TEDx

October 4, 2019

I’m dumbfounded.  I’ve spent a lifetime pouring over medical journals and text, working at staying on the cutting edge of medicine.  Little did I know that much of what I needed to learn existed on YouTube (for free). 

This morning I came across a TEDx lecture by Tim Hague Sr. on the effects of Parkinson’s.  Mr. Hague, a nurse, developed early onset Parkinson’s.  His presentation is both scary, uplifting, moving and inspiring.

Tim and his son won the Canadian version of “The Amazing Race.”  He credits Parkinson’s for getting him the interview and subsequent casting call for the show.  In essence, he won the race because of and despite having Parkinson’s.

Mr. Hague raises the following question, “How do you relate to a new best friend that you hate?”  His new best friend is his Parkinson’s.  Parkinson’s becomes an ever-present part of your life.  It’s the guest that comes for dinner one night and refuses to leave.  It’s the guest that goes room to room through your house, trashing everything it comes in contact with. And, yes, it’s the guest that ultimately takes your life.

Mr. Hague’s answer is simple.  You “introduce friend Parkinson’s to friend Perseverance.”  According to Merriam-Webster, perserverance means “persist in a state, enterprise, or undertaking in spite of counterinfluences, opposition, or discouragement.” Mr. Hague adds the following: “with little or no evidence of success.”  

You get the point.  Friend “Perseverance” is a very important friend to have on your side in the fight against any chronic disease, especially one like Parkinson’s.  While I write about my Parkinson’s, please know that there are many disease names I could substitute in place of the name Parkinson’s that would have the same impact on an individual as Parkinson’s has on me.

What’s important is that learning how others survive with a “best friend they hate” can only help me (and you) persevere in finding the good in the midst of a swamp full of bad and YouTube is a good place to listen to the plight of others. Please share this blog with others.

HONESTY

On a regular basis, someone asks me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be . . .” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too harsh? Are there degrees of dishonesty that are acceptable? While there may be a place in the real world for partial truths and degrees of honesty, there is no room for dishonesty in the exam room. In June of 2011, I published “Three Things,” an article about the importance of being honest with your doctor and being honest with yourself. When surveyed about the three most important things a doctor can tell his/her patients, the most common theme was to be honest. Don’t lie.

Patients have their own reasons for hiding the truth. There are many reasons patients exercise various degrees of honesty. Some patients feel their actions make them look foolish; some fear the doctor’s scorn, some fear the answer to their problem will be too much for them, others are simply embarrassed. Sometimes, patients are in denial.  No matter what the reason, the doctor-patient relationship should be a partnership based on mutual trust and respect. In a relationship of trust and respect, there is no place for dishonesty.

Unfortunately, it’s a two-way street. There are times when I want to be less than totally honest. There are times when I want to “soft sell” the truth, knowing that the truth is going to hurt. After all, my job is to heal, not to hurt. Nonetheless, if I shelter my patient from the truth or mislead him, I break the relationship of trust and respect.

There are other times when family members ask me to spare their loved one the horrors of a bad truth. They want to lessen their loved one’s (my patient’s) pain and suffering. Telling the truth, the whole truth, can be a real problem. 

So, what to do? Risk the relationship of mutual trust and respect to spare someone pain? Then what happens when your patient needs honesty and discovers your deceit? It’s not an easy choice.

We are all humans, striving for the impossible goal of being perfect. The doctor-patient relationship is as imperfect as the two people who make up that relationship. Each has to recognize the other’s imperfection. Each has to strive to be “perfectly honest”. Each person has to realize how difficult it is to be “perfectly honest”, and that honesty can save a life, can take a life,  and can hurt!

I have chosen the path of seemingly brutal honesty, pulling no punches, for the vast majority of my career. I think people deserve the truth and that my job is to preserve the trust in the doctor patient relationship. There have been times when I have regretted that choice.

I hope my patients will choose the honest approach, no matter how difficult that choice. I hope they will understand how important knowing what is truly happening to them is and how the truth will ultimately impact their diagnosis and the success of treatments. I hope they recognize that the life they save may be their own!

I also hope that they will forgive me when I tell them what they didn’t want to hear, what hurts.  One last thing, think about what you want your doc to do and then inform him/her of your choice.

