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My neighborhood is approaching its 1 year anniversary.  I live in an over 55 development in North Carolina. It truly is a special place, populated by special people.  Apparently, Southerners sit on their front porches or, in the case of my neighborhood, on their driveways in the late afternoon.

Tonight, I was sitting in front of my neighbor’s house with “C “and his wife. I was enjoying a Pacifico and we were talking about the blog, telling jokes and remembering days long gone.  I mentioned that I was having a writer’s block and asked if there was a topic he or his wife would want me to write about.

“C” immediately responded, “Write about the health benefits of sitting outside with your neighbors and forming new friendships.” “C’s” idea is brilliant.  In Illinois, I had friends in the neighborhood, but I never remember sitting on the front porch in the evening greeting my neighbors.  In my Illinois community, all the action occurred in the back yard and was inherently a more private affair.

In my neighborhood in North Carolina, a group of six neighbors started sitting in front of one of their houses. Their laughter could be heard from one end of Manor Stone Way to the other.  Their openness was amazing, welcoming anyone walking by.  Typically, everyone introduces themselves, the host offers a chair, a drink and we talk as if we had known each other for years.  If this is the highly touted southern hospitality, I love it.

First of all, an hour in the front yard welcoming relative strangers and turning them into friends is much better than living mostly in the backyard.  The second health benefit is derived from getting old people (the guys are old, the women appear much younger) out of the house, into the afternoon sun and being more active. The benefits of laughter are well documented, and we laugh a lot.  If I’m there, our laughter involves the topic of sex.  Some of my neighbors initially were taken aback by my lewd jokes but they have loosened up and are, themselves, becoming lewd.

Hmm, loose women and lewd men could be interesting.  The list of health benefits goes on and on.   Lisa was right. I’m a lucky man!  So far, I haven’t met a person I couldn’t call friend.

Here’s your joke:

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

April is Parkinson’s Awareness Month and I’m fund raising for our local Parkinson’s chapter. On May 22, 2021, I will be participating in the Move It Walk for Parkinson’s and I’m hoping that my readers will support this worthy cause.  I’ve set my goal at $500 and you can donate on my walk page by clicking on the underlined link and typing in my name.  Of course, I’ll be happy if we surpass my goal.

I am currently on the same medications my father was on 50 years ago.  Support Parkinson’s researchers today.  We need a breakthrough soon.

On April 4,2021, KevinMD published, “No wonder patients detest our health care system, and doctors are leaving medicine in droves,” an article by Dr C Fratila.  Dr. Fratilia addressed an issue that I have been writing about for years, the insurance companies ever-present quest for profits at everyone’s expense.  In particular, her article deals with the ever-present demand for “PRIOR AUTHORIZATION” and its burden on the physician’s staff and resources.

Her solution is novel and something I tried many years ago.  She has her patients become “voluntary” staff and has them deal with the insurance company’s outrageous demands.  Who better to sit on hold for hours, listening to the insurers’ propaganda than the patient whose medication is not on formulary?  Who better to plead the patient’s case than the patient?  After all, the patient knows his/her history better than anyone.  The patient knows the impact of not having his/her meds better than anyone, as well.

So, what’s the problem?  Letting the patient deal with his/her insurer seems logical, right? The problem is that it doesn’t work.  The patient eventually feels put upon and gets angry.  Rather than venting his/her anger at the insurer, he/she vents it at the doc and the doc’s staff.

I’ve written about it before.  Docs have been under fire for years.  The ground they stand on has been undermined by the insurers.  They have been demoted from the MD status of the past to their current position as providers, buried in regulations and paper work.  Their journey into the pits has forced them into contracts they never wanted and employed positions in which they have ceded control of their practice to a cadre of administrators.

Despite all of the changes, they have persisted in their roles as patient defender and advocate.  I know some of you are thinking that I’m out of touch with reality.  Let me assure you, I am not.  The reality is that docs try to defend you but can no longer do so.  The insurers have won and docs are retiring at an alarming rate.  Doctor suicide is at an all-time high! I loved my profession and miss it. 

