The Twelve Health Hazards of The Holidays

1. Hypothermia

Baby, it's cold outside. Depending on where you live, Christmas may be the cold season. I recently returned from a quick trip to Chicago and nearly froze to death. I still had my old Michigan Puffy Coat that is good for thirty below, but even that did not warm these aging, California bones. Children are oblivious to cold and can play for hours in blowing snow. Adults, on the other hand, have varying degrees of tolerance. For you deer hunters, snowmobilers, ice fisherman, and skiers; enjoy. I live about an hours drive from where the Donner Party had an interesting Christmas dinner, so I do not take cold lightly. Every winter season, our local news is filled with snowboarders who went off of the trials, or hikers wandering off to look at the snow-covered Sierras. Not me. I will be peering out of my window, roaring fire behind, an electric blanket over my toes; waiting desperately for the first signs of spring.

2. Ear Pain and Colds

On WebMD's ENT board, I often get this question: "I got an ear infection from going outside without a hat." Not likely. While a cold wind can certainly make sensitive ears hurt, ear pain is not the same as an ear infection. One is caused by poor-planning; the other is caused by germs. Because people are inside more during the winter months and a bit more crowded on this planet, there is a season increase in the number of colds. Just because they are called "colds" and not their true name (upper respiratory illnesses), does not mean they are directly caused by colds. While a recent did seem to link cold weather with changes in the immune system, we most likely caught our colds from someone else. In children, colds are the most common predisposing factor to middle ear infections. In adults, colds are the most common cause of complaining. I think it was Mark Twain that said, "The best way to treat a cold is with contempt."

3. Overeating

One of my favorite vices is overeating, especially good food that others have prepared. When I was a child, my diet was very limited. I was a picky eater. As an adult, I am still picky, but I tend to pick everything and eat it. Yesterday, I ate Calamari salad, pesto, tamales, Chex mix, cocktail weenies, fruit salad, apple pie, pumpkin pie, pickles, olives, ham, Chippewa wild rice, various pieces of chocolate looking for a caramel, and of course, Diet Coke. I really pigged-out, so it is time to watch me diet (again).

4. Over-drinking

I am a non-drinker by choice. I really don't like the stuff, which is sacrilegious when you live near wine country. Why is it when you refuse a drink, that people think you must be a recovering alcoholic? Although I do not indulge, the people around me sure do. While I enjoy watching them, I do not want to be on the road with Holiday Boozers. It will be one sad holiday to remember if one of your loved ones diet in an alcohol-related accident. Sadly, there will be many of those this holiday season. Stiff fines do not deter piss-poor judgment. As a professional designated driver, I hope that no one will allow their friends or relatives to drive while impaired. We have to look out for each other. Isn't this the true spirit of the holidays?

5. Overspending

I heard on the news this AM, that Americans spent six BILLION dollars yesterday alone on holiday gifts. That is a hellava lot of myrrh. Part of that amount is attributed to my wife, who bought so many gifts for the grand-children that we had to take two cars. How did all of this gift-giving get started? According to the Bible, Jesus received some humble gifts from three men that clearly could have afforded more. The gold was nice, and those aromatic resins would certainly help curtail some of those smells in the stable, but I am sure the Holy Family would have preferred clothes. All of our children are adults now, so finding an appropriate gift has become increasingly more difficult. This year, we gave them the "Gift of Each Other". In other words, I have arranged a family get-together at a big beach house (as soon as the weather is warm), so that we can just be a family again.

6. Accidents and Falls

Wet or snowy surfaces seems incompatible to human movement. We are really not designed for these seasonal hazards. Not only do we tend to fall on our butts, we also wreck cars when we under-estimate road conditions. My barber just got out of the hospital after being in a car accident. He went in to an uncontrollable spin on some black ice, when over a guard rail and down an embankment. Fortunately, this was witnessed by a truck driver, who called 911. If this accident was not observed, the outcome could have been much, much worse. In my own experiences in icy and snowy conditions, I have had my own close calls.

In my clinic yesterday, I had four children who suffered injuries on Christmas day: two falls from scooters, one roller-skating, and one flying leap from a trampoline. Fortunately, not one of them broke anything. Their pictures will not appear on my Boo-Boo Bulletin Board (a photo gallery of children in casts, stitches, and holding stuff that I removed from ears and noses).

