Month: August 2020

First published in 2013, this article continues to be true.  Unfortunately, my cronies are retiring, and the private practice of medicine is dying.  Admittedly, I sold out in 2018 and went to work for a large hospital corporation.  I really had no choice.   As a private practice of medicine, I could no longer get reasonable contracts from the insurers and therefore could not survive financially.  My employer recognized my physical limitations and treated me well; however, the writing on the wall was clear. I would need to pick up the pace, see more patients per hour and satisfy the computers lust for data if I was to stay employed. 

July 2013 

Is medicine a profession or is it a business?  To us old timers, medicine is first and foremost a profession; a calling.  As such, the business of medicine has always come second.  Unfortunately, neglecting the business side of medicine has led to my profession’s downfall.

Fast forward to current times.  Medicine has become big business.  Companies such as Walgreens have led the charge.  Obamacare has led to the creation of Accredited Care Organizations owned by corporate entities and poised to suck every available penny out of my once proud profession.  Physicians, Nurse Practitioners and Physician Assistants have become corporate America’s service technicians and patients have become cost centers to be controlled and serviced in mass.

What’s behind the changes in medicine?  Profits!  America’s leading healthcare companies have figured out the business end of medicine and are going at the business full gun.  Pharmacies are now doing acute and chronic care in their Quickie Clinics.  Does anyone see a problem here?  I certainly do!

In past articles, I have written about the ethics of selling cigarettes in a facility that administers care and medication to sick smokers.  Corporate America has taken greed to a whole new level.  Apparently, it is OK to help someone develop chronic obstructive lung disease and then treat him for his chronic illness for the remainder of his life.  

The treatment of chronic diseases entails more than just writing a prescription. It entails helping the patient develop healthy lifestyles.  Will the store front practitioner who is treating a patient for diabetes walk her through the store and show her everything she shouldn’t buy or will the sale on large bags of Reese’s Pieces catch the patient’s eye and will he/she end up with several bags of the sugary delight in their cart?   Will the three 12 packs of Coke for $9 sale be the diabetic shopper’s reward for purchasing his/her healthcare at such a convenient location?

Will the store front practitioner walk the hypertensive safely out of the store avoiding the racks of salt-laden chips and pretzels?  I think not!  Instead, the store designers will continue to set up food gauntlets designed to lead the customer to the most profitable products and fill the corporation’s coffers.

The business of medicine is the end of medicine as us old timers know it.  Ethics and morals will change and it will become completely ethical to sell an obese individual a diet pill, a six pack of Millers, chips, pretzels and candy.   If you can sell cancer sticks in a place of health, hell, you can do anything!

First posted August 31, 2013, this article, like everything else, has changed radically since the onset of COVID.  (My current mindset can be found between the parenthesis.)

Would you hire a painter and ask him to paint your house blindfolded?  Would you call your auto mechanic and ask him to repair your car over the phone?  Would you ask your attorney to draw up your will without sitting down with him and discussing your needs?  Of course not! (However, you might ask a doctor to treat you over the phone.)

So, why would you call your doc and ask him/her to treat your body over the phone?  There are reasons:

• “I’m too busy.”
• “I’m too sick.”
• “I don’t have the money.”
• “The wait’s too long.” 
• (“I’m afraid to be around other people who might give me Covid.)

These are among my favorites!

“But, doc, it’s just a cold!  I don’t have time to come in.  The last time you gave me the Z-pack.  I promise I’ll come in if I don’t get better.”

Mr. C’s cold turned out to be heart failure.  Yes, Mr. C has a cough and congestion.  He also had swollen legs, a cough that worsened when he laid down and an EKG that suggested that Mr. C had suffered a recent heart attack.  Caring for Mr. C over the phone may well have been a fatal mistake. 

Mr. C was too busy to come in.  He had lots to do around the house and was having trouble finding time to do it all.  He also was not very productive as he was short of breath and weak. His heart was having trouble supporting any physical activity.

Mr. C was too sick to come in.  He didn’t know how right he was!  When you are too sick to be seen, you really need to be seen.  If you are too sick to come in, it may be time to call the paramedics.  

Mr. C didn’t have the money to pay his co-pay.  Mr. C drinks a lot.  His congestive heart failure is the result of too much alcohol.  At the price of a fifth a day, it’s no wonder he can’t afford to see the doc.

