The Cure For Doctor Addiction!

Last week Doctor D told you about the dangers of doctor addiction. Today he's going to give you a twelve (actually 5) step program to save junkies!

Doctor Junkies feel an irresistible compulsion to see an MD every time they feel any physical discomfort form their bodies, resulting in risky tests and medicines as well as financial ruin for junkies and the healthcare system. While some responsibility for the problem rests with the junkies themselves, a lot of the blame for this can be laid on doctors who can be dealers and enablers for this deadly addiction.

Doctors are aware of the junkies in their lives. If you hang out with doctors (or read their blogs) you hear them complaining about junkies hitting them up for unnecessary care. "This patient of mine called an ambulance for a stubbed toe!" We gripe about our junkies, but we don't often propose solutions to improve the system that created this problem.

Well, today Doctor D is going to change that!

Doctors must take action to stop this madness before it gets out of control!

Here is Doctor D's plan to deliver our patients from the sad bondage of addiction to unnecessary medical care and lead them to the promised land of wellness!

1) Preach the Natural Healing Power of the Body.

Here's a big secret we don't often tell patients: the human body has an almost magical power to cure itself when infected and heal itself when injured! Who knew? In fact, before modern medicine this secret self-healing power of the body was the only thing that cured sick humans, and believe-it-or-not the human race survived. Modern patients and modern doctors often forget the human body has the ability to heal itself. Doctors are trained to intervene in the rare situations when body's own self-healing fails, but before long we find ourselves intervening when the body is doing a fine job on it's own because we only thing of medical cures not the body's own self-healing.

Doctors need to be spokespeople for the body's own immune system! We should spread the word about the body's abilities. We must acknowledge that even in our "medical miracles" the body does most of the healing on its own.

If MDs preach the amazing healing ability of the body, doctor-junkies will believe their body can handle that runny nose a few days without running to a doctor.

2) Grow a Pair and Don't Piss Your Scrubs at the Mention of Lawyers!

Most docs could easily educate patients on what symptoms usually aren't serious. Heck, we could give you a handout of all the symptoms that don't require a doctors visit if they are short lived: runny noses, coughs, joint aches, low-grade fevers, diarrhea, feeling yucky, etc. We could alleviate your anxiety with one therapeutic dose of knowledge.

Why don't we?

Doctors are terrified the information we give out will be used against us by blood-sucking lawyers.

We won't tell you to stay home with that runny nose because a nasal drainage could also be a symptom of a one in a million cerebrospinal fluid leak. We get terrified of missing zebras, so we kill a lot of horses. Fear of missing a rare diagnosis drives MDs to do irrational and dangerous things. We whip up doctor-junkies into a panic over their harmless symptoms and send them like lemmings over the cliff of over-doctoring.

Medicine is about taking risks. We risk your life every time we write a prescription or order a test. We should also be willing to take a risk by not doctoring conditions that are likely benign. There is risk either way, over-treatment protects us from lawyers, so physicians kill lots of doctor-junkies every year with big work-ups that are solely done to satisfy lawyers. Since we take risks either way, then we should practice with common sense and share our reassuring knowledge that most mild symptoms aren't dangerous with patients.

If blood-sucking lawyers want to sue me for using common sense, fine! Bring it on, bitches! Doctor D is ready!

3) Believe in prevention

Proper primary care can often prevent illness or catch it before it becomes serious. Fighting disease is only a secondary goal of medicine. Preventing serious illness is the real goal of primary care.

What does this have to do with doctor-junkies?

Doctor D has noticed a pattern that the MDs that give out the most unnecessary care to doctor-junkies are the same ones that suck at keeping their patients up to date on their preventive care. Coincidence? Nope.

Dangerous Doctorphilia is a need for the reassurance of receiving medical care. Preventative care fills this need in the safest possible way. Preventative care recommendations are constantly evaluated to insure their benefits far outweigh their risks. Appropriate preventative care and regular physicals can rehabilitate a former junkie. Their body has been checked for and vaccinated against most common problems. With prevention in their lives patients can have the confidence to weather minor symptoms without running to the ER.

4) Talk About the Risks of Medical Care.

Most patients don't realize that even appropriate medical care can be dangerous. Doctor-junkies love pills, and tests, and X-rays. The more the better! I've had junkies accuse me of trying to deny them the good stuff they are due when I'm just trying to protect them. "Order more, doc. I've got insurance!" WTF?

The best time to educate patients is when we are do appropriate interventions.

Many people at some point in their lives get a serious illness that requires aggressive care. If the power modern medicine helped their serious illness, they assume the same weapon should be used on their minor symptoms.

