Patient/Friend/Caregiver

Tuesday was a remarkable day.  I woke up in pain at 4 am as is my usual habit.  It turns out that 4 am is an excellent time to think and compose your thoughts.  The world is very quiet at 4 am.

 Eventually I took my pills.  I take a handful of pills 4 times a day.  When you are sick, life revolves around taking your medication.  I sat down to write.  I had been on ZDogg’s web site the day before and I wanted to write an article thanking the “nurses” that had made my job easier over the years.

Next I made breakfast and then went in the living room (now my makeshift gym) to exercise.  So far, my day was like any other day and I’m sure I’m boring you.  So, I’ll get to the point.

As stated above, Tuesday turned out to be a remarkable day.  My friend/patient picked me up for our weekly lunch.  We went to the Onion Pub.  The food was OK.  The company great.  

The “remarkable” event came next.  My patient/friend had a surgical consultation at 2 p.m. and I accompanied him as a patient advocate would.  The nurse roomed us and the surgeon, a longtime associate and consultant, came in.  I listened.  I watch the reaction of my friend/patient and listened to the surgeon’s explanation.

I was not Dr Segal.  I was not patient Segal.  I was there in a role I never imagined playing.  It was fascinating.  I could listen and process without typing in a computer.  I could listen and process without talking.  I could identify the moment that the surgeon’s medical jargon lost the patient who could no longer follow the conversation.  I noted the anxiety rising in my patient/friend. 

As a third-party observer, I could bring the two parties together, alleviating my friend’s anxiety and interpreting what the surgeon was saying.  I could also clue the surgeon into what my friend/patient was feeling and why.

More importantly, my friend/patient (or is he a patient/friend?) occupied my otherwise boring day with a mentally stimulating opportunity to shed my “invalid” status and add some modicum of validity to my day.  Thank you.

As an aside, by now you should have noticed that on occasion I type “patient/friend” and at other times I type “friend/patient”. My new role can be confusing.  To add to the confusion, this particular friend has also taken on the role of caregiver, watching over my needs, taking me to lunch and reminding me of how much care I’ve provided over the years.

Some of you have commented that my posts had become depressing and that they were worried about me.  Chronic illness is depressing.  Neurodegenerative disorders that slowly steal your abilities are even more depressing!  But friends like this one are more powerful than the highest dose of Prozac.  And maybe, just maybe, this patient/friend who has transitioned to friend/caregiver has helped me discover a new way to help those in need and, perhaps, give old retired physicians a chance to use their skills on behalf of others.

It’s certainly something to think about at 4 a.m.

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Nurses

I’ve started watching ZDogg again.  He is a brilliant educator, entertainer and, at times rebel who is better than ANY of my medical schoolteachers. Today, as he often does, he pays homage to nurses.  Feel free to skip the commercial and go straight to the video.  Just click on the word nurses and you will be taken to the video.

I want to take a moment to thank all the incredible nurses that worked for me and with me over the years.  There are far too many to name.  You know who you are.  In my book, the term “nurse” includes medical office assistants (MOA), licensed practical nurses, and an assortment of other individuals trained to care for patients.

During the last few years of my practice, I was blessed to work with Olga and Darlene.  Not only did they take care of my patients, they also took care of me.  They still call to check on me and offer their help.  While they do not have the education of an R.N., they have the skill and dedication needed to care for the sick and injured. 

I want to thank all of you for taking such excellent care of my patients!  I especially want to thank Olga and Darlene.  As my Parkinson’s and back pain worsened, they did everything they could to make my job easier.  Darlene always knew how to make me laugh and lift my mood.

There is one other remarkable “nurse” I want to thank.  Over the years I worked with Ewa, I witnessed the birth of one of the most dynamic healthcare providers I’ve ever worked with.  Ewa ran my Concierge Practice.  Many of my concierge patients stayed in the program because of the exceptional care and management of their needs provided by Ewa.

The moral of this story is that nurses and those who function like nurses are essential members of the healthcare team and should be recognized for the role they play. Unfortunately, docs, their patients and their staff often forget to say “thanks.”

The next time your doc is running late or you’re upset over some other office issue, don’t take it out on the nurse!  She’s there to care for your needs, not to be reamed for something out of her control.

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Differential Diagnosis

September 24, 2019

My readers have spoken.  Several have complained that my recent articles have been depressing.  While chronic illness often leads to depression, talk therapy helps alleviated it. I’ve been talking it out on paper.

