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Showing posts from March, 2021

Should Doctors Pay Patients When We Are Late?

Some time ago, I flew with my youngest kid, then a high school senior, on a college visit.  He’s the last of 5 youngsters, so I’ve had my share of these visits to various centers of knowledge where young minds are molded to face uncertain and unknown futures.   While I’ve never found these visits to be substantively valuable, they were of great value to me as it was fun to be with them on these exciting excursions. The Hallowed Halls of Higher Learning Photo Credit The formats of the school presentations are superimposable.  There’s an information session, which serves as an infomercial that tries to draw students to apply.  Schools favor receiving large volumes of applicants so that their acceptance rate will be lower and they will appear to more selective than they actually are.   How cynical of me to suggest that there are forces in academia that might be pursuing a self-serving agenda! These sessions are led by effervescent young cheerleaders who present a power po

Why I Don't Advise Patients to Quit Smoking

I don’t advise patients to quit smoking. I don’t exhort alcoholics to stop drinking. I don’t preach to my obese clientele to slim down. And I don’t lecture patients to get the COVID-19 vaccine. This may be the point were some readers are wondering, “What kind of doctor are you?” For the record, I do not endorse or advise cigarette smoking, alcohol addiction, obesity or careless behavior during the pandemic.   I favor temperance in my own life.   I exercise.   I am attentive to my BMI. And I wear a mask and have received my COVID-19 injections with enthusiasm. But it has never been my style, either professionally or beyond the office, to tell people what to do.   Once folks reach a certain age, which for many are the teenage years, you just can’t make them do stuff.   Every parent understands this.  This does not mean that I don’t have influence over people who trust me.   I do and I use it.   However, i t’s a process issue.   How best can we help individuals make sound deci

Tolerating Uncertainty in Medicine

Uncertainty makes everyone anxious, although each of us has a unique threshold for uncertainty tolerance.  In other words, different folks may react quite differently if they are confronted with the same set of facts.  Consider this hypothetical.   Two patients who are of similar age and enjoy excellent health undergo a CAT scan for a stomach ache.   By the time they follow-up with their physicians to review the results, their symptoms have resolved and they feel perfectly well.   A small spot is seen in the liver which the radiologist suspects is an innocent cyst, but he cannot state this definitively.   Each of the patient’s physicians explain that minor accidental findings like this are common and are very unlikely to pose any health threat. Patient #1:   “Ok, doc. I feel great and if you’re not worried, neither am I.” Patient #2:   “Are you sure it couldn’t be serious, like a cancer?   Should I have it cut out just to be safe?” First of all, let me give readers an inside ti

Lockdowns and COVID-19 - Is the Cure Worse than the Disease?

 There’s been lots of talk about lockdowns lately.  This issue, like masks, has become politically contaminated.  It’s been one of the fascinating lessons of the Pandemic of 2020 – the recognition that issues that would seem to be ‘immune’ to political interference became instead potent partisan weapons. Consider two rather distinct reactions to the recommendation to don a mask when frolicking about in public. Citizen #1:   Of course, I will mask up.   This will keep me and others safer.   In a small way, I feel I’m doing my part on the journey to the other side. Citizen #2:   Mask?  Hell no!  Just more encroachment by the government to rule our lives.   Similarly, locking down the economy, both here and abroad, has provoked bitter reactions from all sides. 'No mask for this patriot!' As I have written, I feel awful about the hundreds of thousands of businesses who have closed or are barely hanging on.   I also feel that their plight has not been given the attention