I’M SORRY

I’M SORRY

I read a very sad article on KevinMD today.  The author recounted how he had lost the love for medicine and the many ways he was sorry.  The article hit me as if I had taken a shotgun blast to the chest at close quarters.  For truly, I’m sorry!

I’m sorry I had to give up my practice of medicine.  I never lost my love for practicing medicine, but I had to leave my love behind.  Parkinson’s does horrible things to its victims.  It slowly, progressively diminishes its victim’s physical capabilities. 

I have “off” periods.  They are often spontaneous, and I literally freeze, have trouble walking or shuffle until I’m “on” again.  Then there is the fatigue, (whether from the disease or from the medication), that hits hard and stays for a while.  Naps have become frequent and non-refreshing.  My sleep sucks.  When the medicine wears off, my body stiffens and the pain sets in.

Add a heavy dose of degenerative disc disease, its resultant pain and practicing medicine is no longer possible.  I’M VERY SORRY!  I know many of you are lost.  You’ve told me of the many problems you are having.  I understand your frustration.  I’m sorry for your frustration.  You’ve told me how angry you are when you can’t get your meds refilled.  You’ve told me there are no physicians like me.  I’m sorry. 

Your new physician is not me.  They don’t know you or me.  They don’t know whether to trust my notes.  They may not understand your treatment regimen. They are going to want to see you.  I’m sorry.  You need to get to know your new physician and he/she needs to get to know you.  I’m sorry I can’t be there to care for you.

In most of the spy novels I read, the hero gets caught and tortured.  The villain wants to break the hero and force him/her to their knees.  The hero almost always says, “Do your worst, you’ll never break me.”  Unfortunately, I’m no hero and my captor has done its worst.  It stopped me from taking care of you and your healthcare needs.  It broke me.

I’M SORRY!!

Possible vs. Probable

Many of my patients use the internet to seek information about their health, diagnoses of illnesses and treatment options.  While the internet is an excellent source of valuable information, it is also full of garbage.  The garbage comes wrapped in pseudoscience, is sold as “doctor recommended” and is capable of doing great harm.  Sorting through the heaps of material is difficult, even for a trained physician.   What is real science and what is hype?  Sometimes, I don’t know!  During the last 35 years, I have seen the best of my science proven wrong.  So how does a lay person interpret the data delivered by Google and Bing?

There is no easy answer.  While discussing how to sift through the mountains of data you need to process to be a truly informed patient is beyond the scope of this article, learning the difference between a possible problem and a probable problem may be very helpful.

In the medical world, we believe in informed consent.  Informed consent means we tell you every possible consequence of taking a medication.  Ever listen to a pharmaceutical commercial on TV?  Product XYZ is touted as good for your heart and brain but may cause explosive diarrhea, excessive bad breath, uncontrollable flatus (farting) and a myriad of other things, including death.  After listening to one of these commercials, no sane person would want to take XYZ.  You can thank the lawyers for the absurdity of the disclaimer.

If the auto industry was required to advertise under the same rules as the pharmaceutical industry, car XYZ would be sold as fast and sexy with all the bells and whistles.  The disclaimer would remind the audience of national automotive safety statistics, stating car XYZ may cause death, dismemberment and a myriad of other horrific injuries we all know exist but ignore.  If a pharmaceutical company went to the FDA with a product that cured cancer but had the risk factors of a car, I doubt the FDA would approve it.

Anything is possible.  What is important is the probability that a possible side effect is going to injure you!  If XYZ causes uncontrollable flatus in 90% of people, taking it would be absurd.  If XYZ causes uncontrollable flatus in <1% of people, it is insignificant.  So, before you decide not to take the medication your doctor prescribes because of something you read on the warnings stapled to the package at the pharmacy, ask your doctor about the probability of your getting a side effect.  In general, if there are known side effects of significance, your doctor is going to warn you before giving you the prescription.

The following is a real telephone conversation:

“Dr. Segal, this is Mr. Z.  I’m mad at you!  I want you to know I found the reason I have had so many colds this year!”

“I’m sorry you are mad at me!  What do you think is causing your colds, Mr. Z?”

“The damn medicine you are giving me for my blood pressure.  According to the PDR, 32% of people taking product X get frequent colds!!!”

“Mr. Z, could you look at what the percent of people who got frequent colds while taking a placebo is?”  Dr. Segal asked.

“What’s a placebo?” replied Mr. Z.

