In the news recently:

1. Health care is expensive
2. The government is going to take control of healthcare to keep costs down
3. Some people will die sooner because treatment might be considered a waste of money
4. Women should wait an extra ten years before getting screened for the second-most deadly cancer they might ever face

Who planned the timing of this announcement regarding new mammogram guidelines?  The U.S. Preventive Services Task Force could obviously use some help in their PR department!

It is with bemusement that I note all the hoopla surrounding the new mammogram guidelines.

None of my friends and acquaintances look forward to a mammogram.  I certainly don’t!  Nobody waits with eager anticipation until they are again eligible for their next squishing session.  This is something that people postpone and do as infrequently as they can get away with.  I don’t personally know anyone who is upset about the new recommendations.  It’s more of a collective sigh of relief:  Whew!  Now we have a legitimate excuse to not go for that test!

When doctors claim, “studies show…” it insinuates that laymen are too stupid to understand the meaning of raw numbers.  It harks back to the days of paternalistic medicine.  I’d love to see the facts:

# of people in observation groups
# of people not getting mammograms
# of people getting mammograms – broken into two categories:
       -routine screening
       -in response to the discovery of a lump
# of those people who do self-exams
# of those people who do not do self-exams
# of people who found lumps doing self-exams
# of people who missed lumps in spite of doing self-exams…

# of patients whose mammograms led to biopsy
# of biopsies benign
# of biopsies malignant

# of people who had serious complications from benign biopsies (harmed due to mammogram)
# of people with malignant biopsies who were cured - break this out as to how many were discovered and treated due to routine screening vs how many of those biopsies were not because of a routine screening mammogram

Are we talking about one study or twenty?  Is this data on thirty people, or five thousand?  Show me that these studies were done on large groups of women in a variety of locals, and that the data is the same regardless of race.

An approach that presents the raw data can lead people to a logical conclusion.  Instead of being paternalistic, this method clearly states the facts and implies that people are capable of making good decisions (this might not be true – people frequently make bad decisions, but PR is about perception).

It is so much easier to respond to anecdotes when the facts are readily available.  Facts don’t belittle the heart-rending stories that are circulating; showing the raw data would acknowledge that some cancers are identified by routine screening.  However, it would also make clear whether those anecdotes are typical, or if they’re anomalous.  Make it clear – using incontrovertible numbers – whether more people are helped by routine screenings, or harmed.

(fwiw, this approach would be a good idea when presenting the facts about v.a.c.c.i.n.e.s, too)

__________________________________________________________
Happy Thanksgiving
So grateful to have gotten my flu shots
before getting together with family to share germs.
There are always people who show up sick because they wanted to much
not to miss out on the big get-together.
__________________________________________________________

An age-by-age breakdown of the most important medical check-ups for men

Source:
http://www.mensfitness.com/fitness/555

An age-by-age breakdown of the most important medical check-ups for men

Source:
http://www.mensfitness.com/fitness/555

Since H1N1 is overall a milder flu than even the seasonal flu, the need for rapid identification of cases is likely less important, except in specific cases (as referenced below).  Although, milder overall, H1N1 continues to affect young people more so and the death rate among that group is much higher than normally seen with the seasonal flu.  Rapid detection tests for H1N1 in doctor’s offices are proving to be only modestly accurate with over one third of cases that were positive for H1N1 testing falsely negative.  This means that 1 in 3 persons tested were told, based on a negative test result, that they did not have swine flu, when in fact they did.  The implications for this are obvious, as persons who feel they do not have swine flu may be more lax in taking precautions to prevent transmission to other family members or persons they have incidental contact with.  Careful attention to hygiene, especially hand washing, remains among the most important measures we can take to prevent transmission to ourselves or others of flu viruses.  Additionally, any person with a flu like illness, during this unusual year, should be more vigilant than ever in making sure that they are not the cause of additional cases . . . ben kazie md

Although still used in doctors’ offices and emergency departments, “rapid influenza diagnostic tests” actually do a fairly poor job of sniffing out H1N1, a growing body of evidence shows. Scientists reported last week in The Journalof the American Medical Association that one-third of California patients hospitalized with H1N1 flu had a negative rapid test, which looks for influenza A virus in a sample swabbed from the nose and gives results in a half-hour or less. However, a different test that uses the more sophisticated polymerase chain reaction – or PCR – technology, which can take a single piece of DNA and generate thousands to millions of copies, confirmed they had influenza A or H1N1 – an A strain – in particular.

