Tuesday, August 21, 2007

patrolling the boundaries

In case you were wondering (and I'm sure you were), the penis patrol is on the job.

I refer here not to the willie in question over chez DovBear (have I mentioned that this is my new favorite blog? sorry, JG, but you've been so quiet lately...), but rather to a small boy who has taken to wandering in when I'm in the bathroom.

small one looks at mother, consideringly: Penis? He looks more carefully. Penis?
(At this point, the small one is quite worried.)
mother: no, vagina. Mummy is a girl, and girls have vaginas. You are a boy, and you have...
small, happily: penis!
(pause, while the small looks the mother over once more.)
small: penis? Penis??

Where on earth could the darned thing be?
Outside of the scope of the wee willie patrol, a different sort of observation is taking place, this one somewhat more ominous.

For a variety of reasons, primary of which being the opportunity for indulgent whingeing (yes, I know, I have a blog, but it's just not the same), I see a therapist. Lately, rather rarely, as I am currently recovering from an inconvenient bout of sanity and mental stability. I'm hoping to get over it quickly and go back to wallowing in petty self-centredness.

Serious note: I'm actually a huge fan of psychotherapy. I believe that we could all use a person whom we trust to offer a neutral perspective on our lives. Simply put, occasionally it could help us all to be told that we're behaving like an idiot. So long as the one doing the telling isn't trying to win an argument with you at the time.

Anyway, I went back to the therapist to help me manage my response to the Eldest's anger(Quick sidebar: which, by the way, I'm happy to say is much improved! He's switched from hitting to words, and the worst thing he can think of is to call us 'stupid' or - my favorite - 'rude.' A vast, vast improvement. Most importantly, he's no longer afraid of his own anger, and is in far bettern control of how he expresses it. Huzzah for the Eldest and his 'feelings expert,' as he calls her.). I've gone somewhat irregularly since then, including today, when she handed me a survey from my insurance company. Hm.

At the top of the survey, it says "Important: before answering any question, please read the message on the back regarding the purpose and use of this information." I looked the survey over. It wants to know my age, sex, religious affiliation, my education level (warning bells start going off), job history, lots and lots of details about my mental well-being (do I hear voices? do I want to kill myself? do I have trouble functioning?), my medical history (run away! run away! Note: patient has watched too much Monty Python) and so on. I turned the paper over.

Please be thoughtful and honest in answering these questions. The information may assist your treating provider in understanding how you are feeling, developing a treatment plan, and tracking your progress from the perspective that matters most - yours.

Oh. That looks nice. Funny thing is, I kind of thought my 'treating provider' had a pretty good handle on me. I'm pretty basic: mom of two, trying to balance work and home, high stress levels thanks to medical whatsimacallit and needing a little help in coping. My perspective says that we're doing fine, my 'feelings expert' and I. So why is my educational level important? Whether or not I suffer from dry mouth? And I'm pretty sure my therapist already knows I have no interest in killing myself. Oh, wait, there's more -

Note from Health Plans:
Completing this questionnaire is voluntary; and your eligibility for benefits will not be affected because you chose not to participate. If you are a member of a participating health plan and your health plan is working with [name of company] to administer this questionnaire, [name of comapny] will process the information on this fomr and send a report to your provider. The report to your provider is not intended to replace the clinical judgement of your provider with regard to your treatment.

Then what's it for?

If you have a question about whether your health plan will recieve information on the form, a copy of the report

damn skippy they're getting a copy - this is all surely for their benefit..

or how they will use the information


please call your health plan. Your health plan does not intend to act on any information they may recieve as a treating clinician would and will not make immediate, direct interventions based on your responses.

The key word there might be 'immediate.' Okay, so this is an information gathering project to analyse the types and deserving nature of the crazies who use the mental health benefits. And, as a veteran of any number of cost-cutting measures in insurance, I'm persuaded that the goal is to make my therapist more effective, in weeding out folks who don't really need help (translation: wh don't need to spend the insurer's money to see a therapist) and above all, saving the insurance company money.

Because, when you get right down to it, health insurance is a business. They stand or fall on whether they can make it financially, not on the well-being of their subscribers. Yes, if Blue Cross Blue Shield cuts benefits enough that their subscribers couldn't cover enough basic medical costs, those subscribers would leave and BC/BS would lose money. But what if they cut just enough? Cut enough so that they were more profitable, and the subscribers were getting by? Cut a bunch but threw in some feel good ads? Would that work?

The balance between what the medical consumer requires or desires and what the insurer is willing to provide is a delicate one, and this is not the first attempt we've seen to persuade us to help them decide just how to manage their expenses. Another memorable effort was a nurse who called us, explaining that she specializes in hemophilia and is our advocate within the insurance company for our needs. Did we have enough factor, she asked, did we know how to give it, were we giving it regularly? What kinds of bleeds did the Eldest have? How was he doing?

It became clear pretty quickly that I knew far more about hemophilia than this so-called expert, and that a case manager would do us far more good than this person. In the guise of holding our hand and helping, she was collecting data and evaluating our compliance with the treatment course that the insurance company's experts had decreed appropriate. And not once - not once - in that first phone call, nor in the second, did she tell us that participation in the program was voluntary.

Yup. This survey is all about what's good for ME. Those nice, thoughtful folks at [company's name] are just trying to help out my poor, hapless therapist. Mm, mm, mm, is the mama ever feeling the love tonight.

Oh, and do notice please that not one word above was said about privacy. So who gets to keep this information, and what do they get to do with it? Shudder.


Anonymous said...

Now my 2-year old likes to run around the house after bath going PENIS!!!! (hee, hee, hee, hee) PENIS!!!!

Maybe it's just the loosening of the moral fabric of Northern American society.

Silent JG.

dykewife said...

that's one of the good things about socialized medicine. governments, the departments and any contractor working for them are all bound by the privacy act and cannot share information with another department without my expressed, specific written permission.

when my niece was 3 years old she had a fascination with penises. she would stand with the vacuum hose between her legs and proudly announce that "i have a penis!" then one day, she and i were walking to the park and she loudly announced (much to the shock of the old ladies walking behind us as i judged from the several gasps that should've caused them to faint from hyyperventilation) that "i have a penis!" i responded with, "no you don't, you have a vagina. girls have vaginas and boys have penises. she yelled that she didn't want a vagina, she wanted a penis.

the old ladies behind us promptly crossed the road after this announcement. silly women, they missed the rest of a scintilating conversation about whether or not flowers, bricks, roads, birds, (in other words, everything she saw on the walk) had penises or vaginas.