In actuality, my profession left me long before I retired.  I maintained the position of doc with my long-term patients but was seen as provider to the newcomers.  I fought with insurers daily.  The fights were expensive both financially and emotionally.  Ultimately, the insurers put me out of business.  I became an employed provider.  Amita was good to me.  They gave me time to see my patients.  Eventually, that would have changed.  To earn a living wage, I would have needed to increase the number of patients seen per hour.

What can you do to help your new doc?  Unfortunately, nothing!  They are stuck in their role and you, in yours.  I envision today’s medical complex as a puppet show: we are the puppets and the great puppeteer in the sky is the insurer.

One last thought.  Concierge medicine is a way out for some of you.  Unfortunately, many see it as the rich man’s escape.  In reality, many of my concierge patients were middle income individuals who placed their health above all.  I sure loved taking care of them. Their commitment to being healthy was admirable.

The long and the short of it is that I wish I could be back in LZFTC, seeing patients and fighting the good fight.

Here’s your jokes for the day:

They say that during sex you burn off as many calories as running eight miles. Who the hell runs eight miles in 30 seconds?

“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.

“I bet you can’t tell me something that will make me both happy and sad at the same time,” a husband says to his wife. She thinks about it for a moment and then responds, “Your penis is bigger than your brother’s.”

I’m a lucky man.  Lisa, Steve, Kenzie and Hudson were over for dinner last night.  It didn’t go so well for me.  I had a relatively good day.  I was somewhat functional right up until the time we started prepping dinner and then my Parkinson’s flared and I became immobile.  There goes helping prep food, grilling and serving dinner.  I retired to my room while my family did the rest.  Doesn’t sound lucky, does it?

I took my usual meds a little earlier than I was supposed and prayed they would kick in.  Over the next 90 minutes, I improved enough to join my family at the dinner table.  The kids helped Renee clean up; and, before they left, I asked them if they had any suggestions for today’s article. 

To my surprise, Lisa suggested the title be, “I’m a lucky man.”  Considering how bad I was, her response surprised me.  Nonetheless, I started writing this morning, trying to figure out ways in which I’m lucky.  That’s when it hit me.  When Renee’s dad lived with us, I would come home from work and find him sitting at the kitchen table.  I would greet him, “Hi dad.  How are you doing today?”  Almost always, his response was, “I’M ALIVE, AREN’T I!  I’M DOIN FINE.”

Being alive was good enough for Bernard.  He found contentment just sitting at the dinner table with me, his daughter and his grandchildren.  Unlike me, he never complained about his losses.  Despite how I felt, I’m alive; and last night I found contentment sitting at the dinner table with my family.  I guess I am a lucky man and Lisa was timely in reminding me of that fact!

I’m sure you’ve noticed that I’m up and down depending on my ability to function.  Up and down is good in bed (just had to squeeze in a little SEX for rating purposes) but not in day-to-day life.  I keep searching for a philosophy of life that will help even me out.  I think Bernard’s focus, “I’M ALIVE, AREN’T I!  I’M DOIN FINE,” may be what the doctor ordered.

Yes, I’m lucky to be alive.  I’m lucky to be with my family.  I’m lucky to have moved into a neighborhood with a group of welcoming elders suffering from CRS like me.  I’m lucky to be able to Facetime with my brother every day. I’m lucky to call my childhood friends brothers, as well.  I’m lucky to have my Rock Steady group.  The list goes on and on.  I’M A LUCKY MAN!

(Editor’s note: We are all lucky to him, however we can get him!)

Here’s a joke:

Two guys are sitting next to each other in a pub.

After a while, one guy looks at the other and says, “I can’t help but think, from listening to you, that you’re from Ireland.”

The other guy responds proudly, “Yes, that I am!”

The first guy says, “So am I! And where abouts from Ireland might you be?”

The other guy answers, “I’m from Dublin, I am.”

The first guy responds, “Sure and begora, and so am I! And what street did you live on in Dublin?”

The other guy says, “A lovely little area it was, I lived on McCleary Street in the old central part of town.”

The first guy says, “Faith & it’s a small world, so did I! And to what school would you have been going?”

The other guy answers, “Well now, I went to St. Mary’s of course.”

The first guy gets really excited, and says, “And so did I. Tell me, what year did you graduate?”

