One of my former patients posted the following:

I have a lot of


In my life.

I used to call it STRESS

But I feel much better

Now that I call it


Sometimes, the difference between a winner and a loser is how they manage stress.  While we all experience stress, a person with good coping techniques/stress management skills can turn stress into excitement (or a host of other sentiments/feelings).

How do you handle stress?  Have you had any stress management courses?  Been in counseling?  Read about stress management techniques?  If not, why not?

Most of us have never had a formal education in stress management.  When you realize that all humans experience stress, it’s remarkable that so little education in stress management is made available to us through the educational system.

As a doc, it was not uncommon for me to find myself in highly stressful, life and death situations.  The 60-year-old male having a heart attack in my office was always a stressful event.  When I read the above statement, I realized that I channeled that stress into excitement as I ran my code procedures and waited for the paramedics.

How is it possible that I went all the way through undergraduate, graduate and post graduate training without a single stress management course?  Maybe it’s because admitting that you are stressed is taboo, unmanly.  I do know that I innately possessed good stress management skills.

When I was an ER doc back in the dark ages, the most stressful thing I had to do was put in a chest tube.  In those days, putting in a chest tube was somewhat barbaric.  While I had no problem opening the chest of a 24 year old patient with a knife wound in her heart, I had an unexplainable fear of putting in a chest tube.  My stress management technique was to go to the men’s room anytime a patient needing a chest tube came into my ER. It worked until, one day, Dr. J pounded on the bathroom door.

Dr. J – “Segal, gets your ass out of the bathroom and put in this chest tube.”


Dr. J – “She’s going to die if you don’t get your ass out here.”

Me – “Fuck, What’s wrong with you?  Go put in the tube.  I’ll join you when I’m finished.”

Dr. J – “You’re finished now!  Time to man up and get past your fear.’

Dr. J was a great teacher and he worked side by side with me until I conquered my fear.  Stress management can be taught in a classroom, at work or at home.  There are hundreds of books and programs on stress management.  Is it time for you to get an education? The answer is YES!

There is not much I can guarantee in life but I can guarantee that, if you take a course in stress management, you will be glad you did.

Here’s today’s joke:

Three engineers were arguing.

The mechanical engineer, the electrical engineer, and the civil engineer. They were arguing about what sort of an engineer God must be.

“Well, God must be a mechanical engineer, because look at the human skeleton. Look at all the stress it’s able to absorb.”

“But look at the nervous system. Look at all the wiring. God must be an electrical engineer.”

“Well, God must be a civil engineer, because only a civil engineer would run a liquid waste disposal unit right through a major recreational facility.”


Here’s an oldie but goodie, still pertinent 10 years later ;

Everyone is interested in the “whats” and “whens” of illness.  What do I have?  What are we going to do about it? What is going to happen to me? When will I feel better?  When can I go back to work?  While the “whats” and the whens” are certainly important questions to ask, the “whys” are the most helpful.

Today, I had a lengthy conversation with one of the brightest individuals I have ever met.  Conversing with him is intellectually stimulating.  During our conversation, he mentioned that most people skip the “why” and race to fix a problem before truly analyzing the issues involved.  It dawned on me that the “why” in medicine is often more important than the “what, when and where” questions.

While I can’t always answer the “Why?” of illness, the true path to health lies in finding the “Why?” and preventing it.  Over the last few days, I have been trying to focus on the known “whys” of illness.  “Why aren’t I getting well?”  Answer, “You keep smoking and the smoke is destroying your airway.”  “Why do I need all of these medications for my cholesterol and blood pressure?”  Answer, “You are not on a DASH diet; you are eating fatty red meats and not even trying to change your sedentary lifestyle.”  “Why am I having problems getting an erection?”  Answer, “You are massively overweight and out of shape.  Sex might actually kill you!”

The answers sound harsh.  Reality is sometimes harsh.  The only way to stop the cascade into illness is to find the answers to the “whys” and then do something to change.  Am I frustrated?  Yes!  I often refer to myself as a fireman, pouring water (medication) onto a fire, trying to put it out.  My patients are often arsonists, pouring fuel on the fire and yelling at me to put the fire out.  As I increase my fire extinguishers (medicines), I get yelled at, “I’m on too many expensive medications.  I’m spending $500 a month.  You have to do something.”

