and now, I have to face a personal dilemma about this lazy vs depressed issue with my own son
and I am at wits end.
I am starting to think he may truly be disabled himself, even for my stringent definition, but it is hard for me to accept, since I know he is not retarded, he is quite bright, he is really adept at the gaming, so I know he can learn, make quick decisions, and has really good eye-hand co-ordination.
I have tried to get him into tech schools, but he can't until he gets his GED and he has had so many chances to get it, and he just won't.
He was at a do it at your own pace GED program in Austin, and he dropped out-twice.
Well, I may have to do something I don't want to do here in the near future.
This lazy vs depressed and what to do about it is very close to home with me.
Posted by Phillipa on August 8, 2006, at 22:47:20
In reply to Re: Yikes! I agree with Phillipa, posted by kylenn on August 8, 2006, at 22:36:09
Kylenn be kind to you. Take a few weeks or a few months off. Do it for you and your kids. Love Phillipa
Posted by kylenn on August 8, 2006, at 23:02:10
In reply to Re: cost of drugs, posted by Jost on August 8, 2006, at 21:51:45
I am admittedly not an economist and not an accountant and am very bad at managing my own money.
I was merely responding to the comment about the super rich having all the money and the least amount of social responsibilty as it is currently legislated.
I admit, readily, that most of my opinions are not well thought out with more emotion to back them up than factual and exacting information.
I have not well-thought it out. I do not have the time, the inclination, nor the education to embark on such a task.
I have "heard" these different theories on social economics from various, and perhaps even, dubious, sources.
And I have taken my life experiences, my sense of fairness (especially as it applies to me which is something I will not ask forgiveness for because I also do not think altruism exists except in the case of the soldier jumping on a bomb so that he will absorb all the shrapnel and thereby save his friends and how often does that happen)
my education (excellent at math but ignorant of social economics) and these different ideas from other sources and decided for myself, as best as I can, what I believe to be possible, and if doable, the most fair way to tax the people to run the government which will have certain responsibilities to spend it as the taxpayers, not the lobbyists, see fit.
I did not claim to be an expert.
I admitted it was all conjecture, and opinion, my opinion, and I am offering it forth not only to hear arguments for, but arguments against, (and I do not mind opinions, since that is all I have anyway), to perhaps broaden my mind (and maybe even change it)
and maybe, maybe, broaden someone else's mind.
At least get people to think about it, like I do, because I think people should think about it, even if they aren't experts, because it matters.
We all vote. Well, we all have the right to vote.
And some people vote for someone because he is good-looking. and no other reason.
or he comes from their neighborhood. or he knows their cousin. or whatever. not well thought out, but it is ok, and they vote, and they should, although we all wish we had all the facts, and that everyone was always honest, but we don't, and they aren't.
But that doesn't mean we shouldn't think about it, and it doesn't mean we shouldn't talk about it, and it doesn't mean we shouldn't voice our opinion, no matter how not based in fact or well thought out.
I learned about Finland, and changed my mind about National Health Care just in the course of these discussions.
Maybe I am wishy washy.
Hey, maybe I am a nut case!
But, you know what, I still will say what I think,
and you can say I haven't thought it out, or you can sarcastically say that I have and know I will get what you mean. But, I will not be quiet.
some of what I say makes sense to some people
and some of what I say is right and I will reserve my right to discuss my opinions, based on fact, fiction or the folly of emotions.
Otherwise, I would never open my mouth about anything unless I could guarantee it was 100%, grade A, USDA inspected scientific fact.
And, since I am sure you practice what you preach, neither would you, and it would be a really boring forum, wouldn't it.
The meds I am taking are supposed to work for depression via the serotonin system. But no one knows 100% the mechanism. And it doesn't work for everyone. And some of it's effect may be placebo.
But that doesn't make it a bad drug.
And my not knowing everything there is to know about and all the consequences of my ideas for change in the tax system, etc, of our country, does not mean that I should keep my opinion to myself.
Last time I checked, we still had some semblence of Freedom of Speech in this country.
I do not recall a disclaimer in the Constitution of "but only if you have your facts straight and understand the full consequences of what would happen ifyour ideas were put into action before you put them forth!"
