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.

Mama Knows Best

There are a lot of things your mother told you that you nod your head, smile and say, “That’s a good idea, Mom.”  Walking away you smile to yourself how old fashion old people are.  Guess what, your mother knows a lot more than you think.  Let’s look at a couple.  “Nothing smaller than your elbow in your ear.”  This is a biggy.  People are obsessed with putting things in their ears – pencils, hairpins, keys, and Q-tips.  I can’t tell you how many patients I’ve seen in my office have damaged the eardrums, ear canals, and hearing using these “instruments”.  Or how about, “You can pick your friends, but you can’t pick your nose.”  If you want to get a nosebleed or a nasal infection, pick your nose.  Sometime the infection can be serious, like MRSA or the development of a “hole” in your nasal septum.  Lastly, “A minor operation is an operation done on someone else.”  Remember this one when you are contemplating a “routine operation”.  Always be careful on having surgery unless it needs to be done. So, what is the takeaway from all this.  Sometimes, the answer to good health is listening to Mam

Talk the Talk

Have you ever been frustrated having a conversation with your doctor?  There is a reason for this.  It’s called the electronic medical record or EMR, the computerized version of your visit.  In theory it sounds like a good idea, get all of your information on a computer screen and make it accessible and transferrable.   There is a deeper reason for this, making sure the healthcare professional is asking all the questions to verify his billing code.  To accomplish this the doctor has to continually type into the computer without looking at the patient.  Pretty personal, huh?  It destroys one of the most important parts of the doctor/patient relationship the personal conversation.  This is the time you learn things that can be very important about your patient.  For instance, I saw a patient for some ear pain.  He was an outdoorsman and I always enjoyed listening to his adventures.  On this particular day, he told me about this huge fish he lost ice fishing.   He said the cold weather made him cough.  I asked him if he ever smoked, and he said he had for twenty years but stopped.  I mentioned to him that most docs get a CT scan of the chest with that type of history.  He casually accepted the test and I saw him back a week later.  Guess what the CT scan showed?  Not cancer, but a calcium deposit on the left side of the chest.  I said this could be in his heart and gave him the name of a cardiologist.  I saw him back a month later.  He told me that the cardiologist found a 95% blockage of his left anterior descending coronary artery.  They call it the “widow maker”.  After they put a stent in, he was fine.  All because he had a conversation with his doctor about fishing.

A Dreamer

I think I was born to be a doctor.  It was a perfect career, because I was a science kid.  Math, biology, physics, and chemistry all came easily to me.  The arts were for other people.  When it came to writing, I was lost, and I think my teachers knew it.   I knew that but there was something they didn’t know.  I had an imagination.  Like the time my mother sent me out to burn the trash in the alley.  I saw waves coming off the burning oil can.  Intuitively, I just knew no one else could, because I had mystical powers.  Maybe I was Superman.  Regardless, as I grew older, no one praised my writing skills.  I was persuaded it was a waste of time.  So, I pointed myself to medical school and found that, in spite of the rigorous discipline it took to get there, I liked being a doc.  But something was missing.  The imagination never left me.  I loved telling stories to my friends, and they seemed to like listening to me.  Then one day when I finished recounting to a friend on something that had happened, she said you should write a book.  It was a startling statement.  I had never thought of doing it because I was a science guy, not a writer.  With that simple piece of advice, it was as if someone had given me permission to do something I thought was out of my reach.  And so, started my writing career.  Never give up on your dreams.

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