I have witnessed the success of those patients who have found their “whys” and then done something about them.   I have had lots of success stories over the years!  I also have had too many failures.  The failures frustrate me.  How do I motivate people to find their “whys”?  How do I convince my patients and myself to tackle our problems head on, to take personal responsibility for our wellbeing?

The first step is to make sure they don’t forget to ask why!

Here’s your joke;

What’s the difference between an oral and a rectal thermometer?

“The taste.”


Today, I want to talk about setting realistic, obtainable goals. Over the last 35 years, I have watched my patients, family and friends set grandiose goals and then fail to reach those goals. I have been guilty of the same. My patients have taught me many lessons and I want to share two patients’ histories with you.

Paul was morbidly obese. He had been on multiple diets, losing hundreds of pounds and ultimately finding what he had lost plus some. This time Paul’s stated goal was 75 pounds. I pleaded with Paul, requesting that he adjust his goal to a more realistic and sustainable number. I like 10 pound goals. Ten pounds is relatively easy to lose. I told Paul that once he lost his ten pounds, he could go for another ten if he so chose. Paul was insistent on losing 75 pounds.

Paul lost 50 pounds and then hit a plateau. He just couldn’t manage to lose his last 25 pounds. As he struggled, he got more frustrated. He lost sight of how good he looked and how much better he felt. He saw himself as a loser. One month into his plateau, Paul’s dedication to losing 75 pounds faltered. He started gaining weight. Today, Paul has found the 50 pounds he lost plus twenty more.

Had Paul set a realistic, obtainable goal of ten pounds, he would have won the battle five times. He would have been able to revel in success. He would be ten pounds from his next goal and been able to survive his plateau. Often, we set ourselves up for failure when, in fact, we had achieved a great success.

Joan decided she needed to exercise. She was overweight and truly out of shape at the ripe old age of 35. She had been athletic in high school and college. Her mind remembered what being in shape felt like, but her body did not. Joan decided to buy an exercise routine from the internet, PX90. Her desire to exercise was laudable but her chosen method questionable. On the fourth day of her newfound exercise routine, Joan presented to the office with severe abdominal pain. Two days and many hundreds of dollars later, it was determined that Joan’s pain stemmed from a severe muscular strain caused from intensively exercising out of shape muscles.

Both of these patients had the right idea. Both wanted to be healthy. Both live in a world whose inhabitants strive for instant gratification. Both set very high goals. Both failed. If you look at life as a sprint to the finish line, Paul and Joan got out of the blocks quickly. If you look at life as an endurance race, neither paced themselves and both failed to reach the finish line. It’s the story of the tortoise and the hare all over again.

From a doctor’s point of view, life should definitely be a marathon race. It’s not how fast you get to the end of the race; it’s how long can you run. Setting long -term goals makes sense. The proverbial chicken gets to the other side of the road 1 step at a time.

The next time you decide to exercise, start by walking just 10 minutes and stretching 10 minutes a day. After a week, increase to 15 – 20 minutes a day, then to 30. When you can walk 30 minutes without hurting, pick up the pace. When you can run at four miles an hour for 30 minutes, you are ready to add light resistance training. In high school, the saying was, “No pain, no gain!” In the adult world, it should be “Pain, no gain!”

The next time you decide to lose weight, be happy losing 10 pounds. Ten pounds is a significant win! Ten pounds lowers your risk of hypertension, diabetes and cholesterol problems. You can revel in your success. If you want, you can go for ten more. Most people never really lose weight; they just misplace it. Resolve that what comes off stays off.

Most of all, don’t set yourself up for failure. Be happy, be healthy and run a very long race!

Here’s today’s joke:

I went on the vodka diet recently.

I lost three days in one week.

