Bedside Manners

Answer to Why do doctors often have poor bedside manners, and what as a patient could I do to make their say better?

Because physicians are humans.

You will find the arrogant, rude, inconsiderate, and uncompassionate among us just as in society at large.

However, you will also find the sensitive, caring, loving, and compassionate among us, too. Just like society at large.

I'm not sure about others, but we learned about good bedside manners in med school. My teachers were professors in the Psychiatry Department at the then North Chicago VA. The training was excellent, and I internalized a lot of it. Among other components, we learned which words and phrases not to say, what body language puts patients at ease, and even to change the rate of speech under different conditions. Good stuff.

As for your second question, what can YOU do? Plenty, starting with just letting your doc know how you feel. Try not to make it confrontational. Just simple and honest. This may change how they interact with you, but I doubt you'll make much of a change in their character.

If that doesn't work, write a letter and mail it to the clinic manager/hospital CEO. Snail mail makes a bigger impact than email. That should make some difference. Especially if many others complain.

Then there's always Yelp, or Google Reviews, and so on. Permit me to give you a personal anecdote. I had to change family docs at the end of last year because my insurance changed. My first visit with my new one was February 2nd of this year. The encounter was humiliating.

Last Fall I fell into a manic episode that lasted 6 weeks. During that time I apparently drank. Which is not what I normally do. At one point I fell and kissed the concrete. I was taken by ambulance to an ER where, of course they obtained a blood alcohol level which was just above the legal intoxication level.

Anyway, the new doc walks into the room, introduces himself, then says, “so you are an alcoholic.” Then proceeds to grill me about drinking and abusing drugs, which I have never done. No physical exam, no history taking, nada. On the way out, he says, “see you in 6 months.”

I posted a negative review on Yelp. Someone in the hospital system must have read it and talked to him because at my follow-up visit August 2nd (just last Friday), he was as nice and attentive as can be!

If none of this helps, change docs. It's your right. Good luck.

http://bit.ly/2ML3mXI

Antibiotics and Viral Illnesses

Quora Answer to
Have you ever had a patient refuse to believe the diagnosis you gave them?

Yes. But it was through his wife, a Registered Nurse who should have known better.

I was working in an Immediate Care and Occupational Medicine clinic in Burlington, Wisconsin one night during an influenza outbreak. A very sick man came in with typical influenza symptoms: fever, chills, body aches, non-productive cough, sore throat, and nasal congestion/clear nasal discharge. On presentation, he was a well-nourished, poorly hydrated, middle aged White male, ill-appearing, in mild distress. Eyes were white, sclera non-injected, extraocular muscles intact. Pupils equally round and reactive to light and accommodation.

Neck was supple with a full range of motion. He had tender bilateral submandibular lymph nodes (no anterior cervical lymphadenopathy which is important). Nasal mucous membranes were injected (red) and hyperemic (congested) bilaterally with a clear discharge. Oral mucous membranes were dry, his pharynx was injected, but without exudate (pus).

He had a cough and auscultation of his lungs revealed bilateral wheezing but no rales, crackles, or rhonchi. There was good air movement despite the wheezes.

Vital Signs: Heart rate regular at 98 beats per minute; temperature 100.5 degrees F; respiratory rate 15/minute; and oxygen saturation 96%.

The rest of the exam was unremarkable.

Based on my findings and the fact that there was a statewide outbreak, I felt he had influenza, a viral illness. He was also dehydrated so we started an IV to give him fluids. I added dexamethasone (a corticosteroid) for two reasons: to decrease or eliminate the wheezing, and help alleviate his body aches. I added IV Toradol for the same reason. It also brought down his temperature, which really wasn't alarmingly high.

He responded well to treatment. While we were rehydrating him, his wife tracked me down and wanted to know why I didn't order a strep test and chest x-ray. I explained again why I thought he had a viral infection. She wouldn't buy it and demanded I order them. Both are relatively cheap so I did, mainly to placate her. Both came back negative: no strep pharyngitis; no pneumonia.

