Doctors

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I recently got hold of a copy of Dr. Atkins’ Vita-Nutrient Solution; a book by the same Robert C. Atkins, M.D. who invented the “Atkins Diet” –mainly known as the low-carb diet.  I was impressed by his general erudition and review of the literature.  He had even visited with various luminaries of alternative medicine.  Here was a guy who was capable of writing a pretty complete vitamin and mineral prescription for almost any chronic illness that was part of an internal medicine practice.

In a section titled “My Own Transformation,” he tells how, when he was devoted to mainstream medicine, he found a diet that worked for him and for most folks.  He had found it in the Journal of the American Medical Association, which is perhaps the most mainstream medical journal that exists.  He wrote his first book about that diet.  He was shocked when a consensus panel from the American Medical Association was critical. After all, he had been relying on medical literature which had been reviewed by peers and validated in every way that academics respect and deserve when they have done work.  He started questioning these professional “edicts” and found himself squarely in the world of nutrition-based therapeutics. I have believed for a long time that most psychiatric disorders, maybe all, are the result of a genetically transmitted limitation of the ability to metabolize nutrients.  There is plenty of evidence for this. Read more on Yes, Virginia — Cannabis IS Medicine…

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The psychological ability to adjust to chronic medical illness is an area where there has been very little study.  Lately, I find myself working mostly with this population of people.  I’m noticing that some adjust very well and some do it very poorly.  It depends on a lot of factors.

The situation is clearest when the illness we’re talking about is back or neck pain.  Back pain, more than neck pain, has been clearly correlated to the presence of major depression.  If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.

Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make.  Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary.  Quite honestly, most back pain patients are in no way prepared to do this.  Mostly, this is because anything that is sedentary is going to require a higher level of education.  Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…

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I enjoy having friends, like just about everyone does. But that’s not why I’m in this business. When a patient needs help, I will do my best for them every single time.  And if a few colleagues get bruised egos along the way, so be it.

She was a 53-year-old woman, but I don’t think she even would have liked to hear me to refer to her as a woman.  We’re talking about someone who was short and stout and wore the kind of cap one would expect to see on a newsboy during World War I.  She wore a very male looking zipper jacket, and told me she had the name of the other woman to whom she had dedicated her life tattooed on the back of her neck.

Regardless of all this, her face was red and she was crying. She told me she was chronically suicidal and never thought about anything else.  Despite being medicated, her depression seemed to have gotten worse. Read more on What is there to Treat?…

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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…

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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…

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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)…

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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…

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This air traffic controller thought the pilot declaring an emergency was full of baloney.  I’m afraid the only baloney in his future might be the stuff he’s eating while he waits in the unemployment line.

I cannot be the only person who got angry reading this.  An airline sends an emergency plea for help to air traffic control down below.  The air traffic control decides that this is a hoax and does nothing.

The fact that everyone survives is not a defense — don’t even mention it. Read more on Crying For Help vs. Crying “Wolf!”…

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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…

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“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…

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