One more:

So I’m at Walmart picking up a bag of dog food for my dog. Waiting in the long line the lady behind me strikes up a conversation. She asks if I have a dog, and I think, why else would I be carrying this big bag of dog food?
Then I said “No, I’m starting the dog food diet again. Even though I ended up in the hospital last time.” She looked horrified. I continued, “But I had lost 50lbs before I woke up in the hospital with IV’s and feeding tube and a broken arm and pelvis and a concussion.”
“Oh Dear!” She said. I told her that it was the perfect diet, that you fill your pockets with the nuggets and when you feel hungry you just pop a couple and eat them. And since the dog food is nutritionally complete it works great, and I really want to try it again.
Now everyone in line is listening to me and our discussion. She asked, “Well, was it the dog food that put you in the hospital?”
“Oh, no,” I answered, “I stepped off the curb to sniff a poodle’s butt and a truck hit me…”
I thought the guy behind her was gonna have a heart attack he was laughing so hard…


Today, I want to address the importance of believing what you hear. One of the most important diagnostic tools is a trained ear. Another important diagnostic tool is your brain!  Once a physician hears his patient’s story, he has the choice of believing it, even if it is illogical, or dismissing it in favor of a more conventional interpretation.

Yes, patients often tell you what’s wrong with them and, often, their diagnosis is highly unlikely or even impossible.  Thirty five years of practicing medicine has taught me that the “impossible” is possible and some of my best diagnoses have been made because I choose to believe what my patient told me!

In my second year of residency, I received a call from the floor nurse telling me that Patient Y was asking for Last Rights.  Patient Y was scheduled to go home in the next few days and had no reason to die.  I went to the floor and reviewed her records and then examined my patient.  Patient Y was resolute in her opinion that she would not see the sun rise despite my confident reassurance.  Patient Y died that night.  Her autopsy revealed a tiny cerebral aneurysm rupture as the cause of her death.  I never forgot how incredulous I was at Patient Y’s insistence that she was dying and how healthy she was at the time of her death.

Choosing to believe your patients when their concerns are unrealistic is not easy.  Yes, I’ve run a great deal of tests that turned out to be unnecessary in order to disprove my patients’ diagnoses; and the majority of time, my patients concerns turned out to be truly unfounded.  When my patients’ seemingly unfounded concerns turned out to be real, it reinforced my ability to believe in the impossible and often saved a life.

“Doc, there is something wrong in my head!  No, I don’t have a headache.  No, my memory and speech are ok.”   “No” was her answer to every question, yet she firmly stated there was something she could not describe that was in her head.  She was not crazy!  Choosing to believe her, I sent her for a CT.  She, too, had an aneurysm and it was successfully clipped.  Thirty-five years, later she is doing fine.  Believing what your patient tells you may be hard, but it is vital to good care.

In today’s cost-conscious world, believing is discouraged.  If the patient above walked into my office tomorrow morning, I would have had to convince an insurance clerk to authorize her CT and would probably have been refused authorization.  Trying to meet the requirements of a computer-driven algorithm in order to diagnose a disease process requires more than a belief.  And that, my friends, is the problem with today’s healthcare system.

Here’s today’s joke:

My wife asked, “Are you even listening to me?”

I thought that was a weird way for her to start a conversation.


Just recently, I received a call from a loved one who as complaining of fatigue.  I hope this article helps.

March 17, 2015

Today, my first patient asked me my most dreaded question, “Doctor, why am I always tired?”  Tired, fatigued, exhausted and lacking energy are among the many dreaded symptoms I hear almost every day.  Why do I dread this complaint?  Fatigue is a symptom of almost every disease known to mankind!

In the article titled “Differential Diagnosis” (1/18/11), I reviewed how doctors formulate a list of possible causes for an illness, arrange those possible causes by probability of occurrence and potential for doing harm and methodically work through the list until an appropriate diagnosis is made.  The differential diagnosis for fatigue starts with “A” and ends with “Z”.  There are common causes of fatigue:  anemia; thyroid disease; sleep disorders including sleep apnea; depression; stress reaction; physical exhaustion; diabetes; hypertension; chronic fatigue syndrome; and COPD are but a few.

A typical office visit is divided into three parts: the interview, the exam and the planning stage.  The interview for the complaint of fatigue is often exhaustive.  The interview can also be frustrating as fatigue influences every part of a person’s life.   Doctors work with an interview tool called the “review of systems” (ROS).  The ROS is comprised of 14 organ systems with specific questions relating to each of those systems.  When dealing with a patient who suffers from fatigue, all 14 systems must be explored and most patients have complaints in the majority of systems.  The doctor is often left with the “Chicken vs. the Egg” conundrum.

Now, do you understand why I dread this question?  To make matters worse, the physical exam seldom provides an answer requiring laboratory and other diagnostic testing.  While I am a puzzle solver and very experienced at solving this puzzle, each patient’s puzzle is unique and requires a novel solution and treatment approach.

