CODING

I’m not going to talk about me today.  Instead, I’m going to review what is going on in your doctors’ offices and why it pisses me off.  You’ve heard of March Madness. Well, welcome to December Madness.  Whereas March Madness ends by rewarding one college team with the national title, December Madness ends up with increased overhead, increased workload and the threat of a government audit and charge of “fraud and abuse.”

In 2021, the practice of medicine boils down to cataloguing you, the patient, using ICD10 (diagnosis code) and CPT (procedure code).  Everything revolves around codes.  The coding system changes yearly and there are hundreds of new and modified codes to be aware of and use to describe your patient’s visit.  Every year my staff and I had to learn all the new codes that pertain to family practice.

If you ask me, codes are worthless.  Actually, they detract from patient care and create a further barrier between patient and doctor. So, why do we have such a coding system?  The number one reason is that the AMA sells very expensive coding books every year.  The sale of their books is a major part of their revenue.  Number two is that the insurers of America use the codes as a way of controlling physicians’ behavior and cutting the insurance company’s expenses. 

The insurer, including Medicare, arbitrarily sets the payout on a given code and decides whether they will pay the code outright, deny the code,  or require prior authorization to validate its use.  When I started in medicine, I authorized a procedure prior to it being done and that was it.  Now the doctor’s staff has to call an 800 number, wait on hold forever and start over again.  Getting a procedure authorized for you may cost hours of staff time and that’s not cheap.  You also may be denied the right to do what your patient needs.

By the way, the insurer and Medicare never really deny care, they simply refuse to pay for it.  It’s your choice if you want to pay $5,000 for a non-approved procedure that, if it had been authorized, would have cost the insurer $50.  Doesn’t seem fair, does it?  Denials end up being a major cost savings for insurers and a major expense for physicians.

The number three reason is the coding system sets the physician up for “fraud and abuse’’ charges.  “Fraud and abuse” threats hang over every physician’s head.  What would you think if your doc was charged with fraud and abuse? In the US, we believe people are innocent until proven guilty, right?  Wrong!  Once its on social media, your goose is cooked. Patients who feel their physician charges too much will jump on the band wagon. 

Let’s look at how a code works.  Assume that to code an office visit at 99214 you need A,B,D,M,N,Q,R and Z.  The provider/coder is supposed to know exactly what is necessary to justify the code and document it in detail.  If the physician documents A,B,D,M,Q,R and Z, he/she has not met the criteria for a 99214.  If he does N but does not adequately document it, he is open to a charge of “fraud and abuse” for over charging.  However, there is a catch 22.  If the provider charges a 99213 (a lesser charge) and the auditor feels N was adequately documented and the charge should have been a 99214, the physician can be charged with “fraud and abuse” for undercharging.  It’s a no-win situation and I venture to say that, if a physician’s office is audited, it will be found guilty!  There is no way you can see your patient, treat your patient and accurately detail every bit of information regarding the visit. 

While I wish I was still practicing medicine, the new changes in coding make my not working more palatable.  In many ways, coding has destroyed the profession I loved.  Physicians are not paid for caring.  They are not paid for listening.  They are paid for coding.  What a pity!

Thank God I was never audited by the government.  I did the best I could to code appropriately but, on a busy day, my responsibility was to listen and care for my patient and I’m sure my documentation suffered.  By giving you some insight into what goes on during and after your office visit, I hope to give you a better understanding of your physician and his/her staff.

Here’s your music and a joke. 

Boris Johnson dies…

His soul arrives in heaven and he is met by St.Peter at the Pearly Gates. Welcome to Heaven,” says St. Peter. “Before you settle in, it seems there’s a problem: We seldom see a Conservative here and we’re not sure what to do with you.”

“No problem, just let me in; I’m a believer,” says Johnson.
“I’d like to just let you in, but I have orders from the Man Himself: He says you have to spend one day in Hell and one day in Heaven. Then you must choose where you’ll live for eternity.”
“But, I’ve already made up my mind; I want to be in Heaven.”
“I’m sorry, but we have our rules.”
And with that, St. Peter escorts him to an elevator and he goes down, down, down, all the way to Hell.