She wouldn't buy that either, explaining to me that the rapid strep assay was “only 90% accurate.” More precisely, I explained that it is both highly specific and sensitive, with a predictive value (at that time) of almost 95%. Besides, there is also a clinical algorithm that has a negative predictive value of almost 85%. Basically, in the presence of a cough, the abscence of tonsillar exudate, and no anterior cervical lymph nodes, it is highly likely NOT strep. I explained that to his wife, too. Then I asked her what she thought he had. No kidding, this was her answer: “acute sinusitis, strep throat, and pneumonia.” So of course he needed antibiotics. In fact, she demanded them.

First of all, treating a viral infection with antibiotics is poor medicine. Secondly, and if you've read some of my previous Answers you should understand, what she thought were the causes of his illness violates Occam's Razor. As it pertains to medicine, it means that the preferred diagnosis is the ONE that most precisely explains most if not all, of the signs, symptoms, and test results.

Despite accomadating her about the RSA and chest x-ray, I refused to treat him with antibiotics. Soooo… she called the clinic administrator and complained. The administrator drove all the way from Janesville, WI to Burlington to “please, please give him an antibiotic.” I explained to her why I felt that was not medically necessary. She then went to the other doc working that night and he was more than happy to prescribe one. For a patient he didn't even see.

Later, I asked him why and he said that he always prescribed an antibiotic for every patient who presents with a sore throat. Why? His reasoning was that he would rather prescribe incorrectly than miss a strep pharyngitis. I call that “CYA Medicine.”

Remember that clinic because it's central to another much more tragic story of mine.

https://www.quora.com/Have-you-ever-had-a-patient-refuse-to-believe-the-diagnosis-you-gave-them/answer/Michael-Mangold-4?ch=99&share=1154ff98&srid=TCJzj

My Quora Answer to Healthy Blood

If you want to have really great blood test results for a physical, what should you do ahead of time?

Michael Mangold, M.D. Medicine and Healthcare & Psychiatric Treatment, Rosalind Franklin University of Health Sciences (1990)

Exercise, including cardio and weight lifting

Eat low on the glycemic index

Minimum supplements include Vitamins D, C, A, fish/krill oil, and no more than 400 IU of Vitamin E a day

Eat dark green veggies and deeply-colored fruits for their antioxidents

Eat or drink a probiotic every day

Limit alcohol consumption to no more than two standard drinks a day. Red wine is best.

Get good quality sleep

Meditate/pray every day

Don't smoke

Don't abuse drugs

Come to think of it, these are things we all should do or avoid every day anyway!

Unabated Fever

Answer to Why won't my fever go away even after taking medication from the doctor? by Michael Mangold

The primary answer is that the antibiotic isn't working. It may be due to several reasons including local drug resistance and wrong coverage for that specific bacterium. If the fever hasn't abated after 3–4 days of therapy, go back to your doctor.

Other reasons include that you have a viral infection instead, and lastly that your doc doesn't know what's really going on. I would call that “ignorance” or 'lack of experience” before labeling them a “quack.”

http://bit.ly/30IEPGH

Getting Fit Despite Chronic Health Issues

Answers to What can a person do to get fit that has had several knee surgeries, fibromyalgia, and chronic pain? by Michael Mangold
http://bit.ly/2LlE9TX

Mediterranean Diet for Depression

"This was a big year for brain food. On January 31, 2017, Felice Jacka and colleagues published the SMILES study, which showed that the Mediterranean diet had a significant and positive effect for individuals with moderate to severe depression. One year later, Natalie Parletta and colleagues at the Center for Population Research in South Australia have published a similar study with striking findings. Dr Parletta and her group followed 152 individuals with depression who were randomly assigned to a control group, which participated in a very active support group, or a group that received the Mediterranean diet…

...The researchers followed these participants at 3 and 6 months. What did they find? They found that individuals in the Mediterranean diet intervention group significantly changed their diets. They ate more fish, they ate more plants, and they ate less red meat and fewer confections or processed foods. Investigators also found that participants in the Mediterranean diet group had a significant reduction in their depression scores, with a roughly 45% improvement in their rating scales compared with about a 27% improvement in the control group.”

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https://www.medscape.com/viewarticle/892792?src=mkm_ret_180329_mscpmrk_depression&uac=7038PX&impID=1592643&faf=1