A Flea's Musings

On Call

2005-08-11T13:36:00.000-06:00

I had an interesting page on call this week. Unfortunately it was at midnight. Someone who was worried about a sudden onset of Tb. Seems had been sick for a while (2+ weeks), coughing, green stuff, miserable all around. Then developed chest pain, sharp, stabbing, worse by far with coughing, always on right side.

Seems this person had been in rehab recently, had a positive PPD, and a negative CXR, but was concerned she might now have Tb.

Of course, she didn't think to come in and see her PCP during usual hours. Admittedly she did call and was prescribed Zithromax over the phone, but had only taken one dose, several hours earlier.

I never get this....why do people expect the instant cure? I do understand the quick jump to the worst thing you can think of, like cancer, or in this case, Tb. I also don't get why this sort of thing always becomes an emergency at odd hours. Never during the daylight. We all get calls at 2:00 a.m. from people with pain for six weeks who just can't take it any longer. I've stopped asking why now from these people. I've never had a reasonable response. I think some people just live life on a different clock than the rest of us. 2:00 a.m. is mid-afternoon for some....

Funny business, this medicine thing....

Science, Schmience

2005-08-08T11:02:00.000-06:00

So I had a patient last week who came to me asking about something she had heard about on the radio, something for osteoarthritis, found only in health food stores, that is 'supposed' to work wonders and stop the disease. She was eager to try this, without any more information. I can't remember what it was, but I do remember I had never heard of it, either bad or good.

This same person has been refusing to take Zocor or similar for her lipids for years. This is despite my best efforts to discuss the science behind my recommendation, and the science behind the potential negative effects of statins, which is her big concern. She has heard 'bad things' about statins.

So this is an example of my patient getting and trusting the medical advice from the mass media more than her chosen doctor. This is an almost daily occurance. What does that say about me?? Should I feel insulted or somehow inadequate as a doctor that I can't convince her to take what I know is in her best interest (at least statistically)?? Or is it a larger problem with medicine as a whole, and the distrust we have engendered?? Or is it a societal problem due to the overexposure of the media, which seems to have invaded all our lives in the last decade or so.

I don't know. I just plug along, taking each patient one at a time, trying to tell them what I think is best for them, and basing that on the best available information medicine has. I think that is what they are paying me for. But it is still frustrating and difficult.

Back on Track?!

2005-08-04T09:55:00.000-06:00

When I started this blog, it was to be a forum for me to talk about what was in my mind. Admittedly, I was taking narcotics at the time, so my thinking was blurred, but the whole blog thing seems blurred to me.

Obviously, I've spent alot of time, and I am spending alot of time on addiction and my recovery, but I want to include pertinant medical information about patients I've seen, and other aspects of my medical practice.

I feel as though I been too focused on addiction this past couple of weeks. But I have more in that area, though I feel as though going more into internal medicine makes more sense.

What do you out there want?? Feedback time, make it real please.

Drug Companies

2005-08-02T09:59:00.000-06:00

I am getting more and more disgusted with the big pharmaceutical companies. I believe they are only out to maximize profits.

I think they made up the diagnosis of osteopenia, in order to sell more Fosamax like drugs, there is no science to suggest osteopenia leads to fractures

I think they are behind the move to lower standards for hypertension. Hypertension has traditionally been the disease that we treat that costs the most...in other words, for every event saved by treating hypertension, we spend more money than almost any other disease (due in part the the huge numbers who are treated to save one event). Now they want to increase the number who need treatment by lowering the standards...how much will this cost...any science behind this?? Nooooo...only a 'panel of experts', the vast majority of whom have significant financial ties to the drug companies.

We need to get the drug companies out of the media, out of sponsoring studies, etc. Perhaps they could all contribute to a pool that is used to study various meds completely independant of the companies themselves.

And now I read that they are sponsoring some Dermatology residencies.....is that the fox in the henhouse or what!!!

Next week, a story of rehab, prostitutes, and a half-way house, with alot of addictive thinking mixed in....keep coming back

Puzzles and Meth

2005-07-29T10:43:00.000-06:00

Wow, it was quite a trip to see the tweakers work on puzzles.....It seems even clearer to me now that the current drug of choice for the twenty-something crowd is meth. Not many of us older guys had gone down that road. And some of the stories I heard made me glad. I'm sure I would have loved it, and my bottom would have been so much farther down.

I also saw some permanant damage that I believe the meth caused. Several with paranoid and very compulsive behaviors that were not improving off the drug. I fear for their recovery.

Keep coming back...

Drugs of Choice

2005-07-28T15:09:00.000-06:00

So what did I learn in rehab?? Well, I learned that tramadol causes seizures. I knew it did, after I had one, but everyone I met who was addicted to tramadol had also had one. 100%. This is something that the drug company doesn't tell you. They (Ortho-McNeil) also told me the drug was non-addicting. They even presented me with a reprint that proved it.

I'm here to tell you that they are wrong. It is very addictive, just like any opiate. It creates tolerance, has withdrawal sx, etc. That's why I no longer trust drug reps, or drug companies AT ALL!! I must say, I did like the enhanced sexual performance I got from it, but according to my rehab buddies, that was a fluke. They didn't get that perk. I guess we are all different.

