Month: September 2019

The Back Nine

Once again, I find myself looking through my old blogs searching for inspiration and wisdom.  This morning, I found an article from 2014 that

was inspired by Mr. Wonderful.  My old readers will remember Mr. Wonderful (W).  Let me take a minute to introduce Mr. W to my new readers.

Mr. W is an older gentleman who has turned his life and health around using a vast assortment of tools he keeps in a notebook.  He has hundreds of positive quotes and inspirational axioms that he uses to bolster his will power and keep him moving in the right direction.

I continue to feel lousy and uninspired.  I force myself to exercise in the morning but do not enjoy it.  I force myself to sleep with my CPAP but really see no benefit (yet). The only things that come naturally and create joy are being with my family, writing this blog and eating.

A great deal of my problem is my weight.  I am approaching the size of a blimp.  I need to shop in the “Big and Tall” section, only I’m not tall.  My shirt could serve as a tent and house a family of four.  My buddy, Will Power, still hasn’t shown up.  Hopefully, the article published on April 23, 2014 will help me find the will to get my weight down to a more respectable level and help me find the path back to health and Wellth.

I’m definitely on the back nine and I want to play every hole I can.  So, what can I do?  One thing Mr. W used to say is, “If you fall down five times, get up six times.” I didn’t fall down, I got knocked down by Parkinson’s, my back surgery and the loss of my profession/calling.  I keep trying to get up but, so far, have been unsuccessful.

I called Mr. W yesterday and we are going to lunch next week.  Hopefully he’ll bring his book.  He’s been a patient, mentor and friend for years.  I’m sure seeing him will help me get up and move on.

I hope this blog will find its way to others, like me, who need a bit of inspiration and wisdom to get them back on their feet.  If writing about the transition from doc to patient and the insights a patient/doc helps one person, then I’ve done my job.

April 23, 2014

Mr. Wonderful was in today.  We spent a little time discussing the “Three Wise Men” article and I told him I was looking for the secret ingredient that awoke my three wise men.  I was particularly interested in his opinion as Mr. Wonderful was not so wonderful once upon a time.

Mr.Wonderful’s transition from an average patient, overweight, out of shape and on lots of meds to his current healthy state was nothing short of a miracle.  In answer to my questions, Mr. Wonderful stated, “I’m on the back nine and want to play every hole I can!”

If you’re a golfer over the age of 50, let Mr. Wonderful’s wisdom serve as your motivation to get and stay healthy.  If you’re not a golfer, find your reason to live longer and healthier and start developing a healthier lifestyle.  

As a doc, taking care of healthy individuals is a lot more fun than taking care of the aged and ill.  Are you on medication?  Would you like to be medication free?  Are you winded on walking several blocks?  Would you like to have more stamina?  Do your joints ache?  Would you like to be pain free?

Jenna and I are here to help you start your journey to health. (At least we used to be).  All you have to do is come in and let us partner with you.  There’s no time better than now.

September 20, 2019

I continue to be amazed by how many notes my younger self left for me.  Yes, it appears that, in 2011, I knew that I would be in a state of dis-ease and would need help recovering my health. I knew I might forget Mr. “Qs” story, so I left a reminder in my blog of August 29, 2011.  I’d like to thank myself for being so forward looking and providing me with uplifting stories that have been helping me be more at “ease” with my Parkinson’s.

Reading my old blogs are great therapy. Perhaps I should write a science fiction script involving a young man who sees his future and leaves helpful note for his future self to find. (Wait a minute, its not fiction!) 

I’ve had a really crappy day starting at 3 a.m. when my back pain awakened me.  While I’ve exercised, walked in the neighborhood and grocery shopped; I’ve been miserable. “Dis-ease” has ruined my day.  Looking for an idea for tomorrows blog, I came across the following article.

I hope reading it will help those of you who are in a state of “dis-ease” find some health and happiness. 

August 29, 2011

Yesterday, I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners (http://www.kevinmd.com/blog/2011/08/patients-flock-alternative-medicine-providers.html).  Mr. Luban brought up an interesting question, “What is health?”

Is health simply the absence of disease?  If it is, there certainly aren’t very many healthy patients in my neck of the woods.  Most of the patients I take care of have something that’s not quite right.  I only know one perfect person and I married her!  

In Mr. Luban’s article, he writes, “Health may simply be the flexibility to adapt to circumstances and to continue to have an acceptable quality of life.”  I instantly liked this definition.  If you change the spelling of the word, “disease” to dis-ease, then illness boils down to a lack of “ease” with your condition.

