LISTENING

I’ve got to admit. I was disappointed by the meager response I received to my last article.  While only a few of you sent me their ideas of what it takes to be a good doc, the few who responded agreed that a “good” doc has to be a good listener.  One reader sent an inspiring quote, “The biggest communication problem is we do not listen to understand.  We listen to reply.”

Take a minute and think about it.  How fast does your doc interrupt you when you are telling him/her about how you feel?  There are multiple studies posted to the internet showing that, on average, docs interrupt their patients’ story in eleven seconds.  What is truly regrettable is that, when I started in medicine in 1979, statistics showed the identical 11 second interruptions.

 “The biggest communication problem is we do not listen to understand.  We listen to reply.”  If I’m listening to reply, eleven seconds works.  In eleven seconds, I think I’ve got the gist of what you are saying, I then cut in and start into my diagnosis and treatment plan.  If I’m listening to understand, I let you finish telling your story and uncover facts I missed in the first eleven seconds.

So, why aren’t doctors given courses in listening?  One of the things that impressed me during my first month of residency was an exercise in listening.  Our director played a cockpit recording from an airplane that crashed due to a miscommunication between the pilot and co-pilot.  We spent about an hour analyzing what happened and another hour discussing how it could have been prevented.  That was the extent of my listening training!

While listening to understand is essential in every facet of life, it is particularly critical in medicine. It is also time consuming and, regrettably, time is money. Yep, I had salaries and bills that had to be paid. In a perfect world, docs would be paid by the minute.  You need 60 minutes; you get 60 minutes.  In the real world, Medicare and the insurers pay an hourly rate that doesn’t come close to covering the overhead of a modern medical office.

Do you have a solution?  I did but very few patients liked it.  I learned to limit the number of problems I would listen to during an office visit.  It works like this: 

Patient – “Doc, I’m having problems with a cough.  Oh yeah, I also have acid indigestion.  I almost forgot to tell you, I pee every 2 hours.  My nose is congested …

Me- “I’m sorry you are having so many problems.  I’m going to step out of the room for a few minutes.  Please make a list of everything that’s bothering you and then prioritize your list.  Today, we’ll deal with items one and two.  We’ll see you in a week and follow up on one and two and start on three and four.”

Patient- “Oh, by the way, I forgot to put chest pain on the list.  I’m sure it’s just indigestion.”

Patients who had saved up a lot of problems did not want to wait a week or two to resolve all of their issues, despite the fact that the cough started last year, the bladder issues started 6 months ago, etc.  All too often, the patient’s priorities did not match mine.

At the end of a twenty-minute visit in which we developed a list of problems to be addressed, had addressed the most pressing problems and had arranged for the future handling of unresolved issues.  The patient, while standing at the discharge desk, complained that the doc didn’t listen to him and did nothing for him.

So, when asked how I would fix our broken medical system, I would answer, “We do not listen to understand.  We listen to reply.”  Before trying to fix our broken system, we need to do a lot of listening to develop an understanding of what people truly need.  Unfortunately, only 4 out of a hundred readers responded to my first question, “What makes a good doctor and what makes an excellent doctor?”  Now, what makes a good patient and what makes an excellent patient?

Jokes about miscommunications:

My wife and I have such a wonderful marriage. I always know what she is thinking because she always tells me what she’s thinking.

She always knows what I’m thinking, because she tells me that, too!

PREFACE

Over my many years, I learned a great deal from my patients.  In 1974, I was an anatomy grad student sitting in a lecture hall at the University of Virginia.  The professor brought an octogenarian farmer onto the stage and explained that the gentleman had bilateral inguinal hernias documented in 1954 and was waiting until he retired to get them repaired.  The patient laid down on the exam table, was covered and his pants lowered.  (I was sitting in the back row of a lecture hall holding 350 people).  When the professor said cough, two massive waves of intestines rose from the man’s abdomen/groin and flowed into his testicles.  It was dramatic!

