Thursday, December 29, 2016

When a Doctor Sees a Doctor, Part 2

Doctors enjoy chatting about diseases but not their own. We’re as frightened as you, and we want a doctor who sympathizes and makes it go away.

Some doctors don’t understand this. They assume that, being in the business, we don’t require any touchy-feely stuff and that it’s OK to talk shop.

Twenty years ago my dermatologist biopsied a bump near my ear. When he revealed it showed a basal cell carcinoma, he had me look through the office microscope at the biopsy slide, and I saw my cancer cells. Ik!....

Five years ago, my internist heard a heart murmur and sent me to a cardiologist. After determining that I had a damaged mitral valve, he led me into an adjacent room to show the ultrasound. Since I was a doctor, he took for granted that I wanted to know the technical details, but I absolutely did not want to see a film of my poor, diseased heart in action. As he happily pointed out the leaky valve I tried not to look.

We returned to his office where he extolled the skills of a cardiac surgeon at the nearby university hospital who had great success repairing heart valves. While it wasn’t urgent, he was certain I’d enjoy talking to him.

I found another cardiologist whom I like much better. I might need surgery in the future, he explained. He’ll let me know. I see him for an ultrasound every six months. Otherwise I try not to think about it.

Sunday, December 25, 2016

A Hotel Doctor at the Movies

My phone buzzed. 

I sit on the aisle in theaters, so I can hurry out before speaking.

“Can you see a guest at the Sheraton?”

“Which Sheraton?”

The insurance dispatcher gave an address that I didn’t recognize. It turned out to be in San Francisco, so I was back in the theater in less than a minute. This doesn’t happen often. Mostly, when a call arrives, I leave.

When hotel guests phone directly, the conversation always takes a few minutes. Even if a housecall isn’t necessary, I’ve missed too much of the movie.

When insurance agencies phone, a housecall is almost always necessary, and it takes a few minutes to copy the information. 

What to do then…. Most patients are willing to wait a few hours until the movie ends, but I never ask them. While I don’t deny that I’m a deeply caring person, I’m also a Type-A personality. If there’s work to be done, I can’t relax until it’s done, so I always leave. This does not sit well with my wife, so we usually go to the movies in two cars.

Cashiers give me a refund if I explain that I’m a doctor on-call, but once the movie is under way, I don’t ask. My fee for a visit is much higher than a movie admission. Most of the time I’m happy to get away. I doubt if I return to a quarter of the movies after I’m called away.

Wednesday, December 21, 2016

When a Doctor Sees a Doctor, Part 1

You might believe that doctors deliver better care to other doctors, but I’m not sure that’s true. It might be worse.

As a hotel doctor, I’d rather not care for a guest who happens to be a physician. For one thing, he’s likely to hint that I shouldn’t charge him.

He’s also less likely to give up his authority. Non-physicians often tell me their diagnosis and the proper treatment. Sometimes they’re right, but they rarely object if I disagree. They assume I know more than they do. When physician hotel guests tell me their opinion on the initial phone call, I’m tempted to let them have their way and avoid a housecall. Once in the room, I’d rather not be treated as a colleague. 

When I go to new doctors, I never reveal my profession (under “work” I write “self-employed”). They’re supposed to ask, but it’s not a priority.

My current dermatologist doesn’t know I’m a doctor, so I listen patiently to many explanations that aren’t necessary, but that’s fine with me. I want her to treat me like everyone else. After five years, my family doctor casually asked what I did for a living, and I could detect his surprise when I answered. But I’m satisfied with the medical care he delivers. On the rare occasion he makes a suggestion that I disagree with, I behave like any other patient. I keep my mouth shut and ignore it.

Saturday, December 17, 2016

Some Lawyers are not so Smart

I hate doctor TV series except out-and-out comedies such as Scrubs. All TV doctors say things doctors never say and do things doctors never do. 

I’m certain everyone with expertise, whether in the law, plumbing, or stamp-collecting, rolls their eyes when TV writers portray them.

Having said this, I confess that my wife and I love The Good Wife which is about lawyers. It’s brilliantly written, but I have no quarrel with legions of lawyers who fill the “comment” section of web sites with furious denunciations of its inaccuracies. I acknowledge that those in The Good Wife do things lawyers never do (such as sleuthing), and they are dazzling in courtroom cross-examinations.

I sympathize because, in the years before I became a hotel doctor, I was cross-examined twice. I was not the defendant but one of the doctors who cared for the patients whose misfortune produced the suits.

Having watched TV lawyers tear witnesses to shreds, I was nervous. Asked certain questions, I would have had to think hard to defend my actions, but those questions never came.

