I saw one of my brink-of-divorce patients yesterday. I have plenty of them. They tell me how horrible their men are but they seem mysteriously held to this person who is generally, by their descriptions, a devil on the way to hell so he can commiserate with his demonic colleagues. He devalues her in front of the children or cheats on her of has more drugs in the medicine cabinet than your average pharmacy except they are not the kind where insurance pays for the prescription. And they tell me for all the world about what sounds like an incurable lout who has declined, avoided, or failed every available treatment for a condition she is convinced he is somehow enjoying or profiting from.
I had a colleague, allegedly my preceptor, who would treat woman patients by writing on a small piece of paper the words “Divorce the bastard,” and simply, but ceremoniously, handing it to her. Me, that’s not my style. I would tell her, “You need to know where you came from, who you are, and what you believe. You need to know the situation you are in. And you need to know what you want for the future.” My current patient’s marriage counselor (she still showed up for sessions. Her husband had stopped) told her to weigh the “pros and cons.” Rational. Great. Read more on Divorce Is Not Death…
I just did one of those continuing medical education courses — in psychiatry, my very own field no less. It says that people who get a bout of depression are twice as likely to get a bout of back pain. What I read is a meta-analysis. That means some clever person who probably needed the publication on his (or her) resume did a statistical (and critical) analysis of research other people did. This a noble attempt to asymptotically approach “the Truth and the Light” on a subject. It is also a delightfully erudite way to do research and get a publication without using a lot of time and money that the author had to scrape up.
Look, the relationship between depression and low back pain is something I have seen from every imaginable angle. As a neurosurgeon, it did not take me terribly long to figure out that surgery was not a very good solution for back pain. Of course, we rigorously restricted ourselves to operating focalized sciatica. Cases where we could reasonably infer that an intervertebral disc seemed to be compressing a distinct (lumbar) nerve root that formed part of the sciatic nerve (plexus) that descended from the spinal cord to the leg and foot. There was the physical examination. If someone were lying flat on his (more rarely, her) back and their straight leg was raised toward the ceiling, pain would appear on a trajectory anatomically consistent with one of those nerves. This was the sign of Laseque. And we took it to be as solid as money in the bank. Read more on Depression and Low Back Pain…
Filed under depression, Disease, Doctors, medicine, News, Research by on Jul 19th, 2017. Comment. 
How low can you go? Stealing drugs from veterans? I am a proud U.S. veteran, prouder still to consider myself a veterans advocate. I’ve seen too many veterans in pain. I don’t think people who haven’t been there realize how much war is hell. They were stolen by a doctor. A credentialed anesthesiologist.
I remember when I was first hitting dating bars and such, it was not uncommon for a non-doctor to wear a T-shirt that said “trust me; I’m a doctor” that I guess was supposed to induce young women into the early stages of romance. Read more on Stealing Drugs And Eliminating Health Care…
Filed under Alternative Medicine, Doctors, Education, medicine, News, politics by on Jul 18th, 2017. Comment.
She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious. She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.
Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise. I tend to send even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.” For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.
Filed under Diagnosis, Disease, Doctors, End Of Life, Family, life, medicine, News by on Jul 12th, 2017. Comment.
It was not political correctness, but rather a deep and visceral thirst that has driven me to reach out to people who are different — very different from myself. Being brought up Jewish (traditional eastern-European Jewish Ashkenaze) is not all of who I am, not even close to that, but it is the raw clay out of which I have been sculpted in America. Canada is different. A pharmacist I worked with in Edmonton, Alberta, Canada was well-traveled and told me how it was different from America. “America is a melting-pot — Canada is a salad.”
Americans really seem (or at least seemed) to want to be Americans. I remember the emigrants to America joking about learning about baseball, the bat being likened to a chicken drumstick, a “pulkeh.” To understand and love baseball was a very important part of being American. Part of the lore of the time was that it was possible to unmask a foreign spy who spoke perfect English if you asked him who had won the last world series and he did not know. Very different from Canadians who kept their own traditions and their own languages in tiny equivalents of their native lands around Edmonton where ethnic traditions were publicly exalted, in places called “little Germany” or “little Italy.”
Filed under News, politics by on Jul 7th, 2017. Comment.
I find a lot of things I like in the New York Times. This article resonated with me as few others. First, there is the purpose of the human profiled. Changing medicine into data science? God save us all.
Sometimes I feel the best thing I do for a patient is to be human. Just to have the pretension (a pretension which I do not take lightly) of being one human being in a room with another human being, trying to make them feel better. This does more, I think, to make most of my patients “better” than all of the pills I have spent years studying about. All those years studying normative use of medications on large populations of humans. And they work enough to please the powers that be.
Filed under medicine, News, Psychology, Research by on Jul 3rd, 2017. Comment.
The first psychiatric office I rented had two mildly to moderately comfortable chairs in the center, facing in the same direction. We all know that psychiatry started with the patient lying on a couch, staring at the ceiling, and remains that way in “New Yorker” cartoons. Those of us in the know, we know that Freud was actually a pretty shy guy, not liking to stare his patients in the face, but rather letting their subconsciouses roam freely while staring at the ceiling.
We also know that the subconscious is a scary entity, full of (imagined) murder and rape and pillaging and such. The ideal when I trained was to sit face-to-face across a desk from the patient. Nobody I know actually did that. The reality slipped into 90 to 120-degree angles, exactly like what the classical psychiatrist Harry Stack Sullivan recommended. Read more on High Tech-High Touch Psychiatry…
Filed under News, Psychiatrists by on Jun 21st, 2017. Comment.
Blue Cross of Georgia does not always want to pay for people’s visits to the emergency room. The question, clearly is what they pay for and what they do not. To a certain extent, there are alternatives now that folks saw rarely if at all in the past.
Alternatives like urgent care. In the trade we call it a “doc in a box.” Long waits are not uncommon — it is generally one doctor present at a time, with many nurses and technicians who have enough time to at least have an authentic — if brief — interpersonal relationship with the patient. Sometimes people get wheeled into such places. By definition, patients are usually ambulatory in a “walk-in clinic.” I have worked in such places that specialized in psychiatry, where you could see pretty much anything, although prescription refills were clearly dominant. Read more on Avoiding Emergencies In Georgia…
Filed under Doctors, Government, News by on Jun 16th, 2017. Comment.
I value those behind-the-scenes programs on TV, especially when they warn you of dangers that you may never know. Here is a little behind-the-scenes story that you will really want to read because it might involve you! One of my chief interests in making sure patients are not only treated properly but that all the safeguards and protections are observed.
Filed under Doctors, Government, Healthcare reform, News by on Jun 15th, 2017. Comment.
By now I think folks on the business management level of health care are at least aware that we Americans spend a lot of money on health care and seem to get very little in return. The author of a provocative piece in Forbes thinks “unnecessary health care” is our worst problem. This statement hit me broadside. This does seem pretty true for the example she chose, even though it is decidedly outside of my field.
As far as I can figure, this sort of planned emergency delivery she talks about brings nothing to obstetric science or to the quality of human life whatsoever. Around the net, I see estimates of how much of what we do is actually science. It usually comes out as about 50 or 60%; maybe a little over half. This is happening as part of what seems to be a massive drive towards EBM, known as “Evidence Based Medicine.”
Filed under Government, Healthcare reform, News, Psychiatrists by on Jun 12th, 2017. Comment.