So, when you complain of fatigue, and most of us will during our lifetime, recognize that the “Why” may be difficult to find, requiring extensive searching through your history, your physical exam and extended testing.  Be prepared for some frustration.  Be opened-minded about the various possibilities.  Recognize that one of the differential diagnoses is psychological and do not get offended if your doctor suggests you see a psychologist for testing.  At least, the psychologist’s tests don’t involve needles and KY Jelly!

Before seeing your doctor, ask the why, what, how, when and where questions about your fatigue.  Go through your own ROS.  In doing so, you may solve your own puzzle.  The more you question yourself, the easier it will be for you to answer your doctor’s questions.  While I am trained to solve puzzles by myself, it is easier if I have help.  Bring your significant other; he or she often has insights that are helpful.

One last request, if you could have a run of the mill anemia or thyroid problem, it would make my life easier!  Now, the big question for today is why am I, your doc, so tired?

Here’s your joke of the day:

A beautiful college professor reminds her student of the big test tomorrow. She says “You cannot be absent unless you are wounded, seriously ill or you have a sudden death in the family.” One boy asks “But what about extreme fatigue from a hot night of sex?” When the class is done laughing the professor smiles and says
“In that case you can write with your other hand.”


This article is just as germane to anxiety today as it was in 2012 when it was first published. As my health deteriorates, I’ve become a professional worrier. I hope you find this article helpful.

April 2012

It’s never too late to learn!  Yesterday, I saw Mr. X.  Mr. X has been seeing me for the past 20 years.  He is in his 70s and had been diagnosed and treated for a major anxiety disorder for as long as I have known him.  Despite the best my profession had to offer him, the best medicine, counseling and behavior modification techniques, Mr. X continued to be anxious and worry about everything.

“My knee hurts.  Do you think it could be cancer?”  Mr. X has seventy-some year-old knees and they are worn out.  “My shoulder hurts.  Do you think it’s a heart attack?”  Mr. X carried some heavy boxes from the garage to the attack over the weekend.  “I had a headache two days this week.  Am I going to have a stroke?”  Mr. X’s worries have gotten worse over the years.  In retrospect, the harder I try to alleviate his fears, the worse he gets!

It’s never too late to learn!  Yesterday, I had an epiphany.  Mr. X is a professional worrier.  He worries the way some people play golf, shoot pool or play bridge.  He is the Tiger Woods of worry.  Worry is woven into every facet of his life.  It is part of his social being.  In his younger years, he worried about work, paying the bills and his children.  His worries were less threatening.  As he aged and retired, his worries turn inward, focusing on his physical wellbeing.  His worries have become increasingly more threatening over time.  It’s one thing to worry that your painful knee is arthritis; it’s quite something else to worry that your knee pain is cancer.  

My mistake has been trying to take away his worries.  Doctors are trained to alleviate pain and suffering.  When a patient’s knee hurts, we are taught to diagnose the problem, treat it and provide for future care.  When a patient worries excessively, we do the same thing.  We try to remove the worry.  In the case of a professional worrier, when you say, “Don’t worry, it’s not arthritis.  It’s just your age.  It’s just  a minor sprain,” you take away a benign source of worry and open the door to a malignant worry.  “Could it be cancer?”

Live and learn!  I should have told Mr. X he has arthritis.  He would have been much less threatened by arthritis than by cancer.  I’m learning!  I talked to Mr. X about his worrying and his need to focus on less threatening worries.  I suggested that he buy a lottery ticket and worry about whether or not he would win.  I suggested that he should worry about what winning would do to his life.  I suggested other things he could worry about.

Not being a psychologist, I consulted with Dr. Lapporte, one of my colleagues.  Dr. Lapporte is one of the psychologists who has treated my patients for decades.  I wanted to make sure my new treatment approach was valid and safe.  He concurred, stating that “distraction” was a viable approach.  I think I will prescribe more “distraction” in the future.  It’s cheaper with far fewer side effects than medication.

For those of you who are professional worriers, find something harmless to worry about.  “Will it snow today,” is an excellent place to start.  As you become better at choosing less harmful things to worry about, work on developing healthy worries.  “Will I have time to exercise today?”  

Most of all, be happy and healthy!