In the thirty some years I have been practicing medicine, I have seen patients with horrible illnesses who were healthy despite being ill.  These individuals had one thing in common:  they refused to allow their “disease” to put them into a state of dis-ease.  Mr. “Q” suffered from a neurologic disorder that had progressed to the point where he was confined to a wheelchair.  Despite his crippling disease, Mr. “Q” lived life to its fullest, painting, joking with his friends and family, and running a successful computer business.  Mr. “Q” was at ease with his condition and therefore was healthy.   Over the years, I have met many patients who, despite having what should have been life changing illnesses, remained “healthy” due to their attitude.

I have always believed that, if you could make something good come out of something bad, the bad was not so bad after all.  On my last trip to Puerto Vallarta, I met an artist who was born with no arms.  His paintings were intricate and beautiful.  Each brush stroke was meticulously done by the artist while holding the brush in his mouth.  He was at ease with his physical condition, having found the gift in his otherwise disabling birth defect. 

Unfortunately, I often see individuals who, while otherwise healthy, are not at ease with their human condition.  One common cause of dis-ease is weight.  I’m not talking about the patient who is 50 pounds overweight.  I’m talking about the young lady who is unhappy with her figure because she is not built like the models the media use to set societal standards.  Eating disorders represent a tragic example of dis-ease and the loss of “health” caused by not being at ease with your human condition.

Health should be defined as “the flexibility to adapt to circumstances and to continue to have an acceptable quality of life”.  Health is a state of mind.  Often, as we age, disease intervenes in our lives.  If it’s not our heart, then it’s our lungs, or kidneys, or diabetes, or sores.  Being at ease with whatever the affliction nature deals you makes all the difference in the world.  As doctors, we need to help our patients find ease with their human condition.  That “ease” cannot be found in a pill!  Ease comes from knowledge and understanding.  Imparting knowledge and understanding takes time and, unfortunately, there is never enough time.  As doctors, we need to help our patients by providing them with reliable sources they can use to learn about their condition.  We need to provide our patients with counseling and understanding.  It all starts by defining what “health” truly is.

I normally end my articles with, Be Happy, Be Healthy!”  In the future, I will add, “And be at ease with life!” 

September 19, 2019

Hey, you.  You know who you are.  You’re the learned parent who wants only the best for your kids.  You scour the internet reading articles about how harmful immunizations are.  You dig into the supposed conspiracy that big pharma is spiking vaccines with all kinds of nasty stuff.

Despite pleas from the World Health Organization (WHO), The AMA, The American Academy of Pediatrics, and the American Academy of Family Physicians, your kids go unimmunized.  You want to do everything as organically and naturally as you can. 

Unfortunately, you are just too young to understand the error of your ways.   You have never met a child or adult crippled by Polio.  You have never consoled a mother who has lost her child to measles, a father whose only son is sterile from mumps.  You have never seen the disfiguring lesions from a severe case of chickenpox or worked with a child who was damaged by meningitis.  You have never heard the “whoop” of whooping cough. I have!  The only thing I haven’t seen is tetanus.  Shun vaccines long enough and maybe you will.

You have grown up in a world devoid of these horrors thanks to the vaccines you now shun.   Thanks to your parents and immunization programs required by your local schools, you avoid the misery of these once almost eradicated diseases.

I know I’m going to piss some of you off. I know some of you think Dr Google trumps my years of experience.  I know some of you think doctors are stupid enough to buy anything pharma sells.  We aren’t and you are wrong.

I know the names of all of the kids mentioned above.  I remember their misery.  I remember those I saved/salvaged and those I lost.  I pray you will heed my warnings and vaccinate your kids.  I pray you never see what I have seen in the last 40 years.

One last reminder.  It’s time for your flu shot. Even if it doesn’t prevent you from getting the flu, it generally lessens the course of the illness if you get it.

Here are some excellent links to the most up to date research available and a great video:

https://zdoggmd.com/incident-report-230/

https://zdoggmd.com/immunize2/

September 18, 2019

I’m tired.  I’m tired of hurting.  I’m tired of not being able to do what I want.  I’m tired of taking pills.  I’m tired of fighting and losing the weight battle.  I’m tired of using CPAP.  I’m just tired!

