Friday, December 29, 2006

If you don't behave .....

I just read an interesting post by Dr. Rod Moser at All Ears about how NOT to get your kids to behave. It reminded me of an incident that happened when I was a student nurse.

I was working in the pediatric outpatient clinic at a major teaching hospital and my next patient was about 4 years old. He'd been in the waiting room much longer than his attention span would bear and was more than a little anxious about his checkup. When I called them back his mom was had a little difficulty getting him to come along, so she took his hand firmly and tried to get him to come. He struggled. His mom said, "If you don't stop that right now, the nurse will give you a shot." Then she turned to me and said, "Won't you?"

I'd heard of this sort of parenting, but it wasn't my mom's style and it wasn't something we'd covered in class. Never at a loss for words, though, I looked at the child and said very firmly, "No. I won't."

Not wanting to totally humiliate the mom, I continued more gently, "When your mom was little, nurses did give shots to bad girls and boys. Your mom just doesn't know that we've stopped doing that. Now we only give shots if you need them to help you get better or to keep you from getting sick. We don't give shots to punish children. I'm not sure what your mom will do if you don't cooperate, though."

Mom stood there with her mouth hanging open for a moment, then closed it and followed me to the exam room. To my delight the boy cooperated with me and with the doctor through his exam. I'm pretty sure the outcome would have been different if I'd gone along with his mom.

Dr Moser says he still hears this type of comment in his clinic. I thought parents had given this stuff up. Apparently I was wrong. Parents, if you aren't sure how to handle your rowdy children, head over to Dr. Moser's blog. He's written some excellent posts on the subject and has links to additional articles with suggestions for positive parenting. As an experienced mom, I can attest to the results. Positive reinforcement works. Scaring your kids with threats of what someone else will do to them simply scares them -- and undermines your authority.

Monday, December 18, 2006

Birth Story

A long time ago, in a hospital not so far away, a woman arrived in the Emergency Room with tiny feet protruding from her vagina. They were cold and blue. No heartbeat could be detected. They rushed her to Labor and Delivery.

Since there seemed to be no hurry, the OB attending decided that this would be a good opportunity to instruct the OB resident in pre-term breech delivery techniques. Since they didn't know when the tiny heart had stopped, they thought it wise to invite the NICU team to the delivery although our presence was not expected to change the outcome.

I was precepting a new nurse, and we went through all the motions of preparing an ET tube and drawing up the resus medications. We talked about the ABC's of neonatal resuscitation while the OB attending instructed his resident. The neonatologist planned to make an attempt at resuscitation, but really didn't expect success.

You've probably deduced by now that things didn't go exactly as predicted. The OB attending talked the resident through a perfect delivery, but what happened next surprised all of us.

The baby cried.

The OB resident quickly clamped and cut the umbilical cord before handing this vigorous, if somewhat bruised, 28 week infant over to us. I don't remember the details of his clinical course - it's been over 20 years - but I'll never forget that completely unexpected, but ever so welcome wail.

Thursday, December 14, 2006

Board of Review

Among my many hats, I am on the Troop Committee for my son's Boy Scout troop. Tonight I had the privilege of sitting on the board of review for 3 of the scouts. Only one of them was fully prepared for the interview.

A few tips for scouts:

It is not a good idea to open with "So how long will this last?" That tends to bring up questions about your Scouting Spirit. It also helps if you sit up straight and look us in the eye when you speak to us. Pick one of us or take turns, but don't look at the wall or the floor when you're speaking. We won't fail you for that, because you might just be nervous, but you should give it a try.

Corollary: the best Scouting Spirit and interview skills will not get you through if you have not read the handbook. We have. The answers to our questions are all in there.

We know you only use the one knot, but we are scouts and we learn the others anyway so we CAN use them. Yes, you really can use that taut-line hitch in putting up your tent. It's much more effective than your square knot. There are actual real-life uses for those other knots too. Your book even tells you what they are.

The big dipper does point to the North Star (Polaris), but if you insist on using those top two stars as guides, you'll never find north. You want the two on the side away from the handle and the line points up toward the top of the dipper.

No, moss does not always grow on the north side of trees. I don't care who told you that, it's simply not true. Moss grows on the side which gets little or no sunlight. Often that is north, but it depends on the landscape and sometimes it's the whole way round.

The N on your compass only points north if you're facing the right direction and have lined it up properly. The compass needle has 2 ends. One of them is red, the other is white. If your compass is functioning properly the red one will point to the north. If you make the red end point to the N, then the N is facing north as well.

Please do not follow your drowning buddy to the bottom of the deep end without first notifying the lifeguard that he's in trouble. Yes, we do expect you to know where your buddy is even if we're not calling a buddy check just this minute.

Yes, knowing how and when to use the Heimlich maneuver is a perfectly acceptable response if you can't remember what it's called. In fact, I'd much rather you knew what to do than the fancy word for it with only limited knowledge of what the word means.

No, we really don't enjoy sending you away without that advancement but we want you to be pround of that rank emblem when you wear it on your uniform. That's why we're asking you to study a little harder and come back when you've learned the bit that's in the section for your next rank. We know you can do it and we'll be happy to meet with you again any time you're prepared.

Please try not to wait until the week before the next Court of Honor.

Monday, December 04, 2006

A New Approach to Theft

I got a phone call this morning.

"Hello, my name is Paul(or so he says). I work for (collections agency) and I'm representing (large radiology practice). It seems that you had a CT scan (details of where, when, and what was scanned) on a date in 2001."

I responded that it was possible, but I couldn't be sure, so much time having elapsed.

Paul assured me that not only did I have the scan on the alleged date, but that the radiology practice in question was out of network for me -- something I knew to be a lie -- and that I owed just over $100 and that he could arrange payment or he could report the alleged debt to the 3 major credit reporting agencies.

When I asked for written substantiation of the supposed debt, Paul informed me that his job did not include written notification.

In that case, I responded, this is not my problem.

After doing a little research, I discovered that there is rather a racket going in collecting previously paid and uncollectible (as in NOT OWED) medical billings. I think it's pretty obvious that medical professionals are not in any way benefitting from these scams.

Then I called the major radiology practice billing department and verified that they do not believe that I owe them any money - from 2001 or any other time. When I suggested that perhaps they had a leakage problem with patient names, dates, etc being leaked to unethical people, the "customer service agent" got a little huffy with me - until I mentioned the name of the agency which supposedly employs Paul. I asked to speak to her supervisor and was informed that all supervisory personnel were at lunch, but that someone would call me back.

OK. Maybe they will. Maybe Paul is a former employee of the collections agency or of the radiology practice and maybe they'll be right on top of this. Just speculating, but he got the information SOMEWHERE.

It's been less than 24 hours, but I think I'll be chatting with the lovely folks at the State Attorney General's office and maybe with the local media as well since this appears to be a well-planned scam which could easily fool someone a little less insistent on paperwork or a little more concerned about her credit rating.

Bottom line, if they won't send you the documentation ON PAPER, presume that you do not owe the money. NEVER arrange to pay a collection agency anything based on a telephone call with no written evidence to back them up -- and particularly if they claim that sending the paperwork isn't their job.

For a quick read on similar scams, check this article titled Debt Collectors often Collect Bogus Debts

And for an even scarier story about actual debt collectors and some unethical practices this Boston Globe report.(registration required) At least my scammer can't actually DO anything to me if I don't let him.