And yes, the wait is too long.  Mr. C called the office to get his Z-pack.  The front desk had to answer that call and take a message.  The message had to be routed to a nurse who then called Mr. C to tell him to come in.  The front desk had already told him to come in and he had ignored them, asking to talk to the doc.  Mr. C ignored the nurse’s advice, telling her he was sure that “Stu” would take care of him. For some reason, patients think calling me “Stu” infers that they are my personal friend.   My friends don’t call me “Stu.”

Ultimately, I had to call Mr. C.  By the time I called Mr. C, it was too late for him to be seen.  I told him to go to the emergency room.  He ignored me and showed up the next day.  Shortly after being seen, the paramedics picked up Mr. C.  His wait time was short.  Everyone else’s wait time was excessive.

Not only is phone medicine potentially harmful, (Still true, but practicing medicine can be harmful) it is very time consuming.  With the bad economy, patients are trying to avoid coming in to be seen in ever increasing numbers.  Patients are putting off rechecks and instead asking for refills over the phone.  Today, I had 40 refill requests and 20 phone requests for care (I’m sure it’s the same or worst today).  Some of those patients desperately needed to be seen.  

So, what’s a doc to do?  My practice is designed so that my patients can come in when it fits their schedules.  Yes, some days the wait may be an hour or more, but your needs will be attended to.  I see patients six days a week.  In return, I try hard not to treat my patients over the phone.  When my front desk tells you to come in, please don’t ignore them.  When my nurses tell you to come in, you can be sure you need to. (My front desk exists only in my dreams.  I hated making sick people wait, but I would rather they wait than having to cut patient’s visits short.)

Your doctor needs your help. Work together to provide the best care possible.

Here’s your music and a joke.

Having sex in an elevator is wrong, on so many levels.

I once saw an amazing sight:  a 1951 Ford Crestliner.  It’s amazing, in pristine condition and must be worth a fortune.  Can you imagine owning a piece of history?  I bet every head turns when it goes cruising by, proud owner at the wheel.

This particular Crestliner was all original, having been meticulously cared for over the last 69 years.  I imagine that the owner took it into the shop for regular tune-ups and preventative servicing.  When a part broke, he would do his best to repair it, resorting to using all original replacements only when necessary.

Ford sold a lot of Crestliners in 1951.  Have you ever seen one?  I doubt it.  Unlike the owner of the above-mentioned antique, most owners of cars do minimal maintenance, junking them when they age.  Junk yards across this country are full of rusting heaps of vehicles that once gleamed brilliantly.  A few will be meticulously restored.  Most will be turned into scrap metal and parts.

So, what’s all of this have to do with medical care?  I’ll tell you.  I’m a 1951 model that is currently being restored.  Unfortunately, I had neglected to take proper care of my body, making lots of excuses about why there was no time for diet and exercise, no time to take my body out on the road and run it.  I’ve got to confess, restoring one’s health takes a lot more effort than just preserving.What model year are you?  DO OTHERS ADMIRE YOUR BOD WHEN YOU TAKE IT OUT OF THE HOUSE OR DO THEY SNICKER?  Are you showroom ready or heading for the junk yard?  Whatever shape you are in, start working on restoring your vitality.  Stop making excuses for not eating right and not exercising.  Trim down and take pride in what you have.  I guarantee you, it will be worth the effort!

What’s easier: caulking and painting your house’s exterior or letting it rot and eventually replacing it? The answer is simple, isn’t it?

What’s easier: checking and replacing the brakes on your car when they are worn or dealing with the carnage when the brakes fail? Again, the answer is obvious!

So, what makes sense: taking care of your body by eating the right foods, exercising and seeing your doc for yearly physicals and routine maintenance or letting your body go to fat, your belly sag over your belt and your muscles atrophy from disuse. The answer should be obvious, shouldn’t it? Unfortunately, it’s not!

Many of my patients take their health for granted! They feel well! They’ve never been sick a day of their lives. They work hard at making a living but invest little in staying healthy. Then catastrophe hits and they are sick! Their blood pressure is elevated. They are diabetic or worse; they have a heart attack or stroke. Recovery is a bitch!

