Sunday, November 28, 2021

Thanksgiving 2022


This has been a tough year for America and the world.  For many folks and families, it may be challenging to find reasons to feel thankful.  But we must try.  When you’re in a dark room, you might not see a way to let the light in.  Try to find a window that you can crack open.  Or, one of us will do our best to open it from the outside.

Wishing blessings, contentment and peace to all.

Hoping for a lot more light in the year to come.

Sunday, November 21, 2021

Calling Your Doctor's Office - Frustration #1

There are joys and satisfactions in the practice of medicine.  Indeed, they have sustained me for the past few decades.  I enjoy the work and I continue to be honored that my long-term patients as well as new ones place their trust in me.  Despite my best efforts to deliver perfect advice to every patient every time, I confess that I am a member of the imperfect human species.  I have reminded patients that while I try to offer sound medical advice, I am neither omniscient nor clairvoyant.   If I knew, for example, that the medicine I am prescribing wouldn’t work, or would cause you an unpleasant side effect, then I would not have prescribed it. If you become a ill a week after you have been discharged from the hospital, it does not mean that you were thrown out prematurely.   Excellent medical judgement doesn’t guarantee an excellent outcome.  Conversely, a favorable medical result may occur after mediocre medical care. 

There are also frustrations in the everyday medical world.  Assuming that you can even decode your medical bills, try rectifying an error with your insurance company.  If you didn’t have high blood pressure when you called them to inquire, you will surely have it before the end of the conversation, that is if you actually reach a living and breathing human.  When your doctor’s prescription is denied by your insurance company, does this restore your faith that the insurance company cares deeply about your health?   Have you had the experience of trying to make an appointment to see your doctor to be told he or she is booked out for months?  

I think that the most frustrating experience for patients and us in the medical universe is the labyrinthine telephonic chamber of horrors.  This dwarfs every other frustration and seems to defy any solution.  This can test the mettle of a battle-hardened Marine.  It can bring an athlete to her knees.  It can make a stoic Philistine weep.  After 30 years of medical practice, my staff and I have been unable to crack the code on this. 

Alexander Graham Bell Trying to Reach His Doctor

In each of the 3 jobs I have had as a gastroenterologist, the telephone Theater of the Absurd was there. Of course, this vexes patients who can get through several chapters of War and Peace as they are left hanging on the line.  The lucky ones will ultimately reach a helpful human.  The rest may end up being cut off or simply left dangling on hold for a few months or so.  I suspect that many patients, who hit the jackpot and reach a live human after an interminable wait, have forgotten the reason for the call – yet another frustration!

Trust me, dear patients, that this issue is just as frustrating for us.  Our phones ring constantly which forces our staff to put most of you on hold as they juggle this onslaught.  And, try managing this while they are supposed to be checking in patients, arranging diagnostic tests and responding to impatient physicians who are waving their arms at them.  Sound like fun?

The reality, at least for smaller practices, is they cannot afford to hire a team of dedicated phone answerers.  And, even if they could, would these folks have enough training to handle the calls, or would they simply route the call to another staff member?

So, now you understand better the need for the obnoxious phone menu that greets you.
‘Please listen carefully as our options have changed.’   This is a lie.  The options haven’t changed and I doubt they will. 

Sunday, November 14, 2021

Why I Oppose Medical Marijuana

I don't really oppose medical marijuana, only the process that has brought it to market.

In general, I hew to the philosophy of  ‘leaving it to the professionals’.   Yes, I support all of us engaging in some measure of due diligence, but I try to select advisors and professionals whom I trust. If they have knowledge and experience that I lack, shouldn't their views carry more weight than mine?

In my own life, and probably yours, there are many areas in which I simply am not capable of any due diligence. If a car mechanic, for example, recommends that an expensive part needs to be replaced, I can only hope that this is truly necessary.  If the folks we deal with are honest and experienced, then things will tend to fall into place as they should.  Obviously, for this to work out well, several assumptions need to be true.

