Tuesday, March 1, 2011

Obsessed with Oz

What is it about the media obsession with doctors and the medical field?  It seems like everywhere I turn I hear about yet one more medical show popping up on television. Seriously, are our lives really that interesting? It’s really not nearly as glorious as they make it seem, believe me.  In fact, it’s sometimes downright monotonous and anticlimactic.  I have spent many nights in the E.R, and never have I seen situations like those that pop up on these shows before…not even close.

And I hate to say this, but not many doctors look like George Clooney or James Franco.  Don’t get me wrong, there are some good looking docs out there, but for the most part, we didn’t exactly give up a booming modeling career for a life filled with books and a stethoscope, Dr. Oz included (sorry, Dr. Oz).  So why this strange obsession with all things medical?

As a physician I just simply can’t engage and find myself “hooked” on any of these shows for some reason – is it just me?  Perhaps because the very LAST thing I want to do is to go home and feel as though I am back at work.  I’d rather watch completely mindless television, where I no longer have to THINK when I come home.

Plus, I don’t know about other docs, but for some reason I lose interest quite rapidly when I see situations that I know would never realistically happen.  I mean,  what are the odds of having a pole stuck through two individuals who are awake, coherent, and having a full on conversation for hours in the ER, while the surgeons decide which of the two they should ethically (and I use the term loosely) save; because they can save only one, but of course.  Just can't get into it, crazy me.  I'm sure lawyers feel the same way when they watch law shows, mafia members when they watch mob shows, etc...no?

Here’s my running list of medical shows thus far (some old, some new):

Doogie Howser, MD
Grey’s Anatomy
Dr. Quinn Medicine Woman
Chicago Hope
Third Watch
Dr. 90210
Private Practice
Dr. Oz
The Doctors
St. Elsewhere
Boston Medical
General Hospital (I have to admit, my personal favorite)

Have any more to add?  Please share!

Monday, February 21, 2011

Mr. Noodles

Me:  “Mr. Noodles, your last blood test shows that your sugars are about 200 on average.  Are you taking your metformin twice a day as prescribed?” 
Mr. Noodles:  “I have to admit, Doc, that I have been skipping a few doses here and there.” 
Me:  “A ‘few doses’? How many days a week do you forget to take it?”  
Mr. Noodles:  “Ummmm….about five times a week.”  
Me:  “Five times?!  How about the cholesterol medicine I prescribed?  Your electronic chart reports that you never picked it up?”  
Mr. Noodles:  “Yeah, I haven’t started taking it yet, either.”  
Me:  “How about the baby aspirin?  Did you start taking that at least?”  
Mr. Noodles:  “Ummm…no.  No, I haven’t, Doc.”  
Me:  “Well, gosh, Mr. Noodles, then what made you come in here today?”  
Mr. Noodles:  “Well, I’m here because I’m having some issues with…well…performing.”  
Me:  “You’re having problems with maintaining your erections, Mr. Noodles?” 
 Mr. Noodles:  “Yes, exactly.  Why do you think this could possibly be happening, Doc?!  I can’t figure it out!”

About 50% of men over the age of fifty report experiencing erectile dysfunction, and only about 10% regain the functioning that they lost.  Poor diabetes control results in damage to the nerves and blood vessels that feed the male genital system, and eventually cause problems with normal male sexual functioning.

What is the best way to improve male sexual dysfunction in those with diabetes?  Prevention!  Work closely with your doctor to control your blood sugars in order to prevent this damage in the very first place!

Monday, January 24, 2011

Body & Soul Cleansing

It never ceases to surprise me what some of my patients are willing to put themselves through all in the name of health:

“That stuff I had to prepare me for the colonoscopy – can you give that to me again, Doc?  I need an entire body & soul cleansing, and I want to start with my bowels.”
The colonoscopy is a screen for colon cancer, one of the top cancers found in men and women.  Some people actually rather enjoy the preparation process, which is the most challenging part of the colonoscopy (not the actual procedure itself), like my patient above.  And yet some people rather dread the procedure itself (and not the preparation process), which is really the easy part!

But to be honest, the entire process is really not that bad.  My patients who refuse the procedure either tell me they are too "embarrassed" to have the doctor place a foreign object through their rectum, or are just plain terrified of any discomfort or pain they may possibly face.  But you must remember that the doctor who performs these procedures does them for a living -- one rectum is really not any different than any other rectum to the gasteroenterologist (as special as you may think yours may be).  Please do not be embarrassed.  And as far as pain, it is quite rare.

5 Colonoscopy Expectations:

To combat some of your potential fears, here is what you can really expect from a colonoscopy:

1.  A colonoscopy is a screen for colon cancer, that is recommended either:
     a.  starting at age 50
     b.  or 10 years prior to a first degree relative's (parent, sibling, or child) diagnosis of colon cancer

2.  The day prior to the colonoscopy, you can only drink clear fluids -- broth, black coffee or tea, Jello, etc.  NO solids.  Perhaps the toughest part of the entire process to endure.  But you can do it!

3.  You will be given a special 4 L container of a solution that you will need to chug, and chug quickly (about 8 oz every 10-15 minutes) the night before the procedure.  It will taste better if this solution is chilled.  This will give you the runs -- meaning, you will be literally running to use the bathroom constantly for about two hours after you start drinking the solution.  The goal is to run until it literally runs clear!

4.  If the preparation is not sufficient, then the doctor will be unable to catch a clear view of the colon walls, and this will decrease the validity of the test.  That means that polyps and abnormal spots on the wall of the colon will be potentially missed.  And you may need to go through the entire process once again!

