Current Issues With Our Healthcare System

My apologies in advance for the tone of this rant - I don't feel well today - and I'm just beyond frustrated with the healthcare in my town and in general. 

(HOWEVER, I just added a PS at the end of this post before publishing it, after speaking with my mom, that gives it a happy ending - because it was only 1 of 2 times in my life my mom said words I've always wanted to hear from her my whole life 💞💞)

 

Let me just start with this - this has nothing to do with the argument about public/socialized healthcare - or I guess it does somewhat, but indirectly?

So ... I'm not sure most of the country is aware, but when Trump's "Big Beautiful Bill" went into effect in August, not only did it cut financial aid for my program down to not even covering tuition (much less my materials, and my program was only offered part time), but it also cut financial aid for medical school, advanced  health practitioners like PAC's and APRNs, dental school, veterinary school, law school, and any master's degrees and PhD programs.

(For proof, check out THIS LINK from the American Medical Association - yes, it mentions cuts to public healthcare, but it also goes into detail about cuts to financial aid for medical schools and other advanced-practice healthcare degrees, masters degree, or PhD programs.)

So we already had a drop in medical school enrollment the last few years because no one could afford medical school anymore, even with financial aid, resulting in a doctor shortage causing longer wait times.

Now, after Trump's Big Beautiful Bill went into effect in August, enrollment in medical school and other higher-degree programs is at it's lowest rate in decades, and it consists of not the best students - just those whose families can afford it without financial aid (which aren't many!)

Thus, when people argue against socialized healthcare like in Europe, I roll my eyes and point to the wait times we have now because of the healthcare provider shortage - which is only going to get worse if Congress doesn't do SOMETHING about financial aid and/or healthcare costs.

However, if you DO you approve of these financial aid cuts for medical school, dental school, veterinary school, law school, and any masters degrees or PhD programs ...

... and you also don't approve of socialized healthcare like in Europe (who seem no worse financially overall for it and they are still capitalist overall) ...

Please, do tell us - what do YOU recommend to cover the doctor and provider shortage only getting worse?

Because at this rate, we will quickly go from having among the best and brightest physicians in the world to a small circle of mediocre to poor ones.

Now, on a personal note ...

I've not needed to use healthcare much myself until now, as I've been lucky in that I've enjoyed good health.

However, after this car accident, I have had rude awakening as to how much healthcare has deteriorated in the last 10 years since Mark's stroke - plus I have had a UTI for over a week on top of it with a fever, making everything hurt worse -  and I am now on my second antibiotic, which also doesn't appear to be working!

So the second antibiotic is nitrofurantoin, which I told my urologist's APRN doesn't typically work for me in my visit.

She prescribed it anyway via call in as my second antibiotic.

What I did NOT say, not wanting to act like a Karen and tell her how to do her job is - the AUA guidelines recommend NOT using nitrofurantoin as second-line treatment because it's a fairly weak antibiotic and there is rampant resistance to it now.

So ... why would you ever use a known weak/multi-resistant UTI antibiotic as a second antibiotic, after the first one failed? 

Then to top it off, she wrote me this note when she called in the prescription -  "If this doesn't get it, see your PCP to rule out other causes."

What the ???

That makes no sense.

Because the only symptoms I have are UTI symptoms - and you just proved a UTI with urine culture!

(Though the culture curiously didn't separate between what was first line and second line antibiotic regarding bacteria susceptibility, which it should have/normally does).

AND you're not doing what AUA guidelines say regarding nitrofurantoin use.

But you want to send me back to my PCP  if this antibiotic doesn't cure my culture-proven UTI, though you're a urologist??? 

Why - because you don't want to take the time to investigate it further?

Okay, you can kick that can down the road if you like to my PCP if you want - but all she will do is refer me straight back to you, because urology is YOUR purview - but only after charging me $90 because I'll have to see her to get the referral!

So my mom recommended her urologist at Baptist Health.

I explained that I would love to and tried, but they need 2 positive cultures in a 6-month period or they won't see you.

