Month: February 2015

The eager Salesman and the stubborn Doctor.

     I really don’t enjoy going into a store with a planned purchase only to get hassled and cajoled into purchasing something different. The fact is, with so much information at our fingertips, I decide ahead of time what I want and the price I’m willing to pay.

     Recently, I dropped my smart phone in the toilet bowl.

(Take 1 minute to laugh at me.)

     This event forced me to run to my wireless store and purchase a new smart phone. Despite having done my research, my anticipated 10 minute purchase turned into a 45 minute battle of wills between an eager salesman and my practical sensibilities.

     He couldn’t have been a nicer guy. In his mid twenties, he had energy and enthusiasm for his job that likely made him very successful. His great attitude won me over and I let him do his sales pitch despite fully knowing I only came in for 1 specific purpose that I wouldn’t veer from. He used numbers, diagrams, compliments, (even mild insults!), jokes, clever colloquial lines all to convince me I was making a huge mistake not heeding his advice. In the end, he relented, went to the back of the store and came back with my phone.

     As he was ringing up my purchase on his tablet,  he made one last ditch effort to win me over. In the process, he asked me what I do for a living. I told him I was a physician and suddenly, the entire tone of our conversation changed.

He paused, gave me a forced smile as I watched the wheels spin in his eyes. For the 1st time I sensed the smallest hesitation in his sales pitch and instead of talking about his product, he came back with this:

“How do you treat vertigo?” 

     I felt bad that I made him expend a lot of energy  knowing he’d fail. I humored him and we switched roles. Standing in a quiet corner of the store, I began asking him all the questions I normally would. After a few minutes of trouble shooting, we changed the symptom description to “disequilibrium” instead of vertigo and I reassured him while encouraging further evaluation with his primary care doctor. He seemed grateful but I couldn’t help notice a morose coming over him.

     He explained to me he always worries about something terrible happening to him just like his sister. I delved further to find out several years prior, his 16 year old sister died of a pulmonary embolism. His voice lost clarity as he fumbled around his tablet muttering how all the bad doctors ( pediatricians, ER etc)  missed the diagnosis. He chuckled recalling how an x-ray went missing but was subsequently found and clearly had abnormal findings. Although I didn’t ask, I presumed the x-ray was later found as part of some litigation process.

     I couldn’t imagine how it must have felt to lose a sister when you are a child yourself. I could understand the frustration and anger under his breath that probably took years to soothe. An unexpected death of a loved one is always a tragedy especially when it seems the answers are so obvious and in the hands of the physicians entrusted to figure it out. I felt terrible for him, as he pulled out his own smart phone to show me an old picture of her,

     As objective physicians we always contemplate alternatives. I didn’t know the physicians that treated his sister, but I empathized with them a little bit We are taught very early on in our education that pulmonary embolism is one of the trickiest diagnosis and easy to miss. We are taught about pre-test probabilities and chest pain in a teenager is statistically much less likely to be a life threatening condition. I imagined that could have easily been me, a well meaning physician doing their due diligence and something terrible like this still happening. As a physician, we never get comfortable dealing with the death of a patient. It’s even more difficult when there’s an unexpected death and you’re left wondering what else you could have done. These very personal emotions are occasionally twisted, tossed and turned through malpractice litigation ; a process after which physicians are left confused, numb and questioning their purpose. This is a burden many physicians carry to their own grave, quietly without any expectation of assistance or pity.

     As he finalized my purchase, I completed my thoughts coming to the conclusion that no matter what the circumstances were, he went through a tragic experience and nothing can change that. I was happy to see he survived  and had become a very good salesman with a good attitude and great smile. But on this day he didn’t get the sale he wanted. I regained my connection to the digital world with a new smart phone. I’m hoping he regained the tiniest bit of faith that doctors despite being fallible, listen and care.