It’s no secret. It’s easier to maintain your health than to restore it once you’ve lost it. So, this year, work hard at maintaining your health. Make sure your fall-cleaning list entails cleaning up your diet, tightening up your waistline and exercising. And, for God’s sake, wear your masks and keep your distance.  

The life you save may be your own or mine is a statement I’ve ended many of the 1700 articles I’ve written with. The reality is that you can save your life by the simple means described above.  The question is, will you do it?  Will you take a few minutes everyday to work on a healthy meal plan?  Will you take a long walk, ride your bike or work out in a gym five days a week?  Will you tell a joke a day? LOL? Hug a loved one?   Wish someone a happy new day?  If the answer to any of these questions is “no,” you need to figure out what you really want out of life and realize that you are not likely to realize your goals if you are not healthy. 

May you be so blessed as to never know the disease you prevented and “may your troubles be less, your blessings be more and nothing but happiness come through your door. (Old Irish Blessing) 

Here’s your music for the day and a joke.

The only reason I would take up jogging is so I could hear heavy breathing again.
– Erma Bombeck

Doctor to patient: “What fits your busy schedule better, exercising one hour a day or being dead 24 hours a day?”
– Randy Glasbergen

Do you ever feel overwhelmed? Do you have too much on your plate? Your husband is out of work. You have a full-time job during the day and you are mom at night. Your parents are getting old. Your house needs work. You have too many bills and your children are needy, whiny and unappreciative. Dinner conversations are all about “needs,” that four-letter word. Life needs balance!

Often, we are so focused on our curses and problems that we can’t see our blessings. By adjusting your viewpoint, you can reduce your stresses and better address your problems. Try this exercise:

1. Your husband is out of work; you are blessed to have a husband.
2. You have too much on your plate; you have a table to put your plate on and food to put on that plate.
3. You have a full-time job during the day and are a mom at night; you are lucky to have a job and blessed with children.
4. Your parents are getting old; your parents are alive.
5. Your house needs work; you have a roof over your head.
6. You have too many bills; I can spend less and live with less as long as I have a roof over my head, food on the table to feed the children and a husband I love.
7. My children are too needy; they will learn the difference between wants and needs and learn to be appreciative of what they have.
8. Whiny kids are healthy enough to whine and they will grow up eventually.  

So, make a blessings list. Include everything you are lucky enough to have, everything that makes you smile. Place that list on your bathroom mirror and every morning and night, brush your teeth for two minutes. While you brush your teeth, count your blessings. If you start the day blessed and end the day blessed, whatever happens during the day won’t be too bad. By the way, count the fact that you have teeth to brush as a blessing!

Here’s your music and a joke.

How can you tell if being a suicide bomber really guarantees you blessings in the afterlife?

You have to C4 yourself

Often, I used the analogy of peeling an onion to help my patients visualize their illnesses and health.  An onion has many layers, each unique yet looking similar to the ones next to it.  Each layer of an onion affects all the other layers.  

When you buy an onion at your local supermarket, the outside layer is often thickened and discolored.  In order to assess the quality of an onion, you often have to peel away the outside layers until you reach the healthy core. 

When dealing with humans, physicians often have to get past the thickened, discolored outside layers of a person’s life in order to reach the healthy, vital core of their patient’s existence.  

“Doc, I don’t feel good.  Do you think it’s stress related?”

“Doc, I’m having problems maintaining an erection.  Do you think I have low T?”

“Doc, I have . . .  Do you think it’s  .  . .?”

Solving my patient’s problems often meant peeling back the layers of his life, carefully, one at a time.  Rarely is there a simple cause for human suffering.  Most of the time, the bad layers adversely affect the good layers; and, sometimes, it is impossible to discern which layer is the culprit.

When something is bothering you or making you sick, carefully peel back the onion and explore what is under the surface.  Share your findings with your doc/psychologist/counselor; it will help him/her help you.  

In my case, at the core of my existence is the memories of my grandfather and father, both of whom had Parkinson’s.  Those memories haunt me and are closely tied to the negative/depressing attitudes that bleed through to every layer of my being.  No matter how many times I tell myself that I’m not my father, that life is good, that I am lucky, I see my ancestors in their final stages of Parkinson’s, I freak out and want to puke.