The other guy answers, “Well, now, I graduated in 1964.”

The first guy exclaims, “The Good Lord must be smiling down upon us! I can hardly believe our good luck at winding up in the same bar tonight. Can you believe it, I graduated from St. Mary’s in 1964 my own self.”

About this time, another guy walks into the bar, sits down, and orders a beer. The bartender walks over shaking his head & mutters, “It’s going to be a long night tonight.”

The guy asks, “Why do you say that?”

“The Murphy twins are drunk again.”

It worked; and, then again, it didn’t work.  The mention of sex brought more readers to my blog as expected.  It worked!  The problem arises when I look at how long they stayed on my site.  It didn’t work! My readers left fairly quickly.  Yes, I look at statistics to define who my readers are and what they want to read.  Stay with me today, I think you’ll find this article interesting.

But first, a story.  Years ago, my buddies and I took a trip to Italy.  Italy was fantastic, rich in history, wine and food.  We traveled the countryside with a guide and one of our tours side trips was to Pompei.  It was a glorious, bright sunny day when we arrived at Pompei.  Mount Vesuvius was in its full glory.  As we toured the remains of the city, our guide took us to the local whorehouse.  Pompei was destroyed in 79 AD.  Can you believe it?  In 79 AD, men were frequenting whore houses.

I took lots of pictures with my phone camera.  Due to the bright sun, I could not see the pics on the phones screen until we were back on the bus and heading away from Pompei.  To make a long story short, I have 30 pictures of my forehead.  I had the camera reversed! 

You are probably asking yourself, what’s this got to do with sex?  I promised it would be worth the wait!  If men have been frequenting whore houses since 79 AD, why are whore houses still illegal?  Yep, bet you weren’t expecting to read about sex for money, were you?

Face it, men like sex.  So do women but that’s another topic for another day.  Complicating things is the “Madonna-Whore Complex”. “Accordingly, Sigmund Freud developed a theory to explain men’s anxiety towards women’s sexuality, suggesting that men cast women into one of two categories to allay the uncomfortable dichotomy of fear and desire: the Madonna (women he admires and respects) and the whore (women he is attracted to and therefore disrespects).  The Madonna-whore complex views women’s desirability/licentiousness and purity/maternal goodness as mutually exclusive traits”.

In my years of practice, issues surrounding sex played a large part in the lives of my patients.  I saw both men and women for a multitude of problems surrounding sex, including infidelity and venereal disease amongst many others.  It seems that, while men still desire Madonna in the kitchen and the whore in the bedroom, women eventually tire of playing whore and retire to a life of being a Madonna.  What blows my mind is that this has been going on since at least 79 AD and we civilized beings still haven’t cum up with a solution.  (Oops, naughty me, a misspelled word?)

There are a few places in the United States where whore houses are legal.  Legal means regulated with set healthcare standards and requirements for appropriate safe sex practices (Do you think there should be is a sign in the bathroom, “ALL WORKERS MUST WASH THEIR HANDS .. BEFORE GOING BACK TO WORK?”)  Legalizing whoring would also help put an end to sex trafficking.  There are countless illegal brothels and massage studios nationwide that are unregulated and potentially dangerous.

Whoring is legal in Amsterdam. Best Brothels in Amsterdam 2020 is an interesting read.  The author states, “The majority of girls appear intelligent, well-educated and confident. Talk to them like you would any other woman their age (possibly your intellectual superior). What’s your name? Where are you from? How long have you worked here? These establish a dialogue. Be interested in the answers.”

Of interest is that, while 4 out of 10 US marriages end in divorce, the Netherlands  (brothels are legal) divorce rate is only 1 out of 100.  I’ll be the first to tell you that I don’t know why the divorce rate is so much lower in the Netherlands but I would like to believe it is because both men and women have an outlet where their sexual frustrations can be met.

At this point, I’ve probably upset a few readers.  That is not my intent. I’m happily married and content in my old age but there are many people who are not.  There are many individuals whose only outlet is the Internet and the Internet is not safe. 

