Wednesday, March 14, 2018

Do you smoke?

Me: "Do you smoke cigarettes?"

Patient: "No."

Me: "Did you ever smoke in the past?"

Patient: "Yeah, I quit a week ago when I was admitted to the hospital.  Before that, I smoked a pack a day."

I don't get that.  If a doctor asks you if you're a smoker and you only quit a few days ago, you are still a smoker.  Why do people do that?

Friday, March 2, 2018

Women in medicine

Yesterday, a female resident went in to see a patient.  A bit later, she returned with her male attending.

Patient (to the attending): "You're so lucky you get to bring your wife to work with you!"

Attending: [horrified] "She's not my wife!"

Patient: [winks] "Even better..."

Monday, February 19, 2018

Survey on your experience...

I recently bought some expensive tickets for a show through a ticketmaster-type website.  After the purchase, it said my e-tickets would be delivered to me in twenty minutes.

Three hours later, I still hadn't gotten the e-tickets.  So I sent an email to customer service.

The next morning, I still hadn't gotten tickets or a response, so I called customer service.  The rep I spoke to basically acted like I was being impatient.  She was like, "Well, you bought your tickets at 7PM on a Friday night... what did you expect?"

"I expected the tickets in twenty minutes if that's what your site said would happen."

"Yes, but it was after business hours."

"Right, but the email didn't say I would get them the next business day.  It said I'd get them in twenty minutes so it's obviously automated."

"Yes, but nobody is working on a Friday night."

"Your site says the tickets are supposed to arrive in twenty minutes. If that's not going to be the case, the site shouldn't say that."

We went back and forth like that a bit, and she was basically blaming me for being impatient.  But the show was in a few days and it was clear something had gone wrong.  Finally, she basically put in an email to.... someone. 

"And when should I expect a reply?" I asked. "Like, at what point do I need to call again?"

"I don't know," she said, sounding very exasperated.  "Look, you'll get your tickets before the show!"

I finally gave up on her.  A few hours later, I got an email from customer service, saying my ticket purchase somehow hadn't been uploaded to the system, and they fixed it, and my tickets arrived five minutes later.

In any case, after my call with that woman, I got an email asking to rate my interaction with her.  I essentially never fill these things out, but i was so steamed, I did fill it out, and mentioned how unhelpful she had been and that she blamed me for being impatient when there was actually a glitch in the system.

It just got me thinking about surveys in general.  Sadly, I'm the sort of person who only fills them out when I have only an especially great or awful experience.  That's the inherent flaw in things like Press-Ganey.  Unless everyone is required to fill them out, how can you really get an accurate assessment of care?

Monday, February 5, 2018

Weirdest winter ever

Usually by this point in the season, I've been sick at least four or five times.  Having a cold is sort of my thing.  And this winter has been really bad for everyone around me getting sick.

Yet weirdly, I haven't had one cold all season.  I have had some sinus issues, but no actual colds.

It's honestly almost a little frightening. This hasn't happened since I've had kids. I'm wondering if my body is revving up for some monsto-virus that will result in my death.

Or have I now just acquired every upper respiratory virus circulating in a 30-mile radius and have become immune?

The only other thing I can think of is that I started taking multivitamins this summer.  Could that be why I'm not getting sick??

Thursday, January 25, 2018

An education on late term abortions

I was recently talking to a friend of mine named Joe who works in health care and is an intelligent, well-educated person.  The subject of abortion came up and Joe told me he was pro-choice, but...

Joe: "I just don't think women should be allowed to have abortions at 37 or 38 weeks pregnant.  That's just wrong."

I think I gasped audibly and said, "Oh no!"  I didn't understand how a smart guy in healthcare could believe women were having abortions two weeks before delivery.  Or putting it another way, that there are doctors out there who are effectively willing to murder full term fetuses.

Donald Trump said it during a debate though.  And while people did point out that this ridiculous, I always felt like a big enough deal wasn't made out of this.  Our presidential candidate believed women are allowed to have abortions at full term.  How can we brush that off?

I calmly tried to explain to Joe why this logic made no sense, and he quickly said, "I don't want to talk about it anymore."  And.... that was the end of the discussion.

Now I am someone who sympathizes with people who are genuinely pro-life.  I have female friends who believe life starts at conception, and can talk intelligently on the subject. I am willing to listen to anyone who does not just want to ban abortion as a way to punish women for having sex. But the issue of late term abortion is one that I think is confusing to a lot of people, and I genuinely believe that very few of the politicians, especially the ones trying to ban abortion after 20 weeks, really understand anything about it.

This is an incredible article by an OB/GYN about late term abortions.  Here are the highlights:

1) Late term abortions make up about 1% of all abortions, so banning them does not really reduce abortion rates much.