‘Rapid influenza tests’ often fail to detect H1N1 – http://www.usatoday.com/news/health/2009-11-09-flurapidtests09_ST_N.htm

The recent appearance and worldwide spread of novel influenza A (H1N1) virus (1,2) has highlighted the need to evaluate commercially available, widely used, rapid influenza diagnostic tests (RIDTs) for their ability to detect these viral antigens in respiratory clinical specimens. As an initial assessment, CDC conducted an evaluation of multiple RIDTs. Sixty-five clinical respiratory specimens collected during April–May 2009* that had previously tested positive either for novel influenza A (H1N1) or for seasonal influenza A (H1N1) or A (H3N2) viruses by real-time reverse transcription–polymerase chain reaction (rRT-PCR) assay were used in the evaluation. The results showed that, although the RIDTs were capable of detecting novel A (H1N1) virus from respiratory specimens containing high levels of virus (as indicated by low cycle threshold [Ct] values), the overall sensitivity was low (40%–69%) among all specimens tested and declined substantially as virus levels decreased (and Ct values increased). These findings indicate that, although a positive RIDT result can be used in making treatment decisions, a negative result does not rule out infection with novel influenza A (H1N1) virus. Patients with illnesses compatible with novel influenza A (H1N1) virus infection but with negative RIDT results should be treated empirically based on the level of clinical suspicion, underlying medical conditions, severity of illness, and risk for complications. If a more definitive determination of infection with influenza virus is required, testing with rRT-PCR or virus isolation should be performed. Additional evaluations of the accuracy of RIDTs in detecting novel influenza A (H1N1) virus should be conducted.

Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus — United States, 2009 – http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a2.htm

Most patients with clinical illness consistent with uncomplicated influenza who reside in an area where influenza viruses are circulating do not require diagnostic influenza testing for clinical management. Patients who should be considered for influenza diagnostic testing include:

• Hospitalized patients with suspected influenza
• Patients for whom a diagnosis of influenza will inform decisions regarding clinical care, infection control, or management of close contacts.
• Patients who died of an acute illness in which influenza was suspected.

Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season – http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm

Results During the study period (April 23 and August 11, 2009) there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. 66% of those with chest radiographs performed had infiltrates and 31% required intensive care. Rapid antigen tests were falsely negative in 34% of cases evaluated. Secondary bacterial infection was identified in 4%. 21% received no antiviral treatment. Overall fatality was 11% and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome.

Conclusions In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza.

Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California – http://jama.ama-assn.org/cgi/content/abstract/302/17/1896

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This is going to be one of those — Do as I say things and not do as I did.  Why didn’t I ask about the CT scan before I had the darn thing?  I was hurting with a kidney stone & yes, I know that sometimes you need to be sure.  But did I need to be $2,700.00 sure?  I was “lucky” to have insurance and so it will only cost me $900.00.  Yeah, I just happen to have an extra $900.00 just lying around.  No, I’ll be making payments.  I guess instead of asking if I really needed this test, I should have asked how much it was going to cost.  Now,  I am a pharmacist and I know a lot of things are expensive and some are even necessary,but, I did not know that a CT test was ultra expensive and took 5 minutes.  I won’t be making this mistake ever again.  These are the things that I will be asking in the future:

1- Why does it need to be done?  Can it be done later, if I  do not get better?

2- Will it change my treatment plan?

3- How much will it cost?

Makes prevention sound great doesn’t it?

Last week I attended a potluck.  As we were eating, right in the middle of a nice conversation, one guy took a call on his cell phone.  His end of the conversation sounded something like, “What?  That’s all they think it is?  Well, go back in there and tell them you want a CT scan.  No, it’s important.  You need a CT scan.”

I’ve heard of this phenomenon, but this was the first time I’d seen it.  I shook my head in disbelief and said, “No.  Do not tell doctors what tests to order.  If you visit them for their expertise, then listen to them.”

