“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…
Filed under Doctors, medicine, News by on Dec 7th, 2011. Comment. 
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.”
Filed under Doctors, Education, News by on Sep 9th, 2011. Comment.
It’s been a while since I stated my core beliefs and give my reasons for taking up this patch of real estate on the Internet. Here is one that I produced just this very morning.
Filed under Doctors by on Aug 23rd, 2011. Comment.
The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight. She later admitted to being 380 pounds. I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge. The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began. She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church. Moreover, he was a Sunday school teacher. You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint. But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial. This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.
There was a trial, and she had testified. She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window. By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over. She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty. She couldn’t. She had a panic attack as soon as she entered the courtroom. She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her. I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…
Filed under depression, Diagnosis, Doctors, prescription drugs by on Aug 17th, 2011. Comment.
Several conversations fly into my mind, separated widely in time and space, about what college is supposed to mean and do. I remember one of the few social outings of my college years, a cocktail party with other advanced chemistry students and a few professors, where mostly everyone but me was drunk. We were at the house of a chemistry professor of Kiwi (New Zealand) origin, who was probably the drunkest of the lot.
Another chemistry professor asked me why I was in college. I told him, with sober placidity, that I was simply doing the things I had to do before I got to medical school — medicine being my passion. He launched into a tirade about how I was in college in order to learn. I should learn all I could about anything I could because this would be the last chance in my life to do so, before I went into that sickly-overblown trade school that is medical school, where I would be restricted to learning things that would make me more money. During my childhood, my father rhapsodized about his Harvard experience and how he wanted me to have one equally fulfilling — hopefully at Harvard. Growing up in Harvard it is not hard to generate negative feelings about perceived elitism, more financial than intellectual, dominated by a heavy veneer of snobbery, which my father joyously promulgated.
I was busy spending most of youth being overweight and thus largely a social pariah. Unfortunately, I got little recognition for these twin achievements – unlike the deliciously funny portrait of “Overweight Achievers” in Woody Allen’s film “Celebrity.” Read more on Is College A Waste of Time?…
Filed under Doctors, Education, News by on Jul 19th, 2011. Comment.
If you have a choice and are not involved in an emergency, you can improve your chances of coming out of the hospital alive if you time it right.
I have read lots of articles suggesting that mortality in American hospitals is higher around July 1, when a new group of trainees finish medical school and start in their hospital based clinical training positions. This is not just an aberration in the USA, but apparently is also true in the U. K, where the new training programs start on August 1. Another cause of in-hospital mortality has been identified — When nursing staff falls below certain target levels, patients die. I do recall that nursing schools, at least when I was close to such things, did not have the same kind of fixed scheduling for trainees that medical schools did. When nursing students were present, they always seemed to be observing and logging in time, although whenever they had procedures, they were more rigorously monitored than physicians. Read more on How To Get Out Of The Hospital Alive…
Filed under Disease, Doctors, News by on Jun 2nd, 2011. Comment.
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…
Filed under Asperger's, Autism, Diagnosis, Doctors, Research by on May 13th, 2011. Comment.
I wrote not long ago about the problem with sleep-deprived doctors. Now I feel I must tell you that the person you are relying upon to perform delicate surgery may be so depressed that he’s contemplating suicide.
Why surgeons? I used to be one and maybe I can shed some light.
Of course you can’t prove causality. Maybe just the fact that a person is a surgeon doesn’t mean he is at risk. The same statement about “we can’t tell if there is something causing this or if this is an epiphenomenon” can be a criticism of almost any study, the way those invited to critique this study have spoken.
There is a problem, and this only hints at it.
Filed under Doctors by on Mar 11th, 2011. Comment.
I remember my first time and I shivered with anticipation.
Resident Physicians Don't Get Much Sleep
A kindly matron showed me the tiny bed and told me with a wink that I probably would not get much sleep that night. It was an old bed and had seen a lot of use by a lot of people, but it would be special for me this night.
She was right – I was only able to steal a couple of hours of sleep. But it was what happened when I wasn’t sleeping – and my colleagues congratulated me and cheered me on. Read more on Sleepy Doctors — An Unnecessary Danger…
Filed under Doctors, News by on Jan 29th, 2011. Comment.