From Psychology Today:  Porn Addiction

“Pornography use is a widespread means of dealing with one’s sexual drives. More than 90 percent of young men report watching porn videos with some regularity, particularly in the United States. Many of these videos depict acts that they might never engage in themselves—in other words, erotic fantasies.”

“On Pornhub, the world’s largest porn website, alone, well over 90 billion videos are viewed daily by more than 64 million visitors, 26 percent of them female. Although viewing erotica is nearly ubiquitous among males, some men and women regard watching internet porn as pathological and believe that time spent doing so may be a sign of “porn addiction,” although such a diagnosis is rejected by many psychologists, as are treatment approaches based on addiction models.”

Others believe porn addiction exists. As reported by Fox news,  “According to Men’s Health, the World Health Organization now recognizes porn addiction as a behavioral disorder. Dubbed Compulsive Sexual Behavior Disorder (CSBD), the condition is defined as “a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior.” Oh no, I’ve got CRS and CSBD.  Poor Renee!

Do you think whoring should be legalized in the US?  My bet, 80% of men say yes and 90% of women say NO! Of thee 20% od men who vote no, 80% are probably lying.  Do you think my readership is going to increase?  We shall see.

Here’s your joke for the day:

I can’t believe that you’ve been visiting prostitutes for sex, my wife screamed at me. I’m really disappointed.

You can hardly blame me, I answered. It’s not like I was getting any from you.

Well, that’s your own fault, she replied. You never told me you were willing to pay for it.

Here’s another:

How many prostitutes does it take to screw in a light bulb?

I have no idea. I did hire four prostitutes once, but we did other stuff.

And another:

I’ve dedicated my entire life to getting prostitutes off the streets.

For an hour or so each day.

It’s time to write about SEX again as my readership has fallen off.  SEX is an uncomfortable topic for most people I know. Sure, men joke about not getting enough; but when, as doctor, I asked them about it, they clammed up.  It’s great fodder for jokes of every kind.

Practices once considered to be taboo are now considered normal and displayed everywhere.  If you watch TV, you know that every show has at least one gay and one lesbian couple.  We’ve come a long way from the closet to the stage.  Don’t get me wrong. I’m glad the closet door has opened and no one has to hide his/her love any longer.  I’m glad the world has normalized being gay or lesbian but do we have to see it on every show?

Do you know what LGBTQ stands for?  If not, it is:  Lesbian, Gay, Bisexual, Transgender, and Questioning.  Over the years, I treated patients who fell within the parameters of each group.  Most of the time, they hid their sexuality from others out of fear.  They feared being ostracized, physically attacked, fired or worse.  They had good reason to hide.  Society has a way of subjecting its morals on others and outliers always take the brunt of society indignation.

Now, I’m no expert on the topic of sexuality.  I’m just pandering to my readers and writing about SEX to boost my ratings.  But, ask yourself a question.  Why does my readership triple when I mention sex?  It’s probably because no matter how open or closeted we are about SEX, it is the one topic we all can’t get enough of.  It’s also the one place people are the most uncomfortable.  Why is that?  Is it because of our puritanical past?  Because of what religions have labeled as “sins”? Or is ti because we no longer know what’s normal and what is not normal.

What is normal?  That’s easy to answer.  Normal is what you do alone or with your loved one(s).  Therefore, abnormal is what others do that is different from you.  The operative word is different.  Since the beginning of time, difference in groups of humans has been the justification for war and atrocities.  The world has been at war with the LGBTQ community because they have been perceived as different ,and they have suffered.

I asked a question before.  Do we have to see LGBTQ on every show?  The answer is yes.  If the LGBTQ community is ever really going to get free of the closet, society has to recognize and accept that they are NORMAL.  It’s time!  Many are concerned with the effects seeing openly gay and lesbian couples on TV is going to have on our children.  Hopefully, their generation will no longer use the acronym, LGBTOQ but instead see these people as normal members of our society.

Here’s your jokes for the day:

What does one saggy boob say to the other saggy boob?

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

How do you make your girlfriend scream during sex?

Call and tell her about it.

What’s the difference between a G-spot and a golf ball?

A guy will actually search for a golf ball.

A priests asks the convicted murderer at the electric chair.

”Do you have any last requests?”

”Yes,” replies the murderer.