So, I do.  I puke out all of the negative emotions onto these pages.  Then I re-read the positive articles again and again until the sun comes up and I can celebrate a Happy New Day.  Those of you who suffer with a chronic illness or simply a few rotten layers in your “onion” may want to consider writing/talking about them in an attempt to peel them away, leaving the healthy layers in their place and, if you’ve found any solace in the ramblings of an old family doc, may want to re-read some of the positive articles on this blog until you to can have a Happy New Day.

Here is your music for today and a joke.  

A man goes to a $10 sex worker and contracts crabs. When he goes back to complain, the sex worker laughs and says, “What do you expect for ten dollars? Lobster?”

Crosby, Stills, Nash and Young sang “Our house is a very, very fine house” in 1970.  I fell in love with the song then and still love it today.  This morning I woke up with “Our House” playing in my mind.  Yes, our house is a very fine house and the reason is that it’s where Renee lives.

Home is wherever Renee is! Currently, home is in North Carolina, in a 55 and older community, surrounded by construction, noise, red dirt and pollen.  Despite the mess, I love it because its where Renee and I live.  Those of you who know me well are probably thinking that I’m brown nosing Renee in an attempt to get lucky.  

I got lucky when, ions ago, I went over to Renee’s mother’s house to

visit Cynthia (Renee’s mother) and found that Renee had just moved back to Norfolk from Chicago.  I got lucky when, later that year, Renee said yes to my proposal.  I got lucky when Renee moved back to Chicago as my wife.  I got lucky when she gave me three beautiful children.  I’m already a very lucky man.

Now, 42 years later, I’m lucky Renee puts up with me.  I’m sure it’s not easy watching the one you love slowly degenerate. It’s not easy for her when I insist on doing things myself (while I can) despite her desire to lighten my load by doing for me.  I am sure I’m not easy to live with at times.  My daughter recently pointed out that my less than rosy attitude was all too apparent.  I try not to be a pessimist.  I work at seeing the good in life and ignoring the bad that I know, from experience and training, is just around the corner.

 What’s really bad is seeing the worry on Renee’s face every time my legs don’t work or when I nap all day.  Even worse, is when she tries to hide her fears of what the future holds from me and the rest of the world.  I can see it on her face but, when I ask her, she always responds, “everything is ok.”  In a sense, everything is ok as long as we are together.  Our house is, in fact, a very, very fine house.  

At this point in life, I have a very important task to accomplish.  I have to remember that I am not the only one living with Parkinson’s.  I have to remember that Renee and the children live with the effects of Parkinson’s on a daily basis and, as I have bad days and worse days, so do they.  I have to help them survive the changes occurring in me.  

I have to make the most out of the future and continue to make our house a very fine place to be. I have to remember how lucky I am.  And yes. I’m not above a little brown nosing to get “lucky,” if you catch my drift. 

There is a moral to this story.  Those who suffer with chronic illness often lose track of the fact that their loved ones suffer the effects of the same illness they have, as if they actually were diagnosed with it.  Chronically ill patients often become self-centered and selfish as they deal with their disability/pain.  Their job is to never lose sight of the suffering of their loved ones caused by whatever illness they are suffering with. Caregivers need care!  If you are chronically ill  or suffering from a disability, con’t forget to care for your caregiver.  

Here’s your music and a joke.  

What do you do if your wife starts smoking?

“Slow down and possibly use some lubricant.” 

It’s the time of year I liked to start my wellness drive.  I would talk to patients about yearly physicals, influenza vaccine and a host of other preventive measures they should utilize. The following article has been published several times over the past few years.  It is even more appropriate today than it has been in the past.

Originally published on March 5, 2011, this article ranks in my all-time top five viewed publications.  Covid has changed our world.  It’s our new number one enemy.  The healthier you are the better you’ll do if you get Covid or any other illness.

As insurance and Medicare become more restrictive, medical luxuries become more important.  With the recent move to brand many tests and interventions as unnecessary, what was once cutting edge and “necessary” now falls into the realm of luxury.  The statisticians look at what is “enough lives saved” in their quest to define “necessary”.  PSA screening is one example.  Initially, PSA testing was considered “unnecessary” as not enough lives were saved for the cost of the test.  Frankly, I’ve been away from the office for 18 months and I’m uncertain of PSA’s current status. However, my own opinion, if I save one life, that should be enough to justify the test.  “Medical Luxuries” addresses the word “need.” 