I somehow had the idea that it was the alcoholic/welfare-dependent/ER-abusing/psycho dregs of society that were stupid enough to do that.  To hear an employed, seemingly sane person advocate that someone should demand an expensive medical procedure (one that is not without risks) was…  beyond belief.

It turns out that this guy decided, based on something he read on the internet, that a CT scan was appropriate for his friend.  The internet is a great resource.  There’s a lot of good information available.  There’s a lot of garbage out there, too.  Consulting with Dr. Google can provide just enough information to be dangerous.

The key is to filter out the junk.  It doesn’t make much sense to use a general search engine for reliable medical information.  Whether you like google, dogpile, askjeeves, or something else for general inquiries, doesn’t it makes sense to go straight to medical resources for medical information?  I used to use WebMD, but a doctor pointed out some errors there, so I’ve gone elsewhere.  Family Doctor, Mayo Clinic, Johns Hopkins, and Up to Date are all reliable resources.  Some doctors have started posting short, educational videos on YouTube.

Doctor D’s latest post addresses this very phenomenon.  Apparently people read things on the internet, then see their doctors and demand unneeded tests.  Insurance companies don’t like paying for all those tests, so they raise your premium to make up the difference.  People pay a higher premium, plus their portion of the fee for the unnecessary tests.  Everyone’s health costs go up when this happens.  Go visit Doctor D’s blog and click on the video he shared.

His closing question asks,

So what do you think? Does being an educated, web-savvy patient make you
cost the system more? Do you think reading Medblogs make your
healthcare cost more or less?

I tried to post a short response over there, but blogger kept eating my comments.  Four tries yesterday and one today.  The screen flashes, and my comment disappears.  I’ll just respond here.

I doubt that I count as web-savvy, but my vote is less.  Definitely less.

One example:  my PCP listed a few possible diagnoses and said that I could get an x-ray to find out which it was.  Based on what I’ve read on medblogs, I was able to ask, “What would be the difference in how this is treated?”  None at all.  My goal is not a specific label; my goal is to heal.  If the only thing that will help is giving it more time, then x-rays really aren’t necessary.  Test avoided, money saved.

I’ve learned a ton from medblogs.   Maybe someday I’ll make a list.  Getting the perspective of doctors is incredibly helpful. 

If people are demanding tests that they don’t need, then they don’t really count as educated patients.  More like half-educated.  Obviously they didn’t get enough information from Dr. Google.  Medblogs can help fill in the missing information.

Here are some more photos from the trip preparations. Kapil X-ray is the popular X-ray centre where JNUites go. Me, Nipun Nutan, Sureshika and Christian were waiting for bus.

Zinia and Rishika, often camera shy! The trek was cancelled but these and others did go for some travel independently.

This poster was liked by Christian! Pot painting and pot breaking competitions in the MTNL health mela! Christian wanted these photos for his collection.:)

Fun fact.  You know all those seemingly random generic drug names (basiliximab, desloratidine, etc.)?  There really is a method behind the madness, and the names give you an idea of what the drug can be used for and how it works.  …Ok, that wasn’t really a *fun* fact for most of you, but, for me, realizing some of the patterns was one of those moments where the haze clears and suddenly it’s sunny outside.  Which makes it a tiny bit easier to learn hundreds of drugs for this pharmacology exam…

And just as you need to clean out your medicine cabinet from time to time, it’s time to toss out some old links:

- The NIH is betting on the underdogs, awarding grants to upstart researchers without a long history of publication and also those with ideas that have the potential to be transformative innovation.  Of course the “seasoned investigators” are angry.

- And if you can’t get published, do you just skirt peer review and go to the media?  Under what immediacy?  The media isn’t really qualified to judge scientific research as quality or not…they’ll report whatever they’re fed.  And the public will consume it blindly.

- The annual UW Foundation report shows pretty much what you would expect in a recession.  Though the website itself is beautiful.

- All those excessive medical tests that are being lambasted during this health system reform debate?  An MD examines why doctors order these tests.  And a commenter points out that he probably missed the most important one.  Because time is of the essence, and you can’t get paid for what you can’t quantify.