I had 5 UTIs in 2025.

Then after my current urologist denied my request for estrogen cream as UTI prevention (see story below) that my menopause-certified GYN prescribed - guess what?

No UTIs for a year!

(Until now, after the accident.)

So I don't have 2 in the last 6 months.

But nope, no exceptions/

THIS practice claims this rule is based on "What the AUA guidelines say."

Which brings me to another point about the AUA guidelines ...

So ,,, there's middle ground between not following the guidelines at all and following them too stringently that is even written in the guidelines themselves - because they are guidelines after all, not rules

The AUA guidelines advise to "use your best judgment" on a case-by-case basis, while considering the patient's history and the severity of symptoms.

Did they stutter?

So how about THIS?

How about you at least review the latest guidelines first, before even seeing me, just to make sure you're up to date.

Then, if it makes sense to stringently follow them, do so.

But also do as the guidelines say and consider the patient's history and severity of symptoms first and then "use your best judgment" on a case-by-case basis. 

Or does that make too much sense for you ?

Or perhaps you need it spelled out more explicitly in the guidelines, either because you don't have time/don't want to read them - OR - because there's some sort of reading comprehension issue, in which case, maybe you shouldn't be a healthcare provider at all?

Because making people that have years' worth of cultures proving chronic UTIs have 2 culture-proven only in the last 6 months from other providers before seeing them is just absurd!

It leaves no room for diagnostic or treatment errors from other providers, changes in immunity or health status, or extenuating circumstances like oh, I dunno - blunt force trauma to the lower abdomen from severe car accident?!? 

Thus, because THIS practice goes to far the other way, I have to keep going to the same piss-poor low-rated urologists at Lexington Clinic, who now want to send me back to my PCP despite culture-proven evidence of UTI, because they can't/don't want to figure it out!

Don't get me wrong, out of everyone I've seen since the accident, Baptist Health providers have been the best overall - it's just that rule - which is actually a guideline - is overly stringent and absurd.

Now - the thing is, until now, I've been luckily super healthy in life and still am, I just had a severe car accident (not my fault) that's apparently caused a bunch of crap to go haywire or revealed things I didn't know I had.

Until now, I only saw doctors for routine maintenance like yearly physicals and lab values checks and female stuff, as well as Urology, due to developing chronic UTIs after menopause.

And I already knew there were some issues about doctors not knowing how to treat menopause or post menopause (see JAMA's just-published article acknowledging this problem, - Journal of the American Medical Association), but I just quietly switched to another GYN that was menopause certified, and BOOM, we're done here.

(We actually just had a class discussion about these issues about 3 months ago, so glad they just published this validating thousands of women's complaints about this.)

Thus, though I was aware of the high costs and healthcare becoming a business, as well as lack of information/knowledge about menopause, I wasn't aware of how effed up our actual care in general has become in the last 10 years especially locally, until I really needed them myself!

(Don't get me wrong - like I said, my neurosurgeon and Baptist Health ER- Hamburg have been EXCELLENT.)

But I cannot ignore the series of very severe errors that weren't one-offs - with imaging, medical record/clerical errors, going on hunches rather than further investigation, and generally dismissive/too busy attitudes.

This despite the fact that I rarely go to the doctor except maintenance, and maybe I'm coming in repeatedly now - NOT because I'm a sudden hypochondriac - but because, oh, I don't know - maybe because I had multiple injuries after a severe car accident that didn't all show up the first day of accident due to internal swelling, as is common???

And God forbid that I have a UTI now on top of it that appears to be antibiotic-resistant and more difficult to treat likely because my immune system is overwhelmed!

But hey, let's go with hunches anyway or throwing up our hands and giving up easily, rather than investigating things further! 

Oh, and hey, by the way, Kentucky?

There's this (not so) new-fangled test called a PCR assay that can be done to help with people who seem to have resistance to many UTI antibiotics as well as determine genetic predisposition to help determine which antibiotic is best AND to detect infections masked by uneffective antibiotic use or low-bacteria growth that are still symptomatic?