7. Gastrointestinal Disorders and Food-borne Illnesses

The winter season is a time for gastrointestinal disorders; namely diarrhea and vomiting. Some are food-related, like Salmonella from an improperly cooked turkey, cutting up some vegetables on the same cutting board as raw poultry, or using a contaminated sponge/cloth to wipe surfaces. Some are simply intestinal viruses, like Rotaviruses, that we freely pass to each other. There is a new vaccine for infants called Rotateg that helps prevent one type. One of the best things YOU can do to prevent the spread of gastrointestinal virus is to wash your hands, and be very careful with food preparation.

8. Influenza

If you haven't received your flu vaccine this year, there is still time. We have not seen very many cases of confirmed flu this year in our area, but I am sure it is coming. The holiday travel season is quite helpful in the global spread of this annual malady. Although we take flu lightly, it does kill tens of thousands of people every year, mostly the elderly, immunocompromised, or very young. If you are going to be visiting grandma this year, you owe it to her not to give an unwanted gift that could have serious health consequences. Remember that flu shots are not just to protect you; they help protect ALL of us.

9. Kissing-Related Disorders -- Mono, herpes, respiratory viruses

Kissing under the mistletoe; what could be more innocent and sweet? Most of the time, a peck on the cheek is not going to put you at risk, but be careful of those mouths. Direct mouth-to-mouth contact is a great way to spread micro-organisms, such as cold and flu viruses, herpes simplex, mononucleosis, hepatitis, etc., just to name a few. I am not advocating a no-kissing policy, but you need to "Read those Lips" before your kiss 'em.

10. Boredom / Sleep Deprivation

We got out of attending the annual Christmas Pageant this year. It was sort of cute the first dozen times, but I am not sure I can watch it without falling asleep. We have been working full time in our clinic jobs and preparing for the holidays. My wife fights the shopping crowds (I refuse to do this) and comes home very late with packages galore.

Our grandchildren were demoted this year. Last year, our youngest, Tynan, was the Baby Jesus, the middle one, Dylan, was one of the Wise Men, and our oldest, Shelby, had the role of Mary. This year, they were downgraded to a sheep, a shepherd, and a donkey. I did watch the video, however. I almost fell asleep.

11. Parking Lot Rage

One of the reasons I do not shop is parking. While I do not mind walking quite a distance to the store, it is a great pleasure to find one of those rare, close spots; the ones adjacent to the handicapped spots. I spied a car leaving one of those choice spots the other day and raced around to get it. Before I had a chance to pull in, another car sped around me and whipped into it first. I witnessed a Christmas Miracle. This rude driver shot into this open space (my space) and side-swiped the car in the next slot. The man sitting in the damaged car was not pleased. I was elated. There IS a Santa Claus.

12. Television Football-Related Injuries - Heart Attacks

I am not a sports fan, but I am an observer of sports fans. To see grown men leap to their feet, screaming and dancing when a touchdown or interception occurs is a sight to behold. Blood pressures rise, perhaps aided by salty chips and beer. Fat guys jump out of their reclining chairs; grease dripping from their Polish sausage sandwiches. These are heart attacks waiting to happen. I don't watch the games, but I do review my CPR protocols.

From all of us at WebMD, I would like to wish you a safe and sane Holiday.

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Technorati Tags: health hazards, holiday, wellness

The Naughty List

As a devout, Santa-believing child, my biggest fear was being on that infamous Naughty list. As a matter of fact, my very religious Aunt Norine (now 92 years old), told me that God also keeps a detailed list of the bad things that I had done. My first-grade teacher also kept a list, writes my name on the blackboard periodically so that others know of my misdeeds, and of course, sends home an occasional note to my mother, so she can be informed as well. She didn't really keep a list, but certainly remembered my all of my discretions. Basically, by the time I was five years old, I was screwed. My name seemed to be on every list, except maybe, the CIA or McCarthy's Un-American Activities List.