The Psychiatrist will see us all tomorrow at Septebmer 24, 2009 at 10: 30 pm [and not with the medical board later as informed before].

Thanks to Christian for the info.

All JNUMC participants have to undergo Pulmonary Function Test [PFT; group of procedures that measure the function of the lungs, revealing problems in the way a patient breathes]. This post has even photos of the lab and the machine!

These are photos of the interesting test and a how-to on how to visit the place and what to expect.

We [Vikas, Theresa, Tristan, Swastika and Ratnesh] went by auto to Safdarjung hospital and reached their by 9 am [they want you to be there by 9 am; don't be late]. You have to get your OPD cards made from Room no. 414 and assemble near the lab [room 403?].  The process for us was over by 11 am. Once your tests are done in the lab, you have to go the doctor [Dr. J. C. Suri, HOD for us] who will have a word with you and then you are done!

As you enter Safdurjung hospital, go straight for some 40 metres and take the first left [The Biochemistry Department; third floor]. This building is where you have to go.

This is the lab. On the left is technician Mr. Devendar Singh and Mr. Ramavtar on the right looking on.

This is the chamber where you have to sit. The door is not locked.

Tristan in the chamber

The graph responds to your physical activity of inhaling and exhaling

Ratnesh undergoing the tests. You have to breathe in and breath out as suggested by Mr. Devendar. His way of speaking and gesticulation makes it more exciting!

Swastika had to take the tests twice

Theresa completed the tests in the shortest time! Here she is sitting in the cubicle only for photos!

Your height and weight is also measured before it begins. Tristan is more than six feet tall!

Waiting outside the lab!

Coming out after it’s all done!

As decided in the training yesterday, all of us assembled at the health centre at 8 am to collect our medical papers [9 pages] which will have a record of all our tests. Six of us including me, Theresa, Tristan and Vikas 2 [SL] underwent two blood tests at about 9 am and 10:30 am [first cone was on hungry stomach]. We six also submitted our urine sample for analysis.

Five students [including Rishika and Xinia] went to the Safdarjung for PFT [Pulmonary Functional Tests].

The photos from today’s meeting of the JNUMC autumn trekking at the JNU health centre.

Bibek and Christian at the health centre at about 8 am

Theresa and Tristan coming to the health centre

The group collecting their medical papers

You have to submit your blood and urine sample in this room.

You have to submit your urine sample in this box!

Waiting for the process to start

Theresa smiling and bookworm Tristan!

Sureshika and Vikas of SL.

The Pediatric Insider

© 2009 Roy Benaroch, MD

Sandy said, “Do you have a suggestion on how to handle a child who is hysterical at the thought of a strep test? Not just ‘I don’t want to’ but screaming and crying hysterically, running around the exam room to avoid the nurses.”

I’ve seen kids like this—scared out of their wits. I know a strep test isn’t the most pleasant thing in the world, but some children think they’re the most painful, horrible thing possible. Fighting and holding them down won’t help dispel their fears!

First, I hope that your pediatrician only wants to do a strep test if it’s really necessary. Most sore throats, even in the winter during strep season, are not caused by strep bacteria. Strep throat typically looks like this:

• Sudden onset
• Severe sore throat, with red and swollen tonsils
• Swollen, tender lymph nodes in the neck
• Usually fever
• Sometimes abdominal pain, nausea, or vomiting
• Sometimes headache
• Seldom cough or runny nose

Most viral sore throats are more like this:

• More gradual onset
• Milder sore throat, without swollen nodes, or with small non-tender nodes
• Often runny nose and cough
• Fever, if present, will only be there for the first day or so

Based on the symptoms and physical exam, you and your doc can make a pretty good guess whether it’s likely to be strep. If it seems far more likely to be viral, it’s unnecessary to do the test. In fact, it’s more than unnecessary—it’s a very bad idea. A strep test isn’t perfect; if the “pre-test probability” of strep is very low, even a positive test will probably be incorrect.

What if based on the symptoms and physical exam the possibility of strep is very high? In that case, it may also be a good idea to skip the test—your doctor is probably going to prescribe antibiotics anyway, so why do the test? Strep tests are most important in that grey zone, when it’s kind of hard to know for sure whether an infection is likely to really be strep.

