Bob's Blog Saturday 5-16-09

[BobN]

Bob Here

Do you all know how you save a doctor from drowning?

You take your foot off his head.

Whoops, sorry, let a little venom out there.

In case you can’t tell, doctors are not exactly my favorite kinds of people right now.

Now before everybody gets up in arms and tells me how wonderful their own doctor is, I will grant that there are some good ones out there, some people who can make a positive difference in our lives, and who are all things good.

I just haven’t come across any myself, is all.

I’ve been trying to pinpoint what it is about doctors that makes me want to see their next convention take place at the bottom of the ocean.

I think it’s a combination of them having such a powerful say in our lives, and their being, as a group, some of the most clueless creatures who have ever walked upright on this earth.

Yes, I think that summarizes it nicely.

What really sends me into orbit is when a doctor looks to you for answers.

I had one, a nephrologist I was working with when I was in the first throes of kidney failure. 

We’ll call him “Dr. Smith”. 

As in ‘Lost in Space.’ 

Very appropriate.

Since this was obviously my first experience with ESRD, I was not an expert in what I was going through.

I had been to his office for some blood tests, and he calls me the next day.

“It’s Dr. Smith.”

“Yes doctor.”

“Your potassium’s high.”

Now, I didn’t know what this meant, so I’m waiting for him to continue.

Nothing.

Finally, I said, “Can you tell me a little bit more?”

“Yes, your reading came in too high.”

“I gathered that, but what does this mean?”

“It means that your potassium level is too high.”

At this point, I’m starting to twitch.

Then he says, “Why do you think your potassium is too high?”

The smartass in me started to rear his ugly head.

I said, “Why do you think it’s too high?”

“I don’t know.”

“Oh, ok, well it’s been really nice talking to you doc.  Don’t be a stranger.”

And I hung up.

This is when I first had the thought that you must have to fail an intelligence test to qualify as an MD.

Turns out, he called me back later and wanted me to re-take the test.

But did he really have to torture me first?

It wasn’t just this bozo either.

I’ve been to a dermatologist who looked at a spot on my skin and said,

“What’s this?”

I thought, oh boy, here we go again.

I said, “Don’t you know what it is?”

“Looks like an Actinic Kerotosis.”

I said, “Ah, that was my next guess, right after ‘Little Red Spot’.”

Another time a doctor took my blood pressure, and it was a little high, and he said,

“Hmm, your blood pressure’s a little high, any idea why?”

Then we had another little back-and-forth on who should really know why it’s high.

He says, “Let me take it again.”

Lo and behold it was even higher.

I said, “At least this time I know why it’s high.”

When you think about it, it’s pretty rare to be around someone who can cure you and make you sicker all at the same time.

Anyway, after a few of these sessions, I was about at the point that if another doctor looked to me for a diagnosis, I was going to jump off the nearest ledge.

In fairness, sometimes I think my tendency to use attempts at humor (and sarcasm) might not exactly nurture my relationship with those in the medical profession.

I went to see one nephrologist, who kept me waiting for a long time in his waiting room, even though the office didn’t seem that busy.

I know he was there too, I could see him walking around in the back, shooting the breeze with a cute nurse.

Finally, they took me back to an exam room, where I had another seemingly interminable wait.  It was getting close to an hour and a half, and of course, this was a work day.  So, I started really getting steamed, and Evil-Bob started to appear.

When I finally heard him pick up my chart outside the room, I took out my cell phone and pretended that I was on a call.

When he came in, I was talking loudly into my phone, saying something like, “That guy tries to make it with grandma again, I’m gonna take him in the back alley and make him my bitch!!”

He just kind of stood there, stunned, not knowing exactly what to do.

I calmly said into the phone, “Gotta go now, the doc’s here.”

Then, all cheery,  I said, “hey doc, how’s it going,” as if everything was normal.

That guy never quite looked at me the same again.

How have all your experiences been with doctors?

Again, I’m sure they’re not all bad, but it does seem like it can’t be a coincidence that I’ve had a high proportion of losers among the ones that I’ve seen over the years.

Anyway, thanks for reading.

I hope everyone has a good week of treatments.

Remember to stay active.  Take care.

[Zach]

Remember the patient who lives the longest is the one who gives the ulcers, not gets the ulcers.

[petey]

My husband Marvin has had thousands -- literally thousands -- of doctors over the years.  Nephrologists, surgeons, gps, hematologists, dermatologists, cardiologists, neuro-opthamologists, infectious disease doctors... you name the speciality, and he's had that kind of doctor (except gynecologists -- he hasn't seen one of those yet  ).

He's had a couple of GREAT ones -- like Dr. McCann (vascular surgeon at Duke), Dr. Smith (nephrologist at Duke), Dr. Macik (hematologist at Duke), Dr. Harland (surgeon at Duke), and Dr. Moore (nephrologist at DaVita clinic).  Then, he's had some "okay" ones, but for the most part, the vast majority of them have been in the "pitiful to clueless" range.  Why is that?