”Can you please hold my hand?”

Which statement is correct:

1. No pain, no gain
2. Pain, no gain

I used to think I knew the answer.  I told my older patients that the correct answer was number 2: pain, no gain.  Now, I’m not as sure.  Pain, no gain is partially responsible for my current condition.  To avoid more pain, I avoided exercise. 

Right now, I’m in pain!  As I’ve already told you, I’ve enrolled in “Rock Steady” (a Parkinson’s exercise program).  This is Parkinson’s Awareness Month and there are all kind of events scheduled.

Personally, I’m aware of Parkinson’s every day from the time I wake up until the time I go to bed.  I’m also aware of the effects of degenerative arthritis, depression and obesity. I’ve finally ACCEPTED my problems and I’m actively fighting all three at once. My Rock Steady class is my best weapon.  I exercise 3 times a week in class and the rest of the week, at exercise at home.  Exercise hurts.

So, back to my initial question.  I have pain this am in my knees. Yesterday, I worked on being able to get onto and off of the floor. I know it sounds easy (even a toddler can do it) but it isn’t.  I didn’t succeed.  Tomorrow, I’ll work on it again.   Getting on and off the floor is critical as Parkinson’s patients, me included, tend to fall a lot.

I work with two instructors. They are excellent.  They give you tasks to complete and work with you to help you succeed.  They advise that you work at your own pace, rest when needed.  I’ve had five six sessions and am frustrated by the fact that I have worsened with each session.  I doubt I’ll even attempt getting on the floor in tomorrow’s session.

It seems that the “no pain, no gain” approach is going to fail as did the “pain no gain”.  What’s a guy to do?  The obvious answer is to quit exercising.  That’s also the wrong answer. So, I’ll keep exercising and look for a less painful midground.

The lesson for today is not whether number one or number two is correct.  The lesson for today is about ACCEPTANCE.  Until I accepted my disability/illness, there was nothing to fight, nothing to understand, nothing to learn about and, certainly, nothing I could do about it.

With acceptance comes a host of possibilities, Rock Steady and deep brain stimulation are the two I’m focusing on currently.  Hopefully, research will find even better options in the future.

Over the next few days, I’m going to hit you up for donations to the Michael J Fox’s Parkinson’s Foundation.  They need funds to continue to explore treatments for Parkinson’s.  There will be a Parkinson’s event in your area this month; please join in.

Here’s your joke for today:

A general is being driven in a jeep through the desert on the way to a training exercise. Out in the middle of nowhere, the jeep breaks down. The female jeep driver jumps out, opens the hood and starts working on the engine. The general, wanting to be helpful, finds a toolbox in the back and opens it. “Do you want a screwdriver?” he asks. “Might as well, it’s going to be a while before anyone shows up,” she says!

Yep, occasionally things happen that can only be described as “OOPS.”  The hardest part of dealing with oops is not laughing.  Sometimes, you just can’t stop the laugh. 

So, what’s an oops?  In residency, I had a big oops.  I was zapping a bunch of skin tags on a patient’s neck.  The nurse would spray a topical anesthetic on the tag and I would destroy it with a hyfrecator (electric cautery).  The patient was large-breasted and the topical anesthetic (very cold liquid liquid) was dripping into her cleavage.  The nurse, trying to prevent the freezing liquid from irritating the patient’s breast, held a 4×4 gauze pad in between her breasts.  As it turned out, the anesthetic was flammable; and, once saturated, the 4×4 went poof.  The momentary flare singed the patient’s eyebrows and hair. This oops was not laughable although the look on my boss’s face was.  Can you imagine telling your boss, “I just blew up the patient in room one?”

A 62-year-old, hard of hearing, female presented for a pelvic.  As the nurses brought her back to the room, she emitted a steady barrage of farts.  She couldn’t hear them so she thought they were silent.  Everyone in the lobby was giggling.  The nurse set her up for a pelvic; and, with me sitting at ground zero, she let a huge one fly.  I was sure it would measure on the Richter Scale even though the patient ignored it.  Anyway, the nurse tried to hold back her laughter but failed.  Laughter can be infectious and I started, followed by the patient.  Being thorough, the next thing to do was a breast exam.  She was large breasted; and, under the right breast, I found ½ of an Oreo cookie.  The patient immediately said, “My grandson must have left it there.  The nurse and I had to leave the room.  We could not stop laughing.

