Good Grief on Voice America

My interview with Cheryl Jones on Voice America regarding my book: I Am Your Doctor And This Is My Humble Opinion.

Do Our Words Hit The Mark?

Loitering in the hallway of my son's school awaiting his parent/teacher conference, I completely forgot that the woman introducing herself and shaking my hand was an alcoholic.  I forgot that she had visited me in the office a decade prior for a consultation.  I forgot all of it.

What I remembered is that we had gone to high school together.  We had grown up in the same city, in the same neighborhood, on the same block.  We were never compatible socially.  She was gregarious and popular, and I quiet and introspective.  We may have nodded familiarly or said hello if we passed on the street, but nothing more.  We were acquaintances by proximity.

We exchanged pleasantries in the school hallway for a few minutes.  Our kids were of a similar age.  She looked happy.  Healthy.  I glanced at my watch and prepared to enter my son's classroom when she stopped me, and asked the question that I assume hand been hanging on her lips the whole time.

You don't remember, do you?

She had come to my office nearly ten years prior for a routine physical.  It was a mid-morning appointment, and as I listened to her heart I recognized the faint odor of alcohol poorly covered by breath mints.  I waited patiently till the end of the appointment, and then gently discussed with her my suspicions.

She was drowning in new motherhood.  Her job was taxing.  She was fighting with her husband.  The alcohol originally was meant to help her unwind at night.  With time, however, she was consuming more and more.  She was hiding her habits from her family and friends.

She was an alcoholic.

Her words cleared the cobwebs in the vaults of my distant memory. I remembered telling her that she wanted to face her alcoholism now for her children.  That she wanted to be healthy when they grew up and needed her.   I handed her a few brochures, gave her a few numbers, and scheduled up a follow up appointment.

I made her promise that she would get help.

As it turns out, she never came back to my office for the follow up.  But that morning she began a long successful journey toward sobriety.

Now, a decade later, she was thanking me for saying the words that launched that journey.

Years into the practice of medicine, I have spoken millions of words in the exam room and forgotten the majority of them.

I humbley hope that some others have similarly hit the mark.

MU With Or Without You

The whole thing was rather awkward.

I have to admit that I was nervous.  I perused the records before he walked through the exam room door.  These conversations were always difficult and felt out of place in the office.  But I had looked at the numbers over and over again.  There was a glaring deficiency that had to be corrected.  I planned to jump in right away, but we got sidetracked..

He wanted to discuss blood pressure.  His cholesterol numbers were slightly off, and we spent quite a few minutes discussing the difference between HDL and LDL.  I  readily counseled on diet and exercise as my mind drifted to the unpleasant conversation that only I knew was coming.  I wondered if I would ever get to my agenda.

During a brief pause, I thought I found my opening.

Unfortunately, he was just building up the confidence to talk about erectile dysfunction,  That's right, I was foiled by ED!  Again, I waited patiently and listened as he described in detail his current situation.   We discussed lifestyle modifications, medications, and finally the utility of blood tests for accurate diagnosis.

When he packed up his things to go, my face turned crimson.  I knew there was no escaping.  I started the conversation tentatively with a question.

I wonder if you could do me favor?

He looked at me quizzically as I tried to explain.  I described Meaningful Use and the reasons the government had enacted such policies.  I directed that he would get an email inviting him to join a patient portal so that he could access his medical information remotely including medicine lists, diagnoses, etc.

I told him that I was being graded on participation, and would suffer economic consequences if I failed to enroll adequate numbers of patients and have them message me through the system.  I begged, nay pleaded, that he would go home and sign up today.

He shook his head.  He had done this once before with the hospital and spent hours trying to sort through password problems before he gave up.  He swore he would never participate in such silliness again.

Besides, I never really look at that stuff anyway.  If I have a question, I just call you and you answer right away!

I have had a patient portal available for 2 years now.  To date, almost none of my patients have signed up for it even though they get email reminders regularly.

The outcry of late has been "No MU without Me"

Apparently what is meaningful to the government and even healthcare advocates, may not be to the average patient.

