The Great Come and Get It Day

Health insurance has no more place in health care provision than does car insurance in the daily operation and maintainence of a car.
Health care can and should be entirely federally financed from public funds. All providers of health care should be salaried, with appropriate incentives, under federal auspices. That would eliminate excessive provision of care because of the greed of the provider.
"Malpractice" lawsuits, which are rarely based on negligence and commonly based on undesired and often unavoidable outcomes, should be banned. That would eliminate excessive provision of services in the name of "defensive medicine".
Then all that remains is to reign in unnecessary demand by the public for excessive services based on fear, ignorance, and panic.
Also eliminate the services provided to people who are simply seeking controlled substances, or who are interested in a three day weekend, but need a note for their employer, school, or other entity so that they will not be penalized for taking it. Or those who feel they have more discomfort than would allow them to continue to work as usual.
And perhaps also limit services for those people who inflict illness upon themselves by abusing drugs, alcohol, firearms, and motor vehicles.
What about those people whose benefit from the service is marginal, like the 105 year old who would like a bone marrow transplant for treatment of a recurrent cancer?
And who is to decide, and who will enforce the decision, to deny a "medical" service based on lack of "necessity". Will they be held harmless by the legal system if they are occasionally wrong, as they inevitably will be.
Will all care be rendered as requested, then unnecessary expenses recouped by a tax levied on the abuser and collected by the IRS?
As technology advances and allows more to be done over a longer life, how will the increased cost be funded? What if the cost results in taxes on average of more than 80% of your paycheck?
Perhaps a two tiered system, one private pay and one publicly funded, would develop to cater to those individuals whose desires are not considered needs under that authority we were talking about.
But there will always be the inevitable lawsuits, anecdotes about the poor helpless soul ill-treated by the system, and the tsk tsk tsk of the media.
So it isn't all so simple as "i was sick and i needed...." or "everyone deserves...."

Swine Flu

When pigs fly, swine flu.

A lot of people have it, it's a mild disease as these things go. So relax.

Wait until the real flu season. In an average year about 30,000 people in the US die of the flu. Judging from the way the media has been handling this mild outbreak, we'll be getting body counts nightly from October to February.

I Remember Mersa

No, not the girl you took to the prom in high school. MRSA - multiply resistant staph aureus. It used to be found in hospitals but now you can find it anywhere. Gets around, just like the girl you did take to the prom.

Well, just being exposed to it won't do anything. And even having it grow on you won't do anything, for the most part. You have to actually have an infection for it to matter.

But if you do have an infection due to MRSA, it doesn't mean you're in grave danger ("You said danger, I said grave danger, you said is there any other kind"). It can still be treated, but not by just any antibiotic.

So don't sweat it.

Second Course of Antibiotics

If you're not better after the first course of antibiotics, getting a refill and taking more isn't a great plan. Any germs you could have killed are long dead. The only ones remaining are the ones you couldn't kill with that antibiotic, and now maybe not with any others either.

Antibiotic Resistance

And in case you're worried about over use of antibiotics causing resistant organisms, we have this little tid bit: a high school science project revealed at least seven antibiotics in the Potomac River. It gets there because animals are fed antibiotics, they excrete them, and after the rain the run-off discharges them into the river.

So all the germs in the soil, the water, and the animals, get exposed to these antibiotics, and the ones that live are resistant and take over the world.

Forget about the one you took twice.

Patients Are Idiots Four

Not to be outdone by doctors, patients have worries about treatment of a respiratory infection that are specious too.

Amoxicillin is the antibiotic of choice to treat these infections, not the latest most expensive antibiotic to come down the pike. Its inexpensive, well tolerated, goes well with other commonly taken medicines, and more effective than many of the more popular designer antibiotics.

We've seen one case of pharyngeal abscess in a 17 year old boy which would have been a non-event had he been treated with amoxicillin rather than the super new antibiotic he received initially. Anaerobic bacteria are abundant in the oropharynx, and they are often the cause of this complication.

We've read of another similar incident in the well read medical journal, The New York Times, in which the 17 year old boy developed an abscess and subsequently Lhermite's sydrome (as Casey said, you could look it up), which resulted in his death.

Doctors Are Idiots Four

In contrast to conjuntivitis, most doctors will treat an upper respiratory infection with a negative strep test with Tylenol and little if anything else.

Which is too bad. First, there are other germs besides viruses and strep which cause these infections, and second, because four out of five people with upper respiratory infections due to viruses will develop secondary bacterial sinusitis.

You know the mucous you get (you see the little yellow guys in commercials all the time on tv). Well, its warm, dark, moist, and filled with the foods bacteria love best. And every time you breathe in, millions of bacteria find a new home there.

So antibiotics are a good bet from the get go, despite our academic background.

But if you don't get rid of the mucous too, with antihistamines and nasal rinses as well, you'll have a recurrence two weeks later.

And if your sinuses have mucous, because of allergies, you'll get infected.

The good news is that nasal rinses and antihistamines work, are sold without prescription, and generally don't have little yellow yucky guys in their ads.

Doctors Are Idiots Three

Pink eye. Conjunctivitis. What is it?

Although there are other causes of a red eye, by far the most common is a viral (or possibly allergic) origin.

Neither of those is treated with antibiotics successfully.
Tears themselves are antibacterial agents.
Why then do doctors reflexively prescribe antibiotic eye drops to treat it?