“A placebo is a fake pill, it contains no active ingredient.”  Dr. Segal answered.

Mr. Z went back to the PDR, and called back a second time.  “Thirty six percent of people on the “no active ingredient” pill got frequent colds.”

“Wow, Mr. Z, if 36 % of people taking a placebo got colds and only 32% of people on product X got colds, then product X decreases the chances of you getting a cold.  Maybe the reason you get frequent colds is your smoking!  It may also be the reason you have high blood pressure and are on product X.”

Remember, what is important is the probability of getting a possible side effect.  Also, remember that “placebos” have side effects and risk!

I FEEL FINE

“How do you feel?”  One of the most frequent questions I get is, “How do you feel?”  While the person asking the question is sincere in caring about how I feel, I get the impression that most of the time they want a simple “fine.”   Dealing with how I feel, or any other sick person’s feeling, can be depressing, especially if they haven’t been fine in a long time.

Dealing with “fine” is much easier, uplifting, and allows the individual asking the question to move on, confident that they showed their concerned and caring nature.  I know I’m being hard on a group of individuals who appear to be sincere but really aren’t.  Often, they have their own problems that are wearing them down and they really can’t handle any additional burden.

“Fine” is not a good answer if you really aren’t fine.  Lying to yourself and others often has real consequences, most of which turnout to be negative.  “Fine” cuts off your ability to get help from your family and friends.  “Fine” means that your abilities or disabilities will be misjudged.  “Fine” is a term that socially and mentally isolates the chronically ill patient.

So, what do you answer when someone asks, “How do you feel?”  I answer with a question of my own, “Do you really want to know?”  I don’t listen to what they say in response to my question.  I look at the expression on their face.  If they can take it, I let them know I feel like crap.  If they genuinely want to help, I tell them what crap feels like. 

If they are asking to be polite or proper, “I’M FINE” is just fine.  

One phenomenon of aging is that the vast majority of my social circle is not fine!  These days everyone I know is dealing with something.   The first 10 minutes of most social encounters consists of sharing how crappy we really are.  Now that I’ve put my thoughts on paper, maybe we should just say we are “fine” and move on.  Confusing?  What do you say when someone asks you how you are?

One last thought.  When I feel lousy, haven’t shaved nor showered in 48 hours,  have stains on my shirt and have obviously crossed into the blimp zone (if I get any larger the postal service may assign me my own zip code), don’t tell me, “You look great.”  If you think I look great, you either need an eye exam, to see a psychiatrist or are just full of sh.t.

Ideal vs. Real

October 9, 2019

Sometimes I’m just stupid.  This is one of those times.  When I first started blogging in 2011, I created this site to better educate my patients and teach them to advocate for themselves.

In 2011 the practice of medicine was changing rapidly, and the changes were not good.  Over the next few years, my articles became increasingly political and I began attacking the medical insurance companies and Medicare.  Eventually, the insurance industry hit back, threatening to drop my practice from their plans.  I quit blogging.

I’ve always said, “If you can make something good come from something bad, then the bad can’t be too bad.”  MY PHYSICAL CONDITION, BACK PROBLEMS AND PARKINSON’S, ARE THE BAD.   Being able to resume my blog is the good. While I promised myself that I would not become political again and that this site would be strictly educational, I find I have to break that promise.

It’s Medicare enrollment time and the commercials are flooding the air. The ads infuriate me!  I get angry!  What angers me? The ads for Medicare Advantage promise you lots of freebies like transportation to the doc, vision care, …   The ads also talk about the fact that the plans have “narrow networks.” So, what do you give up to get the new freebies? Your network of physicians, hospitals and labs.

Do you know what a “narrow network” is? I do!  A ”narrow network” means that there are few docs in plan and that, to see a specialist or have a test may be nearly impossible.  To see a subspecialist, you may need to wait months and drive far from home.  Medicare Advantage should be called Medicare DisAdvantage.  When the guy on the street corner promises to sell you everything for next to nothing, beware!  Ideally, you buy the best insurance and supplements you can.  Realistically, you may need to take a lesser policy due to the expense.  Buyer beware.  Know what you are truly buying into.  Don’t complain when your doc can’t get you that referral, test or procedure in a timely manner.

As I promised that this blog would be educational, I am republishing “Ideal vs. Real.”   It’s well worth reading.

