ON OFF

The on/off phenomenon that Parkinson’s patients can experience is hard to understand.  When I treated Parkinson’s patients, I was aware of the on/off (freezing as in “can’t move”) periods they could have but never really appreciated the cataclysmic effects an off episode could cause.

This morning, I am “off”.  Imagine walking through a muddy bog, the thicker the mud, the harder it is to move your feet.  My feet feel like they glued or cemented to the floor.  Most of the time, if I muster all of my strength, I can move them.  Often, once moving, I’ll freeze again. Episodes can last minutes to hours and occur on a random basis.

When I use the term cataclysmic, I’m not exaggerating.  Imagine you have to urinate.  You head to the bathroom and freeze at the doorway to the toilet room.  (Freezing at portals is common.)  You’ve really got to go, and you can’t move.  Yep, you wet yourself and the floor.  Now, imagine that rather than being home, you are at the grocery store. “Off” periods are horrible and capable of scaring anybody who is around you. 

Imagine seeing me in the local market, standing rock still at the entrance to the bathroom, wetting myself.  Horrifying?  Luckily, it has never happened.  When you have unpredictable off periods, you stop at every bathroom you pass. It’s not uncommon for me to go straight to the bathroom when I enter the store and prior to leaving the store.  When we moved to Carolina, Renee learned the names of the key roads we would need to get around.  I learned where all the clean bathrooms were.

“On” periods can be amazing.  If you see me during an “on” period, you might think I’m normal.  On a rare occasion, an “on” is so good that I almost feel normal.  Other times, I can move but still feel like shit. “Ons” are precious moments in which you can exercise, swim, work on a project or simply enjoy a shower without fear of falling.

So, what can you do to help? The first thing to do is simply ask me if there is anyway you can help.  I’ll tell you to tap on my right shoulder as sometimes that helps.  Most of the time, I do not want to hold on to your arm or hand.  I can’t explain it but holding on to someone seems to make it worst. 

Just as thresholds may provoke an off episode, so might obstacles on the floor.  I might ask you to clear a path for me.  On occasion, I can’t break the “off,” in which case having a chair to sit in is very helpful.  So far, I’m lucky.  My “off” periods are always followed by “on” periods.

If you know someone with Parkinson’s, talk to them about the on/off phenomena and be prepared to assist them if necessary. If you see Renee hitting my left shoulder, I probably pissed her off.  If you see her tapping my right shoulder, I’m frozen and she’s trying to get me moving.

Here’s your joke for the day:

Difficult things to say when Drunk. 1. Innovative 2. Preliminary 3.Cinnamon. Very Difficult things to say when Drunk. 1.Specificity 2.Passive-disorder 3.Transubstantiate

Things that are just down right impossible to say when drunk.

1.No, thanks, I’m married.

2.Nope, no more for me.

3.No, I don’t want to see your tits.

NEW DAY

Happy New Day! Yep, I’m back.  My sabbatical is over and I’m ready to get my act together and go on the road.  Yesterday, Renee and I dressed up to go out to dinner with friends.  I should say Renee dressed; I tried on clothes that were mine but obviously belonged to the old me.  Nothing fit! Not only did my clothes not fit, they weren’t even close to fitting.

Along with the embarrassment of having outgrown everything I wear came the flood of memories of the multitude of obese patients I treated and the sagely advice I gave them.  The realization that I had ignored everything I know about obesity and weight loss was staggering.

When you are fat, well meaning friends and colleagues are quick to tell you about their experiences with the latest and greatest diets.  At any one point, there must be 100 fad diets circulating the globe.  They all work for some individuals and fail for others.  Most are restrictive plans that dictate what can be eaten and what cannot.  In reality, I know what works for me.  I’ve just been ignoring it.