My Aunt interpreted the Bible literally, but freely added her own version, not unlike the early religious leaders. I believed with all of my heart, the God opens a huge book, goes to the "M's", runs his benevolent finger down the page until he gets to Rodney. He then whips out a red pencil and puts yet another check mark. Aunt Norine was never really clear if God had an eraser on that pencil, or has a Nice List (like Santa).

Without thinking and usually with good reason, I would chuck a rock at Billy Haines. No sooner than that rock left my hand, I would know that God's red pencil was out. "Sh--" I would exclaim, and then be double-horrified when I realized that this spontaneous profanity would earn me a second red mark. Not a good day.

I assumed that Santa would start a new Naughty/Nice book on December 26th, so there was always that clean slate you could count on. God forgave sins on a regular basis, but yelling, "Sorry, God", before the rock reached its apogee apparently is not a viable loophole in this belief. According to my Aunt, that type of forgiveness didn't count, so I gave Billy a quarter not to tell on me.

I don't think I was a particularly bad child, but I did get coal in my stocking one year. The coal, I was later to discover, was put there by my older brother, Larry. I was not amused as I threw the coal-filled stocking down the basement steps. I can still hear 'em laughing! Yeah, I probably deserved a little of that coal, but come on, Santa! It's Christmas!

Parents have always used all authority figures, like Santa, God, policemen, teachers and yes, even medical providers, in a negative manner. If you lie, Santa will put coal in your stocking, and God will simply send you to Hell - a double-jeopardy that kids do not appreciate. You do something bad in school, like kick some kid in the nuts, you may have to stand in the corner or in the cloak room (kids didn't even wear cloaks) and give up future recesses. To further complicate this random act of boyhood, a note is sent home, so your embarrassed mother will hopefully punish you as well. All of this takes place without a trial, legal representation, or even written statues that you could have reviewed. Kids are simply sentenced.

In my clinic, I hear parents tell a disruptive child that if they don't behave, I will give 'em a shot. When I hear that, I want to give the parents a shot. What a terrible thing to say. Kids are just being kids. I do not appreciate being the Executioner for bad parenting. Medical providers often have to perform uncomfortable procedures, so we have enough trouble shaking off our reputations as pain-givers.

In pediatrics, we keep an ample supply of stickers and sugar-free lollipops. As a matter of fact, we spend thousands of dollars per year on these little rewards - rewards of GOOD behavior. I try to be an example of positive parenting during all of my visits. I must say a dozen times, how proud I am that they are cooperating and allowing me to examine them. Their little eyes beam when I take out the sucker jar and allow them to pick. Eating a well-deserved sucker is one of life's little pleasures. One of the pediatricians in our group refuses to give suckers. The other day, a parent dropped off a big box of candy for us to share as long as we didn't give any to Dr. Carl. No suckers. No candy. See how he likes it.

I have to say that a small contingency of my little patients are well-tuned, combative little brats. When they request a sucker at the end of the visit, I am faced with a dilemma. Do I reward this type of uncalled-for behavior? Not wanted to be a bad guy, I chose to give the sucker to the parent. I let THEM decide if the child deserves it or not. That'll teach 'em. I often tease the kids a bit and tell them that we have new lollipop flavors: tuna, earwax, dirt, and pig's feet, just to see their reactions. Some will simply select the tuna one and eat it. Others will be hesitant until I tell them this is a joke. For the brats, I really wish I had some tuna-flavored ones!

So, teachers... Santa... parents... and God, give up that Naughty List. It doesn't really work. In January, start a Nice List. Check it twice. You are gonna find out, that kids will wanna be nice.

Have a "Nice" Holiday.

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Technorati Tags: Christmas, New Year, kids, pediatrics

Holiday Stress Affects Santa, Too

For some, Holidays are a time of joy and excitement, but for others, Holidays are a time of endless stress. Stress can affect anyone, but when Santa is starting to feel it, we all should take notice.

A few weeks ago, I was cleaning out my garage and came upon a saved letter that my youngest son had written to Santa about 20 years ago. One statement caught my eye: "Santa, you have been doing this for a long time. You should be proud of yourself."


Endless Letters
My wife is really into catalog shopping. I can hardly open our mailbox sometimes because of the glut of catalogs and sale announcements. Can you imagine Santa's mailbox? Millions of letters are pouring in, written by children and written in a few hundred different languages. More and more kids are choosing to e-mail him now. With e-mail comes spam.