Monday and Tuesday were relatively good days.  I at least had enough energy to go out with Renee, do a little shopping, do a few menial things around the house. Yesterday, I was napping on my daughter’s couch by 2:30 pm.  Yesterday was my granddaughter’s second birthday party.  I was at the party, but I really wasn’t.  As per usual, Renee asked me if everything was OK. She stated, “You’re awfully quiet.”

When I’m out of energy or my legs won’t work, I get quiet.  There really is nothing to say other than, “It is what it is, so just move on.”  It’s hard to move on when those around you tell you how good you look.  I know they are trying to cheer me up or they are blind.  IF they are trying to cheer me up, then be honest.   I look like shit!  If they are blind, get some glasses.

I wonder how many of my patients over the years have felt the same way but not had a way of expressing/venting it.  I wrote an article years ago about fatigue.  I stated that fatigue was my most hated diagnosis because EVERYTHING causes fatigue.

Now I know what fatigue really is!  It is still my most hated diagnosis, but now I hate it because it insinuates itself into every phase of life.  It is relentless and self-perpetuating.  It’s primary treatment, exercise, is thwarted by the fatigue itself.  It’s aftermath, in my case; obesity, leads to more fatigue.  It’s an unhealthy spiral that is hard to stop.

The “retrospectrascope” is a very precise device. You’re always much smarter when you look back in time.  Looking back now, knowing what I now know, I could have done a better job with those of you who are chronically fatiguesdand tired.

“High Jack.  You look like shit.  How do you feel?  Yeah, I know, I look like shit, too.  Yeah, I’m tired.  I worked out this morning.  Did you? Yeah, I hated it, but I have to break the downward spiral of fatigue or it will break me.  My diet is getting better slowly, yours?”

Medical education really starts once you are in practice. That’s why they call it the “Practice of Medicine.”  As for me, my education is continuing despite the fact that my practice has ended. Hopefully, I’ll find a way to make my new found knowledge useful to those I have cared for over the years and those who find this blog.November 29, 2011

An article from November 2011 for you and me:

In researching for my articles, I often come across valuable sources of material on the internet.  Quote Garden is one of those sources.  I found seven pages of quotes referencing diets.  Some of the best are listed below with my thoughts about their significance.

“Your stomach shouldn’t be a waist basket” – Author unknown!  Not long ago, I saw an overweight patient of mine in the drive-in window of a fast (fat) food establishment.  He was putting fried junk into his belly.  He puts premium gas in his car.  What’s wrong with this picture?

“Don’t dig your grave with your own knife and fork.” – English Proverb.  Raucous Ralph, a character in my book and one of hundreds of patients I have seen over the years, did just that.  Who do you love more, your spouse, your family, or your food?

“Inside some of us is a thin person fighting to get out, but they can usually be sedated with a few pieces of chocolate cake.” – Author unknown.  Many people use food as a drug/medication.  Do you?  If you are depressed, see your doc, not the local baker.  If your marriage is bad, see a marriage counselor.  Don’t have a closet affair with Godiva!

“A diet is a penalty we pay for exceeding the feed limit.” – Author unknown.  Yes, diets are penalties; and yes, we pay BIG!  It’s time to stop dieting and, instead, learn who you are and what you need to do to get healthy.  If you’re healthy, stop fretting over your figure and enjoy life.  If you are not healthy, work at getting healthy the right way.  Diets and Other Unnatural Acts will help you.

“People are so worried about what they eat between Christmas and New Years but they really should be worried about what they eat between New Years and Christmas.” – Author unknown.  I’ll end on this note!  A healthy lifestyle has room for holiday treats but no room for holiday cheats!

September 17, 2019

Before you can practice medicine, you must complete 4 years of undergraduate work, 4 years of medical school and 3-5 years of residency.  Upon successful completion of your prescribed training program, you are a highly trained and, hopefully, skilled DOCTOR OF MEDICINE.

You are ready to setup practice and see patients. You are ready to diagnose and treat a vast array of illnesses.  You have read the most up-to-date journals and practice evidence-based medicine. Really?

While you may think your education has prepared for life and death decisions, it has not.  Realistically, once you start seeing patients, your real training begins. You’ve been taught by a system to prepare you for the routine, everyday patient with textbook perfect complaints and treatments.  

In simple everyday terms, you have been trained to put square pegs in square holes and round pegs in round holes and you’ve gotten quite proficient at your task.  Then, one day, you’re given triangular pegs.  What do you do?