So, Doctor D actually educates people about the risks of care when he is giving it appropriately, "Antibiotic have some very real risks and I wouldn't give them if I didn't think your infection was serious." A word like this can save a patient from the frustrating and dangerous life of a doctor-addict who will beg for antibiotics every time they get a cold.

5) Educate Fearlessly!

Ultimately the cure for doctor-addiction is education. Instead of laughing at doctor-junkies' errors MDs should show them the light. Most doctor-junkies aren't stupid or irrational, they are just misguided about the proper use of medical care. It will take time and a bit of risk for doctors to show junkies a better way, but it is worth it.

After all, they are our junkies. Who is going to help them if not for doctors?

What do you think? Do you think this plan could will stem the tide of doctor-addiction? Have you ever had a doctor educate you on the power of your immune system or the risks of medical care? Did it help you avoid unnecessary medical care later?

As always Doctor D loves to hear your thoughts in the comments!

Mammogram Madness

The U.S. Preventive Services Task Force recently advised that most women don't need mammograms as early or often as previously believed. Now you can't turn on a TV without some reporter telling us how angry Americans are about this.

What is Doctor D's take on the new guidelines?

As a working clinician I trust the USPSTF. They have no agenda-axe to grind and spend a lot of time studying mountains of data. These experts meticulously examine the thousands of studies that I just don't have time to read. They crunch numbers and come up with carefully considered recommendations.

While I can understand all the public concern, I am irritated that many doctors seem eager to jump on the irrational bandwagon.

What no one seems to comprehend is that even relatively safe tests and treatments can still be deadly. Doctor D has hurt some very nice people with the "right" treatment because all medical interventions have risks.

Men can also get Breast Cancer, just less often. Men die of this disease. Would screening every male "save lives" by catching some early cases? Probably. Would there be lots of false positives? Absolutely. Would the number of men we maim or kill with work-ups and treatments outnumber the lives saved? Almost certainly. Hence the need for evidence-based guidelines.

Breast Cancer is a horrible disease, so it was worth a try to screen women in their 40's. But now we have years of data indicating that we hurt more low-risk women than we helped. Uh-oh! It's one thing to hurt people with what we hope will be the right intervention, but when we hurt people by doing something we know doesn't work it's shameful. The same thing happened with prostate screening for men. We don't need to keep doing things that don't work.

We have a natural bias towards doing something rather than doing nothing. People expect doctors to "do something!" Doctors like to do things for patients. Hence over-testing and over-treatment run rampant in all fields of healthcare. Sometimes we make educated guesses at interventions and hope they work, but when we have evidence showing we aren't helping people, it's time to acknowledge that doing nothing is safer and wiser.

The trouble is that the guidelines are based on mountains of studies that the public, politicians, and many doctors are unequipped to evaluate for themselves. So we go for next best thing: anecdotal evidence. We base our opinions on heart-wrenching stories of women in their 40's that died of Breast Cancer. All the evidence in the world is no competition for a really moving story.

What the USPSTF needs to do is come up with a convincing narrative. Stop referring to data that nobody understands and give your arguments a human face! Parade the widowers of and orphan kids of women that died as the result of a workups for false-positive mammograms in front of every TV camera you can find. Get doctors up on stage and have us apologize, "Sorry, we did what we thought was best, but now we know we were wrong. We'll do better in the future."

Doctor D realizes he'll probably loose some readers over this post, but somebody had to defend the USPSTF against this crayzee smear campaign.

Feel free to post your thoughts, but please don't accuse me of "not caring about women's lives." I follow the recommendations because I care about women, and I've been saying the same thing about PSA in men for a while.

Getting To Know Your Body (First Visits)

Now back to a question I only halfway answered before:

One thing I would like to see answered on your blog is, what do you do on a first visit? Especially if you're not sick?

On your first visit with Doctor D:

• First, you and Doctor D size each other up. A doctor-patient relationship can be a complicated thing. You gotta know who you're working with. What is the doctoring style of the physician? What are your wants and needs as a patient? How will the relationship work? It is a lot like a first date. We may not be discussing it directly, but Doctor D and his patients are carefully listening and watching to figure out if we are compatible. If you have strong opinions about your care, you should probably let me know, especially if your expectations are out of the norm: "Doctor D, I want you to take care of me without using any medicines" or "I refuse all preventive care." This helps prevent misunderstandings later.
  

• Second, we go over your medical history. This is when you tell Doctor D all the stuff that has happened to your body in the past. We talk about surgeries, pregnancies, illnesses, drug reactions, as well as any current diseases, symptoms, and medicines. For some of you this will be a short discussion but for those who have been through the ringer in the medical system this could take a while.