Santa is much too busy to sort through Viagra offers. Additionally, the increasing demand for high-end gifts and intangible requests, like Peace on Earth, must get to him. We would all like that Peace on Earth one.

Labor Relations
I am not sure what elves are paid, but I bet it hovers around minimum wage. Unless you have some highly-skilled elves, whipping out those X Box 360s and iPods are going to be difficult, especially in light of copyright infringement. Santa is most likely facing some stiff competition from foreign elf subcontractors, including a large contingency of prison labor elves. I am not sure where Santa is getting his financial resources, but I bet the IRS is watching him.

Delivery Problems
Santa has obligations to children from all over the world; children in war-torn areas; children in unsafe, high crime neighborhoods. If pizza delivery boys get robbed and shot at, you can understand Santa's reluctance in visiting Los Angeles. There are some neighborhoods that wearing red is just not cool.

With Homeland Security Issues, I am sure Santa is a bit anxious when he crosses over from the Canadian side. Can you imagine a Customs Officer saying, "What's in that bag?" In our area, new homes are not being built with wood-burning stoves due to Clean Air Standards. Even Santa, with all of his magic, is not going to be able to negotiate a fake fireplace, or thwart modern security systems.

Animal Rights Activists
Santa has always used reindeer. They actually have a pretty cushy job, working only one day a year; dragging a fat guy and a bunch of toys around. He is good to 'em and has had the same eight or nine loyal reindeer for as long as anyone can remember. If things were that bad, they would be seeking other employment hauling around Easter Eggs or teeth for the Tooth Fairy. For the last several years, Santa has been under fire for his use of animals in this manner.

Nuisance Lawsuits
Any guy that slides down a chimney is bound to track some soot on a nice carpet, or knock over a lamp. Things happen and people should accept a certain amount of shared responsibility when it comes to collateral damage. To be sued for carpet cleaning or damage to a roof solar panel is really uncalled-for. Sure, lawyers gotta eat, too, but let's get Santa out of Small Claims Court.

Sexual Harassment
Sitting on Santa's lap is sort of expected, but he better keep his hands in full view at all times. It's going to take just one "Santa touched my butt" comment and you are going to see him on the 11 o'clock news. Santa loves children and would never hurt them, but when it comes to sexual abuse charges, the media will consider Santa guilty until proven otherwise - a public relations nightmare.

Infectious Disease Exposure
Kids are the vectors for many community-acquired illnesses. I deal with hundreds of ill children every week in my clinic, but I am prepared. I know they are sick and I can take the proper precautions. Santa is clueless. When was the last time you saw Santa wash his hands between kids? Granted, he wears gloves, but he isn't changing gloves! Kids wipe snot on your clothes, sneeze in your face, cough on you, and occasionally leave a "lap gift". Because of his advanced age and lack of basic hygiene, Santa has got to be a risk, both to himself and spreading it around. It took a year and a half for influenza to spread around the globe during the 1918 Flu Pandemic. Santa certainly has the potential of causing a world-wide pandemic, unless he starts cleaning up his act.

Unhealthy Lifestyle
Santa does seem to work one day a year, but he doesn't. He delivers one day a year but he works the other 364 in a very demanding executive position. I am absolutely amazed that he is still married. Santa is clearly, hypertensive and pre-diabetic, if not an uncontrolled diabetic already. There is no way Santa is going to maintain his delivery schedule if he is using the toilet at everyone's house. He is wolfing down all of those high-fiber cookies, drinking whole milk, and doing a lot of sitting. He is going to be one unhappy, constipated Santa. Instead of Ho, Ho, Ho, we might start hearing, Oh, Oh, Oh!

So, next time that you complain about your job, or the incredible stress the Holiday is for you, think about Santa. I would not want to be in his boots.

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Strep or Not: The Dance of the Worried-Well

I have been absolutely hammered in my clinical practice this week. I sort of expected it, since this is the usual pre-holiday rush. No one wants to be sick during an important family holiday where they may be traveling to points afar. This week was certainly the Dance of the Worried-Well — people that think they are sick, or concerned that they may become sick in the next few days. Yes, I am talking about the antibiotic-seekers.

