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…
Filed under Diagnosis, medicine by on Jul 2nd, 2012. Comment. 
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…
Filed under Diagnosis, medicine, Personality Disorders, Psychology by on Jun 7th, 2012. Comment.
“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…
I’ve written before about Dr. Milhaud — one of the professors in my French medical school. I really liked him.
He was practical and he was enough of a friend to come visit me when I returned to the USA for my general and orthopedic surgical residency staff at the Jewish Hospital of Cincinnati, Ohio.
Nobody else on my faculty at Amiens even thought of doing that. Read more on Why Use Medical Testing?…
Filed under Diagnosis by on Dec 15th, 2011. Comment.
I was trying to remember when prescription drugs were allowed to advertise on television (called “Direct To Consumer Advertising, or DTCA”). Fortunately, I didn’t have to bust my memory cells – I just had to “Google it.”
1995. The year all HHHHell broke loose. At least if you were a doctor.
Suddenly, patients could make their own diagnoses and prescriptions and just phone the order in to their doctor. At least, that’s how most patients thought it should work. And – hoo boy! – were they upset when it wasn’t quite that easy.
Comedian Dennis Miller has a hilarious line: “I divide medical practitioners into two camps. Those who will give me a scrip for Vicodin over the phone, and those who won’t.”
Hilarious if you aren’t a doctor, that is. Read more on RX Package Insert — Just Read It!…
Filed under Diagnosis, medicine, News, prescription drugs by on Dec 1st, 2011. Comment.
Most people don’t seem to understand how disability benefits work – and that includes doctors as well as patients. There’s a very good reason for that. The system is screwy.
Thinking that your own regular doctor might be prejudiced and just dish out disability benefits ad infinitum so you never have to go to work (Gee – where did the government get that idea?) the patient is sent to an outside doctor to do an evaluation.
I’ve done plenty of those in my day. I’ve done them for veterans and for Social Security and for worker’s comp and even such exotic things as employee plans for large corporations (such as GM and Ford) and unions (like the Railroad Workers). Read more on Diagnosing For Dollars…
Filed under Diagnosis, News by on Sep 30th, 2011. Comment.
Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers. He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.
The first class of drugs I think about, when I think of sudden death, are the stimulants. I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first. Doctors asked a lot of questions about chest pain, and administered an electrocardiogram. These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight. He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…
Filed under depression, Diagnosis, End Of Life, medicine, prescription drugs by on Aug 19th, 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.
I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of.
He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care. He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.
The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…
Filed under depression, Diagnosis, eating disorders, Stimulants, weight by on Jun 16th, 2011. Comment.
It is a sad fact of modern life that it takes tragedy to bring important information to the notice of the general public. In this case – the death of a young person participating in sports. Read more on Sports Dangers Are Too Often Revealed In Tragedy…
Filed under Diagnosis, Disease, News by on May 24th, 2011. Comment.