Renee asked me how I feel this morning and I told her every part of my body hurt.  When you think about it, my body should hurt.  I’m carrying around a 50-pound sack of potatoes 24/7.  As an exercise in reality, I used to have my obese patients carry around a 5-pound bag of flour all day and measure the effects of that added 5 pounds on their general wellness.  Almost always, they noted an increase in aches, pains and fatigue after a few days living with 5 extra pounds.  Well, I skipped the 5-pound homework project and jumped straight to 50 pounds of mega fat!

It’s time to dust off “Diets and Other Unnatural Acts” and go to work on my body. Turn on your TV and, no matter which news channel you turn to, you’ll hear about the dismal state our country’s infrastructure is in.  The government is proposing that a trillion dollars go into the repairs needed.  My infrastructure is 70 years old and in desperate need of repair!  I only need a billion dollars to accomplish my goals.  While I’m waiting for my billion, I’m getting started on my remodel Stewart job.  I figure its going to take 1 ½ years.  In the meantime, I’m going to resume writing my blog and working on my book.

Here’re your jokes for the day:

After a month of dieting, I lost 30 days!

Definition of “diet” is I ate it.

I’m a light eater.  As soon as the light comes on, I eat!

Today’s jokes come from Best diet jokes ever – Weight loss jokes for funny moments.

GIVERS AND TAKERS

There are “care givers” and “care takers”; and, when a care giver is forced into being a care taker, all hell breaks loose.  Let me explain.  In general terms, there are givers and takers, the takers far out numbering the givers. Over the 40 years I was doc, my job was to take care of both groups; but I always felt that care givers should be given an extra dose of care, no matter the cost or difficulties associated with that extra care.  Without care givers, the sick and injured would be in a world of trouble.

In May of this year, I wrote an article entitled Superwoman.  The article was about Renee and I referred to her as Superwoman. Through the years I have written numerous articles about my Superwoman.  You see, Renee is a care giver, and that makers her precious.  I, too, am a care giver and that’s where the trouble starts.

The other day, we went out to lunch.  Renee insisted on getting the walker out of the trunk as she worries that I’m going to fall or hurt my back lifting the walker.  Her fears are valid.  I insisted on getting the walker out of the trunk as Renee has a bad back and getting the walker out means stressing her back.  Both of us want to care for the other and both of us are frustrated when the other insists on doing what we feel we should be doing to care for them.

To make matters worse, when a young passerby asks if he can help, both of us thank him and quickly point out that we can handle it.  It’s hard for a care giver to accept help. It should be noted that care givers are often stubborn when it comes to their ability to give care.   I believe the stubborn refusal to accept help stems from a loss of the pride they had felt by helping others.

It’s critical that care givers learn two things.  Thing number one is that they need to care for themselves so that they will be healthy enough to care for others.  Thing two is that they need to learn to accept care from others.  It’s not easy but is so necessary!

 It’s also a matter of common sense.  By accepting a little help now, they lessen the odds of breaking a hip and needing a lot more care in the future.  The point of this article is that, eventually, care givers will become care takers; and, that by learning to accept care from others, they will ultimately lessen the amount of care they need.  Yes, it is confusing.

Think about who are the givers and takers in your life, then pay special attention to the givers.  Offer them as much help as you can but don’t be offended when they refuse your help. Keep offering them help as they age and give them a copy of this article.

Here’re your jokes of the day:

Husband and his wife were celebrating 50 years together. Their three kids, all very successful, all agreed to a Sunday dinner in their honor.

“Happy Anniversary, Mom & Dad,” gushed son number one, a surgeon. “Sorry, I’m running late. I had an emergency at the hospital with a patient, you know how it is, and didn’t have time to get you a gift.”

“Not to worry,” said the father, “the important thing is that we’re all together today.”

Son number two, a lawyer, arrived and announced, “You and Mom look great, Dad.”  I just flew in from Los Angeles between depositions and didn’t have time to shop for you.”

“It’s nothing,” said the father. “We’re glad you were able to come.”

Just then, the daughter, a marketing executive, arrived. “Hello and Happy Anniversary! I’m sorry but my boss is sending me out of town: and I was really busy packing, so I didn’t have time to get you anything.”

