LIVE THE WELLTHY LIFE

I have a new secret weapon in my war against obesity.  When I was a child growing up in Norfolk, Va., one of my favorite things to do was to go to City Park.  City Park was our local zoo and there were two attractions which I loved.

The first attraction was the monkey cages.  There was an old chimp who loved to spit at people.  At times, the chimp would resort to other, more grotesque behaviors, including throwing his poop or even masturbating (I’ll leave the rest to your imagination).  As a child, his outrageous behavior was funny, especially if you were with an out-of-towner who didn’t know he/she would need to duck.  As an adult dealing with HMOs, I often thought of that chimp and I had a lot in common (locked in a cage and put on display) and how much fun it would be to throw stuff at the insurers of America.

But this article is not about spitting on the insurance companies.  It’s about the second reason I loved going to City Park.  My dad would take me to the concession stand (an old log cabin) and buy me a root beer snow cone.  On a hot summer day, there was nothing better than a root beer snow cone.  Fast forward to three weeks ago.  I had failed multiple times in my quest to improve my diet.  I had just discovered The Snow Cone Cabin and fell in love with it.  It made me feel like a child again.  It was also too crowded and many of its patrons ignored the Covid rules to such a degree that I was uncomfortable being there.

So, I came home and surfed the net.  I found exactly what I was looking for.  My Zeny snowball machine is fantastic!  Now, any time I want a snack, I make a snowball. Unfortunately, I have not found a diet root beer syrup yet, but diet cherry or grape suffices. Filling, refreshing and zero calories, my secret weapon is my new best friend.  Stop by and enjoy one with me anytime!

Now, all I need to do is find that chimp!  There are some insurers I’d love to introduce him to.

Here’s your music and a joke.

When I was five, my dad put Snowball into the blender to make a slushie.

I miss Snowball.  She was a good cat

Doctors are problem solvers.  After 10,000 hours of training, they still need to consult journals, textbooks and specialists in order to develop the best solution to their patient’s problem.  During the first 8 years of practice, I had a library in my office.  The computer world changed everything.  Books gave way to computer searches.  The most up-to-date research became available at the click of a mouse.  Consultants, carrying pagers at first, then cell phones, became available 24 hours a day.

Despite all of the above advances, the most precious resource a physician has are his own patients.  I called it my “Gold List.”  In a large practice such as mine, there were leaders.  As a group, these individuals wielded immense power and knowledge.  They had access to an unbelievable list of resources and the ability to use them.  Yet, my profession looked down on tapping this resource.  As many of you know, I did whatever I needed to care for my patients including, if necessary, tapping into the resources that my “Gold List” could muster.

I learned, early on, the cost of inappropriately using the “Gold List.” We were closing on the house in Long Grove and had a 24-hour window where we had to finish the sale of our Buffalo Grove house and close on our Long Grove house.  We were strapped for money and didn’t think we could get an interim loan if everything did not go smoothly.

The builder called the day before closing and informed us that we would not be able to close as a vital transformer had not showed up and we did not have electricity.  I freaked!  I went to the office and search my patient files for someone who had the resources necessary to fix the problem.  I found the name I was looking for and the next morning we had power.  We closed on time.  What a relief!  Disaster avoided!

Two weeks later I walked into room 3.  The patient was a young woman who was distraught, crying and needed something to sleep.  It seems that the generator that the generator that was to provide power to her house disappeared.  Her closing was delayed.

God had sent her to my office to teach me a lesson.  Naturally, I didn’t charge her.  I didn’t sleep for weeks.  I had learned my lesson. From that time on, I was very careful about how I used the “Gold List.”  I will forever be indebted to the people on that list.  When charity was needed, they were always there.  When a talented patient I delivered needed a leg up in the business world, an interview was available.  When new medical technology became available, the president of the company that pioneered the technology brought it to Lake Zurich and made it available to the rest of my patients.

One story that always makes me smile has to do with Motorola.  At one time, close to 30% of my patients had ties to Motorola. Being a boy at heart, I love electronic toys and my Motorola patients often used me as a test subject.

I was in an elevator in Las Vegas.  A bunch of suits excitedly got on the elevator.  It soon became apparent that they worked for an electronics firm.  They were excited because they were about to see the newest innovation in cell phones.  It was a major breakthrough in cellular technology.  I felt like such a bigshot.  I wanted to tell them that I had one in my pocket.  I had used it for 6 months and it was even better than they thought it was.  I had signed a non-disclosure agreement, so I just stood there and smiled.