An 80 plus year old farmer became the first patient to teach me, “Where there is a will, there is a way.”  He brought his homemade hernia belt and the device he used to connect it to a plow used to prepare his fields for planting.  When future patients balked at surgical repair of their bothersome hernias, I might prescribe a hernia belt even though they were no longer an accepted treatment.

When I was diagnosed with Parkinson’s, I went through every emotion you can imagine.  It just wasn’t fair.  Afterall, I was a caregiver, not a caretaker.  At one point, I rationalized my illness by deciding that God was sending me back to school to become a better physician by studying illness from a different viewpoint.  It dawned on me that by the completion of God’s lessons, I would no longer be able to practice medicine so why teach me in the first place.  The answer was obvious.  I always loved teaching and it was my opportunity to teach a new generation of medical students, residents and doctors a new way to understand and treat their patients.

As many of you know, I have been planning to write a new book detailing the transition of a doctor from physician to a chronically ill patient and the lessons learned in the process.  For most of a physician’s career, he/she is taught by older physicians who are well and have not yet been personally touched by disease.  Would a physician who was suffering from a disease be better suited at teaching his/her younger colleague?  I think so!

In the past few years, Parkinson’s has given me a whole new perspective on medical care.  From the first call to the doctor’s office to the waiting room experience, everything changes when you are the patient.  The changes continue as you see the nurse who prepares you for the doctor’s grand entrance and the doctor’s visit itself.  In each interaction the sick patient has with the medical complex, there are lessons to be learned and taught to future doctors.

As I started to organize the 2000 articles I’ve published over the years, I realized that I am missing a critical piece of information.  I’m missing you, my readers, input.  Over the next few months, I’m going to ask for your help.

Today’s question is, “What makes a good doctor and what makes an excellent doctor?”  Think back to all the docs you have seen in the past and the ones you see now.  The more detailed you can be, the better.  Thanks, in advance, for your help.

NORMAL YET?

I just went through pictures from Jeremy and Allyson’s wedding 10 years ago.  Happy Anniversary!  What a difference 10 years makes.  Actually, what a difference the last year made.

Do you remember what life was like pre-covid?  After a year of wearing masks everywhere, social distancing and an obsession with topical antiseptics, do you remember crowding into an airport terminal, sitting down in a restaurant, visiting with family and friends, going to work, etc?  I don’t!  When I look through the wedding pictures, the first thing I notice is an absence of mask.  Second, and just as amazing, is that people are dancing with each other.  Those were the days!

Has your life started to normalize?  Are you vaccinated?  Do you trust the vaccines, CDC and talking heads on TV?  Have you gone out to eat?  Gone to the movie theater? Gone to the office to work? Had friends and family over?  Taken your mask off in public?  Have you hugged a friend?  (I saw five doctors this week and not one of them shook my hand.)

Will life ever return to pre-Covid normality?  Unfortunately, no one knows!  Renee and I are normalizing our lives now.  We are fully vaccinated and have re-entered society, masking only if the hospital, doc’s office, store or restaurant we are in requires a mask.

After spending our first year in Charlotte in seclusion, it’s going to be fun exploring all that Charlotte and the surrounding cities have to offer.  Unfortunately, many establishments have yet to fully open and some have closed forever.  Hopefully, new owners will move into empty spaces and expand our ability to enjoy our surroundings.

I actually miss shopping in stores.  I’m sick of Amazon and other online vendors.  It seems like salespersons and clerks are friendlier post-Covid.  Certainly, my doctor’s front office staff and nurses are friendlier and more helpful.  My bet is that the improved attitudes and demeanor I’m seeing is related to spacing appointments further apart and, in the retail world, less customers. 

Having run a large medical office, I am very familiar with the costs of running a practice and the reimbursement for taking care of patients.  In prior articles, I have mentioned that I was sorry I was not still practicing medicine.  Frankly, if I were still in practice, I would be going broke.