In the end, I am appreciative that I did have that seizure, as it started me down the road to recovery, which has been the best journey I've ever taken. Just wish I could have got here some other way.....

How much Vicodin is too much!!

2005-07-26T10:06:00.000-06:00

So, I learned many new and interesting things in drug rehab. For instance, I met several people who were taking like 45-55 Vicodin a day. That's like 20+ grams of acetominophen!!! I could not believe these people were alive!! Granted, their LFTs were abnormal, but were no worse for wear otherwise...amazing.

Also amazing to take 55 Vicodin and still function.......I guess function is too generous a word for where these guys were at. That's why they were in rehab!!! And I was totally unaware you could buy that many Vicodin over the internet...shipments of several thousand a month...wow...no wonder we have a problem with prescription drug dependancy in this country.

More to come.....

I'm Baaack!

2005-07-25T12:04:00.000-06:00

So, after a four month absence, I'm back in the saddle!!

You might ask where I went.....I might answer...and if I did, I would say rehab.

Yep, I am an addict and I went to rehab. That was quite an experience, to say the least. But now I am back home (rehab was an inpatient thing you see) and back at work full time. I'm donating body fluids on a regular basis, and going to AA.

Anyone else out there with a fun rehab experience recently?? Let's talk about it...

ARGGGGGGGGGG

2005-03-31T10:34:00.000-07:00

I hate eBlogger....what is wrong with this system....Must move blog....must find better site.....must not explode....must not hit monitor with fist....must check xray of hand...

End of Life Stuff

2005-03-31T10:25:00.000-07:00

With the death this morning of Terri Schiavo, it gets me to thinking about end of life issues. I completely agree with Terri's husband, that to go on living like she was, is no way to spend a life, and now that she has expired, my former Catholic, now Protestant beliefs tell me that she is in a better place, released from her physical limitations and impairments.

I am outraged that the Congress of the USA, as well as the President of the USA, felt that they were entitled to meddle with the personal decision, and therefore liberty, of a single American citizen. This country is based on the right to make decisions for ourselves, even when they are not in the best interest of the individual. The laws in this country clearly state that the spouse of an incapacitated person is felt to best know the wishes of that person, and therefore has the right to make the decisions for that person.

These same Congressmen were up in arms about the sanctity of marriage just a few weeks ago, when same-sex marriage was on the table, and now they want to subvert the intimacy of marriage in this case and override Terri Schiavo's husband. What hypocrites!!!!

As for myself, I have discussed the issue with my wife, and we are clear. Just so there is no question, I have tattooed the words, 'Shock x1, then DNR' on my chest, and I am actively seeking a ENT to tattoo my throat with the words 'Do Not Intubate!! Ever'

What do you think out there in bloggerland!!!???

Don't Give Up on Me Yet!!

2005-03-29T10:09:00.000-07:00

I've been out of town. I'm working on new post...should it be a medical story, a medical issue, or a 'humourous antecdote'??

Check back soon!! I promise!! Trust your doctor!!

Da Viagra Code

2005-03-17T10:25:00.000-07:00

Viagra has been quite the boon to the over 80 set. I am still amazed at the number of 80, no make that 85+ year old men who come looking....
I remember one gentleman quite specifically....he was 90, had just lost his wife of 60 years to cancer (I wasn't her doctor, so no details were forthcoming), and here a month after her death, he was looking for Viagra...turns out he had remarried already, and needed to 'make it legal' and needed a little pharmaceutical help. I know most widowers don't stay single forever, but he set some kind of record...

A second type of user is the widower, single man, again usually over 80, who is clearly only entertaining himself (certain, how shall we say, grooming habits, or lack thereof, make it clear there is no female input present). This also amazes me, how many men seem to have the need for sexual satisfaction, whether alone or with a partner, at all ages. Many women may think they will be off the hook later in life, but I'm here to tell you, men are men at any age...looking for and thinking about only one thing....

I, of course, am completely different, and able to keep any such primitive 'urges' in complete control. As I tell my wife, 'I can take it, or leave it'......

Too Many Mastectomies?? Who Says??

2005-03-10T10:33:00.000-07:00

I know I promised more stories about people, etc. but I just can’t let this issue pass unnoticed.

I saw a story last night on NBC about how women may be getting unnecessary mastectomies, because the surgeon gets paid more for the longer mastectomy than the shorter lumpectomy.

This is crap!! The news media continues to do all they can to portray physicians as money grubbing, greedy, intellectually aloof baboons….I know there are some baboons in medicine, as in any profession, but by and large, medicine is still populated by physicians who genuinely care about taking care of people and work very hard to provide the best care they can….EVERY physician I know personally regularly uses his/her own personal time and/or money (in the form of no reimbursement) to take care of patients. This does not happen once in a while, it is ongoing. There is always someone who needs more time, more help at home, more something. Every member of my group, and all the primary care groups in town I am familiar with, goes the extra mile to help, regularly!!

The other part of the story that infuriates me, is the comment from the surgeon at MD Anderson Cancer center, that they are trying to get paid better for ‘better work, smarter work, work that requires more intellectual skill’.