Oops, you’re pregnant.  I was consoling the mother of four after telling her she was pregnant again.  She wasn’t planning on another kid but, while stunned, was happy.  She wanted me to break the news to her husband before she went home but first needed to check on her kids.  Her eldest child was babysitting her baby and toddler while she was in the office.  When she opened the exam room door, I knew something was wrong.  She didn’t know whether to laugh or cry.  Oops, the baby had gotten its diaper off and painted the interior of her car with poop!

The last oops was a big one.  My billing clerk (“B”) had sent the niece of a well-known gangster to collection without discussing it with me.  Half joking, I told her to be very alert when crossing the parking lot to her car.  That afternoon, using a gruff and accented voice, I called and asked for the billing clerk by name. 

“B” you shouldn’t have sent my niece to collection.  We take care of our own.  We don’t appreciate being disrespected!   “B,” you’d better fix this now and apologize.”

Oops! “B” locked the front door and closed the office.  Everyone including “B” laughed for weeks once I owned up to the joke.

Practicing medicine can be incredibly stressful.  Medical mistakes happen.  People die despite excellent care.  Humor helps relieve some of the stress.  As a chronically ill patient, I find that humor is often more effective at alleviating depression and pain than pills.  On the one hand, doctors are supposed to be professionals and act like professionals.  On the other, docs are human; and, using magic or a fart machine to lighten the mood is just what the doctor ordered.

My patients appreciated the humor.  If they didn’t, they left me for a more archetypical doc. When I didn’t have a firm diagnosis, I often listed “lackofsexitis” in the differential.  Lackofsexitis always lightened the mood, putting a smile on my patient’s face.

Renee, I feel tired and weak.  I think I have Lackofsexitis!  I need a treatment now before I get worse!

Here’s your joke:

A family is at the dinner table. The son asks the father, “Dad, how many kinds of boobs are there?” The father, surprised, answers, “Well, son, a woman goes through three phases. In her 20s, a woman’s breasts are like melons, round and firm. In her 30s and 40s, they are like pears, still nice, hanging a bit. After 50, they are like onions.” “Onions?” the son asks. “Yes. You see them and they make you cry.” This infuriated his wife and daughter. The daughter asks, “Mom, how many different kinds of willies are there?” The mother smiles and says, “Well, dear, a man goes through three phases also. In his 20s, his willy is like an oak tree, mighty and hard. In his 30s and 40s, it’s like a birch, flexible but reliable. After his 50s, it’s like a Christmas tree.” “A Christmas tree?” the daughter asks. “Yes, dead from the root up and the balls are just for decoration.” http://www.laughfactory.com/jokes/sex-jokes astghik

The AMA has consistently advised against treating friends and family.  A good summary of their rules and the thought process behind their rules can be found on Google.  As a family physician, I treated multigenerational families.  In a sense, I became part of those families, at first caring for a young couple’s babies, then their toddlers, progressing to the point of caring for the babies of the infant I cared for 25 years prior.  In the 34 years I practiced medicine, I cared for families that included great grandparents, grandparents, their sons and daughters and their grandchildren.

Notice the word “caring” in the sentence above.  Caring is what it is all about; and, if you genuinely care for your patients, then eventually they become friends or even family by choice.  So, do you fire your patient because he/she has melded you into their family?  Of course not! 

Surely, knowing the entire family history and how injury or disease affects not only the patient but his/her significant others gives the family physician a distinct advantage over other specialists.  In turn, the family knowing their physician through multiple interactions gives the family and its individual members the trust they need to respond in dire times and difficulty situations.

Don’t get me wrong.  Treating family and friends does pose special problems but a well-trained physician should be able to deal with those instances.  A few examples will help you understand my stance on the AMA’s position.

I’ve known family “A” for years.  I care for their parents and their children.  I bump into the wife (”W”) at Costco and we spend a few minutes catching up on life.  I haven’t seen “W” as a patient in 6 months but she has been in multiple times with the children.  I note that “W” is not herself.  She seems a bit anxious and guarded which is distinctly different from her usual affable demeanor.

