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?

My ego surrenders (and it is a wonderful thing...)

Well, it has happened again. I have had to yield to my wife. As a man, I feel the need to be correct about most things, even when it comes to tiny issues. I, like my XY chromosomed brethren, choose to put pride before acceptance and continue to believe that the blame must lie elsewhere, that I am certainly not responsible for the crummy situation that I have landed myself and loved ones into. Of course, my wife, being the caring, nurturing woman that she is, tries to put up with it as long as humanly possible until she cannot take it anymore and must break out the big guns, shooting me down where I stand and quickly putting me in my place. She assumes that I will come to my senses and clarity of mind will prevail but that doesn't always happen. My fall from grace is well deserved and needed as my simpleton male brain cannot fathom that the ultimate culprit in the current debacle is none other than the one staring back at me in the mirror...For this, I am forever grateful...that someone has my back, and that my ego will be kept in check...
I sometimes think that my job has ill prepared me for marriage. I have been molded through my 12 years of post high school education that I must be the best-the smartest, sharpest and most competent student and caregiver. Then I start in private practice and I am expected to be on an "island", separate from my partners and able to care for my patients without asking for help. To ask for help, in my male mindset, would be considered a failure in my training...I spent countless hours studying, practicing, and training for life on the "island" and damned if I let that training let me down. I would do it on my own because it was what was expected of me.....
Fast forward to now. I must come home from my "island" and re-enter society, interacting with my wife and children. This, I can tell you is not as easy as it looks. I have found that I bring my "island" home with me and expect everyone to conform to my life on the "island" even when that is not what I intend to happen. My hard wiring as a male and as a doctor are a synergistic duo that can make me a pain in the ass sometimes. It is not intentional I can assure you. However, my wonderful wife, after nearly 12 years of marriage has me figured out (while I am not even close to solving her cryptic puzzle). She lets me think that I have come up with the answer when it is actually her idea and solution. It is quite Machiavellian and supremely effective, however sometimes it doesn't work and the direct approach is necessary. Confrontation is required and I can tell you it is tough being on the receiving end of this. It requires self evaluation and my pride must take a back seat. She is sharper than many psychiatrists and therapists I know and much more to the point. It cuts and hurts at first, but after "objective" evaluation, I see the utter correctness in it all.
She is beautiful and deadly at the same time and I realize that she is the Mama Bear, gentle and nurturing until something threatens her family-in this case her husband's inability to see past his issues-then the claws come out. Luckily as the Papa Bear, I am getting a thicker coat from the occasional, but definitely needed swipes from very loving paws...

Of Medicine and Nonagenarians...

Today I saw two of my nonagenarians. I love when they come to see me. You want to know why? It's because I have discovered a very intriguing lesson with these jewels of humanity. The more I do to them (ie treat them), the worse they become. That's right. I try to do as much nothing with these patients as I can. I figure that they have reached this far without me, who am I to step in and ruin their day? Case and point: Mr. L came today and complained of being tired. His wife says that he spends "20 out of 24 hours of the day in bed. I think he is depressed..." No. He is just 92 years old. I decide I will placate his wife by saying that I will try to adjust a few of his medicines to give him some more "oomph". After 10 minutes of screaming at him (he is hard of hearing of course), trying desperately to explain to him that no, the 20 mg pill will no longer be used but instead 2 and a half 10 mg pills will be substituted, I give up. I say, "Mr. L, there is more of a chance of you hurting yourself by taking the wrong dosages thereby obviating the benefit I was trying to provide. Stick with the red pill in the morning and the green pill at night." He was perfectly happy with this. You see, he didn't want me to change anything...he LIKED it just the way it was, even though his wife didn't. Some physicians would say that this isn't the way to practice medicine, but I beg to differ. After age 90, folks are on borrowed time so it all becomes more social during our quarterly visits. "Oh, what a beautiful walker you have, Mrs. J and might I add that your great grandchildren sure are getting big...." It is this artful dance we do, enjoying the conversation, knowing that as long as we don't stray too far from the current treatment plan, they may just make it another year closer to being featured on the 100 year old birthday Person of the Week by Willard Scott (if he hasn't already died himself). This way of slowly rearranging the deck chairs on the Titanic is what I call the Art of Medicine. Knowing what to do is elementary, it can be learned from any medical school. But knowing what NOT to do, now that is something all together different. That my friends, is truly the Holy Grail of medical knowledge...

I learn something from Coach tonight as well...

Tonight was Jack's 4th baseball game in 4 nights, and all of them have started after 7 pm. Never mind that I personally find this reprehensible, we pulled on our Red Sox and dutifully took the field. Jack has been having problems with his fielding. The game just hasn't clicked for him yet. The ball is hit, he watches the play and forgets at times that he is actually IN the game and the game speeds by him. It has been getting frustrating for me to watch this as I want my son to succeed at whatever he chooses to do-up until baseball it has come naturally to him, no real learning curve needed. Watching these past 4 games, I have come to the realization that he just doesn't get it. He plays in the outfield and he doesn't know where the ball goes once he has it. He plays second base and he doesn't move to the bag to cover it (despite my continued shouts and urging for him to do so). It has been getting so I spend more time telling him where to go rather than following the flow of the game, enjoying the beauty of a boy's game with friends. That is, until tonight...

Jack continues to struggle, and I continue to slowly turn into THAT Dad, you know the one, constantly correcting his son from the sideline. Jack was up to bat, gets on base but because of a miscommunication with his coach gets caught in a double play. I do my usual "Good job, Jack" as he runs without looking at me into the dugout. During the next inning as Jack is in the outfield, the coach comes to me and says "Bring Jack over when he comes in. Give him some encouragement. He sat and cried in the dugout after the mistake with the base running. I told him it was okay and that he was doing a great job, but it may be better coming from you." UGH. My heart broke at that very moment. My son had been listening to everything I had been screaming to him and he just felt bad that he didn't do the "right" thing. My inadvertent attempts to make him into the player I never could be caused him to think that I was somehow disappointed in how he was playing, somehow a failure. I felt and actually still feel like a heel-a piece of absolute feces for causing my son to feel this way. And it wasn't just tonight. I vaguely remember seeing streaks of dirt in tear tracks on his face last night as well. When the game was over, I took him aside and gave him a huge hug, told him how proud I was of him and that I love to watch him play. Gone are the bleacher coach remarks, the yells to cover the base, the screams to get his elbow up in the batting box. All gone-all to be replaced by only positive remarks, no criticism, constructive or otherwise, will be uttered again. I realized tonight that my comments toward my son, while well intentioned, fell onto already struggling, self deprecating 8 year old ears. I was the failure tonight, and I hope in time my boy forgives me.

I would like to thank his coach, for being so caring to my son, supporting his efforts and his emotions. I would also like to thank him for dressing down his father without saying a single negative thing to him... His comment made me feel 6 inches tall and I deserved every bit of it. I am relieved to have a saint for Jack's coach...Lord knows, we need someone to guide us through the Hell of Little League baseball....