What’s So Funny Today?

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On Tuesday, my writing class suggested that for the next class we should all write something funny.  I left the class and started to rack my brains for something funny to write about.  I even thought about rewriting one of my other blogs.  However, I have a goal to come up with at least one original writing each week.  The thought of rewriting an earlier blog seemed like cheating.  After a fruitless mental search, I was willing to sacrifice creativity for humor.  But not one of my 900 or so blogs struck me as funny and something that I could rewrite.  I would have to come up with a new idea.

41Ug6TO4iwLI remembered from many years ago, a leader at a support group that I belonged to advised me that I should have more humor in my life.  I asked him “Do you know any good books about getting more humor in one’s life.”  He laughed, “You can’t read about humor, you have to do it.”  The thought has often struck me over the years that it is one thing to read about things, it is another thing to do them.  Could it be, I am just a writer and not a doer?  Was it still possible that I needed more humor in my life.  Maybe a clown I am not?

I brought the subject up to my spouse Karen and she reassured me that I am often very funny.  I know that I can be very sarcastic.  Like the time that I told the woman sitting on the plane next to me that maybe the human race was going to be extinct soon like many other species.  Why did she think that we had any superior reason to inhabit the earth when many other species have already perished?  “Climate change” I told her “Proves that we cannot take care of the earth.”  She gave me a truly angry look and went back to reading her book.  I suppose she was reading some tome about “How we can save our planet in nine days or less.”  I doubt that she thought I was funny.

Over the last four years, I have laughed often about Donald Trump, Republicans, Trumpists, Trump sycophants, climate change deniers, power hungry politicians, greedy lawyers and lying real estate developers.  My top three lying groups include the aforementioned individuals.  Can you guess which are my top three?  My laughing at these groups has come from my incredulity at the things they say and do.  I could never have thought that there was so much stupidity in the human race.  Is stupidity funny?  Does laughing at stupidity give one a sense of humor or a sense of sadness?

A few hours after my writing class this week, I was stricken with some type of intestinal gas attack.  It was very painful and not very funny.  I did find some humor in this attack which I would like to share with you.  I think this might be a genuine bit of humor, but I want to know if you find it funny.  If so, I will consider this writing effort a success.  It might prove that I can find humor in my life even if it be in strange places.

gallbladder-painA year ago, (June 2020) almost to the day, I had a sharp pain in my chest.  I fell to the floor and passed out.  I know that this is not very funny but stay with me and I will get to the funny part.  I promise.  Karen thought I was having a heart attack and she called 911.  They came, attached an IV to my arm and I had my first ever ambulance ride to the emergency clinic in St. Croix Falls.  After a blood test, an Ultra Sound, an X-Ray, and a CAT Scan, they decided that I had a Gall Bladder problem.  Three hours later, I was sent home with an appointment for the next day back at the hospital to see a doctor.

I arrived for my appointment and was met by a doctor who told me that I needed to have my Gall Bladder removed.  Now, I am not against surgery, but I have often advised and written on the perils of rushing surgery.  I have spoken my thoughts many times about the hasty and frequently unneeded surgeries that the medical profession pushes on a naïve public.  Thus, I argued about the need for surgery.

My point was that they did not know what caused the Gall Bladder attack.  They had no evidence (since the Gall Bladder was too swollen to see anything) if I still had any potentially dangerous Gall Stones waiting to attack me again.  I suggested a second Ultra Sound in a few weeks when the swelling had subsided.  I was curtly advised by the doctor that they could not do another one and that either I got the surgery or not.  The surgeon was available the next day.  I decided not and left the room.

Subsequently, I was advised by friend and foe alike that Gall Bladder surgery is a breeze and I had nothing to fear.  “You don’t really need your Gall Bladder.”  Disdaining all this well-intentioned advice, I stuck with my decision to keep my Gall Bladder.  The coming year went by event free except for the Covid 19 Epidemic.  Nothing funny about that.

As I mentioned earlier, just after my weekly writers’ class, I started to get gas in my chest and a pain in my lower right side.  I sometimes get gas pains after eating but I had not eaten anything in several hours and the pain was not in my abdomen but more in my chest.  It was just under my right ribs exactly where the Gall Bladder pain was one year ago.  It continued to increase.