February 22, 2015

I have spent a great deal of time writing about the ideal way to care for yourself and those you love. When I recommend a treatment course, whether it be diet or medicinal, I recommend the ideal approach. When I prescribe a medication, I recommend the ideal brand or generic, whichever is best. 

I recognize that there is often a difference between the ideal and the real. That difference is getting wider every day. The poor economy, the insurance industry, the government and the internet all are having a negative impact on our ability to live up to the ideal. Life, in general, and the practice of medicine have become compromises.

When is it ok to compromise? How much are you willing to compromise? What is the cost of compromise? These are all important questions. It is clear from looking at my parking lot that many of my patients will not compromise on transportation. They drive very safe, very nice cars. The price of those cars is often exorbitant, leading them to compromise elsewhere. Does it make sense to drive a Mercedes and compromise on medical care and treatments?

Case in point:  a Mercedes owner complained that he could not have a procedure because he had a high deductible and the test would be in excess of $2,000. Having the test is ideal; the real is something quite different. In his case, the answer was simple. His Mercedes has every safety feature imaginable and safety was the reason he bought it. He had been in a life threatening accident and wanted the best protection even if it was not truly affordable. The ideal test for his condition is a valuable safety feature for his health. Without it, he may be heading for a major accident. After explaining this to my patient in terms he could relate to, he relented and will find a way to afford the test.

Make sure you inform your doctor when the ideal is truly not possible. Be ready to negotiate and compromise. In order to make the safest decision possible, find out why the ideal choice is the best choice. Find out what the risks of compromise are. Compare the financial, physical and emotional costs of both the ideal treatments and the negotiated treatments are and then make the best decision you can. Most importantly, be prepared to live with your decision and its effects on you, your family and friends. 

Preparing For Your Office Visit

In 1980, I was an ER doc at a local hospital.  I was so amazed at how many non-emergency patients came to the ER that I started asking every patient that I saw one of ten questions as to why they were there.  I took the top 5 reasons, found the solution to each, and opened the Lake Zurich Family Treatment Center. Searching for my patients’ medical needs and finding solutions for them proved to be one of my best things I ever did.  Forty years later, I’m on the other side of the fence looking in.  What I see is not pretty.  The medical world I grew up in is extinct and the new world (and those who inhabit it) are radically different.

Below is a checklist created to enhance your next patient visit.  It was created by Dr. Segal, the physician, and will help you interface with your doctor and his/her staff more effectively.  Now that I’ve transitioned to a patient role, I feel that it’s time to make a list of things I need from my doctor.  What do you need from your doctor?  If you will include your answers in the comment box, I will collate and publish the responses.

The better prepared you are for an office visit, the more you will get out of it.  The following are my top recommendations:

  1. Come prepared with clear objectives.  Define your first and second most important problems by going through the: who, what, when, why and how of your issues and know what you want.  If you are having chest pain or breathing problems, that is number one!
  2. Stay on track.  So many of my patients come in for one specific problem and then do the “Oh, by the way, while I’m here” spewing forth six other problems.  It is hard to do justice handling seven chronic medical problems during the course of an office visit.  Attend to your top two and set up time to do the next two and so on until the list is empty.
  3. Prioritize your list.  It is important to know what the top two are.  Your doc needs to know everything that is on the list.  Sometimes, what you think is the most important problem really isn’t.  Sometimes the doc will re-prioritize your list.  Use an “A” next to a problem to delineate a current/active problem.  Use a “P” to delineate an past/old/resolved problem.
  4. If you are seeing other doctors, tell the nurse who you are seeing and tell her what you are seeing the doctor(s) for.
  5. Bring your medications with you.  “I’m on a blue oval pill, two yellow ones and a green one” is not only worthless, it is dangerous.  Keep the pills in their original bottles.  Make sure you bring all of them, even if someone else prescribed them.
  6. Bring your supplements and vitamins.  They may impact your treatment.
  7. Wear appropriate clothes.  If you are modest, wear your bathing suit under your clothes.  If your knee is killing you, don’t wear tight jeans.
  8. Don’t forget to ask questions.  If you don’t understand what the doctor is telling you, ask for clarification.
  9. Ask for a written set of instructions if they are not provided.
  10. Know which pharmacy you want your prescription sent to.  In the world of electronic medical records, prescriptions are sent over the internet.
  11. Have a written list of your known allergies.
  12. Bring your insurance cards.  Different plans have different rules and panels.  Also, bring your driver’s license and co-pay.  Don’t be angry at the front desk when you are asked to present these at each visit. 
  13. Bring your old labs and x-rays if they were done elsewhere and they are available.