Why do some schools, places of employment, and even hospitals, require treatment for 24 hours with an antibiotic before returning to work? The patient will still be contagious, if its viral, and it can't improve the disease.

We think its because of fear, a form of ignorance. Doctors are not comfortable diagnosing or treating "the red eye". So they give people the magic bullet, hoping to cover all bases. But we've seen many people return with a chemical conjunctivitis from the antibiotic eye drops.

So better to make a correct diagnosis and treat the problem symptomatically.

Doctors Are Idiots Too

Have you had a swab of your throat done? Did you gag?

The same saliva bathes the pharynx, tongue, and the rest of the mouth. Is there any reason to think that the germs causing a sore throat limit themselves to the deepest recess of the throat? They probably entered through the nose or mouth in the first place. So why should they not be present throughout the oropharyngeal cavity (and maybe even in the sinuses and eustacian tubes - they're less than an inch away).

Couldn't you just swab the oral cavity somewhere near the back without inciting a gag reflex and achieve the same result?

We think you can, and it would eliminate a lot of unpleasant memories for the kids, young and old (and the staff too, if the patient is induced to vomit) while providing the same information.

But I've Known My Body for a Long Time

So there's no way our diagnosis or treatment can be correct.

You can probably drive a car too, but do you know how it works and can you fix it when it doesn't?

Do you argue with the mechanic who fixes it?

Anyway, we've been in practice longer than you've been alive.

So there.

My Wife Says.....

Husband is seen, or brings child to be seen. After a comprehensive visit where all problems are discussed and treatment is explained to the complete satisfaction of the responsible adult, wife/mother calls on the phone.

Rant:
"You didn't (insert phrase of choice - perform the correct test, provide the correct medicine, provide a referral to a specialist) and you should have. I'm going to report you to the (insert choice -Medical Board, Insurance company, Lawyer)"

What we wanted to say:
If it was that important, why didn't you accompany the patient.
Where did you get your medical degree.
How long have you been in practice.
How high is your malpractice premium.
Do you know its a felony to practice medicine without a license.

What really happened:
A letter of explanation is sent to the medical board in response to a notice of investigation of your practice to determine why amoxicillin instead of azithromycin was prescribed for a sore throat.

Malpractice premium rises as a consequence of an inquiry by the Medical Board

It Hurts Me Here....And Here....And Here

When we were in medical school they called it the "Maladie du Petite Papier" wherein someone, usually a woman, would unfold a piece of paper with dozens of complaints to discuss. We were warned to move these people out as quickly as possible; they were nuts.

Now we ask our patients to write down their questions before the visit so we can cover all their issues and not be repeatedly interrupted after they leave with phone calls posing questions they forgot to ask.

I Have the Worst Pain....

And have for years. But my back specialist, or regular doctor, or oncologist, isn't available today.
Or
I'm from out of town, and can't reach my regular doctor.
But I have a copy of my MRI, or pathology, or a note from my doctor....

Give me some Percocet. The higher dose pills. Enough for three months.

Of course when you as a doctor refuse the request, they rant, curse, threaten, and refuse to pay for the visit.

Like that will endear them to you and gain your sympathy.

That Antibiotic Doesn't Work For Me

Apparently germs in this individual are different from those in anyone else. Or perhaps they mutate to a unique form immediately upon encountering the privileged individual.

But Doctor, There MUST Be Something.....

The truly sad lament of the patient with serious illness who has exhausted their therapeutic options.

To our great dismay, there are many things we simply cannot cure.

Mal-Appropriate Medical Terms

I had.....
the weasels
roaches of the liver
sick as hell anemia
chicken pops
special mighty Jesus

Don't give me a genetic drug.

I had a destructomy.

And a new addition: cafe latte spots

An Antiobiotic Can Cure Anything

Including a twisted ankle.


Really. Just ask the patient who told me so.

My Aunt Had a Fever and Turned Out to Have......

Leukemia. Or cancer. Or a leg removed. Whatever.

Fever apparently is such a unique sign of illness that one can diagnose any number of diseases simply from its presence.

Wish I'd known that.

My Friend at Work Says ......

Expert opinion on any illness, symptom, or sign. From the other guy who works at the job.

Clearly superior in knowledge to the physician. I wonder why I spent all that time in medical school, residence, and fellowship, let alone 30 years of practice and mandatory CME, when I could have simply worked at another job and gained such expertise.

Every Rash is Poison Ivy

People are familiar with poison ivy, but not with other rashes. So every rash becomes poison ivy in their view, and they reject any suggestion to the contrary.

I guess if all you know about is nails, everything you pick up is a hammer.

I Never Had That Before

The way some people object when you make a diagnosis they don't agree with.

Of course not having had some disease previously is not a guarantee that you won't ever get it.

I've Been to Seven Doctors and None of Them....

The cry of the woebegone with a complaint whose origin cannot be detected despite thousands of dollars of high tech testing and specialist consultation.

But remember, even a crock gets sick.
"I told you I was sick" is inscribed on this one's tombstone.

Thank God its Not Strep

The mantra of the sore throated. Of course, if they did have strep they'd be cured overnight with antibiotics. But if its a viral illness, no soap. But thank god its not strep.

And a sore throat is not only strep or virus. There are other germs too. So an antibiotic might be useful even if the rapid strep test is not positive.

The Sore Throat

"I think I might be getting a sore throat....I think....for the last hour or so".



Yep, a real quote, and not from just one patient either. About three times a month. The younger the patient, the higher the socioeconomic level of the patient, the earlier in the illness they complain.