Stereotypes and diseases – only guidelines

Gout is that disease that old men who drink lots of wine get, right?  Their big toe gets sore and they get cranky.  It’s not supposed to run in families. 

I just love stereotypes.  My first gout attack happened in my early 40s.  I had switched some medications around and developed pain in one of my ankles.  I had no idea what this pain was.  I went to see my orthopedist about my knee.  I asked him about my ankle and, voila! A diagnosis of gout. 

Female

 Just barely in the age range (40-60)

Positive family history

Ankle

I get .25 out of 4.  But I still have the disease.

I learned about gout, which is controlled by diet mostly.  I behaved myself, and didn’t have another attack until I had an “indiscretion” around my 50^th birthday.  Everyone asked what I wanted for my birthday, and I answered “lobster”.  Not a good thing in my situation.

I have been really good since then.  The pain is so nasty that I’ll do anything to avoid it.  I have no idea why my MIDDLE toe turned red and got really sore a couple of weeks ago.  I thought I had an infection.  Gout never hit that joint before.  And I have been behaving myself.  Really.

Walking has been “exquisite pain”.  That’s a lovely doctor’s phrase.  I’ll let you all contemplate what that means.  I understand why the pictures have the old guy with his foot up.

Just remember, stereotypes don’t always fit the disease.  Remember that the disease doesn’t always manifest itself the same way every time. 

I’ll go heat my foot and take my new medicine.  Just contemplating going upstairs (ouch!)

Differential Diagnosis – Mom of Toddlers

When my children were little, one of my favorite parts of the day was right after I came home from wherever I had been.  The three little guys would drop whatever they were doing (unless they were eating) and come running.  It was “climb on Mom time”.  Literally.  

As they got bigger, I learned to sit down on the floor as soon as I could so we could have our “group hug” / “pile on Mom” without me getting hurt.  I still would end up with bruises from feet and hands grabbing.  I considered them badges of honor.  We would roll around and hug and tickle.  I got to hear the laughter and excitement of my little guys. 

I also spent lots of time getting my glasses adjusted from getting them grabbed or knocked off.  I stopped wearing jewelry for quite some time because it was so fascinating to little hands. 

Now you know how to tell those Moms of toddlers – no jewelry, bruises in funny places, often a short haircut or hair pulled up, dark circles under the eyes, a little disorganized, speaking in “small words”, correcting your grammar, and always talking about their kids. 

It’s a phase.  I wouldn’t have traded it for anything in the world. 

Medical Office Quandaries – 5

My Patient Said What?

There are days when I just don’t believe the nerve of some people.  I have been a doctor for a long time.  When I started practice, we were just at the end of the era where the doctor knew everything.  Patients didn’t dare question what they were told.  They took their medicine, did their exercises, and had their tests or whatever.  They came back and told the doctor what happened and then did whatever they were told to do next.

Ah, those were the days.

Times have changed.  Now patients often have learned something about their problems before they come to see the doctor.  Our patients have access to the internet.  They are taught about their bodies and body systems in school.  Sometimes they didn’t get the whole message, but at least there’s a foundation to build on. 

Still…..

1.     Unless you have a PhD in anatomy, don’t argue with me about where something is in your body.  99+% of the time you will be wrong. 

2.     Don’t tell me it “has to be” some kind of disease unless you have the lab work, x-ray or pathology report in your hand.  I may very well disagree with the doctor you saw before.  I may have different information. 

3.     I will usually disagree with Aunt Mable, Cousin Herbert or most of your relatives, unless they have an MD after their name and have examined you.  Talking to you over the phone does not count.

4.     Anyone that tells me that “you’re a doctor, you have to…..” will generally be shown the door.  I have a medical license to maintain.  I do what’s best for my patients.  I have to follow the law and my best judgment.  Period.

5.     We spend a lot of time and money training and learning our craft.  Four years of medical school after college.  Then residency (three to eight years), subspecialty training for some, and continuing education all the time.  Then we keep doing what we were trained to do.  We do expect to make more than minimum wage.

6.     Remember that what you pay at the front desk covers more than the doctor’s fee.  You are paying the nurse, the receptionist, the cleaning lady, the lab person, the lawn guy, the tax man, the electricity, the computer, and on and on.  Sometimes, depending on your insurance, there is no money left for the doctor.  So don’t:

A.   Stop payment on your check

B.   Cash your insurance check and not pay the doctor

C.   Forget to tell the office that your insurance was cancelled or changed

D.   Refuse to pay your deductible or co-pay when you are in the office

E.    Argue with the office about what the insurance paid

All of those things have happened to me.  Sometimes the amounts were significant.  They destroyed my relationships with those patients.

I’m not saying it’s time to return to the old days.  But I think a little mutual respect is in order.  Doctors are professionals.  We provide our knowledge and our skill.  We try to treat our patients with respect.  We expect to be treated with respect in return.  We also expect to be paid for our time and skill.  You can “vote with your feet” about your care.  If you are not happy, don’t come back.  Consider, however that your doctor could have been right.

Telephone Diagnosis

Why Your Doctor Needs to See You

There are many times when patients call the doctor’s office about a problem that they want to have treated over the phone.  This leaves the office “in a pickle” for several reasons. 

If this is a new problem, we have no idea whether or not your diagnosis is correct.  I have had patients call with “a yeast infection”.  When I start questioning them, the symptoms are indeed “down there”, but do not sound like yeast.  When they come in for an exam, they may have a bacterial infection, a bladder infection, herpes, a sexually transmitted disease, a chemical reaction or a number of other things. 

If I treated the “yeast” over the phone, the patient would not get better, she would waste her money, and she would be miserable for a longer period of time.  Besides, she can give some of those things to people that she is very close to.  Nope, better to have her come to the office. 

What about a patient who calls and says “my asthma is acting up and I need my inhaler called in”?  Is it asthma, pneumonia or even heart failure?  Sir, can you put the phone next to your lungs and breathe deeply?  Yeah, right.  Better come in so your doctor can listen to your heart and lungs, check for swelling, check if you have oxygen in your tissues and all that stuff that internists do. 

We are all concerned about the cost of medical care.  Most doctors work hard at keeping costs down.  We are aware of the costs of testing, medications and hospitalizations.  However, if you catch something early, you can avoid significant expense later.  I even keep the local pharmacy $4 and $5 medication lists on my desk so I can pick the least expensive medications that will work for your problem.

A doctor’s office visit with EKG, Chest X ray and some lab work is cheaper than a week or two on a ventilator in the ICU for severe pneumonia, right?  Treating that infection with the right medication the first time saves time and discomfort over multiple treatments with the wrong medication.  It also prevents possible spread.

I don’t want my patients to get sicker because I missed something by treating a diagnosis made over the phone.  Medical care is available 24 hours a day somewhere if you really need it.  Don’t take the risk of a wrong self diagnosis.  See a doctor.  We went to school for that.