how much are you earning?

[Gailete]

As to the opening post of this thread, I do make income on line from my sewing and craft store as well as small amounts from Google AdSense. I would prefer not to say how much I make, but I can say it is way down from what it used to be unfortunately. So I have some other thoughts on things to do. I just run out of time and energy to boost my business the way I would like to.

[~bs]

You make medicine sound so simple that anyone with two legs could do it. When working I was an RN. I remember many times after doing my mini 'physicals' on my patients at the beginning of the shift and coming back to chart what I found. I would also see what other nurses and the docs had charted. I found it interesting that many times I was charting things like heart murmurs, the bruits & thrills on a dialysis site, etc. Did the nurses not notice? Did they not check? Did they not care? I don't really know. I was glad to see that when I heard a murmur the doc did as well! So your saying anybody can do it, you'd better be hoping you got a nurse that graduated near the top of the class instead of the bottom. I can't imagine doing all those things needed by remote or in a booth. So many things can be missed by not paying attention to the right things. I give you the prime example of the lady we had that people decided she had scabies and were trying to treat her for that. I came in looked around her room and discovered the woman was into snuff and had it all over herself and her bed. I don't suppose you would see that over video.

I think due to the spiraling cost of healthcare, more of these changes are going to come down the pipeline though. Video/phone conferencing with hospital staff may eventually become the norm rather than the exception. When I was a kid, and had a skin condition, I could simply go see a dermatologist. Nowadays, they run me through a gen practitioner, and if he deems it necessary, I can see the dermatologist. Everything the companies do is in the name of saving money and containing costs. More and more nowadays nurses are taking responsibilities once handled by doctors. In some hospitals/clincs, you won't even see a gen practictioner unless the nurse determines the issue is serious enough for you to see one.

[disneysteve]

I think due to the spiraling cost of healthcare, more of these changes are going to come down the pipeline though. Video/phone conferencing with hospital staff may eventually become the norm rather than the exception. When I was a kid, and had a skin condition, I could simply go see a dermatologist. Nowadays, they run me through a gen practitioner, and if he deems it necessary, I can see the dermatologist. Everything the companies do is in the name of saving money and containing costs. More and more nowadays nurses are taking responsibilities once handled by doctors. In some hospitals/clincs, you won't even see a gen practictioner unless the nurse determines the issue is serious enough for you to see one.

A few comments on this:

1. "Everything the companies do is in the name of saving money and containing costs." That's how they spin it but the reality is just the opposite many times. Let's say you injure your knee and come to see me. I want to order an MRI, but no, the insurance company won't allow that. First I need to send you for an x-ray. Then I need to send you for 4 weeks of physical therapy. Only then might they allow the MRI. If they still deny it, I then have to send you to see an Orthopedist and they order the MRI. So if they would have approved my initial request, they would have just paid for the MRI and one visit with me. Instead, they end up paying for at least 2 visits in my office, an x-ray, 4 weeks of PT, one or more visits to the Ortho, and still paying for the MRI anyway. Where exactly did that save money?

2. Dermatology is actually one place where telemedicine makes a lot of sense. The "exam" in many derm cases is 99% visual observation. That's something that could be effectively done via camera. When I was in training, I worked with one dermatologist who was an old, morbidly obese guy. He would literally sit in a chair and patients would come in to the exam room one by one. He never touched them. He just asked some questions, took a look at their skin, and treated them. That could easily be done remotely.

3. It is true that advance practice nurses (nurse practitioners and physician assistants) are doing many tasks formerly done only by physicians. That's really been driven by two factors: cost cutting (NPs and PAs work for less than MDs and DOs) and the growing shortage of physicians, especially in primary care. Where I work in urgent care, we have both physicians and APNs on staff and we work side by side with each other. I have absolutely no problem with that. We can't hire either doctors or NPs/PAs fast enough to keep up with our demand.

[rennigade]

You make medicine sound so simple that anyone with two legs could do it. When working I was an RN. I remember many times after doing my mini 'physicals' on my patients at the beginning of the shift and coming back to chart what I found. I would also see what other nurses and the docs had charted. I found it interesting that many times I was charting things like heart murmurs, the bruits & thrills on a dialysis site, etc. Did the nurses not notice? Did they not check? Did they not care? I don't really know. I was glad to see that when I heard a murmur the doc did as well! So your saying anybody can do it, you'd better be hoping you got a nurse that graduated near the top of the class instead of the bottom. I can't imagine doing all those things needed by remote or in a booth. So many things can be missed by not paying attention to the right things. I give you the prime example of the lady we had that people decided she had scabies and were trying to treat her for that. I came in looked around her room and discovered the woman was into snuff and had it all over herself and her bed. I don't suppose you would see that over video.

You just made some great arguments with the flaws in doctors/nurses. How did you chart the heart murmurs? Do you have some magical ability like xray vision? My guess is they were being monitored by some sort of machine? Why isnt there something in place like a computer program to record/spit out that data instead of relying on someone to manually read them? If there is something abnormal with the heart beat couldnt an error display on the screen stating such?

