Utility and Functionality

It is one of the most ancient stories wending it's way through modern history.  The hotheads of late have coined the term creative destruction.  But this concept of replacing old with new,  or innovation upending tradition, is no more novel than the concept of change itself.

There is nothing truly original in the world.

I ease off the gas pedal of my already outdated hybrid Prius.

My job will eventually fall prey to a computer named Watson.  My practice will be gobbled up by the nearest Goliath medical center as history scoffs at the arthritic physician bending over a doorbell with leather bag in hand.

There is no flash of glory here.  No smart technology.

The echo vibrates through cracks in the sidewalk and drags me unwillingly forward to the unkempt house at the end of the block.

Adapt or perish.

I open the door without knocking and find a decrepit figure slumped into a reclining chair in front of the television.  His car keys were long ago taken by some relative or another.  He waits for nothing in particular.  Scraps of food have been left on the side table by a home health aid.

There are memories of being gainfully employed.  Road trips across barren lands and such.  His son is now grown up and makes decisions on his behalf.  A nursing home is a far safer environment than this empty old house.

My visits to the end of the road are numbered.

Old is replaced by new.

Utility and functionality apparently are relative terms.  

And by and by something is lost.

Those Dumb Physicians Aren't Getting The Job Done

The insurance company insisted that they would be saving money in the end.  So they sent the PA (physicians assistant) to my patient's house.  They didn't take in to consideration that I was just there a week before.  Or that I made home visits on a regular basis.  In fact, they didn't even inform me about the appointment.

My patient later told me that the exam was exhaustive.  The PA, who incidentally graduated school the day before and had never seen an actual patient as a licensed practitioner,  poked and prodded the ninety year old woman for over an hour.  He asked her about drugs and sexually transmitted diseases.  He examined every joint and performed a Babinski test.

A few days later I received a call from him.  He tried to leave a message with my secretary, but I intercepted the call.

He had two recommendations.  He thought I should do a better job of addressing the patient's knee pain.  When I asked if he thought it was a result of her polymyalgia, rheumatoid, or osteoarthritis, he had no idea.  When I mentioned that the pain had been treated in the past with various medications (and physical therapy) and the patient had stopped them all due to fatigue (even Tylenol), he was surprised.  When we discussed that she was in the hospital multiple times for pain control before I met her, and now had avoided hospitalization because of better symptom control, he said he was unaware.

His other recommendation was to start the patient on Detrol for overactive bladder.  He, of course, had no idea that her urologist had tried the same thing a few years back and she had become dizzy and broke her hip.

It wasn't the poor PA's fault.  There was no way he could have known what I gleaned from a year's worth of hospital, nursing facility, and home visits.

He just didn't know the patient as well as I did.

Which, of course, brings us back to the insurance company.  They believe that complex problems can be solved with simple solutions.

Just get some PA to go over there and make recommendations.

Those dumb physicians aren't getting the job done.

Till Death Do Us Part

Even though they were such carelessly spoken words back then, Jill took her vows seriously. Till death do us part.

She was just a child when she married Tim. He, a few years her senior, was like a father figure. But they grew together: first professionally and then personally. 

When the kids came, everything changed. He spent late nights at the office, and she transitioned her schedule to part-time so she could be home in the afternoons. 

Jill’s love grew and expanded. Of course the romance was still there, but what she valued as she grew older was the companionship. Her and Tim were partners in every sense of the word. They traversed life’s paths together, avoiding roadblocks, and choosing carefully for their little family. 

The kids were well into high school when Tim developed the numbness and tingling. Jill wasn’t concerned in the beginning, until his symptoms progressed. A flurry of doctor’s appointments later, they held hands in the neurologist’s office and listened attentively to his description of multiple sclerosis....

Read the rest of this post at The Medical Bag.

Safe Zone

When I first began the practice of medicine, I used to think of the entranceway to the exam room in mystical terms.  How else could I explain my patient's willingness to suspend all social rules and norms upon passing through those magical doors?  They would sit down in front of their baby faced-doctor and talk about things.  Private things.  Scary things.

Conversations occurred that would be unthinkable if two strangers were to meet in the outside world. I learned of abuse and infidelity, pain and yearning, secret joys and countless regrets.  I bore witness to the inner pain and struggles that often were hidden from one's closest friends and family.

People undressed.  They replaced their clothes with unflattering gowns.  They demonstrated their body parts unabashedly.  Pointing to that which looked out of place.  Wincing from pain induced by my clumsy touch.

The exam room became a safe zone.  A place where judgement was replaced by support and understanding.  A place where one's darkest secrets could be revealed but not allowed to consume them.

When I abandoned my traditional practice for home visits, I feared that something important would be lost.  I often wondered if there was a certain element of depersonalization that came with such sterile environs.  Maybe my patients revealed their inner needs and fears because the institutional setting of the exam room was a sufficient departure from normal life.

Then there was the question of my lab coat.  The wizard's frock symbolized a certain otherness that separated me from the rest of society.  Again I conjured up visions of a magnificent veil that allowed me special access of a most personal nature.

It's been almost two years now, and I have visited countless homes without the comfort of the exam room nor the lab coat to hide behind.  My fears, of course, were completely unfounded.

My patients still tell me their triumphs and tragedies.  They still pull their shirts up unashamedly to show me a rash or lump or bump.

And I have come to realize that it was never the sanctity of the exam room nor the long gray coat that droops from my shoulders.

With both great awe and humility,

I have come to the conclusion that it is me.

I am the safe zone.

In-between

We walk into the hip burger joint for dinner.  It's not like what we had when I was growing up.  Not exactly a greasy-spoon, and not fast food either.  We sit on stools which pull up to butcher block tables.

The television above us is playing Ferris Beuller's Day Off.  The volume is muted and a radio blares When Doves Cry by Prince.  A mother sits in front of us with her two teenage children.  A boy and a girl.  She mouths the words to the radio as her kids bury their heads in their mobile devices.  Her face is animated, and her body sways with the music.  I understand.  Because that's exactly how my body responds when I am transported back to my childhood.

The woman and her kids leave, and a young college-aged couple takes their place.  Their faces are fresh and soft.  She blushes as she coyly looks into his eyes.  He moves closer when they talk.  Their bodies almost touch.

The music on the radio has now changed.  Adam Levine is singing Lost Stars.  One of my current favorites.

The burger is dressed with chipotle ketchup.  The fries have more pepper than salt, and are served with blueberry mayonnaise.  The flavors are different than what I grew up with.  Yet I like them all the same.

The crowd is heterogeneous.  A group of older ladies huddles against a counter in the corner.  They talk softly and sip craft beers.  My wife and children, sitting beside me, have stopped talking.  They are too busy inhaling the delicious food in front of them.  A few young kids chat amiably at tables dispersed among the other restaurant goers.

And I realize that I am neither retro or new.   I am neither young nor old. I am caught somewhere in the middle.

In the great in-between.

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.