Two Weeks To Go

I am in denial that I will board a plane to go to Denver in two weeks for my oral exam. How did I procrastinate like this? I had purchased some review books last YEAR, and only found them covered in dust this past week. To my credit, I already did one mock oral exam with my former residency director- and he passed me. I will also do another mock oral boards with another former supervisor. Both of them had actually been judges at the REAL boards. So I think I will be set, but still, I gotta be careful to NOT make things up. It befuddles me, how people make things up and then insist that they are absolutely correct. I hope I don't fall into such a trap.

Aidan and Zoe got to enjoy my parents for a whole week recently, and it was great fun. It was fabulous to see my parents jump in and help with A&Z, especially because they got up SO early that by the time A&Z were up, they were dressed and ready to interact with them, and that was precious. Hubby and I also got to go on a few dates. Perfect.

We went to see my brother's lovely bride receive an award of valor. VALOR, people. She bravely saved a stranger's life while on duty with LAPD! When we went shopping, she carried a gun in her purse. So. Cool.

Hubby and I were ecstatic to hear that a space opened up at the year-round school for Aidan: School will start on July 30th! We are so excited for him, for all that he will learn at this school, and the vacation we can take in October. That's right, the chief benefit of year-round schooling is that we will get to go on vacation when everyone else is in school! I can't wait. October would be a perfect time to do cruises, and possibly, a trip to China next year. I can scarcely believe it, I have been invited to LECTURE at BEIJING University next fall! (More on that later, much later, like next fall.)

Tomorrow, the children and Hubby will be at Maker Faire, and I will be reading and memorizing all random kinds of things.

Bible Study

Aidan asked to sing during dinner tonight, and Hubby and I decided that it would be awesome to have a little Bible Study after bath time and that we would incorporate some singing.

Well, forget your typical Bible study structure.

We, the adults, sang El Shaddai and Shout to the Lord, while the children jumped on the air mattress that my parents have been sleeping on in the play room. Then a pillow fight ensued.

We moved on to the Scripture portion, and as I read the story of how Jesus loved little children and told his disciples to let children come to him, Aidan and Zoe were reading Star Wars.

We moved on to sharing. Aidan ran to his room and grabbed two stuffed animals to share. Hubby stated that what had been weighing heavily on his mind was that he wanted to know what happened to his life.

Then we tried to pray while A&Z were trying to sit on top of each other. I yelled, "SIT DOWN! WE ARE TRYING TO PRAY." They listened and looked kinda shocked- I couldn't blame them, shouting would not be part of a normal Bible study. Then Hubby and I could not stop giggling. Then A&Z were laughing, and then Aidan was crying.

We finally did pray for everyone to get some good sleep.

And that was our Bible study.

I think I should write a book about family Bible studies.

(BTW, my parents are actually at a real Bible study and thus did not participate in the jumping of the mattress kinda of Bible study.)

Physicians, Heal Thyself

Sometimes, I wonder what my patients see in me. Day in and day out, I hear about people's problems. Problems with their marriages, children, work, finances, friends. Problems about their depression, anxiety, irritability, and inattention.

Then I come home, usually to my two adorable children, a loving husband, yet occasionally, I find myself sounding like I am in need of a psychiatrist.

"YOU PEOPLE NEED TO BE QUIET AND LET YOUR MOTHER TALK TO HER HUSBAND IN PEACE!"

"YOU PEOPLE NEED TO NOT LEAVE YOUR SOCKS ALL OVER THE HOUSE!"

"I NEED A BREAK!"

As I say these things, always in a calm and soothing voice, of course, I wonder, if my patients ever think that I encounter their problems in my own life, ALL THE TIME, just not the same severity.

Yup. I chose psychiatry for a reason, of course. Probably because I saw a little bit of myself in all those patients I encountered (and probably not a great thing to write about in one's application to residency.) Indeed, Hubby and I were talking about my parents' upcoming visit, and yes, it is making me a little nervous. I just haven't seen them in a long time, and well, you know, I haven't been in practice of being a daughter. Hubby said, "You know, you can be anxious."