It’s time to get back to the basic premise of this blog, to educate as many people as I can both about living with illness and prevention of illness.  Today’s article was first published in 2011 and is just as valuable today as it was then.

Differential Diagnosis

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians.  Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list.  While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct diagnosis is made and the patient recovers. 

The differential diagnosis (DD) is one of the cornerstones of modern medicine.  The DD is a list of possible causes of an illness/disorder.  It is formulated based on probabilities and ranked according to the severity of the illnesses on your list.  From the time you walk into your physician’s office, the physician begins building a DD.  He begins collecting data the minute he walks into the exam room.  The patient’s demeanor, dress, movements, speech, skin pallor and posture are just a few of the things a physician observes, even before he begins to interview the patient.  During the interview (history taking), a DD begins to take shape.  The DD is refined during the exam.  Often, laboratory and x-ray results help to further illuminate the DD.  Once formulated, the DD serves as the basis for a treatment plan.

Someone once said, “When you hear hoof beats, think horses, not zebras.  During my training, my residency director would often criticize me by remarking that I was always looking for zebras in a herd of horses.  I would always respond by pointing out what a pity it was that he would never see a zebra.  From my perspective, a gifted diagnostician keeps an open mind and a fluid differential diagnosis.  Case in point:   

A 15 year old has a sore throat, fever and enlarged cervical glands.  Her strep test is positive.  She obviously has a strep throat and should be treated with amoxicillin.  Three days after she starts on her antibiotic, she breaks out in a horrendous rash.  Now her diagnosis is acute allergic reaction.  The doctor treats her rash and places her on a different antibiotic.  She gets worse.  Why?

The diagnosis was obvious but only partially correct.  The differential diagnosis of a sore throat with swollen glands and a positive strep test is extensive.  If your physician anchors his diagnosis to the positive strep test, he misses the diagnosis of mononucleosis.  The diagnosis of the rash seems obvious.  The patient was on amoxicillin and must have developed an allergic reaction.   Again, if mononucleosis (mono) is in your DD, amoxicillin is contraindicated.  Ninety nine percent of patients with mono will develop a rash when given amoxicillin.  If mononucleosis is included in the DD, another antibiotic is prescribed.  The patient does not get falsely branded as allergic to amoxicillin.

Helping patients understand the process and complexity of formulating an accurate differential diagnosis is important for a multitude of reasons.  In today’s stressful financial times, patients look for cost saving short cuts, including avoiding tests and follow up visits.  As stated above, tests help refine the DD and follow up visits help verify the DD or help modify it as new information is obtained.  Patients often stay at home believing they know what is wrong based on their own DD, founded on their life’s experience and Google.  Unfortunately, the stakes are high and too many lose.  Some die.  Even worse, patients leave the doctor’s office with a diagnosis and a treatment, only to get worse.  Because the doctor told them what they have and what to do, they stay at home waiting to get better rather than following up when they worsen.

There is an important take home message!  Your doctor’s diagnosis is always provisional.  You may well have what your doctor told you.  You may also have something else, something further down the DD list or maybe not even on it.  It is critical that the patient, like the doctor, keep a fluid list of possibilities.  It is also important that the patient take an active role in helping the physician formulate an accurate differential diagnosis.  Please, don’t hesitate to add your two cents.  It is one place where two cents is still valuable.

Posted by Live Wellthy at 4/6/2011 6:44 AM

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Most Memorable Day

September 23, 2019

What was the most important and memorable day of your life?  Was it the day you met your wife?  Married your wife?  Perhaps it was your children’s birthdays.  Or was it the day your loved one died?  The day you won the lottery?  There are lots of answers and the answers often change depending on your current circumstances.

Mine is the day G-d first talked to me.  I’ve never been very religious.  I would say I’m more spiritual than religious.  In the early days of my practice of medicine, I often had trouble relating to patients whose faith was a mainstay in their lives.  I would support their religious beliefs as they related to their health and that of their families but doubted that their fates were going to be modified by prayer or ceremony.  My science would save them.

Then several things happened.  First, I got a call from Good Shepherd Hospital.  The nurse told me that my DNR patient, we’ll call him Mr. Q, was dying and she wanted me to come over and see him.  Mr. Q knew and accepted the fact that he was going to die.  His wife knew he was going to die.  This was pre-hospice times and he was hospitalized to die in peace. DNR means DO NOT RESUSITATE.