Taking it a step further, what would happen if you and the doctor decided to just skip the test, and make a guess? One of these four scenarios would occur:

1. The child really has strep, and you’ve decided to give antibiotics. Well, that’s just peachy.
2. The child really has strep, but you’ve decided against giving antibiotics. In this case, Junior will most likely get better anyway—but it will take a few extra days, and in the meantime he might be infecting other people. There’s also a small, but real chance that the infection can spread into an abscess, and a very small risk that untreated strep could result in heart damage from rheumatic fever (this is often given as the main reason to do the strep test, to avoid untreated strep. But in fact rheumatic fever for reasons unknown has become very rare in the developed world, even without antibiotics being used.)
3. The child doesn’t have strep, but you put him on antibiotics anyway. We’d like to avoid doing this—unnecessary antibiotics contribute to bacterial resistance, and put your child at risk for allergies. Still, a single course of antibiotics is unlikely to make a huge difference in any significant way.
4. The child doesn’t have strep, and you’ve decided to withhold antibiotics. Perfect.

Though it sounds like sacrilege to say it, this Pediatric Insider thinks: none of these four scenarios is likely to end in disaster.

So think carefully, and ask for your pediatrician’s input: for a child truly terrified of a strep test, is it really necessary to do it? Under ordinary circumstances, I think a strep test should always be done prior to antibiotics—there are risks of antibiotic overuse that are a real problem—but in an individual case where a child is going to be traumatized, there really is wiggle room for compassion and judgment.

OK, you’ve decided: you need to do the test. There are ways to (hopefully) minimize the discomfort and anxiety of the child. Some of these tricks I’ve tried:

• Let the doctor do it instead of the nurse. I think some patients think I’m more gentle. I don’t know if that’s correct, but if makes Junior feel better, I’m game to try.
• Let the child do it himself. Really. Tell Junior to hold the stick, and stick it down there, and swoosh it around. I’ll look with a flashlight to make sure you did it right, and I’ll keep my hands behind my back—promise. This really has worked for me, more than once.
• If the child’s willing to work slowly with me, I’ll take the swab and just rest it on his tongue awhile. Let him get used to it. Keep talking, distracting, and inching it back. It sometimes might take a few false starts, but this can work.
• Spray benzocaine solution back there to numb things up, wait 10 minutes, then do the test. Honestly, I’m not sure if maybe the benzocaine spray might interfere with the test—but at least the child feels he’s overcome some fear, and you can build from this positive experience in the future.

One thing I would not recommend is brute force. It might work—once—but it reinforces the worst lessons and scariest feelings, leaving the child vulnerable and completely out of control. It also makes future interactions a nightmare. Whether a strep test is done is never a critical issue. This isn’t someone who might be having a heart attack, or who needs an essential test to see if he has cancer. Keep things in perspective, and have some compassion. He probably feels pretty bad already, and doesn’t need some big galoot holding him down!

Notification of medical test results under Obama-care…

What could possibly go wrong:

The phone rings and the lady of the house answers, “Hello?”

“Mrs. Sanders, please.”

“Speaking.”

“Mrs. Sanders, this is Dr. Jones at St. Agnes Laboratory. When your husband’s doctor sent his biopsy to the lab last week, a biopsy from another Mr. Sanders arrived as well. We are now uncertain which one belongs to your husband. Frankly, either way the results are not too good.”

“What do you mean?” Mrs. Sanders asks nervously.

“Well, one of the specimens tested positive for Alzheimer’s and the other one tested positive for HIV. We can’t tell which is which.”

“That’s dreadful! Can you do the test again?” questioned Mrs. Sanders.

“Normally we can, but the new health care system will only pay for these expensive tests just one time.”

“Well, what am I supposed to do now?”

“The folks at Obama health care recommend that you drop your husband off somewhere in the middle of town. If he finds his way home, don’t sleep with him.”

I know, another shameless Tony Stewart mention, but once again, there’s an off week in NASCAR and I will be slowly going into withdrawals by the time next weekend arrives, so bear with me as there are many things to talk about.

I haven’t had much time to post anything and there have been many things going around here.  I’m awful, I know, but this semester has me loaded down with schoolwork.  I’m trying to figure out the best way to start this post (and still provide you with all the juicy details).