The word “need” means different things to different people.  In an earlier article, I referred to “need” as the new four letter word.  People overuse and abuse the word “need”.  In my practice of medicine, I defined three levels of need. 

A level one need is critical and worth fighting over.  I saw level one needs two to three times a week.  Level one needs are exemplified by the 60-year-old hypertensive male who has chest pain.  He needs to be in the hospital now!  He needs to go by ambulance now!  His life depends on it.  When he refuses to follow my advice, I dial 911.  When he is at home and refuses to heed my advice, I call 911 and his wife.  Level one needs are absolute! 

Level two is where I spent the majority of my time.  My job was to inform you why you needed whatever it was you needed, what the benefits and risks were, what the expense was and how soon I think you should get it done.  I then left it up to you to decide if and when you were going to do it.  I might disagree with your decision but respected it.  A routine colonoscopy is the standard of care at the age of 50.  It is a level two need.  (If you have a family history of colon cancer, it is a level one need.) 

Level three needs are luxuries and the topic of tonight’s article.  Luxuries are needs you can do without but can do better with!  In medicine, a luxury is anything that is either unproven (but promising), not standard of care, or not covered by insurance.  We live in a peculiar world.  I have patients who won’t get a chest x-ray ($200) because their insurance won’t cover it.  They drive to the office in a BMW but won’t spend $200 on their own health.  I have patients who eat at expensive restaurants every weekend ($75 per person) yet want an inferior generic because the branded cost is $100 per month.  The insurance world has convinced us that if, they won’t pay for it, either you don’t need it or it is too expensive to afford.  

Luxuries can save you money and your life.  Several years ago, I was called in to the hospital to see a very sick patient at 5 a.m.  I dressed quickly, jumped into my car, backed out of the garage and slammed into my daughter’s car.  I had not spent the extra money to buy back up sensors when I purchased my car.  My decision had consequences.   I had to tell my daughter I smashed her car.  I had to pay for her repairs, as well as mine.  What seemed like a luxury item at the time turned out to be more of a necessity than I had anticipated and a costly error in judgment as well.  Luckily, the patient did fine. 

So, what are luxury medical items?  Cardiac Scoring is a good example.  It measures the calcium load in your coronary arteries and predicts coronary artery disease.  A healthy 50-year-old male with no family history of heart disease is buying a luxury when he gets one.  Insurance won’t pay for it and technically he doesn’t need it.  So why get it?  Most of us are healthy until we are not.  If his results are normal, he gets peace of mind.  If his test is strongly positive (it happens to the healthiest of us), he may well have saved his life. 

Every year there are unexpected deaths in our community.  Could the purchase of a healthcare luxury, an annual physical, an EKG, blood test or x-ray, have saved their lives?   I would like to think so.  The next time your doc asks you to get a test or buy a medication that is not a covered benefit, think twice before you dismiss the idea.  Times are tough and money is tight; but, if your roof was leaking, you would find a way to get it repaired.  I often use analogies to make a point and my favorite has to do with your house.  Your house is very important; and, when it needs repairs, we find the means to do so.  Your house shelters your body; your body houses your soul.  Do everything you can to protect your body and keep it fit for many years to come. 

Here is your music for today and a joke. 

A 90-year-old man goes for a physical and all of his tests come back normal. The doctor says, “Larry, everything looks great. How are you doing mentally and emotionally? Are you at peace with God?”

Larry replies, “God and I are tight. He knows I have poor eyesight, so He’s fixed it so when I get up in the middle of the night to go to the bathroom, poof! The light goes on. When I’m done, poof! The light goes off.”

“Wow, that’s incredible,” the doctor says.

A little later in the day, the doctor calls Larry’s wife.

“Bonnie,” he says, “Larry is doing fine! But I had to call you because I’m in awe of his relationship with God. Is it true that he gets up during the night, and poof, the light goes on in the bathroom, and when he’s done, poof, the light goes off?”

“Oh sweet Jesus”, exclaims Bonnie. “He’s peeing in the refrigerator again!”