The doors open and he finds himself in the middle of a lush country house garden. Standing in front of it his dad…and thousands of other Conservatives who had helped him out over the years…….
The whole of the “Right” was there. .
Everyone laughing…happy…casually but expensively dressed.
They run to greet him, hug him, and reminisce about the good times they had getting rich at the expense of the “suckers and plebs”. They play a friendly game of croquet and then dine on lobster and caviar.

The Devil himself comes up to Johnson with a frosty drink, “Have a Marguerita and relax, Boris!”
“Uh, I can’t drink any more, I’m watching my weight,” says Johnson, dejectedly.
“This is Hell, Boris: you can drink and eat all you want and not worry, and it just gets better from there!”
Johnson takes the drink and finds himself liking the Devil, who he thinks is a really very friendly guy who tells funny jokes and pulls hilarious nasty pranks. kind of like an Oxford undergrad.
They are having such a great time that, before he realizes it, it’s time to go. Everyone gives him a big hug and waves as Johnson steps on the elevator and heads upward.

When the elevator door reopens, he is in Heaven again and St. Peter is waiting for him. “Now it’s time to visit Heaven,” the old man says, opening the gate.

So for 24 hours, Johnson is made to chill with a bunch of honest,
good-natured people who enjoy each other’s company, talk about things other than money and treat each other decently.
Not a nasty prank or mean joke among them; no fancy country seats and, while the food tastes great, it’s not caviar or lobster. And these people are all poor, he doesn’t see anybody he knows, and he isn’t even treated like someone special!
Worst of all, to Johnson, Jesus turns out to be some kind of hippie with his endless ‘peace’ and ‘do unto others’ stuff.
“Whoa,” he says uncomfortably to himself, “Margaret never prepared me for this!”
The day is done, St. Peter returns and says, “Well, then, you’ve spent a day in Hell and a day in Heaven. Now choose where you want to live for eternity.”

With the ‘Jeopardy’ theme playing softly in the background, Johnson reflects for a minute, then answers:
“Well, I would never have thought I’d say this – I mean, Heaven has been delightful and all – but I really think I belong in Hell with my friends.”
So Saint Peter escorts him to the elevator and he goes down, down, down, all the way to Hell.

The doors of the elevator open and he is in the middle of barren scorched earth called Brexit Britain covered with garbage and toxic industrial waste…

He is horrified to see all of his friends, dressed in rags and chained together, picking up the trash and putting it in black bags. They are groaning and moaning in pain, faces and hands black with grime.
The Devil comes over to Johnson and puts an arm around his shoulder.

“I don’t understand,” stammers a shocked Johnson, “Yesterday I was here and there was a country house and we ate lobster and
caviar….drank cocktails.
We lounged around and had a great time. Now there’s just a wasteland full of garbage and everybody looks miserable!”

The Devil looks at him smiles slyly, and purrs, “Yesterday we were campaigning; today you voted for us”

https://upjoke.com/nasty-jokes
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WANTED

It’s really not fair!  The producers of the TV show, “Wanted,” got me hooked last season and promised to do the same this season. Only, they threw in a twist that ruined the show and created this article.

The heroines in “Wanted” are two loveable females who get caught up in a web of murder, robbery and theft causing them to go on the run from the bad guys and the police.  The two women start off as strangers and become mother/daughter/sisters as they live through crisis after crisis.

As the show progresses, it becomes obvious that the women not only are running from the bad guys and police; they are running from themselves.  So, here’s where the writer sneaks up and stabs me in the back.  The young, beautiful, naïve, heroine is a character you can fall in love with.  She is running from her rich, overprotective father for a multitude of reasons.

Running with her is a beautiful, strong, worldly woman who has led a rough life but survived doing whatever she needed to survive.  She’s running from her past, as well. She’s loveable in her own way.  So, the two loveable women grow, episode by episode, setting the hook in the viewer’s mouth and reeling him/her in.

