Monday, September 16, 2013

What you need to know about your friendly road-weary MD

Today was a hard day at the office. Most days I feel like I do help people feel better. But today was one of those days when each door opened to another person peering at me through suspicious eyes, ready to tell me how much I didn't know about their condition or how my motives were somehow not aligned with their best interest. So, I have created a list of things you people just need to know. Because I don't think I can survive too many more days like today. 

1) Please do not ever say to your doctor: "I know you're a doctor but I know my body better than anyone." Until you can tell me the difference between a bacteria, a virus, a parasite, an allergen, and an antigen or describe the process of oxygenation of hemoglobin including the transportation across alveoli or describe the process of sodium secretion and reabsorption in your kidneys then I can assure you, I do know your body better than you do. And speaking of that...

2) Do you really think doctors would train for a decade, incurring sometimes hundreds of thousands of dollars worth of debt, and shave years off their life through sleep and social deprivation only to learn something they could have just researched on the Internet? Perhaps all of the training we go through gives us a bit of perspective and knowledge that you just can't possibly read on WebMD. Until you can walk me through the design of a randomized double-blinded control trial, sensitivity, specificity, and statistical significance, then give us a little credit.

3) Do not make an appointment with a doctor if you do not plan on taking his or her advice.  And for goodness sake, don't keep going back to that same doctor over and over again if you are not going to trust her. It is a waste of both of our times.  

4) "All natural" and "prescription" do not make things inherently good or evil. Cyanide is all natural and will kill you. Antibiotics can save your life but they can also kill you too. All things ingested (which includes everything swallowed up to and including food) have side effects. The key to healthy living is weighing the risks with the benefits and determining the best course of action with the most information you have at the time. Remember the point of consumer make a sale.

5) And speaking of that, let's talk about Big Pharma.  The times of drug companies being able to woo doctors with trips to fabulous places or nice swank gifts is over.  The only thing I get from drug companies is samples to pass out to patients (which means I give away approximately $5000-$10000 PER DAY) and lunch for my staff three days a week. In exchange for that, I agree to listen to drug reps drone on and on about how fabulous and superior their product is.  Sometimes, when I've had enough coffee, I'll fire enough questions at them to make them realize they are trying to educate me on something I know much better than them but generally I just smile and thank them for feeding my staff because well-fed nurses make happy nurses and that makes happy patients which in turn makes happy doctors.  Perhaps the major problem with today was the lack of food.  I digress.  Drug reps cannot give me so much as a tissue to blow my nose and while they know how much I do and do not prescribe their drug, I could not tell you what drug any of them peddle despite seeing some of them on a weekly basis for the last 3 years.  That is all to say, when I prescribe a drug to you, it is not because their is a kickback to me.  It is because I think it is the best drug for you, weighing your other medical problems, your lifestyle (i.e. do you work alternating night and day shifts so a medicine that needs to be taken on an empty stomach at the same time each day just isn't going to work for you), your insurance, and your financial situation.  Yes, if a branded medication has a pretty sweet coupon card, I may choose that first if it ends up costing you less than a generic.  But let me be clear.  I do not get any kind of reimbursement from drug companies or pharmacies.  So please do not accuse your doctor of being in cahoots with anyone.  I can assure you I rather despise your insurance company and Big Pharma probably as much as you do, but likely for much different reasons.

6) Antibiotics.  Similar to as above stated in #5 in that I have absolutely no financial incentive to prescribe meds, I also do not have any financial incentive to withhold them.  Take a big breath and hear me out on this one.  Just because you are sick does not mean you have an infection that an antibiotic will kill. And just because you were sick once, or even 10 times, and "an antibiotic worked for me then" does not mean it will work for you now.  Nor does it mean it even worked for you then, as most of the time you would have gotten better anyway and the antibiotic was started about the time that upswing was taking place. I know a thing or two about bacteria.  I would never go to my mechanic and say "I know you are telling me my brakes are bad but I can assure you, I know my car much better than you and I am certain the reason my car will not stop properly is because the tail lights are out.  Replace them and leave the brakes alone." Any good mechanic would send you packing.  Unfortunately, since you can sue me, I can't be so blunt.  Nor do I have enough time or energy in my day to explain the difference between a bacteria and a viral infection to 20 people times 5 days a week times 52 weeks in a year. Truly, it would just be easier for me to give you the antibiotic that will not fix you and could possibly kill you (we will save malpractice lawsuits for a different days rant) but, as a physician, I am charged with antibiotic stewardship.  Antibiotic resistance in this world is growing at an alarming rate. We are already seeing bacterial infections that are 100% untreatable.  This is caused by overuse, and more importantly, improper use of antibiotics.  i.e. You have a cold. It is viral. It has to run its course. I know you "don't have time to be sick" but that's something you'll have to take up with Mother Nature because I left my magic wand at home today and I'm not going to replace your tail lights because your brakes are broken. See #1.

7) If there were a safe pill that would easily make you young / thin / live forever, don't you think all doctors would be prescribing it and also owning stock in whatever company was making it?  We aren't and we don't so please believe me that it doesn't exist.  If you want to be as healthy as possible, only eat what you can grow or kill.  And spend the energy actually growing it and killing it.  That will solve most all of your inability to lose weight.

8) You cannot describe any bodily function or odor or fluid that will embarrass me so please don't waste the energy fretting about that.  Foamy urine or foul smelling poop or anal leakage hasn't made me blush yet.  Doubt it ever will.

9) If every doctor you've ever been to along with the CDC, the NIH, and most public health institutions strongly encourage you to get a flu shot, do you really think we're just saying that for some type of financial gain?  If so, please reference #5.  Not only are we trying to save your life or at the very least about 7-10 days of your absolute misery, we are (more importantly) trying to save all the lives of the people in our community much more susceptible to dying from the flu than you (like my children and my mother).  It's called Herd Immunity.  It's one of those things we learned in medical school. Again, reference #1. Get your flu shot. (And by the way, if you truly want to look like an absolute idiot to a physician, just say "I don't get flu shots because they cause the flu." Yes, Chicken Little, the sky is falling.  But only on you.)  

10) There is not one single stinking thing you can tell me about smoking that makes the fact that you continue to do it anything other than you willfully trying to kill yourself.  Period. 

11) I don't do my job for free.  I am paid well for my time.  But I am not paid as well as you think I am so please refrain from using phrases in my office such as "Well, you couldn't possibly understand because you're a doctor" and "clearly you don't have to worry about money"  and "I wasn't as lucky as you to have the chance to go to college."  Not only does that make a lot of assumptions about me (and we all remember that to assume makes an ass out of u and me) but it also completely disrespects how hard I have worked to get where I am.

I am sure the above won't change many minds out there.  But if, at least, you can go into your next office visit with a little less animosity and a little more humility, I think the visit will be so much more productive for both of us.

End of rant.  

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