Month: March 2023

I read an article about ChatGPT today.  ChatGPT is an AI (artificial intelligence) medical program which, according to the article, could pass the medical licensure exam.  The author of the article lists the pros and cons of patients utilizing AIs.

Years ago, I published an article called “Cyberchondria”.  Googling symptoms often introduces patients to diseases they have never heard of and provoking anxiety reactions and fear out of proportion to the initial symptoms.  Patients who googled their symptoms prior to coming to the office often requested inappropriate testing, brought up diseases which they were highly unlikely to have, and were often convinced that they had cancer.

Office visits were often prolonged as I tried to convince a patient with a sore throat that they did not have leukemia.  Google fatigue.  What you’ll find is a list of every disease known to mankind.  Working up the list of every disease known to mankind leads to ordering every test possible.  Ordering every test possible leads to the discovery of false positive results and added anxiety.  The end-result is panic and increased financial and psychologic costs!

While physician-level AIs may one day fine tune the diagnosis associated with patients’ symptoms, Cyberchondria has to be accounted for.  One last thought, often just watching my patient walk into the exam room and interact with me led to the proper diagnosis.

Today’s joke is about attributing cause and effect falsely and the danger of doing so.

 I took the batteries out of my carbon monoxide detector. It was beeping so much it made me dizzy and gave me a headache.

I’m finally catching up on my reading and came across a fascinating podcast from February 24^th.  If you take medication, you should listen to what ZdoggMD in The Ugly Truth Behind Soaring Drug Prices (And How To Fix Them) w/Dr. Alex Oshmyansky – ZDoggMD.

When I started my practice in the early 80s, the cost of medical care and medications was quite reasonable.  There were very few health insurance companies and no prescription plans. You paid for the treatments you received; and, if you had insurance, your insurance company reimbursed you.  A “Sports Physical” was $5.  A vitamin B12 injection was also $5.  By the time I retired, a “Sports Physical” ran as high as $150 and a shot of vitamin B12 cost $75.

The physical did not change.  It did not take any longer or require any special tests.  The B12 was identical to the B12 given in the 80s.  So, what changed?  What changed was the insertion of an insurance company that requires prior authorization, additional billing steps and inflated prices in order to make a living.  On the pharma side was the addition of a “pharmacy benefits manager” who simply skimmed massive amounts of money off the top of every prescription written and filled.

Dr. Oshmyansky is the CEO of Mark Cuban’s company, Mark Cuban Cost Plus Drug Company.  After listening to the podcast, research your medications on his program by checking out the cost of you.  It’s about time someone cut out all the middlemen in the medical world.

Renee and I just took the family on a Mediterranean cruise.  I now need assistive devices 70% of the day. A vacation on a large cruise ship meets my needs.  I rented a scooter and used it 95% of the time.  I even used it when we got off the ship in Ocho Rios, Jamaica.

The ship we were on was brand new and handicapped friendly.  The bathrooms were the best I have ever seen.  The shower in my room was large, with rails, handheld shower head, seat and non-slip flooring.  The only thing the ship was lacking was handicapped accessible pools. 

My favorite place on the boat was the observation deck. I’m usually awake at 3 am and I spent many mornings looking out at the sea, reviewing my life, playing the “would’a, could’a, should’a” game I have written about in the past. I’ve always recommended that my patients avoid playing this game as you can’t win it.  I now recognize that despite not being to win the “would’a, could’a, should’a” game, as you age and near the end, you have to play it.

What I learned was that I jumped into a rapidly flowing river (complete with rapids) at an early age and went with the flow.  I moved though life at so a rapid rate that I didn’t appreciate the life I had created.  I did it for my family, my patients and my ego. 

I missed so much!  Do you ever think how incredible walking is?  I do.  I watched the world walk by and wondered how many of them ever thanked God for for the ability to walk.  I never did.  I took it for granted. As I’ve lost function, I realize that I really didn’t understand what was truly important.

Now that I’m walking in my father’s shoes, I understand them better.  I owe them many apologies.  If they are looking down from wherever we go when we die, I know sorry is not good enough but its all I have to offer. By the way, dad, Parkinson’s really does suck!

My advice to my children and my patients is to slow down, spend less time at work and more time with your children and parents.  Both will eventually leave you and you are doomed to play the “would’a, could’a, should’a” game.

I want to give a shout out to Jeremy and Allyson.  You’re playing life right!  The balance you and Allyson have established is precious.  Keep it up.

When is enough, enough?  Answering this question becomes increasingly more important the older you get.  Go to any healthcare facility and the person registering you will want a copy of your advanced directives and healthcare power of attorney.  Do you have advanced directives?  Healthcare power of attorney?

I don’t!  I don’t have an excuse for not having a healthcare power of attorney; and by the time I finish this blog, I will.  As for not having advanced directives, I have lots of excuses. While I have yet to put my directives on paper, my family is well aware of what I want and I trust that they will honor my wishes.

The simple answer is that I don’t want to be resuscitated.  Parkinson’s is a degenerative disease and I’ve already lost too much of me.  Do I sound selfish?  People are quick to point out the fact that I’m blessed to have a wife, children and grandchildren and they should be all the reason I need to be resuscitated.  In actuality,  they are a good reason not to be resuscitated.  Visiting me in a nursing home on Sundays would become quite a burden.  Changing my diaper is even more repugnant.  I’ve told Renee that if I have to start wearing diapers, then I should be allowed to breast feed again.

A good friend called me from the ICU at her local hospital.  Her friend had a witnessed cardiac event and was resuscitated.  She then had a second cardiac arrest and was resuscitated and placed on life support.  My friend wanted to know what she should do. Number one on the list of what to do is listen to the doctors caring for your loved one.  Not knowing the patient’s wishes, my answer was qualified.  “If it’s me, let me go! No life support, no further resuscitation!!  In her case, I told her to rely on the docs.  They have the patient’s best interest in mind.  The patient coded again and died.  RIP!

Please make sure your loved ones know what you want for yourself.  This is one place where being selfish is appropriate.

Here’s your joke for the day:

“Give it to me! Give it to me!” she yelled. “I’m so wet, give it to me now!” She could scream all she wanted, but I was keeping the umbrella.