Follow up: Big Companies Behaving Badly

Or: Comcast, Where Are You?

Several weeks ago, I posted a rant about Comcast and the difficulty I was having with their customer service department.  I received a reply from someone apparently in the national office.

It took me a while to get back to this person. 

Evidently using the e-mail address he left me gets the same sort of answers that I got when I called my local Comcast office. 

NONE!

It has been a week. 

Comcast, Where Are You?

That might work. 

Leave me an address I can use.

A New Year’s Wish – Medication Lists

This is something I have done for myself.  As a physician, I would wish that every person who has any medical problems would do this for themselves, too.

Please make a list of every medication you take.  Copy the name of the medication off the bottle.  If you get them from different doctors, write down the doctor’s name.  Write down the dose of the medication.  How often do you take it?  What do you take it for? 

Here’s a chart that you can copy or use notebook paper to set up:

Medicine Name	Dose	Directions	Reason	Doctor’s Name

Add as many lines as you need.  Mine is over half a page.  It wouldn’t hurt to write your allergies on the bottom or the other side.  Also put down a contact number in case you are in an accident and are unable to talk.  Your primary doctor’s name and phone number would be nice on there, too.

If you put this paper in your wallet behind your driver’s license, it will be available for any emergency personnel.  It will also be available any time you go to a new doctor or hospital. 

I tend to forget at least one of my medications when I’m stressed.  I know I’m not the only one.  I’m especially bad with the newest ones.  I actually told my medical doctor I was on the dose that was purple.  I was sure it was 20 mg; he thought it was 10 mg. We had to open up sample bottles to figure out which one it was.  I was right. 

It would save medical people lots of time if everyone would take a few minutes and write down their medicines.  I keep my list in my computer in a table like the one above.  If you don’t know how, get your kids or your local computer geek to show you how.  We will all be glad you did.

“Out of Peanut Butter and Jelly Sandwiches, Mom”

Mr. Impatient has learned to make his lunch for school.  This morning he hollered up the steps:

“Out of Peanut Butter and Jelly Sandwiches, Mom.”

“What?”
“Out of Peanut Butter and Jelly Sandwiches, Mom.”

“Do we still have bread?”

“Yup.”

“Do we still have jelly?”

“Yup.”

“Are we out of Peanut Butter?”

“Yes, Mom!”

“I’ll be right down to show you where the extra jar is.”

I also showed him how to scrape the jar and get another couple of days out of it.  And we put PB on the list for our next shopping day.

This is almost word for word the conversation we had this morning.  I’m not exactly positive, because I hadn’t had coffee yet. 

Autistic minds are just a little different.

For Mr. Impatient:

Around the Web – Doctors on End of Life Care

This is an interesting article that a doctor friend of mine shared on a web site I spend entirely too much time on called Sermo. http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/ 

The article is written by a physician.  He talks about those of us who know what all those end of life interventions mean.  Things like CPR, or having a tube in your throat and being on a respirator….   We know the side effects.  We know the risks and benefits.  Some of us have spent our professional lives trying to help patients make the same decisions that we would now be facing.  We administer those treatments. 

I remember a conversation I had with MY mother.  Her father was a physician.  My grandpa sat her down one day and told her that HE didn’t want all those machines when it was his time to go.  He knew what he would face if his relatives wanted to “do everything”.  It was not for him.  Mom felt the same way.  She died at home with hospice. 

I think the article is thought provoking.  I’ve had this discussion with my family.  Think about it.  Have the discussion with your family.  It’s awful when family starts arguing when a member is terminally ill. 

“I’m on to you” – a patient who “only lied about one thing.”

“I’m on to you” – a patient who “only lied about one thing.”

Today I saw a young female patient with two children.  She supposedly has chronic pain after an accident. I "inherited" her after her last pregnancy. Her OB doctor maintained her on narcotics during her entire pregnancy, then discharged her. I have been seeing her for 5 months. She does have pain, but it is not pelvic.