• Third, we evaluate your risks. We talk about what might happen with your body in the future. Doctor D will ask about diseases your family members had. He'll ask about your habits (diet, drugs, exercise, sex life, etc.) and do a review of systems to look for symptoms you may not have noticed. Then we talk about how to either prevent diseases or catch them early. Any Primary Care doc who only treats what you have now without preventing future illness isn't doing their job correctly.

• Finally, Doctor D takes a look at your body. I might find some hidden disease on this exam, but I usually don't. The real purpose is so Doctor D knows how your body looks, sounds, and feels when it isn't sick. Diseases change the body; to properly recognize these changes it helps to know how the body looked when well. You may say, "Come on doc, I feel and look great!" Doctor D also suffers from a delusion of physical perfection he developed as a cocky 19 year old, but the fact is that even healthy bodies still have lots of little quirks or abnormalities. If I see you for the first time when ill I might mistake one of these physical quirks for a new problem and misdiagnose you. Similarly I might assume some small abnormality has always been there when it's really an important clue to your problem.

A while back Doctor D was in the ER and a dude comes in with a runny nose and headache--pretty standard viral cold, except that one eye was much bigger than the other. This gets Doctor D thinking about tumors in the eye socket and other scary stuff.

Doctor D asks about the eye and the guy says he's never noticed any between his eyes. Uh-oh! Then Doctor D shows the dude his own face in a mirror and the man is like, "Which eye doc?"

WTF? How does someone totally not notice one eye is fricking huge compared to the other? We doctors are trained to notice physical weirdness you stopped paying attention to when your mom taught you not to stare, so maybe this dude never noticed his funny eye? So Doctor D calls the family from the waiting room and they say he looks normal. Dr. D points out the eye and they are all like, "Well, what do you know? It is bigger!" Nobody knows how long it's been this way.

Luckily somebody had a childhood picture of this dude, and D discovered one eye has always been bigger. Apparently this guy has had a odd eye his whole life and nobody noticed! Stuff like this happens more often than you think. A lot of times this dude would have gotten his head pumped full of radiation in a big workup just because he was born funny looking.

It is really important that you have a doctor that knows you and your body well. First visits take a while even if you are healthy, but they are really important so don't skip out on them.

Incidentally Doctor D has his first visit with his new Primary Care doctor next month. What is the weirdest thing that ever happened to you on a first doctor's visit? Doctor D would love to hear your stories in the comments.

Why See A Doctor If You Aren't Sick?

A reader question:

One thing I would like to see answered on your blog is, what do you do on a first visit? Especially if you're not sick?

When someone shows up in Doctor D's exam room with an advanced case of some truly nasty disease D will often ask them, “But why haven't you seen a doctor since the Clinton administration?” They always answer, “Because I haven't been sick, doc.”

Waiting till you get sick to see a doctor is like waiting till you're in the water to get a life jacket.

It is a common misconception that doctors save a lot of sick people. Only rarely do we “save” you after you are sick. Usually we hold off a disease which still gets you in the end, or your body heals itself (and we take the credit). The real lifesaving is in preventing diseases or catching them before you feel the first symptom:

First, we help you prevent or postpone serious illness:

• Your doctor can review your genetic and lifestyle risks. What diseases are you more likely to get in the future? What can we do to prevent them?
• We can help with healthy diet, exercise, weight management, and avoiding things that will kill you (like cigarettes). Of course, everyone knows this stuff from highschool health class, but how many of us are really doing it? Even Doctor D needs his doctor to regularly remind him to eat right and exercise. It just isn't as easy to do it as Happy Hospitalist says.
• Get your shots. Doctors have probably saved more lives with vaccines than any other treatment ever invented. Seriously, at least talk to a doctor about it, even if an Oprah guest told you not to.

Second, preventive visits can find serious problems before they cause trouble. Most people can't feel high sugar, high blood pressure, or high cholesterol until it is too late, but those things will kill ten times as many Americans as H1N1 this year. And some of the most common cancers can be caught with early screening—early enough to make a difference between surviving or not.

Remember these preventative things should still be done even if you already have a disease. People with chronic or frequent illnesses often understandably focus on what is giving them trouble. Don't be that guy that focuses so much on what is hurting, when the real thing that might kill you is hiding in plain sight!

So even if you aren't sick or you are seeing a specialist for something else, you really should see a Primary Care Doctor at least every year or two. We cover a lot in these visits.

Doctor D promises he is not trying to get you into get preventive care just to line his pockets. If he wanted to get rich Doctor D would have chosen just about any specialty other than primary care. He also wouldn't be spending all his off-time on this blog.

What is the longest you ever went without Primary Care? Do you think it affected your health? Doctor D would love to hear your experiences.