Life was awfully good then.  The point of my story is that a doctor has lots of resources available to help his patients thrive.  One of those resources is his own patients.  Like the strongest of my medicine, I had to learn when it was appropriate to utilize a patient’s skills and when it was not.

Currently, the power of my Gold List is being turned on me.  Everyone of my patients was worth their weight in gold and now they call me to cheer me up, to comment on this blog and to offer their love and care.  Thanks for an awfully good ride. I miss you and wish I could open an office at 504 South Rand Road.  I would love to be there for you again and I appreciate your being there for me now.  

PS – Thanks Jim for being a great landlord.  You were an unseen member of my practice and supported me through lean times.

Here’s your song and a joke.

Three vampire brothers decide to hold a competition to see which one of them is the most powerful. The first brother is the strongest.

“Watch this,” he says, and takes off at nearly 100 miles per hour. Two minutes later, he returns, his mouth covered in blood.

“What happened?!” his brothers exclaimed.

“You see that mansion over there?”

“Yeah?”

“Well, I went over there and sucked each and every last family member dry. They are all dead.”

“Wow!” his brothers say. “As expected, for you are the strongest.”

The second brother to go is the oldest.

“Watch and learn, boys,” he says, and takes off even quicker, at 150 miles per hour.

Five minutes later, he returns, both his mouth and his neck covered in blood.

“What happened?!” His brothers exclaimed.

“You see that village over there?”

“Yeah?” They said.

“Well I went over there and killed every last person in the entire village. There is not one left alive.”

“Wow!” his brothers say in awe. “As expected, for you are the oldest and have the most experience.”

The third brother is the fastest. Not to be outdone, he says “Watch this, and don’t blink or you might miss it.”

He flies off, faster than the rest of them, going at *least* 200mph.

In only ten seconds, he returns. His entire mouth, nose, and neck are covered in so much blood, it stains the front of his shirt.

“What happened?!” his brothers exclaimed.

“You see that giant tree over there?”

“…Yeah?”

“Well I sure fuckin’ didn’t.”

Did you ever kick yourself for having an idea and not following through on that idea?  I just kicked myself.  I just saw a commercial for Reputation Defender.com. I created Reputation Defender.com years ago.  As the internet grew, it became apparent that your reputation could be destroyed, in seconds, by an angry individual.

If you go to any of the physician ranking sites, you’ll find physicians who have 5 stars out of five.  On the surface, five stars is impressive.  The only problem with an all five-star rating is that, when you see 40-50 people a day, you are bound to come across someone who doesn’t like you or your staff.  Patients who like their docs rarely go to the internet to rate their docs.  Patients with a grudge can’t wait to get home and post an unflattering review.

Several years ago, I met a truly pompous A-whole who wrote an outrageous review of my ability as a physician.  The one thing he failed to comment on was the fact that he had never been a patient in my office.  He had come in with a friend, several textbooks, a stack of articles (none from a legitimate medical journal) and a chip on his shoulders.  He lectured me on his diagnosis of his friend’s condition, and he was prepared to spend the rest of the day trying to sell me on a non-existent parasitic disease. After trying to address each of the friend’s suggested diagnoses, it became clear that the friend wanted Dd. Google’s answers. At that point, I had no choice but to ask my patient’s friend to wait in the lobby.

He was upset when I asked him to wait for his friend in the lobby and gave his friend an ultimatum; either he leaves with him or he was on his own.  Unfortunately, my patient left with his friend and I never heard from my patient again.  I certainly heard from his friend in an internet review.

In olden times, there were no reputation builders that you could hire.  Luckily, when I need help, I could always go The Spring.  The Spring is the source of love and kindness and always knows how to fix anything that is broken or just plain messed up.  Anyway, The Spring reached out to many of my patients and they responded by posting lots of five-star reviews. Within a couple of days, the A-hole’s review disappeared and my rating went to 4.9.

That’s when I came up with the idea to start a reputation repair service.  Over my lifetime, I came up with lots of viable business ideas.  The problem was that I was always too busy being a doc to work on anything other than patient care.  My plan was to provide doctors’ offices with patient surveys and then post the positive remarks on the physician ranking sites.  My staff would monitor the online reputations of the docs that hired us.  I wish I had acted then.  I would have something to do now!  There I go again lapsing into the “woulda, coulda, shoulda.”