The lawyers seemed not terribly sharp. It was clear that they hadn’t boned up on their client’s medical problems. I had no trouble.

One lawyer enlarged a xerox of a page in the patient’s chart and displayed it before the court. Unlike the other illegible scrawls, my entry was neatly typed. Clearly that was suspicious, he proclaimed. How did I explain that?

This did not show great acumen. How much IQ would it have taken to learn that I typed all my chart notes?   

Tuesday, December 13, 2016

Don't Harm My Child

Examining a sick child during a routine hotel visit, I asked about previous illnesses, allergies, and hospitalizations. I asked if his immunizations were up to date.

“They’re not,” said the mother. “We don’t do vaccinations in this family.”

Evidence that immunization saves lives is overwhelming. Evidence is also overwhelming that people with deeply held beliefs are immune to evidence, so using it to change their minds is fruitless. I’ve never succeeded.

Sticking to straightforward common sense, I explain what these parents must do.

“Your family doctor is a menace. It doesn’t matter that you like him or that he agrees not to immunize your children.”

“He believes that immunization is good. Your research convinces you that he’s wrong, and you’re certain you’re preventing him from harming your child. But if this doctor believes one horribly wrong thing, there must be others. We use thousands of injectables, drugs, and procedures. There’s no way you can check them all out.”
“The only logical solution is to take your child to someone who will never do anything that might harm him. M.D.’s and osteopaths are hopeless. Even alternative schools – herbalists, naturopathy, acupuncture, chiropractic – do stuff. You should consider a psychic healer.”
In truth, I’ve never said this. I take care of the immediate problem and keep my mouth shut.

Friday, December 9, 2016

You Don't Want to Know

A doctor should wash his hands before examining you. If he doesn’t, do you remind him? I’m sure you don’t although popular health writers urge you.

A doctor in the office has seen someone who may be sicker than you before he arrives. You may not want to know this, but studies confirm that handwashing is rare.

I wouldn’t be writing this if I weren’t an exception. Ironically, before most visits I’m at home where no one is sick. My hands are less likely to transmit an infection, but I wash anyway.

In a hotel room, I have no high-tech office and subservient staff to proclaim my charisma. It’s all on me, so I wear a dark suit and tie, carry a traditional doctor’s bag, and maintain a quiet dignity. After interviewing the guest, I excuse myself to wash my hands.

I also wash before leaving. In this case, I’m looking out for myself. Perhaps half of sick hotel guests suffer upper respiratory or GI infections, and I don’t want to catch them. For the same reason, I ask the guest to open the door for me.

Monday, December 5, 2016

A Bright High School Student

The Kentucky legislature recently required doctors to pass a course in abusive pediatric head injuries. I’m licensed in Kentucky as well as California.

With an afternoon to spare, I found an approved course on the internet, paid $30, and spent an hour reading a mass of information on the causes, symptoms, treatment, prevention, and my legal obligations when I encounter babies with brain injuries from abuse. I can’t remember any, but doctors regularly miss them.

I couldn’t possibly recall more than a fraction of that material, but there would be mass confusion if too many doctors failed, so the test at the end was easy. I printed a certificate of completion and filed it in case the Medical Board checked. They do that but not very often.

California requires every physician to pass a course on domestic violence and another on care of the elderly. After finishing Kentucky's mandatory AIDS course, I discovered that the Board had cancelled the requirement.

Doctors grumble about activists who persuade states to add their favorite subject to the education hours that we must all fulfill. But no one has solved the problem of keeping us up-to-date. Ninety percent of problems a G.P. sees are easy. A bright high school student could handle them. The remaining ten percent require thought, but even if we mess up, most patients do OK over the short term. That’s why fakes with no medical training but a professional manner can practice for years before a disaster unmasks them.

Thursday, December 1, 2016

Drilling a Hole

A guest stubbed her toe.

Her big toenail turned black. This was a subungual hematoma: bleeding under the nail. If blood can’t escape, pressure builds, and it hurts.

The solution is to make a hole. Medical books have long told us to heat the end of a paper clip until it is red-hot and then burn through the nail.  

I don’t know about you, but I wouldn’t allow anyone near my flesh with a red-hot instrument. One can also dig with something sharp such as a scalpel. That takes work.

The solution is an electrical drill. One can buy one with a tiny bit, but I don’t see many subungual hematomas, so I borrow my wife’s. The smallest bit is 1/16th inch which is larger than necessary.

It’s a hefty instrument that makes a loud noise. Guests look uneasy when I approach, but the operation is painless, and when the breakthrough produces a spurt of blood, pain vanishes.