After they finished dessert, the father said, “There’s something your mother and I have wanted to tell you for a long time. You see, we were very poor. Despite this, we were able to send each of you to college. Throughout the years, your mother and I knew we loved each other very much, but we just never found the time to get married.”

The three children gasped and all said, “You mean we’re bastards?”

“Yep,” said the father, “and cheap ones, too!”

 http://www.jokesoftheday.net/

Question: What does one boob say to the other boob?

Answer: If we don’t get support, people will think we’re nuts.

LUCKY ME

I’m happy to report that day one of my new diet went extremely well.  I followed the rules, eating only food and only when I was hungry.  I was surprised how easy this diet is!  Once I resolved the issue of what was on the good list and what was on the restricted list, all guilt went away.  Of course, all food is on the good list giving me a limitless supply of choices.

Day two is going well.  I had food for breakfast and then took a walk around the block.  It’s off to the pool now and then fried flounder for lunch.

Strangely enough, I lost 3 pounds since yesterday.  I actually ate less partly because I didn’t worry about what or when I was going to eat and partly because the night before I started my diet, I ate everything cold and sweet in the frig. 

I’ve got to admit, guilt free eating is a pleasure.  It also eliminates the urge to eat special foods.  When we lived in Long Grove, I obsessed over Krispy Crème Doughnuts.  If we were lucky enough to find a KK, we stopped; and I ate a half dozen.  What a guilty treat!   On my current diet, a half dozen hot KKs is perfectly acceptable as they fall firmly into the category of food; and all foods are permissible.  Now that I can eat them anytime I want, I don’t want them.  I passed the “HOT” sign twice yesterday and had no urge to stop and eat some.  Goodbye, KKs.

I think comfort foods will lose their allure and sinful foods will lose the excitement that comes with sinful acts.  The other big plus is I do not need to record calories, cholesterol, etc.  Food has no limits!

I am recording exercise.  For this diet to work, I have to exercise.  Goodbye for now. I’m off to the pool for pool aerobics.  This afternoon, I’ll walk around the block a few times. 

My current plan is to give this diet a few years to work and then assess the results.  Meanwhile, I’ll keep doing fat jokes:

I wish I could see what it was like to be fat for just one day. I’m tired of being fat every day.

Fat people are lucky. They get to eat whatever they want and not worry about getting fat.

I’M SO FAT

If, at first, you don’t succeed, try, try again.  If you fall down 4 times, get up 5 times.  There are countless cliches dealing with failure.  They all have a common theme:  you can overcome failure by being persistent in your quest for success.

Personally, I’ve failed every attempt I’ve made to lose weight.  I’ve become obsessed with food and weight loss and obsessions are almost never good.  I spent 40 years counseling others on diet, weight loss and wellth.  I was quite good at it, although I did have my failures.  In retrospect, those failures were probably related to the patient’s obsession/ psychological ties to eating.

I could take the easy way out and blame my medications.  One of the meds for Parkinson’s clearly warns patients that they are high risk for obsessive behaviors.  I could blame the medical marijuana for causing the “munchies.”  I could also blame my upbringing as my family was in the food business and my mother was a perpetual dieter. Lastly, I could blame my weight gain on the effects of depression.

Realistically, placing blame is a worthless exercise.  Laying blame only helps when, by recognizing the contributing factors, you can actually change them.  I’m not going to change my meds!  I can’t change my family history.  Medical marijuana helps the Parkinson’s!  So, what can I do?

My kids will tell you the Segal Motto is, “Go big or go home.”  I’ve gone big!  Big, as in, “You’re so fat the post office is issuing you your own zip code” big.  If carrying around an extra 50 pounds was easy, I would just accept my own zip code with pride and put on a little more.  The problem is carrying an extra 50 pounds is a lot of work and it’s killing my back and knees.

So, I’ve decided to go on a very strict diet.  I have decided that I’m only going to eat food for breakfast, lunch, dinner and snacks!  I’m going to limit the amount of food I eat to whatever it takes to fill me.  I’m going to stop obsessing about calorie counts, fats, etc.  I’m going to enjoy guilt free eating.

