When Guests Drop Hints -Part 2

        Guest:  “I try not to.”

        This means “Yes” in answer to questions like:  “Do you cheat on your diet, stick Q-tips in your ears, consume too much food, alcohol, tranquilizers, salt,  or laxatives?.”

        Guest:  “I try.”

        This means “No” when I ask if someone has obeyed instructions that are almost impossible to obey (take a pill every four hours, stick to an exercise program, ignore a crying baby)...

        Guest:  “Everyone tells me what a great doctor you are….”

        My heart sinks when I hear this because it precedes a request that I’m not likely to fulfill.

When Guests Drop Hints - Part 1

Here are some phrases that I have to interpret.

Guest:  “You’re the doctor.”

This means “You’re wrong.”  Other hints that I’m off base include:

“I wonder if I need something stronger…”

“My regular doctor always gives me...”

“My husband had the same thing, and the doctor said it was...”

Guest:  “If I don’t get something it turns into (...bronchitis, strep, walking pneumonia, a sinus infection...).”

This guest is saying:  “I want an antibiotic.”

Patients often work hard to convince me that their cough, congestion, or sore throat has a special feature that requires an antibiotic.  They tell me that -

“I have an important meeting, and I can’t afford to be sick.”

“I have a tendency to strep.”

“It’s not a cold.  It’s bronchitis!”

“If I don’t catch it quick, it goes to my chest.”

Plus the old favorite:  “My regular doctor always gives me...”

Guest:  “Are you sure I need this?”

This means the guest won’t fill my prescription.

Similar hints include:

“I don’t take medicine unless it’s absolutely necessary.”

“My mother is allergic to this.”

“I have a sensitive stomach.”

Why We Get Old and Why We Die

People believe that bodies wear out as they age, but that's wrong except for teeth and joints. These are also two areas where medical science is perfecting good replacements, so it’s possible to get the wrong impression.

You can’t wear out your eyes by excessive reading any more than you can wear out your nose by excessive smelling. You can speed up matters through bad habits such as allowing the sun to shine on your skin, but aging is built into your genes.    

Evolution designed organisms to pass their genes on to future generations as efficiently as possible. After peak reproductive years – the 30s in humans -- evolution loses interest, and the performance of your incredibly complex metabolism declines. Efficient processes become less efficient. Things break. You don’t wear out; disease eventually kills you.

If you want encouraging news, it’s possible in theory to physically alter genes so that metabolism doesn’t peak at 30 but at 100 or 200 or never.

In fact, over the past decade biologists have developed ingenious techniques to manipulate DNA. I reviewed a good book on this called A Crack in Creation. Look it up on Amazon.

Nothing about vast life extension violates natural laws, so it’s probably inevitable, but you and I were born too soon.

When Stupidity Takes Over

In 2002 I had the satisfying experience of reading a front page story about my leading rival hotel doctor.  The California Medical Board had lifted his license, and he was in serious trouble for providing narcotics to more than one celebrity. You can google it.

Most drug abusers must take to the streets and run risks, but a few are rich enough to pay a doctor to make housecall to give a single shot of whatever they prefer.  A doctor for luxury hotels gets such request regularly (“My back went out, and I have a meeting I can’t miss...”).  If a doctor is quick with the needle, the word gets out.  Calls pour in.  Money pours in.  Most likely the doctor realizes he can charge a good deal more for this service and related services. Stupidity takes over.

Eventually, prescriptions labeled with this doctor’s name are sitting in medicine cabinets, purses, and glove compartments throughout the city. Their owners are fairly careless. This doctor is doomed.

Yearning for a Rare Disease

When I was an intern, a young man came to our emergency room with fever, body aches, and general miseries.  It seemed routine until we noticed a spotty rash on his hand and feet.  Then everyone perked up.  Rash-on-hands-and-feet is a medical puzzle with plenty of answers.  We racked our brains for diseases that qualified.

“Rocky Mountain Spotted Fever,” said an intern.

“It could be secondary syphilis,” said a resident.

“Maybe typhus,” another suggested.

An old professor arrived, looked over the patient, and then turned to us. “Those are all possibilities, but any virus can produce that rash,” he explained. “It’s probably the flu.” Sadly, from our point of view, he was right.