Doctors

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Many illnesses have support groups and even official organizations that help sufferers and families understand and cope with that illness.  You know, like The Arthritis Foundation and the Diabetic Association. Read more on “Accomodating” or “Taking Advantage Of?”…

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As you may have heard me say before, not all doctors are saints.  Patients often tend to revere doctors — of which I heartily approve! But as with any group there are always bad apples.  And if not all of the apples are bad, there are also incompetent ones.  Sometimes they are well-meaning.  Sometimes they are just hoping nobody catches on so they don’t lose their livelihood. But I am definitely NOT anti doctor, anti medicine, anti prescriptions or anti anything else.  I know there is good and bad everywhere. Unfortunately, in medicine, the bad or the incompetent can mean the death or suffering of innocent people.

Read more on What? You Missed The Newsletter?…

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I saw one of my brink-of-divorce patients yesterday.  I have plenty of them. They tell me how horrible their men are but they seem mysteriously held to this person who is generally, by their descriptions, a devil on the way to hell so he can commiserate with his demonic colleagues. He devalues her in front of the children or cheats on her of has more drugs in the medicine cabinet than your average pharmacy except they are not the kind where insurance pays for the prescription. And they tell me for all the world about what sounds like an incurable lout who has declined, avoided, or failed every available treatment for a condition she is convinced he is somehow enjoying or profiting from.

I had a colleague, allegedly my preceptor, who would treat woman patients by writing on a small piece of paper the words “Divorce the bastard,” and simply, but ceremoniously, handing it to her. Me, that’s not my style.  I would tell her, “You need to know where you came from, who you are, and what you believe.  You need to know the situation you are in.  And you need to know what you want for the future.” My current patient’s  marriage counselor (she still showed up for sessions.  Her husband had stopped) told her to weigh the “pros and cons.”  Rational.  Great. Read more on Divorce Is Not Death…

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I just did one of those continuing medical education courses — in psychiatry, my very own field no less. It says that people who get a bout of depression are twice as likely to get a bout of back pain. What I read is a meta-analysis.  That means some clever person who probably needed the publication on his (or her) resume did a statistical (and critical) analysis of research other people did. This a noble attempt to asymptotically approach “the Truth and the Light” on a subject. It is also a delightfully erudite way to do research and get a publication without using a lot of time and money that the author had to scrape up.

Look, the relationship between depression and low back pain is something I have seen from every imaginable angle. As a neurosurgeon, it did not take me terribly long to figure out that surgery was not a very good solution for back pain. Of course, we rigorously restricted ourselves to operating focalized sciatica.  Cases where we could reasonably infer that an intervertebral disc seemed to be compressing a distinct (lumbar) nerve root that formed part of the sciatic nerve (plexus) that descended from the spinal cord to the leg and foot. There was the physical examination.  If someone were lying flat on his (more rarely, her) back and their straight leg was raised toward the ceiling, pain would appear on a trajectory anatomically consistent with one of those nerves. This was the sign of Laseque.  And we took it to be as solid as money in the bank. Read more on Depression and Low Back Pain…

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How low can you go? Stealing drugs from veterans?  I am a proud U.S. veteran, prouder still to consider myself a veterans advocate. I’ve seen too many veterans in pain.  I don’t think people who haven’t been there realize how much war is hell. They were stolen by a doctor.  A credentialed anesthesiologist.

I remember when I was first hitting dating bars and such, it was not uncommon for a  non-doctor to wear a T-shirt that said “trust me; I’m a doctor” that I guess was supposed to induce young women into the early stages of romance. Read more on Stealing Drugs And Eliminating Health Care…

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She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious.  She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.

Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise.  I tend to send  even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.”  For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.

Read more on Don’t Ignore Chest Pain…

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Blue Cross of Georgia does not always want to pay for people’s visits to the emergency room. The question, clearly is what they pay for and what they do not. To a certain extent, there are alternatives now that folks saw rarely if at all in the past.

Alternatives like urgent care.  In the trade we call it a “doc in a box.”  Long waits are not uncommon — it is generally one doctor present at a time, with many nurses and technicians who have enough time to at least have an authentic — if brief — interpersonal relationship with the patient. Sometimes people get wheeled into such places. By definition, patients are usually ambulatory in a “walk-in clinic.” I have worked in such places that specialized in psychiatry, where you could see pretty much anything, although prescription refills were clearly dominant. Read more on Avoiding Emergencies In Georgia…

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I value those behind-the-scenes programs on TV, especially when they warn you of dangers that you may never know. Here is a little behind-the-scenes story that you will really want to read because it might involve you! One of my chief interests in making sure patients are not only treated properly but that all the safeguards and protections are observed.

Read more on Informed Consents Are Often Skipped…

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Too many Americans can’t afford to and simply do not–take their medicines as prescribed. That estimate is based on information from the (American!) Centers for Disease Control). I have had patients come into my office who take their medications –in both cases, for life-threatening infectious diseases — only every other day, simply because that is all they can afford. I explained to each one individually the idea of the half-life of a drug. They only stay in your body for a certain length of time, then they leave your body in waste products.  That is why taking a drug every other day is not really effective. They both gave me almost exactly the same response — It was all they could afford, and it was probably better than nothing. Read more on Big Pharma Is Capitalism Out Of Control…

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If you were alive and in America in 1971, you probably heard John Denver sing “Take Me Home Country Roads.”

The lyrics start:

“Almost heaven, West Virginia…”

Read more on Almost Heaven West Virginia …