Having practiced medicine close to 40 years, I can attest to the fact that all patients are different and many cannot be successfully diagnosed and treated using the most up-to-date rule books. What do you do?  My answer is easy.  You customize your treatment protocols to fit the individual patient’s needs and wishes. Sometimes, it takes months or even years to find the right treatment regimen for your patient.  Sometimes, if you listen closely to what your patient tells you (and you choose to believe your patient) deciding what to do is a slam dunk!

Why am I writing about this today?  My patients are actively searching for new docs as I am no longer in practice.  Some of the new docs will review the patient’s history, his old charts and his treatment regimen and, despite the fact that the treatment does not stand up to present day standards, will choose to continue it because it works!  It has safely worked for 20 years and survived the test of time.

Other docs will choose to stand by the latest treatment protocols, decide that Dr Segal did not know what he was doing, and change the patient’s treatment plan simply because they don’t understand how it was developed.  Reading 20 years of chart notes just isn’t possible.  For the physician, it’s easier to simply start from scratch.  For the patient, it is not so simple.  Sometimes, it’s like squeezing a square peg into a round hole.

What can you do to make the transition of care easier on you and your new physician?

The solution may be as simple as making a phone call.  While I no longer have access to your chart, I can answer many of your new physician’s questions if he/she will call me.  My number is 847-846-2131and I will be happy to help in your transition of care to a new doc.  Feel free to share this post with your new physician as well.

The solution may not be simple.  It may take several attempts to find a new physician who fits your need.  Trust your gut.  If you don’t feel comfortable with your new physician, move on.

I am truly sorry that I’m no longer here to take care of your needs.  I want to thank all of you for your calls, cards and prayers.

The following article was published on April 27, 2011 and is even more pertinent today then it was then.

No, I haven’t lost it.  Today’s article is all about fitting a round peg into a square whole.  My profession is changing.  “Payers,” those entities that have taken on the responsibility for paying for and ultimately providing healthcare for my patients, want statistics.  They collect data on every visit, every medication ordered and filled, every test ordered and done (or not done).  If you are afraid of what Google and Apple are doing with your geographic data, you should be more afraid of “payers.”  The government, in the guise of Medicare, is the worst.

Protocols, for medical care, are being actively built and implemented on a daily basis.  When the President says that the electronic exchange of medical information will save money, he means it.  Information (data) is being harvested from every patient encounter.  That information is used to create evidence on what the least costly and, therefore, most effective treatment protocols are.  I am forced to follow these protocols every day.

Today, my patient needed a stat CT scan of her lungs to assure she did not have a pulmonary embolism.  Her insurer’s protocol required prior authorization (article 4/15/11) for this potentially lifesaving test.  Failure to follow her insurer’s protocol would result in thousands of out-of-pocket dollars expense to my patient.  Delay in care could result in her life.  What to do? 

Protocols don’t take into effect an individual’s needs; they make an individual fit within the protocol’s needs.  Protocols are in the best interest of the “payer”, not the provider and his patient.  In “Normal,” published 2/28/11, I wrote that I had never met a “normal” or “average” patient.  I see individuals and they come in all sizes and shapes.  Protocols are devised to care for that fictitious, average, normal individual.

In “Are We There Yet?” (4/14/11), I wrote about a fictitious New York city in the year 2020.  There, everyone lived by protocol, from what they ate to when they died, protocol controlled everything.  We aren’t there yet, but I think we are on our way.  Certainly, from a medical point of view, we are being pushed to sacrifice the personal aspects of care for the sake of cost control.

How do you fit a square peg in a round hole?  Try using a hammer, chisel or saw.  I’m afraid that the new world of medicine is going to be uncomfortable for most patients and downright painful for many.

September 12, 2019

As I write this article, I realize I’m about to get in trouble.  My editor, also known as my wife, is going to rake me over the coals.  “How much is too much” is a question often answered in retrospect.

Let me give you an example.  My wife is upstairs with my 2-year-old granddaughter who is pitching a fit. My daughter is in her office a few doors down from my wife, working. I’m in the kitchen looking out at my pool which needs vacuuming.  I’m actually feeling pretty good.  My motor skills are as close to normal as they get.

After a careful risk assessment, I decide to do a little work vacuuming the pool.  All is well until it isn’t.  I’m working in a relatively tight area in the low end, surrounded by chairs and rafts when my motor skills fail me.  I go into an “off” cycle and freeze.  Off periods last a variable amount of time and can freak me out.