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By 11:30 PM, it was apparent that I was not going to be able to sleep so following some advice I read on the Internet, I grabbed a hot ginger tea and went for a walk.  I was accompanied by Karen who wanted to make sure she was around if I passed out again.  Going for a walk in Frederic Wisconsin at Midnight was very surreal.  We met only one other person.  It was a local police officer accompanied by a canine companion.  The dog acted as though we had just robbed the First National Bank of Frederic.  The police officer pulled him closer and announced that his dog was often suspicious of strangers.  I suppose an old lady and old guy out at midnight would constitute “suspicious” strangers.  We continued our walk.

I felt somewhat better by the time we got back home.  I laid down and the pain started to come back.  In a short while, it hurt too much for me to find any sleep.  I sat up and tried to read but could not concentrate.  I tried to think of something funny but still had no luck.  Funny would not come.  Eventually, I managed a long night of quite restless sleep.  When I woke the next morning, we called the local clinic for an appointment.  They gave me an appointment at 11 AM that same morning at the Frederic Clinic in town.

frederickI saw a Physician Assistant at the clinic.  He was polite and thoughtful.  He gave me some rudimentary tests.  A little prodding and touching here and there.  He then advised me to go to the Emergency Department at the St. Croix Medical Center.  He said the Frederic Clinic was not equipped to do the more complicated tests that I would need and that I should get these tests done immediately..  He suggested that it might be time to get rid of the unneeded and problematic Gall Bladder.  I was quite ready to agree.  I had managed to keep my Gall Bladder for almost 75 years.  It had a good run, and perhaps it was time for it to retire.

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Karen and I drove down to the St. Croix Medical Center, parked our truck, and walked into the Emergency Department.  They greeted us very warmly and after the usual administrative stuff and a brief wait we were ushered into a patient room.  A friendly doctor came into the room.  A few brief introductions and then he listened as I informed him about my past history with this Gall Bladder.  I conceded that I was ready to have my Gall Bladder removed. They could get the 37,000 dollars that Medicare reimburses for such a procedure.

He nodded wisely and then described the tests that he wanted to have done.  These included several blood tests and an Ultra-Sound.  Unlike the previous doctor from a year ago, he did not seem anxious to remove my Gall Bladder.  He concluded with, “Let’s wait and see what the tests show.”

57171431-cartoon-wise-old-doctor-gestures-and-emotions-After a short wait, I was brought by wheel chair into another room.  I laid down on yet another bed.  A new nurse (or was it a technician) came into the room.  I assumed that she was going to perform the test.  Someone else brought the apparatus for conducting the Ultra Sound into the room and left.  The nurse or Ultra-Sound Technician started to poke and prod me with a rod connected to the machine.  This increased my burping considerably and went on for longer than I had remembered a year ago.  I guess they wanted to be really sure this time that I needed my Gall Bladder removed.  I was resigned to this eventuality.

After the test was over, I rested in bed for about ten minutes before the friendly doctor I had seen earlier came back to see me.  He had a big smile on his face.  I figured for sure that he was thinking about his share of the 37,000-dollar operation that he was about to perform.  As they say at comedy shows, “Give it up for the Doctor.”  Or as my mom used to say, “Every dog has its day.”

“Well,” he started “your Gall Bladder looks great.  No evidence of swelling or gall stones.”  I could not believe my ears.  Was I hearing him correctly?  Something stopped me from asking if he was kidding or trying to be funny.  He looked profoundly serious.  Could they have made a mistake?  Did they really want me to keep this Gall Bladder for another 75 years?  What about the 37,000 dollars?  No surgery?  “Nope, just go home and take some Maalox and you will be fine.”  He then apprised me of the fact that I had some fat on my liver and that I should watch my fat intake more.  I wondered if he had any advice on how to get rid of a fatty liver.  How about surgery, I was tempted to ask but decided against it.

Do you see the humor here or the funny part?  It strikes me as exceedingly funny.  First they want to take my Gall Bladder and I refuse to give it.  A year later and I want them to take my Gall Bladder and they don’t want to take it.  Should I call it the “Miracle of Peake Street and the Cured Gall Bladder?”  Would it start my qualification as a saint in the Catholic Church?  Old guy goes from faulty useless Gall Bladder to healthy like new better than ever Gall Bladder?  I think some of the official Catholic saints had less going for them than this.

