Author: wellthy

Many of my patients use the internet to seek information about their health, diagnoses of illnesses and treatment options.  While the internet is an excellent source of valuable information, it is also full of garbage.  The garbage comes wrapped in pseudoscience, is sold as “doctor recommended” and is capable of doing great harm.  Sorting through the heaps of material is difficult, even for a trained physician.   What is real science and what is hype?  Sometimes, I don’t know!  During the last 35 years, I have seen the best of my science proven wrong.  So how does a lay person interpret the data delivered by Google and Bing?

There is no easy answer.  While discussing how to sift through the mountains of data you need to process to be a truly informed patient is beyond the scope of this article, learning the difference between a possible problem and a probable problem may be very helpful.

In the medical world, we believe in informed consent.  Informed consent means we tell you every possible consequence of taking a medication.  Ever listen to a pharmaceutical commercial on TV?  Product XYZ is touted as good for your heart and brain but may cause explosive diarrhea, excessive bad breath, uncontrollable flatus (farting) and a myriad of other things, including death.  After listening to one of these commercials, no sane person would want to take XYZ.  You can thank the lawyers for the absurdity of the disclaimer.

If the auto industry was required to advertise under the same rules as the pharmaceutical industry, car XYZ would be sold as fast and sexy with all the bells and whistles.  The disclaimer would remind the audience of national automotive safety statistics, stating car XYZ may cause death, dismemberment and a myriad of other horrific injuries we all know exist but ignore.  If a pharmaceutical company went to the FDA with a product that cured cancer but had the risk factors of a car, I doubt the FDA would approve it.

Anything is possible.  What is important is the probability that a possible side effect is going to injure you!  If XYZ causes uncontrollable flatus in 90% of people, taking it would be absurd.  If XYZ causes uncontrollable flatus in <1% of people, it is insignificant.  So, before you decide not to take the medication your doctor prescribes because of something you read on the warnings stapled to the package at the pharmacy, ask your doctor about the probability of your getting a side effect.  In general, if there are known side effects of significance, your doctor is going to warn you before giving you the prescription.

The following is a real telephone conversation:

“Dr. Segal, this is Mr. Z.  I’m mad at you!  I want you to know I found the reason I have had so many colds this year!”

“I’m sorry you are mad at me!  What do you think is causing your colds, Mr. Z?”

“The damn medicine you are giving me for my blood pressure.  According to the PDR, 32% of people taking product X get frequent colds!!!”

“Mr. Z, could you look at what the percent of people who got frequent colds while taking a placebo is?”  Dr. Segal asked.

“What’s a placebo?” replied Mr. Z.

“A placebo is a fake pill, it contains no active ingredient.”  Dr. Segal answered.

Mr. Z went back to the PDR, and called back a second time.  “Thirty six percent of people on the “no active ingredient” pill got frequent colds.”

“Wow, Mr. Z, if 36 % of people taking a placebo got colds and only 32% of people on product X got colds, then product X decreases the chances of you getting a cold.  Maybe the reason you get frequent colds is your smoking!  It may also be the reason you have high blood pressure and are on product X.”

Remember, what is important is the probability of getting a possible side effect.  Also, remember that “placebos” have side effects and risk!

“How do you feel?”  One of the most frequent questions I get is, “How do you feel?”  While the person asking the question is sincere in caring about how I feel, I get the impression that most of the time they want a simple “fine.”   Dealing with how I feel, or any other sick person’s feeling, can be depressing, especially if they haven’t been fine in a long time.

Dealing with “fine” is much easier, uplifting, and allows the individual asking the question to move on, confident that they showed their concerned and caring nature.  I know I’m being hard on a group of individuals who appear to be sincere but really aren’t.  Often, they have their own problems that are wearing them down and they really can’t handle any additional burden.

“Fine” is not a good answer if you really aren’t fine.  Lying to yourself and others often has real consequences, most of which turnout to be negative.  “Fine” cuts off your ability to get help from your family and friends.  “Fine” means that your abilities or disabilities will be misjudged.  “Fine” is a term that socially and mentally isolates the chronically ill patient.