PACE lap…..

School started back for both me and my two boys on the 18^th.  I thought at first that it would be a welcome surprise to get back into the routine of school and homework.  School is routine.  The amount of homework that I have to do is insane!  My first class requires me to read 20 books!  I almost fainted.

GREEN flag… go, go, go…..

Over the summer, I found out that my friend had broken up with her boyfriend.  Now, this particular boyfriend just so happens to be in my Biology class.  I’m thinking, “Lord, I hope that we don’t end up in the same group.”  Well, in lab, we are not in the same group.  In class, we are in the same group.  I suppose that I should be happy because most of the people in my group, including him, are pretty decent to work with.  My only problem with him is that he did my friend wrong.

So anyhow, this guy (we’ll call him, oh, I don’t know, maybe… No Clue [NC]), NC managed to get into my group in class.  Now, my question to you is this:  Have you ever met someone that thinks they are funny, yet they are the ONLY ONE who thinks so?

That is NC.  He sits in class making slight comments about everything and I assume they are supposed to be funny, because he laughs and yet, I sit there thinking, “Oh my God, I hope this class is over with soon!”

So now, NC tries to start up conversations with me.  The biggest one is his complaint about being in pain.  Then it leads up to, “My shoulder really hurts.”  This goes on until finally one day this week, I just made him happy and asked, “What happened to your shoulder?”

His reply, I must admit, took me by surprise, and it was all that I could do to not fall off the stool I was sitting on and roll [literally] in the floor laughing.

You see, he swears up and down that our mutual friend (his ex-girlfriend:  M) did it.  Now, I’m thinking, I could just see her taking a swing at him with something and dislocating his shoulder, except, that is not what he said happened.  [To make this even funnier, she’s not a large woman, and he is a big ex-cop!]

You see, he was in the bed, and she threw him out of it with her mind.  [Yeah, that’s what I said too!]  Then, she caused him to have a fainting spell by speeding up his heart and running up his blood pressure so that he passed out in the floor of his bathroom.  [Again, with her mind, and again, I agree with you.]  He claims that she did this all with her mind and from her home which is 25 miles away from his.

Okay….  [Now do you know why I wanted to roll around on the floor laughing?]

CAUTION flag…

I managed to spend some time with my dad last Sunday.  It was nice, except that I have such a hard time talking with him.  Now, we managed to carry on the same old conversations.  We sat around and discussed NASCAR.  We talked about Tony Stewart’s bad luck at Bristol the night before and how it would affect his championship run.  We discussed our mutual disdain for Jimmie Johnson and how we agree that everyone is trying way too hard to give him the championship.  We also discussed the fact that we both cheered when he had problems with a lug nut.  HA!

The one thing that I know I can talk to my dad about is racing.  I think it is because I secretly wanted to be in that club.  I wanted to one of the guys standing around talking about gear ratios, wedge, and torque.  I suppose that had my dad not pushed me so far out of that circle, I wouldn’t have wanted it so bad.  But he would always look at me when I said that I wanted to be a race car driver and say, “Marcy, racing is not for girls.”

Those words made me want to race that much more, but it wasn’t going to be possible.  I remember daydreaming about winning the race, taking my helmet off in front of everyone, and letting those guys know that they just got beat by… a girl!  How great would that have been?

Instead of words of encouragement, I received nothing.  So, my connection to my dad would be talk about the sport that he loves so much. I received the same talk when I wanted to play football.  But I think that trying to out-do the guys in my neighborhood, I became a tomboy.  I didn’t mind playing football and I could tackle with the best of them.  I played basketball.  I played baseball.  I climbed trees.  I jumped ramps with my bicycle.  I rode motorcycles.  I worked on cars.  If my brother could do it, then so could I!

Nonetheless, the conversation soon turns to my Mom and I’m unsure as to who brought it up.  The one thing that I do say is how much Kyle not only looks like her, but how much he IS like her in every way.  He has her compassion, her concern, her talkativeness, and her nosiness.  My Mom was the one person who could stand on the front porch and tell you what was going on in everyone’s lives in the neighborhood.  That is Kyle as well.