For a multitude of reasons, it’s time to return to normal.  It’s time to put Covid behind us and celebrate life.  There are those of you who won’t be able to return to pre-Covid life.  I recommend you see your docs, as depression and PTSD secondary to Covid are on the rise.

Have a great holiday weekend.  It’s a good time to get started on the rest of your life.

Here’s a joke for today:

This holiday season I’m just looking for a nice girl. A girl-next-door type who is just sweet, caring, smart, and funny…

Someone I can laugh with, you know? Someone who is there for me. Just a kind, and loving individual with absolutely massive tits. Is that so much to ask for?

DECISION TIME

The following article is meant to serve as a decision making guide to help you organize your thoughts should you be contemplating elective surgery. 

Step number one is done.  Today, Renee and I met the neurosurgeon to explore the benefits and risks of DBS (deep brain stimulation). We were both impressed with his bedside manner.  He succinctly went through the procedure he would do, as well as the risks (brain bleed/stroke, infection, misplaced wires, etc.) and expected benefits.  He listened to our concerns and answered our questions in a caring way.  We both liked him.

Step two is deciding if I’m going to have DBS.  Many of you know that I have a unique way of looking at statistics.  In his hand, the risk of a significant brain bleed is around one percent.  In my experience, it’s around one percent for the masses; but, for the individual, it’s 50%.  Yep, either you are going to have a stroke or you aren’t.  I already have neurologic deficits, a bleed would mean a worsening of my deficit.

Step three involves deciding when and where to have my surgery if I should decide to have DBS.  Recovery is 6-8 weeks and I love summer, gardening and swimming.  That means the soonest I would contemplate surgery is October.  Certainly, the decision of when is predicated on the progression of my disease.  At my current rate of deterioration, I’ll be able to wait till October.

Steps four and five are the hardest.  Step four is losing weight and getting into better shape. There is nothing like the threat of surgery to motivate me to get into shape.

Step five is to write ironclad advanced directives.  Should something catastrophic happens, leaving me more disabled than I already am, my family needs to promise to let me go.  I am never to be admitted to a nursing home or bedridden in my own home.  (Well, maybe if my nurse’s aids are hired at the local whore house, I’ll consent to a few days as a bedridden invalid before I’m dispatched to wherever we go when we are dead.)

My decision is not going to be an easy one.  It won’t be easy for me or my family.  For the time being, I’ll live with the deficits I have and make the best out of them.

Renee, I need another shower. ….. I know it’s only been 2 hours but I’m sweaty. …. OK, if that’s not a good enough excuse, I spilled pickle juice all over me……. I forgot I used that excuse this morning. ……Oh no, I’m incontinent!  I really need another shower.

Here’s your joke for today:

I called my wife at work and asked, “Do you ever get a shooting pain across your body, like someone’s got a voodoo doll of you and they’re stabbing it?” Sounding concerned, she said, “No.”

I responded, “How about now?”

SUPERWOMAN

Thank God for Renee!  I would be really hurting without her.  Without Renee, I’d stink, literally.  She bathes me. To tell the truth, not that I don’t always tell the truth, her bathing me is one of the only good things to come from the Parkinson’s. I’ll leave it at that and move on!

I’d be nude from the waist down much of the time.  She helps dress me.  There are times when I just can’t get my legs to do what I tell them to.  For sure, I would never wear socks.  Ninety percent of the time I can’t reach my feet.

I would be thin!  Yep, I would starve.  I try to cook dinner, but dinner time is also freeze in place time.  Food prep is a bitch!  I’m not complaining; I’m just taking a minute to praise my wife.  I don’t do that enough.  When you read your wedding vows and said, “For better or for worse,” you couldn’t imagine how bad worse could be.

She also cleans up after me, laughs at my jokes, lets me catch her from time to time and goes out of her way to make me happy anyway she can.  This week, she’s my sexetary (I meant secretary).

Today started with a shower.  Hallelujah, it’s a hell of a way to start the week!  Next, it’s off to the eye doc. 