I’ve learned all kind of triggers to break out of an off episode.  They all fail.  Usually, I just wait them out.  Today, my diuretic kicks in and I have to pee!  Wetting myself on top of being busted for being stupid is out of the question. I force myself and move at the risk of falling into the pool.  Success! I cleared all the obstacles, broke out of the “off” period and made it to the bathroom.

How much is too much?  I’m learning.  The problem that I have is that there is a fine line between too much and too little.  If I restrain from doing things like vacuuming the pool, then I end up sitting in a lift chair all day, playing video games.

I’ll vacuum later when Renee can be outside with me. I’ve learned my lesson for today.

September 10, 2019

I went to the pharmacy yesterday.  What a horrible experience.  I take all sorts of medications on a four times a day schedule.  I have 12 pills a day designed to treat my Parkinson’s. Then, I have a water pill, a potassium pill to treat the side effect of the water pill, aspirin for arthritis, and two pills to treat the side effects of the aspirin.  Then, there are three more pills designed to assist my aging prostate and Vitamin D, as I am deficient in D.  Now, add in an as needed Tramadol for back pain not controlled with aspirin and taking and arranging to take my pills becomes a part time job. 

Yes, I hate taking all those pills.  Unfortunately, I haven’t been able to eliminate any; and I’m a good patient, taking what my Doc prescribes.  I also hate going to the pharmacy.  

Despite having an Insurance card, a Good Rx Card and a Kroger’s card, my costs are exorbitant. I literally will spend thousands of dollars every year on medication.  My choices are lousy!  

My Parkinson’s meds are the most expensive.  Without them, I’m non-functional.  I can’t buy them at a discount online as online pharmacies can’t be trusted (see article below).  Luckily, I can afford the expense, but it surely will cut a deep furrow through my retirement funds.

What do people who can’t afford it do?  Go bankrupt? (I just read an article about the University of Virginia Hospital system driving patients into bankruptcy over unpaid medical bills.). Most roll the dice and buy online.  

In the past, I have recommended that my patients take a vacation to Canada or Mexico and meet the pharmacist.  I now recognize the problem with my advice.  Traveling abroad is difficult when you are sick, as well as being yet another expense on an already tight budget.

I guess the best thing to do is eat lunch and dinner at Costco. For one buck and a half, you get a giant kosher dog and drink.  On the front end, you save a lot of money.  Of course, the side effects of obesity and high cholesterol will need to be addressed.  You guessed it:  more meds.

September 30, 2012

I’ve been sitting by the phone all morning expecting it to ring.  I’ve been expecting a lot of calls from apologetic patients now that the news about online pharmacies selling bogus medications has hit the airways.  Nobody has called, no apologies have been offered.

Over the past five years, I have warned my patients about the risk of online pharmacies thousands of time.  I have wasted valuable time trying to educate my patients about the risks of counterfeit medications and false promises.  I have been mostly ignored.

Mr. C – “Doc, I get my Viagra from Canada.  I order it online.  My friend has been doing it for years and has never had a problem,” is the common retort I get!  Patients order all sorts of medicines online.  Women are the worst.  They should know better.

“Mrs. B, is that a real “Marc Jacob” purse (sells for $600)?”  

Mrs. B – “No, I got it in Florida for $30 and you can’t tell the difference in it and an original.  DO you want me to pick one up for your wife?”  

Yes, women buy knock-off purses, jeans, and shoes.  Men buy knock-offs, as well.  A $25 dollar knock off of a $5,000 watch tells time.  While everyone is aware knock-offs in the apparel and electronic world, no one believes that they might actually be receiving knock-off pharmaceuticals.

Finally, the FDA has stepped up to the plate and tackled the impending disaster Internet pharmacies represent.  It’s in the news in a big way.  Not only is the FDA warning about knock-offs being expired medications or not containing any medication in the capsule you are sold, they are warning that some of the pills contain poisons (arsenic and rat poison was mentioned in the Daily Herald’s article) and other contaminates.

The FDA now has a website dedicated to helping you find safe and legal pharmacies.  Yes, you will need a prescription from a licensed doctor.  Yes, your prescription should be purchased from a licensed US pharmacy.  And yes, if the price is too good to be true, it’s not true.

I’m still waiting to hear from those of you who doubted and ignored me.  By the way, Mr. C and his friend may yet have problems from taking their bogus medications.  The effects of contaminates and poisons can take years to manifest themselves.