The conversation never stays there.  It always moves on to how much we each miss her and we wonder what Terry is up to these days.  That, in itself, makes me sadder than anything knowing how our family was ripped apart with my Mom’s death.  So I decide after a few more topics that I really need to go, because before long, I know we will find another one that brings us back to Mom (We always do.)

Back to GREEN…

RD finally proved his name: Dummy!

RD, in a fit of stupidity, pulled a gun on one of the other neighbors.  Unfortunately, my youngest son was among those.  This neighbor called the law on RD.  He becomes angry and decides, “I’ll show them.”  So what does he do?  He grabs a guy’s dirt bike and takes off down the road with no helmet on.

According to my youngest son, he was gone for a few hours, before the owner of the dirt bike decides, “Hey, maybe I better go look for him, ‘cause he may have just stolen my dirt bike.”

They found him off the side of the road.  His toes were peeled back to his knees.  His shoulder dislocated and his head lay open.

I’m reminded of a saying I heard once:  God looks out for fools, drunks, and children.  I guess RD is in at least two of those categories.

It was amazing that he was still alive when they found him.  It is even more amazing that he’s still alive, though he’s in critical condition.

I hate the fact that I’m torn between two different feelings for RD.  On the one hand, I think he got what he deserves:  justice.  On the other, I hope this is his wake up call:  change.  Will it change him?  Only time will tell.

WHITE flag is out.  Only one more lap…

Thursday I went to class as usual, even though I felt nauseous.  My theory is that it was way to early in the semester to be missing classes.

By the time Biology was over with I was really starting to feel it, so I decided to skip chapel (even though this semester I’m having to take Remedial Chapel because I missed too many chapels last semester)  and go home.  Before going home, I thought, “I’ll go by Wal-Mart and pick up some lunch meat before going home.”  At this point, I thought the nausea was from being hungry.

While standing in the checkout line, I grabbed a bag of trail mix (with the nuts and stuff in it) to eat on the way home.  Boy was that a mistake!  When those nuts finally hit my stomach, I had the worst pain I’d ever felt in my life!  I was bent over double and begging CH to take me to the Emergency Room.

He suggested Wal-Mart to go and get some Pepto or something.  While at Wal-Mart, I nearly hit the floor and he said, “Hmm.  Maybe we should have gone to the ER.”  Ya think?

Wouldn’t you know that my ER doc would be the same one who treated me for pneumonia in May?  You remember?  The one who wouldn’t look at me when he spoke to me.

Well, he looked at me when he spoke to me this time, and I kind of wish that he hadn’t.  His eyes told me that he had nothing good to tell me.  The only good news that he could tell me was that he was going to give me something for the pain.

Imagine my CH’s surprise when he left the room only to come back and find me looking stupid!

The nurse came in and said, “I’m going to give you some Phenegren for the nausea and some Demerol for the pain.”

I sat and waited as she squirted the medicine into my IV.  Before I could ask, “When will it start to work,” I was sinking into the bed, kind of melting into one with it.  Or as CH said, “Your eyes were rolled back in your head.”

But the wonderful news here would be I was scheduled for an ultrasound the next day.  Woo-hoo!  Medical tests!  Yeah, right.

CHECKERED FLAG………….

So I went to the Ultrasound by myself.  I should have taken Tony with me, but I left him at home.  Unfortunately, I now have to have another test on Thursday.  I am not looking forward to it at all.  I hate having medical procedures done because I feel they only lead to bad news.

All my life I’ve lived in fear of something bad happening to me.  I fear the unknown and the tragedies that are just waiting out there for the opportunity to strike.

Well, tragedy did strike, though it wasn’t a medical one.

My youngest son, Kyle, turned 12 the same day as the Ultrasound.  With it came the raging pre-pubescent hormones that he is not adept enough yet to handle.  The child, who never talks back, threw a temper tantrum in Wal-Mart because we would not let him buy a BB-gun with his birthday money.

On our way to Anderson to the restaurant to go eat, he said, “I might as well call Meme B up and tell her not to give me a Wal-Mart gift card for my birthday anymore.  She just needs to send a Babies R Us card instead!”