So, what do you answer when someone asks, “How do you feel?”  I answer with a question of my own, “Do you really want to know?”  I don’t listen to what they say in response to my question.  I look at the expression on their face.  If they can take it, I let them know I feel like crap.  If they genuinely want to help, I tell them what crap feels like. 

If they are asking to be polite or proper, “I’M FINE” is just fine.  

One phenomenon of aging is that the vast majority of my social circle is not fine!  These days everyone I know is dealing with something.   The first 10 minutes of most social encounters consists of sharing how crappy we really are.  Now that I’ve put my thoughts on paper, maybe we should just say we are “fine” and move on.  Confusing?  What do you say when someone asks you how you are?

One last thought.  When I feel lousy, haven’t shaved nor showered in 48 hours,  have stains on my shirt and have obviously crossed into the blimp zone (if I get any larger the postal service may assign me my own zip code), don’t tell me, “You look great.”  If you think I look great, you either need an eye exam, to see a psychiatrist or are just full of sh.t.

October 9, 2019

Sometimes I’m just stupid.  This is one of those times.  When I first started blogging in 2011, I created this site to better educate my patients and teach them to advocate for themselves.

In 2011 the practice of medicine was changing rapidly, and the changes were not good.  Over the next few years, my articles became increasingly political and I began attacking the medical insurance companies and Medicare.  Eventually, the insurance industry hit back, threatening to drop my practice from their plans.  I quit blogging.

I’ve always said, “If you can make something good come from something bad, then the bad can’t be too bad.”  MY PHYSICAL CONDITION, BACK PROBLEMS AND PARKINSON’S, ARE THE BAD.   Being able to resume my blog is the good. While I promised myself that I would not become political again and that this site would be strictly educational, I find I have to break that promise.

It’s Medicare enrollment time and the commercials are flooding the air. The ads infuriate me!  I get angry!  What angers me? The ads for Medicare Advantage promise you lots of freebies like transportation to the doc, vision care, …   The ads also talk about the fact that the plans have “narrow networks.” So, what do you give up to get the new freebies? Your network of physicians, hospitals and labs.

Do you know what a “narrow network” is? I do!  A ”narrow network” means that there are few docs in plan and that, to see a specialist or have a test may be nearly impossible.  To see a subspecialist, you may need to wait months and drive far from home.  Medicare Advantage should be called Medicare DisAdvantage.  When the guy on the street corner promises to sell you everything for next to nothing, beware!  Ideally, you buy the best insurance and supplements you can.  Realistically, you may need to take a lesser policy due to the expense.  Buyer beware.  Know what you are truly buying into.  Don’t complain when your doc can’t get you that referral, test or procedure in a timely manner.

As I promised that this blog would be educational, I am republishing “Ideal vs. Real.”   It’s well worth reading.

February 22, 2015

I have spent a great deal of time writing about the ideal way to care for yourself and those you love. When I recommend a treatment course, whether it be diet or medicinal, I recommend the ideal approach. When I prescribe a medication, I recommend the ideal brand or generic, whichever is best. 

I recognize that there is often a difference between the ideal and the real. That difference is getting wider every day. The poor economy, the insurance industry, the government and the internet all are having a negative impact on our ability to live up to the ideal. Life, in general, and the practice of medicine have become compromises.

When is it ok to compromise? How much are you willing to compromise? What is the cost of compromise? These are all important questions. It is clear from looking at my parking lot that many of my patients will not compromise on transportation. They drive very safe, very nice cars. The price of those cars is often exorbitant, leading them to compromise elsewhere. Does it make sense to drive a Mercedes and compromise on medical care and treatments?