Then, the SOBs who wrote this series ruin it.  The beautiful young accountant ends up having Huntington’s Chorea, a progressive degenerative disease of the nervous system which is going to destroy her body and maybe her mind as it kills her.  Yep, her hand starts to tremor and she goes to the doc.  The test is positive, forcing her to face the fact that she has the same disease that killed her mother.  SOBs!  I could accept if she was caught, tortured or murdered by the bad guys, but not watching her demise at the hands of her own genes.

While Huntington’s and Parkinson’s are not the same disease, they certainly share too many of the same traits, ending up the same. So, there will not be a happy ending to this show. As my readers know, I have Parkinson’s.  Just as the heroine watched her mother die from Huntington’s, I watched my father die from Parkinson’s.  I’m watching my hand tremor right now.  I’m afraid I won’t have a happy ending either. 

Nonetheless, I’ll live my life to its fullest.  I’ll cherish the time with family and friends.  I’ll also keep watching this show, hoping the writers will pull off a Hollywood happy ending.  And I’ll remind myself that I shouldn’t identify with the young, beautiful heroine. On second thought, it might be fun to be a young beautiful female.

Here’s your music and a joke.

A blonde asked her coworker, “Do you have any kids?”

“Yes,” she replied. “I have one child that’s just under two.”

The blonde said, “I might be blonde, but I know how many one is.”

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OK, SHRINK ME

Another day, another new experience.  As my readers know, I’ve been somewhat depressed.  My gerontologist suggested that I see a counselor; and, as much as I didn’t want to engage with a counselor, I said I would give it a try.  Today was my first telesession. 

One career path I contemplated was becoming a psychiatrist.  I was accepted in a psychiatry residency at Stonybook in New Jersey.  Ultimately, I chose a family medicine residency; and, while I’m glad I did, I maintained a lifelong interest in counseling.  I was blessed to be mentored by an exceptional doctor.  I sat with Harry at my friend’s wedding.   I remarked that there were times when I couldn’t discern whether Harry was a patient or the doc.  Harry responded by telling me that he had the same problem.  He said, “When I’m not sure whether I’m the patient or the doc, I look for a diploma.  If the diploma is in front of me, I’m the patient.  If it’s behind me, I’m the doc.”  As always, Harry had a lesson to teach and, on that day, the lesson was that we all have emotional issues and what is truly important is that we recognize ours and put them in their proper space.

Of all of Harry’s lessons, the most valuable occurred at 3 a.m.  I was on medicine call and bumped into Harry at the nursing station.  Harry insisted that I do a thorough history and physical on the gentleman in room 315.  I told him I was exhausted and going to bed!  Harry pulled rank and insisted that I see him now as he was going home in the morning.  I gave in and met a 50 something, overweight, balding truck driver.  I did a half ass history and exam, thanked the patient for putting up with me and started for the door.  The patient stopped me in my tracks, reminded me that his doc wanted me to do a thorough H&P.  Turns out, the patient was a female who had been on male hormones for years.  The lesson was that you can’t cut corners and you can’t believe everything you see or hear.  I never forgot Harry’s lessons and my patients benefited immensely from his teaching.

So, I’ll put aside my doubts aside and give counseling my all.  Conversing with my new counselor was interesting.  She started by discussing the rules she lives by, all of which I lived by for my entire career.  She administered a screening test called a PHQ9.  I must have administered that test a thousand times.  I had scored myself before she finished the test and knew that, according to the results, I was moderately depressed.  I also recognize the tests limitations.  Overall, being on the patient side of the room was a new experience.

My new counselor was pleasant and seemed competent.  She certainly has her hands full.  Having treated depression for over 35 years, I know too much.  Nonetheless, I am willing to give counseling a chance. It sure would be nice if she has a little magic.

In the meantime, one of my patient/friends recommended that I volunteer at the Humane Society.  He volunteers to sit and pet/love dogs that desperately need attention and he thought it would be good for me.  I know how much I love when Renee pets my belly so I figure petting dogs’ bellies will make them feel good too.