One more word of warning comes from the Daily Herald article today.  “Besides likely getting fake drugs, that includes the risk that they will infect your computer with viruses, will sell your personal and financial information to other rogue websites and Internet scammers, or charge you for products you never ordered or received.”  Infect with virus are three words a doc never wants to hear and that patients should strive to avoid.

Questions?

Questions?  I have a lot of them.  I woke up at 4 am, again.  Why can’t I sleep past 4?  I don’t know. My doc has me on a machine for sleep apnea.  Yes, I’ve added sleep apnea to a litany of other problems.  

I think CRS may be the worst of my ailments. Most of my friends have CRS.  Just in case you don’t recognize the name, it stands for “Can’t Remember Shit.”  Yesterday, Renee and I totally blew off some very important people due to our CRS and an assortment of other problems.  No excuses! If you read this, I’m sorry!

If exercise is the fountain of youth, why do I hate doing it?  Why did my brother have a stroke?  He rarely ever missed a day in the gym.  Obviously, my brother’s stroke is foremost on my mind.  Don’t get me wrong.  As a doc, I highly recommend a regular regimen of exercise and healthy eating. Of course, there are those, like my best friend Robert, who believe that humans have a fixed number of heart beats in a lifetime and that when they run out, they die.  Robert thinks its foolhardy to waste heart beats in a gym.

Hallelujah!  Last night on the news, they announced that napping decreases your risk of heart attack and stroke.  Finally, a beneficial side effect from the mass of pills I take.  I am the napping king!  Of course, this may be the notorious fake news we’ve heard so much about.

I really don’t like being a patient.  There are too many docs to see.  Too many pills to take.  Too many side effects.  Too many tests.  Too much money spent.  Oh G-d, I have discovered a new ailment, the “Toos.”  Luckily, I have CRS and will have forgotten all of the above by noon.

One last question.  Is anybody reading this blog?  If you are, let me know.  If you’re not, its ok.  As a retired doc, I highly recommend finding something meaningful to do with all the empty hours you spend waiting to see your next doc or take your next set of pills.

Here’s an interesting view from 2011.

October 24, 2011

Sometimes I amaze myself.  Apparently, there is now a name for what I have been doing for the past year: “Patient Engagement/Activation.”  KevinMd recently published “Physicians should embrace patient engagement” by Dr Ken Bottles (http://www.kevinmd.com/blog/2011/10/physicians-embrace-patient-engagement.html).  

This blog has been my way of engaging/activating patients.  Knowledge is power and providing my patients with the knowledge they need to become active participants in their healthcare has been my goal.  

In Dr. Bottles’ article Jessie Gruman, a cancer survivor is quoted as saying, “As a savvy and confident patient who is flummoxed by so much of what takes place in health care, I am regularly surprised by how little you know about how little we patients know. You are immersed in the health culture. But we don’t live in your world. So we have no idea what you are talking about much of the time. One way to help us feel competent in such unfamiliar environments is to give us some guidance about what this place is and how it works. What are the rules?”

In August, I published, “I Am A Responsible Patient.” (https://livewellthy.org/2011/08/31/i-am-a-responsible-patient.aspx)  The article outlined “the rules” for my patients, as well as for any of my readers who were interested in taking an active role in their health.  I have published multiple articles over the last year designed to help patients “feel competent in such unfamiliar environments is to give us some guidance about what this place is and how it works.” (Bottles)

According to Dr. Bottles’ article, “The ten categories of the Engagement Behavior Framework are:

1. Find safe, decent care
2. Communicate with health care professionals
3. Organize health care
4. Pay for health care
5. Make good treatment decisions
6. Participate in treatment
7. Promote health
8. Get preventive health care
9. Plan for the end of life
10. Seek healthcare knowledge.

I agree with each of these 10 principles.  It is critical that, as physicians, we engage and activate our patients.  The article goes on to report, “Recently Klick Pharma invited 19 health care activists from a wide variety of disease states to participate in a conversation about an ePatient Bill of Rights that would support patient engagement and activation. After four hours of conversation, this group reached consensus on the following key messages of such a bill of rights:

1. Shared access to my data
2. Attitude of collaboration and overall respect
3. The patient is the largest stakeholder
4. Transparency and authenticity across all areas
5. Voice of the patient is a legitimate (clinical) source
6. The right to efficient communication with providers who utilize the technology we need”

I think the key remark in this entire conversation is number three, “The patient is the largest stakeholder.”  The patient is the largest stakeholder, the one with the most to win or lose.  In this ever-changing world, it is incumbent on the patient to take an ever growing and active role in his/her health.  