As I Lay Dying

As I lay dying

Open the windows and doors.  Welcome the wayward breeze, biting cold, tendrils of sun, or beating rain.  Worry not of the elements as they caress my motionless body.  Discomfort, after all, is for the living of which I am still yet a part.

Talk as if I am myself.  Even if I don't answer.  Argue and disagree as we are wont to do.  If you offend, I may curse you silently.  Wordlessly.  Or if you bore, I will likely ignore you altogether.

Weep and I will weep too.  Laugh and I will laugh with you. Pray and I will remain solemn.  Joke and my lifeless countenance will become that of the jester.

Place your hands on me.  Caress my fingers.  Cradle my chin and pinch my cheeks if the moment so moves you.

Fear not the skin of the dying.  It remains sensitive even after the rest of the body has long forgotten.

Invite my enemies to peer down upon me.  To dispel the last remnants of venom or perchance to regret.  My family and friends too.  Even those who I have long forgotten or have forgotten me.

Open my doors for all to see.

Except for the indifferent.

They are no longer welcome in my home.

Closing The Intimacy Gap. When Doctor/Patient Narratives Intertwine

From my book reading 4/23 at Bookends and Beginnings.

I Am Your Doctor And this Is My Humble Opinion.

Does Your PCP Feel Like A Doctor Anymore?

We both agreed that it was unfortunate.

I sat on Paul's living room couch with a computer perched on my lap as he recounted the events of the last few weeks.  His business flight was interrupted by severe spasms of cough and high fever.  He called me upon landing, and based on my advice, went to a local urgent care center.  After waiting for a few minutes, he was seen by a friendly and competent physician who diagnosed him with pneumonia.  Antibiotics were started, and he was given the name of a local physician to follow up with in a few days.

Paul was never the type to rest.  He took the antibiotics, and plowed through his business meetings as if he was completely healthy.  Luckily, the fever abated, and his cough resolved.  By the time he appeared in the physician's office, he felt much better.

The doctor was kind enough.  He peered down at Paul through a conservative pair of spectacles balanced precariously on the tip of his nose.  Although he appeared in his late fifties or sixties, he could type on the computer as agilely as his younger counterparts.  After listening to the chest and finishing his electronic note, he declared Paul cured, and got up to leave the exam room.

Paul stammered and sputtered for a moment, caught off guard by the briskness of the doctor's exit, and asked for advice about his colitis which the antibiotics had exacerbated.  The physician turned his head, and glared at his patient as the rest of his body was already leaving the exam room door.

You might want to consult a doctor about that!

Paul searched around the room thinking he was on a candid camera show.  But he found no cameras, no laughing audience, or genial host.

As he recalled the visit, sitting comfortably in his own home, he figured this was the doctors way of letting him know the conversation was over.

I agreed, but couldn't help but wonder if this physician felt like so many primary care doctors around the country.  He was overwhelmed by electronic medical records, rushed by a a waiting room full of grumpy patients, and reduced to a box checker, list follower, and specialist referrer.  He didn't have time to deal with the really complex problems anymore.

In fact, he no longer even felt like a doctor.

Certainly not the kind he had been trained to be.

Good News

Janice had come to terms with her disease.  The swelling in her legs and the shortness of breath were overwhelming.  Her gasping for air with almost every movement made the sedentary life her only option.  Her family members had long since moved away or died. 

She was alone.

The current bout of heart failure had been severe enough to land her in the hospital again.  The paramedics shook their heads in disgust as they hauled her out of her cluttered, cockroach-infested apartment.  The ride to the emergency room was her first trip outside of the confines of her four small walls since the last hospitalization.

Janice wasn’t depressed; she was just tired.  Her heart could no longer support the mass of edematous flesh that hung wantonly from her body. The cardiologist confirmed what she had long expected.  The damage to the cardiac muscle was too great.  The floppy organ was pumping at less than 10% the normal strength.  The blood confirmed another heart attack.

It was with grave faces that the team of doctors gathered to give Janice her options.  Her prognosis was poor.  She would likely die in weeks, maybe months.  They waited solemnly for what they expected would be a melancholy reaction. 

But they were wrong.

Read the rest of this post at The Medical Bag.