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?

Thursday, December 7, 2017

Mailbag: Smelly doctor

Sometimes I get emails from readers asking me questions.  This was one that the reader asked if I could post, so here it goes:

Dear Fizzy,

I was hoping I could get advice from your readers on a problem I'm having!

My problem is, quite simply, one of the doctors I work with smells really bad.  I'm not talking about coffee breath either.  I'm talking about a stink that's noticeable from three or four feet away.  If I see her charting in a room, I will try to leave the room.  When we have a conversation, I breathe through my mouth.

I'm not the only person who notices this.  I've heard other people comment, "Do you think Dr. K knows about her BO?"

Unfortunately, Dr. K is a pretty important person at our hospital.  She's been working there much, much longer than I have.  Furthermore, she's a consultant who is not employed by the hospital, so she doesn't answer to our HR.

I don't know what to do, if anything!  I can't tell her she smells!  But I feel like someone should do something, right?  If I smelled bad, I'd want to know about it.

Thanks in advance!

Friday, December 1, 2017

The good stuff

I've been struggling with sinus issues on and off for the last few months.  I took Sudafed a few times and it didn't help much, which is generally the case with Sudafed these days.

Then a friend of mine pointed out to me that I could get the "good" Sudafed (pseudoephedrine) at the pharmacy without a prescription if I show my ID.  So I did.  And poof..... the haze I've been in was finally lifted!

While I was happy to feel better, I'm also pissed off.  Sudafed (phenylephrine) is essentially USELESS.  I've taken it multiple times and it does NOTHING.  Why bother even selling it?  Pseudoephedrine is so much better!

Stupid drug addicts ruin everything.  Patients can't even get neurontin anymore without being made to feel like a criminal.  Neurontin?  Seriously??  That stuff is practically a sugar pill.  How do you get high off that??


Monday, November 20, 2017

Likability

Because Press-Ganey is such a big deal lately, I've been trying my best to be more likable to my patients.

I've been mostly trying to be an attentive doctor, because I think that's the right way to be likable.  But I think there's an element of charisma that adds to likability, in spite of any medical care you provide.  That's not something that comes natural to me. 

So I've been trying to be as NICE as I can.  I've been trying to smile a lot... I literally am constantly aware of whether there's a smile on my face, and if there isn't one, I try to put one there, unless we're talking about something sad, in which case, I furrow my brow attentively.  I feel like a freaking saleslady.

Tips? Tricks? Advice?  How do I get people to like me? 

(Story of my life...)

Monday, November 13, 2017

THC

I've been hearing more and more lately about THC.

A friend of mine is on chronic pain meds and has started taking a mix of THC and cannabis to relieve pain, and has found it significantly cuts back on his narcotic use.  And the formulation with minimal THC doesn't really even get you high at all.

In a time when opioid abuse is at epidemic levels and death from overdose is out of control, I don't understand why we can't explore THC/cannabis as a serious treatment for chronic pain.  Yet right now, insurance won't pay for medical marijuana and they won't even pay for visits to doctors who are prescribing it.

Although this is talking from the perspective of being in a place where recreational use is not legal.  Maybe in states where recreational use is legal, it's more acceptable to use this as a treatment?

Thursday, November 2, 2017

Creepy Halloween Guy

So the other night, I was trick or treating with my kids and a friend of my daughter.  When we got to one of the houses, which was lavishly decorated for the holiday, a man opened the door holding his phone.

"Before I give you candy," the man said to the kids, "can I take your picture?"

So he took a photo of my kids while I waited on the curb, feeling extremely uncomfortable about the whole thing.  Then they took candy from him and left.

Later, the mom of my daughter's friend whispered to me that man always takes photos of the trick or treaters, and she finds it really creepy, but never says anything.  My husband said he wanted to tell the guy not to do it, but it all happened so fast and the kids were already running ahead to the next house.

I still don't know what to make of the whole thing.  Doesn't the guy realize how creepy it is that he's taking photos of random kids?  But then again, they're all wearing masks or costumes... it's not like they were in bathing suits.  But somehow it just seems like someone should tell him to STOP. 

I'm glad I don't live in that guy's neighborhood.

Friday, October 27, 2017

George HW Bush

I have to say, I'm irritated by the accusations coming out against George H. W. Bush that he groped women while posing for photos.

It's great that women are more comfortable going public with their sexual assault allegations against rich and powerful men.  That's a major step for women. 

It's different with Bush though. 

First of all, he's 93 years old.  He suffers from vascular Parkinson's and is on medications for that.  The chances that he doesn't suffer from at least some degree of dementia are slim.  He's probably sexually disinhibited.  I see patients like that all the time, and yes, they do sexually inappropriate things sometimes. Lucky for them though, it doesn't land them in the newspaper to be humiliated in front of the whole country.

I really don't think Bush would make a David Cop-a-feel joke if he were all there.  The proof is that even with all these women coming forward about the photo op harassment, nobody has made any accusations about non-demented Bush from years ago.  Now would be a perfect time to do it, but nobody has.  Which makes me think this is new behavior from his dementia.

Is it right that Bush grabbed those women?  No.  Do they have a right to come forward?  Yes, absolutely.  Is it Bush's fault this happened? I don't think so.  Is it somebody's fault?  Yes. Somebody around him who was aware of this behavior should have warned the women or not put him in a situation where this was likely to happen.  I mean, at least if the women were warned, they could be prepared and know it's not meant in a predatory way. 

I guess my point is I feel there's something wrong with tarnishing Bush's reputation because of things he does while demented. Hate him for Desert Storm, don't hate him for this. The finger-pointing should at least be directed at the right people.

Monday, October 23, 2017

Medical slang

From a discharge summary: "Patient went to the ER with sinusitis, and was treated and street'd."

Aside from the fact that I've never used or heard anyone actually use the term "treated and street'd" in real life... honestly, is that really the language you want in a medical document

Not that this is the equivalent, but I was reading a story about a doctor who had entered “TTFO" (this apparently means "told to f*ck off") on a patient’s chart. When he was asked about it later, the practitioner said that the initials stood for “to take fluids orally."