Investing the time and effort in “self” is critical.  “Seeking healthcare knowledge” (Bottoms) is time consuming and difficult but well worth the investment. Getting “preventative health care” (Bottoms) is important but practicing “preventative health care” (Bottom) is more important (Segal).  

What is missing from Dr. Bottles’ article is the importance and key role of the concept of “continuity of care.”  Communicating with your healthcare provider and forming a longstanding, health care team is essential in optimizing your health.  Long term patient-physician relationships promote trust and trust is the critical factor that allows for “safe, decent care.” (Bottoms)

Dr. Bottles’ article goes on to state, “Experts in patient activation/engagement suggest that hospitals and medical practices provide each patient with a short guide that explains how best to be a patient in that unique setting.”

A “short guide” on “how best to be a patient in that unique setting” does not exist.  There are now 326 articles on this blog and more to come.  Each article hopefully will enable you to be the best patient you can be.

If only there was a “short guide” to being the best doc you can be!

September 9, 2019

As a family doc, I am acutely aware of the stages of life each of us eventually go through.  I counsel young sleep deprived parents of a colicky baby.  I reassure the parents of teens pointing out that their irresponsible child will go to college, go to work and become a success.  I help 50-year olds survive their mid-life crisis.  I also work with the elderly helping them through an assortment of losses and eventually death.

Knowing what’s coming really doesn’t help. I really expected that I would skip this stage of life. Instead, I become more like my father every day.  My dad started life as an optimist and ended life as the world’s greatest pessimist. I think Parkinson’s and the unavoidable, degrading losses of motor function does that to you.  At least I haven’t started reading the obituaries yet.  He started his day looking at who died.  Of course, the internet and Facebook bring that info to your desktop in real time.

Yes, I’m in the “Golden Years.”  I’ll share a little secret with you.  They are golden years because you need gold reserves to pay for your medications, nursing home and funeral.  Are you depressed yet?  Are you ready to exit my blog and do something else?  Read on.  I promise it will be worth it!

Here’s my gift.  I’ve often told my patients that the devil exists, and his greatest accomplishment is the concept of tomorrow.  By giving us tomorrow to worry about, save and plan for, the devil ruins today.  Today is the only thing we really have.  Don’t waste it.

They say, “No one knows what the future holds.”  I do. For most of my patients, it holds regrets.  Most of my patients put off happiness and work their lives away so that “one day” they will be secure and realize their dreams.  Don’t wait for “one day!”  It may not come.

I am amazed at how bright I was in 2011.  It’s as if I could predict the future and left myself notes in the form of my blog to help guide me through rough times.  Below is an article published August 26, 2011.

Last night, I watched “The Big C”, a TV show about a woman diagnosed with an advanced stage of melanoma, a nasty skin cancer.  The show follows Cathy, the main character, through the various stages of dealing with a life-threatening disease.  The show is funny and sad, uplifting and depressing.  Living with and dying from cancer is often a rollercoaster ride.

In last night’s episode, Cathy, while counseling a friend, remarked, “Don’t delay the happiness!”  Too often, we delay the happiness while dealing with today’s stressors and tasks.  We promise to get together with friends and family.  We promise to call mom and dad.  We plan to run away from it all and be selfish.  We will do it all, one day.

Sometimes, there are no more “one days.”  I have seen patients die for no reason.  One day they are here, the next day they are forever gone.  “Don’t delay the happiness” is sagely advice.  One thing is for sure: today is your day to find happiness.  Today is a good day to make that call, see that friend, and make definitive plans for your runaway vacation.

Yes, you have to work, to make a living, and provide for yourself and your family.  Yes, you are a responsible individual who others rely on.  Yes, you have a list of problems a mile long.  You also have time to count your blessings and you need to make time to do something nice for you and your special ones.  Recently, I wrote about regrets.  Don’t set yourself up for regrets.

Most of my patients are so focused on retirement that they forget to live.  Don’t live to work; work to live.  Your job tomorrow, and every day, is to find happiness.  Happiness is best when it happens spontaneously, but life’s complexities means that finding happiness often requires some work.  Work hard to be happy and then share it with others.  “Wellthy” is not just about being physically healthy; it is also about being emotionally happy.

Horace wrote, Carpe diem, quam minimum credula postero – “Seize the Day, putting as little trust as possible in the future.”   Yes, you have to plan for the future, but not at the cost of the here and now.  

