"Ok, you're ugly too..."

... As a primary care doc, I see a myriad of ailments and complaints from a variety of people who are all shapes and sizes from all walks of life.

But there are a few common threads, observations, demands that pop up enough from my patients that merit some translation through my "Doc, what I'm really saying" translator (coming sooon as an app for your iPhone :)).

What they say: "I'm having trouble losing weight and I'm tired all the time, I'd like to have my thyroid checked out."
What it means: It usually comes from the 30 to 50 year old female wearing too much eyeliner and clothes that are 2 sizes too small - screaming kids are optional. They have a knock-off handbag that is filled with mentos and a 2 liter bottle of Mountain Dew. What she means is "I haven't exercised in years; I still eat like I did when I was a teenager; I like to drink and smoke .. alot. I'm starting to get fat and lonely and I want an easy solution that doesn't require any real work." Trust me, it's not your thyroid. Put down the twinkie and go for a walk.

What they say: "Your nurse said my temperature is 98 degrees; that's a fever to me because my temperature is usually 95 degrees."
What they mean: This usually comes from the mid 30's to mid 60's professional or soccer mom who looks pissed that they have to take a break from their busy day to see the doctor. They're not really that sick, but it usually means "This virus is annoying and disrupting my already too-hectic life. Write a prescription for an antibiotic, you little twit, so that mentally I'll feel better through the placebo effect. And no, I don't give a crap about causing community-resistance to common bacteria, I've got shit to do." Relax, take a day off of work, put your cell phone in a drawer, sit on the couch and eat chicken noodle soup and watch cartoons - the world and it's problems will still be there tomorrow. Yes, I will also validate your assertion, that because your "temperature is normally 95 degrees", you are unique and special.

What they say: "Tylenol and Ibuprofen don't seem to work for me."
What they mean: The patient will have some sort of pain complaint - twisted ankle, migraine headache and the classic, non-specific lower back pain. He or she is wincing and groaning and being incredibly histrionic - Emergency Room patient identification bracelet optional. Ocasionally will have rotten teeth and may actually be actively 'tweaking'. Their body language is screaming, "Give me oxycodone, hydrocodone, hydromorphone, morphine, tramadol, valium, horse tranquilizers, those frogs that you lick from the amazon-freekin-rainforest - anything that will get me high as a kite so I can get away from my miserable life for 10 minutes." I used to be sympathetic. Now, It just makes me sad.

What they say: "What? Hop along marietta beaver?"
What they mean: This is an elderly couple, usually in their 80's to 90's. She is deaf but refuses to wear hearing aids. He is pleasant but has dementia and always wears a baseball cap too high on his forehead. They are usually being seen for vague symptoms like fatigue, lightheadedness, insomnia and achey joints. This is usually the response to when I ask "How long have you had a fever?" What they really are saying is "We're old and tired and in pain. We want someone to listen to us and take us seriously. We know we're coasting into the 'beyond' but we want to enjoy the trip and remember the ride. Thanks for listening." Besides tweeking (not 'tweaking') their medications a little bit, that's all I usually do and it's that all they usually want.


Avoid saying any of the above and your doc may take you seriously the next time you're seen. Oh, never ask me for a 2nd opinion as you'll get the response (I can't help it) that's in the title ...

That stuff will kill ya ...

... I talked to an old acquaintance from medical school the other day. He's a respected cancer researcher in a small but very vital facility back east.

We weren't good friends in med school but we ended up in the same residency program where "batttleground friendships" are soon quickly formed after 36 hour shifts and little sleep. Nothing like defibrillating an octagenerian at 2am to bring out one's true personality.

As it turns out, Jeff (as I'll call him) was a good guy - nice, smart, compassionate - and quirky. He was fun company on call.

We used to hit the vending machines in the hospital cafeteria at 3 am when we'd trade beepers so that one of us could catch a few hours of sleep. We'd grab something unhealthy and sign out to the other person. Then one of us would go to sleep and the other would go back to the floors or the ICU.