I explained all of the above to the nurse who still insisted that I come in to see my patient.  The nurse was so adamant that I left the office and drove over to see MR. Q.

Here’s the interesting part.  Upon entering Mr. Q’s room, I knew I had to keep him alive!  My gut screamed at me.  I did the unthinkable.  I turned to Q’s wife and told her that I was going to rescind his DNR.  I told her I didn’t know why I had to resuscitate him, I just knew I had to.  I called a code, intubated my patient and sent him to the ICU.

He was alive.  I was in trouble.  I had broken the rules I lived by.  I probably broke multiple medical rules.  When Mr. Q woke up, he scribbled horrible things on the communication board.  They weren’t nice.  He was mad! I explained that, while I did not know why, I needed him to live another 24 hours.  I promised that I would take the tube out in the morning and let him go.  I told him to trust me and he did.

At the funeral, his wife pulled me aside.  She told me I did not know he had a son.  He had not talked to his son for many years and didn’t even mention his son when discussing family history.  His son flew in the night he was in the ICU.  They spent hours together (after the tube was removed) and healed the wounds that had festered for years.

I expected to hear from the Chair of the Department of Family Medicine, the ethics committee and medical staff president.  I expected trouble.  It never came.  I learned one of my most valuable lessons.  I learned to trust my gut.  I learned that no matter how much I thought I was in control, that G-d could always take over and guide my care.

I had several other instances where I could clearly see G-d’s hand in my patient’s care.  I discovered a powerful prayer group in Lake Zurich and will swear I saw an inordinately high number of miracles in my practice.

Then it stopped.  I stopped hearing from G-d.  The leaders of the Lake Zurich prayer group died.  Miracles seemed to vanish.  I grew to believe that G-d went on a protracted vacation.  My calling/profession went to hell.  The almighty computer linked to the insurer/government took control.

I got sick.  Here I am today.  More questions than ever and fewer answers.  Is G-d on vacation?  Am I losing my hearing and just can’t hear him? I am on the back nine and will fight to make the most out of every hole.  One thing I know for sure; I’m supposed to write this blog.  Perhaps visiting the past and writing will help answer my questions.  

Next week starts the Jewish New Year, a time of reflection and atonement for past and future transgressions.  I wish you all a healthy and happy New Year.

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The Back Nine

The Back Nine

Once again, I find myself looking through my old blogs searching for inspiration and wisdom.  This morning, I found an article from 2014 that was inspired by Mr. Wonderful.  My old readers will remember Mr. Wonderful (W).  Let me take a minute to introduce Mr. W to my new readers.

Mr. W is an older gentleman who has turned his life and health around using a vast assortment of tools he keeps in a notebook.  He has hundreds of positive quotes and inspirational axioms that he uses to bolster his will power and keep him moving in the right direction.

I continue to feel lousy and uninspired.  I force myself to exercise in the morning but do not enjoy it.  I force myself to sleep with my CPAP but really see no benefit (yet). The only things that come naturally and create joy are being with my family, writing this blog and eating.

A great deal of my problem is my weight.  I am approaching the size of a blimp.  I need to shop in the “Big and Tall” section, only I’m not tall.  My shirt could serve as a tent and house a family of four.  My buddy, Will Power, still hasn’t shown up.  Hopefully, the article published on April 23, 2014 will help me find the will to get my weight down to a more respectable level and help me find the path back to health and Wellth.

I’m definitely on the back nine and I want to play every hole I can.  So, what can I do?  One thing Mr. W used to say is, “If you fall down five times, get up six times.” I didn’t fall down, I got knocked down by Parkinson’s, my back surgery and the loss of my profession/calling.  I keep trying to get up but, so far, have been unsuccessful.

I called Mr. W yesterday and we are going to lunch next week.  Hopefully he’ll bring his book.  He’s been a patient, mentor and friend for years.  I’m sure seeing him will help me get up and move on.

I hope this blog will find its way to others, like me, who need a bit of inspiration and wisdom to get them back on their feet.  If writing about the transition from doc to patient and the insights a patient/doc helps one person, then I’ve done my job.

April 23, 2014

Mr. Wonderful was in today.  We spent a little time discussing the “Three Wise Men” article and I told him I was looking for the secret ingredient that awoke my three wise men.  I was particularly interested in his opinion as Mr. Wonderful was not so wonderful once upon a time.