Case in point:  a Mercedes owner complained that he could not have a procedure because he had a high deductible and the test would be in excess of $2,000. Having the test is ideal; the real is something quite different. In his case, the answer was simple. His Mercedes has every safety feature imaginable and safety was the reason he bought it. He had been in a life threatening accident and wanted the best protection even if it was not truly affordable. The ideal test for his condition is a valuable safety feature for his health. Without it, he may be heading for a major accident. After explaining this to my patient in terms he could relate to, he relented and will find a way to afford the test.

Make sure you inform your doctor when the ideal is truly not possible. Be ready to negotiate and compromise. In order to make the safest decision possible, find out why the ideal choice is the best choice. Find out what the risks of compromise are. Compare the financial, physical and emotional costs of both the ideal treatments and the negotiated treatments are and then make the best decision you can. Most importantly, be prepared to live with your decision and its effects on you, your family and friends. 

In 1980, I was an ER doc at a local hospital.  I was so amazed at how many non-emergency patients came to the ER that I started asking every patient that I saw one of ten questions as to why they were there.  I took the top 5 reasons, found the solution to each, and opened the Lake Zurich Family Treatment Center. Searching for my patients’ medical needs and finding solutions for them proved to be one of my best things I ever did.  Forty years later, I’m on the other side of the fence looking in.  What I see is not pretty.  The medical world I grew up in is extinct and the new world (and those who inhabit it) are radically different.

Below is a checklist created to enhance your next patient visit.  It was created by Dr. Segal, the physician, and will help you interface with your doctor and his/her staff more effectively.  Now that I’ve transitioned to a patient role, I feel that it’s time to make a list of things I need from my doctor.  What do you need from your doctor?  If you will include your answers in the comment box, I will collate and publish the responses.

The better prepared you are for an office visit, the more you will get out of it.  The following are my top recommendations:

1. Come prepared with clear objectives.  Define your first and second most important problems by going through the: who, what, when, why and how of your issues and know what you want.  If you are having chest pain or breathing problems, that is number one!
2. Stay on track.  So many of my patients come in for one specific problem and then do the “Oh, by the way, while I’m here” spewing forth six other problems.  It is hard to do justice handling seven chronic medical problems during the course of an office visit.  Attend to your top two and set up time to do the next two and so on until the list is empty.
3. Prioritize your list.  It is important to know what the top two are.  Your doc needs to know everything that is on the list.  Sometimes, what you think is the most important problem really isn’t.  Sometimes the doc will re-prioritize your list.  Use an “A” next to a problem to delineate a current/active problem.  Use a “P” to delineate an past/old/resolved problem.
4. If you are seeing other doctors, tell the nurse who you are seeing and tell her what you are seeing the doctor(s) for.
5. Bring your medications with you.  “I’m on a blue oval pill, two yellow ones and a green one” is not only worthless, it is dangerous.  Keep the pills in their original bottles.  Make sure you bring all of them, even if someone else prescribed them.
6. Bring your supplements and vitamins.  They may impact your treatment.
7. Wear appropriate clothes.  If you are modest, wear your bathing suit under your clothes.  If your knee is killing you, don’t wear tight jeans.
8. Don’t forget to ask questions.  If you don’t understand what the doctor is telling you, ask for clarification.
9. Ask for a written set of instructions if they are not provided.
10. Know which pharmacy you want your prescription sent to.  In the world of electronic medical records, prescriptions are sent over the internet.
11. Have a written list of your known allergies.
12. Bring your insurance cards.  Different plans have different rules and panels.  Also, bring your driver’s license and co-pay.  Don’t be angry at the front desk when you are asked to present these at each visit. 
13. Bring your old labs and x-rays if they were done elsewhere and they are available.

What I need from my doc:

1.  Listen to and address my objectives.
2. Re-prioritize my list when necessary to address more threatening problems as rapidly as possible.
3. Tell me what you think I have and what you need to do about it.
4. Tell me what I need to do about it.
5. If you need to do tests, tell me which ones you are ordering and why.  Let me know how I get my results.
6. If I need meds, which ones do I need and why.  How should I take them?  What are the risks?
7. When do you want to see me again?
8. What warning signs, if any, do I need to watch for?    When should I call you or your nurse if any warning signs show up?