She dropped me at the front door and then parked.  After the appointment, she picked me up at the front door and took me home where she served lunch.  After lunch, she drove me to the imaging center and waited while I had an MRI of my back.  The imaging center wanted an old study for comparison; so, while I was in the MRO machine, she ran home and searched for the last MRI disc.  She then gassed the car, went grocery shopping and then came back to get me.  In a few minutes, she’ll take on the role of editor and chief of Livewellthy and proof this article.

Tomorrow starts with a trip to the neurosurgeon to discuss Deep Brain Stimulation.  She’ll take copious notes and ask the questions I forget to ask.  After the neurosurgeon, we’ll do lunch, then it’s off to the hand surgeon.  Then it’s home for dinner and sex (only joking, or am I).

Wednesday is an easy day.  At 11, she’ll take me to the dentist.  Hopefully, we’ll spend a few hours at the pool, then drop the car off for servicing.  She’ll follow me to the mechanic and bring me home.

Thursday is baby sitting day, as is Friday.  She’s the best Bubby in the world.  When she’s in Bubby mode, she’s really sexy.  I always loved how she looked with a baby in her arms.  By the end of the day, she’s exhausted; so I try to leave her alone.  I also work hard at preparing meals and whatever else she needs.

Saturday is her birthday.  For her present, she gets to bathe me, feed me, dress me and then take a nap.  Have you got the picture?  I married Superwoman!  I sure am lucky!

Here’s your joke for the day:

Inside every older person is a younger person — wondering what the hell happened.

-Cora Harvey Armstrong

I REFUSE TO GIVE UP!

Bummer!  My readership is down.  Normally, I would write about sex but I’ve gone as far as I can with that topic.  Unfortunately, sex is the only topic that gets a rise out of my readers.  I thought about writing an article or two on diet and healthy eating, but I seem to have lost that battle.  For sure, I don’t want to write about a failure of mine.

Renee’s lifelong friend from Norfolk has been visiting.  Last night, we talked about diet and exercise and I realized that food was my last great pleasure.  I had chalked up my failure to the loss of my companion, Will Power.  In reality, Will is still at my side, I’m just ignoring him.

The real problem is that I have to make an important decision.  My weight is reaching critical mass.  There is a point in every fat man’s life where either his weight crushes him or he loses weight.  If my weight keeps going up, exercise will become impossible.  So will simply going out and doing anything else fun.  At that point, it would be me and my smart-ass refrigerator.

Did I tell you my LG refrigerator utilizes smart technology?  Well, it does; and, if I’m anywhere near it, I hear its call, “Stewart, come here, I’ve got something good for you!”  Yep, just being in the room with it is dangerous.  There I go again blaming something else for my failure. 

So, what do I do?  One quick solution is to live in my car.  Renee bought us a convertible and riding in it is better than taking antidepressants.  She’s my chauffer and really enjoys driving me around.  However, I can’t hide in the car.  The other option is to burn more calories.  Walking and exercising is growing harder due to my Parkinson’s and obesity.  I’ve never let something hard block me from reaching a goal.  I’ve also never had a crippling disease. 

So, what do I do?  I’ve scanned the internet for success stories.  I’ve re-enlisted my buddy, Will Power, and I’ve decided to keep eating and counterattack by burning more calories.  The sun is coming up and my walker and I are going for a short walk every 2 hours.  Later today, Renee will drive me up to the gym. I’ll ride the recumbent bike (if I can get on it) for 3-5 minutes, do some stretching and come home exhausted.

I’m taking the “chicken steps (every little step is important)” approach and expect to make a little progress weekly for a long time to come.  My hand is healing so I’ll resume Rock Steady next week.  Most importantly of all is resolving not to go over the obesity cliff I’m facing.

 I used to read a book to the kids that was about a train climbing a hill going, “I think I can, I think I can, I think I can.”   I know I can!

Here’s your joke for the day:

Patient goes to the doctor about his obesity…

He says, “It’s not my fault doctor, obesity runs in my family.”

Doctor replies, “No, the problem is no one runs in your family.”