I wish you many years of happiness and no regrets. 

Posted in Philosophy of Care| Leave a comment | 

September 8, 2019

I’m at a loss for words.  In August of 2011, I publish “I AM A RESPONSIBLE PATIENT.”  I actually have patients who follow the health contract as closely as possible.  Despite living a “Wellthy” lifestyle, they get sick.  Really sick?  What do you say to them?  To their families?  

“Bad luck dude,” just doesn’t cut it.  “G-d works in mysterious ways,” really doesn’t help either.  Do you tell them how scared you are for them? How sad you are that they are sick? In this circumstance, rather than asking “why me?”  the question is “why them?” So what wise and helpful thing can you say?

My brother is in the hospital.  He’s in trouble.  He’s the Segal that has spent pretty much every day of his adult life in the gym. He’s the one that eats a healthy diet, is happily retired with a thin muscular physique. He’s active; cutting his own lawn and walking the dogs daily.  He skipped the family curse, Parkinson’s.  Yet, he is now in a hospital fighting for his life.

Why him?  I have no answers.  What I do know is that his years of exercise and healthy living hopefully have given him the physical reserves necessary to fully recover and resume a normal life.

As to what you say.  Nothing at first.  At first, just listen.  Then let them know that you are there for them.  Let them guide you.  Sickness takes away your control of your life.  Make sure in your attempt to help your loved one, you grant them as much control as they can handle.  

Many of my patients have reached out to me since my surgery.  Their thoughts and care have been uplifting.  Thanks, guys, for caring.

Below is a copy of my healthcare contract.

Monthly Archives: August 2011

I AM A RESPONSIBLE PATIENT

Posted on August 31, 2011 by Stewart8022

August 31, 2011

I often refer to myself as a fireman pouring water on the flames that are burning my patients.  Often, I view my patients as arsonists, pouring gas on the fire I am working to put out.  Taking personal responsibility is a critical component of success in any of life’s ventures.  While my patients are very responsible business and family men and women, they often take no responsibility for their own health.  This blog has been successful at helping many individuals recover and maintain their health.  It has failed to help those who continue to be irresponsible.

In an effort to clearly define my patients’ role in their healthcare, I have developed the following contract:

I AM A RESPONSIBLE PATIENT

I, ______________, am a responsible patient.  As such, I take full responsibility for my health and my healthcare.  My responsibilities include but are not limited to:

1. Learning how to promote my own health and wellness.
2. Learning how to deal with illness, both acute and chronic.
3. Actively working to eliminate those unhealthy habits I have acquired over my lifetime.
4. Eating properly, exercising, and striving to eliminate those stressors within my control.
5. Seeking medical advice when appropriate.
6. Understanding the medical advice I receive.
7. Asking questions when I do not understand the advice offered.
8. Following the medical advice when mutually agreed upon by my doctor and me.
9. Taking my medications as prescribed.
10. Notifying my doctor prior to stopping my medication.
11. Notifying my doctor should I have any adverse reaction from my prescribed treatments.
12. Keeping a list of all medications, both prescription and non-prescription (including herbals, homeopathic, and nutraceuticals), that I take and who prescribed them.
13. Bringing my medication list to the office at every visit.
14. Knowing when I will need refills and not running out of pills.
15. Completing diagnostic tests (lab, x-ray, EKG, etc.) in a timely fashion.
16. Keeping my follow up appointments.
17. Seeing consultants when necessary.
18. Understanding my diagnosis, learning about its effects on my body and how I can help manage it.
19. Studying and learning about my diagnosis.
20. Being an active partner in my medical care.
21. Notifying my doctor when I have added other professionals to my healthcare team.
22. Being honest about what I am doing, taking, and who I am seeing.
23. Paying the bill on time.
24. Setting up a payment schedule when I cannot pay the bill and following that schedule.
25. Know the rules of my insurance policy, what benefits are covered and what are not.
26. Notifying the office if any contact information changes occur.
27. Having an emergency contact listed should critical information need to be relayed to me.

My health is important to me, my family, and loved ones.  I will work hard to care for myself.  I understand that my doctor cannot help me if I will not help myself.  I expect my doctor to offer me his/her best advice based on his/her medical training.  I understand that, without my active participation, my doctor’s ability to help me is limited.  I understand that my doctor is the consulting partner, I am the working partner.  Working together, we can accomplish great things.

Signature____________________       Date___________Posted in Philosophy of Care| 2 Comments