Medical care is as much art as it is science. Medical science has performed modern miracles in the world of pharmaceuticals, diagnostic technologies, and unbelievable surgical treatments. In spite of those advances, it is still impossible to definitively predict if someone will become ill, or to treat a potentially-evolving illness now in order to guarantee that a person will remain well. Simple exposure to a biological insult (germs) does not necessarily imply that the exposed person will become sick. Every exposure... every person... and every immune system is different.

Strep throat infections are a prime example of this implied fear. A child wakes up with a severe sore throat and fever. Oh, my God. It could be the dreaded Strep infection. The family has plane tickets to leave the next day to visit the grandparents. In a panic mode, they show up at the clinic demanding to be seen. In our facility they really do not have to demand, since we have anticipated this with a program called Open Access. We have set aside dedicated appointment slots for this purpose and will see every person that walks through our door. On the days before holidays, most of my appointments are open. Keep in mind, that this child has only been sick for about an hour or so.

Strep tends to have a very characteristic appearance on clinical examination: a bright red throat with petechiae. Petechiae are tiny ruptured blood vessels that area as bright-red dots or a rash on the palate (the roof of the mouth directly above the uvula, also known by many patients as that "little hanging thing in my throat". The tonsils may be enlarged and red as well, but not necessarily exudative (that cheesy material that forms or collects on the tonsils). Children tend to be feverish and they may also have an upset stomach. Abdominal discomfort with Strep is relatively common in children; uncommon in adults. The lymph nodes in the neck may be enlarged and tender as well.

For experienced clinicians, Strep also has a characteristic smell. In severe infections, we can literally smell it when we enter the exam room. For some, we often get a good whiff when we look at the throat, or when (or if) we take a throat specimen for Strep analysis.

The Gold Standard for diagnosing Strep is the throat culture; a 100% accurate test that unfortunately takes about two days to complete. Rapid Strep Tests are commonplace now in clinics, but they are only about 80% or so accurate, depending on how carefully the specimen was collected (I like to do my own), and of course, how much Strep the person has at the moment. When a child has only been sick for an hour, the body really doesn't have enough time to (a) develop those characteristic clinical findings, and (b) colonize a sufficient amount of bacteria that can be easily detected.

When it comes to diagnosing Strep, there are many clinicians that feel they can just diagnose Strep simply by the examination finding. They are correct only about half the time. Knowing that 90% of all sore throats are not due to Strep (viral), some clinicians will still blanket-treat everyone with a sore throat with an antibiotic. This is really an irresponsible practice in light of the problems we are experiencing with overuse of antibiotics. Finally, there are clinicians (me) that only treat Strep when it is clinically-proven by an objective lab test AND corresponding clinical findings on examination.

When the Rapid Strep Test comes back positive, parents are happy, since the child will be treated. Their biggest fear is that we will tell them it is viral and they will leave without antibiotics. When the test is negative, and there are absolutely no clinical signs present to suggest a Streptococcal infection, then the ONLY logical and responsible course of action is to treat the symptoms; primarily the pain and discomfort. Even though it is no big secret that viral infections will not respond to antibiotics, many parents will still ask for them anyway. As much as I hate being the Antibiotic Nazi and tell them, No, I do have an obligation to carefully explain my rationale for this non-treatment. If a patient leaves unhappy and unsatisfied with their care, they will simply go somewhere else. There are plenty of medical providers out there that will simply prescribe an antibiotic when a desperate person begs or pleads.

Most sore throats, either from Strep or viruses, tend to improve on day three or four, a fact that often comes back to help or haunt us. For instance, if I see a person on day one (sick for one hour) and send them away with a diagnosis of a simple viral infection, they will continue to have a sore throat for another few days. An impatient patient may head off to the ER or urgent care on day two or three where an antibiotic is prescribed (unnecessarily). Lo and behold, they experience miraculous improvement the very next day! Even though patients would have experienced improvement anyway, they attribute the cure to the antibiotics that I would not prescribe.