Me – “W,” what’s wrong?

W –  Nothing.

Me – You don’t seem yourself today.  Is everything at home ok?

W – Everything is fine.

Me – I’m glad everything is fine.  You know you can talk to me about anything if you need to.

I got a call that afternoon.  She thought about it and decided to share what was happening.  She did not want any information shared with her husband and I assured her it would not be.  She had a sexual problem and felt her gyne was ignoring it.  She wanted an internal exam; and, since we were kinda friends/family, she didn’t want to put me in an awkward position.  I reassured her and she came in for an exam.  Problem solved.

The husband called me that afternoon to pump me for information.  He called me “Stu” which was a tipoff that he was going to play the friend/family card.  He was upset that I would not divulge any information but quieted when I reminded him that I held my patient’s information to be every bit as sacred as a priest did in the confessional.  I knew he was a devote Catholic and that the comparison to a priest’s responsibilities would win the day.

Had I not known her well enough to pick up on the subtle changes associated with her fear of illness, her diagnosis and treatment would have been delayed.  Had she not felt comfortable with me in my physician role, she would have gone untreated.  One of her concerns was the fact that she needed an internal and how that would affect our friendship/family relationship.

In life, each of us wears many hats.  When I put on my doctor’s hat, I go into doctor mode.  In doctor’s mode, an internal is no different than a throat swab.  The trick is getting the patient to understand that fact.  When patients become friends/family, they get to see the transition from Stewart the jokester, foodie, family man to Doc, the caring, serious diagnostician. 

Story number two involves a 60 some year-old female in for her pap smear.  Her doc had just retired and she was looking for a new doc.  I had been taught to talk my way through an internal; and, before doing her rectal exam I asked, “have you ever had a problem with the rectal part of the exam?”  Her answer was an emphatic NO and that no one had ever done a rectal on her and no one ever would. 

I was blown away!  Her lifelong gynecologist was one of my best teachers and Dr. “K” taught his students to do rectal exams on all patients who were in for their annuals.  I talked with Dr. “K” a few weeks later and he reassured me that his notes were accurate and rectals had been done but never discussed.  The difference was obvious: “K” had a long-term trusted relationship that allowed him to do what he needed to do without informed consent and I didn’t.

What has being retired due to illness taught me about treating family and friends?  Story number three:

On the day I was discharged from inpatient PT, a longtime patient (I’ll call him LTP) called asking if there was anything Renee or I needed.  My usual request is for a 40-year old red headed nurse and he said he would find one.  I was joking; he was not.  He called several times over the next week and we finally decided that he would pick me up at rehab (giving Renee an afternoon off) and we would go to lunch.  We had a blast.  Turns out that he was funny as could be; and, if not for the AMA rules, we would have been lifelong social friends.  I have thanked God for LTP on a regular basis.

While I treated friends, I rarely socialized with them.  I often ducked dinner invites and other offers including a villa in Greece.  I shouldn’t have!  My life would have been richer had I socialized with my patients.  I should have taken Renee to Greece when I was whole.

My advice to future physicians is to ”care” for and about their patients; and, if that caring relationship leads to friendship, then accept it as long as you can maintain appropriate barriers when needed.  As far as treating immediate family, who better to know their history, personalities, strengths, and weaknesses.  Make sure they know who to see if they are uncomfortable seeing you and that you have adequate referral sources should you be uncomfortable seeing them. 

For those of you who believe that you will not treat family, wait for that 3 am fever and abdominal pain and see how strong your convictions really are!   I bet you’ll treat them rather than awaken the doc  on call.

Here’s your joke:

A woman playing Golf hit a man nearby. He put his hands together between his legs, fell on the ground & rolled around in pain. She rushed to him & offered to relieve his pain as she was a Doctor.

Reluctantly, he agreed. She gently took his hands away. Unzipped his pants & put her hands inside. She massaged him tenderly for a few minutes & asked: “How does it feel?” He replied: “Feels great but I still think my thumb is broken.”

And my favorite:

I went to the doctor and he said, “Don’t eat anything fatty.”