We are just a month away from the beginning of the Jewish New Year. This past year has been pretty rough for most of us.  Covid has changed our lives in so many ways that it’s hard to imagine a happy future.  Anxiety and depression are just two of the negative effects of Covid and is worsened by “Breaking News” segments burning the daily death counts into our brains and promising more bad news to come.  Something needs to change. Perhaps part of the answer can be found in an article I wrote in 2011:

I’ve always loved New Years!  New Years is a celebration of life.  New Years is full of hope with everyone wishing each other a happy, healthy, and prosperous year.  New Years is a time of reflection, looking back at the time that was, assessing what was good, what was bad, and what you wished you had done. 

New Years marks a new beginning as you look forward to what you pledge to accomplish, the things you want to set right, and the things you failed to do in the preceding year.

Why can’t everyday be New Years?  Why not start every day off by wishing each other a happy, healthy and prosperous day?  Why can’t everyday be a reflection of the past and a renewed pledge to do better in the future?

Think how much we could accomplish if each and every day we awakened by celebrating today as if it was the onset of the New Year.  I think I’ll try to follow my own advice.  I will proclaim a new holiday called, “Happy New Day”!  May today and every day bring you health, happiness, and prosperity.  May every morning you awaken and be blessed with hope and the knowledge that each day is a blessing.

Sometimes it’s easy to lose sight of the fact that each day you walk the earth is a blessing.  As many of you are aware, my own attitude has been quite negative lately.  As I stated yesterday, it’s time for me to go to work and improve my health and attitude.  It’s time to post my Blessing’s List on my mirror and count my blessings every morning and night.  Perhaps it’s time for you to do the same.

I wish you could hear my 3 year old granddaughter singing, “It’s a Beautiful Day in the neighborhood” as I finish this article.  Time to go play.

Here’s your music for the day and a joke.

A biker walks into a bar and sits down on a bar stool near the end of the bar.

He takes a look at the menu and it reads as follows:

Hamburger – 2.99

Cheeseburger – 3.99

Chicken Sandwich – 4.99

Hand Jobs – 19.99

The crusty old biker waves the bartender down, and up walks this tall, busty, beautiful redhead in her mid-twenties. She smiles at the biker coyly, and he asks in a quiet voice “Are you the one who gives the hand jobs?” The bartender blushes slightly and says “Yes, I am” with a sexy little smile. The biker grins and says, “Well wash your hands, because I want a cheeseburger.”

Over the past 30 years, I’ve written many articles vilifying the word “try.”  When my patients, children or friends used the word “try,” I would pounce on them.  Try is a word that almost always is accompanied by the word “but.”  People who try to lose weight fail.  An employee who promises to try to finish a project by Friday is not likely to finish it.  

“I tried to get it done but my wife got sick and I had to pick up the kids,” is a great excuse, isn’t it? 

“I’ll tried to take the garbage out, but I had to go to a study group for my math exam.” Another great excuse, isn’t it?

Yes, when you accept the word try from another person, you should expect that they will disappoint you.  You can bet there is a “but” coming your way.  I never accepted the word try.  Instead, I would explain the difference between trying to do something and working at doing something.  When you use the word “work,” there is an expectation that you will finish the job.  Work is usually hard; but, when the work is assigned to you, no matter how hard, you are obliged to finish it.  People who work are expected to make mistakes from time to time.  They are also expected to fix and learn from those mistakes.  When you have a job, you are expected to show up for work everyday until you have finished it.  

Yes, there is a big difference between “trying and working.”  Today, while looking for something to write about, I came across several old articles I’ve written on this subject.  I also recognized that I’ve been trying to lose weight and get healthy/wellthy.  I realized that “do what I say, not as I do, is stupid.  So, it’s time to come out of retirement and go to work at getting healthy and wellthy.   Working on being healthy means walking/biking every day, no excuses.  Working at losing weight means eating healthy no matter how good the Krispy Kremes smell.  Working at being healthy means no ifs ands and buts!  I will finish this job.  The job is going to take a year to complete so accepting the job is a long-term commitment. I’ll make that commitment.

How are you doing?  Are you working on being healthy and wellthy or are you trying to be healthy and wellthy?  If you are sitting on your butt rather than doing what you should be doing, throw out the “but” and work hard at fulfilling your obligations to yourself an others.

Here is your song for the day and a joke.

Teamwork is important.  It helps to put the blame on someone else!