LIVE THE WELLTHY LIFE

Every once in a while, I read something on Facebook that hits home. Are you a glass half full or a glass half empty sort of person. As I age, I see my glass emptying.  Recently, it has felt as if my glass has a gaping hole in it.

Last night I said goodbye to my pinball and Galaga machines.  They had been in my basement for 30 years and have been played by hundreds of kids and adults, including my grandchildren.  While they were full of memories, it was time to part with them as Renee and I prepare to downsize. Today, the estate salespeople are in the house cataloging our belongings.

The Facebook post I referred to at the beginning of this post stated that, if your glass was half empty, you should pour its contents into a smaller glass, leaving you with a full glass.  I’m trying to do just that.  It’s not easy but parting with material goods isn’t really what’s got me down.  Leaving you guys is next to impossible.

Yesterday,Jerry and I reviewed my new house’s electrical schematics in the am, I lunched with Pat, and, on the way to the car, bumped into Alice and got a great big hug.  In the afternoon, Linda called and set up a lunch.  In the mail was an invitation from Lynn and Charlie.  Bill, as always, posted something nice on Facebook.  As I say goodbye to my patients and transition them into the friend column, I realize how much I’m losing, and I cry.

Then I realize how cold it is.  I realize how gray the sky is.  I remember how much I hate Chicago weather.  I feel how bad the cold is on my joints. I think about how much I miss my grandchildren and my family, all living on the East Coast now.   

When life gets you down or is overwhelming and you feel like you are drowning, look for a lifeline. Then grab it and pull yourself out.  I moved to Illinois for an education fully intending to move to the outer banks of North Carolina to set up my practice.  Meeting Jerry, Pat, Linda, Lynn, Alice, Bill and many others kept me in Illinois.  It’s time to complete the circle and settle down in NC.  I’ll take all of you with me on this journey.  I’ll pack you guys up and carry you in my heart.  

And I’ll work on writing more uplifting articles in the future.  I’m downsizing to a smaller, full glass and will be happy.

I first read the term “Cyberchondria” on KevinMD.com.  I immediately fell in love with the term, as it aptly described a phenomenon I see on a regular basis.  Out of every 10 patients who Google about their healthcare, I get one cyberchondriac.  That one cyberchondriac is miserable, locked into a perceived diagnosis that threatens his very existence. 

ON 12/20/10, I wrote an article about a patient who was so worried she had a disease that her stress was making her sicker than if she actually had the disease she was worried about.  “Cyberchondria” can make you sick.  It can make you sicker than if you actually had whatever it was that you were worried about!  “Cyberchondria” is a very expensive illness.  Google will inform you that you should have a large number of laboratory and radiologic procedures and see multiple specialists.  Google will also give you dietary advice and sells you vitamins, herbs and snake oil. 

“Cyberchondria” is one of those symptom complexes that I hate to deal with.  It is worse than fatigue.  It is a lose, lose situation for me and the patient.  Despite my degree and 30 plus years of experience, Google trumps me every time.  I am forced to admit that my patient “could” have XYZ disease, even though XYZ disease has only been reported in the wilderness of South Africa.  I am pressured into running expensive tests to prove my patient doesn’t have XYZ disease, and once I have proven my point, I am confronted with the other possibility Google mentioned, CDF disease. 

I published “Possible vs. Probable” on October 11th, hoping that it would help patients when they search the internet and explore their health.  I should publish a companion article entitled “Could and Would” as well.  When my patient asks me, “Could I have..?”, the answer is always yes, you could; however it is not probable.  So, how do you prevent becoming a cyberchondriac? 

Be careful when you Google anything.  Google brings you lots of really good information thrown in with lots of garbage.  The garbage is cleverly packaged by experts in marketing and looks so good that I have trouble discerning what is real and what is not real.  I had created a resource page at https://lzftc.com/that offered hyperlinks to the websites I use for research.  Feel free to logon and search!  (The site is now defunct but clicking on the link took me back in time and put a smile on my face.  I hope it does the same for you.)   When you search the internet, try to remember that everything is possible.  What you are truly searching for is the probability that you have a given disease.  

Most importantly, try not to anchor yourself to any diagnosis.  “Anchoring” occurs when you grab hold of a diagnosis so tightly that you can’t see the other possibilities.  “Anchoring” is a phenomenon physicians and patients alike should avoid.  It leads to errors.  