What I need from my doc:

  1.  Listen to and address my objectives.
  2. Re-prioritize my list when necessary to address more threatening problems as rapidly as possible.
  3. Tell me what you think I have and what you need to do about it.
  4. Tell me what I need to do about it.
  5. If you need to do tests, tell me which ones you are ordering and why.  Let me know how I get my results.
  6. If I need meds, which ones do I need and why.  How should I take them?  What are the risks?
  7. When do you want to see me again?
  8. What warning signs, if any, do I need to watch for?    When should I call you or your nurse if any warning signs show up?

We know these simple tips will help make your office visit a more fulfilling experience.

YouTube

Awakening at 3 am is a killer!  Yes, we don’t have to worry about Parkinson’s killing me, sleep deprivation will get me first!  I’m being a good patient and wearing my CPAP.  It’s not helping.  I go to roll over and the pain in back hits.  If I stay in one position long enough, I get stiff and can’t move.

At some point I get up, come downstairs and try to be constructive.  It’s 4 am and the dishwasher has been emptied, a load of clothes has been run and I’ve straightened up the house. Time to write but nothing comes to mind.

I’ve discovered YouTube.  It’s been helpful in occupying my time.  I’ve blown through the Parkinson’s content.  This morning I discover “TEDx.” I watched “The Magic of Not Giving a F***, “How To Stop Screwing Yourself Over,” and “No Sex Marriage-Masturbation, Loneliness, Cheating.”

What a morning.  I learned about destressing your life by being honest and saying “NO” to what you don’t really want to do.  Sometime ago, I developed my Fuck It List and have done well with it.  Number one on my list is I will no longer put a noose (necktie) around my neck and go out pretending to have a good time.

I learned how to stop “screwing myself.”  The speaker states I can have anything I want. (Renee, I want …)  The speaker further states getting what you want is simple (but not easy).  She talks about “activation energy,” self- parenting and forcing yourself to get what you want.  Her video was actually helpful.  She used dieting as an example and I’ve been miserable at dieting since my surgery. While I need to lose weight, I want to eat the Danish!  Time to parent myself and force myself not to eat the Danish or anything not on my diet.

In “No Sex Marriage,” I learned I’m doing pretty good!  Whew!!  If you’re not, watch Maureen McGrath’s TEDx.  The best news today is threefold.  One is that sex exists well into the 90s.  Two is that sexercise should be done daily.  Three is that all marital arguments should be settled in the bedroom, naked.  I like this therapist.  I think I’ll be argumentative and see what happens.

A Doctors Life

October 4, 2019

As I was composing the “Attaboy” article, it dawned on me that part of every patient’s education should be getting a first-hand look at the life of their physician.  Being a patient-physician gives me a lot of insight into what goes on behind the counter in the office and in the exam room and helps make my visit to the doc much more pleasant than yours.

Did you ever wonder why, after 30 years of making morning rounds at the local hospitals caring for my sickest patients, I suddenly stopped making rounds?  For 30 years, it was up at 5 a.m., in the hospital by 6 a.m. drove to the office and prepped for the day by 7:30 a.m., work 10-12 hours and then go back to the hospital.  Understand, I’m not complaining.  Caring for people was (and still is) my mission.

At 3 a.m. my phone rang:

Nurse – “Dr. Segal this is Ellie from 4 north, Mrs. P just fell and I’m calling to notify you.”

Me – “How bad did Mrs. P hurt herself?  Do you need to transport her to the ER?”

Nurse – “Oh, she didn’t hurt herself at all.  Her vitals are stable and her exam is normal.  She just kinda slipped onto her buttocks.”

Me – “Why are you calling me at 3 a.m.  Not only did you wake me up, but you woke up my wife.  You know I’m in the hospital by 6.”

Nurse – “It’s hospital policy to notify the patient’s doc if they fall.”

Do you have bad days?  Physicians do for a multitude of reasons.  This is just one of those reasons.  In reality, most of my working days could be described as bad!  While my patients brought me a great deal of joy, my job entailed dealing with illness and injuries.  I remember the kids who died in a homecoming accident.  I remember the patients who had devastating strokes and heart attacks.  I remember the names of those who committed suicide and those who suffered in agony but would not commit “suicide.”