Well, as Porky Pig said “Th-th-th-that’s all folks!”

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Where did the Drug Crisis Start?

Where did the “Drug Crisis Start?”  Since 1980 deaths from drug overdoses in the USA have steadily increased every year.  In 1999, the per capita rate of drug deaths (Based on 100,000 people) was 6.1 for all drugs while the rate of deaths from opioids was 2.9.  In 2017, the rate was 21.7 for all drugs and 14.9 percent for opioids.

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Why are so many dying from Opioids?

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This article in the Guardian states that the main reason for the increases was the epidemic created by the pharmaceutical industry in pushing drugs for pain relief for very common problems such as arthritis and back pain. 

Thus, while we arrest drug dealers, the real culprits go scott free and become billionaires on the suffering of the US population. 

Certainly there is a causal link between an aging population, increased obesity, back pain, prescription drugs and drug deaths.  But as we should have clearly seen even twenty years ago, the solution is not more PAIN Killers.”

It should have been obvious to the doctors, pharmaceutical executives, FDA and all of our political leaders.  However, truth and reality are too often forgotten when it comes to making profits.  Greed trumps all other considerations and millions of Americans have become hooked on painkillers to alleviate symptoms that can often be treated with much simpler and more effective solutions.

Why a Health Advocate Is Your Most Important Health Care Plan!

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This is the final article in my series on health care.  This article has been preceded by nine other articles.  There is no need to read them in order but if you have not read the other nine, you will be missing a good deal of information that just might help you live longer, healthier and happier.  As I finish this series on health care, I am gratified that over the ten weeks I have been writing about the subject, I have found only more evidence that confirms the advice and opinions I have given in this series.  In this final article, I want to talk about how important it is to have someone as an advocate when you enter the health care system in this country.  Let me tell you a personal story that illustrates this point very well.

Several years ago, my sister lay dying in hospice care.  Hospice care is a gentle humane way of helping ease out a person who is at deaths door.  By gradually increasing their doses of morphine, the patients’ bodily functions will eventually slow down and finally cease.  If a patient is accepted into hospice care, it is assumed that they are terminally ill.  What might be a slow lingering painful death without hospice, becomes a respectful and hopefully painless termination of vital processes and death.

My mother went into hospice care in 1994 and died in three days.  She had a terminal infection which was beyond treatment.  We (sisters and brother) sat with her until she expired.  My sister Sheri was also accepted into hospice care in 1999.  She was only fifty-one years old.  She was considered terminal due to her advanced cancer.  As a family, we began another vigil waiting for my sister to succumb to the cancer and morphine.  However, things did not go the same path with my sister.

We noticed that she would seem to come in and out of consciousness.  Often, when she came out she would seem quite rationale and even energetic.  The nurses did not seem to pay much attention to these episodes.  One day, the morphine drip somehow came unplugged.  My sister became quite lucid and wanted to know if it was time for her to do taxes.  She did not seem like a patient near death.  We demanded that they take her off the morphine.  This met with much resistance as I assume they thought my sister would be in great pain and that we would be the instigators of a now painful as well as inevitable death.  Such was not the case.  My sister revived and seemed very healthy.  In a day or so she was out of the hospital.  She moved in with my sister and lived another three years before she passed away in 2002.  The next three years were not always good ones for my sister but we never regretted the decision to take her out of hospice.

Advocacy-bannerThe point of this story is that if we had not been siting vigil at my sister’s deathbed, we would not have been able to prevent a premature death.  This is merely one example of the value of an “advocate” when you must go to a hospital.  I am sure everyone reading this blog has at least one example that highlights how important it is to have someone as an advocate when you are in the hospital.

A health advocate is a family member, friend, trusted coworker, or a hired professional who can ask questions, write down information, and speak up for you so you can better understand your illness and get the care and resources you need – giving you a peace of mind so you can focus on your recovery.