I asked, ” No bacon? No burgers?!”

To which he replied, “No, Fatty, just don’t eat anything! “

Yesterday, I learned a valuable lesson.  I should have learned it in medical school.  Since they never teach you how it feels to be a patient, you would think that I would have learned it from observing my patients during the 34 years I practiced medicine.  I didn’t!

In medical school and in practice, we learned that treating patients with medications carried significant risk.  We were taught that it was our duty to review those risks with the patient prior to giving them the medication.  We were taught the risks of surgery and other interventions as well.  We were taught to discuss benefits and risks of almost everything we do.  We should have been taught that everything we do has an impact.

We learned that tests had consequences and to look for false positives and false negatives.  Shoot, just coming to my office carried risk (I might uncover something you didn’t want known).  So, what am I talking about?

When my mother came to live with us, it became apparent that her memory was failing.  I shared my concerns with her and sent her for Neuropsych testing.  I explained that Neuropsych testing was a 4hour exam (quoting google) “to understand cognitive strengths and weaknesses, neuropsychological testing (further) evaluates:

Attention and concentration

Verbal and visual memory

Auditory and visual processing

Visual spatial functioning

Language and reading skills

Sensory development and sensory integration

Gross and fine motor development

Social skill development

Executive functioning

Emotional and personality development”

What I didn’t take into account in my ordering the test was the amount of anxiety such an awesome test could provoke.  I didn’t take into account how worried a patient might be coming out of the test and waiting for the results.  I didn’t know because, despite having ordered hundreds of Neuropsych evals, I had never had one.  She had to wait 3 weeks for her results!  Knowing her the way a son knows his mother, those must have been horrible weeks.

I had forgotten how bad test anxiety could be!  I rediscovered that anxiety over the last few weeks.   I was going to take a test that would compare me to my peers and uncover my weaknesses.  Had I known what I now know, I would have done a better job at preparing my mother and my patients for what was to come.  At the very least, I would have asked my patients how they felt about taking such a test.

The doc responsible for interpreting my test did an excellent job at describing the test and how it is graded.  She explained that the test was meant to establish a baseline on which any future changes could be evaluated.  She explained that nobody gets 100% right.  She explained that my results would be compared to the results of my peer group and she would review them with me in 1 week.

If my peer group is comprised of chimpanzees, I did great!  Seriously, I came out of that test feeling like I was an idiot. The examiner said, “I’m going to give you a list of numbers and I want you to repeat them in reverse order.  Ready?  Six, nine, seven, eight, one, four, nine, seven, five, six, one, one, two.  Now repeat those number in reverse order.”  I’m sure someone can remember all those numbers and reverse them, but I can’t.  The more tasks I couldn’t complete the more my testing anxiety increased.  Eventually, my mouth went dry, my brain froze and my performance worsened.

I’m sure my peer group went through the same phenomena.  I’m sure my mother did as well.  I bet she came out of the test thinking she had Alzheimer’s.  I did, at least, until my memory came back online and I remembered all the times as a youth when I came out of an exam thinking I had failed it and instead aced it.

The moral of the story is simple.  Doctors are taught to think as doctors.  What if doctors were taught to think as patients as well? I think they would be much better as doctors if they understood the effects they and their tests had on patients.  I know I would have been.  I know that, having been through this experience and the myriad of experiences I’ve had since becoming a chronically ill patient, I would have spent far more time preparing my patients for this test and its aftermath.  Oops, I’m playing “woulda, coulda shoulda” game (click on the underlined words) again.

In this case, the “woulda, coulda shoulda” game that I have cautioned some many mothers against has a purpose.  I think that an integral part of a doctor’s education should involve learning the patients’ point of view.  This blog will eventually become a book designed to give doctors and patients alike1 a unique view of chronic illness, a view born from my long tenure as a doctor and my newfound view as a patient with an ongoing, neurodegenerative disease.

Now for my daily joke:

I’m not saying my ex is fat…

But my memory foam mattress took a year to forget her.

I’m including the following joke because, just the mention of sex, increases my readership:

Did you know too much sex can cause memory loss?

I read that in a medical journal on page 34 at 3:23 pm last year on Wednesday November the 7th.