Seriously?

Neurotic, I will admit to. But anxious? Hmm. In quiet reflection, of course, I can be anxious. One really wants some level of anxiety in one's physician, you know, that is what makes a physician thorough, diligent, and less likely to make errors. Some anxiety also helps me to be on top of mothering A&Z- that is how they get enough sleep, and don't develop butt rashes ALL the time. (Just sometimes.)

So anyway, I am thinking about the phrase, "Physicians, heal thyself!" Perhaps I need some cognitive behavioral training to cope with all that is on my plate. Like the oral boards that I need to prepare for...

Trimming...

Five weeks into working for myself, and I have decided that I am working entirely too much. (My mortgage broker might not think I am working enough, however.)

Anyway, so I am trimming back my patients- I am not getting rid of them, per se. I am converting those weekly psychotherapy cases into twice monthly/monthly medication checks.

Thus, I am very dedicated to talking with these fine folks, "So, do you think you are better? How much better?" And most importantly, "What else do you want to work on before we wrap up psychotherapy and move on to medication maintenance?"

So I find myself saying really weird, strange, things.

I have this person who wants to improve his/her sexual functioning to a satisfactory level before we stop meeting weekly. Therefore, for the last few sessions, it has been about sex, for 50 minutes at a time. As I listen and ask for more details, I am just thinking, "Please, please, please, don't think that I am speaking these things out of first person experiences. These are ALL text book experiences. Wait, would it be better if these were first-person experiences?"

It is curious, how people talk about sex. For instance, I hear this a lot. "I just have no sensations." (What does that mean, exactly? Like you can pinch yourself and it would not hurt? What are you talking about?) Thus, I ask for clarifications.

The conversation would go like this.

Me: "It is not satisfying?"

Pt: "No, not at all. We try to have sex, she orgasms, and we go for a while, and then nothing happens."

Me: "Tell me more."

Pt: "What?"

Me: "Well, tell me about what you mean by nothing happens."

Pt: "I lose my erection."

Me: "After how long?"

Pt: "Hmm, maybe fifteen minutes?"

Me: "What happens during these fifteen minutes?"

Pt: "You know, we have sex."

Me: "What position are you in? Do you change positions?" Blah, blah, blah.........

Pt: "She doesn't like oral sex."

Me: "She doesn't like giving or receiving oral sex?"

Pt: "Well, I guess neither. She gags a lot."

You see, it is repetitive, getting these necessary details. Then I wonder if my patient thinks I am a pervert.

Rest assured, pervert, I am not. I am just a therapist who is tired, and cannot keep up with her case load.

(I was thinking about getting a related picture here, but couldn't come up with a suitable one.) Thus, here is Aidan, getting measured for the tux he is gonna wear in July, on an occasion to celebrate, a-hum, two people having sex later that day- so I guess the picture is related! Also, a picture of Zoe, swinging and using her strong arms! =)

Mother's Day!

I had the most wonderful night of rest, and I woke up completely refreshed and eager to start the day. It was Mother's Day, of course, and I was refreshed because I slept in! The children were particularly obedient, sweet, and extraordinarily charming. We got ready, enjoyed a lovely breakfast and made it to church with lots of time to spare!

After worship, the children and Hubby went to the park while I went home and lounged around. Lunch was served using our finest china, and A&Z were so gentle with everything, that no water was spilled, and no plates got cracked.

I napped, Hubby napped, and Zoe napped, while Aidan played very quietly in the playroom. Then we went out for a long, leisurely walk. Dinner was at this new Cajun joint I had heard about, and it was lovely. Bath time was a breeze, and I had the best Mother's Day, ever.

Ok. So the above didn't actually happen...

While I had a great Mother's Day, I didn't sleep well at all. Zoe had gotten sick last week and infected me with this awful congestion. I was up sneezing, coughing, with lots of nose blowing. And nope, there was no sleeping in- what was the point, since I was too congested to sleep?

A&Z were their usual selves, full of energy and occasionally without listening ears. Aidan was chided for stealing Zoe's yogurt, and Zoe was timed out for not listening.