Renee, it’s time!

Here’s your music and joke for today.

 Q. How many psychologists does it take to change a light bulb?
     A. One, but the light bulb has to want to change.

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CHANUKAH/CHRISTMAS

I love this time of the year.  I love to shop for presents.  I love giving presents away.  Most of all, I love to see the smiles on my grandchildren’s faces when they open their presents.  With one exception, I scored big this year.  RJ liked his magic set so much that he fell sleep playing with it.  Makenzie keeps her Cocomelon doll close to her at all times.  I also love giving educational toys. STEM products are fantastic.

My one big flop was the kitchen sprout garden.  I thought it would be great if my grandkids could plant seeds, nurture them and watch them grow into edible food.  Upon opening the sprout garden, Mackenzie stated, “That’s not very exciting!” Hopefully, as they grow into delicious, healthy snacks, she’ll change her opinion.

The main reason I love the Chanukah/Christmas season is that, most years, people are nice to each other. People hold doors open for you, are much less likely to cut you off in the parking lot or break into line at checkout.  You even catch people whistling to the music playing overhead.  Unfortunately, the joy of the holidays only lasts 3 weeks, then people go back to being grumpy as they return presents that weren’t very exciting.

There is a dark side to the giving season.  As a practicing physician, I treated a fair amount of holiday depression.  While I expected that those individuals living in poverty or from paycheck to paycheck would be more likely to deal with holiday depression, I soon found out that well-to-do individuals were just as likely, if not more likely, to deal with holiday depression.

One of my most interesting cases was a gentleman I saw for depression with suicidal thoughts.  This individual had a 6-figure job, a loving family and lived in a beautiful neighborhood in a high-end community.  Believe or not, his depression was triggered by an advertisement for a car.  My patient felt like a failure because he could not afford to buy his wife a Lexus with a bow on the roof. 

I’ve already explained why I love this time of the year.  Now, let me tell you what I dislike about this time of the year.  Being bombarded by commercials telling you what you should buy your loved ones or what they should buy you is harmful.  I imagine that this year holiday depression will be worse than usual as Covid has impacted so many households.

If you are feeling depressed, talk to your family, your friends or your doctor.  Don’t try to hide it or live with it!  Work on your blessings list and study it daily.  Turn off the TV and don’t read the internet ads that flood your inbox.  If you haven’t noticed, I write about my ups and downs on this blog.     In return, I get a lot of support from friends, former patients and family.  I have a large support group and you can join it at any time.  I think you’ll find that you aren’t alone. 

Let this holiday season be your best.  Be happy and healthy and realize that it’s not what you give that’s important.  Simply put, the act of giving is what counts, even if it’s just a hug, a kiss and a happy Chanukah and a Merry Christmas!

Here’s your music and a joke.

My mother once gave me two sweaters for Hanukkah.

The next time we visited, I made sure to wear one. As we entered her home, instead of the expected smile, she said, “Aaron, what’s the matter? You didn’t like the other one?”

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YOUR DOC, THE FIREMAN

While I would like to believe that I am better at predicting storms than the weather- man, unfortunately, I am not.  If you are wondering if I’ve lost it, I haven’t.  Once upon a time, my first patient of the morning left the office by ambulance.  After taking a careful history and performing a thorough exam, my assessment was that he was in imminent danger, much the way the weatherman declares a tornado/storm alert.

Yes, a major storm was in the making, one we docs call sepsis.  Calling in the paramedics is the equivalent of calling up the National Guard.  As always, they responded quickly and efficient, securing my patient against what could have proven to be a major tempest.  The next day, my patient is much better.  The storm has blown over and, thanks to G-d, was nowhere near as devastating as I had predicted.

Unfortunately, there are times when medical storms strike fast and appear from nowhere.  No matter how good my patient and I are at practicing preventative care, there are many occasions when medical twisters touchdown in our lives wreaking havoc.  Covid is one of those storms.