Nurses, doctors and staff all want to do a good job and provide wonderful healthcare.  However, our health care system is under tremendous pressure to cut costs and reduce expenses.  This translates to less time available to care for each patient.  Less time that a nurse or doctor can spend with each patient.

advocateAn alarm might go off in an intensive care room but not be noticed for quite some time.  I have personally observed many times when a patient needed to call someone for assistance but no one came.  Unable to get out of bed, a patient may have to wait a long time before someone is finally able to help them.  In many cases, an advocate in the room can help a patient with minor personal needs.  If more severe needs exist, the advocate can be of assistance if finding someone to help and making sure that the patient needs are not overlooked or even forgotten.

Advocates assist people with making sure their rights are respected. They help consumers to resolve complaints about health or disability services. They operate independently of government agencies, the Health and Disability Commissioner, and the funders of health and disability services.

70b2adaac53bf082bb116c279362275c_advocacy-clip-art-clipart-download-advocacy-clipart_1822-1415Another function an advocate can provide is to stand up for the patient when needed.  Most of the time when we are feeling sick or hurting, we are in no position to stand up for what we need or want.  In such instances, a patient only wants the pain to go away.  Hospitals and health care providers often have needs that transcend the needs of the patient.  The patient that must play second fiddle to a variety of administrative and financial procedures.  Another example might clarify this.

Three years ago, I went to the Mayo Clinic for prostate surgery.  The surgery went fine and I was sent to a room for recovery.  The night passed as most do in a hospital.  Interminable interruptions for pills, blood tests and getting up to walk the surgery unit for exercise.  The night nurse was polite and helpful.  She left sometime after 7 AM and a new nurse came on shift.  She immediately informed me that I had to be out of the room by 12 PM and I should try to do more walking.

I had thought that I was doing a great job of getting mobile but I had not met my new nurse’s standard.  I started to try to walk more and meantime I became fixated on the clock in my room.  I still felt like shit as I watched the hands on the clock move inexorably towards 12 PM.  I am sure that Cinderella did not feel as bad as I felt since she would only be outed as a pauper while I be would be viewed as weak, wimpy and unable to meet standards that every other male prostate victim in America had met.

Fortunately, when the witching hour arrived, I had my advocate intercede on my behalf.  My wife Karen who had kept vigil with me this whole time told them in no uncertain terms that I was not going anywhere until I felt better.  It was now 12 PM but with her assurance, I fell into a deep sleep.  I awoke two hours later and immediately saw that the clock hands were on 2 PM.  Somehow, this extra sleep time was all I needed.  I practically jumped out of bed and started grabbing my clothes.  Karen who had been napping in a chair beside my bed woke up.  I said, “Lets go, we are getting out of here.” She replied, “but we are not packed.”  I replied, “I don’t care, I want to get out of here now.”  Karen grabbled whatever we could and we made the 2-hour drive back to Arizona City from Scottsdale.  I was not sure how I was going to handle two hours in the car post-surgery but I did not care.  I wanted out of the Mayo Clinic and back in my own bed.  To this day, I wonder how much stock my second nurse had in the Mayo Clinic.

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My rule now is this.  I will never let a friend or relative go to a hospital for treatment (regardless of how minor) by themselves.  If I have a friend who has no one to go with them, I will be their advocate.  If Karen needs to go to a doctor, clinic or hospital for any reason, even a hangnail, I will go with her.  Hospitals can be places of healing but they can also unexpectedly be places of death.  No one should assume or take for granted what might or might not happen at a hospital.  I could provide many more examples of unintended consequences that happened to friends and people we knew when they went into a hospital.  Better to be safe than sorry.

Patient advocates can work to help patients and their families by providing a variety of services, depending on the patient’s needs and the advocate’s area of expertise. They may help them to secure health care, manage insurance, or make treatment plan decisions.

Your advocate is your best health care plan.  Your advocate can have your back when you are under the weather or unable to defend yourself.  Your advocate can help make sure that the hospital and its providers live up to their own expectations.  Your advocate can help watch over you when everyone else is busy with other patients or administrative tasks.

Pity the poor person who goes into a hospital without a personal advocate.

This now concludes my series on health care.  I hope my blogs on health care have been useful and that you have found some ideas that will help you to lead a healthier, happier and more robust life.

Time for Questions:

Can you think of a time when you wished you had an advocate?  Were you ever an advocate for someone else?  What role do you think an advocate should play in healthcare?  Do you agree that everyone needs an advocate?  Why or why not?

Life is just beginning.