Mr.Wonderful’s transition from an average patient, overweight, out of shape and on lots of meds to his current healthy state was nothing short of a miracle.  In answer to my questions, Mr. Wonderful stated, “I’m on the back nine and want to play every hole I can!”

If you’re a golfer over the age of 50, let Mr. Wonderful’s wisdom serve as your motivation to get and stay healthy.  If you’re not a golfer, find your reason to live longer and healthier and start developing a healthier lifestyle.  

As a doc, taking care of healthy individuals is a lot more fun than taking care of the aged and ill.  Are you on medication?  Would you like to be medication free?  Are you winded on walking several blocks?  Would you like to have more stamina?  Do your joints ache?  Would you like to be pain free?

Jenna and I are here to help you start your journey to health. (At least we used to be).  All you have to do is come in and let us partner with you.  There’s no time better than now.

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September 21, 2019

The Back Nine

Once again, I find myself looking through my old blogs searching for inspiration and wisdom.  This morning, I found an article from 2014 that

was inspired by Mr. Wonderful.  My old readers will remember Mr. Wonderful (W).  Let me take a minute to introduce Mr. W to my new readers.

Mr. W is an older gentleman who has turned his life and health around using a vast assortment of tools he keeps in a notebook.  He has hundreds of positive quotes and inspirational axioms that he uses to bolster his will power and keep him moving in the right direction.

I continue to feel lousy and uninspired.  I force myself to exercise in the morning but do not enjoy it.  I force myself to sleep with my CPAP but really see no benefit (yet). The only things that come naturally and create joy are being with my family, writing this blog and eating.

A great deal of my problem is my weight.  I am approaching the size of a blimp.  I need to shop in the “Big and Tall” section, only I’m not tall.  My shirt could serve as a tent and house a family of four.  My buddy, Will Power, still hasn’t shown up.  Hopefully, the article published on April 23, 2014 will help me find the will to get my weight down to a more respectable level and help me find the path back to health and Wellth.

I’m definitely on the back nine and I want to play every hole I can.  So, what can I do?  One thing Mr. W used to say is, “If you fall down five times, get up six times.” I didn’t fall down, I got knocked down by Parkinson’s, my back surgery and the loss of my profession/calling.  I keep trying to get up but, so far, have been unsuccessful.

I called Mr. W yesterday and we are going to lunch next week.  Hopefully he’ll bring his book.  He’s been a patient, mentor and friend for years.  I’m sure seeing him will help me get up and move on.

I hope this blog will find its way to others, like me, who need a bit of inspiration and wisdom to get them back on their feet.  If writing about the transition from doc to patient and the insights a patient/doc helps one person, then I’ve done my job.

April 23, 2014

Mr. Wonderful was in today.  We spent a little time discussing the “Three Wise Men” article and I told him I was looking for the secret ingredient that awoke my three wise men.  I was particularly interested in his opinion as Mr. Wonderful was not so wonderful once upon a time.

Mr.Wonderful’s transition from an average patient, overweight, out of shape and on lots of meds to his current healthy state was nothing short of a miracle.  In answer to my questions, Mr. Wonderful stated, “I’m on the back nine and want to play every hole I can!”

If you’re a golfer over the age of 50, let Mr. Wonderful’s wisdom serve as your motivation to get and stay healthy.  If you’re not a golfer, find your reason to live longer and healthier and start developing a healthier lifestyle.  

As a doc, taking care of healthy individuals is a lot more fun than taking care of the aged and ill.  Are you on medication?  Would you like to be medication free?  Are you winded on walking several blocks?  Would you like to have more stamina?  Do your joints ache?  Would you like to be pain free?

Jenna and I are here to help you start your journey to health. (At least we used to be).  All you have to do is come in and let us partner with you.  There’s no time better than now.

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Dis-ease

September 20, 2019

I continue to be amazed by how many notes my younger self left for me.  Yes, it appears that, in 2011, I knew that I would be in a state of dis-ease and would need help recovering my health. I knew I might forget Mr. “Qs” story, so I left a reminder in my blog of August 29, 2011.  I’d like to thank myself for being so forward looking and providing me with uplifting stories that have been helping me be more at “ease” with my Parkinson’s.

Reading my old blogs are great therapy. Perhaps I should write a science fiction script involving a young man who sees his future and leaves helpful note for his future self to find. (Wait a minute, its not fiction!) 

