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Thursday, December 13, 2012

It's beginning to feel more like Christmas

They're coming in daily now. A slow but steady trickle. A few every day.

Turns out, some people still actually send Christmas cards. In the mail. Real envelope with a stamp and handwritten address and signed by the actual person and everything.

Years ago, I used to send out hundreds of Christmas cards. No, really. Hundreds. It was crazy. These days, I send out very few Christmas cards. I only send to people I know I won't see during Christmastide and/or to those who send to me. I just can't justify the cost of postage and using all that paper makes me uncomfortable.

But, oh, my goodness, I love getting the cards that are montages of pictures. Especially of the little ones. They tell a better story than any letter ever could.

Sometimes, Christmas letters are important. I especially love the ones that express gratitude for all the gifts that have come the past year. I was so inspired by one of them, that I decided to write a Christmas gratitude letter of my own to tuck into my Christmas card.

Not everyone will get this letter.  It was only to a select group of people.

A little background story: When I moved to DE, I arranged with my NJ doctors to stay in relationship with them. I mean, I've been seeing my primary care physician for the past 15 years. I've been seeing the others for 7-14 years. We have a relationship, you know?

I don't mind the schlep up the Jersey Turnpike.  Besides, I'm very healthy which is due, in equal parts of taking care of myself - a healthy diet, moderate exercise, vitamin supplements, an annual physical exam including mammography, pap smear, etc. - and having confidence in the skills and abilities of my doctors and nurse practitioners.

Now, I'm fortunate. I have health insurance. I have a car and the finances and the time and the ability to choose to schlep to NJ for my health care. Furthermore, the way the "system" works these days is that, if/when you are admitted to the hospital, you never see your primary care physician. You see the doctors who are staff in the hospital. Your primary care docs get the report after the fact. And, s/he sees you over the period of recovery, so might as well stay with the docs who know me.

But, it seems that there was a bit of a dust up of sorts between my health insurance and my health care providers. For some strange reason, certain counties in NJ - the ones farthest from the NY border, were excluded from coverage. Indeed, my primary care physician was in one county that was excluded, by my GYN nurse practitioner and two other specialists were not.

Well, that's what it said on the website of the medical group where I saw my physicians. When I called my insurance company, however, the "customer service agent" informed me that she did not have them listed. She said I should check with the medical group. When I called them, the "customer service agent" there said I should check with my insurance company.

After weeks of this sort of back and forth, I finally threw my hands up in the air and decided to start looking around for a new primary care physician here in Delaware. After a lengthy search and interviews, I finally found one. She comes very highly recommended and I'm sure she'll be great, but after I made the appointment, I knew I had one more thing left to do before I could move on.

I couldn't just send my health care providers a Christmas / Hanukkah / Kwanza / Generic 'Holiday' Card. I knew I had to write a letter of gratitude for all they have done for me over the years.

This, in part, is what I wrote (after explaining the situation as I wrote it above):
The Affordable Care Act has done a great deal to fix a broken system between health insurance companies and the health care profession, but it’s obvious to me that the system is still broken, apparently driven by profit margins and not patient care.

I wanted to take the opportunity to thank you for all of your care over the years. Thank you for your thoroughness and skill. Thank you for your warmth and compassion. Thank you for never missing an opportunity to educate me about my own health. Thank you for the occasional reminders that I need to lose some weight or congratulating me when I succeeded in doing so. Thank you for asking about my professional life and my family members. Thank you for training your staff to be efficient without compromising a sense of warmth and concern. Thank you for your condolences when one of my family members died. Thank you for listening – really listening – to me when I had a health concern and taking it as seriously as I did. Thank you for those times when you shared a little bit of your own personal life with a few stories about your children or your spouses.

I will miss each and every one of you.
May God continue to bless you in your lives and in the work that you do. Never doubt for even a moment that you are making a real difference in the lives of those you serve.
Yes, I sent a copy to the ED of the Medical Group as well as my health insurance provider.

Yes, I needed to write that letter in order to "let go". To "move on". You know, for "closure".

More importantly, I needed to express my gratitude to my doctors and nurse practitioners with whom I've had such a significant and important relationship over the years.
I believe that it was in the late 90s when I read a study on the life expectancy of people living with AIDS which had been conducted at Johns Hopkins. As I recall, there were four consistent factors to those who were living “long and well” with AIDS: compliance with medical regiment, being part of a supportive family/community, having a sense of spirituality and having a good relationship with one’s physician(s). 

Obviously, I don't have AIDS or a diagnosis with life-threatening implications, but I feel as if one of the legs of the four-legged stool of my health care has been removed. 

I'll rebuild it. I'll be fine.

I'm better, however, for having taken the time to write out a letter to each of my health care providers and expressing my gratitude to them.  On real paper.  Placed in a real card Christmas / Hanukkah / Kwanza / Generic 'Holiday' Card as appropriate, in a real envelope written in my handwriting with a real stamp on it and everything.

That, to me, is part of the "Spirit of Christmas". It's what Jesus is all about: Teaching us to be aware and alert and conscious and attentive. To be thankful. To make Eucharist from the common stuff of life. To take the humble mangers of our lives and build them into altars of sacrifice and praise. 

Call it part of my Advent Spiritual Discipline. 

Yes, it's beginning to feel a little bit more like Christmas.

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