“For he who has health has hope; and he who has hope, has everything.”  — Owen Arthur

 

Should We Be Cautious When Seeing Our Family Doctor?

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This is the first of the ten perspectives I am going to discuss about medical care in the United States in the 21st Century.  Before I begin, I have already warned you that if you regard physicians as gods or if you love your MD for saving your life and cannot bear to hear anything wrong about the medical profession, you should probably not read what I am going to say.  One of my friends on Facebook sent me this message or caveat:

“I practiced medicine for 30 years. Be careful about generalizing. I got burned out, I cared. I saw the whole person. I’m not unusual. Medicine is hard. You are always looking over your shoulder. Afraid to be sued. We go into this not for money but to help. Really. Believe it.”

I am quite sure that what she says is true.  True for some.  Not true for others.  Is it the majority?  I don’t know.  But there are a lot for whom the medical system is not working and even more importantly for whom it is dangerous and harmful.  Let’s start with some specifics.

After writing and publishing this blog, a good friend of mine reviewed it.  He had a very different perspective on things than I present.  Together, we are like the Yin and Yang. I see the negative side of things and he sees the positive side of things in the medical profession.  It is my belief that we need to see more of the problems with our medical practices and bring them out so that they are more transparent.  Nevertheless, I realize that there are thousands of medical people who work hard and try to do their best to help their patients.  Thus, I am going to print Fred’s letter to me following my comments.  I hope this will “balance” out my negativity somewhat and create a more balanced view of American medical practice in the 21st century.  (Thank You Fred for taking the time to send us your thoughts.)

  1. Number of Needless Surgeries that are Done

There are many people who are enamored with surgery.  There are an equal number of doctors who are enamored with surgery.  When anyone in the first group goes to anyone in the second group, you can bet that surgery will be the answer to all their problems.  AbracadabraAnd like magic, their hip pains, knee pains and back pains will go away.  The patients are joyous, (unless they die on the operating table like my friend did last summer after going in for a hip replacement).  The doctors are joyous since they are thousands of dollars richer and of course the hospitals are also joyous since they too are also thousands of dollars richer.

signs-that-you-should-see-a-doctor-physical-therapyHave you ever heard of a doctor turning anyone down for back surgery, knee surgery or hip surgery by telling them that they are overweight and would be better served by an exercise program or by physical therapy?  If so, I can guarantee they are not typical of most medical practitioners.  How many doctors look at the major cause of back, knee and hip problems and try to deal with that?  Impossible, because doctors do not treat you over a lifetime.  You don’t see a doctor until you have a problem and by then it may be too late.  Surgery is the fastest solution because exercise, dieting and physical therapy take discipline and time.  Doctors do not want to tell you the truth because it is an inconvenient truth but many problems should not be treated by surgery until it is a last resort.  Too often, it is the first resort.

  • Data show that 10% to 20% of some common surgeries are done unnecessarily – USA Today – June 20th, 2013
  • “I think there’s a higher percentage who are not well trained or not competent to determine when surgery is necessary, Santa says. ‘Then you have a big group who are more businessmen than medical professionals — doctors who look at those gray cases and say, ‘Well, I have enough here to justify surgery, so I’m going to do it.” — USA Today

Here per the study reported by USA Today are the six leading surgeries that often performed and just as often not needed:

  • Cardiac Angioplasty, Stents
  • Cardiac Pacemakers

Pacemakers are used to correct heartbeat irregularities, but research shows that more than 22 percent of these implants may be unnecessary.

  • Spinal Fusion Back Surgery

lumbar-spine-surgeryIf you have low back pain and see different specialists you will get different tests: rheumatologists will order blood tests, neurologists will order nerve impulse tests, and surgeons will order MRIs and CT scans. But no matter what tests you get, you’ll probably end up with a spinal fusion because it’s one of the “more lucrative procedures in medicine,” author Shannon Brownlee says – even though the best success rate for spinal fusions is only 25 percent!

  • Hysterectomy
  • Knee and Hip Replacement, and Arthroscopic Knee Surgery

Patients who were informed about joint replacements and alternative treatments had 26 percent fewer hip replacements and 38 percent fewer knee replacements than those who did not. Arthroscopic knee surgery for osteoarthritis is also one of the most unnecessary surgeries performed today, as it works no better than a placebo surgery.