I also remember missing my children’s’ sporting events, recitals, school function and . . .  All of this takes a toll and at time, the stresses and sorrows spilled over into the exam room.  

My front desk team was comprised of the nicest, most competent and caring people you would ever meet.  At least the above description was accurate at 8:28 in the morning.  By 8:30, they had been chewed out by patients over the paperwork they needed to fill out, over payment of past due bills, over wait time and . . .  The list of patient demands and complains was overwhelming and usually out of our control.  There are rules doctors’ offices have to follow.

So, I gave up seeing inpatients at the local hospital.  I alleviated some of the stress but the nature of a busy family practice meant that there would always be sorrow mixed in with the joy.

So, when my doctor keeps me waiting, appears short or even rushed, I understand what his/her day is like and I cut them some slack.  Perhaps you’ll think twice about chewing out your new docs’ staff or writing a bad review. Perhaps you’ll cut your doc some slack also.  You could even ask, “Hey doc, how’s your day?  Are you OK?”  

In the next few weeks, I will publish a list of things you can do to prepare for your visit to the doc.  If you are properly prepared, I can guarantee your visit to your new doc will be a more fulfilling encounter.

Attaboy

Tonight, Renee and I dined at a friend’s house. I was talking about my ideas for this article when my friend asked me the following question?  How many “Attaboys” does it take to cancel one “Oh Shit.”  It was an excellent question and we debated what the right answer should be.  My opinion was that it was highly dependent on what the “Oh shit” was.  His was that one “Oh shit” did not cancel any “Attaboys.”

If you think I’ve lost my mind, read on.  As a practicing physician, I’ve seen many thousands of individuals over the years.  While many have loved me, there have been those that did not.  (A good guess places my career visit count near 400,000 patient visits).  The “did nots” tended to be a very vocal group using the internet to slash out at me.

There are multiple internet sites that rank physicians.  Most physicians simply ignore these sites.  I never could.  What angry people post becomes reality in many reader’s minds.  Unfortunately, the situation is complicated by two things:

  1.  Happy patients rarely ever go to the internet to give you an “Attaboy.”
  2. For a multitude of reasons, physicians cannot respond and defend themselves.

Let me give you an example.  One of the most viscous attacks I sustained as a practicing physician came from a person I never saw as a patient.  The individual came to the office with a friend and several textbooks and articles printed from the internet.  The person’s intent was to be the patient’s advocate.  What ensued was ludicrous, with the “advocate” reading from the text and articles and demanding that certain tests be run on my patient and certain medications prescribed.  Ultimately, I had to demand that this individual leave.

The next day, there was a scathing review of me on the internet by a “patient” that I had never treated.  I could not respond as responses often lead to further unjustified garbage being printed or worse, physical threats.  Responses also take the chance of unwittingly releasing patient information.  Notice that I have been very careful not to mention whether my attacker was male or female or anything about my ex-patient even now that I am no longer practicing. 

In my youth, I did in fact respond.  I defended myself against a liar and was shocked when the Chief of Police showed up in my office.  He proceeded to tell me that the person I had angered was known to the police and very dangerous.  He stated he would have patrol cars in front of the office in the morning and evening and I needed to watch my back.  I wore a Kevlar vest for months.  I learned to walk away from angry people.

So, what does a physician do?  Some choose to ignore the internet altogether.  In my case, my patients formed an “Attaboy” call tree; and, if someone attacked my online persona, the call tree triggered and published gobs of real “Attaboys’” were posted. Some physicians hire outside firms whose jobs are to monitor, clean and enhance their online personas.  Now you know how a physician consistently scores a 5 out of 5 without even one blemish.

There is a moral to this story.  If your physician (or any body else) takes good care of you, they deserve an “Attaboy.”  Go on the internet and praise them.  Nobody can tell me exactly how many “Attaboys” it takes to get rid of one “Oh, Shit” but the more “Attaboys” one has, the better.

By the way, if you’re pissed off, take a breather and cool down before you attack.  Then call or write your doc and present your case.  You may well get an answer.  You may even get an apology.  You may get an explanation that makes you happy.  Once you go public, all lines of communication stop, leaving you and your doc in a lousy place.