The take home point today is that, if you like your doc, go online and give him/her five stars.  Your doc will benefit from positive reviews.  If you can’t give him/her a five, drop them a note and let them know why.

As for me, I still go to The Spring when I need a wise and caring opinion or help finishing a task.  I’m lucky to have found The Spring.

Here’s your music and a few one liners.

The road to success is always under construction.

If at first you don’t succeed, we have a lot in common.

Being a hypochondriac is going to save my life one of these days

It’s the start of a new day and it’s already much better than yesterday.  For the most part, my body is functional today.  Renee and I had a nice ride on our tandem bike this am.  I’ve decided to go back on Weight Watchers so I’m doing some diet planning.

I tried my introductory shipment from Daily Harvest and loved every smoothie and oat bowl.  Unfortunately, it’s expensive and I can’t figure out how to calculate WW points as there are lot of ingredients in each product.  There are a few listed on the WW site but their point counts are unbelievably high, representing a quarter of my daily allotment of points.

I don’t understand why food has to be packed with calories.  Food should be like sex.  There is no such thing as too much!  You should burn calories by eating and digesting food.  The act of consuming an Italian Sub from Publix should be pure pleasure and amount to minus 1500 calories.  If I was designing the relationship between mankind and food, you would have to eat 4,000 calories a day just to maintain your weight.  Essential food groups would be sweets, fats and sausage.  In addition to the standard salt and pepper shaker, there would be a bacon shaker.  Bacon goes with everything.

Unfortunately, I’m not in control.  Eating sweets, fats and sausage with a sprinkle of bacon cause weight gain and illness.  Thinking about living without my essential group of three is depressing.  There are two types of people with depression.  Type one medicates themselves with food.  They gain weight, and, as they gain weight, they get more depressed.  The more depressed they are, the more they eat.  I’m a group one member.

Group two lose their appetite when they get depressed.  They also lose weight.  I’d love to be a group two member but, having never lost my appetite, doubt that I will ever be allowed to join group two.  

Weight Watchers allows me the luxury of eating anything my heart desires.  It allows me to eat my usual food groups, while limiting quantity. Quantity is another problem I deal with on a daily basis.  In Segal Motto is “Go Big or Go Home!”  On WW’s “Green Plan” I get all the fruit I want.  Fruit is considered to be a free food (NO POINTS.)  Last night, I ate ½ of a large watermelon.  I don’t think I was supposed to eat ½ of a watermelon.

The more I write about food, the more I realize that I’m not committed to dieting at this time in my life.  I’m having an affair with food and enjoying it.  I will continue on WW as I work on stabilizing my weight and imposing some limits on quantity.

Diets are unnatural acts.  When I come to my senses, I’ll design a new Wellthy Plan and get healthier.  Until then, I’ll increase my exercise, enjoy eating and use WW to help deal with quantity issues.

Here’s your music and joke for the day.

Ate salad for dinner! Mostly croutons and tomatoes. Really just one big, round crouton covered with tomato sauce. And cheese. Fine, it was pizza. I ate a pizza.

With all my knowledge about medicine and Parkinson’s. I’m still amazed at how one minute I can be fairly normal and the next, completely abnormal.  Today is my worst day yet.  Not only am I miserable, but it started that way at 4:15 a.m. and is just now improving (2:00 p.m.).

So, what’s miserable?  Miserable is when every muscle in my body is stiff and my legs don’t want to walk.  I stutter step and feel like I’m going to fall. Usually, within 20 minutes of taking my pills, I’m better.  Today was as if I hadn’t taken my medication.

As a doc, I know how easy it is to make medication errors.  To guard against taking too many or too few pills, one day a month I set up my pill dispensers.  They have 4 slots for pills; morning, noon, midafternoon and night.   Each day I take out a full day’s worth of pills and if there are pills in a given slot, then I haven’t taken them. If the slot is empty, I took them.

As you age, it’s critical that you develop a means of monitoring your use of medications.  I set a recurring alarm on my phone and watch to remind me it’s time to take my medication.  Renee carries a back-up set of pills wherever we go just in case my CRS is active. Yep, I feel older than Methuselah.

Are you old enough to be on multiple medications?  If so, do you have a system set up to protect you from overdosing or of underdosing?  If not, please set one up.  Amazon has a large variety of pill dispensers.  Find one that fits your needs.  If your memory sucks, have a family member take over the task of loading your pill dispenser on a monthly basis.  If you are computer savy, set up a recurring alarm on your phone or watch.  If not, have your grandchildren program your devices.

