It’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient. The general consensus, unsurprisingly, was that the first was far too cheeky — not to mention insulting — to effectively convey the necessary information. The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send the …
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada.
Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …
I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop …
“Am I a hypochondriac?”
It’s a question I hear with quite some regularity, almost never from people who suffer from bona fide anxiety disorders related to their health.
No, the fact that all you have is a simple upper respiratory infection — the common cold — instead of a potentially lethal strain of H1N1 avian flu does not qualify. Not when your response to my reassurance is relief. That’s completely appropriate, and …
There’s a patient I don’t like very much. I’ll call her Mrs. X.
Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur.
Every time she makes an appointment, …
What if a big TV station came out with a blockbuster story claiming that infant car seats were implicated in cerebral palsy (CP)? After all, something like 99.7% of babies diagnosed with cerebral palsy had been brought home from the hospital in a car seat. In fact, every single time they went anywhere in a car, they were strapped into them. That’s …
I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back.
Let me explain.
A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing …
I had a silver-and-gold Passover. Hearkening back to the old Girl Scout song I learned from my mother:
Make new friends, but keep the old;
One is silver and the other’s gold.
With no space or equipment to have a seder myself, I was nevertheless the lucky recipient of not just one, but two invitations. The gold was thanks to a quarter-century-plus friendship; the silver was from a family we met the week before …
Round and round and round we go yet again. The system is broken. Do something. Health care reform!
“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.
Quality is very much in the eye of the beholder, and …
I do not provide health care. What we physicians do is practice medicine, and what we do for patients is called medical care.
No one says, “I want some health care.” What they think is, “I don’t feel well. I want to see a doctor.”
People get sick and they get hurt. It’s true that many these conditions occur as a result of things they do (smoke, eat junk food, drink too much alcohol, …
The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food.
He lived alone, hated his job, saw few people, had no friends — so he told me at every visit. His visits …
I just didn’t like the looks of him.
It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in …
The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.
The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of …
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“Do you mind telling your legions how long you intend to work?”
Certainly. The short answer is, “Indefinitely.”
The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts.
First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my …
I am furious.
For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don’t do it at all.
The United States Preventive Services Task force reviewed the literature and …
Once upon a time, women with suspicious breast masses were put under general anesthesia for surgery not knowing whether they were going to wake up with or without their breast. If the biopsy showed cancer, the surgeon went right ahead with the mastectomy. No time to lose. It’s cancer, you know. Breast reconstruction? Don’t be silly. No one does that. You should feel lucky to be alive!
Can you imagine? Doctors …
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Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean.
Specialist’s recommendation (ortho, seen for fracture):
Frequent falls resulting …
There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against.
I received the following mailing:
We want you to screen our members for cancer. Please do these things:
- Call the member to discuss colorectal, skin, and prostate …
It’s happened at last: the epitome of ridiculousness in the already pretty ridiculous world of drug prior authorizations. I wish I could say that I made this up.
I got a fax from a pharmacy requesting a prior authorization for a brand name drug called Protonix, one of a family of medications used to treat ulcers, acid reflux, and other forms of tummy ache. This happens. Because there are five different …
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A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.
As I read her screed against the ND who conducted a cursory history and exam before checking off $750 worth …
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