Once you have the information you are looking for, see your physician.  Keep an open mind.  Rely on your physician to help you find the truth and then find a solution.  Do not self-treat.  Most of all do not worry yourself sick!   

Knowledge can empower you.  Knowledge can also cripple you.  Use your newfound knowledge well.  The life you save may be your own. 

I wrote this article February 8, 2015; and with a few exceptions, it holds true today. The most evident exception is in the first line.  What’s a bookstore?  Do they still exist?  The world I live in really is changing radically and I’m feeling older by the day.  Both the bookstores I used to frequent are now medical centers.  Go figure!

The second exception is that, in today’s world, many diet gurus are taking a psychologic approach, using phone apps to track your habits and provide positive feedback and rewards for good behavior.  I like this approach!

I’m on the Weight Watcher’s new point plan which does not vilify any particular foods but instead gives you points to spend on food and a long list of “free foods” that, within reason, you can eat at will.  WW blends nicely with my Live Wellthy non-diet plan.  Its phone app is quite useful.

By the way, I’m on WW because I’m in shit shape.  Between the back surgery, back pain and the Parkinsons, I’ve gained 30 pounds and get very little exercise.  One thing is for sure, you don’t want to “Pity Eat,” and gain 30 pounds.  And, for sure, walk, jog and run as much as you can, NOW!  You don’t realize how precious those abilities are until you lose them!

February 2015

I was in the bookstore the other day and was blown away by how many diet books were on the shelves. Each book proclaimed its plan’s ability to help you lose weight and become healthy. Most of the books turned certain food into villains, banning you from eating some essential nutrient and proclaiming that “medical research” has determined that fat/carbohydrates/protein/gluten/ etc. are bad for you.

My patients, looking for rapid weight loss, eliminate whichever essential nutrient has been vilified and, in fact lose weight. Unfortunately, they gain their weight back (plus some) later. I don’t believe that G-d made bad foods. I believe that we take good foods and turn them into villains in our never-ending quest for culinary satisfaction.

As an example of what mankind does with nature, let’s look at a cucumber. Cucumbers are low in calories (15 cal/100 g) and sodium and high in fiber, vitamins C, A, and K. Cucumbers also are a good source of beta-carotene, one of nature’s beneficial antioxidants; and they contain lutein (recommended by ophthalmologists for ocular health). In addition, cucumbers have diuretic properties beneficial for weight loss and in hypertension.

Now, let’s take a healthy cucumber and soak it in brine and spices, add some sugar and turn it into a spicy sweet pickle. While it tastes great, it’s now full of salt and sugar and no longer a healthy vegetable. Let’s go one step further, coating it in flour and frying it the way they do in the south.

I was just in Atlanta and can attest to how great fried pickles, dipped in a mayo based spicy pickle sauce, taste. Fried pickles are addictive! Fried pickles are also lethal. Greasy and rich in salt and sugar certainly fulfills our culinary needs by tantalizing our taste buds. The cucumber, which once served as a diuretic and lowered our blood pressure, when converted to fried pickles, raises our pressure and increases our weight.

Foods are not inherently bad for you! What you do with them is the real problem. Read “Diets and Other Unnatural Acts” (available on Amazon) and refine your own diet.   (It’s not a great book but it’s an easy read and the concepts presented are important to your health.)Learn how to make a healthy cucumber taste great without dowsing it in salt, sugar and grease.

Establishing a new life in North Carolina is both exciting and scary.  The scariest thing on the list is finding a new doc.  The public is not aware of how bad things have become for docs in general, but I am.  My Virginia friends were complaining about how hard it is to find a new family doc and that a new patient appointment takes 4-6 months to obtain.

Things are going to be worse here.  In the last few weeks, local healthcare institutions have fired 60 docs, replacing them with nurse practitioners.  Doctor suicides are at an all time high.  ZdoggMD recently did a podcast on the subject of unhappy docs (click on the highlighted words).  Take note of the fact that this brilliant, passionate healer is near tears when he speaks about what has happened to his beloved medical profession.

The really depressing part of his podcast is that he advises his audience (M.D.s) to find what makes them happy and then do it, giving up the practice of medicine.  Unfortunately, despite all the negative changes in medicine, I still loved practicing and would have continued to practice until I dropped.  (My wife pointed out that, in fact, I did practice until I dropped.)