BEWARE

I have written multiple articles on the risks of over the counter (OTC) pills sold as all natural, miracle cures.   This morning’s KevinMd published “The complications of drug regulationby Julie Craig, MD, an addiction specialist.  Dr. Craig’s article is well worth reading.

Were you aware that addictive, narcotic-like substances, can be hidden in OTC pills?  Were you aware that the government has chosen to take a hands-off approach to OTC pills, nutraceuticals, and supplements?  Were you aware that the product being sold must state, “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnosis, treat, cure or prevent any disorder.” The manufacturer can infer anything they choose.

Think about it for a minute.  If an OTC product promises to make you more alert, energetic and keep you awake, how does it do that?  It must contain a stimulant.  Is it safe for you to take a stimulant?  Might you have a heart attack or worse while hyped up on an OTC product?

If a product promises to alleviate pain, could it contain an addictive new narcotic yet to be classified by the FDA?  Might you become addicted to a “harmless, all natural” supplement?  It’s no longer a secret!  My poop is all natural, made from the finest foods the earth has to offer. It’s processed in the most natural of factories and has stood the test of time.  If I bottle it and sell it as a high protein, low carb, “all natural” supplement, I could probably make a fortune.  Of course, every bottle would state: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnosis, treat, cure or prevent any disorder.”

The bottle would clearly state, “Recommended by doctors” as I am a doctor; and I would offer shares in my new company to other docs.  It would cost $59.95 plus shipping.  If you buy today, we’ll ship it for free.  Of course, there is a money back guarantee. And, since we want to help as many people as we can feel better, think clear more clearly and be healthier, we’re going to give you a second month’s worth of pills absolutely free.  You’ll pay shipping and handling cost on the second bottle ($59.95).

Do you know what a placebo is?  Do you know what a placebo effect is?  A placebo is a fake treatment that has nothing in it and should have no measurable effect.  Believe it or not, in valid research, the placebo effect ranges from 30-80 %.  That means if I give you a capsule of Segal’s Miracle Shit and tell you it is going to give you mare energy, keep you alert, and make you brighter, 30-80% of the time, it’s going to work!

So, if I sell it to you, add a 300% mark-up and 30% of my customers experience a positive placebo effect, then I can afford to accept a 70% return rate and still make a pretty profit!

The moral of this story is easy.  Be very careful what you put into your body.  Read labels with great caution; and, if there is a disclaimer, don’t buy the product!  The disclaimer is a warning that you may be in dangerous territory.  The life you save mat be your own.

Here’s your joke of the day:

* A psychologist is a person who tells you what everybody knows in a language nobody can understand.
* The superego is that part of the personality soluble in alcohol, or the superego is that small inner voice that warns us that someone may be looking.
* A neurotic is a person who has discovered the secret of perpetual emotion.
* A Freudian Slip is when you say one thing and mean your mother.
* A hypochondriac is a person who wants to have his ache and treat it too.
* A kleptomaniac is a person who helps himself because he can’t help himself.
* Consciousness is that annoying time between periods of sleep.
* A sadist is a person who does kind things to a masochist.
* The Freudian Virus causes your PC to become obsessed with its own motherboard.
* Guilt feelings are the attempt to express the good intentions you never really had.
* Lysdexia is a peech imspediment we live to learn with.
* A lottery is a tax on people who don’t know statistics.

LIFE SUCKS?

“Life sucks!”  I can’t tell you how many times a week I hear that expression.  I hear it from both young and old.  I hear it from the rich and the poor, the employed and the unemployed.  “Life sucks!”  And yes, I say it from time to time.

How can life suck?  Life, itself, is a gift.  Life carries with it limitless potential.  Every day you are alive is a day in which you may find success, happiness, love and wealth.  Happiness is a choice!  You can choose to concentrate on the good things in your life or ignore all that you have and concentrate on what you don’t have.

