June 17, 2013
In March 2011, I published “Possible vs. Probable”. The premise of the article was that, while everything is possible, what is truly important is what the probability of an illness or outcome is. Today, I want to apply the premise of “Possible vs. Probable” to the realities of getting old and being ill.
Mrs. “X” is in her 70s. She has diabetes, high blood pressure and her kidneys aren’t up to par (renal insufficiency). Mrs. “X”’s most pressing problem is her arthritis. Her neck, low back, hips, and knees hurt all day long. It takes Mrs. “X” “forever” just to get out of bed in the morning. Mrs. “X” also worries about everything.
Mrs. “X” worries mostly about her kidneys. Her kidney doc has warned her not to take any NSAIDs (ibuprofen, naproxen, etc.). Theoretically, NSAIDs can adversely affect kidneys causing ...<< MORE >>
June 16, 2013
Flash back to September 24, 2011when I wrote:
On Thursday, I read, “http://www.kevinmd.com/blog/2011/09/unintended-consequences-standardizing-physician-practice.html.” The article reminded me of many I have written and helped solidify a concept that has been growing in my mind like an evil seed.
The “Art of Practicing Medicine” is dying, soon to be replaced by the “Art of Template Medicine.” When I searched my www.livewelthy.org for articles on medicine by protocol, I found that I had written dozens of articles about the death of medicine as I know it and the advent of its evil twin. One of my articles, the dehumanization of medicine ...<< MORE >>
June 15, 2013
In 2011, I published the following article. I don’t know why I failed to act on it. I should have. I’m sure my readers have noticed the negative, almost hostile tone of my articles lately. In assessing my practice, I am currently treating an increasing number of disorders related to poor lifestyle habits. I am also spending way too much time on the phone chasing after patients who have not followed up as directed. I hope you will print and sign the article below and take its intent to heart!
I often refer to myself as a fireman pouring water on the flames that are burning my patients. Often, I view my patients as arsonists, pouring gas on the fire I am working to put out. Taking personal responsibility is a critical component of success in any of life’s ventures. While my patients are very responsible business and family men and women, they often take ...<< MORE >>
June 14, 2013
I often ask myself the following question: Why would any doctor in his right mind prescribe a brand named medicine? In order to answer that question, I need take you on a little journey.
There was a time, not too many years ago, when practicing medicine was exciting. New breakthroughs in treatments were common and the future was full of hope. Patients wanted the best medicine had to offer, not the cheapest alternative. At cocktail parties, people would brag about their cholesterol and the wonder drug they were taking to combat heart disease.
Then, the bottom fell out. The insurance companies took control, the economy collapsed and new and exciting was replaced by cheap and generic. Docs were accused of destroying the nation’s economic health by ordering expensive tests and medications. The government and insurers banded together and demanded that the ever rising cost of medical care be reined in ...<< MORE >>
June 13, 2013
Today’s theme is things patient say all too often:
“Just give me 3 more months, Doc. I’ll lose weight and stop drinking excessively.”
Yes, just 3 more months and my errant patient will change his ways. Of course, he told me the same thing 3 months ago and 3 months before that visit. All I want to do is put him on medication for his extremely elevated blood pressure and cholesterol. You’d think I was sentencing him to the electric chair. In actuality, not taking medicine for what ails him may lead to an electrocution of sorts when the ER doc applies the paddles and yells, “Clear!”
“Doc, I’m afraid of the side effects of taking medication. I’ve seen those TV commercials. Your medication can cause some dangerous side effects.”
Yes, medications can cause dangerous side ...<< MORE >>
June 12, 2013
Last night, I heard the following:
Nurse - “Mrs. X, your blood pressure is a little high today.”
Patient – “I always get nervous when I come to the doctor’s office.”
My patients have all kinds of excuses for why their blood pressure is elevated. Other common excuses are:
“I had an extra cup of coffee this morning.”
“I had a bitch of a bad day at the office.”
“I had an argument with my wife/girlfriend/child.”
“I had to pay the bills.”
“I knew you were going to yell at me about my weight.”
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June 11, 2013
Patient – “Oh, yes, I’m also on Viagra.”
Doc – “Who’s prescribing the Viagra?”
Patient – “Nobody, I buy it over the internet.”
Doc – “You buy it without a prescription?”
Patient – “Yes!”
Doc – “Did it ever dawn on you that, if the site you are buying from is willing to break the law, the product they are selling you might be counterfeit or dangerous?”
Buyer, beware! I’m tired of sounding skeptical or paranoid, but that seems to be my lot in life. Over the past few years, I have repeatedly warned my readers about counterfeit drugs and bogus Canadian pharmacies. They continue to ignore my warnings.
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Patient “M” is thirty-something and I have been caring for her for years. She is a very hard working, responsible adult with a lot on her plate. As with so many young adults, she is financially strapped, over worked, and overwhelmed with the transition to adulthood.
Patient “M” needs to see the gastroenterologist for an esophagogastroduodenoscopy (EGD). She has chronic acid reflux which, while controlled by over-the-counter (OTC) medication, needs to be monitored. An EGD costs approximately $2500 and Patient “M” has a $2500 deductible insurance policy. When I asked her why she had not scheduled the test, she started listing a litany of things she has to do and asked me to write an article on managing priorities.
Patient “M’s” car needs repairs and has student loans that need to be repaid. She has rent and utilities payments. She needs winter work clothes and a new washer to clean them. She works 60 hours a ...<< MORE >>
June 8, 2013
When I was younger, there was a movie entitled “The Good, The Bad and The Ugly.” The last few articles have dealt with the good, the bad and the ugly of life. The good is almost always easy to deal with, isn’t it? Of course it is. However, sometimes the good comes with some of the bad and even some of the ugly.
The Good – My son does great at his job and gets promoted.
The Bad – He gets transferred to Atlanta where he flourishes.
The Ugly – As a father, I’m supposed to be proud of him and happy for him, and I am. As a human, I feel bad. I won’t see him as often and will have to learn to live with a long distance relationship. I recognize the selfish side of fatherhood.
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June 7, 2013
I’m officially old. Today, I’ll be in Charlottesville celebrating my 40th college reunion. I’ll spend time with old friends walking the streets that, as much younger version of Stewart, I walked and played on. My mind will return to its 21 year old state of utter happiness. I’ll visit the fraternity house where I jumped off the roof tied to a rope and swung to and fro. I’ll remember how exhilarating it was. I walk through grounds remembering victories and defeats (mostly girls).
Unfortunately, I’ll walk those same streets and remember those exhilarating moments in a 62 year old body that suffered a lot of damage jumping off that roof and from an assortment of other foolish stunts. Thus is the paradoxical nature of life! If I knew then how I would feel at 62 would I have done it? Your damn right I would! Those were the years when I was invincible, full of potential, piss and vinegar (and ...<< MORE >>