But hell no, that's too scary and new for Kentucky, and expensive - let's not do THAT claiming it MIGHT be wrong and increase antibiotic resistance - but then make patients go through a series of antibiotics like guinea pigs and rack up their bill anyway with repeat visits, which created the problem in the first place?!?

So you wait 6 weeks for an an appointment due to provider shortages, get there and they seem rushed and busy, spend 15 minutes with you as a new patient, not really listening to you, making hurried decisions - and then when the thing they recommended doesn't work, they throw their hands up - ESPECIALLY if you have more than one issue, God help you, it overwhelms them because they're trying to squeeze in all your issues in about 15-20 minutes.

And we're paying hundreds and thousands out of pocket and with private insurance for THAT???

And you're afraid to say anything because THEY'RE the doctor!

(If this were a new car or TV or iPhone, or like a contractor or plumber, people would raise all kinda hell, but we don't because they're doctors, oooh)

How is any of that any worse than public health insurance, and in fact, it's worse because we pay thousands more out of pocket to get that kind of care? 

Do you have any idea what European countries with socialized healthcare pay for healthcare and prescriptions versus here?

It's literally a difference of thousands of dollars per person!

So you're paying for it anyway, either privately or publicly - just actually more with private healthcare!

Because healthcare has become a business in America -  they literally have a quota of patients to see per day now.

And let's not even start with already overreliance on AI being much of the problem with getting the medical records and imaging results wrong.

And in the end, do you know what all of those errors result in?

Costly second and third visits to the ER or doctors or need for second opinions - which of course begets higher healthcare costs.

Thus, if I DO get a settlement out of this accident, I may be spending most of it on unnecessary medical bills, which had they done their job right the first time, I wouldn't have needed!

I have no idea what to do, don't feel well, and beyond frustrated with healthcare, ESPECIALLY in this overly conservative city.

Yes, we went blue with our US district rep - but that doesn't mean that we don't still have a significant amount of MAGA,or that we are on the forefront of anything either way -  blue OR red - by any means, despite the unwarranted arrogance by our healthcare here!

Lastly, let's talk some more about the sad state of women's healthcare post menopause.

As mentioned earlier, there is a just-published JAMA-proven study and discussion on lack of provider knowledge with women post menopause(see link), 

Do you know what it feels like to be a post-menopausal woman having a health issue, but no one knows how to treat it properly because there are few proper studies on it?

It feels like - "FU, you can't have children anymore, so you have no value - you are not a priority, unimportant now, and we just don't care."

I'm sure it's NOT meant that way - at least I hope it's not conscious - but that's how it feels.

As alluded to above, just 3 years ago, I asked for estrogen cream as UTI prevention after reading a new study on it, but my urologist said it hadn't been proven.

(Um, yes, it had, a few years earlier actually, or I wouldn't have asked - but I didn't want to argue with him).

So I went to my menopause-certified GYN nurse practitioner (there were only 2 in town at that time, now there are 4) and requested it - and lo and behold, it worked to prevent them for over a year, after having 5 in a row the year prior!!!

NOW my urologist prescribes it, trynna act like I never asked for it 2 years ago and it was THEIR idea! 😂

You know, when you are up on the latest studies by years ahead of your doctor, it may be time for a new doctor - and I'm trying!

The problem is, I ran out just before my car accident, and believe me, going to have an annual pelvic exam with back and rib fractures to get a refill was not at the top of my doctor-appointment list, so thank God the urologist is now prescribing this himself/herself - albeit after I already have a UTI again!

Okay, rant over.

*HOP* off my soapbox now, fueled by feeling like sh*t today lol.

_____________________

PS -- My mom and little sister chimed in today. My mom wants to push her urologist to see me anyway and also her PCP.

So ... I may ask for others' input, but I'm not used anyone stepping in to help me fight my battles for me, or even with me, even Mark. 

(Sometimes he's done so without my knowledge and I scold him later when I find out, but I never ask him or anyone to.)