When you pick up your medication at the pharmacy, make sure the directions on the bottle are the same as the directions given to you by your doctor.  Any discrepancies should be handled immediately. It’s important that you learn the names and doses of your medication. “Doc, I’m taking 2 white footballs, 3 yellow round pills and a beige triangular pill,” just doesn’t cut it.  There are lots of white football shaped pills and yellow round pills.  If you can, take a picture of each pill bottle and store it on your phone.

Unfortunately, medication errors are a persistent problem in our country, many leading to death or disability.  Being an active member of your medical team is essential.  Mistakes can occur in the doctor’s office, the pharmacy or in your own home.   It’s your responsibility to find them and have them corrected.  You are the end user.  You are the one who actually swallows the pill so if you think something is not right, don’t swallow the pill.  Talk to your doc and the pharmacist as soon as you’ve identified a problem.

Epocrates is an app that I’ve used for years.  It tells me everything about the medication I’m taking, including a physical description of the pill and the number embossed on the pill.  I believe the basic version of Epocrates is still free.  You will also need to download GoodRX.  GoodRX will give oney saving coupons to use in buying your medications.  The program is especially helpful when you are in the donut hole.

Lastly, on a yearly basis, it’s wise to verify that you still need your medications. As a resident, I used to be blown away by the number of unneeded medications the older docs had their patients on.  It seemed like once a medication was prescribed, its need was never reassessed.  I swore I would never do that to my patients.  Then I got older and found I was falling into the same trap my predecessors fell for.  Once started, there is a tremendous clinical inertia pulling on the patient and the doc.

“Doc, I feel good.  I’m afraid to stop ABC medication.  I don’t want to relapse and I’m so busy at work that, if I relapsed, it would be a catastrophe.  When things settle down, we can try stopping ABC.”

Invariably, the doc goes along with the patient’s request.  Things never settle down at work and the medication is never stopped. And that, my friends, is how you end up on 12 medications a day.

Here’s your song for the day and a joke.

An old woman walked into a dentist’s office, took off all her clothes, and spread her legs. The dentist said, “I think you have the wrong room.” “You put in my husband’s teeth last week,” she replied. “Now you have to remove them.”

It’s another day in the 90s and, without a pool to swim in, I don’t want to go out.  It looks like my community’s pool is going to open in 2 weeks.  I have no idea when it will close.  They are working on the vegetable garden now and I probably won’t plant anything until next year.

Renee and I met one of the neighbors last night.  She seemed nice and we talked about having a driveway cocktail party with all of the other new neighbors.  Looks like we’ll sit in our driveways and yell across the street.  Whoopy!

I have writer’s block; I’ve not gotten very far with my book ideas.  I’ve also not found a job I can do from my home office yet.  I had my telemed visit with Dr Bianchi last week and it was better than expected.  Of course, knowing him for 20 some years helped.  Other than being grossly obese and having extreme fatigue, I passed with flying colors.

I’ve finished everything good on the 3,000 (maybe I’ve exaggerated a little) channels I have access to and now I’m doing comedy on You Tube.  There are some interesting pod casts on You Tube in addition to the comedy.  Maybe I should do stand-up comedy.  In my case, I’d have to call it Lean-on comedy, as, I can’t stand long periods of time without leaning on something.  Shopping carts are great for bad backs.

I’m sick of Covid-19.  I want to go to Nueva Vallarta and spend 2-3 weeks on the beach. They actually have as many problems as we do.  I want to go to Hilton Head and lounge on the beach or at the pool but I’d have to worry about exposure there as well.

I’d like to fly back to Chicago and see my friends, go to fine restaurants and do a little boating on the Chain of Lakes, but again, it’s too risky. The longer this virus stays active, the longer my list of things I want to do gets.  Also, the closer I get to going insane.

Actually, going insane doesn’t sound so bad right now.  It feels like I’m living in LaLa Land. Baby sitting on Monday and Tuesday helps some.  Smiles and kisses from Mackenzie are better than drugs.  Hudson is a crier but still a lovable.  Luckily, I’m half deaf and can nap right through one of his fits.

We close on the Illonois house August 31.  My friend Barb ran a 3 day yard sale which flopped.  No one came.  What a pity!  I left some really great stuff to sell but Covid kept everyone home.  A local church group is going to take everything and give it to the needy.