Proof of this is a double-blind placebo-controlled multi-center (including Harvard’s Mass General Hospital) study published in one of the most well-respected medical journals on the planet, the New England Journal of Medicine (NEJM) over 10 years ago.

knee surgeryRecent research has also shown arthroscopic knee surgery works no better than placebo surgery, and when comparing treatments for knee pain, physical therapy was found to be just as effective as surgery, but at significantly reduced cost and risk. And yet another study showed exercise is just as effective as surgery for people with chronic pain in the front part of their knee, known as chronic patellofemoral syndrome (PFPS), which is also frequently treated unnecessarily with arthroscopic surgery.

  • Cesarean Section

According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent. The US rate, at nearly 32 percent, is the highest rate ever reported in the US and is higher than in most other developed countries.

The USA Today article went on to talk about many diagnoses that were based on limited medical knowledge and that doctors often lacked the expertise to explore alternative treatment modes.  This is an issue of incompetence and it seems to be a major problem in the medical field with many doctors getting their information from their pharmaceutical representatives.

I have not even touched on the issue of malpractice.  But I will say a few words about this.  No one is perfect.  Everyone makes mistakes.  Medical treatment and diagnosis is a very difficult process.  I will not blame any doctor for an honest error committed with good intentions and not simply out of ignorance or greed.  This is one area where I sympathize with the doctors and hospitals more than I do the lawyers.  Nevertheless, there are some egregious examples of medical practice and a lawsuit might be the only recourse for such cases.

I use the information from the USA Today article, but none of it surprises me.  I have had many friends who have undergone surgery for the situations noted above. I have often tried to counsel them as to other solutions but it is generally a waste of time.  I have had two notable successes though and they have both expressed their gratitude to me for sharing my opinions and thoughts with them and preventing them from getting surgery.

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  1. Pills, Pills and more Pills

If life were fair, many doctors would be in jail right alongside of other drug dealers.  Doctors do not have the violence associated with illegal drugs because they have a license to prescribe drugs.  However, doctors prescribe drugs that are no more needed than heroin or cocaine and at much greater rates than your street drug pusher.

The size of the illicit drug trade (2012 data) in the USA including Marijuana, Heroin, Cocaine and Methamphetamines was estimated to be about 100 billion dollars a year.  —- How Big is the U.S. Market for Illegal Drugs?  We can assume that street dealers and drug pushers are responsible for most of these drugs.  So how much do doctors push?

If we look at the following fact, we can extrapolate from it the total amount of prescription drugs sold each year in the USA.

“In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. —  The High Cost of Prescription Drugs in the United States (2016). 

deaths from over druggingSo if we assume roughly 326,000,000 (USA Population in 2016) people and we multiply that by $858 dollars per capita, the total amount should equal the total amount spent on prescription drugs.  This amount equals = $279,708,000,000.  This is almost three times what is being spent on illegal drugs.  I am not even going to talk about caffeine, alcohol, nicotine, and other “legal” drugs.  Given that doctors love to prescribe pills and many patients love to take them, is there any wonder that we have or are currently experiencing an opioid epidemic in the US.

“Americans are in more pain than any other population around the world. At least, that’s the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States…. The 300 million pain prescriptions equal a $24 billion market.”  — Americans consume vast majority of the world’s opioids (2016).

I say again that if life were fair, many doctors would be called drug pushers or DP’s rather than MD.’s   They would also be in jail.  Who should be responsible for the opiate epidemic if not doctors.  When and where do they stand their ground.  Even if people are stupid or lazy enough to want surgeries to cure problems of obesity and diet or if they want pain killers to mask the problems from their obesity and lack of exercise, who is the expert here?  Do parents give their children everything they ask for?  You go to an expert on medicine to get help and not to have them take advantage of you for their own benefit or pander to you because they are afraid to tell you the inconvenient truth.  What is this inconvenient truth?  I will talk more about this truth later in this series but to be quite direct and blunt it is this:

“British businesswoman and columnist Katie Hopkins has a controversial view on the obesity epidemic: that the solution is simply to eat less and exercise more — and that fat people have no one to blame for their weight issues but themselves.” — I gained 43 pounds to prove obese people are lazy