So, what can we do?  In the case of a severe weather alert, most of us get busy securing our homes, checking on our flashlights, making sure we have gas for our generators and snow blowers and fill our pantry.  We check on our loved ones and neighbors and then hunker down for the night.

In the case of a medical alert called by your doc, respond promptly, heeding his advice.  Don’t argue as it wastes time.  If the doc says, “Call 911,” call 911.  Take proper precautions.  If your doc warns of an approaching storm in the form of a future heart attack/stroke/diabetes, take action by improving your lifestyle, complying with medication and seeing the specialist when recommended.  If your doc says wear a mask and stay 10 feet away from other people, do it!

Yes, my predictions are often wrong.  When I warn of impending doom and it fails to develop either due to your precautions or not, I’m one happy camper.  Now, if I can only figure out how to predict those sudden acts of terror that occur when illness is lurking in the wings but invisible to the modern medical eye.

Here is your music for today and a few jokes.

  1. The world has turned upside down. Old folks are sneaking out of the house, and their kids are yelling at them to stay indoors.
  2. If you need 144 rolls of toilet paper for a month-long quarantine, you probably should’ve seen a doctor long before COVID-19.
  3. My husband purchased a world map and then gave me a dart and said, “Throw this and wherever it lands—that’s where I’m taking you when this pandemic ends.” Turns out, we’re spending two weeks behind the fridge.
  4. I never thought the comment “I wouldn’t touch him/her with a six-foot pole” would become a national policy, but here we are!
  5. washed my hands so much because of COVID-19 that my exam notes from 1995 resurfaced.
  6. Two grandmothers were bragging about their precious darlings. One of them says to the other, “Mine are so good at social distancing, they won’t even call me.”

Jokes are from https://bestlifeonline.com/dark-coronavirus-jokes

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BETTER DAY

I think you will all agree that my last article was depressing.  Life, especially in the Covid universe, can be very depressing. In past articles, I have outlined the various treatments for depression, including medications, counseling, exercises such as creating a  Blessings List, physical exercise, meditation, etc.  In my last article, I was very upfront about not wanting to take any more medicines.  

First, let me tell you that, when you’re drowning in shit, it’s not uncommon to find yourself in the midst of a “cascade” making it hard to dig out.  In older individuals, it was not uncommon to see one problem lead to another (cascade) and so on and so on.  Yesterday, I learned that I have a melanoma on my chest wall and will need surgery.  What next?  I don’t know!  I know what to do and I started yesterday.  Boy, did I get lucky.  My doc gave me a referral and I did a Google search and scheduled an appointment.  The doc saw me yesterday and he was great with high “care level” and “listening” scores.

Of interest is that I scheduled an appointment with the wrong doc (their office names are very similar) and he turned out to be the right doc for me.  In the course of 24 hours, I’ve consulted my dermatology professor from residency, my general surgeon in Barrington and Dr Nowicky and have a plan.  I’ve added Dr. Nowicky to my “Blessings List” and lucking into an appointment with him has lifted my spirits.

Further lifting me out of the gutter is Chanukah.  I love the act of giving and over the last 2 weeks I have had the pleasure of shopping for my grandchildren and seeing the joy in their eyes as they open their gifts.  RJ is 6 and lives in Georgia. He is a very active and gifted kid who gives great hugs, loves building Legos with his Zadie (me) and has learned to facetime with Renee and me.  Before I left Georgia, I got a heavy dose of love from RJ.

Hudson is 9 months old and they say he looks like me.  Hudson’s eyes lock onto me and melts my heart.  His giggles and hus laughter makes me smile (not an easy feat) and laugh.  Like RJ, he gives me a heavy dose of love and, between the two of them, my depression is fading.

My 3-year-old granddaughter, Mackenzie, goes hot and cold.  Right now, she is into to Renee, often giving me a perfunctory hug and kiss, then running off with her Bubby.  Watching her open presents last night did the trick.  The sheer joy she experienced when seeing her new baby doll, her Cocomelon doll, and Troll infused me with strength and happiness.

