Idiot Savant

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He was just 18. He had been followed by child psychiatry with a diagnosis of depression. He had long refused to take any pills.  As far as this poor, agricultural county was concerned, I was just seeing him so I could bill MediCal and fatten up the county coffers. The previous psychiatrists had simply noted he was depressed, was not suicidal, and refused any participation in his own treatment.

He was a young man of few words, with a common Hispanic name.  He sat there and twirled one of his lush curls. It became pretty obvious he wasn’t going to give me a complete history.  He said he would never take pills, not ever. To his credit, he did say I could talk to his mother, if I wanted to, but he had to be in the room and hear what she said. Someone brought her to me, from the waiting room.  She spoke only Spanish; fine with me. I learned my Spanish mostly from my patients, who in that time and place could rarely communicate well in either Spanish or English. His mother was charming, really grateful that I wanted to talk to her. She kept complimenting my clothes and elegance. I told her it was all thrift shop.  I doubt she believed me. Read more on Diagnosis From The Guts…

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When I was an undergrad at Boston University, I took a course in the department of sociology in “medical administration.”  I was compelled to understand the social context of medical practice, for whatever reason.  I remember little of the course itself.  There was a very attractive older woman sitting next to me who amused herself by “adopting” me, which she thought gave her a right to criticize my then overweight figure and poor clothes.

I remember more about her than I do about the professor, a wacky guy the university had seen fit to import from New Zealand.  He had published a couple of relevant papers down there, but was still pretty new to the American health care system.  He told us that New Zealand had lots of sheep and was a big wool producer.  He talked about this great wool magnate who had this neat wool mill — a big one — and how it was he actually became quite wealthy. This was someone who knew about the tremendously loud machines that were used to process the wool.  The wool mill owner decided to hire only deaf people.  They asked for little; generally, they had problems finding jobs.  They were really happy and thankful to be able to work, so they worked hard.  They did not have any kind of a problem with the very loud machines.

That struck me so much then that I remember the story now, 50 years later.  Even then, I already felt that I would be in some kind of a management position as a physician and could do something that clever, becoming as rich and powerful as that New Zealand guy.  The professor had said something about Americans not thinking that way. The opportunity has not really presented itself.

Probably the closest I ever came was when I was running the day treatment center at the Veterans Affairs Medical Center in Oklahoma.  I had a lot of schizophrenic gentlemen who were not rich in social skills, but many of whom liked computers better than people.  Certainly, they related to computers better than they related to people.  I tried to get them computers, maybe even a little training. Read more on How to Employ an Individual with Asperger’s…

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I Am A Doctor, But I Don’t Play One On TV

Personality-wise, the cranky and inconsiderate title character of the hit TV series House, MD are mirror opposites.  I actually LIKE people – especially people who need help (patients).

Obviously many people enjoy this series, since it is one of the highest rated. But for me, the challenge is to out-diagnose him.

In case you’ve never watched, the formula for each episode is a seemingly straight-forward illness, which (of course) is the wrong diagnosis.  The rest of the show is slapping another diagnosis on the patient, and testing the patient, which makes the patient worse.  Read more on Being Locked-In May Not Be So Bad For Everybody…