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Health Insurance ; A prerequisite to the American Dream

The American dream is alive and well. We still live in the land opportunity where hard work is the ticket to endless opportunities. On the contrary, bad health poses a major impediment towards fulfilling that dream. Besides the physical toll of an illness, the financial cost of an illness can make the American dream impossible to achieve. Millions of people without health insurance everyday face the spectre of their dream becoming a health care nightmare. Recently I got some great news about a family member who immigrated to the U.S a few years ago. A middle aged man with a wife and 2 kids, he came ready to do whatever it takes to secure a future for his family. An educated man, he struggled to find employment. He latched on to several different jobs that helped continue to build his skills but was given no health care benefits. He didn’t qualify for Medicaid and couldn’t afford private health insurance. Just like many Americans in this situation, his health took a backseat. But recently, he was finally able to secure a job that offered benefits including health insurance. He now had the security that seemed like a natural prerequisite towards pursuing his own American Dream. He took this opportunity to finally seek out world class healthcare. From a distance, I began to get caught up with what was happening with his health. Fortunately, he didn’t have too many medical problems besides benign prostatic hyperplasia (BPH). It was significant enough that he was referred to a urologist. He felt lucky to find a local well renowned urologist with many positive reviews (both online and word of mouth) that also took his excellent new health insurance. After 1 visit, it seemed like he was appropriately placed on some medications to try to alleviate his symptoms. What was surprising is that he was also placed on brand name testosterone replacement. Immediately, skepticism towards testosterone replacement therapy began to engulf my thoughts. I began to wonder if my family member was another victim of the “Low T” marketing campaign. Furthermore, I was shocked to find out that within weeks of seeing this doctor, he was being offered greenlight laser prostatectomy. Granted I am looking at this case as an outsider. But without trying various types of medical therapy at optimal doses and for significant periods of time, the recommendation for surgery seemed very premature. Since then, my family member has been directed to a second opinion.
Health insurance is an extremely high priority issue for most Americans. It is the sensible thing to attain, whether it is to ensure wellness or treat illness that might otherwise derail a lifetime of hard work. But my family member’s reward for obtaining health insurance wasn’t good health but rather a glut of potentially wasteful and dangerous medical care. As we continue to expand health insurance in an attempt to cover all Americans and provide them access to care, we have to continue efforts towards curtailing health care that is not evidence based, wasteful and only serves to fulfill the American dream of providers and drug companies while taking advantage of hard working naive citizens. 

Don’t hate the Anti-Vaxxer

     It’s easy and convenient nowadays to take a few minutes to rally against the “Anti-Vaxxer” movement. With the recent measles outbreaks, there’s no shortage of articles, memes, jokes and cartoons to share on blogs, Facebook, Twitter etc. But I’m going to throw a very small teeny tiny microscopic bone to the Anti-Vaxxer camp. I will do so with the disclaimer that as a primary care physician I think vaccines are an extremely important part of good health. Anyone that doesn’t see their value, is misguided and perhaps misinformed.

    Having said that, there’s no denying that the Anti-Vaxxer  movement  is real and unfortunately seems to be growing. They have quietly become a significant part of the general population. The reason for their growth is multifactorial, but the easiest targets are probably defrauded scientists, celebrities and politicians with dubious opinions. But the target that’s probably hardest to identify is the one looking right back at us in the mirror.  When a problem afflicts society, the easiest thing to do is blame others. The introspective route asks us to look within to identify causes and offer solutions.

     How did we let this happen? The Anti-vaxxer movement is just another example of the growing mistrust and lack of faith in our doctors and healthcare system. There are many reasons for this. When it comes to vaccines, why aren’t we, the trusted physicians able to educate and change their minds? Perhaps we are not living up to the true latin meaning of the word “Doctor” which is “to teach.” Perhaps the modern doctor,  gathered and taught in traditional (antiquated?) methods are struggling with modern informed patients who challenge and question rather than accept paternalistic physician decision making. Perhaps we simply just don’t have time to have a decent conversation with our patients about the importance of vaccines.
    Whatever the reasons, we need to figure out better ways to connect with this subset of our patients whose beliefs about vaccines post significant individual and community health risks. What we don’t need to do is further alienate this population by kicking the proverbial horse while it’s down. The amount of  seemingly joyous vitriol pouring from the medical community against anti-vaxxers is disappointing and at times bordering on classless. Social media is teeming with derogatory descriptions of this population.  I think this only furthers many people’s views of rampant intellectual elitism in our doctors. The most disappointing stance on this issue is when doctors proclaim they will refuse to see patients who don’t believe in vaccines. Hey genius, if you don’t see that patient, then they definitely don’t stand a chance of getting a vaccine!
   The anti-vaxxer type of population is something that has always existed in most medical practices. They represent a group of people who don’t believe in the gospel you are preaching. I have patients who don’t believe in cancer screenings, statins and a whole host of other great evidence based ideas. They can be frustrating and time consuming.  But they are still my patients and I will continue to respect them and care for them with the confidence to know I will eventually change some of their minds.