That brings me to the moral of the story:  one’s Blessings List, counting your blessings, often works.  That’s not to say that medication and counseling aren’t important adjuncts when properly used, but it points out that there are other options.  Sometimes, when you are depressed, you are blinded by your sorrow and can’t see your blessings.  Have you noticed that I share my feelings with you?  Sharing your feelings with others grants them the right to help you.  In this case, many of my readers and all of my family were quick to offer support and guided me back to my blessings list and recovery.

There are those of you who like to worry. Don’t worry about me!  My melanoma will be taken care of and, even though there are more bumps in the road to come, I have family, friends, former patients and readers to get me through.  Thank you for always being there.

Here’s your joke and music for the day.

What did the banana tell the vibrator?

You’re the one shaking?! I’m about to get eaten!

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BAD DAYS

WARNING!  IF YOU ARE DEPRESSED, YOU PROBABLY SHOULD NOT READ THIS!

When last week’s bad days are this week’s good days, you’re in trouble.  I certainly am.  As each week passes, I find there is less and less I can do.  Today, my attitude sucks!  There are things I want to do but can’t.  About the only thing I still can do is write but writing uplifting articles is becoming more difficult.  Part of me wants to quit writing rather than write depressing material.  Part of me wants to document the effects of having to live with a degenerative disease and the progression from an active, healthy individual to an invalid.

I used to encourage/push my chronically ill patients to concentrate on what was good in life rather than on what was bad.  I used to push antidepressants despite their side effects and the patient’s pill burden.  I had full time counselors in my office to help my depressed patients find happiness or, at least, be less depressed.  Now I question if any of those interventions really made sense.

Pill burden is real.  Despite taking meds 5 times a day, I still watch myself failing.  Does living to take pills really make sense?  I’m not sure, but I do it anyway.  Coming from a physician, it may sound like heresy, but I really can’t see adding an antidepressant to the mix.  I’m dealing with enough side effects as is.  Besides, the physical destruction of my body is NOT from depression.

The best medicine is still being with Renee, our children and grandchildren.   

Renee is my mainstay; and, right now, her back is out.  RJ, my grandson is a natural born caregiver.  At six, he’s amazingly loving and low maintenance.  Just feed him Chick-Fil-A breakfast, lunch and dinner and he is content.  Unfortunately, I can’t do much more with him right now and I fear his memories of me will be as bad as my memories my grandfather’s Parkinson’s.  I can’t imagine what his 6-year-old mind thinks when he sees my stutter stepping and body freezing.  Today has been unusually bad. 

What’s truly scary is that, if my body follows its usual course, today’s really bad day will be next week’s good day and I don’t know how much longer I can do this for.  One of my patients used to say, “life sucks and then you die.”  I didn’t believe him.  So, I medicated him and had him in counseling and then he died.  Did I do any good?  I thought so. I’m no longer sure that he wasn’t right. 

If you are a physician, understand that with all of your training, you can’t possibly imagine what it really feels like to be chronically ill or have a degenerative disease.  The “LF” I wrote about a few days go becomes extra important.  Perhaps there should be a new specialty whose requirement for certification should be along the line of “been there and done that” and survived.  In other words, one should have had or have the disease he/she is treating.  I certainly would be better at treating Parkinson’s today than I was 10 years ago.

This is the last of my morbid articles.  If I can’t say anything good, I won’t publish anything.  Hopefully, I still have some good lessons/thoughts to share with you.

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

The old man sees an older woman sitting on a bench by herself and decides to sit by her. They make small talk for a little bit, and it is obvious to her that the old man is into her. 

He asks her if she’d be interested in holding his penis for a while. She thinks he’s cute, and she hasn’t seen a man’s penis in decades, so she says ok and holds the man’s penis. 

They do this on and off for a week straight. One day the woman is sitting on the bench and the man doesn’t show up. Another day passes and still no sign of the pervy old man. She wonders if he is ok and hopes nothing bad has happened to him. 

She gets up and decides to start walking home. Further into the park she notices the old man sitting on a bench with another woman and she’s holding the man’s penis. 