Now, I have to find a new family doc, neurologist, urologist, neurosurgeon, podiatrist, dentist, etc. in North Carolina.  Getting old is a bitch!  I suspect finding my way through the medical maze in Charlotte is not going to be easy.  Afterall, I am looking for an endangered species.  Most of all, I’m looking for a physician who appears to care about how I am doing.  I’m looking for someone in their late 50s with a fair amount of experience under their belt.  I’m looking for an independent thinker who is aware of modern-day protocols but not afraid to ignore them.  I’m looking for someone who listens then speaks.  I’m looking for someone who still loves practicing medicine.  I think I’m looking for a miracle.

Of note should be that I am not necessarily looking for a brilliant physician.  A physician who cares and listens will find the knowledge necessary to take care of me.  One last point, I’m looking for someone who will allow me to be the patient and then lay out his/her plans as if I was not a doc.

I know many of you have been frustrated and have yet to settle in with a new doc.  I want to encourage you to find that new doc while you are well and not wait to find yourself questioning whether the new doc is good or not while you are in the midst of a major illness.

Meanwhile, I have a bad cold.  I don’t want to sound like a baby, but I am when it comes to nasal congestion, cough and just feeling yucky!  Do you want to know the real solution to the common cold?  It’s a secret but I’ll share it with you. Sex!  As much as you can tolerate.  Now, if I could just get a prescription for some and someone to fill it, I’d be on my way to recovery.

Several of my readers have suggested that my recent blogs have been somewhat depressive.  They are right.  Getting old can be depressing.  Getting sick is depressing.  To make matters worst; retirement sucks!

I belong in the office, caring for my patients. I was born to be a doc and there is nothing quite like watching a newborn grow into a man.  Being a family doc is like raising a family of thousands.  Sure, there are tough times.  Patients get old, sick and eventually die.  You mourn for them just as you would a family member and then move on to the next new patient, welcoming him/her into the practice.

I always thought that I would die in my office while caring for my patients.  With that in mind, I wasn’t at all prepared for retirement.  I have no hobbies.  Living the life of a family doc, I never had time to develop hobbies.  I imagined that if I had to retire, I might work with wood. Parkinsons makes woodworking somewhat perilous.  Even as a young man, I stunk at golf.  I used to bowl.  My fused back and persistent back pain make even thinking about bowling a painful experience.

So, I guess my readers are right, my writing can be depressing at times.  I have counseled thousands of elderly patients over the last 40 years, teaching them to accept the losses of aging gracefully while concentrating on what they can do, not on what they have lost.  Frankly, I’m surprised that no one laughed at my suggestions.  Maybe they did when they got home.

Maybe my advice was valid, and I just have to work harder to find my happiness.  Despite the worsening Parkinsons, my life is still full of blessings.  My family continues to grow and thrive.  My youngest has moved to Charlotte, NC.  All of my kids and grandchildren now live on the East Coast.  

My patients are meeting me for dinner and offering to be there if I need them.  Their friendship and kindness put a smile on my face and lifts my spirits.  Pat has been a God sent blessing.  We have a weekly lunch date.  We eat fine food (not good for my diet), laugh a little and spend a few hours solving the world’s problems.  Pat’s transition from patient to dear friend is one of the best things that came out of my retirement.

Unfortunately, my weekly social engagements will be ending all too soon.  I love my house, my pool, my screened in porch.  I love picking pears, sour cherries and apples on my property.  I love harvesting fresh vegetables from my very fertile soil.  I hate the frigid cold, grey winters.  I also miss my family.

Renee and I have bought a new home in Charlotte, NC and will be moving in the spring.  Charlotte is beautiful.  We will be 4 ½ hours from Jeremy in Georgia and Erin in Virginia.  While Charlotte has a winter, it is much milder and sunnier.  The house is in a 55 and older community so hopefully there will be new friends and more for me to do.

Moving away from my friends and former patients will not be easy.  Starting over is both exciting and horrifying!  I HOPE TO SEE MANY OF YOU BEFORE WE MOVE!

In the meantime, if you know someone looking for a beautiful home with a 25 x 50-foot pool, magnificent screened in porch, fruit trees, vegetable garden and fantastic neighbors, contact me.

It’s that time of year again! As the season changes, physician offices around the country gear up for the cold and flu season of 2019. Most of us start getting busier, as congested, coughing and feverish patients flock through our doors seeking relief and, hopefully, a cure.

The medical business world is unlike any other. If you are in the hardware business, you are currently stocking your shelves with snow shovels, salt for the sidewalks, and portable heaters. You are hoping for a frigid winter which will increase your sales, pay your bills, and leave you with a nice profit.