Technically she should be seeing an orthopedist, but they won’t take her insurance. She has that "good insurance" (Medicaid). I don't participate anymore (you can all clap now) so she pays me CASH. I have been trying to get her to the University to see orthopedics since summer. She has had every excuse in the book.

She has been to the ER twice since she has been coming here. Both times there have been “issues”. The first time she was accused of child abandonment. Both times she was apparently inebriated.

Her story today about the injury that took her to the ER was different than what she told the staff and Doc there. I know for a fact that she was in jail for 7 days for domestic abuse since she was here. I had a call from child protective services yesterday about her.  They are concerned about her children and considering removing them from the home.

She has failed every urine drug screen since she has started here. On discussion today, she really doesn't like that Clonazepam. She just can't feel it. (She was on Xanax when she came here. I won't prescribe it to new patients). So she doesn't take it, and doesn't tell me she's not taking it. Her last two urine screens were negative for it. Others had other problems.  For non-medical people, Xanax is a medication that is used for “anxiety”.  It works fairly fast.  Apparently there is a good feeling with it.  Clonazepam is used for the same thing.  It is long acting, and has no rewarding “good feeling”.

I discharged her today in the office. Gave her 30 days of meds and sent her on her way.  My state requires 30 day notice before discharging a patient.  It’s a stupid rule in my opinion, but it’s the law.   She was shocked. "But I only lied to you about that one thing!" She tried to negotiate for staying without the Clonazepam. Then she wanted to stay "just one more month". Then she wanted to know if I would write her medications for her withdrawal when she got to the end of her prescriptions. 

I hate being manipulated and lied to.  She continued to try with a phone call about something after she left.  “I’m on to you!”

Teenager Audio Reception Problem

Do You Think I’m Talking Just to Hear Myself?

I’m sure every parent has had this problem.  I have asked my children to do the exact task for the last three or four days.  It isn’t difficult.  It is something I am not physically capable of doing.  Last night I specifically asked to have it done after dinner.  Again. 

What I asked them to do was restock the refrigerator in our garage with drinks so we would have cold beverages.  This is not hard.  But I am having issues with postural hypotension from medications, so can’t deal with it right now.  

Evidently they each assumed the other one was going to do the stocking.  This morning, when I went out to get our morning drinks “to go”, there were none in the refrigerator. 

Do you want to know how mad I was?  This was not the way to start my day.  I got some wimpy excuses on the drive to school, but nothing to make me happy.  I discussed communication, since they had not discussed it.  They just both assumed that the other one was going to do it.  We will have to have a “sit down when I am not angry.   I discuss stuff better when I am calm. 

That’s something I have learned over the last (number deleted to preserve my dignity) years. 

Autism, the I-Pad and Speech

Personal Reflections

I just watched a story on 60 Minutes about how some schools are using the I-Pad to help autistic children communicate and learn.  It doesn’t work for all of them, but it does work for some.  Most of these children were small.  They looked to be between 4 and 7.

I remember the frustration of trying to unlock communication.  My autistic son didn’t start speaking until he was around six years old.  We tried all kinds of different things.  American Sign Language (ASL) was helpful.  I think something like the I-Pad would have been wonderful if it had been available at that time.  Mr. Impatient is a whiz at computers. 

There were several mothers who talked about how difficult it is to not be able to understand what is inside those little guys.  I could see the tears welling as they talked about their precious children.  Any small progress is like moving mountains.  In fact, I started tearing up as I watched this program.

I still remember the very first time my son said “I love you, Mommy.”  It was one of the sweetest moments.  I waited a long time to hear it.

Comments Are Fixed!

Comments appear to be fixed – and I didn’t need my high school friend.  Try it!  You might like it.  I would. 

Thanks in advance.  Dr. Lasermed

If not - e mail at lasermed@gmail.com Thanks.