Here’s today’s joke:

I actually had anxiety for so long I went to a psychiatrist. And I said to the guy, ‘I’m constantly anxious. What do I do?’

He told me I had obsessive-compulsive disorder.

I was shocked. I had to call him nine times to make sure he was certain.


Is your loved one having an affair?  No, not a sexual affair with another human.  I’m referring to an affair with his job!  Yes, some people are bigamists, married to their jobs and their spouses.  Is your spouse married to his/her work?

A work affair can be worse than a physical entanglement with another human.  It can be harder to break up with work than with a human lover.  An affair with your job can be just as destructive to your marriage and can cost you your life.

Not long ago, I saw a leader of American industry whose job took precedence over all else.  Being responsible for a Fortune 500 company’s success is an awesome responsibility.  The company demands constant attention, nurturing and stroking the company’s growth. Responding to changing needs.  Being a successful corporate leader requires long hours, travel, business meals, and more, leaving no time for self and family.

As in any affair, denial plays a major role.  The unfaithful spouse will deny any impropriety, claiming that his/her long hours at work are spent on behalf of his family!  He/she claims that he/she works long hours in order to provide financial security for his/her family.   He/she claims that, one day, he/she will retire and enjoy his/her family and life.

As a patient, the office bigamist often neglects his health, skipping appointments, running out of medicine, and complaining that there is never time for exercise.  Certainly, business lunches and dinner are not amenable to proper eating habits.

Diets and Other Unnatural Acts was partially inspired by just such a corporate giant.  Being married to your business may provide for financial success and security, but money without health and family is worthless.  Carl was living proof.

Are you married to your work?  Is your work an abusive spouse?  Does it demand so much of you that there is no time to take care of yourself or others?  Or are you a stress junky?  A success junky?  

Sometimes business demands are not the problem.  Sometimes the personal need for success creates stresses that are self-imposed.  I’ve written about the two brothers, one whose has “everything” and the other who has “enough.”  Both brothers have identical assets, the difference is perspective.

Whether you are a work bigamist or a stress/success junky, it’s time to change your perspective!  Money without health is worthless.  Over the last 30 years, I have seen many patients sacrifice their health and family relationships in the name of making a living.  I have seen many spouses cheat on their loved ones by marrying their businesses.  In every case, the only thing the family ever wanted was time with their father/mother/spouse.

Success in your job is important.  Success as a spouse and family man/woman is more important.  They need not be exclusive of one another.  Make your health and your family your primary responsibility.  They will be with you long after your business is gone.  Don’t wait until your health fails or your family is irreversibly estranged.  Remember, the life you save may be your own and that life is important to others. 

Here’s a joke:

The Worst Way to Die

It got crowded in heaven, so, for one day it was decided only to accept people who had really had a bad day on the day they died. St. Peter was standing at the pearly gates and said to the first man, *”Tell me about the day you died.”*

The man said, *”Oh, it was awful. I was sure my wife was having an affair, so I came home early to catch her with him. I searched all over the apartment but couldn’t find him anywhere. So I went out onto the balcony, we live on the 25th floor, and found this man hanging over the edge by his fingertips. I went inside, got a hammer, and started hitting his hands. He fell, but landed in some bushes. So, I got the refrigerator and pushed it over the balcony and it crushed him. The strain of the act gave me a heart attack, and I died.”*

St. Peter couldn’t deny that this was a pretty bad day, and since it was a crime of passion, he let the man in.

He then asked the next man in line about the day he died. *”Well, sir, it was awful,”* said the second man. *”I was doing aerobics on the balcony of my 26th floor apartment when I twisted my ankle and slipped over the edge. I managed to grab the balcony of the apartment below, but some maniac came out and started pounding on my fingers with a hammer. Luckily I landed in some bushes. But, then the guy dropped a refrigerator on me!”*

St. Peter chuckled, let him into heaven and decided he could really start to enjoy this job.

*”Tell me about the day you died?”*, he said to the third man in line. *”OK, picture this, I’m naked, hiding inside a refrigerator….”*


The phone call came last night. Damar Hamlin’s on-field cardiac arrest caused my patient to relive his own cardiac arrest, death, and rebirth. He called to thank me for bringing him back years ago.

Dying and being reborn doesn’t occur every day. Everything has to be just right. First, you need a witnessed event.   My patient arrested in front of his wife. Next, the witness needs to call 911 and start CPR. Done! From this point, you need God’s intervention.

