Paging Doctor Google....Paging Doctor Google...

As I sit down to my computer on my day off (which is really a misnomer because is there really ever a day "off"?  Always stuff to do such as laundry, clean the house, write blogs, etc.  But I digress...), I am again amazed at the fact that people come to me and ask my advice on things.  Not just little things like which deodorant is best or which restaurant has the best hummus, but real, substantial stuff.  Their health.  And not just their health but all of those dark secrets that they carry around with them but are too afraid to mention because it may somehow magically make it true.  Google tells them that they certainly must have some dastardly disease that will invariably maim or scar them, and it is my job to separate the wheat from the chaff.   I find that patients come to me not for my knowledge of human physiology but for something far more valuable- assurance.  Assurance that they are not going crazy, assurance that the problems they have been harboring in their brain are really nothing at all, assurance that they are just as normal as the next person.  But isn't that all anyone wants?  To be deemed "normal"?

I have found that patients will go to great lengths to obtain this validation before coming in to see me.  They will ask their friends, their neighbors, their hairdressers long before seeking my advice.  This, however, is really difficult for me to deal with because I then have to go to extraordinary lengths to undo the damage that Herb the barber has done to my poor patient.  Here is a small case report to illustrate my point.  The names have been withheld to protect the innocent...

Patient:  Doc, why is it that when I get out of the shower, my right pinky toe is more red then the left one and tingles for 2-3 seconds?  Do you think that it means I am going to have a stroke?
Me: No.  You are not going to have a stroke.
Patient:  You sure?  I asked my stylist and she says that her aunt's neighbor complained of the same thing and she was dead of a stroke a year later.
Me: I can't tell you whether you are going to have a stroke a year from now but I can tell you that the tingling in your toe after a shower is not a stroke.
Patient:  Really?  I was watching Dr. Oz and he said that tingling in the hands or feet could mean a stroke and that I should see my doctor.
Me:  Well, you are seeing me now and I am telling you that this is not a stroke.
Patient:  Well, I googled these symptoms and there is a doctor in Bangladesh that specializes in this type of thing.  Do you think I need to see them?
Me: Really? I mean, really?

Maybe I need to start my own talk show for my patients and dole out little vague nuggets of medical wisdom that can be interpreted in a myriad of ways.  I could be like Dr. Horoscope.  Anything I say could be taken completely out of context.  No, what my patients need is exactly what I give them.  The ability to release their inner bugaboos in the safe environment of the exam room.  I sit and listen.  I don't judge.  I just continue to assure them they are going to be okay.  This is something that was never taught to me in medical school or in residency.  When I first started in private practice, I was so concerned with getting the correct diagnosis that I was oblivious to what the patient really needed.  I ordered lots of tests to assuage my need to know the diagnosis, when in actuality all my patient wanted to know was that their tingly toe was not going to kill them.  Now that doesn't necessarily mean that they don't want to know the diagnosis, it just means that it is lower on their list of "needs" that they require from me.  Sometimes the only medicine the patient needs is a stout dose of "listen and do nothing" than "do something and don't listen".  Maybe that is what makes makes barbers and hairdressers so appealing for patients.  They are a captive audience.  If doctors did more listening and assuring and less talking and testing, maybe patients would come to us before going to Herb at the barber shop.

The Doctor Visits A Foreign Land...and HATES It.

As I wait for my next patient to be put back into an exam room, I just wanted to let everyone know that I would not trade my job for anything. Now it may not be for the reasons that you would think, such as the love of the science, the art of the practice of medicine, or the ability to drink coffee all day long without the repercussions of annoying my cubicle mates with my incessant jitteriness. No, I love my job because it is not YOUR job. I have had a taste of the other side and it is bitter and distasteful to my palate. I am, of course, referring to the routine "office" life. I have taken a position as a physician leader with Norton Healthcare helping them implement the new computerized medical record. It has required me to meet with the "suits" of the administration who are the drivers of this fantastic organization. It is a lifestyle that the majority of people have to deal with in their workplace, one that includes countless meetings, power point presentations, and God forbid, the dreaded Webinar. It is one of the strangest worlds that I have every been in, similar to how Alice must have felt when she fell into that hare hole so long ago.

Emails I have been inundated with emails. Emails about meetings (with follow up appointment reminders), emails about receiving an email discussing an upcoming meeting, and my favorite one of all- emails disregarding an email that I haven't received concerning a meeting that has not been scheduled yet. Geez.
 
Meetings I have been attending meetings once a week to discuss the ins and outs of implementation. In my practice, I am used to making a decision and that decision leads to a direct action and a consequence. However, during these meetings, we must hash and rehash the same information until I forget the point of interest that necessitated the meeting in the first place. If I hear another person say that they "understand why this could make you frustrated and I respect your position, but..."  There is always a but. Always.  If I hear this guilded jibberish one more time, I may just go apeshit on someone.

I have come to realize that the beauty of my job is that I get to dictate my day. I can decide how long I choose to deal with Aunt Gertie's toe nail fungus or Uncle Jim's concern that he gets "swimmy headed" when he gets up too fast. If medicine were run by the "suits" nothing would ever get done as there would be meeting after meeting to deal with why Mrs. Smith needs her CT scan or a special committee set up to discuss Mr. Jones' piles (that's a term I learned in residency. It is Eastern Kentucky speak for hemorrhoids- as in "Doc, I rode my tractor all day yesterday and got my piles all riled up..."). No, for me I work better on my little island, making decisions quickly, decisively, and without others approval. I am not saying my way is better, just more comfortable for me. God bless those who can navigate the jungle of cubicles and conference rooms, the endless emails, and the streams of meeting reminders. I know someone has to do it, but I am just glad it is not me.