Diagnosis

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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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I read a joke once about a husband’s preemptive strike in the bedroom.  He walks in holding two aspirin and a glass of water.  When his wife asks what it’s for he says it’s for her headache.  She replies “But I don’t have a headache.”  “Gotcha!”

Headaches are no fun, so we might as well get a little chuckle at their expense.  And if you suffer from sinus headaches, there might be quick and inexpensive relief your doctor hasn’t shared with you.

Listen, I have had allergies since I was small but sinus headaches have been rare.  That is, until I got my complete dental implants.  They have wildly improved my quality of life, but I have had more intense and regular sinus headaches as a result.  My surgeon had removed teeth prior to the implants and freely admitted he had been up in my sinus area.  He said I could see an ear nose and throat specialist if the sinus headaches became too much of a problem.  He tried to ignore my laughter as I told him I could fix this myself. Read more on What Your Doctor May Not Tell You About Sinus Headaches…

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Maybe the folks who continue to argue against stem cell research are just afraid their own stem cells could beat them at a game of checkers.

Listen, I want to live forever.  Not like in the song “Fame,” but like in the way that most of us would do anything to live.  Or like the guy who had to leave the country to get life-saving treatment for cancer of the trachea.  Now he is alive when everyone thought he wouldn’t be. It’s a treatment he couldn’t get in the States.  In the States, stem cell benefits are masked by misinformation and fear.

Okay, so I had a metabolic disease that threw me into a coma and nearly killed me a few times.  But here I am to talk about it.  I think about it every blessed day and I find myself grateful to this universal intelligence.  Yes, I am a theist. But I still live in a personal world where I would do anything to live. Read more on Stem Cell Benefits Masked By Fear and Misinformation…

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Sure, the malpractice system is broken.  And there are lots of suboptimal doctors out there.

I have told some what the correct diagnosis is and they have ignored me.  Some are too busy to take phone calls from me.  Institutions have refused to order tests that I’ve requested.

On the other hand, I have been lectured about the necessity for “cover your ass” medicine.  I could not practice it if I wanted to.  Nobody would pay for it.  In my specialty, I am always told to look for ways to cut costs while some patients cry to me they cannot afford their medicine.  We do our best. Read more on Capping Malpractice Damage Awards…

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Narcissistic men have raised cortisol – or physiological stress — from being these bully-others sorts. But women do not? Hmmm.

A narcissist is somebody who puts their needs above yours in any relationship.  I can count on one hand the times I have seen them in treatment.  They are “bullies” and we usually see their victims.

Cortisol – commonly known as the “stress” hormone — can be accurately measured with a mouth swab.  Because of this, people can do research — many of whom appear to be a great deal more open minded than doctors. Read more on Physiological Validation of Narcissism…

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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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