I was driving and nearly lost control of the car laughing so hard!

It’s funny how my little boy is caught between getting older and still being my little boy.  I have to give him some credit though.   I never would have come up with that BRU line!

Of course, after he said that, CH started talking about blowing smoke up his own butt rather than trying to discuss things with Kyle.  I was crying with laughter by the time we made it to the restaurant.  But to make things right, we asked for the kiddy meal… just to see him puff up like a bullfrog on steroids.  If I can get the picture off the phone, I’ll have to post it.

So, now you are caught up, for the most part and I hope to stay caught up as things are really picking up pace around here.

When I chose “Pissydoc” for the name of this site I had no idea how common the term was, especially in referring to a physician that a patient didn’t agree with, i.e. This doctor told me I didn’t have this (the disease  I know I have) or he wouldn’t give me the prescription I wanted, or he wouldn’t do any tests—wha wha wha!

You wanna know what constitutes a “Pissypatient”? How about some butthead who thinks he knows as much as me after a two hour stent Googling hypothyroidism, or the lady who is convinced I’m rationing care inappropriately cause I won’t do the test she wants me to do.  Maybe I’s the whiner who has to see me every month for a problem and can’t understand why he’s not better when he can’t even follow simple care instructions. One of my favorites is the jerk who never gets any better because he won’t get his prescription filled because he doesn’t have the money, but he has a pack of smokes in his pocket, his breath smells of McDonalds, and, god forbid he ever miss his 3 beers in front of the tube at night.

My point is this, it’s a two way street and whether you want to believe me or not (and I really don’t care) doctors get no secondary gain for being jerks, but some patients… Well, they lie and manipulate, steal your DEA numbers and sometimes supplies right out of the exam rooms. Some treat you like you’re a prescription writing, test ordering service, or they want you to take over mommy’s job and give them an excuse to get out of this or that. Some are downright criminal, expecting you to commit insurance or Medicare fraud.

The people who really burn my butt are the hypocrites, the ones that bitch about the cost of insurance but then head to the ER for their colds because their regular doctor can’t get them in the office till tomorrow. These are the people who demand the xray/cat scan first instead of trying more conservative approaches, or they want unrecommended screening tests because their cousin Louis said they should have it done.

Sometime in the future we’re gonna take the kid gloves off and shine the spotlight on patient/family driven wastes in the health care system. Before we can do this though, we need to back away from the current business model in medicine. Patients need to be patients, not clients. Hospitals need to stop remaking themselves as hotels for sick people and drop the emphasis on customer satisfaction. Yes, I want my patients satisfied (and I guarantee you they are that and more) but the next time I get a drug seeker threatening to go to hospital administration because I won’t give her enough narcs I’m gonna have her surgically prepped from head to toe—accidently.

                Okay, so this is an example of an “over-the-top” rant based on some real life issues. Doctors can be jerks, I know I have been. Empathizing with patients can be a challenge these days when we have to get 30-70 patients in and out of the office just to pay the rent and staff, knowing that  more than a couple patients are going to be playing you for something. You need to know however that no one in his right mind would practice medicine if he or she didn’t care. We get nothing by making mistakes and so we try to do our best in a thoughtful way. Most of what we’re taught in medical school is how to observe and integrate information from histories and exams so we can best arrive at timely diagnosis without relying on tests. Fact is, the best test for whatever ails you is the doctor him/herself—even if they don’t touch you. Anyone can order a test and if that’s all we did the healthcare system would crash faster than me after an all-nighter.

So here’s my advice if you are having run-ins with your doc.

1)Always assume he/she is in a hurry, and relatively sleep deprived.

2)Talk to him in the same tone you wish him to use with you.

3) Understand that while he can be frequently late for an appointment, you can’t.

4) Know that for every minute he spends with you face to face, he spends another 3-5 minutes with other duties involving your visit (a five minute visit for you can be a 15-30 minute for him/her).

5) Expect him to find away to avoid unnecessary tests, referrals and medications , but be sure to ask what his next step will be if the first plan doesn’t work.

6) A doctor doesnt have to touch you to do his exam but he does need to talk to you. Stick to the issue that brought you to the office that day but if he can’t talk to you about your problem, find one that can.