There are no rules in medicine that state a person can only get one illness at a time. A child with a two day viral illness jumps on a plane for a five-hour flight to Grandma's. While on the plane, they lick the tray table, breathe everyone's air, and touch every surface in those tiny bathrooms. They arrive at their destination; a community filled with alien viruses that they have never encountered before. They are kissed and hugged repeatedly by loving relatives. Guess what? The next day they are sicker with a new illness. They may have even been newly-exposed to Strep since up to 20% of people are asymptomatic Strep-carriers. Parents drag them back to an Urgent Care and they are given an antibiotic... the same antibiotic that I refused to give them a few days prior.

The vacation is ruined and it's my fault. I have been found guilty in the Court of Parents without due process and no way to defend myself. Such is the double-edged life of a clinician.

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Technorati Tags: antibiotics, sore throat, strep throat

What is that dark cloud? And, why is it following me?

There are some days that would have been better and safer if you would have just stayed in bed. Yesterday was one of those days for me.

I had a very stressful weekend. I had to catch an early morning flight from the west coast to a big, cold and windy Midwestern city on Sunday in order to testify as an expert witness on a trial. The case involved a baby that sustained permanent brain damage because a medical provider did not notice or appreciate the early signs of meningitis. I was there to defend this child in an action against the hospital. I gave my expert testimony on Monday. The trial is still going on. This child had pneumococcal meningitis; a life-threatening disease, now, virtually preventable with vaccine (Prevnar). For people that think vaccines are worthless or dangerous, should have been there to see what pneumococcus did to this innocent, unimmunized child.

Although my son is a lawyer; we have friends that are lawyers, I am not a big fan of the legal system. Personally, it scares the crap out of me and I have no idea why I agreed to help in this case. I guess, I just wanted to help that little baby. I am so glad that my part is over.

So, without much quality sleep over this stressful weekend, and of course, on the plane, I arrived home only to hop in bed so I could work my 12-hour shift the next day. I sat wedged in the window seat in the back of the plane, next to a huge, sweaty Swedish fellow in the middle seat. In the seat in front was a mentally-challenged woman with a four month old baby who cried most of the way. Mom was really doing a good job, but clearly the child was not happy about something. Based on the smell, I am guessing, "gas". The stressed mother stood up most of the way, rocking her baby, and blocking the movie screen. So, between the BO and the poop smell, I had a wonderful flight. I am really getting too old for this stuff.

I headed for the clinic Tuesday morning in the usual and customary manner - the same car and even the same lane I always drive. As I rounded a curve on the freeway, I encountered a huge chunk of metal in my lane. Since I could not safely change lanes, I tried to straddle it. Whatever this chunk of junk was shattered my rear tire and nearly caused me to roll my truck. I managed to make it to the shoulder; called my work and then called AAA. Believe it or not, AAA arrived in less than 10 minutes (probably because it was not raining!). The nice man put on my spare and I dropped the remnants of my other tire off at the tire shop. In less than 40 minutes, I was back on my way to work.

Fifteen minutes later, while in the far right (slow lane), a woman in a SUV happily gabbing on a cell phone, abruptly turned into my lane to avoid rear-ending the car she was tailgating. He was stopping at a yellow light. She must have assumed he was going to run it; likely her intention. I laid about 40 feet of tire rubber to avoid hitting her. She pulled off to the side of the road, exited the car, and seemed to be visibly shaken. As much as I wanted to stop and give her a piece of my stressed mind, I let her go with a dirty look. She was lucky this time.

There were no further incidents the rest of my 12-hour shift. The dark cloud had dissipated by now. On the way home, I saw a relatively FULL MOON. I knew it! Some people are absolutely crazy during a full moon. That is where the term, Lunatic originated (Luna means moon)...just in case you didn't know.

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Technorati Tags: full moon, stress, meningitis

Long Distance Diagnosis = Bad Idea

Nearly every day on the WebMD Ear, Nose, and Throat message board, I have to post the following disclaimer:

"Unfortunately, since I do not know anything about you, your medical history, or more importantly, have any way of examining you, it is not possible to determine the cause for your symptoms based solely on a brief description. There are just too many diagnostic considerations that cannot be sorted out via the Internet. You will need a hands-on medical examination for a proper diagnosis and treatment."