Feel free to correct me if I am wrong.
Posted by kylenn on August 8, 2006, at 23:09:38
In reply to Re: Yikes! I agree with Estella » kylenn, posted by Estella on August 8, 2006, at 22:04:50
Yes, I have asked them.
Usually, it is phrased thus:
"Mrs. X, your daughter has been ill for several days, you must have been really worried.
Can you tell me, what was different about her symptoms tonight that led you to bring her to the ER."
sometimes they have a really good reason, and it can be important to coming to a diagnosis.
sometimes they don't, and sometimes, I have gotten sideways looks and defensive answers, even though I need to ask the question, as it is central to figuring out the problem.
It is, to me, and to most people who make it through med school that have learned what they were taught, a very important, maybe the most important question in the history of present illness, which is the first, and most important part of, the evaluation of a sick patient.I am fed up with explaining things that I keep assuming would be understood.
Of course I ask them.
I am curious by nature, and usually it is an important part of the history, and can be very, very important.
Geez.
Posted by kylenn on August 8, 2006, at 23:21:19
In reply to Re: Yikes! I agree with Estella » kylenn, posted by Estella on August 8, 2006, at 22:04:50
As far as knowing it is ringworm,
again, I would NEVER presume a mother KNOWS it is ringworm, or ANYTHING ELSE.
I use this example, because this actually happens.
The mom comes in SAYING my daughter has ringworm, and they won't let her go back to school without a doctor' excuse.
How much more do you need to know??????
I am tired of the personal bashing I am getting.
As usual, no place for me.
No place for a PHYSICIAN with depression to be able to participate in an open, supportive forum.
I am merely presenting ideas.
Yes, I have opinions.
Yes, I may sound harsh.
Why do I keep being misinterpreted?
I do not understand.
I ran into this during my worst part of my depression.
VEry isolating, being depressed and not having any peers.
I didn't fit in with the Cadaceus groups because they are mainly a 12 step group for addiction.
I looked, but could not find, a support group for physicians with mental illness without addiction problems.
I have read many posts in this forum and found many to be interesting and insightful, many seem to be well-informed and supportive.
But, not for me.
And, I am sorry if I have offended alot of people.
I am sorry.
I know a lot of what I say and think is not "politically correct". And I do not like to go around just saying what ever to who ever, for fear of just this. Like a lynching.
Thanks alot, guys.Well, I'll keep plugging away at my job.
I know I help people; I keep my opinions to myself with patients, and when they give me opinions and such, I do not argue with them; that is not my role.
I am there for them; I am there to make them feel better in whatever way I can.
But, you guys are not my patients.
Apparently, not my comrades, either.
Good luck,
God bless,
and keep looking up.
See ya on the other side, guys, when we'll all have the truth and our worries will be but a memory.
a
Posted by kylenn on August 8, 2006, at 23:27:56
In reply to Re: Yikes! I agree with Estella » kylenn, posted by Estella on August 8, 2006, at 22:04:50
one last thing, estella,
I did say that it happens, the well off abuse the system.
Good god.
And when they do, YES, EVERYONE in the ER knows, and discusses, the abuse.
A simple sore throat, does not belong in the ER.
rich, poor, or purple and hairy.
Missed my point.Look, I am not spouting things that are not nearly UNIVERSAL among health care workers.
EVERYONE that I talk to, hear talking, or just mumbling to themselves, says the exact same thing,
I never used the word "poor", that was your word.
I said that the workers without insurance are the least likely to use the ER.
What the f ever.
go ahead on thinking like you do.
keep your head in the sand.
you sound like the one who is getting emotional!
little bit of an overreaction to a totally non-personally directed statement.
why?
you know what, it doesn't matter.
it is ok.
maybe you just gotta be there.
Oh, and hon,
I am not overworked.
but thanks for caring.
Posted by Phillipa on August 8, 2006, at 23:30:00
In reply to Re: Yikes! I agree with Estella, posted by kylenn on August 8, 2006, at 23:21:19
Kylenn Please take some time for yourself and your children. Love Phillipa
Posted by Estella on August 8, 2006, at 23:46:57
In reply to Re: Yikes! I agree with Estella, posted by kylenn on August 8, 2006, at 23:21:19
> I am tired of the personal bashing I am getting.