If I had listened to my mother, I would have been able to keep both the Illinois house and the Carolina home.  I can still hear her. “Stewart, you spend too much on the kids.  You need to save more for retirement.”  

I love summers in Long Grove!  I’m not going to get into the “shoulda, coulda, woulda” conversation.  I enjoyed spending money and still do.  My three great loves are sex, food, and spending money.  At 69, eating is the easiest of the three.  I have sex almost every day of the week!  Almost on Monday, almost on Tuesday, almost Wednesday, etc.  Spending money out of my retirement fund is not wise.  That leaves eating.  I’m still a world class cook and eater.  Lucky for me, North Carolina’s restaurant scene is not nearly as good as Chicago. 

So, when I can’t think of anything to write about, I turn inwards and start looking at myself.  I’ve been overly indulgent with food and it’s not healthy.  I seem to find enough will power for 2-3 days of healthy eating, then relapse.  As Bruce taught me, if you fall down six times, get up seven.  So, I’ll get up again and again until I get it right.

Time to go for a walk.  It’s been too hot to ride the bike.  I’m looking forward to fall and cooler temperatures.  In 10 years, I’ll probably write about missing snow.  NOT!

Here’s your music and another joke.

Little Timmy was sitting on the front porch with his grandpa when he saw the man take a sip of whisky.

Little Timmy looked up at him and said “Hey, PopPop?”

The grandpa looked down at him and asked “What’s on your mind, boy?”

“May I please have a sip of that whisky”? He pleaded. 

Thoughtfully, the aged man stroked his beard and asked “Well, can your dick touch your butthole”?

Unsure of his point, Timmy said, “No?”

The grandpa laughingly chortled, “Then you’ll have to wait when you’re older”!

Little Timmy was upset as he saw his grandpa light up a cigar. Little Timmy asked with a hopeful voice “Hey, PopPop? May I please have a suck on that cigar”? 

Amused by his persistence, he repeated “Well, can your dick touch your butthole”?

Upset, Timmy just sighed as he looked at the floor. Smiling still, the old man said, “you’re going to have to wait until you’re older, Tim”.

Little Timmy moped his way inside the house where his grandma saw him in such a dreary state. Thinking to herself that she knew exactly how to cheer him up, she started making his favorite chocolate chip cookies.

Waking up from his nap outside at the smell of cookies, the weary man stood up out of his rocking chair and followed the smell inside where he laid eyes upon his grandson eating cookies to his heart’s content. Strolling over to the boy, he quietly mused “Gee, Timmy. Those are some awfully good smelling cookies. Mind if I have one”?

Pondering this for a couple of seconds, Little Timmy finally asked “Well… Can your dick touch your Butthole”?

Smiling, the grandpa slowly said “Why, yes it can. “

“THEN YOU CAN GO FUCK YOURSELF! GRANDMA GAVE THESE TO ME”!

My cousin, Steven, sent me a picture the other day.  Steven is building his family tree so naturally, there is a spot for me.  The picture is from 1932 depicting a large gathering of old people sitting at a table (apparently a birthday party).  Naturally the picture was of interest to Steve and the rest of the Segal clan because my grandparents were in the picture.

What makes this picture truly amazing is that Renee’s grandparents were at the same table. In all the books I read, the detective always says, “I don’t believe in coincidences.” So, were Renee and I destined to be together or was she just plain unlucky?  Relax, that’s a joke.   I’m OK, it’s a good morning.

But really, how freaky is it that Renee and my ancestors partied together in 1932?  I believe she is my soul mate and our getting together was predestined.  So, if our being together was fate, then is the rest of life prewritten and we can do whatever we want without fear of changing the future?  If so, time to attack the refrigerator.  Pimento cheese sandwiches are to die for/from!

Let me change topics for a minute. STURGIS!  I am blown away by the thousands of bikers in Sturges.  They must believe that life is a prewritten play that they are just acting out.  Their acting out by not wearing appropriate facemasks and keeping social distancing may well create a major spike in illness and death across the country.

I don’t believe in coincidences.  Where there is a major gathering of people, there is a spike in Covid cases.  When people put on masks and practice social distancing, the number of cases decreases. In all the pictures I’ve seen, few people in Sturges are wearing masks and certainly there is no distancing.  We should all probably say a prayer for Sturges.

Here’s your music for today and a joke.

Why should you never fight Destiny? 