Usually, I do not know the particular demographics of the person posting, so many requests for an Internet diagnosis may come from naive teenagers, but I suspect not all of them. A diagnosis cannot be conclusively made without a detailed medical history (requires a dialogue of questions between the examiner and the patient), and that all-important hands-on examination. Some diagnoses are made entirely by the medical history, and some are purely visual, such as a dermatological (skin) condition. Vague descriptions just won't do it. And, even if I could diagnose the person, there is a very grey, legal area about treating someone who is not really one of my patients. (Besides, WebMD wouldn't let me for the reasons I stated here)

If I call my automobile mechanic and say that my engine is making this weird noise, and ask him what does he think it is, and if there is anything that I can do at home to fix it (since my car insurance does not pay for repairs). He will think I am absolutely crazy. This is not unlike many of the requests that I get on the Boards.

While I am very sympathetic about the cost of medical care, the fact that a person does not have insurance or the financial resources to seek proper medical care; does not change the situation one iota.

One time, I overheard another medical provider talking to a patient on the phone. Only hearing one side of the conversation, I quickly grasped the concept.

"I understand that you do not have transportation. I know it may be difficult for you to arrange to come in to the office, but I have to see you."

"Yes, I understand, but you still have to come it."

"Uh, huh, but you still have to be seen."

"Yes, you need to come in. Perhaps you can do that."

At the conclusion of the conversation, the doctor said that she can go on like that indefinitely until the person solves their own dilemma. She said if you keep restating that they have to come in, over and over again, and NOT offer them solutions, they will eventually solve it. For instance, if you tell them to take a taxi, they will say they have no money. If you tell them to get a neighbor, they will tell you that their neighbor is not home. In other words, it is always best to allow the person to solve their own logistical or financial problem; with a little prompting, of course. Medical providers do not lack compassion. They are just faced with their own logistical problems.

Medical providers help their patients financially all of the time. You may or may not notice it. Fees are adjusted or down-coded for patients who are paying cash or have no insurance. Pharmaceutical samples are often given, or medications are prescribed that are known to be inexpensive or available generically. Some providers simply write NO CHARGE on the fee tickets.

Attorneys charge for phone advice, but rarely do medical providers charge for lengthy consultations. I spend at least an hour or more of non-compensated time dealing with these issues. Phone medicine has the same limitations as Internet-based medicine, but the big difference is that these are your patients. You know their medical history. You can review their charts. And, you know them as people.

I get unsolicited junk e-mails every day offering me prescription drugs, such as Viagra via the Internet. Many state that their "doctor", after asking a few questions, will prescribe it for you. Granted, this sounds like a good job for a retired clinician, but really! Can a medical provider truly ascertain the medical risks of a person on the phone or Internet based on a few questions? I don't think so. This is really no different than the Golden Age of Medical Quackery.

I visited the Museum of Questionable Medical Devices a few years ago in Minneapolis. Among the impressive collections was a huge quackery machine, filled with lights and dials, and an antenna. This machine, according to the operator, was capable of diagnosing anyone via the airwaves. All you need to do is send in your money, along with your list of complaints. This information will be entered into the machine, which will pick up your waves. A diagnosis and treatment would be mailed back to you. As crazy as this sounds, this worthless machine generated the inventor quite an impressive income. A fool and his money soon part.

I have been providing health information and advice on the Internet for eight or nine years now. I suspect that I have answered ten thousand questions. I have helped many, and have frustrated some by posting my disclaimer. Hopefully, even reading the disclaimer will educate the naive and misinformed about the limitations of this educational service. Unfortunately, it is not possible to help everyone, at least in the way that they would like help. Now, if I had one of those machines....

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My Late Wife

First, let me tell you that my wife is not dead, but she is perpetually late, at least for things that she perceives as not being important. It has always puzzled me why people refer to our dearly departed loved ones as "late". Late for what? Personally, I don't think they will be showing up at all. With that morbid observation out of the way, let's get back to lateness.

Tonight is the annual holiday formal for our medical group. It is a nice affair; good food; music too loud; people that you work with every day dressed to the hilt walking around carrying their wine glasses; and of course, dancing. My wife really hates to go. I am neutral about it, but go anyway since I believe it is the right thing to do. It starts at 6:30 PM, or 6ish...or 7ish...or 8ish in my wife's liberal timeline.