I'm sorry that you feel like you have been getting a personal bashing. I'm sorry if I've said anything to contribute to that.
> As usual, no place for me.
I'm sorry that you feel like there isn't a place for you. I've felt like that a lot of my life. Like people wish I wasn't around. It isn't a nice feeling :-(
I think that Babble can be a very nice place. I think you could stick around if you choose and you might be able to find some support here.
> Yes, I may sound harsh.
Why do I keep being misinterpreted?
I do not understand.Do you understand why you got PBC'd? The bit that Bob picked out to PBC you? Can you see how that statement is likely to lead to people feeling hurt and feeling upset themselves and then the conversation is likely to escalate into a conflict? That is the purpose of PBC's. To show us our role in why it is that people may be likely to get wound up and misinterpret / misunderstand etc.
I have trouble sometimes. I want support but I'm feeling kinda upset and irritable. When I feel like that I tend to free associate my thoughts kinda like what you have been doing. And that can be okay... But it is a fact of life that we have to be a bit careful in *how* we express ourself so that others are more likely to support us rather than feeling upset in response and posting something hurtful back at us.
I've learned a lot about interpersonal communication in my time here. It is hard... It can be very hard for me.
I'm sorry you are having a hard time of it. I hope you stick around. I'm not sure whether some of the things you have said since your PBC are likely to result in admin action or not. I'll be sad to see you blocked. I hope you stick around. It is okay to express yourself... But one does have to be careful about *how* one expresses oneself because of how other people are likely to respond.
Posted by Estella on August 9, 2006, at 6:00:07
In reply to Re: » kylenn, posted by Estella on August 8, 2006, at 23:46:57
Is their anyway that you could go to see a therapist with him? Not a matter of blaming or ganging up (on either of you) but more a matter of your being concerned about what he is doing with his life and your wanting him to try and talk to someone about what he wants to do with his life because... You can't keep on supporting him like that (financially) forever. You have other kids and retirement and medication and stuff like that that you have to worry about too.
Smoking dope and sleeping all day and sitting around all night playing x-box does sound kinda depressive / avoidant / drug abusive. I'm not thinking lazy so much as... There is something wrong, yeah. Drug abuse / addiction can be a problem. Can make you forget about the long term... What does he see himself doing in 5 years? How about 10?
Does he envisage staying at home with you forever? Does he want to maybe get married one day? If he could have any kind of job... What would he like to do? Are there related things? What could he do towards being able to do a job that he would like to do?
When he was little... What did he think he wanted to do?
Mj can make those plans kind of... Go out the window.
A councellor could help you both. Help him think about where he wants to go in life, what he wants to do, the kind of life he wants to have. Help you set limits on what you are prepared to do in the way of providing for him (x box live connection, food, clothing, rent etc) and what you expect from him in return.
Maybe starting with little steps like... Cleaning the house adequately in exchange for internet access. Maybe have a chat with a councellor and see how it goes. Come up with some things that you and your son can both agree to and then progress reports to therapist.
You know he isn't stupid... But does he? Maybe he has troubles with self esteem. Maybe he does think that he is stupid. Chatting to a councellor (by himself) might be able to help him sort some of that out... Perhaps.
Sometimes kids need... Boundaries. Direction. Limits. I imagine that is the hardest thing in the world. Really. I honestly don't know how people raise kids...
I'm sorry things are hard for you.
Posted by kylenn on August 9, 2006, at 6:07:37
In reply to Re: Your son, posted by Estella on August 9, 2006, at 6:00:07
thank you
Posted by Estella on August 9, 2006, at 7:54:38
In reply to Re: Your son, posted by kylenn on August 9, 2006, at 6:07:37
You are welcome.