Church was fine, there was plenty of parking even though we were late by a few minutes- I guess all the other mothers were sleeping in. They did go to the park afterwards, but I went to Costco, where there was no lounging around- but actually, I rather go to Costco over trying to not get mad at other people's kids at the park ANYDAY. I did make us lunch, using our lovely china and nothing was damaged, thankfully.

Some of us did nap while one of us made loud crashing noises while staging Lego battles. Then we ran around town like mad people trying to go see as many open houses as we could in the span of 40 minutes before open house hours closed. (What is up with such short time frames!?) We tried to go to this Cajun joint, but alas, they were closed. (Apparently, they had a Mother's Day brunch and wasn't gonna be serving dinner. What?!) We got Chinese food instead, where the menu had NO Chinese words on them. (Surprisingly, it was quite good, and not oily and loaded with MSG.) Then we stopped by a gelato place, which was fantastic. Once we got home, Aidan got a haircut, courtesy of Hubby. I bathed Zoe, then Aidan, dressed Zoe, then Aidan, read to Zoe, and finally, tucked them in.


Then I did billing. (So it was self imposed...)

What I have to show for this Mother's Day? Hubby got me a new springy purse, Aidan gave me a new trivet with his hand print and a few special cards with 'treasures' on the submarines he drew, and Zoe made a planter pot (with teeny tiny seedlings already!) covered with little caterpillars made from her thumbprints.

Anyway, Happy Mother's Day to all different kinds of moms!

CMS 1500

I am entering a new realm of medical billing.

I should have seen this coming. Last month, I had a very nice older gentleman who called me and requested my services. I should have realized that since he was older than 65, his insurance through my panel was his secondary insurance, and his primary insurance was managed through MediCare. And I should have avoided taking him on. That's right. There are times when the hassle of getting paid will make me simply say no. Usually, when people with MediCare call me, they are upfront about it and I never actually think twice about saying, "I am sorry, I am not currently accepting MediCare patients." And that would be that. However, like I said, I was not paying attention and even though I knew he was born long, long, long time ago, it didn't occur to me. So anyway, we established a therapeutic relationship and he had been quite a hard working patient and therapy itself had gone very well.

I billed the insurance panel, and they rejected my claim. I called customer service and had the following exchange:

(A very long, lengthy discussion about which patient, who I am, dates of service, blah, blah, blah, blah, blah...)
Me: "So, Mr. MediCare's claim was denied, and what does that mean, exactly? I thought he had received authorization?"

Rep: "It shows that you need to bill MediCare then send in the paperwork from them, and then we will send you the difference."

Me: "I am new to this, so please help me. How do I do this?"

Rep: "You use the form."

Me: "What form? Do you have it? Can you fax it to me?"

Rep: "We don't have the form here. You need to call Federal Form Agency and request the claim form. Their number is 202-xxx-xxxx."

Me, thinking, "Ok. What claim form is this? Does it have a number? I bet the Federal Form Agency has lots of different claim forms, you know, for tax rebates, legal services, whatever."

Me: "Is there a number attached to this form? How do I ask for this?"

Rep: "This is the form used by all doctors to bill all the time."

Me, thinking, "Ok. Not all doctors, since I don't have one. And if it is used by ALL doctors for ALL billing, how come, YOU, a BILLING CALLING CENTER, do not have this form?!"

Me: "Hmm. I guess just not this doctor. So how do I get this form?"

Rep: "It is form CMS 1500."

Me: "Ok, thanks. Bye."

I hung up. Then I decided to call a patient. I picked up the phone, got ready to dial, but then, I realized that SHE WAS STILL ON THE PHONE! And, SHE WAS MAKING FUN OF ME to her colleague about the fact that I didn't know the existence of a form that was so universal that even they didn't have it!