My new obsession is going to be exercise.  I’m going to obsess about burning calories.  I’m going to start everyday with sexercise, then walking, swimming and doing whatever I can to burn calories.  Of course, my Parkinson’s and bad back almost guarantees failure, as walking and swimming are difficult; and, at 70, sexercise is pretty much a mental exercise. But, at least, I’ll succeed at enjoying my all-natural food diet.  I will continue Rock Steady twice a week until I’m strong enough to go three times a week.

Wish me luck.  Who knows, I might even lose a pound or two as my obsession with exercise grows!

Here’s my fat joke for the day:

I’m so fat I wore a yellow rain jacket and people yelled, “TAXI.”

ASK AN OLD MAN

Let’s assume that nothing I say or do is going to change today’s medical delivery model.  Assume that the qualities listed in past articles that make a physician truly great are either innately present at the time a student enrolls in medical school or that they are not part of the student’s tool chest.

Further, let’s assume that today’s employers of medical providers have no interest in teaching providers how to listen, comfort and reassure, as those traits take time and time is money.  If you doubt my assumptions, take a minute to think about “telemedicine,” the newest doc in a box.

Take the time to schedule a “telemed” visit.  Experience, first-hand, what the future of medicine looks like.  Did the doc listen to you?  He/she should have!  He/she certainly couldn’t touch you, examine you or draw lab.  Did you feel you were cared for?  Were you comforted?  Can you imagine developing a relationship with the doc on your computer screen?

I think not!  So, if I’m right, what’s a person to do? Perhaps the answer is in training and developing a new type of healthcare coach, the patient advocate. There are thousands of retired physicians in the United States, many of whom would like to work, part-time, in their chosen fields.  Licensure requirements, malpractice insurance and the overhead of running a business prevent most retired physicians from practicing medicine.

“Ask An Old Doc” (AAOD) could be the answer to the patient’s need for an experienced and caring advocate, as well as meeting the needs of the retired doc who wants to continue to support patients in need of advice.  AAOD would employ retired physicians in the role of healthcare advocates and life coaches.  While the AAOD employee would not function as an MD, his/her wealth of knowledge and experience would prove to be invaluable tools in helping individuals through whatever situation they find themselves in.

AAOD would function best as a not-for-profit organization, charging patients on a sliding scale basis according to need.  Before I go any further with this idea, I’d like to hear what your thoughts are.  Would you likely use such a service?  What would you be willing to pay/donate to AAOD? 

Here’s your joke for the day:

A mentor of mine once told me that a great way to let go of your anger is to write letters to people you hate and then burn them. Well, I did that; and I feel much, much better, but I’m not sure what to do with all these letters.

MODERN MEDICINE

As I look back over my blog, I realize that my central premise is faulty.  The medical complex I grew up in is long gone.  New docs are graduating this summer and entering a system so foreign to my background as to be almost unrecognizable.

When I graduated, everybody went into the private sector, either hanging out their own shingle or joining an established practice.  Today’s docs will sign employment contracts with large medical conglomerates.  They will be given an employee manual outlining their responsibilities to the corporation and the corporation’s patients.

Their marching orders may not tell them how long to spend with a patient or what to prescribe but, instead, will give them parameters that they must follow in order to be financially successful.  The electronic medical record (EMR) will grade their care:  what percent of their prescriptions are generics, what percent of their specialty referrals were to docs employed by the healthcare conglomerate, how many antibiotics did they write, how many patients did they see per hour, etc.

In the new world, my proposed book is worthless.  Yes, a small percentage of the doc’s overall performance rating will be dependent on patient feedback’ and, following the guidelines I’ve laid out, patient satisfaction should be high but it’s going to be almost impossible to be a good listener, a caring and comforting doc and address the demands of an uncaring EMR whose only goal is to collect data. Much of what transpires between the doc and the employer will be invisible to the patient; but enough will be visible that, inevitably, the patient will be unhappy and uncomfortable.