I really am sorry that things turned out as they did on the thread (before and after the redirection). I got to reading back through it and you know... I think we actually have a lot of the same ideas about politics and stuff.I imagine that your job is pretty stressful. I don't mean that as a comment on how you are coping, I just mean that I imagine you get all kinds of people coming through the ER and when it is late and things are busy and stuff... Well I imagine it would be a little trying on my patience at times (hell, I don't know that I could do that kind of job).
The son thing is a bit of a hard one. I guess I'm thinking back to something that a councellor tried with me when I was at school. I wasn't allowed to do anything because I was always being punished for something. The councellor met with me and my mother and tried to help us agree on what things were reasonably to be expected of me in exchange for what kinds of things I could reasonably be allowed to do in exchange. The councellor was a helpful comparatively objective third party. It stopped the discussion between my mother and me disintegrating in unhelpful ways... It helped both of us sort out reasonable limits and reasonable things I would be allowed to do.
It was kind of helpful. He is a bit older than a teenager now, but sounds like this situation has been going on for a while now. Mj can also affect social and cognitive development so in many ways he might be more like a teenager than the young adult that he is.
But I do indeed think that it is realistic that he have some responsibility around the household. Doing laundry or chores or something like that. Maybe even something external too in exchange for you financially supporting him. Steps might have to be slow at first. A councellor might also be able to assess the extent of his drug use. Sometimes... Kids don't tell their parents all...
I guess the hardest part might be getting him along to see one. Also finding one that he can get along with. Does he have a father around? Maybe some kind of guy who he can respect and look up to a little as a positive role model would be a nice bet. Someone who isn't going to take sides... But someone who he can perceive as being on his side. I think it is likely that he doesn't think there is anything meaningful that he can do that he would enjoy. He is good at x-box so that makes it meaningful to him and a source of pride :-) It is about extending that into other areas. Especially if he had a bit of a hard time of it at school...
Posted by adrift on August 9, 2006, at 10:39:53
In reply to Re: Yikes! I agree with Estella, posted by kylenn on August 8, 2006, at 23:27:56
Kylenn, I hope you do not leave. Although I understand that this was a heated thread and probably didn''t feel all that welcoming. But, I for one, found reading your posts very interesting/thought provoking. I hope you stay!
Posted by kylenn on August 9, 2006, at 11:05:31
In reply to Re: Your son » kylenn, posted by Estella on August 9, 2006, at 7:54:38
Thanks again for the advice.
Some of those things have already been done.
I mean, counselling, that has been done several times.
He actually had a job with Microsoft problem shooting for customers via telephone about their new XBOX consoles; and he reports he was one of their best people at that job.
But, he lost it because one day his friends and he all got together for a "lan party" which is basically like a little video game competition with your friends.
He decided the game/party was more important than showing up for work.
It was not his first time to get fired from a job for misplaced priorities.
I told him this morning after thinking about what you said last nite about me providing the xbox live hookup and I told him I was cancelling our internet connection at the house, and he told me no problem because he has so many games stored up he could play those and not miss the live connection at all. And he could go down to McDonald's because they have free wifi, and on and on.
He rightly told me that I would be the one to suffer most by not having an internet connection.
I have to padlock my bedroom when I go to work because just asking him not to go in there has never worked. He told me two days ago that he has gotten in my room 3 times in the last week to get stuff while the door has been padlocked.
He simply unscrewed the latch from the door, went in, and then screwed it back in.
I also, unfortunately, cannot afford to pay for him to go to counselling anymore.
His father was an absentee father. He never even sends a card on Richard's birthday.
I have also thought that the lack of a good male role model probably played a part in his lack of initiative.
But, all that is behind me now.
It is getting really close to crunch time for my son. And I have to be really strong and not let my feelings of sadness and guilt cause me to enable him for much longer.
That is going to be the hard part for me.
It will break my heart to have to kick him out of my house.
But, I am getting near to that as my only option to keep my own sanity.
Either choice is a threat to it.
THe only thing that would be good for me is if he got up today and found a job and his life finally turned around.
But, I have been hoping for that for a really long time.
Posted by Dinah on August 9, 2006, at 11:39:30
In reply to Re: Your son, posted by kylenn on August 9, 2006, at 11:05:31
I'm sorry about your son. That must be so heartbreaking for a mother.