I waited patiently for her to finish. Then I said, "And that doctor is STILL ON THE PHONE with you. I would like to speak to your supervisor." She hung up on me immediately, but the system automatically forwarded me to a survey to evaluate my satisfaction with the rep. I gave them a piece of my mind. And I should have demanded to know what CMS stood for while she was being all condescending. (FYI, CMS is for Center of MediCare/MediCaid Services. And so, it is NOT a claim form used by ALL doctors for ALL billing.)

Anyway, billing sucks.

By the way, having a nationalized health care insurance system like MediCare for everyone, does NOT mean health care for everyone. People like me, when able to pay attention, opt out of taking care of people with MediCare and MediCaid, because well, billing for that just SUCKS. SUCKS. Did I mention that it just SUCKS? Also, the reimbursement SUCKS even more.

Ok, I need to go think about something more pleasant before bedtime, like the Mothers' Day Breakfast with Aidan and Zoe at school tomorrow AM!

Just Enough Space for Two

I hear about this constantly at work: People report dissatisfaction with their sex lives, and they typically have this in common- they share their bed with a pet.

Since I didn't grow up with a pet, and I don't plan on living with a pet, ever, perhaps I do not understand the intricacies of pet ownership. But I try. I try to hear from these people and get a sense of how much they LOVE their pets, and thus, they sleep with their pets. However, people, get this: Sharing a bed with your pet inevitably equals to infrequent/unsatisfactory sex.

I imagine it isn't the pet that leads to infrequent sex, and probably, the problems in bed predates the arrival of a new bedmate. However, whatever the sequence, having a pet there certainly seem to put a damper on things.

Of course, perhaps I don't hear about people's happy sex lives (because these people are probably not sitting on my couch) and how they share their bed with a pet. Even veterinarians say to proceed with caution in this area, for different reasons.

I won't even be tempted to talk about bed sharing with children. Nope, not going to go there.

Another interesting tidbit I learned today: Reptiles often develop skin PARASITES and thus they need to see a vet. PARASITES on a SNAKE, people.

Best Job, EVER

I really do think I have the best job, EVER.

I have this patient, with a diagnosis that makes it rather...hmm, how do I say this nicely... boring to sit through 45-50 minutes of a therapy session. While I do think therapy would be very helpful for this person to improve her functioning, it is BORING!!! She typically rambles on and on and on for a long while, and I am thinking, lady, get to the point!!! Must stifle that YAWN.

Therefore, today, I decided to do something about this. We practiced relaxing for a while (who else gets to do this?!) and we decided to play games for our next session. GAMES! GAMES!! GAMES!!! I can see it already, we will be sitting criss cross applesauce on the floor, playing a mean game of "The Thinking, Feeling, Talking Game" and the hour would just fly by! She would get better. I would not fall asleep. It will be beautiful.

Seriously. Best. Job. Ever.

Not Be Slaves Again!

I am putting my iPod into good use these days. A&Z like to request songs, and they are actually quite good about taking turns, and of course, my job is a dream when they request the same songs.

For quite a while, they have been intoxicated by various selections from The High School Musical. Aidan is very curious about what exactly is The High School Musical, and I actually have no idea. We tell him it is about high school kids and their experiences. (Is that actually true?!) He manages to sing along actually, and it is so sweet to hear him sing, "I gotta go my own way."

Zoe is in LOVE with "So Close" from Enchanted. She will yell to let me know, during the interlude, that is the time when the two people are dancing. She also like the cleaning song, and of course, "Ever ever after."

Recently, they are also infatuated with selections from Les Miserables. Aidan went through this phase already about 2 years ago, and this time around, he is asking what the words mean. He wants to know, who are the slaves, and what exactly is freedom. (I didn't really want him to request to have full freedom at this point, and in some ways, my explanation of what slaves are can mirror his life. You know, slaves are people who don't get to choose what they want to do- such as, AIDAN! GET OVER HERE AND WIPE YOUR FACE! Or, slaves don't get paid- AIDAN! Come and put your clothes away, and no, you are not getting paid for this.) Anyway, I try to change the topic quickly.

However, I do want them to be with familiar with the music, because when we go to NYC in the summer, I want to take them to see Les Miserables. It IS still playing in NYC, right? I better check.