Sounds depressing, doesn’t it!  It’s time to put the top down and go for a ride.  It’s almost impossible to be depressed while cruising, top down, on a sunny summer day. For those of you who don’t have a convertible, my suggestion is to find an old doc who is still independent, not yet disillusioned and settle in with her/him.  If you can’t find an old doc, find one of the few who work for physician owned groups. 

Meanwhile, I’m going to take a brief sabbatical from writing while I reassess the premise behind this blog.  Feel free to make any suggestions or share any thoughts you have with me.

Here’s your joke of the day:

My grandfather, Randy, was a brick layer.

He said: “I was a brick layer for 10 years, but no one calls me Randy, the brick layer.

I was a farmer for 20 years, but no one called me Randy, the farmer.

But you have sex with just one goat…”

GOLIATH

I just got a frantic call from an old colleague of mine.  He’s a modern-day David fighting against one of the Goliaths of medical corporations, AMG.  My friend and I have served the northwest suburbs of Chicago for decades.  When I opened in Barrington, EHS (Evangelical Hosp Systems) ran the local hospital. EHS had a heart of gold and a charitable policy like none other.

A simple phone call to the COO of Good Shepard Hospital could zero out the account of a patient who was about to go to collection or worse, whose choice was pay the hospital bill or feed the kids.  More than once, the hospital provided babysitters for a patient whose spouse was in the ICU or dying from a horrible disease.

During those golden years, Good Shepherd’s staff was comprised of some of the best generalists and specialists you could find anywhere.  The physician practices were all privately owned and unencumbered by insurance companies or employers, thus decisions regarding testing or referrals were made by the patient’s physician in conjunction with the patient.

Over the years, the insurers slowly took control of the medical decisions by creating specialist and diagnostic panels that both generalists (Internal Medicine/Family Practitioner) and patients were required to use or suffer a financial penalty.  In the last 15 years, a new player joined the game. 

Hospital corporations, like EHS, started to merge into much larger and powerful healthcare conglomerates.  As they grew, they started buying medical practices.  Their business models were ingenious.  First, the hospital bought a large number of internal medicine and family practices.  Then, they purchased key specialty groups and fed all of their patients into a few, corporate owned specialty practices. 

Over time, this new model changed and continues to change the referral pattern by choking off the patient flow that independent specialists need to keep their offices open. Eventually, independent specialists either give their practices to the hospital corporation or they retire.  As the number of specialists decrease, independent generalists begin to have problems obtaining specialty consults. Eventually, the generalists either give their practices to the hospital conglomerate or they have to retire. 

Specialty care is an essential part of medical care. Imagine the following scenario:

“This is Dr Segal’s office.  His patient, Mr. X, needs to see a cardiologist this week.   Can you please find him an appointment and call him?”

“I’m really sorry.  We are so busy taking care of our employed physician’s patient that we couldn’t fit your patient in for at least 120 days.”

“Dr Segal, would like to talk to Dr AMG?  Can you have your doc call mine?”

“Is Dr Segal an AMG doc?”

“No.”

“Sorry, I can’t help you.”

Now, do you understand why my old friend and colleague is frantic? He’s an independent and recognizes that the above scenario is actively unfolding in Barrington.  Unfortunately, I think Goliath wins this and all future rounds.  Unfortunately, you lose, too.  As your choices for specialty care dwindle, so may the quality of your health care.

I’m happy I’m retired.  .

Whenever possible, support independent physicians!

Here’s your joke for the day.

There was a man named Billy. Billy worked at a pickle factory. One day Billy comes home to his wife and says…

…“Honey, I want to put my pp in the pickle slicer.  His wife tells him that’s absurd and not to do it and then went to sleep. Billy goes to work the next day and comes home and tells his wife, “Honey, I put my pp in the pickle slicer!” His wife yelled, “What happened? Was it bloody? Did it hurt?” The man tells his wife, “No, but I got fired and so did she.