There are multiple articles on this blog aimed at helping you find health and happiness.  “Blessings List” is still my favorite.  Do you have a Blessings List?  You should.  You should accept every day as a gift from G-d and be thankful for what you have even if the only thing you have is life itself.  If all you have is your life, you are rich with potential!

What sucks is going to the wake of a young adult.  What sucks is mourning for the recently departed.  Life doesn’t suck but some days do.

PRAYING HANDS

Published in 2011, this article holds just as true today.

In order to understand this article, I need you to do the following:  put your hands together, fingers extended as if you were in prayer.  Next, interlace your fingers, making one large, clenched fist.  Now imagine that your fingers represent different parts of your life or problems that you are having.

Life is complex and the problems my patients come in with are rarely simple.  On a daily basis, I see patients with the metaphoric clenched fist I described above.  My job is to find the key that will open the clenched fist and relax the fingers into a peaceful, happy set of praying hands.

On July 25th, 2011 I wrote about Mrs. “X”, a patient with diabetes, hypertension, kidney problems, and arthritis.  Mrs. “X” is also depressed; wouldn’t you be?  Imagine that each of her problems is represented by a finger on her hand.  The other fingers represent other parts of her life; her relationship with her family, her friends, her finances, the excessively hot weather and her aging eyesight and hearing.  Mrs. “X” is miserable and can’t tell me why.  She is confused about which of her many problems she should address first.  She is frustrated!  Every time she fixes one thing, something else breaks.  Her fingers are interlaced and clenched into a painful death grip of a fist!

Now, interlace your fingers and tighten the grip for as long as you can, until it hurts.  When you open your hands and pull them apart, note that your fingers are tight and sore.  The tighter and longer you keep your fingers locked together, the harder it is to pull them apart.

Mrs. “X” has allowed her multitude of intertwined problems to lock together for so long that she can no longer separate one from the other on her own.  My job is to pry her fingers apart, one by one until each has been addressed and healed.  The process is time consuming and frustrating.  As her doc, I think I know what the primary issue(s) is, but I may be wrong.  I am searching for the key that will more readily unlock her hands and place them in a relaxed, healthy, praying stance.

I start with her index finger, depression.  I have written about depression before.  Depression is a normal state of life but can be severe, affecting everything else in an adverse manner.  Healing depression is often a potent key that allows one to more readily heal everything else.  Mrs. “X” fights the idea of depression; it is a stigma no one wants.  I explain that she can either admit to depression, as a sane person would in her circumstance, or be insane.  I pry her finger open.  I pray that by doing so, I can unlock the rest of her fingers.

Today, I work with her arthritic pain, prying a second finger open.  I work on opening a third, allaying her fears of the theoretical worry about NSAIDS.  Eventually, finger by finger, I will help Mrs. “X” open her hands and live with the burden of age.  I help her recognize her blessings.

Oh yes, I work on one more finger today.  I talk to her about “An Attitude of Gratitude.”  Now, I’ll place my hands in a praying position and say a prayer that I get this right the first time.

PS – If this article sounds like you, it would not surprise me.  Mrs. “X” represents thousands of people I have seen over the last 28 years.  I have interlaced my fingers into a fist, assigned a multitude of attributes to each finger, and then unfolded my fingers into praying hands every week, painting a picture of the healing process for those in need.  I hope to do so for another 28 years!

Here’s your joke for the day:

A young newlywed couple wanted to join a church. The pastor told them, “We have special requirements for new parishioners. You must abstain from having sex for two weeks.” The couple agreed and came back at the end of two weeks. The pastor asked them, “Well, were you able to get through the two weeks without being intimate?” “Pastor, I’m afraid we were not able to go without sex for the two weeks,” the young man replied. “What happened?” inquired the pastor. “My wife was reaching for a can of corn on the top shelf and dropped it. When she bent over to pick it up, I was overcome with lust and took advantage of her right there.” “You understand, of course, that this means you will not be welcome in our church,” stated the pastor. “That’s okay,” said the young man. “We’re not welcome at the grocery store any more either.

