Getting the ol' Screwgie again this year....

Over the weekend, I picked up the latest Louisville Magazine and I was treated to the annual "Doctors Issue". This is the issue where all the doctors in town get to vote on their favorite (read 'most referrals') brethren. The categories usually include all the subspecialties as well as primary care. Most of the time it seems to be just like high school, with the popular east end docs getting the votes while the lowly downtown docs get snubbed (correction: Dr. McClellan gets snubbed-but no...I am not bitter about it). This issue was different. It had the top surgeons in town with rankings of everything from boob jobs to toe nail removal. Need butt implants? We have you covered. Nose job? Here too. Even a category for emergency appendectomy. Really?? I don't know about you but I have never had a patient in the throws of an acute appendicitis say "Who is going to be doing my surgery? Were they listed in the most recent Louisville Magazine? No? Well, I think I will wait it out instead...".

I tell you what you won't find. You won't find rankings about the little things, the things that really matter. So here is a partial list that I would like the magazine to consider for next year's publication:

1)MD who is most on time-we all have crap we need to do and the last thing you want is to spend 4 hours in the doctor's office just to have them see you for 3 minutes then charge you an arm and a leg.

2)MD who will actually listen to what your complaint is-many times patients have their list of problems to cover and the doctors have theirs. I can't tell you how many times a patient will tell me that they mentioned something to the subspecialist only to have them receive a blank stare followed by a completely unrelated series of questions dealing with medications, how their hemorrhoids are doing, anything but the answer to their question. Irritating to say the least...

3)MD most likely to examine you-believe it or not (I didn't when I heard it from some of my patients), when you go and see a doctor....they are actually supposed to examine you! As a doctor that examines patients, it is my lowly opinion that some sort of touching should occur (not bad touches, just healthy touches). My wife gets mad at me when she has an ailment of some sort and the first thing I do is touch it. "Why are you always touching and squeezing on me? It's just a mole!" It is called examining and I believe that something CAN be gleaned from using all of the 5 senses...

4)MD with the most patience with your parents-for all of my friends that are now caring for their elderly parents, you know exactly what I mean. For those that don't understand, you probably still have someone caring for you...

5)MD who is best at filling out forms from insurance companies-good gravy, I am getting so good at doing this I should pimp myself out. Still hate it though...

6)MD with the best office staff-needless to say, having a good office staff is one of the true keys to a successful office practice. Some offices are good, others are horrendous.

This is only a partial list. I am sure there are quite a few more categories that are worthy of notice but I can't think of anymore at this time. I am sure I will think of more, that is, unless I am in the Louisville Magazine next year for being a "Top Doc" in which case I will think this blog entry is frivolous and nothing but a bunch of "sour grapes" by an overlooked, frustrated by "the man getting him down", under appreciated internist from the hood (aka downtown Louisville). Thanks for your time and don't forget to vote next year!

Excuses, Excuses

I love my patients. I really do. I empathize with what they have to put up with in regard to their chronic medical disease. Their pain and suffering, both mental and physical, can take there toll over time. I love that they come to me and ask my medical opinion regarding their treatment and prognosis. However the thing that I especially love is when they think that their doctor takes everything they say at face value. It is amazing that people will lie right to my face about why they haven't done what I have asked them to do when last I saw them. Here is a smattering of the excuses followed by the true interpretation. We will start out with some easy ones, then gradually get to the more ridiculous....Ready? Here we go...

1)Me: Why haven't you taken your blood pressure since I last saw you?
PT: I haven't been anywhere that I can have it done.
Me: You haven't been to the pharmacy? Grocery store? You can even come here to our lab...
PT: Well, I don't get out much...
INTERPRETATION: I don't want to get my blood pressure checked. It may be high, then you will put me on medicine.

Get the picture? Alright, let's move on...Here is the EXERCISING/WEIGHT LOSS edition:

2)Me: Are you exercising?
PT: Yes. But probably not as much as I should...
Me: How much?
PT: I do a lot of walking at work.
Me: That doesn't count.
PT: Well, it IS a long distance to the copy machine...
INTERPRETATION: I am way too lazy to do any exercise, and I don't want to do any exercise. I like my TV and Cheetos more. Can we change the subject?