Communicating With Your Doctor 101

The Importance of Two Way Conversation

Many people are nervous or concerned about talking to their doctors.  Remember, we are here to help you get better.  The best way to do this is to have good communication.  It is important that you are comfortable telling your doctor everything that he or she needs to know about your medical problem.  Sometimes this is difficult on your first visit.  Hopefully this visit won’t be about a particularly sensitive subject. 

A good time to get to know your doctor is at a first visit for a physical for sports, school or other “annual” examination.  Since I am a gynecologist, this often is for a Pap smear and either scheduling a Mammogram, discussing hormones or birth control, or discussing other wellness issues.  You can discuss health issues that you are concerned about, like a family history of heart disease or osteoporosis, and get some recommendations about what things you can do to keep yourself healthy. 

Your doctor will want to get to know your history.  If you are older (like me), on many medications (ditto), have had several surgeries (sigh!), you might want to sit down before you go to the office and write all of this down.  You know you are going to be asked about all this stuff.  The older we are, the more there usually is to tell, and the longer it takes to fill out those forms.  I also have problems remembering dates for surgeries and doses of medications.  It doesn’t hurt to carry some of that information in your wallet or purse in case you need it in an emergency. 

We are also going to want to know whether or not you have any allergies or reactions to medications or other things.  An allergy is different than a reaction.  If you are not sure which it is, write down what the medication is, and what happened.  For example, Benadryl (a common over the counter antihistamine) will often make people sleepy.  This is a known reaction, not an allergy.  If, however, it makes you short of breath, slows your heartbeat, and someone had to do CPR, then you are allergic to it.  That itchy, red, bumpy rash is an allergy, too.

Things that you need to be prepared for the doctor to ask about include: smoking, legal and illegal drugs, sexual problems, birth control, urinary incontinence, domestic violence and sexually transmitted diseases. You should be honest about these. You may choose not to discuss these on the first visit. That's fine.  Your doctor is working on the information that you have given him or her. If you are not completely honest with your doctor, they cannot necessarily help you.  But don't wait until the doctor is on the way out the door to bring up a sensitive problem like pain with intercourse, loss of urine with coughing, or abnormal discharge. We need to address these problems before we do our exam, not after. If you bring them up at the end of the visit, you can guarantee yourself another visit.

You might want to write down a short list of questions you want answered. Remember that you only have a limited amount of time with the doctor, so limit the questions.  You should probably write down what the doctor recommends or ask to have written instructions. That way, you don't forget.

Then try to follow the directions.   If you can't, you need to be honest about why you can't. We as physicians assume that you did what we advised you to do and are still doing it. If you only took one month of your blood pressure pills and stopped, your blood pressure is going to go right back up. If your medications make you feel funny, call and make an appointment. If you took the hormones incorrectly, you will probably bleed. I can't fix it if I don't know what you really did. If you can't afford a medication, let me know that, too.  There are sometimes cheaper medications or places I know that sell medications cheaper.  Don’t be embarrassed.  I can often help. 

My oral surgeon tried to give me a medication that I was supposed to take 4 times a day.  I have three teenagers and a medical practice.  I bluntly told him that there was no way I could remember 4 times a day.  He thought about it for a minute and gave me a different medication that was twice a day.  Problem solved. 

Please call the office during regular office hours unless there is something really major wrong or your doctor told you to do something else. Remember that doctors usually have families and lives outside of the office. We tend to be asleep at 3:00 AM (unless we have newborns, in which case we don't really want to talk to you about your blood pressure medication at that hour either).

Also, don't insist on speaking to the doctor when you call the office. Most of the time the nurse or medical assistant can help you, or will speak with the doctor and call you back. If you need to speak with the doctor, you may have to wait several hours. S/he is probably trying to keep on time in the office. Some doctors have designated phone hours.  Or you may need to make an appointment if you need to talk to the doctor.  Ask when you call.  Your doctor is probably trying to keep the office from running behind!

I hope this has answered some of your questions on how to communicate with your doctor.  Most of us want to work with you to make you better.  I’ve tried to give you some help joining the team.