When I got to the ER, the patient had already been diagnosed as brain dead. He was in a decerebrate posture consistent with the diagnosis. I had read about something called the Artic Blanket. The hospital had a brand-new one sitting on a shelf in its original box. While the ER had bought it, they had never used it.

With nothing to lose, we instituted the Artic Protocol and prayed. The next day, my patient woke up. From brain dead to fully functional was indeed a miracle. Ten years later, he’s still doing well. His call couldn’t have come at a better time. Parkinson’s and my assorted medical problems have caused me to question my faith. My patient’s call and “thank you” reminded me that I was present at his miracle.

Since his call, I have replayed other miracles I witnessed during my years as a physician. Thank you for taking me on a ride down memory lane. I want to invite all of my former patients to share their stories with me and my readers. Just as my reading about the Artic Blanket saved a life, your stories may help others in unimaginable ways.

Here’s a story I used countless times in practice:

A farmer is in Iowa during a flood. The river is overflowing. Water is surrounding the farmer’s home up to his front porch. As he is standing there, a boat comes up. The man in the boat says, “Jump in, and I’ll take you to safety.”

The farmer crosses his arms and says stubbornly, “Oh, no thanks, I put my trust in God.” The boat goes away. The water rises to the second story. Another boat comes up. The man says to the farmer, who is now at the second floor window, “Hurry, jump in. I’ll save you.”

The farmer again says, “Oh, no thanks, I put my trust in God.”

The boat goes away. Now the water is inching over the roof. As the farmer stands on the roof, a helicopter comes over, and drops a ladder. The pilot yells down to the farmer, “I’ll save you. Climb the ladder.”

The farmer yells back, “Oh, no thanks, I put my trust in God.”

The helicopter goes away. The water continues to rise and sweeps the farmer off the roof into the swiftly moving water. Unfortunately, he drowns.

The farmer goes to heaven. God sees him and says, “What are you doing here?”

The farmer says, “I put my trust in you, and you let me down.”

God says, “What do you mean, let you down? I sent you two boats and a helicopter!”

This time of year, I always repost the “BLESSING LIST\

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; You can spend less and live with less as long as you have a roof over your head, food on the table to feed the children and a husband to 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 a joke.

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, no,” exclaims Bonnie. “He’s peeing in the refrigerator again!”




“Doc, I was so sick over the weekend that I almost went to the emergency room,” is a statement I heard all too often.  The fact that the patient was in my office and telling me about it is the good news.  The bad news was that, sometimes by delaying going to the emergency room, my patient missed an opportunity to avoid disaster.  I know going to the emergency room is time consuming and expensive.  I’ve heard it all!

What amazes me is how casually people gamble with their health and their lives.  How sick do you have to be to go to the emergency room anyway?  Do you have to be on death’s doorstep?  I think not.  Yet many of my patients wait until they are knocking at death’s door to call 911.

How much pain do you have to be in before you seek help?  The guy with the ruptured appendix waited until the pain was a 12 on a scale of 0 to 10 with 10 being the worst pain he had ever felt.  Actually, he only decided to go when his temperature hit 104!

How long do you have to suffer before you seek help?  Would it amaze you if I told you that a patient seen recently waited a full week before coming in to be treated for his chest pain?  I understand not wanting to go to the ER.  So, if you don’t want to go to the ER, how about calling the on-call provider?  Every practice has an on-call service.  If you thought about going to the ER and weren’t sure what to do, don’t you think calling your doc would be a wise decision?

While I’m on the subject, another thing I hear way too often is straight from the spouse’s mouth.  “I told him I was calling the paramedics but he said if I did, he would never speak to me again!”  Wake up!  If he dies, he’s never going to speak to you again!

My advice is that if you think about going to the ER, go.  If you decide not to go, call your doc.  Then pack a bag because he’s probably going to send you to the ER.  What happens if you go to the ER and everything is ok?  I guess you get to live another day.  Sound better than dying or spending an extended amount of time in the ICU?  I think so!


A doctor is examining a woman in the Emergency Room.

The doctor takes the husband aside and says, “I don’t like the looks of your wife at all.”

“Me neither, Doc. But she’s a great cook and she is really good with the kids.”

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