Because then you will have to fight the bouncers, and every other stripper in the club.

Sometimes I’m an idiot.  It’s well known that I think many of us hold on to life too long.  We push our doctors to do everything possible to give us more time even when any quality life is long gone.  I’ve also written about being truthful when others ask you how you feel.  Like everything else, there are exceptions to the rules and sometimes it’s just better to say, “I’m fine.”

The other day I was talking to a former patient and longtime friend who was born with Cerebral Palsy. He asked how I was doing, and I told him the truth.  I’m doing crappy.  There are times of the day when my ability to walk is compromised badly enough to use a walker.  I also complained that the day was coming when I would be wheelchair dependent, seriously affecting my quality of life.  

Sometimes I’M AN IDIOT!  It dawned on me that my friend had lived with his disability for his entire life.  He’s made the most of his life, his career, his marriage and life after his wife passed.  He rarely complains.  On the other hand, I complain too much, partly because I believe in being honest and partly due to fear of future worsening.

Then there is my brother who is making the most out of his post-stroke disability by going to PT on a regular basis, working on regaining his strength and making others smile by cracking jokes whenever possible.  When I ask him what his day was like, he’ll often respond that he went sky diving, did some water skiing and had a marvelous time.  Sometimes he’ll call me using an Australian accent and give me The Outback Weather Report.  I admire how well he handles things and appreciate when he makes me smile.  The idea of publishing a joke a day indirectly came from Alan.

So, the big question is should I tell the truth when asked how I feel. Or should I say fine, tell a joke and leave my friends and family in blissful ignorance.  I truly don’t know the right answer but suspect that the right answer is different for different people.  In the meantime, don’t ask me how it’s going unless you want the truth. 

One last thing.  When my father’s Parkinson’s was deteriorating, I lived hundreds of miles away.  When I asked about his condition, my mother almost always said fine.  The only times she let on as to how he was really doing was when he fell.  Living in a fantasy world was good for me up until shortly before the end.  Seeing how bad he had gotten was a real shock.  Knowing that my mother had been sole caregiver as all of her children had moved away left me with a large of amount of guilt to contend with.

It also left me dreading the future.  I am not my father (although many would debate that).  When I start to drown in regrets, I remember my father telling me he had no regrets, that his life was good and that his job was to launch us (the children) and watch us thrive.  Well, all my children have been launched, I’ve had an exceptional life, and I’ll make the most out of what’s left.

Have you heard the one about the twin brothers?

Two identical twin brothers, George and Ted, turned 100. George’s hearing was just as good as ever, but Ted was slightly deaf.

An attractive female photographer came to the retirement home to take the brothers’ picture. “I’m going to take your picture,” she said.

“What did she say?” asked Ted. “She says she’s going to take our picture,” replied George. So George and Ted followed the photographer to a room.

Inside the room were two chairs. “Now sit down in these chairs,” she said.

“What did she say?” asked Ted. “She says we should sit down in these chairs,” replied George. So George and Ted sat down in the chairs.

The photographer pulled out her camera and pointed it at the birthday brothers. “Now let me focus,” she said.

“What did she say?” asked Ted. “She says she’s going to focus,” replied George.

“Wow!” exclaimed Ted. “Both of us at the same time?”

Humor is good medicine. I always tried to inject a little humor into every visit. Making patients smile or laugh, even for a moment, made them feel better.  Sometimes, I flopped.  Everybody has a different sense of humor.  On an occasion, the patient, having been lifted by laughter, responded with a joke of their own. 

When patients relaxed and started telling their own jokes, I would get a glimpse of who they really were.  Assessing a patient’s sense of humor quickly showed me a side of their personality that the standard review of personal history and their health inventory would have never revealed.  Sometimes sharing jokes created a bond/rapport with my patient.

Sometimes, I discovered a side I was uncomfortable with.  Either way, joke telling is revealing.  Towards the end of my practice, I used joke telling as a diagnostic tool and, on occasion, as a teaching tool.

As a child, one of my favorite jokes was the following:

The president of Mexico and the United States were at a conference in New York.  While on a break, they went to the bathroom, standing at the urinal (I’m sure Donn was in the urinal).  The president of the US finished urinating first and as he was walking out, the president of Mexico said, “Mr. President, in Mexico, they teach us to wash our hands after going to the bathroom.”  The US President responded, “Mr. President, in the US, they teach us not to pee on our hands.”

