Saturday, May 09, 2009

Disability Evaluation - a new job with new challenges

I have been working an extra job lately on some Saturdays, performing physical exams for a company that contracts to the state disability determination services. Clients apply for disability, get an interview with an intake person, supply various supporting documents, and then get scheduled for a physical exam. I receive electronic records ahead of time, whatever the state has received to date, and I am given 30 minutes to talk to the client and examine them. After a very full day of appointments (last Saturday I saw 15 clients) I dictate a report on each client. My instructions are to "provide a complete history and physical" to the people who take it from here. The next steppers will review all the records, including my report, and make a decision about whether the client is disabled and, if so, how disabled.

Thankfully, the final decision is not mine. It's hard enough making some kind of statement about how each "allegation" (the official term for the medical condition that is affecting the client or claimant) impacts the health and functionality of the client. Many cases involve pain, which is very hard to objectively document.

Naturally, I can't mention specific cases here, at least not in enough detail to be able to identify anyone. I have already seen a huge variety of medical problems, from amputations to aneurysms, back pain (lots of that) to bipolar disorder. Plenty of suffering. Everyone suffers. But are they suffering enough? Enough to get a government handout? If a man has been a plumber all his life, and can no longer crawl and kneel, what should he do? Should he be required to learn a new skill after all these years? Should he kick back and live on disability payments? What about the young person who has years of productive life ahead of them? Should a car crash that leaves them with occasional or even frequent back pain ground them for life?

I don't know the answers. I do know that some of the people I examine seem very disabled, and some don't. Are there scammers in the lot? Probably. There are also frustrated hardworking people, embarrassed at their unintended impotence and wishing they were back on the job this minute. There are also bewildered disenfranchised folks without health insurance who are hoping to access health care through this particular back door into the system.

No doubt I'll have more to say on the subject with time. I'm learning a ton.

Thursday, May 07, 2009

Writing an article

I'm working on an article on hydration. Well, taking a break from working on an article about hydration. It occurred to me it might help me make progress if I put my process into words. So yes, this is a self-serving analysis of how one writer writes. Feel free to ignore.

My process has evolved over the years. I never planned ahead what my process would be, but it has come to a pattern that looks something like this.
  1. Pick a topic. Either choose from a question sent by a reader or, if none have come in, pick something timely. Example: health during finals week (last week's topic, published yesterday)
  2. Research a bunch online, using both medical and lay sites. Some of my favorites are NIH and CDC. Copy and print key stuff, or copy and paste into a research doc.
  3. Write a terrible, rambling, ungrammatical verbal vomitage, full of sentence fragments, runons, slang, random unrelated thoughts, anything that comes to mind.
  4. Go away.
  5. Come back to it and look at it. Lo and behold, a flower or two arises from the garbage. Dig out the flowers and transplant them into a new document.
  6. More verbal vomit of ideas I've digested since the last purge.
  7. More garbage gardening.
  8. Leave the stinking pile and move full time to the new document, pruning, filling in, spiffing up.
  9. Go away again, preferably overnight.
  10. Come back, tweak and polish. Done!
At the moment, I'm between Step 2 and Step 3. And this little analysis didn't provide me nearly the procrastination time I was hoping for! Dang. Oh, but that reminds me. I didn't include diversionary tactics, or time wasters, or even legitimate break taking! Just like stretching the body, I need to stretch my mind, my eyes, and my thoughts from time to time. And speaking of hydration, a drink of water is always a good idea, in addition to being a diversionary tactic. In fact, I'm getting thirsty right now...

Saturday, May 02, 2009

Viral Fear

Swine flu. It's in every conversation, on every mind, in every newscast. Every half day, the CDC adds states to their list of confirmed cases and updates their latest recommendations. New Mexico is not yet on the list, but I have no doubt that will change, and soon. We have several suspected cases, and after all, Mexico is our very near neighbor. Lots of travel back and forth. Just a matter of time.

Meanwhile, there's a second pandemic, a worldwide infection of that most resistant of viruses, fear.

"How scared should I be?" people ask me. Interesting question. Fear, although occasionally useful for motivating us to do something important, like get out of the way of a speeding truck, usually does more harm than good. Fear causes you to lose sleep, to get bellyaches and headaches, to get distracted from your responsibilities and your happiness. Fear is living in the future, and who knows if that future will ever materialize the way your fantasy has painted it?

I don't recommend stirring up fear, in yourself or anyone else. How scared should you be? Not scared. Responsibly behaving so as to avoid catching the swine flu, sure. Staying informed about the disease and the latest recommendations, absolutely. But there's no point in worrying about a potential future catastrophe. You're more likely to get killed in a car wreck than die of swine flu. So pay attention when you cross the road. Pay attention to your life, right now, in this moment. As one of my favorite authors says, we only have moments to live! One at a time.

The Authors of "50 Ways" Interview on KCHF TV

50 Ways to Leave Your 40s TV interview with Phoenix' Pat McMahon