3)Me: Any luck with losing weight?
PT: No. My wife is just too good of a cook.
Me: Well, it is about portion control...
PT: I just eat what my wife puts in front of me. If I don't eat it, she will be pissed at me.
INTERPRETATION: I don't want to push my fat ass away from the table, close my pie hole and show some restraint.

4)Me: Any luck losing weight?
PT: No, and I don't eat that much (says the 300# woman). I have yogurt for breakfast, a Fiber One bar for lunch (God forbid she get backed up) and a salad for dinner.
Me: How MUCH salad are you eating? (Just kidding, I wouldn't say that...)
INTERPRETATION: I really don't know how to count calories OR I am putting twinkies on my salad for dinner...

5)Me: How are you doing with the Overeaters Anonymous classes?
PT: I have eliminated sugar, wheat and flour and I still can't lose weight. *Stern look in her eyes* What are YOU going to do about my overeating? I don't want a bunch of medicines either. How are YOU going to fix it?
Me: Sew your mouth shut. (of course I didn't say this but I almost lost control of my inner monologue...)
INTERPRETATION: There is a hell of a lot more going on with you than not being able to control your voracious appetite, lady.

All of these conversations have occurred at one point in my 8 years of practice. I have heard it all, but really all I want is the truth. Is that so hard?

Monday!

I gotta say, I am beat. Today was a rough one. Not only was it a Monday, but it was a Monday with a catastrophic blunder. Here I am in clinic, bee-bopping along when I go in to see my 86 year old patient who is accompanied by her daughter. Without thinking, I say "Well hello there! Where is your husband? He decide to stay home today?" Complete silence and a confused look on my visitors' faces. "Daddy died in April. Remember?" Oh Snap! Talk about awkward! I am still tasting my shoe polish after my foot spent the next 30 minutes in my mouth while I apologized profusely for my major gaff. I haven't felt this bad in a loooong time. Instead of moving slowly through my day, methodically reading the chart before entering the room, I feel confident enough to roll in and start what I thought was a lighthearted icebreaker. Wrong! This is Monday you are dealing with! It doesn't fuck around....It is out for blood and if you don't watch it, it will pounce on you and beat you to a useless pulp. Needless to say, Monday had the upper hand the rest of the day, making me watch everything I did, worried another ignorant statement would come flying out of my mouth. Luckily I am home now, where my mistakes are not noticed by my children and if they are, they forgive me with a smile and a pat on the back. Curse you Monday! I have been foiled again by your sneaky, brain draining ways! I will not be so easy to defeat next time, I guarantee!

Confessions of an Addict

Hi, my name is Chris and I am an addict. That's right. The first step in the healing process is admitting you have a problem, right? Well, I do have one. It is a big one too. I find myself thinking about it at least a dozen times an day, longing to be with it and not where I am at the time. I find myself not able to devote any time to myself lest I feel guilty for not spending an ample amount of time on my addiction. I have come to the conclusion that I will probably never excel at anything again. Oh sure, I may dabble in things and may even be good at some point, but the drive to truly master something will never be there. It just takes too much time away. For this I blame my addiction. I purposely put things out of my mind that don't pertain to this ever present fixation. At times, I need to have my wife force me to get away, to remove myself from this invisible bind I have and to surrender completely and focus on only me. It seems so utterly foreign to contemplate and even while writing this I am feeling guilty. For you see, my addiction is my family-my wife and kids. I can't seem to get enough, and when I do, I feel horrible that I desire to get away. I once was able to spend hours upon hours focusing on studies, reading, and even athletics but fortunately I have been cursed with the unwavering desire to be "A Family Man"... Wow. This catharsis has helped soothe some of my internal anxiety regarding my problem, but I am going to need everyones' help to force me to take a little time for myself. All work (in this case, family) and no play makes for a dull boy and I must remember that I am expected to be a well balanced, happy and productive member of society, even as I nurse this extremely dark and private addiction...P.S. when is the next FA (Family-aholics Anonymous) meeting? Will there be childcare provided?