At the time, I thought it was hysterical.  I ignored the fact that it presented a degrading view of Mexicans.  Later in life, I went to medical school in Mexico.  In addition to finding out that Mexicans were an intelligent, loving, family-oriented people, they gave me the gift of a medical degree. 

Mexico taught me humility.  Mexicans showed the faulty base on which many of my prejudices were built on.  Forgive me if I’ve told this story before (I have CRS, “can’t remember shit”) but it’s important to tell here.  I was driving into Guadalajara, returning to school after summer break ended when my car broke down.  I was in the middle of nowhere.  The Green Machine, their roadside assistance truck, eventually found a water pump and installed it.  When it was time to put water in my car, they dished it out of a rusted oil barrel. I turned to my passenger and stated, “I don’t want that shit in my car” at the same time a kid walked over to the barrel, scooped up a cup of the brown liquid and drank it.  This family was sharing their drinking water with me.  These were not criminals and rapists.  These were the kind of people you would want for neighbors or family.

What I used to consider funny now is often not funny.  Yes, I still tell jokes at the excuse of ethnic groups or gender, but I tend to tell jokes about my own ethnicity.  As to gender, women know how much I appreciate them, so they are fair game.  I do wonder if our president washes his hands when he leaves the men’s room.  After all, he won’t wear a mask.

EVEN IF YOU DIDN’T PEE ON YOUR HANDS, WASH THEM!  MASKS ALONE ARE NOT GOOD ENOUGH. And, identify and eradicate your own prejudices.  Don’t let a journalists color your vision with their ability to slant the news.

Here’s your daily music and a joke. 

Three old Jewish guys were sitting around the breakfast table talking about their sexual prowess.  The first guy brags that, in the middle of sex, he uses a feather that causes his wife to moan and groan loudly ending in an incredible orgasm.  The second guy says he’s sure his wife moans and groans more than the first guy’s wife.  He says he uses Japanese wonder balls to bring his wife to a screaming climax.  The third guy says, if you think your wife moans, groans and screams more than mine, you are wrong!  He says he’s done 1-2-3, then gets up and wipes himself off on the curtains.  “You should hear her scream!”

I started out intending to write a fairly negative article about telemedicine and then got hijacked by the TV show that was playing in the background.  First and foremost, I think face to face encounters are necessary at least 80% of the time in the medical field.  There are multitude of reasons why an in person medical encounter is essential and the number one reason is developing that “caring” relationship I discussed many times in the past.

Second on my list is obtaining an adequate physical exam.  While telemedicine is in its early stages, home diagnostic equipment already can provide the phone doc with BP, pulse rate, temp, weight; and my bet is that, in the not too distant future, a telemed doc will be able to see inside your throat, ears, nose and listen to your chest and abdomen.  Of course, a Facetime rectal (I’ve got to come up with some other term) is going to be a little more uncomfortable; and a pap, well, I’ll leave that to your imagination. Treatments will be defined by protocol.

In the future world of telemedicine using the home diagnostic equipment described above, will you really need a doctor, or will a computer program suffice?  When I think about it, and I do, a computer could do just about everything I did with the exception of caring for you, as an individual.

It’s my core belief that the true art of medicine is in the ability to develop multiple, caring/trusting, relationships. 

Now back to that TV show playing in the background.  I must confess, I’m a Judge Judy junkie.  There’s just something about watching an authority figure put aside political correctness and call an idiot “an idiot and a stupid one to boot.” I love the fact that she doesn’t take shit from anyone and her judgements are final.  She’s also quite humorous!  You rock, Judge Judy!

So, what’s Judge Judy got to do with telemedicine?  Well, the case she was hearing pertained to a internet scam based on developing a trusting/ caring internet relationship.  As I watched this woman make a complete fool of herself, I thought about a patient who sent hundreds of thousands of dollars to a Nigerian address because of a similar scam.  Researching this scam made it apparent that caring/trusting relationships can be made over the internet and maybe, just maybe, telemedicine can replace the conventional doctor patient relationship I hold so dear.

NAH!  That’s bullshit.  Telemedicine may be good for small things and routine follow-ups, but, for the stuff that really counts, in-person care will always be preferable and, in most cases, necessary.

Here’s your music for the day and a joke. The Judge said to the defendant, “I thought I told you I never wanted to see you in here again?” 

“Your Honor,” the criminal said, “that’s what I tried to tell the police but they wouldn’t listen.”