I’ve had a really crappy day starting at 3 a.m. when my back pain awakened me.  While I’ve exercised, walked in the neighborhood and grocery shopped; I’ve been miserable. “Dis-ease” has ruined my day.  Looking for an idea for tomorrows blog, I came across the following article.

I hope reading it will help those of you who are in a state of “dis-ease” find some health and happiness. 

August 29, 2011

Yesterday, I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners (http://www.kevinmd.com/blog/2011/08/patients-flock-alternative-medicine-providers.html).  Mr. Luban brought up an interesting question, “What is health?”

Is health simply the absence of disease?  If it is, there certainly aren’t very many healthy patients in my neck of the woods.  Most of the patients I take care of have something that’s not quite right.  I only know one perfect person and I married her!  

In Mr. Luban’s article, he writes, “Health may simply be the flexibility to adapt to circumstances and to continue to have an acceptable quality of life.”  I instantly liked this definition.  If you change the spelling of the word, “disease” to dis-ease, then illness boils down to a lack of “ease” with your condition.

In the thirty some years I have been practicing medicine, I have seen patients with horrible illnesses who were healthy despite being ill.  These individuals had one thing in common:  they refused to allow their “disease” to put them into a state of dis-ease.  Mr. “Q” suffered from a neurologic disorder that had progressed to the point where he was confined to a wheelchair.  Despite his crippling disease, Mr. “Q” lived life to its fullest, painting, joking with his friends and family, and running a successful computer business.  Mr. “Q” was at ease with his condition and therefore was healthy.   Over the years, I have met many patients who, despite having what should have been life changing illnesses, remained “healthy” due to their attitude.

I have always believed that, if you could make something good come out of something bad, the bad was not so bad after all.  On my last trip to Puerto Vallarta, I met an artist who was born with no arms.  His paintings were intricate and beautiful.  Each brush stroke was meticulously done by the artist while holding the brush in his mouth.  He was at ease with his physical condition, having found the gift in his otherwise disabling birth defect. 

Unfortunately, I often see individuals who, while otherwise healthy, are not at ease with their human condition.  One common cause of dis-ease is weight.  I’m not talking about the patient who is 50 pounds overweight.  I’m talking about the young lady who is unhappy with her figure because she is not built like the models the media use to set societal standards.  Eating disorders represent a tragic example of dis-ease and the loss of “health” caused by not being at ease with your human condition.

Health should be defined as “the flexibility to adapt to circumstances and to continue to have an acceptable quality of life”.  Health is a state of mind.  Often, as we age, disease intervenes in our lives.  If it’s not our heart, then it’s our lungs, or kidneys, or diabetes, or sores.  Being at ease with whatever the affliction nature deals you makes all the difference in the world.  As doctors, we need to help our patients find ease with their human condition.  That “ease” cannot be found in a pill!  Ease comes from knowledge and understanding.  Imparting knowledge and understanding takes time and, unfortunately, there is never enough time.  As doctors, we need to help our patients by providing them with reliable sources they can use to learn about their condition.  We need to provide our patients with counseling and understanding.  It all starts by defining what “health” truly is.

I normally end my articles with, Be Happy, Be Healthy!”  In the future, I will add, “And be at ease with life!” 

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Immunizations

September 19, 2019

Hey, you.  You know who you are.  You’re the learned parent who wants only the best for your kids.  You scour the internet reading articles about how harmful immunizations are.  You dig into the supposed conspiracy that big pharma is spiking vaccines with all kinds of nasty stuff.

Despite pleas from the World Health Organization (WHO), The AMA, The American Academy of Pediatrics, and the American Academy of Family Physicians, your kids go unimmunized.  You want to do everything as organically and naturally as you can. 

Unfortunately, you are just too young to understand the error of your ways.   You have never met a child or adult crippled by Polio.  You have never consoled a mother who has lost her child to measles, a father whose only son is sterile from mumps.  You have never seen the disfiguring lesions from a severe case of chickenpox or worked with a child who was damaged by meningitis.  You have never heard the “whoop” of whooping cough. I have!  The only thing I haven’t seen is tetanus.  Shun vaccines long enough and maybe you will.

You have grown up in a world devoid of these horrors thanks to the vaccines you now shun.   Thanks to your parents and immunization programs required by your local schools, you avoid the misery of these once almost eradicated diseases.

I know I’m going to piss some of you off. I know some of you think Dr Google trumps my years of experience.  I know some of you think doctors are stupid enough to buy anything pharma sells.  We aren’t and you are wrong.