If you are in heating and air conditioning, you are selling preventative maintenance, cleaning and starting home furnaces, and hoping for a frigid winter which will bring you more business and pay your bills.

Most merchants are stocking up on winter gear, looking forward to the type of weather that causes customers to empty their shelves. If you’ve got something to sell, you want conditions to be such that it drives demand, and, with demand, allows you to sell your highest priced goods.

Doctor’s sell health, but the bulk of their profits comes from treating illness. If doctors were good businessmen and women, they would never sell a flu shot, pneumonia vaccine, or any preventative care. The profit margin on a flu shot is minuscule. The profit on a patient with Influenza is tremendous!

Imagine. Your temperature is 103 degrees. Every muscle in your body is aching. Coughing causes searing pain. You can’t stop shaking. You are lying on the table in your doc’s office; your wife is at your side. Your wife is not sick, yet. Hers won’t hit her for another three days. Your doc spends 20 minutes with you. There is a lab fee and an office visit fee. You got to your doc too late for him to effectively treat you. You will be sick for 2-3 more weeks, generating 2-3 more office visits. If you get worse, you may spend several days in the hospital, generating daily visit fees.

Your wife gets sick three days later. Your children get sick shortly thereafter. Influenza is a bonanza for a medical office. It’s better for business than a blizzard is for the merchants in your local town. Influenza pays the bills with plenty of profit to boot!

What’s the best business decision? You decide. Sell flu shots that prevent the flu, take in a minuscule amount of money and safeguard your patients’ health; or forget about the flu shot and go for the bonanza?

Docs are lousy businessmen. They have this crazy notion that their job is to keep you and your family safe. They promote the very shot that stops them from financially prospering. Think that’s crazy?

Here’s something more insane. Patients refuse the flu shot. “I’ve never had the flu! Why should I get a shot?” I hear it all the time. I teach patients about the flu. I tell them the flu is a killer, killing up to 30,000 people a year. I tell them the flu probably won’t kill them. It will just make them wish they had died. They may well miss 3 weeks of work. They still refuse to be vaccinated.

“I had a flu shot in 1977 and it made me sick! I don’t want one.” If you think being sore after the flu shot is sick, wait till you have the flu.

I often respond to the above false sense of security with the following analogy. I ask my patients if they have ever been rear ended by a semi at 40 mph. I point out to them that they buckle up every time they get in the car despite never being forcibly ejected through the windshield because, once struck, it’s too late to buckle up. Seatbelts save lives.

Your flu shot is your seatbelt against being struck from behind by Influenza. Influenza is a speeding semi and I guarantee that, when it hits you, you will feel like you have been catapulted through the windshield and hit the pavement hard. 

Guess what. Many patients still don’t get vaccinated. Too bad for them but great for business! A sick Influenza season pays a lot of bills. Some days I wonder why I waste my time trying to keep my patients healthy.

There are many times my wife doesn’t listen to me or follow my advice. Imagine that. However, she does get her flu shot every year. Thank G-d, that’s one “I told you so” I’ll never get.

My family, my friends and my patients think being selfish is bad!  I bet you do, too.  I used to think so, as well.  Forty years in practice has taught that being selfish is good.  Actually, selfishness is essential to an individual’s health.

Once, I saw a selfless young woman who was ill.  She had an assortment of complaints.  She had not felt well in months.  If she was the CEO of a Fortune 500 company, she would have been diagnosed with executive burn out and given two months at Canyon Ranch, an executive retreat.   Unfortunately, she is the CEO of a typical American family.  She is married, has five children, a dog and works full time.  She has living parents who are aging and require help.  She is a hard worker, dedicated to caring for her nuclear and extended family, as well as excelling at work.  She has no time for self.  She is one of hundreds of such mothers in my practice.  She is stressed to the max but does not have the luxury of going to Canyon Ranch.

I often tell the story of the hand.  The thumb is you.  When you are young, you are self-centered, egocentric.  The world revolves around you and only you.  One day you realize that you have parents (your index finger), and you are responsible to them, as well as yourself.  As you age, you meet the love of your life (the middle finger) and are responsible to your mate.  In time, children come along (ring finger) and they need lots of your time.  You become very responsible for them.  Then you have you job (little finger).  As you grow in your job, responsibility grows as well.  You are a good person and want to excel at everything.  Your parents are aging and require more attention.  Your children are aging and require more attention.  Your job is growing more complex.  Your mate, who is often responsible like you, is in the same position.  