We know these simple tips will help make your office visit a more fulfilling experience.

Awakening at 3 am is a killer!  Yes, we don’t have to worry about Parkinson’s killing me, sleep deprivation will get me first!  I’m being a good patient and wearing my CPAP.  It’s not helping.  I go to roll over and the pain in back hits.  If I stay in one position long enough, I get stiff and can’t move.

At some point I get up, come downstairs and try to be constructive.  It’s 4 am and the dishwasher has been emptied, a load of clothes has been run and I’ve straightened up the house. Time to write but nothing comes to mind.

I’ve discovered YouTube.  It’s been helpful in occupying my time.  I’ve blown through the Parkinson’s content.  This morning I discover “TEDx.” I watched “The Magic of Not Giving a F***, “How To Stop Screwing Yourself Over,” and “No Sex Marriage-Masturbation, Loneliness, Cheating.”

What a morning.  I learned about destressing your life by being honest and saying “NO” to what you don’t really want to do.  Sometime ago, I developed my Fuck It List and have done well with it.  Number one on my list is I will no longer put a noose (necktie) around my neck and go out pretending to have a good time.

I learned how to stop “screwing myself.”  The speaker states I can have anything I want. (Renee, I want …)  The speaker further states getting what you want is simple (but not easy).  She talks about “activation energy,” self- parenting and forcing yourself to get what you want.  Her video was actually helpful.  She used dieting as an example and I’ve been miserable at dieting since my surgery. While I need to lose weight, I want to eat the Danish!  Time to parent myself and force myself not to eat the Danish or anything not on my diet.

In “No Sex Marriage,” I learned I’m doing pretty good!  Whew!!  If you’re not, watch Maureen McGrath’s TEDx.  The best news today is threefold.  One is that sex exists well into the 90s.  Two is that sexercise should be done daily.  Three is that all marital arguments should be settled in the bedroom, naked.  I like this therapist.  I think I’ll be argumentative and see what happens.

October 4, 2019

As I was composing the “Attaboy” article, it dawned on me that part of every patient’s education should be getting a first-hand look at the life of their physician.  Being a patient-physician gives me a lot of insight into what goes on behind the counter in the office and in the exam room and helps make my visit to the doc much more pleasant than yours.

Did you ever wonder why, after 30 years of making morning rounds at the local hospitals caring for my sickest patients, I suddenly stopped making rounds?  For 30 years, it was up at 5 a.m., in the hospital by 6 a.m. drove to the office and prepped for the day by 7:30 a.m., work 10-12 hours and then go back to the hospital.  Understand, I’m not complaining.  Caring for people was (and still is) my mission.

At 3 a.m. my phone rang:

Nurse – “Dr. Segal this is Ellie from 4 north, Mrs. P just fell and I’m calling to notify you.”

Me – “How bad did Mrs. P hurt herself?  Do you need to transport her to the ER?”

Nurse – “Oh, she didn’t hurt herself at all.  Her vitals are stable and her exam is normal.  She just kinda slipped onto her buttocks.”

Me – “Why are you calling me at 3 a.m.  Not only did you wake me up, but you woke up my wife.  You know I’m in the hospital by 6.”

Nurse – “It’s hospital policy to notify the patient’s doc if they fall.”

Do you have bad days?  Physicians do for a multitude of reasons.  This is just one of those reasons.  In reality, most of my working days could be described as bad!  While my patients brought me a great deal of joy, my job entailed dealing with illness and injuries.  I remember the kids who died in a homecoming accident.  I remember the patients who had devastating strokes and heart attacks.  I remember the names of those who committed suicide and those who suffered in agony but would not commit “suicide.”

I also remember missing my children’s’ sporting events, recitals, school function and . . .  All of this takes a toll and at time, the stresses and sorrows spilled over into the exam room.  

