I don’t think I know anyone who can say they’ve never had a headache. And some have them often enough that they’re given about as much attention as a hiccup or a sneeze. But sometimes, a headache can be more than a headache.
I was in Minneapolis doing a rotation in neurology through a university headache clinic. A lot of people were referred through primary care physicians and some even from other neurologists. They were strange headaches to them, but headaches that were frequently seen by these university neurologists in Minneapolis.
I remember seeing a professional football player who had cluster headaches with such intense pain that it brought him to tears. There were many middle aged and older people, but there’s one girl I remember in particular. She was 23 years old and was given to me to see with no pre-screening. Read more on Headache or Tumor…
Ever heard of capitation? In healthcare, it can mean that a clinic makes more money by following more patients. Payments are per person, rather than per service. I guess I shouldn’t be surprised, then, that they refused to dismiss this guy from their care.
He was a 32 year old young man who was diagnosed with an anxiety disorder. He had been working independently as a pool cleaner but he couldn’t stand it anymore. He was always nervous. As a matter of fact, this man was nervous about everything he did. Perhaps it was a generalized anxiety disorder, but surely something a great deal more. He wasn’t having panic attacks, and he exhibited far more than the usual one or two things found in generalized anxiety disorder.
I tried to start him on some medications — as much as I didn’t like the medications he had been started upon. He had been given regular Xanax in slowly increasing doses. As nervous as he was, he wasn’t stupid. He said, “It’s really funny. The medication makes me sleep, but it sure doesn’t stop me from being nervous.” Read more on The Nervous Pool Cleaner…
I have spent as little time as possible on the staff of hospitals. The interface between doctors and administrators has always seemed to be dominated by petty politics. People are interested in money, and secondary to that, some vague sort of reputation or power.
A large and prestigious Midwestern hospital used to have a certain kind of meeting every few months. This hospital had only the vaguest of University associations — just enough to make it look academic and research oriented. I knew perfectly well it was neither.
It was a luncheon meeting of the medical staff and a few administrative types — uncommonly well-catered. There were about 25 folks, but only two other women who looked as uncomfortable as I was.
The meeting was to discuss certain hospital statistics, including some case details. As the meeting agenda was passed around, the head of the hospital reminded us of the meeting “rules.” We were gently reminded that no recordings were permitted and neither were extraneous notes. We each received an agenda, which were carefully counted out as they were distributed. We were told that at the end of the meeting they would be collected — and counted — before any of us could leave. Read more on Hospital Accountability Is An Ideal (Not Always Reality)…
It’s always convenient to have somebody else to blame, but I’m afraid that doctors are mostly to blame on this one. They call them “hospital acquired infections” and they are killing patients who should otherwise be just fine.
Like this writer’s father, who walked into a ritzy New York academic hospital with what used to be called “walking pneumonia.” He went on to die of – you guessed it – a “hospital acquired infection.”
Walking pneumonia is basically an infection of the lungs that may cause a cough — or even a painful cough — and makes it hard to breathe. Typically, it does not hurt the patient’s general well being enough to make her or him an invalid, a hospital inpatient, or certainly not an intensive care inpatient. This guy’s dad should have easily made it home. Read more on Medical Science Develops Harmful Products…
Seems to me that doctors are starting to think like insurance companies.
And it seems to me they are making decisions for the wrong reasons.
No. This is the wrong way to think. Read more on Unnecessary Medical Tests…
“Concordance.” That means doctor and patient wanting the same thing. In psychiatry we call it a “therapeutic alliance.” We work for it — assuming we have the time. But if the time is not there, on some level we all know that nothing will happen.
Leave it to the pharmacists to at least touch on a reason for “lack of concordance” that nobody seems to discuss. “With increasing numbers of medications shown to do more good than harm when taken as prescribed, low compliance is a major problem in health care,” reads an unpretentious sentence in the abstract.
And people wonder why there is no “trust” between patient and doctor. Read more on Trusting Your Doctor…
“There’s no such thing as a free lunch” – but there are plenty of free samples when you go to your doctor’s office for a prescription.
Be wary of free samples.
What? Am I asking you to look a gift pill in the mouth? Drugs are expensive, even the co-pay for drugs can be expensive. What’s wrong with getting a freebie?
First, the drug companies that make them do not give them out forever. Usually, they give out samples on a newer drug as part of a launch – kinda like a “grand opening” at a store. The prices are really great that first week and it gets you trained to go to that store.
Another reason drug companies discontinue free samples is that, very often, the insurance companies or government programs may not have them on the “formulary” (the list of available drugs) right away. As soon as the relevant insurance (mediCal in California) starts paying for them, you can say “Bye-bye” to free samples. Read more on Free Samples Might Carry Heavy Cost — Health…
The first thing you get when you “in-process” into the Army — at least the first thing I got — was dog tags. I had to decide if I wanted my religion on my dog tags, and tell the lady at the typewriter what kind of funeral I wanted. For all my ups and downs, I decided I would die Jewish, and get a traditional funeral, and make the Army find a rabbi. I could put that on them with no thought of guilt. I had the option of putting my faith on my dog tags. I was warned, in the most dispassionate possible way, that some enemies of the United States of America would kill me if it said “Jewish.” I chose a resolution some co-religionaries had chosen in World War II. I chose “Hebrew,” feeling more in common with the ancient faith than with the heavily politicized modern tripartite (Orthodox, Conservative and Reformed) ways of filling congregations.
Then I got my “Geneva Convention” card — Lavender and black and white, it said in 22 languages, roughly the equivalent “Don’t kill me. I’m a doctor.”