The problem with doing something a certain way for so long is that you cant possibly see another way of doing that very thing. The old saying "if its not broke dont fix it." Modern medicine is so new. No one can wrap their heads around what its going to be like 100 years from now let alone 500 years from now assuming we dont blow ourselves up or an asteroid doesnt hit us.

For thousands of years people had to use horses for transportation. The first car was invented in the late 1800's. Then came the first flight in 1903...59 years later we sent people to the moon in a metal tube. Now you can travel around the world in less than a day in a cylinder with wings. Is it really such a stretch to think a patient couldnt be hooked up to a device and a doctor monitor them from across the globe?

[Gailete]

You just made some great arguments with the flaws in doctors/nurses. How did you chart the heart murmurs? Do you have some magical ability like xray vision? My guess is they were being monitored by some sort of machine? Why isnt there something in place like a computer program to record/spit out that data instead of relying on someone to manually read them? If there is something abnormal with the heart beat couldnt an error display on the screen stating such?

I think your problem is that you don't know or understand medical things. How did I chart the heart murmurs when I noted them? With my own hand in pen on paper although now it would be on a computer. It doesn't take any magical xray vision to hear a murmur because you can basically only see it on an echocardiogram, a specialized test that is not done at all via a video conference. A trained nurse can HEAR it via her stethoscope. If she notes that the doctor hasn't noted it, she brings it to her charge nurse's notice to let the doctor know, or if you are the charge nurse like I usually was, I would be sure that the doctor was aware. Some murmurs are not problematic others can be, so you don't blow off something like this. Not every patient in a hospital is being monitored for what their heart is doing - that would be horrifically expensive. I was in the hospital ER myself about a month ago after a bad fall and what I could see of the cardiac monitor it wasn't showing MY murmur. DisneySteve would be more aware of that, but I don't think the machines are set up for that. Many people have heart murmurs. If a new one is found it is generally through the sharp ears of a nurse or doctor, PA, RNP. The same can be said for an aortic aneurysm, and other interesting things that a nurse on the ball finds and works with the doctor to be sure that the best care is being offered to the patient. It is vitally important for a doctor or nurse to be hands on with a patient, even if it is a visiting nurse that has done the physical assessment part of a video conference. Something as simple as noting the patients skin color, if the whites of the eyes are yellow, things like that which can be distorted by the camera and lighting conditions. Sometimes even the smell a patient is giving off helps to diagnose a patient. Like Emeril used to say there is no smellavision. It would take, I believe nurses with specialized training and great powers of observation to make this work and if I was the doctor I would want to know them personally in a professional capacity and so would be able to judge for themselves whether the nurse was competent enough for the extra things she/he has to observe and report.

[disneysteve]

Is it really such a stretch to think a patient couldnt be hooked up to a device and a doctor monitor them from across the globe?

I don't think that's a stretch at all. To use the heart murmur example, a murmur is a sound generated in the heart when blood is flowing across an abnormal heart valve. Today, we diagnose murmurs by putting a stethoscope on your chest and listening, but surely, we could just as well put a microphone on your chest and the person listening could be anywhere in the world.

What you're still missing, though, is that medicine isn't an exact science. Your body is not a machine with standardized parts, gears, belts, and circuit boards. We can't just plug you into a diagnostic device, get a read out of what's wrong, and know exactly how to fix it.

As both Gailete and I have explained, there is a lot more to it when dealing with humans. Appearance, tone of voice, odor, body language, information from family and friends, and other factors all play into the assessment and treatment plan.

So surely some of the "mechanical" parts of the process can be automated (a lot already have been) but replacing the human parts of the process will be far more difficult.

[Poppasmurf]

As to the opening post of this thread, I do make income on line from my sewing and craft store as well as small amounts from Google AdSense. I would prefer not to say how much I make, but I can say it is way down from what it used to be unfortunately. So I have some other thoughts on things to do. I just run out of time and energy to boost my business the way I would like to.

Do you use AdSense to bring customers to your craft store?

[Gailete]

Do you use AdSense to bring customers to your craft store?

No, I have tried Adwords when Google gave me free credits to do so but I never could connect even one sale to using it. Adsense are the ads that Google displays on my blog and in my store. Which is the opposite of Adwords. My inventory at my store is huge as I sell mostly sewing patterns, and with arond 8000 items for sale, rather difficult to focus where to send the ads, even if I try general catagories. I tried the Adwords several times and I just either wasn't doing something right (entirely possible) or I couldn't come up with enough enough money to make the campaign worth it (again entirely possible but who wants to put out several hundred dollars to sell a couple of patterns for $10. Not too cost effective.

I do promote in other ways however.

[greenskeeper]

How much do I earn? Significantly more than I spend (and I'm far from rich)