Upset she runs up to him and asks, “What does she have that I don’t have?”

The man looks up at her and says “Parkinson’s”.

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NANOTECH

In a conversation about the anticipated Covid vaccines, one of my patients asked me what my thoughts were in regard to the nanotechnology being incorporated in the vaccines.  HIs concern was that nanotech provides the authorities (whoever they may be) with the capability to monitor those individuals who have received the vaccine including the ability to verify whether an individual received the vaccine or not.

Frankly I do not know anything about nanotechnology and vaccines, nor had I seen any mention of such devices in my literature.  I did promise him that I would scan my literature and see what I could learn.  Conspiracy theories flourish on the net and I was sure that his was one of the more ludicrous rumors.

My patient is an avid sci-fi reader and a learned man.  He quickly pointed out the fact that much of what was sci-fi when we were growing up is now fact. Knowing that I wear an Apple watch, he reminded me of how unrealistic Dick Tracy’s video watch was when it showed up in the comics in the 50s. As per usual, my patient has a good point.  Researching nanotechnologies use in medicine is scary only because in the world of sci-fi, nanobots usually destroy the earth.

Before I proceed with what I’ve found, I am fairly certain that, if any medical personnel performed any procedure on you without your permission, they could be charged with felony assault and battery and open to all sorts of malpractice suits.  So, if the day comes when vaccines not only protect you from disease but tag you with traceable material, you will be given proper informed consent prior to their administration. A future article will cover informed consent but for now let’s say that informed consent outlines benefits, and risk associated with any procedure or medication given.

Ever hear the expression, “That’s Greek to me?”  In fact, nanotechnology is being used in today’s research into vaccines but how it’s going to work is Greek to me.  It seems that nanotechnology looks promising but in its earliest stage of development.  

The definition of nanotechnology is ”the branch of technology that deals with dimensions and tolerances of less than 100 nanometers, especially the manipulation of individual atoms and molecules” (according to Google and we all know Google is the world’s authority on everything).  Simply put, nanotechnology is a huge field dealing with tiny objects. Unfortunately, when someone mentions “nano” many people think of James Bond and saving the world from evil scientist and their nanobot attacks.  I’m sure evil scientist exist and will one day attack with the fruits of their evil labors (Covid?).  Fortunately, today’s vaccines are being developed by multiple of the world’s foremost pharmaceutical companies and scrutinized by governments and scientist worldwide.

In answer to the question I get most often, I look forward to being vaccinated against Covid.  I need to normalize my life as soon as possible.  However, I’m certain that I will mask even after receiving the vaccine.  Playing mask man to the rescue with Renee is fun!

Here’s your music and a joke.

Looks like the end of the world…

Is also made in China.

Two men are at the bar drinking, when all of a sudden, a breaking news report comes on. “Breaking news, the world will end in one week! According to top scientist a meteor will hit the Earth in 7 days!” The first man looks at his friend and say, “so what are you going to in your last days?” To this his friend replies, “fuck anything that moves, what about you?” the first man then says, “not move!”

Writer’s note:  My editor is under the weather, so this is an unedited publication.  Please refrain on commenting on my punctuation and spelling.

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CARE FACTOR

For forty years I lived in a protective bubble.  I was a practicing physician with all the privileges of a physician.   I was in a unique position that allowed me to judge other physicians in the community and as such, I knew who I could trust, their clinical prowess and, most of all, their “Care Factor.’

“Care Factor” (CF) is a term I coined and of all the scales one could rate a physician on, the “Care Factor” was the most important.

When looking for a physician to care for my family or my patients, I needed a well-trained, experienced physician who cared about his/her patients above all else.  Moving to North Carolina burst my bubble.

I never realized how scary it was when you were sick and looking for a doc to take care of you especially when you did not know anyone in the community.  I never realized how difficult it was to assess a new doc’s “Care Factor” on first seeing them.  My former status as a practicing physician certainly helps in my assessment of my new medical family but I still find meeting a new doc to be a scary event.