5.  On the day of the procedure, you will be given a medication that will make you very sleepy.  Most people do not remember the procedure and are asleep for the entire thing.  As you can see, there is no need to be afraid!

Have YOU had your colon cancer screen?!

Tuesday, January 18, 2011

5 Tips to Keep in Mind When Reading Medical Websites

During my transition from public to private health, I have indeed noticed some interesting differences that have forced me to practice medicine a perhaps a tad differently.  One big surprise:  in private health, I have to admit that I have been pretty astounded to see that my patients quite heavily rely on the internet before they even come to see me for their given ailments. 

In public health, some of my patients were not even able to read, let alone surf the internet.  Many were not even able to afford a computer in their home.  My challenges there were not generally to find myself having to defend my practice of evidence-based medicine and to explain my medical reasoning on a step-by-step process, as I am doing now; all thanks to the internet.  The internet has truly made it seem as though it is a daily battle, to wrestle and knock out each erroneous pseudo-factoid out there.  No doubt about it, it has made my job harder in many ways.

But perhaps it’s not necessarily a public vs. private health difference, but more of an advancing-in-technology-with-time issue.  More and more patients seek the internet for health information and advice as time goes by – that is just the reality of medicine today. 

But unfortunately, most of the websites my patients are reading are unreliable, I have come to learn.  That is what scares me, not that they are actually yearning to learn more about their health conditions.  Sometimes, a little bit of knowledge can actually be a scary thing:

“Doc, I have this tingling in my hand for the last four days, and I am convinced it’s Lupus!”

“No way am I getting the flu shot – I saw that cheerleader video on YouTube!”

“I’ve had this back pain for two weeks now, and this websites says I need an MRI.  Can you order me one, Doc?”

“I am so afraid -- I keep gaining weight and I read online that it could be a growing tumor!”

So I have started to adapt how I practice now, and am actually enjoying and embracing this new challenge that advanced technology has thrown at me.  I love the fact that my patients want to educate themselves on their health conditions.  The more knowledge they have, the better they will take care of themselves I have learned (in general).  But I do encourage my patients to refer to some more reliable sources of health information online.  Here’s the list I give to my patients:

5 Tips to Keep in Mind When Reading Medical Websites

And when they are reading, I ask them to PLEASE keep these few tips in mind:

1.  In general, please be wary of any website with the ending “.com”, and opt for those websites with “.gov” or “.org”. 

2.  If you are reading info online that is starting to become frightening to you, that is your signal to turn the computer OFF and make an appointment to see your doctor instead.  Please do not continue to terrorize yourself, because most of the time, what you are reading is not what is really going on.  Nothing good can come from that.

3.  Always ask yourself, “Who is writing this article?”  Is it written by a physician?  Most of the time, it’s not.  Many online health articles are written by journalists with “special focus” on medical information – and what does that mean, ask yourself.  Whatever that means, it’s NOT typically sufficient enough to be giving patients medical advice.  They are primarily writers, designed to catch headlines and grab your attention, not medically trained professionals who have enough knowledge to give accurate advice.  The scarier and more controversial their writings, the more money they make.

4.  Find out who sponsors the article, and if the writer is affiliated with any entity that wants to sell you a product.  Does the author work for a drug company?  What are they trying to sell you? Be wary…very wary.  Where is this article written?  I mean, is Vogue magazine a reliable source of medical information?

5.  Anything you read is one dimensional.  The computer cannot solve complex medical problems that require a background of experience and human reasoning.  The computer cannot perform a physical exam, or feel your level of pain, anxiety, or whatever it may be with one look.  Medicine is complex, that’s why it takes a minimum of eleven years of school to become a doctor.  Otherwise, doctors would be out of a career. Trust your doctor.

"Technology is just a tool. In terms of getting the kids working together and motivating them, the teacher is the most important." 
-- Bill Gates

Tuesday, November 16, 2010

Doctors Are Human, Too

Two upset doctors in corridor after surgery

Since starting my new job, because I don’t have a full panel of patients yet, I have naturally been seeing more patients belonging to other docs in my clinic when they can’t get an appointment with them.  Most of the time, they are grateful to be seen by me, even though their doc is not available.  But sometimes they come in so angry with their doc for whatever reason it may be, ready to chew my head off:

“He doesn’t listen to me.”
“She made me come in today just to get my refill.”
“He gave me a bogas medicine that doesn’t work.”
“She couldn’t help me, and I doubt you can do anything, too. I don’t know why I even came in.”
“I hate doctors.”

Ok, I get it.  You are mad at your doctor.  Sometimes it’s a legitimate concern, and sometimes it’s a misunderstanding; and ok, so sometimes it’s completely warranted.  But why are you angry with me before you even meet me?  I am a nice person, gosh darn-it.  And I am eager and willing to help you. 

I don’t walk into the exam room mad at my second patient just because the first one gave me a hard time.  I don’t carry that emotion into that next visit with me.  I don’t generalize and think that “all” patients are mean and nasty just because a few are a tad less than courteous.  In the same way, not “all” doctors are mean and nasty just because you had a few who were a tad less than courteous.  We are all people – patients and doctors alike.  We all deserve common courtesy.

We have feelings, too.  It makes our jobs so much harder when we meet patients who are very angry.  It can really make or break our day.  We become doctors because we like taking care of patients, and generally have big hearts.  We care.  Really, we do.  I can’t say we are perfect, because nobody is perfect, but we do care and want to help.

So before you walk into your next doctor’s appointment (especially if it’s a doc you’ve never met before) please remember that doctors are human, too.