I'm not saying I've never in my life asked for help - only if the situation is really, really bad - and it's been financial, but even that was EXTREMELY rare - but NEVER to actually fight a battle for me - and I wasn't asking for any help now, either, she just offered..

It's feels very "damsel in distress" and icky to me?

So I told my mom I'd think about it.

Not only am I not used to people in general offering and meaning it, I'm especially not used to my mom offering.

So at this particular moment before she says the incredibly meaningful thing she says, I was talking about how I did understand antibiotic resistance very well - but that guinea-pigging with which antibiotic will work even after culture is only making that worse. 

I also was lamenting how doctors used to be, like when my daughter was little, how her pediatrician actually listened to me and it saved her life once - how that was the scariest thing I've ever been through in  my life, including my car accident.

(She contracted antibiotic-resistant Strep pneumonia from another student in daycare, who ended up dying from it despite being on antibiotics - because they didn't realize in time it was resistant to regular penicillin!)

I said it was tough because I was completely alone in it, no help from anyone but her pediatrician and my microbiology professor, pushing me to push past her pediatrician's receptionist and speak directly to the doctor about antibiotic switch, and I stayed up for a full 48 hours straight with an alarm on meningitis watch.

(See, when it was my daughter or Mark or my grandmother, I could do it with encouragement - when it's me, I can't find my inner "Karen" 😂)

Then my mom said "Well, I'd like to be here for you NOW, if you'll let me. "

Wait, what?

My GOD - who are you and what have you done with my mother? 😂

I literally sat down hard on my bed - and started crying, like full-on crying, which I haven't done this whole time since the accident.

NOT because I was sad, but healing tears - because these are words I've hoped to hear my whole life and thought I never would!

Plus, I think I just needed to, as I haven't since the accident, and tears release stress hormones, that's the purpose of tears.  

And I realized it doesn't mean I'm weak or a baby or overreactive or crazy - it means this has gone on a long time, I've handled as much as I could on my own, but now I'm sick with an infection inadequately treated and it's getting worse - and I'm allowing myself to face the reality that maybe this DOES suck a little, but just temporarily, before I go back to pushing forward again.

So as mentioned, we were estranged, before my mom was properly treated for bipolar disorder and other mental illness, because she literally hated me for being the first one in my family to say something else was clearly wrong other than PTSD from my Dad's abuse, when neither she, not anyone else in my family, was ready to accept that.

Now, there's no denying it - and she was actually diagnosed in 1973 with it and has been desperately trying to hide it all these years until she couldn't anymore in 2011.

So ... though she couldn't acknowledge her past behavior, I guess in the end, maybe I don't need her to - all I needed to hear was "Well, I'd like to be here for you now, if you'll let me."

WOW ... just, wow.

Whoever her therapist and shrink are now, they deserve a big 'ole raise! 😂

But I do need some adjustment time?

Because I can't say I trust it completely, either. 

My mom is 1000 times better on regular meds, but she has her moments still.

And yet it's a precious pearl moment I will always remember. 💓

This reminded me of Amy Acton, for some reason.

Amy, your situation was way worse with your mom and though I experienced abuse as a child,  I never experienced sexual abuse - but I can relate to some degree because I had a mentally ill mother that hated me and called me a liar, too, for telling the truth she didn't want to hear, and convinced a lot of other people I was for a very long time until she couldn't anymore and received proper treatment.

But I am living proof that once they are treated, it can change - they may not be able to ever admit or even remember what they did or didn't do, but they recognize it wasn't what they intended and that they want to make up for it now, if you let them.

Then, you get to see all of the best and most beautiful parts of your mom that you remember, however rare they were before treatment, your favorite parts - because very few people are all bad - they're just buried under a lot of mental illness and their own pain. 😊

Lastly, you have just achieved what is extraordinarily rare, if not nearly impossible, for survivors of child abuse of any kind, especially after efforts to intentionally trigger you in such a public way - and we are so proud of you!

Best to you! xo