I think a good doctor (whatever his/her speciality) has these qualities (and in no specific order of priority):
1) the doc sees the patient as another human being and not just a sick body;
2) the doc takes the time (whether he/she really has the time or not) to explain things to the patient and his/her caregiver and answer any questions from either;
3) the doc is smart enough to have some clue (or at least an educated guess) as to what's going on with his/her patient -- and the doc is smart enough to explain it in layman's terms;
4) the doc realizes that the patient and his/her caregiver are an integral part of the treatment plan and total care, too;
5) the doc stops to think, "What if this were my father, my brother, my spouse...what would I advise?"
6) the doc is a doc for all the "right" reasons and not all the "wrong" reasons;
7) the doc actually listens when the patient talks;
the doc will do everything humanly possible to save the patient's life or improve the patient's life;
9) the doc realizes that the patient and his/her caregiver are living through some of the most frightening moments of their lives;
10) when all "normal, text-book" treatments/plans/procedures don't work, the doc refuses give up and tries something else.

Marvin's favorite doctor of all time (and mine, too) is Dr. Richard McCann (Department of Vascular Surgery, Duke Hospital).  He fits all the criteria I listed above and then a little more, too.  He has operated on Marvin about 20 times and saved his life (and I mean this literally) about a half a dozen times.  If Dr. McCann needed my remaining kidney, I'd give it to him in a skinny minute!

[okarol]

Doctors - you remember the really good ones and the really bad ones - the rest is a blur.

[monrein]

I've had many doctors, mostly excellent and some mediocre, but my approach is always to give the benefit of the doubt that the new doc in front of me is one of the caring, wanting-to-be-good ones.  From that point on I try to give feedback so they know how I think they're doing.  Just recently I had to explain to a young surgical resident who thought he had been sent down to earth directly by and from God himself, that while I was sure that he knew a whole lot about bodies in general his knowledge about my specific body (and my tiny bladder in particular) was not up to snuff.  I also told him that since he was refusing to allow my catheter to be removed I'd have to page his boss, my surgeon, to be convinced of the medical reasons for that decision.  The cath came out two hours later.  I've also refused IV needles from doctors, asked them to please wash their hands and so on.

I also try as much as possible to give accolades and praise to those who get it right and who go above and beyond the basics.  I go to a teaching hospital so I get a wide assortment of newly minted medicos who have access to me.  I tell them directly when they've done well and I make a special point of mentionning it when the flock of seagulls come around on rounds.  That way, the praise is amplified in front of their peers and most importantly in front of their bosses.  My neph is the head of the entire unit so being noticed by him is a feather in one's cap.  I had a really great resident/intern/whatever who was from India and who saw me when I came in to the ER.  He had read my chart so thoroughly that it was very impressive and he hadn't missed a single thing of any real significance.  The next day he came in with two other students and my neph.  I turned to my neph, whom I've known for 25+ years and said  "You've got a really good man here in Dr. G.  I swear he knows my chart better than you do after all these years and he paid attention to all my bits and pieces, not just the kidneys and urinary tract.  Do we get to keep him?"  Dr. G was visibly surprised and pleased and my main doc looked at him with a big smile.

I also ask many, many questions so that I continue to learn as much as I can about my health and the implications of blood work etc. and I am very clear that we need to work together.  One resident, whom I liked very much but who had made a couple of mistakes on me (missed a stitch when trying to tug out my central line, and wrote a prescription he "forgot" to inform me about) was a little taken aback when he wrote another script with a med change and I refused the meds from the nurse until I had heard about it from him first.  Same mistake, second time around. I told him that if ever he was too busy to come see me about it then he could just write a quick note at the same time he entered it in the computer, but I needed to know that it was a real order an not a nurse's error.  I try to not be obnoxious in these situations and use humour as much as possible and I try to explain WHY I need things done a certain way but I'm just not able to have things done to me without being a part of the thinking and decision making.

If I ever had a doctor who would be with me longer-term and I wasn't satisfied with them I'd change doctors and I'd let them know exactly what didn't work for me and why.  I want feedback from them at all times, the truth about what we're facing and what the options are so that I can understand and make good patient decisions and I expect them to receive feedback from me, both positive and not so positive, so that they can be their best doctor selves.  I've had very good outcomes with this approach and I don't think I've had many "bad" doctors. 

[G-Ma]

Once my 2nd husband had to start going to different Dr's weekly due to CHF and amputation he made a strict rule..(his own) but it appeared to work.  He only waited 15 minutes for the Dr or a reason the Dr was not there and if neither happened, he was out the door.  I can't tell you how many times you saw a Dr running down the hall after this patient and several times George had on a gown and couldn't care less who saw what...I know he enjoyed this so after my first embarassment watching this, I would just pretend I was not with him and just watch.  He actually only missed being seen once, came home and called insurance company with reason why and did not get billed.   

[paris]

Bob, you got us all going today!  Great subject and hits a nerve with all of us.  I enjoy Saturdays and reading about your week.

[KICKSTART]

BobN  Rotflmao     true oh so true ! 

[TiffanyJean]

Remember the patient who lives the longest is the one who gives the ulcers, not gets the ulcers.

We love our team of nephrologists - there is only one doc on the team that we have worked with only one time, and hes just ok... but the other docs are great. and I'm sure we have created a few ulcers. i am very glad that we have a great primary neph, and that the rest are good too!

TJ