I think you're right about it being time to draw boundaries and enforce them. When he told you about taking off the padlock to your room he crossed a big boundary. Stand firm.
I understand your frustration. I think anybody who works with the public in a capacity where you run into people who don't feel the rules apply to them feels that same frustration, especially if they try to live by those rules. It happens. It stinks that it happens. It's not fair. I wish there was some way to make the world fair.
But I'm guessing a black market trade in luxury items to avoid taxation would flourish just as the underground economy flourishes now.
People are ever resourceful at things like that.
Posted by kylenn on August 9, 2006, at 13:48:05
In reply to Re: Your son » kylenn, posted by Dinah on August 9, 2006, at 11:39:30
so true
Posted by AuntieMel on August 10, 2006, at 8:51:25
In reply to Re: cost of drugs, posted by kylenn on August 8, 2006, at 20:56:08
"My employees all worked about 10 hours of overtime a few weeks ago. I was excited for them and they were excited. Guess how much
more their average paycheck was? Less than $30 more than if they had worked NO OVERTIME. They were essentially paid LESS
THAN MINIMUM WAGE for their overtime hours. WHY? BECAUSE THE STUPID INCOME TAXES TOOK SO MUCH MORE OF
A PERCENTAGE SINCE FOR THAT TWO WEEKS THEIR INCOME GOT BUMPED UP A BIT.
noW, who thinks that is fair???????
I know they did NOT."In addition to my day job, I keep the books and do the payroll/payroll taxes for my hubby's business.
The payroll is done using IRS generated tables, for the income level the person is in. In the one-off case of a lot of overtime, or a big bonus, the amount of taxes really does look large.
But that isn't really the true tax bracket. This gets evened out at the end of the year when the total taxes are figured for the hear. If too much was taken out in that one-off case, they will get it back then.
If the employer knows that it really is a one-off, they can request a new W4 with more dependents listed for that pay period, and then get a new W4 to go back to normal.
Posted by AuntieMel on August 10, 2006, at 9:02:57
In reply to Re: Yikes! I agree with Estella, posted by kylenn on August 8, 2006, at 21:27:29
Well, then, where you live is better than the part of the US I live in.
My mom was an ER nurse for years and years and she *did* see lots of people come in for sore throate and all.
And they were generally people on medicaid.
But, see, where we are medicaid will pick up the bill for an ER visit, but many doctors don't take it for regular clinic practice. And there are no clinics for those who can't pay. So, actually the ER is the only place they have to go.
So, they wait until the doctor's offices are closed, because if it is regular office hours the ER will turn them away. But if the offices are closed, they can't.
It's a huge burden to the hospital staff, the taxpayer, and the people themselves who have to go this route.
I live in a much larger city in the same state and we don't have any clinics either - at least on this end of town. So the situation is the same.
And that's not counting (touchy subject for many) the undocumented aliens - those who can't get medicaid - who are the working poor. They, too, have no where else to go and human kindness (not to mention the local law) tells us to not turn out sick kids.
----------------------"You are right about the ERs being used as clinics. but as a person who has worked in ERs MANY times as a student, resident, and
now as an attending, I have to point out that the ones who truly abuse the ERs generally (sorry, I have to generalize because I am
aware that there are exceptions but public welfare systems run on statistics and statistics are, by definition, a way to find out,
GENERALLY, what things are or how things are used, etc)
but generally, the biggest abusers of the ER for things like an earache for 3 days brought to the ER at 10p.m on Thursday night ARE
folks that are taken care of by the system, and they DO have clinics they can go to during the day and they GENERALLY get better
care, wait less, and have better follow up, if they go to their clinics.
But, they don't they go to the ER. At 10pm or 1a.m or 4a.m with their 6 year old who has had a sore throat for 5 days. I kid you not. Now,
what was that kid doing on Monday, Tuesday? Wednesday, all day Thursday? I have EVEN seen them come in like that and actually
say THAT THE KID IS FEELING BETTER TO DAY BUT THEY THOUGHT THEY SHOULD JUST GET IT CHECKED OUT!!!
Guess what, I agree, but why the ER? why in the middle of the night?
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