2) 80% of late term abortions are for serious birth defects, many of which are incompatible with life.  Should politicians really get to decide if women have to spend four months with a baby with no brain in her uterus?  Why is that even a political issue???

3) Most of the remaining 20% are for serious maternal health reasons.

4) After 24 weeks, abortion is NEVER performed.  Delivery is always attempted.

Essentially, these politicians want to keep women with the most heartbreaking situations (tragic birth defects, life-threatening conditions) from getting medical treatment.  I can't figure out any way to justify it other than ignorance about late-term abortions.

Tuesday, January 23, 2018

Watch phone

You guys always give great advice when I ask for it, so I’ve got an important question:

My 11-year-old has already destroyed one laptop by dropping it on the floor.  I want her to have a phone but she’s assured me she’ll probably lose or break any phone I get her.  So I’ve been considering getting her one of those watch phones for kids that has a GPS, can call a few select numbers, and text a little.  They seem to run $30-70 on Amazon.

Does anyone have any experience with these phones? Recommendations? Advice? If it makes a difference, we have AT&T.

Tuesday, January 16, 2018

Physician suicide

I was talking to a medical student recently who said he didn't want to do a residency in NYC because "everyone there kills themselves."  I think that's a little dramatic, although I do recall several years ago there was a rash of suicides in residents.

I just read an excellent article on physician suicide.  What's sad is that if a physician really was feeling suicidal, I guarantee there's no way they could seek counseling quickly that wouldn't jeopardize their career and confidentiality--the only effective way would be to threaten suicide, which would take them to the ER and give them a record of suicidal behavior.... a fate many proud physicians would consider worse than death.

I'm going to take a step further and say mental health treatment in this country is really bad.  This is not a jab at mental health professionals, who are probably fine individually.... just saying there aren't enough of them. The system is bad. If someone is feeling depressed or suicidal, they can call their local behavioral health center and maybe get an appointment in a month or two.  Hopefully they're alive by then.

I had a few really down periods during my medical training, so I can speak to all this from experience.  There were no mental health services available.  At one point, when I was having a really hard time, I called some student health hotline, and the person told me that this wasn't the purpose of the line. I asked where I could go, and they said such a service didn't exist at the school. They talked to me a little, but it was clear that they were just doing it to be a good human being, and not because it was their job or something they were trained in. 

So.... I guess the takeaway is don't get depressed because if you do, you're shit out of luck.

Monday, January 8, 2018

Guest post: Weight loss surgery

Tuesday I sat through another hard sell for weight loss surgery. I'm so done.

I'm weary of doctors who won't hear my "no" and plow ahead extolling the virtues of procedures I have already investigated and decided are not for me. I would be at high risk of suicide if I allowed myself to be bullied into this. (That is not true for most people but would be for me.)

Today I felt calm enough to respond via email. To be sure, I responded plenty in the moment but everything I said was ignored or argued with and the doctor just kept going. My husband was present and he was shocked--as a fat man himself his doctors bring things up and then drop it if he says no. I talked with him about how hard it is to turn around and look for another doctor because I don't even know how THAT doctor will handle the sensitive issue of weight. If there's one thing I'd wish of doctors is that they come to appreciate how we've already survived a lifetime's worth of assaults on our self esteem based on our weight. Unless they've been there I don't know how easy that is to understand--but I wish they'd try.

I sent the following to Doctor M:

Subject heading was "Boundaries."

I understand that all doctors will discuss weight with their fat patients. I expect that it will be brought up. What I did not expect was the hard sell on weight loss surgery after I repeatedly indicated that I was not remotely interested in it and had firmly decided it was not for me for many reasons. You continued for something like 20 minutes AFTER I indicated that. But what is dangerous to my well being and survival was that you did so after learning I had spent months being verbally abused and was dealing with the resulting depression. Fortunately I've had years of therapy and could deal with the hurt, shock and distress I felt after having my boundaries violated.

It also concerns me that you'd dismiss the value of walking simply in relation to weight loss.

WEIGHT LOSS IS NOT A GOAL OF MINE. A Health at Every Size strategy of movement and eating healthy food IS. Obesity research has demonstrated that 95% of us regain. This is a feature not a bug.

Can you respect boundaries?

Thursday, December 21, 2017

The flu shot

Who got their flu shot?

This year, I’m hearing the flu shot was only 10 percent effective. Not too great. I’ve already had some patients with the flu who were especially bummed because they got the shot.

I still personally always get it. But there is still a faction of physicians I work with who refuse, even if it means they are pressured to wear a mask in patient areas.

What do you think? Do you get the flu shot each year?