Yesterday, I saw a new dermatologist, Dr C Julian.  I had met him at my son’s house on a prior visit to Atlanta and therefore had already assessed his abilities and “Care Factor.”  In his case, he exudes care.  There are some docs that, on first glance, obviously care about their patients and profession. I was lucky to find him and, when he wanted to excise a suspicious lesion, found it easy to say yes and sign the surgical permit.

When searching for a generalist/geriatrician, I admit that I was nervous on arriving at her office for the first visit.  In her case, the receptionist/nurse that greeted Renee and at the door, was remarkable.  She exuded warmth and care and my nervousness quickly dissipated.  Again, I was lucky that I found a physician that appeared to have a strong “Care Factor.”  Dr. Rosen also has mastered the art of listening.  “The Listening Factor” (LF), is a close second to the CF in its importance and ability to allay fear. 

Unfortunately, assessing the CF and LF of a particular physician is usually a difficult task requiring multiple visits to determine.  If I had a lot of time and resources, I would quickly abandon those docs who didn’t exude care and continue my search for the perfect medical team.  I don’t have a lot of time and am no longer in my protective bubble, so I will stay the course with the rest of my clinical team and assess them as time passes.

My fears are real yet tempered by my knowledge as a MD.  I can’t imagine what this stage of my life would be like if I didn’t have that unique perspective.  I would like to believe that I was one of those docs who exuded care and allayed my patients fears.  I would like to believe that I had a huge LF.  But I’m a realist and, as such, realize that there were those days when the practice of medicine was overwhelming and my CF and LF were not at their best.

Had the new patients who met me on a bad day abandoned my practice, they would not have known that my CF was the essence of my life and practice or that my LF scored extremely high.  Instead, they would have told you that Dr. Segal was a jerk.  They would not have known that 10 minutes before they met me, I had to comfort a family whose loved one just died or dealt with a case of child abuse.So, how do you deal with the anxiety of seeing a new doc?  Hopefully you’ll get lucky and find physicians that exude care but if you don’t, cut them a break and assess their skills over time

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HUMPTY DUMPTY

To be perfectly honest, I don’t think I had anything to do with it.  However, it is curious that, as my health fails and I fall apart one body type at a time, all of my kids have started eating right, exercising and tremendously improving their health.  I’m proud of each and every one of them.

For 40 years, I’ve preached the benefits of exercise ad diet to everyone except my kids.  I had a home gym that, like many home gyms, became a place to dump junk.  While most of my patients ignored my advice and did as I did and not as I said, for whatever reason, my kids ended up with gyms they actually use.

I’m visiting Jeremy in Atlanta.  Last night at dinners, he talked about the fact that he rarely eats red meat and monitors his cholesterol.  That blew me away.  Renee and I both have cholesterol issues and heart disease runs in our families.  Jeremy’s diet used to parallel mine and my diet was not particularly good.  To witness the transformation he and my daughters have undergone is exciting.

It’s also somewhat depressing. My 3 year old granddaughter said, “Zadie, you’re falling apart.”  She is right!

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall.
All the king’s horses and all the king’s men
Couldn’t put Humpty back together again.

Well, I’m Dr Dumpty and had I not carelessly climbed that damn wall, five slices of bacon and a dozen Krispy Kremes at a time, I wouldn’t have to struggle as hard to get put back together again.  I had the knowledge necessary to avoid the fall or lessen its impact; but, like so many of you, I concentrated on work, family and friends all the while ignoring myself.  Actually, that’s another partial truth.

I pampered myself with food, and always found something to do other than exercise.  To my children, let it be known how proud I am of your transformation but heed my warning.  You have accomplished step number one.  You have regained your health and vigor.  Now you need to maintain it for the rest of your life, regardless of whatever the world throws at you.

Meanwhile, I’ll keep working at putting Humpty back together again.

Here’s your music and a joke.

My wife gave birth 3 times and still fits in her prom dress from high school. I gave birth 0 times and I don’t fit in my pants from March.

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