The Rich Doctor

You know the “rich doc”. He’s the one that plays golf every Wednesday, drives a fancy car, and always sports a suntan. Right?  Wrong.  Getting a medical education is a financial back breaker.  By the time the “soon to be rich” doctor graduates medical school, he is $200,000 in debt.  And his big payday after graduation is to work as a resident up to fifteen hours a day for seven days a week for a meager salary.  In fact, I spoke with a physician at the hospital the other day who told me he compared himself to his uncle who is an electrician.  In terms of income, he wouldn’t equal his uncle’s income until he is fifty-five.  And when they eventually go into practice they are buffeted by malpractice insurance, electronic medical records, personnel issues, and hospital requirements. What does this mean?  It means that these graduating doctors are not doing it for the money.  It’s because they are devoted professionals who are truly interested in the well being of their patients.  So, the next time you see the insurance bill it’s not about the doc.

The Internut

Don’t get me wrong, I’m a big fan of the internet, but with medical issues, sometimes it goes too far.  Patients seem empowered by its diagnostic potential.  When they hit the office, they often come with a sheaf of papers printed up from a website.  Sometimes, before I even have a chance to examine them, they hand me the print out and proudly tell me what their diagnosis is.  I am a patient person and try not to be dismissive.  My response is to smile and quietly ask them what medical school they graduated from.  Most of the time they laugh and the examination proceeds.  Sometimes they are put off by my comment.  I am not trying to be rude, I am merely trying to have them focus on why they came for my opinion.  When I finish, I look at their papers.  Sometimes they are right.  Most of the time it is a futile exercise.  Instead of discouraging them, I give them my diagnosis and then suggest that they to use the internet to make sure they are satisfied with my diagnosis.   Sometimes they don’t believe what I offered to them.  That is their choice.  A medical diagnosis doesn’t have to be complex, in fact it is often simple, like hearing loss from wax in the outer ear.  It can also be complex.  Trust your physician’s initial diagnosis.  If you are not getting a satisfactory answer, don’t hesitate to get a second opinion.

The Sinus Headache

This is one of the most overused diagnoses in medicine.  Where did it come from?  I think doctors are responsible.  Patients don’t like to hear, you have a cold, take two aspirins and call me in the morning.  Instead, doctors often give the patient doctor-speak and relate it to a real anatomic finding.  Sad to say, a sinus headache sounds better to the patient.  Unfortunately, sometimes, the patient is even given an antibiotic.  Don’t be fooled.  Unnecessary antibiotics can be serious, especially in the development of resistant superbugs.  No question there are sinus headaches, but there is an algorithm to describe it.   A real sinus headache has a fever, yellow nasal discharge, point tenderness on the face, and a CT scan that shows evidence of sinusitis.

A common virus can cause a runny nose, muscle aching, a low-grade fever, and a headache.  Antibiotics won’t help. Allergies can cause a clear runny nose, no fever, and headaches.  Antibiotics won’t help.  Grinding your teeth or TMJ dysfunction can cause headaches that may mimic a sinus headache.  Antibiotics won’t help. Migraine headaches cause one-sided headaches, visual disturbances, and a runny nose.  Antibiotics won’t help.  My advice: be an informed consumer and be careful before taking un-needed antibiotics.

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The Castle
2500 Castle Dr
Manhattan, NY

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