THE GOOD PATIENT

We’ve defined the some of the attributes needed to be a good/great doctor.  Now, let’s explore what attributes a great patient brings to the doctor-patient partnership.  I bet you have never considered your role in healthcare, have you?

No matter what your doc does for you or to you, he/she will be ineffective without your input and cooperation.  Coumadin, a common blood thinner, is also used as rat poisoning.  When patients find out that they are on “rat poisoning,” they freak out.  There are a multitude of horror stories associated with Coumadin.  

I routinely informed my patients about Coumadin’s usage, benefits, and risks.  Until recently, Coumadin was an essential medication used to prevent strokes and blood clots.  Making coumadin even harder to use is the fact that its anticlotting property is managed with blood work and must be kept in a tight range.  Too much and the patient bleeds, too little and the clot or stroke.

The story goes like this:  I spend a half hour reassuring my patient that, in her case, Coumadin is a life-saving medication.  I remind my patient that she is not a rat and doesn’t have to worry about taking a “rat poison.”  She agrees and goes on Coumadin for a while.  One day, she reads an internet rant about Coumadin and stops taking it. A few weeks later, she has a massive stroke.

No matter how good your doc is, he/she can’t help you when you make unilateral decisions.  A simple call could have saved a life full of misery.  The internet is not a reliable source of medical information.  At best, its use should help patients formulate questions to be answered by their docs. Luckily, there are new meds that take the place of Coumadin; but all medications have risks and part of what your doc does is risk manage.

The qualities of a good/great patient are the same as the qualities that make a good physician.  My favorite patients were engineers.  They are usually analytical and organized.  They are usually good at describing their symptoms and breaking the symptoms into their various components:

“Doc, I’ve been feverish and tired (general symptoms).  My nose is congested, and I’ve got a sore throat.  My ears are popping (HEENT). I’m coughing up clear sputum.  I’m a little short of breath (respiratory).  Otherwise, I’m fine.” 

The engineer has done most of my job in advance of coming to the office.  Engineers are usually good listeners, analyzing what I’m saying as I’m saying it.

I know, you’re thinking, “I’m not an engineer.”  You don’t have to be.  You should organize your needs, thoughts and questions before coming in to see your doc.  All too often, I would get a phone call a few hours after I saw you with an “Oh, by the way, I forgot . . .”  The absolute worst is when the patient’s wife calls, “Doc, did he tell you he has chest pain?”  My response was no, he denied any chest pain.  In the background, my patient is yelling, ”It’s just indigestion!”  He refuses to go the ER. Hours later he collapses and spends 3 days in the cardiac ICU.  Luckily, he survives.

As a patient, not only do you need good listening skills, but at some point you need to accept and act on what you hear.  In this gentleman’s case, I told him that we had to make sure he was not having heart pain and that I would gladly apologize for panicking him once I knew he was well.  I loved being wrong about chest pain but, most of the time, was right.

As a patient, you need to be assertive, your own advocate. Second opinions are great if there is time.  When the stakes are high, the ER is your second opinion.  “Doc, I know my body better than anyone and I know this is indigestion, not heart.  I have no family history or risk factors.  I’m a distance runner.”  Yes, by history, the patient is in a low-risk category but he had significant coronary artery disease (widow maker). Yes, he was unlucky enough to be the first in his family. He ignored the ER doc’s advice and went home against medical advice.  He wanted to see his chiropractor/naturopath.  He made a widow out of his wife.

Being a good patient means knowing when to comply, when to follow through and when to get a second opinion.  One of my favorite patients was an anxious patient who came in with 5-10 pages of hand-written history, observations and questions.  She always apologized for taking up too much time; but, actually, she saved me time by being prepared.   If the visit was for her husband, she came with him in the role of patient advocate.

Tomorrow, we will discuss the patient advocate role’s importance. Here’s your joke: What’s worse than ants in your pants? Uncles!