My front desk team was comprised of the nicest, most competent and caring people you would ever meet.  At least the above description was accurate at 8:28 in the morning.  By 8:30, they had been chewed out by patients over the paperwork they needed to fill out, over payment of past due bills, over wait time and . . .  The list of patient demands and complains was overwhelming and usually out of our control.  There are rules doctors’ offices have to follow.

So, I gave up seeing inpatients at the local hospital.  I alleviated some of the stress but the nature of a busy family practice meant that there would always be sorrow mixed in with the joy.

So, when my doctor keeps me waiting, appears short or even rushed, I understand what his/her day is like and I cut them some slack.  Perhaps you’ll think twice about chewing out your new docs’ staff or writing a bad review. Perhaps you’ll cut your doc some slack also.  You could even ask, “Hey doc, how’s your day?  Are you OK?”  

In the next few weeks, I will publish a list of things you can do to prepare for your visit to the doc.  If you are properly prepared, I can guarantee your visit to your new doc will be a more fulfilling encounter.

Tonight, Renee and I dined at a friend’s house. I was talking about my ideas for this article when my friend asked me the following question?  How many “Attaboys” does it take to cancel one “Oh Shit.”  It was an excellent question and we debated what the right answer should be.  My opinion was that it was highly dependent on what the “Oh shit” was.  His was that one “Oh shit” did not cancel any “Attaboys.”

If you think I’ve lost my mind, read on.  As a practicing physician, I’ve seen many thousands of individuals over the years.  While many have loved me, there have been those that did not.  (A good guess places my career visit count near 400,000 patient visits).  The “did nots” tended to be a very vocal group using the internet to slash out at me.

There are multiple internet sites that rank physicians.  Most physicians simply ignore these sites.  I never could.  What angry people post becomes reality in many reader’s minds.  Unfortunately, the situation is complicated by two things:

1.  Happy patients rarely ever go to the internet to give you an “Attaboy.”
2. For a multitude of reasons, physicians cannot respond and defend themselves.

Let me give you an example.  One of the most viscous attacks I sustained as a practicing physician came from a person I never saw as a patient.  The individual came to the office with a friend and several textbooks and articles printed from the internet.  The person’s intent was to be the patient’s advocate.  What ensued was ludicrous, with the “advocate” reading from the text and articles and demanding that certain tests be run on my patient and certain medications prescribed.  Ultimately, I had to demand that this individual leave.

The next day, there was a scathing review of me on the internet by a “patient” that I had never treated.  I could not respond as responses often lead to further unjustified garbage being printed or worse, physical threats.  Responses also take the chance of unwittingly releasing patient information.  Notice that I have been very careful not to mention whether my attacker was male or female or anything about my ex-patient even now that I am no longer practicing. 

In my youth, I did in fact respond.  I defended myself against a liar and was shocked when the Chief of Police showed up in my office.  He proceeded to tell me that the person I had angered was known to the police and very dangerous.  He stated he would have patrol cars in front of the office in the morning and evening and I needed to watch my back.  I wore a Kevlar vest for months.  I learned to walk away from angry people.

So, what does a physician do?  Some choose to ignore the internet altogether.  In my case, my patients formed an “Attaboy” call tree; and, if someone attacked my online persona, the call tree triggered and published gobs of real “Attaboys’” were posted. Some physicians hire outside firms whose jobs are to monitor, clean and enhance their online personas.  Now you know how a physician consistently scores a 5 out of 5 without even one blemish.

There is a moral to this story.  If your physician (or any body else) takes good care of you, they deserve an “Attaboy.”  Go on the internet and praise them.  Nobody can tell me exactly how many “Attaboys” it takes to get rid of one “Oh, Shit” but the more “Attaboys” one has, the better.

By the way, if you’re pissed off, take a breather and cool down before you attack.  Then call or write your doc and present your case.  You may well get an answer.  You may even get an apology.  You may get an explanation that makes you happy.  Once you go public, all lines of communication stop, leaving you and your doc in a lousy place.