She has known about this annual affair for several months and already has her dress, however, it was only yesterday that she remembered to adjust her patient schedule so that she will have ample time to finish her charts, change into her dress, and meet me ON TIME, so that we can arrive at this event ON TIME. Her last patient will be at 3 PM and she has agreed to meet me at 6 PM at Borders, twenty minutes from her office. I selected Borders bookstore so that I can browse around, have coffee, etc. while I am waiting.

She already knows she will be late. I know she will be late. She is already anticipating that I will be ticked off about it (true), so this morning, she decided to mount a preemptive argument about the fact that she will be late. Perhaps, if I am confrontational, she will simply announce that she will not go. She has done this before, and I have gone to a formal affair by myself; constantly explaining why she isn't with me. I just told everyone that she was late. Tonight, if she does show up on time tonight, she will be sarcastic about it.

Being selectively late is not a rare trait for my wife. She is chronically late for most things; usually the things that involve me. I have to lie to her about movie start times, so that I can see a movie from the beginning and not sit in the front. When we are flying somewhere, I have to fudge a bit on our take-off time or else we will be bumped from our flight. I say "most things", since she does have the capability of being on time if she desires. For instance, if she has to be at a school to watch a theatrical performance of one of the grandchildren, she will be on time, in front, video camera warming up. She is not late for hair appointments, her sewing classes, mammograms, or dental appointments.

I can give you hundreds of examples of her lateness, but I think you get the idea. I don't know why she even has a watch. I am her exact opposite when it comes to being ON TIME. As a matter of fact, I am usually early for most of my appointments, so that I will NEVER be late. I allow for traffic, weather patterns, terrorist attacks, engine trouble, flat-tires, and parking difficulties. I look up the addresses and often get a computer-generated map. I cannot remember a time when I was late for an appointment. As a matter of fact, I can drive 700 miles, navigating traffic in Southern California, and get to an appointment ON TIME. The answer is planning.

Punctuality may be genetic, since my brother has the same issues with his wife. When he was dating his first wife in college, he used to call over to the sorority house and have them tell her that he was downstairs waiting. He would then take a shower, get dressed, and drive over. When my brother and I take road trips, he has his GPS. I can guarantee that we are ON TIME anyplace we need to be.

Every day in the clinic, I am faced with patients that are late for their appointments. I work in pediatrics, so I will see any ill child, whether the parents are late or not. Kids don't drive, so it is not their fault. I love hearing the excuses, too. Of course, they are very grateful that I did not turn them away at the door. Some of the doctors in our practice have a 15 minute rule--if you are fifteen minutes late, you will have to be rescheduled.

I know that a mother's day is hectic, especially when you have a sick child, so I have no intention of making a bad day worse. I do have chronic abuses of my lax late policy, however. These are the people that never show up at all, and don't call to cancel. These are the notorious NO SHOW people. We mark their charts when a big, red NO SHOW stamp.

The clinic has a series of escalating, nasty letters that are sent to the NO SHOW people. At first, the letters are nice reminders. Later, the letters will threaten dismissal from the practice. The last letter IS a dismissal from the practice. I don't use these letters. It is terribly disrespectful to be late, or not show up for an appointment. I suspect that most of these NO SHOWS are really just late, and are too embarrassed to show up.

Back to my wife...As much as I would like to be a nice guy about her chronic lateness, it does tick me off. I feel that it is disrespectful to me - her husband - the guy that married her and loves her. Why can't (or won't) she be on time? Is it an overt, passive-aggressive action? Is lateness genetic, too? Maybe her mother or father was always late and she cannot biologically help it? Maybe her internal clock a cheap Timex? I would absolutely love to be purposely late for some important event of hers, but the last time I tried it, I became so anxious that I was on-time, as usual. Damn. I can't even purposely be late.

Is it wrong to always be on time? Am I wrong to be upset because my wife is chronically late; or even anticipates that she will be late a day or more BEFORE she is actually late?

I suspect my wife will outlive me. Then, and only then, can she refer to me as her "late husband". She, of course, will be late for my funeral. Finally, a good excuse.

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