RESPECT IS A TWO WAY STREET

One of my readers, in response to my recent articles about the qualities of an excellent doctor, wrote, “Respect is a two-way street.”  Indeed, it is!  Those of you who have followed my blog over the years know that my childhood doctor played a major role in who I was to become.

I don’t know why, but I called Dr Perlman by his first name, Jerome.  I was very ill and very scared!  I suspect I started using his first name around the time I started getting sick and was in his office frequently.  No matter the reason, Jerome never balked, never corrected me.  In turn, I never balked when a patient used my first name. 

Yes, the title “Doctor” brings with it a certain level of respect at the onset of a relationship; but, realistically, respect should be earned over time.  By the same token, the titles “Mr.” and “Mrs.” should also be treated respectfully.  In the instance my reader and former patient wrote about today, he was rebuked for calling his doc by her first name.  He writes:

“She was a taken back and said that’s Dr. (insert first name). I asked, what do you call me? Her answer was hi or hey. Sorry, not acceptable. If you’re Dr. such and such, my name is Mr. C. Otherwise, you lose the title. Respect is a two-way street. “

In 1984, I used the Mr. and Mrs. designation until I got to know my patients well.  In the nineties, I became more relaxed and dropped the Mr. and Mrs. and started using my patients first name from the onset of our relationship.  By the turn of the century, my established patients started using my first name.

Yesterday, I wrote about kindness and compassion as key elements of an excellent doctor.  Today’s blog is about comfort!  Respect is a two-way street and is best when earned.  When my patients became comfortable enough with me to drop my title and use my first name, I knew I had finally earned their respect.  I know that sounds illogical but the initial respect they showed me was really for the title I had earned, not for the man holding it.

When my patient became comfortable enough to call me by my fist name, I knew I had truly established a caring relationship, a medical home.  I knew the comfort I felt in having “Jerome” caring for me and had finally arrived in my journey from a good doc to a great doc.  A great doc makes his/her patients comfortable in his/her presence and with his/her care.

If I was Mr. C’s doc, I would have welcomed the transition from the formal “Dr.” to Mr. C’s comfortable “Brenda.”  Confusing?  Definitely!  I told you this was a tough topic to write about.

To make things more confusing, doctors are supposed to keep a professional distance from their patients.  I think the idea is that, by keeping a professional and emotional distance, the doctor will make more objective decisions, decisions not influenced by emotions.  BULLSHIT!  Keeping a professional and emotional distance is what is wrong in medicine today.  Maybe it worked in the old days when docs were put on pedestals but not in today’s world.

Docs are taught to care for strangers but caring for those you hold close comes naturally.  My office was my home and should have been a place of comfort and security.  When you were comfortable enough to drop the title, you were finally home. 

A quick story.  When patients would call and tell my front desk that they were good friends with “Stu” or “Stewie,” my staff would crack up.  No one who knew me used either of the diminutives.  While my first name was a welcomed title, diminutives were not.

Initially, give your doc the respect of using his/her title. If and when you become comfortable with your doc and want to transition to a first name basis, ask how he/she feels about it. Your doc might surprise you and realize that he/she has now truly EARNED your respect as both a physician and a valued healthcare partner in your life.  

Here’re your jokes for the day from the great Rodney Dangerfield:

“When I was a kid, my parents moved around a lot; but I always found them.”

”What a kid I got! I told him about the birds and the bees and he told me about the butcher and my wife.”

“I haven’t spoken to my wife in years. I didn’t want to interrupt her.”

“My wife and I were happy for twenty years. Then we met.”

“My wife’s cooking is so bad the flies fix our screens.”

“I told my wife the truth. I told her I was seeing a psychiatrist. Then she told me the truth: that she was seeing a psychiatrist, two plumbers, and a bartender.”

“It’s tough to stay married. My wife says no because she’s tired, then stays up and reads her book.”

“Once somebody stole our car. I asked my wife if she saw who it was. She said: “No, but I did get the license number”.

60 Best Rodney Dangerfield Quotes And Jokes You Need To Know (humoropedia.com)