This is what Internists have been saying for decades. We do the hard part, the intellectual part, the work of taking care of the WHOLE patient over time, and send the patients to the surgeons when they need an operation…like say a gall bladder out, or bypass, or breast cancer surgery. And who gets paid better….the surgeon. I would LOVE to see better reimbursement for ‘smarter work, work that requires more intellectual skill’. That is what I do each and every day, and yet each and every day, I am penalized for my decision to become an internist. Not only do I receive far less in the way of reimbursement for my professional services than do my procedure oriented colleagues, but I have to employ an entire army of staff, from reception, to nursing, to support my outpatient practice.

Surgeons on the other hand, do much of their work in a facility operated by someone else, staffed with personnel employed by someone else, and get away with minimal facilities or staff outside the hospital. Many have found that this is not good enough, so they have built their own outpatient facilities, and obtained their share of the fees paid to maintain and operate these facilities (read outpatient surgery centers). They then pick and choose, leaving the complicated, time consuming, poorly paying procedures to the hospitals (otherwise known as ‘cherry picking’).

So on top of being paid far less than my procedure oriented colleagues, my overhead is far greater, further reducing my compensation for my ‘work that requires more intellectual skill’. You bet I’m all for better compensation for better, more intellectual work. Bring it on!!! (and let the surgeons suffer!!)

Survey Says!!

2005-03-07T16:09:00.000-07:00

Just a quick survey. Had one of my reception staff come up and ask, almost in hysterics, if we dealt with 'pecker problems' Seems one of my patients had a problem with his pecker and wanted to see the doctor.

How many of you out there have heard the term pecker?? Hands up please.....

How many have said the word out loud in the last six years?? Hands....

How many would have said they are the proud owner of one??

Just wondering....

Money and Medicine

2005-03-05T16:56:00.000-07:00

Since I mentioned money and medicine, I thought I would do it again. Many people think that doctors make buckets of money. While I admit my income is probably above the median, it certainly is not what you think. Yet medicine is INCREDIBILY expensive!!! So in medical insurance.

As a small business owner, I have the privilege of buying health insurance for my employees. The cost to me for that privilege has gone up about 65% in the last two years. As a physician, I also am on the receiving end, getting payment from the same insurance companies I send premiums to. Do you think my reimbursement has gone up by 65% as well?? Of course you don't, and of course it has not. It has not gone up one cent. So where is all the money going????

To the drug companies...

When a ten day course of antibiotics for a sinus infection can cost well over $150, something is wrong. When the typical American on Medicare is taking three or four medicines that average three times the cost of gold on a gram for gram basis, something is wrong. When drug companies can afford to send every physician in the USA a FedEx overnight letter introducing their newest wonder drug, you know they are making money hand over fist.

I think this is one area where the federal government could step in and provide some regulation and cost reduction, and make great strides in controlling medical costs. I would prefer this over any sort of socialization of medicine on any other scale.

However, with all the money in the bank accounts of the pharmacutical manufacturers, and since money seems to talk the loudest in Washington, D.C., any intervention by the federal gov't would be a miracle, or would be completely ineffective at controlling drug company profits.

At least they (the drug companies), make entertaining TV commercials......I really like the last Levitra ad.

OK, enough about money and medicine. I promise more in depth stories about people and experiences, etc.

Take Two

2005-03-03T13:42:00.000-07:00

Well, I've been distracted, and unable to add to my new blog for a while, but there's no time like the present.

I continue to wonder about people and money and medicine. I just had a complaint from a patient who was upset that I charged her for a physical, or preventative medicine exam, and that Medicare doesn't pay for that...so she is stuck with the $173 bill herself. Her old doctor apparently never billed her 'physicals' as such, rather as E&M visits, so Medicare would pay.

I pointed out to her that this is technically insurance fraud and that I could be fined or even jailed if caught. I also pointed out that Medicare kindly provides a phone number on each and every EOB that beneficiaries are to use to report suspected fraud...so they are not kidding!!

What makes me even more upset is the amount of money involved. I took my car in last week, and I paid some grease monkey over $200 to replace my brakes...and now this patient of mine is balking at paying less than I did for brakes, for the services I provided her in an effort to keep her healthy. Not to mention that I spent eleven years after high school training to do what I do (I bet the grease monkey didn't even spend eleven months training). Then there is the whole issue of overhead, expenses, malpractice, etc. People just don't expect to have to pay a cent for health care.

I think that is the root of what is wrong with our system. I'm not at all in favor of any sort of socialized medicine, but the disconnect between those who are paying for medical services (insurance companies, Medicare, etc.) and those who are receiving the services (patients), results in the American assumption that everyone deserves the most expensive and complete evaluation and treatment for every problem, no matter how minor. And all this is not supposed to cost anything.....

Argg.......some days I wonder why I don't just learn to do brakes and change oil myself and get out of the aggravations of practicing medicine....

Test Run

2005-02-10T17:38:00.000-07:00

Well, this is my first entry. A test run if you will. Making sure all the various settings are correct. As a newbie, I'm not sure how to do it all. Will take some time to get it just how I want it, I'm sure. Bear with me.