I know the names of all of the kids mentioned above.  I remember their misery.  I remember those I saved/salvaged and those I lost.  I pray you will heed my warnings and vaccinate your kids.  I pray you never see what I have seen in the last 40 years.

One last reminder.  It’s time for your flu shot. Even if it doesn’t prevent you from getting the flu, it generally lessens the course of the illness if you get it.

Here are some excellent links to the most up to date research available and a great video:

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Fatigue

September 18, 2019

I’m tired.  I’m tired of hurting.  I’m tired of not being able to do what I want.  I’m tired of taking pills.  I’m tired of fighting and losing the weight battle.  I’m tired of using CPAP.  I’m just tired!

Monday and Tuesday were relatively good days.  I at least had enough energy to go out with Renee, do a little shopping, do a few menial things around the house. Yesterday, I was napping on my daughter’s couch by 2:30 pm.  Yesterday was my granddaughter’s second birthday party.  I was at the party, but I really wasn’t.  As per usual, Renee asked me if everything was OK. She stated, “You’re awfully quiet.”

When I’m out of energy or my legs won’t work, I get quiet.  There really is nothing to say other than, “It is what it is, so just move on.”  It’s hard to move on when those around you tell you how good you look.  I know they are trying to cheer me up or they are blind.  IF they are trying to cheer me up, then be honest.   I look like shit!  If they are blind, get some glasses.

I wonder how many of my patients over the years have felt the same way but not had a way of expressing/venting it.  I wrote an article years ago about fatigue.  I stated that fatigue was my most hated diagnosis because EVERYTHING causes fatigue.

Now I know what fatigue really is!  It is still my most hated diagnosis, but now I hate it because it insinuates itself into every phase of life.  It is relentless and self-perpetuating.  It’s primary treatment, exercise, is thwarted by the fatigue itself.  It’s aftermath, in my case; obesity, leads to more fatigue.  It’s an unhealthy spiral that is hard to stop.

The “retrospectrascope” is a very precise device. You’re always much smarter when you look back in time.  Looking back now, knowing what I now know, I could have done a better job with those of you who are chronically fatiguesdand tired.

“High Jack.  You look like shit.  How do you feel?  Yeah, I know, I look like shit, too.  Yeah, I’m tired.  I worked out this morning.  Did you? Yeah, I hated it, but I have to break the downward spiral of fatigue or it will break me.  My diet is getting better slowly, yours?”

Medical education really starts once you are in practice. That’s why they call it the “Practice of Medicine.”  As for me, my education is continuing despite the fact that my practice has ended. Hopefully, I’ll find a way to make my new found knowledge useful to those I have cared for over the years and those who find this blog.November 29, 2011

An article from November 2011 for you and me:

In researching for my articles, I often come across valuable sources of material on the internet.  Quote Garden is one of those sources.  I found seven pages of quotes referencing diets.  Some of the best are listed below with my thoughts about their significance.

“Your stomach shouldn’t be a waist basket” – Author unknown!  Not long ago, I saw an overweight patient of mine in the drive-in window of a fast (fat) food establishment.  He was putting fried junk into his belly.  He puts premium gas in his car.  What’s wrong with this picture?

“Don’t dig your grave with your own knife and fork.” – English Proverb.  Raucous Ralph, a character in my book and one of hundreds of patients I have seen over the years, did just that.  Who do you love more, your spouse, your family, or your food?

“Inside some of us is a thin person fighting to get out, but they can usually be sedated with a few pieces of chocolate cake.” – Author unknown.  Many people use food as a drug/medication.  Do you?  If you are depressed, see your doc, not the local baker.  If your marriage is bad, see a marriage counselor.  Don’t have a closet affair with Godiva!

“A diet is a penalty we pay for exceeding the feed limit.” – Author unknown.  Yes, diets are penalties; and yes, we pay BIG!  It’s time to stop dieting and, instead, learn who you are and what you need to do to get healthy.  If you’re healthy, stop fretting over your figure and enjoy life.  If you are not healthy, work at getting healthy the right way.  Diets and Other Unnatural Acts will help you.

“People are so worried about what they eat between Christmas and New Years but they really should be worried about what they eat between New Years and Christmas.” – Author unknown.  I’ll end on this note!  A healthy lifestyle has room for holiday treats but no room for holiday cheats!