I had a friend that I used to ride motorcycles with.  He died in a motorcycle crash a few years back.  He was a great guy.  He always had a smile and something nice to say to someone.  His name was Gary.  He was also obese and exercised little.  He had chicken legs and bad knees.  Well, what would you expect if you weighed 100 lbs. more than you should and you let your leg muscles go to hell.  Of course, he went in to see his doctor with knee pains.  The doctor was more than happy to suggest Gary should lose some weight but in the meantime, he would schedule the surgery for knee replacement.  To my mind, this is criminal, irresponsible and ignorant behavior on the part of his doctor.  Gary got the surgery.  Never lost much weight and died not too long after from other causes.

Doctors pushing pills, pushing surgery.  It is like the Yin-Yang of American medical practice.  Throw into the mix a lot of lazy people who do not exercise or take care of themselves and you have a health care system spending tons of money on acute care when preventive care would be a much more sensible solution.

  1. Me Doctor, Me Busy.  Who are You?

Some of you might remember the skit on Saturday Night Live with Martin Short playing a doctor.  When asked what his badge that said MD meant, he would reply somewhat superciliously “Me Doctor, You Patient.”  When I was working as a consultant to some hospitals, it was not uncommon to hear nurses complain that doctors were like gods whose every word should be obeyed.  They seldom came to team meetings because “their time was too valuable.”

I will stay away from the subject of how much money doctors rake in since they often ascribe their high incomes to the length of time it takes to finish medical school and all of the attendant costs.  This sounds like a reasonable explanation but an alternative theory might mention the strangle hold that the AMA had on medical admissions and the role that restricting the supply of doctors has had on the cost of their services.  The law of supply and demand says that if you have fewer doctors, the cost per care will be higher.  For years, the AMA did all they could to help keep the supply of doctors down.

  • But the entities that will be most injurious to the nation’s health are not so much in the evil-mongers’ group but the first group, including the American Medical Association–a doctors’ cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. — The Evil-Mongering Of The American Medical Association (2012)

So, doctors come to regard themselves as the elite who know more than you do and who must be smarter than you since they make a great deal more money than most of their patients.  Doctors used to do house calls many years ago; back then, a doctor might have known something about your family and you personally.   My wife Karen told me the following story about her family doctor.   It generated the following conversation:

Karen —

“When I was married, and raising four children, my ex-husband Ron and I became good friends with a local White Bear doctor.  He became a family friend as well as our family doctor.  We knew him for over thirty years and he knew me and my family personally and really cared about us.” 

John —

“Okay, so now you have been seeing a doctor in Frederic for about seven years.  How much does she know about you personally or really care about you?”

Karen —

“I think she really cares about me.”

John —

“But how much does she know about you personally.  Your goals.  Your dreams.  What you did this past winter?”

Karen —

“Well, at first, she used to take more time to talk to me but the past few years she has seemed much busier and anxious to keep our meetings short.  I suppose the clinic has a quota for how much time she can spend with a patient.” 

Again, there are numerous anecdotes and articles describing the lack of time doctors have to spend today with patients.   Here is an excerpt from one:

“Joan Eisenstodt didn’t have a stopwatch when she went to see an ear, nose and throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

‘He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,’ said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.” — You’re on the clock.  Doctors rush patients out the door (2014)

I can guarantee you that if your doctor only takes a few minutes with you, once or twice per year, there is not much they can know about you personally regardless of how caring and concerned they are.  You might ask “well, why is this important.”   Here is the reason stated very well I think in Wikipedia:

“The quality of the patient–physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient’s disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient’s knowledge about the disease. Where such a relationship is poor the physician’s ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice.”  — Wikipedia

Conclusions:

I promised some solutions to each truth that I am telling you.  Here are some that might help you to deal with this first truth.

  1. Get a second opinion for any surgery.
  2. Use the Internet to search for alternative treatment modes. Get advice if you are not Internet savvy. Remember, there are many opinions and not all are right.
  3. Exercise and have a health care plan. Follow it.
  4. Don’t take any pills unless you must. Try to unwean or get off them as soon as possible.
  5. Beware side effects from pills. Every pill has a side effect.  Make sure you are aware of any that might affect you and be cognizant of any changes in your life while taking these pills.
  6. Take a friend with you whenever you go in for an appointment or treatment. Talk to your friends to get their insights and opinions.
  7. Don’t assume your doctor is God and knows what is best for you. Be a skeptic but be realistic.  Modern medicine is better than sorcery but not always much better.
  8. Don’t assume that your doctor is your friend or has your best interests at heart. They might not have enough time to care.