EXPECTATION

This article is just as pertinent today as it was when I published it in 2011.  My hand is getting better and I will begin writing new articles soon.

I just read an article about expectations in medicine.  Expectations can make or break a relationship.  They can be the source of great excitement and joy or of great disappointment and sadness.  Expectations, in medicine need to be clearly defined and, when possible, successfully met.

Several years ago, I did a full physical on a new patient.  Patient “X” had been referred to me by a mutual friend and I did my usual, thorough job.  I was dismayed when my friend called me to report how disappointed patient “X” had been!

I called patient “X” to discuss the results of his exam and why he felt I did a “crappy” job.  Mr. “X” started with, “Doc, I like you but you did not do/order a stress test, Carotid Doppler, lung function test, PSA or colonoscopy.  I went to Dr. “Y” and he ordered them for me!”  To Mr. “X’s” surprise, I asked him why he thought he needed those tests.  Mr. “X” responded, “My partners’ docs ordered those tests.”

In retrospect, the problem was obvious.  Mr. “X” had expectations I did not meet.  I had expectations, as well.  My expectation was that Mr. “X” wanted a thorough, customized physical.  “Mr. “X”, I’m sorry you were unhappy.  Let me venture a guess:  your partners are all in their mid sixties.”  His answer was “yes”.  “Mr. “X”, had you been in your sixties, I would have ordered those tests and perhaps more.  You are 41 years old and, with your personal and family history, as well as excellent physical condition, I did not feel you warranted any of those tests.”

Mr. “X” cancelled all of his tests and sees me yearly for his exam.  I learned a valuable lesson.  My patients’ expectations may not match mine.  Setting realistic expectations are an important part of any doctor-patient relationship.  Patients must recognize that doctors have expectations and doctors must realize that patients have their own, distinct expectations.

Expectations can range from fantasy to reality.  In the medical arena, it is crucial that expectations be founded in reality.  As your doc, I expect you to follow my instructions.  I expect that, if you are going to vary from my instructions, you will let me know.  These are realistic expectations.  

An example of false or unrealistic expectations would be if you were 75 pounds overweight, drank a bottle of wine and six cocktails, and smoked two packs a day; and I expected you to lose your excess weight while giving up smoking and alcohol simultaneously within 6 months.  (I would give the above patient at least 6 1/2 months). 

Sometimes I set unrealistic expectations for myself and my patients.  When the stakes are high enough, you do what you have to do in order to survive.  Unrealistic expectations can be met when truly necessary!

Patients often set unrealistic expectations.  The most common example of an unrealistic expectation is when the patient, mentioned above, expects his doc to cure his cough, repair his damaged liver, and save him from the heart attack he is about to have.  Doctors don’t heal patients, they help patients heal themselves.  Expecting your doc to save you from a sinking ship while you are punching holes in the hull is another example of false expectations.

So what can you do?  Discuss your expectations with your doc.  Let him/her know exactly what you want; what you are thinking.  Be sure of what your doc expects of you.  Expect that your doc will work at meeting your expectations.  If he/she falls short, discuss it with him.  Work at meeting your doc’s expectation.  Expect that your doc will confront your shortcomings, as well.  Most of all, be honest with yourself and your doctor.

P.S. – I believe in miracles.  I have been blessed to see many miracles in the last 28 years of practice.  It is ok to have false or “fantasy” expectations, as long as you know that the only way they will come true is to receive a miracle.  It is not OK to sell yourself on false hope as the vast majority of time it will end in disaster.  

Here’s your joke for the day:

A man walks into bar with a dog and orders 2 Glasses of Whiskey.

He & his dog empty the Glasses.

The girl behind the bar is surprised and asks – Can your Dog perform any other tricks?

Man-Yes, He can fully satisfy a Woman.

The girl is too curious.. Deciding that she’ll test the dog, she undresses and lies in down spread eagle.

Dog looks at her and does nothing….

Man to Dog: It’s always the same with you, now this is the last time I am showing you how to do it!