October 4, 2019

I woke up this am in pain with a very stiff back.  My Parkinson’s symptoms were marked, making it difficult to walk.  I took my meds and tried to convince myself that I should get into my lift chair and try to go back to sleep.  I failed.  The only thing I wanted to do was to go to the office and get ready to see my patients.  The problem with that is the office is gone.  There are no patients. 

Actually, I’m a patient.  I don’t like being a patient.  I want to find a way to reconnect with those I’ve cared for over the years.  Now that I’m a patient/doc I have a lot to offer.  Being ill has given me a new perspective in life.

My phone beeps notifying me that I have a text message. The message reads, “32 years ago today you were just leaving Good Shepherd Hospital after spending 3 hours with Ted and me and baby Bob, giving us a foundation on how to be parents and care for a baby, thank you!”  I smile from ear to ear.  

That message is just what I needed.  It made me realize that the connections to my patients are still there and, in many cases, will be there for my lifetime.  Now, if I can only figure out how I can use those connections to improve the health, happiness and “wellth” of my former patients, I’ll be complete again.

This blog will serve to keep the lines of communication open and provide an educational platform for my readers.  Unfortunately, I’ve not been able to get the comment section running which leaves me able to reach out to you but no way for you to contact me.  Until I can figure out how to fix that issue, you can reach me at ssegal@lzftc.com.

Secondly, I do not have a list of former patients and therefore have no way of spreading the word that I’m writing again.  I need your help.  Spread the word that www.livewellthy.org is the place to go for medical education on the internet.  You don’t have to be a former patient of mine to use this site.   That brings me to problems number three.

I stink as a web developer.  My home page does not catch your attention and therefore most readers who find my site move on immediately.  Yes, Google monitors everything and lets me know how many pages are read, by how many visitors.  If any of you are web developers and can help me improve this blog, please contact me.

Once again, as I read my old blog, I find answers to my own questions.  In 2013, while I was fed up with the outside constraint that had been placed on my medical practice by the government and insurers, I could still dream.

Many of you have asked me who they should transfer their care to.  That’s a hard question to answer.  Having had a hybrid practice that offered a Concierge Choice option, I can tell you that concierge medicine is as close to “free medicine” as you can get.  Perhaps, you should look for a concierge doc.  

Dinosaurs still exist.  Dinosaurs tend to be older docs who remember a pre-computer world and strive to give their patients the individualized care they need regardless of the insurer’s edicts or the computer’s algorithm.  Some dinosaurs even see patients in the hospital.  Perhaps you should look for a physician who will care for you in the hospital, as well as in the office.

Yes, the idealist in me dreamed of being able to provide the individualized care my patients both needed and deserved without artificial constraints, prior authorizations, codes, etc.  Look for a doc who has similar dreams.

October 23, 2013

When I grow up, I want to practice “Free Medicine!”  You may be asking yourself, “What is free medicine?  Does he mean he wants to run a free clinic or give out free pills?”  “Free Medicine (FM)” is a concept I just created in response to a comment from a reader on yesterday’s article.  My reader is a brilliant doc, educator and writer who serves both as mentor and colleague.

Dr M’s comment pointed out the fact that primary care docs are already a medical bargain.  While the world clamors over the ever-rising cost of medical care, Dr. M reminded me that the cost of seeing a primary care doc is miniscule in comparison to the cost of chemotherapy, surgery or going to the Emergency Room.

“Free Medicine” is an old idea whose time has come.  FM means being able to practice medicine as it was meant to be practiced, unencumbered by governmental and insurer rules and regulations.  Yes, I dream of being able to provide the individualized care my patients both need and deserve without artificial constraints, prior authorizations, codes, etc.  

FM means the ability to shelter my patients’ most private problems from the intrusion of modern day medicine’s fixation on sharing virtually everything with insurers, government workers and statisticians.  While their intent may be laudable, the information amassed in “The Cloud” may be used to destroy the very health we are pledged to preserve (witness the anxiety and depression of those whose data was recently stolen from a large hospital chain).