Fred’s letter to me:

I read your blog on medical practice and it was indeed thought provoking.

I’ve had good results with doctors over my lifetime. Not always perfect but usually satisfactory and in some cases, it was excellent.

Medical care is a process and requires the same attention as any process. It seems especially complex today because of how rapidly technology and all the stakeholder’s needs and expectations are changing.

Overall, it’s greatly improved in its capabilities. My main concern for medicine is the same as I’ve had for years in business. My business life became more and more controlled by the bean counters and the lawyers. The same is true of medicine. Blaming doctors is blaming people, which is always a red flag to me as one who has a bad habit of judging others without knowing them. Like the driver for quality improvement, expectations always move to higher and higher expectations. And based on what I’ve heard from friends over my life, expectations are often unrealistic.

A friend recently died. He was an old school, oil field production engineer and didn’t trust any of his doctors. He’d get pissed at one and then begin to “doctor hop”; never telling one what the other had done or prescribed. I questioned him many times, always inquiring why he’d not share his history. His reply: “I ain’t telling them anything.  They make good money and are supposed to tell me what’s wrong.”

I see the process much as we viewed our manufacturing and service processes ..with customers, suppliers, inputs and outputs being carefully considered. A critical output is the result when your illness is diagnosed and this is too often a major problem source. My friend tends to expect this to be an exact outcome but in reality it isn’t. It’s only a statistical prediction that too many older doctors failed to point out to naive, uneducated patients.

In recent years, our doctors point out the statistics and involve us in the decisions for corrective action. My wife’s breast cancer surgery was a good example. Years ago, the doctor would have made the decision for which surgery, mastectomy or lumpectomy. Sandra made the decision armed with various study statistics and discussion with the Doctor. The Internet was a source for me to verify the statistics but that isn’t easy because there are often many studies,

The surgeries are complex and the statistics often work out for the worst. Records on lawsuits and doctor reviews are more readily available today. I recall a bad experience with my dad years ago. Our family doctor became a friend from making many house calls as 3 kids were raised. Dad was a merchant seaman and would provide Porte Rico rum for our good doctor. They were the best of buddies and talked about the old days during visits. Dad visited him yearly but when dad’s tobacco tarred lungs became late stage cancerous it was too late. Doctor “Tom” as an individual practitioner didn’t have the computer technology that red flags today’s doctors. Doctor Tom was as heartbroken as my dad. He and his wife nurse apologized that they’d not x rayed dad 6 months earlier. We probably could have sued but dad would never have agreed to such.

The body of knowledge has expanded too much for any one doctor to master it all, so now we have multiple knowledge based “Specialists” having to deal with the directives from medical organization bean counters and their lawyers.

I consider our medical providers to be leading edge. They seem to focus on continuously improving to meet customer expectations. I’m hoping, but doubt the doctors and staff will be given additional support. They track customer satisfaction inputs so I should be more confident.

I can email any of my doctors and I can access historical results. I especially like being able to take a picture of a physical observation and sent it in.  A couple of years ago, I tore a muscle on the back of my leg and a huge blue area surfaced overnight.  It scared the heck out of me. I emailed a picture and he emailed back telling me what it probably was, how to treat it and to see a doctor if it didn’t heal. My expectations are now at an even higher level which puts more load on the doctor. He not only has to live up to corporate standards on office visits but he must respond to patient emails. Just yesterday I received a corporate email announcing that they have decided to do “Face Time” appointments for $25!

Overall, I have concerns for the profession but I think problems are “process” related. To think otherwise would go against what I’ve believed for a long time.

Fred

Time for Questions:

How satisfied are you with your medical care?  Why or why not?  Have you ever had a loved one die?  How were they treated by the medical profession?  What do you think could be done to improve medical care for you and your family?  What would you like to change in the American medical care system?

Life is just beginning.

“We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.” — Donald Berwick

 

 

 

 

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