Many people today soundly reject the ‘leave it to the professionals’ philosophy.  For most of my life, the curricula in our public schools was dictated by education professionals.  When I was a student in grade school through high school, I don’t recall any protests or objections to our courses of study.  Yes, I’m sure that if our assignments, book reports, reading materials and classroom discussions were viewed through today’s prisms, that there would be many legitimate issues to criticize.  But, the zeitgeist today seems to be to criticize and protest everything.  Dialogue is neither encouraged nor practiced.

Indeed, there’s a benefit today to reject professionals' advice.  Candidates today are buoyed by championing the rights of parents to have a real voice in what their kids are being taught in public schools.  Police departments are being monitored by citizens who do not have formal training or experience in law enforcement.   I’m not weighing in on these issues, only pointing out how the situation has flipped. 

Medical Marijuana Approved by Legislators!
(What Have They Been Smoking?)

Here in Ohio, a bill has recently been sponsored that would add various medical indications for medical marijuana use including autism, muscle spasms, headaches, arthritis and other conditions.  In my view this is ridiculous.  I’ve written before and continue to be believe that elected legislators should not be making medical decisions.  Not only do they have no requisite training and experience, but their mere involvement politicizes the process.  It’s axiomatic that politicians support stuff in order to get folks to vote for them.  How is such a process defensible with regard to medical care?  (Hint, it isn’t.)  And to those who defend it, why not then have lawmakers decide on drugs or treatments for heart disease, Alzheimer’s disease or cancer?  Do you think that lobbyists or corporate donors might be able to influence legislators on adding a disease or two to the medical marijuana list?  (Hint, answer 'yes' here.)

Sure, there are medical studies out there that show medical benefits of marijuana.  But, this is not sufficient.  Medical marijuana, like any proposed medical treatment, must be subjected to rigorous and impartial scientific inquiry with final approval or rejection falling to the FDA, where this authority resides.  

There are spheres of society where professionals must remain in charge, even though others voices should be heard.  If you want medical advice, then ask a doctor.  If there’s a rattle in your car, then don’t ask me.


Sunday, November 7, 2021

How to Treat Your Upset Stomach

There is a general fascination with the medical profession.  Consider how many television shows over past decades have had a medical motif.  And today’s patients are so ├╝ber-informed and empowered, that at times they dabble with the practice of medicine themselves as an avocation.  When a patient, for example queries me about Barrett’s esophagus and dysplasia or if I intend to test them for H. pylori, a germ that resides in the stomach, then I know by their use of medical terminology that the office visit will be a  "peer to peer” experience.

So, I’ll ask my erudite reader-practitioners to respond to the following medical inquiry. 

A patient is suffering from a chronic upset stomach (called dyspepsia) nearly every day.  The cause of the condition cannot be ascertained, and the treatment options are wanting.  Assume that the medical professional has undertaken an appropriate evaluation and that no cause has been discovered.  Assume as well that there is no established treatment for the condition. Nevertheless, it is commonplace for doctors to offer various prescriptions to these patients.

The stomach often hurts for mysterious reasons.

If you were the doctor, which of the following would you advise?

Tell the patient that there is no effective treatment for his condition and that he will need to continue to live with it as best he can.

Tell the patient that, while there is no proven remedy, that there are various medicines to consider that the he has prescribed to others.  You recommend one of them.

My guess is that most readers and patients would prefer option #2 for reasons that need not be explained.  Most doctors and patients would rather do something than nothing.

As medical professionals know, and often lament, there are too many drugs being prescribed.  We know this and yet we physicians are the perpetrators.  And, the public has an outsized appetite for pharmaceuticals.  This has proved to be an unshakable cycle to break. 

What could be wrong about offering a prescription to a patient with unexplained dyspepsia? 

  • Physicians and patients should be guided by science and truth.
  • It is not fair to expend resources on ineffective medicines
  • It is not ethical to expose patients to risks of adverse reactions without any reasonable promise of benefit.
  • Physicians should not serve as willing accomplices in the over-medication of our society.
  • The medical profession and the public should come to terms that not every medical symptom has a pharmaceutical remedy.

So, what could be done for these patients?  There is a rising role for integrative medicine and other alternative medical practices for patients with unexplained and unexplainable medical symptoms.  And, if a conventional doctor like me starts carping that those alternative folks operate without data or proof, then point out that  we medical doctors have been doing this forever.