So, what do you do?  Things are out of control!  You have to take care of your parents, your mate, your children and your job.  The only thing you control is you, so you sacrifice yourself.  Try using your hand without using your thumb.  What you find out is, without the thumb, your hand is useless.  No matter how hard you work to make your four fingers function, without the thumb, the hand falters.

If you are not healthy, you cannot help those who need and depend on you.  If you are not selfish enough to save time to care for and nourish yourself, you will get sick.  Those around you will have to function on their own.  Why wait until you are exhausted, burnt out or sick?  The answer is simple.   Your parents taught you not to be selfish.  They taught you to be a responsible individual.  It is time you teach your loved ones to be responsible to themselves, to set healthy limits, to take time off, to laugh and be happy.  Set a good example; get healthy.  At first, those who are used to getting all of you will rebel.  They may call you selfish.  Teach them that a part of a healthy you is better than part of an unhealthy you.  In the end, by being selfish, everyone will be better off.

Uh Huh!  Two potentially dangerous words!  When my children were young, we visited with my wife’s parents in Virginia.  I was sitting at the kitchen table reading the newspaper.  My mother-in-law placed a plate loaded with eggs and bacon in front of me which led to my asking, “What’s this?”  Her reply was “You said you wanted it!”  My 10-year-old daughter, with the wisdom of youth, then proclaimed, “GRANDMA, when my father says, “Uh Huh” it means he’s not listening to you!”  The eggs were great (her food always was), but I really didn’t need the bacon.

In my mother-in-law’s kitchen, “Uh Huh” caused no great harm.  In my office, Uh Huh could be lethal.  Let me explain.  Medication errors are a fact of life in the world of medicine.  We work hard to prevent them, yet nationally, the numbers are embarrassing!  So, how does this happen?  On every visit to my office, the nurse reviews your medication with you.  Then I come in and review your medicine with you. 

Nurse: “Mr. Patient, are you still taking 30 mg of medication A?”  

Mr. Patient  “Uh Huh”.  

Nurse: “120 mg of medication B?”  

Patient: “Uh Huh”.  

This process then repeats itself over and over until the bottom of the list.  The result is errors in medication doses and names.  When I come in to see Mr. Patient and ask about his medications, he often sounds put out.  After all, the nurse just went over them.  Again, I get “Uh Huh”.  Mr. Patient thinks all this is ridiculous. His doctor should know what he is taking.  He says, “Don’t you keep records?

Previous articles have focused on the doctor patient partnership and education.  In a true partnership, both sides take responsibility for the outcome.  In an educated partnership, the conversation goes like this.  

Nurse: “Mr. Patient, are your still taking 30 mg of medication A?” 

Patient: “Let me check my list.  Yes I am.”  

Nurse: “120 mg of medication B?’   

Patient: “No, I’m on 240 mg.  My cardiologist increased it the last time I saw him?”  

Nurse: “Are you taking medication C twice a day?”  

Patient: “No, the gastroenterologist stopped that one.”

Now, I know the gastroenterologist and cardiologist are supposed to send me consult notes.  Those consult notes have to be read and filed.  All of that takes time.  It’s a complex dance fraught with possible omissions and errors, especially if the patient is also saying “Uh Huh” in the specialist is office.

Making matters worse is the phone call to the office requesting “Please have the doctor refill my medications”.  Often patients make blanket statements, giving no name, no dose, no directions, just please refill all of them.

Most practices have instituted electronic prescribing so that, ideally, requests come directly from the pharmacy and prescriptions go directly back to the pharmacy.  All of patients are encouraged to carry an up-to-date list of all of their medications with them at all times.  Patients should go on the patient portal and review their medications for accuracy.  Rather than calling the office for refills and having the front desk staff transcribe the request and send it to the nurses, we encourage you to request your refill directly thorough the portal or through your pharmacy.  It is of paramount importance that we, patient and doctor, listen carefully to ensure the best of care. 

I hear it all the time!  “I didn’t come in sooner because I thought I would be better in the morning.”  Instead, I’m interviewing the patient in the Intensive Care Unit of my local hospital.  Ever hear of a man dying from indigestion?  Neither have I.  What I too often see is the patient (usually a male) who says “Doc, I thought it was just indigestion.”  It wasn’t!  It was a massive heart attack and precious time was lost as heart muscle died and, ultimately, so did the patient.