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The Real Medical Education

September 17, 2019

Before you can practice medicine, you must complete 4 years of undergraduate work, 4 years of medical school and 3-5 years of residency.  Upon successful completion of your prescribed training program, you are a highly trained and, hopefully, skilled DOCTOR OF MEDICINE.

You are ready to setup practice and see patients. You are ready to diagnose and treat a vast array of illnesses.  You have read the most up-to-date journals and practice evidence-based medicine. Really?

While you may think your education has prepared for life and death decisions, it has not.  Realistically, once you start seeing patients, your real training begins. You’ve been taught by a system to prepare you for the routine, everyday patient with textbook perfect complaints and treatments.  

In simple everyday terms, you have been trained to put square pegs in square holes and round pegs in round holes and you’ve gotten quite proficient at your task.  Then, one day, you’re given triangular pegs.  What do you do?

Having practiced medicine close to 40 years, I can attest to the fact that all patients are different and many cannot be successfully diagnosed and treated using the most up-to-date rule books. What do you do?  My answer is easy.  You customize your treatment protocols to fit the individual patient’s needs and wishes. Sometimes, it takes months or even years to find the right treatment regimen for your patient.  Sometimes, if you listen closely to what your patient tells you (and you choose to believe your patient) deciding what to do is a slam dunk!

Why am I writing about this today?  My patients are actively searching for new docs as I am no longer in practice.  Some of the new docs will review the patient’s history, his old charts and his treatment regimen and, despite the fact that the treatment does not stand up to present day standards, will choose to continue it because it works!  It has safely worked for 20 years and survived the test of time.

Other docs will choose to stand by the latest treatment protocols, decide that Dr Segal did not know what he was doing, and change the patient’s treatment plan simply because they don’t understand how it was developed.  Reading 20 years of chart notes just isn’t possible.  For the physician, it’s easier to simply start from scratch.  For the patient, it is not so simple.  Sometimes, it’s like squeezing a square peg into a round hole.

What can you do to make the transition of care easier on you and your new physician?

The solution may be as simple as making a phone call.  While I no longer have access to your chart, I can answer many of your new physician’s questions if he/she will call me.  My number is 847-846-2131and I will be happy to help in your transition of care to a new doc.  Feel free to share this post with your new physician as well.

The solution may not be simple.  It may take several attempts to find a new physician who fits your need.  Trust your gut.  If you don’t feel comfortable with your new physician, move on.

I am truly sorry that I’m no longer here to take care of your needs.  I want to thank all of you for your calls, cards and prayers.

The following article was published on April 27, 2011 and is even more pertinent today then it was then.

No, I haven’t lost it.  Today’s article is all about fitting a round peg into a square whole.  My profession is changing.  “Payers,” those entities that have taken on the responsibility for paying for and ultimately providing healthcare for my patients, want statistics.  They collect data on every visit, every medication ordered and filled, every test ordered and done (or not done).  If you are afraid of what Google and Apple are doing with your geographic data, you should be more afraid of “payers.”  The government, in the guise of Medicare, is the worst.

Protocols, for medical care, are being actively built and implemented on a daily basis.  When the President says that the electronic exchange of medical information will save money, he means it.  Information (data) is being harvested from every patient encounter.  That information is used to create evidence on what the least costly and, therefore, most effective treatment protocols are.  I am forced to follow these protocols every day.

Today, my patient needed a stat CT scan of her lungs to assure she did not have a pulmonary embolism.  Her insurer’s protocol required prior authorization (article 4/15/11) for this potentially lifesaving test.  Failure to follow her insurer’s protocol would result in thousands of out-of-pocket dollars expense to my patient.  Delay in care could result in her life.  What to do? 

Protocols don’t take into effect an individual’s needs; they make an individual fit within the protocol’s needs.  Protocols are in the best interest of the “payer”, not the provider and his patient.  In “Normal,” published 2/28/11, I wrote that I had never met a “normal” or “average” patient.  I see individuals and they come in all sizes and shapes.  Protocols are devised to care for that fictitious, average, normal individual.

In “Are We There Yet?” (4/14/11), I wrote about a fictitious New York city in the year 2020.  There, everyone lived by protocol, from what they ate to when they died, protocol controlled everything.  We aren’t there yet, but I think we are on our way.  Certainly, from a medical point of view, we are being pushed to sacrifice the personal aspects of care for the sake of cost control.

How do you fit a square peg in a round hole?  Try using a hammer, chisel or saw.  I’m afraid that the new world of medicine is going to be uncomfortable for most patients and downright painful for many.

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