FM opens a physician’s mind, allowing him/her to be creative in coming up with difficult to make diagnoses and treatment plans.  “Best Practices” close the physicians mind, stressing compliance with “established” protocols.  Heed my warning, cookbook medicine, better known as evidenced based medicine, has infested my profession and stolen our freedom to think and act as highly educated professionals.

“Free Medicine” means being a DOCTOR, not a provider, gatekeeper or service technician.  FM means working for you, my patient; not corporate America.  Yes, I dream of being free.  I also have nightmares.  In my nightmare, I am being sucked into a huge vortex, falling uncontrollably into the world of ACO bondage.  I know there has to be a way out:  I just can’t see it!  Finally, it’s there; the door to freedom opens.

What is cost of freedom?  What’s it worth to you?  Will you be sucked into a world where your healthcare is provided in accordance with protocols created by insurers and Medicare or will you break free?  Will I survive long enough to find my door to freedom?  I pray so!

My door to freedom lies in cutting the tether that binds me to the accursed computer and its EMR.  Breaking off from Medicare and insurers and starting a fee for service/cash only practice of medicine is freedom.  Once again, proudly hanging out my shingle and opening my door to all that would want to come in, all that cherish their freedom, is freedom.

Primary care accounts for a miniscule amount of the cost of medicine in this country.  If we were free from filing insurance and Medicare claims and free from coding and accumulating meaningless reams of data, we primary care docs could  reduce our fees and do what we love best:  care for you, the patient, who places your life in our hands.

Yes, I dream of the day I am part of the “Free Medicine” movement.  The question is, will you join me?  I can’t do it unless you think freedom is worth paying for.  I cannot exit the vortex and leave all those souls I am currently responsible for to be sucked into the depths of illness without me.  I am truly torn! Captains are supposed to go down with their ship, aren’t they?  

“Attention on deck.  The ship is sinking!  All hands man the lifeboats!”

October 1, 2019

Awakening at 3 am is a killer!  Yes, we don’t have to worry about Parkinson’s killing me, sleep deprivation will get me first!  I’m being a good patient and wearing my CPAP.  It’s not helping.  I go to roll over and the pain in back hits.  If I stay in one position long enough, I get stiff and can’t move.

At some point I get up, come downstairs and try to be constructive.  It’s 4 am and the dishwasher has been emptied, a load of clothes has been run and I’ve straightened up the house. Time to write but nothing comes to mind.

I’ve discovered YouTube.  It’s been helpful in occupying my time.  I’ve blown through the Parkinson’s content.  This morning I discover “TEDx.” I watched “The Magic of Not Giving a F***, “How To Stop Screwing Yourself Over,” and “No Sex Marriage-Masturbation, Loneliness, Cheating.”

What a morning.  I learned about destressing your life by being honest and saying “NO” to what you don’t really want to do.  Sometime ago, I developed my Fuck It List and have done well with it.  Number one on my list is I will no longer put a noose (necktie) around my neck and go out pretending to have a good time.

I learned how to stop “screwing myself.”  The speaker states I can have anything I want. (Renee, I want …)  The speaker further states getting what you want is simple (but not easy).  She talks about “activation energy,” self- parenting and forcing yourself to get what you want.  Her video was actually helpful.  She used dieting as an example and I’ve been miserable at dieting since my surgery. While I need to lose weight, I want to eat the Danish!  Time to parent myself and force myself not to eat the Danish or anything not on my diet.

In “No Sex Marriage,” I learned I’m doing pretty good!  Whew!!  If you’re not, watch Maureen McGrath’s TEDx.  The best news today is threefold.  One is that sex exists well into the 90s.  Two is that sexercise should be done daily.  Three is that all marital arguments should be settled in the bedroom, naked.  I like this therapist.  I think I’ll be argumentative and see what happens.

October 1, 2019

A recent article dealt with the importance of listening. 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.