Not long ago I saw the patient who was having bad headaches and walking into walls.  His symptoms persisted for over a month before he saw me.  Again, my patient rationalized his problems.  “I’m just stressed.”  Stress does lots of things but it doesn’t cause you to walk into walls.

The earlier the diagnosis, the more chance I, and my team of specialist, have to intervene on your behalf.  The emergency room has special procedures called “stroke alerts” and “cardiac alerts” designed to quickly and expertly bring together a team of highly trained individuals and advanced medical techniques proven to limit the damage from a heart attack or stroke.  There is a golden window of opportunity.  In the case of a stroke, the “alert team” has to intervene within the first six hours of symptom onset.

So please don’t linger at home in pain, presuming it is indigestion or stress.  If you are not sure what to do, call your doctor.  Please, do not drive yourself to my office or the hospital.  If you lose control of your car you may well kill yourself and innocent bystanders.  Use the paramedics!  Their ambulance is a mobile intensive care unit.  Their skills are phenomenal.  They can have the appropriate “alert” team waiting for you at the door of the hospital.

One last thing, please listen to your spouse.  In the case of the husband, I know it breaks the unwritten rule that men cannot listen to or admit that their wife is right, but she is!  And remember, when your spouse threatens never to talk to you again if you call the paramedics, if he dies, he certainly won’t ever talk to you again!  Go ahead and call the paramedics and spend the next 30 years with a silent, but living, spouse.

Sometimes, you just can’t win!  In medicine, sometimes is way too often!  “Doc, do I need that test?” published in February 2011, reviewed the issues surrounding screening colonoscopy exams.  The dilemma is always the same.  Do I order a test or don’t I?

If I order a test, there are consequences.  Some are obvious; some are not.  Tests cost money and money is in short supply.  One consequence of ordering a test is that my patient may be held responsible for a big bill.  Having to pay for the test may well stress my patient and his/her family.

A second consequence is that the test may not prove anything or help make a diagnosis.  In this case, not only have I wasted hard earned money, but I have frustrated my patient.  Ordering too many tests that turn out normal shakes your patient’s confidence in your abilities as a doctor.  It may also lead to the accusation of profiteering or practicing defensive medicine.  In reality, a negative test helps remove items from the “Differential Diagnosis” list and helps make an accurate diagnosis.

A third consequence is that a positive result may lead to more testing, more expensive and more risky procedures.  PSA testing is used to screen for and diagnose prostate cancer.  A positive PSA test is suggestive of a problem but certainly is not definitive.  If your PSA is elevated and your digital rectal exam is normal, your doctor may simply repeat the test in a few months to monitor the situation.  If there is any question of malignancy, your doctor will probably refer you to a urologist for further testing.  Further testing often entails multiple biopsies of your prostate, painful and expensive procedures.

As a physician, you are really damned when the positive blood test leads to a biopsy and the biopsy is negative!  Rather than being happy that he does not have prostate cancer, your patient is pissed that he had to have a biopsy and even more pissed that he has to pay for everything.

You are also damned if you don’t order a test!  Fail to order a test that might have revealed a disease at an earlier date and your patient will be even more pissed!  

“Cyberchondria,” a relatively new phenomena, is a disease in which patients read about illnesses on the internet and then convince themselves that they have those illnesses.  They often come in requesting an assortment of tests, some expensive and some invasive in nature.  While making your patient happy is preferable, ordering a barrage of tests without clinical reason is both wasteful and inappropriate.  The patient who thinks they have “XYZ” disease wants an MRI of his/her brain.  “XYZ” is extremely rare and present only in people of Asian origin and your patient’s family is from Hoboken, New Jersey, having come over on the Mayflower.  Do you order the MRI? No!  You explain that you see neither signs nor symptoms of “XYZ” and look for another cause for the patient’s ailment.  The patient eventually finds   a “real” doc who orders an MRI and is pleased to find that they don’t have “XYZ.”  They tell everyone you are a “quack”, don’t listen to your patients, and don’t care.

You are really, really damned when the MRI verifies that your ex-patient is the first non-Asian in medical history to have “XYZ.”  

So, as a physician, what do you do?  How do you win?  You partner with your patients.  You make your patients responsible members of the medical team.  You help educate your patients to the benefits, risks, limitations, and costs of testing and treatments.  You listen to your patients and offer your best advice.  You write a nightly column.  Then you say a little prayer!  May you be so blessed as to never know the disease you prevented.