I'd usually get an ice cream sandwich or a Reese's peanut butter cup - chocolate would give me energy for the waning hours or fill my belly, allowing me to catch some z's. Jeff would go to the same machine every night but would always get something different. Sometimes he'd happily gobble down some Doritos or peanut butter crackers, but othertimes he'd disdainfully pick through an ancient bag of trail mix or choke down some dry nilla wafers. His choices seemed weird and totally random.

After a year or so, my curiousity got the better of me and I would discreetly stand behind him pretending to search my scrubs for a wadded up dollar while he make his vending machine purchase. He was always deliberate in his choice but always purchased random foodstuffs.

After a month or so, I realized what he was doing. And, for a budding oncologist, I thought it was quirky, endearing and brilliant.

He'd always go to the same machine and buy whatever was in the slot "B-9".

Say it out loud. It seems that the guy who was going into a potentionally depressing field was also a closet optimist ...

Brother, can you spare a dime ...

... Well, this recession or correction or whatever is hitting people pretty hard.

I'm not going to pretend that I'm some financial wizard or economic know-it-all; I've always been a selfish bastard when it comes to the vagaries of the economy and the GNP et al. I want to know how it affects me and mine. What action do I need to take to ensure I get to retire before I'm old and limbless or let me buy the flat screen TV without having to skimp of necessities - fast food, "man toys" and Peter's shoes.

I thought that by being in the medical field, I was insulated against recessions. Hell, everybody gets sick - everybody needs health care.

Or so I thought.

My clinic schedule has been anemic the last few months; probably only seeing 1/2 to 3/4 the usual amount of patients. My phone and email "in basket" however is overflowing with work.

While some of my less fortunate patients have lost health care altogether, others can't afford the co pays. So instead of coming in for a cold, the medication refills for hypertension, the "itching down below" and the occasional growing lump - I'm getting deluged with people wanting to be treated over the phone or the Internet.

I understand and I can treat sometimes, but most times, I can't - practically (ever have a patient try to describe a rash over the phone? "It's red") or legally (who wants to be the doc who misses the patients signs and symptoms of a stroke because they aren't able to do a good neurological exam?).

Patients invariably get upset and complain about high-deductible plans and that I'm saying they need to come in because I need to pay off my yacht, etc. Or serve my poodle steak tartare.

I empathize, but believe me, I don't have a yacht and my wife's allergic to dogs. Yes, I make a good amount of money but I'm 39 and still will be paying off my student loans (which amount to a nice sized mortgage payment every month) until I''m 50!

I feel the recession too. Less patients mean less income for me. Most physicians are not paid on salary, then get paid according to a compensation package that is based loosely on seeing patients. So, at this point in my life, I'm getting trickled down upon - or is that trickled up? Who knows? All I know is that it sucks.

Getting back to patients who don't want to come in - I had a gentleman, whom I knew pretty well, contact me to complain about belly pain. This is a big, old stubborn Minnesota man who never complained of anything - ever - even after getting shot in the head in the Korean War. We played phone tag with symptoms for days and finally I told him he had to come in for an exam and there was nothing else I could do over the phone.

He reluctantly showed up for the appointment and bitched the whole time. After a few minutes, it became clear that the "belly pain" he was referring to was actually lower chest pain (I guess he missed anatomy class in high school). I got an EKG and a chest x-ray ("doc - this isn't covered by my deductible!") - it looked like he was having a stuttering myocardial infarction probably due to an aortic aneurysm that was slowly rupturing in his chest. I told him we had to get him to the ER immediately and he needs surgery within the hour or he was going to die.

He sighed, looked at the ground for awhile and finally said, "shit ... this is going to fuck my premiums up."

He had the surgery and didn't damage his heart (too much) and is doing well postoperatively, thank god. But if he didn't come in, he would've died. If he came in sooner, he might have saved some of his heart muscle that infarcted.

As stated earlier, I don't know what's wrong with the economy - but for all my reasons, it's gotta get fixed. Soon.


For now, I'm just waiting on my tax refund.