HOW TO THINK LIKE A DOCTOR

It's 3 am Thursday morning and I just finished my first book with the above title! Who should buy this book when it is published? Anyone who has ever been a patient. Anyone who has never been a patient. All med students, NP's, PA's, EMT's, Paramedics, and MA students. And those scared of doctors like children and hospital administrators.
Also for anyone who has walked into a clinic, saw the doctor, then walked out thinking "what the hell just happened?
If you think in your own mind that you "know better" than your physician, then read this book and show her the error of her ways.
Read this book then begin to use it like a medical journal of your own health and wellness. Did Dr. Pitel do all the things a good physician does as explored in the book or did he leave something out that Dr. Mangold said should have been done? Or did the medication Dr. Poofandsmoker from Hartford Hospital give you match up with your story and his six minute exam? Did he explain side-effects and med interactions with you or did he punt that off to the pharmacy tech instead?
So please pass on the word. It will only be published as an eBook available at amazon.com for a very reasonable rate. Click on the amazon link to the right to take you there.
Comments and criticisms are welcome but may make me cry.
Thanks all. Get out the word.

PARACHUTING IN CIRCLES

Stream of consciousness tonight. Watched "The Hobbit" with the Young Padawan, the Cowboy, Blair Corbett of Ark of Hope fame, and Gimli, son of Gloin. The Cheshire Cat would pounce in and out of the viewing area while the Cowboy seemed to think that the chair and his bed were interchangeable living arrangements.

Gandalf healed Thorin with prayer. In my practice, that occurred 10% of the time. Can I prove it? No. Prove I'm wrong.

Angie once bragged that her brother was a great photographer because he had a lot of great photography equipment. I still won't let her live that one down. In photography as in medicine, there are paths of knowledge where critical factors overlap. My own father was a professional photographer. One of my best friends was the photographer extraordinaire Dan Harris. They both trained on high-tech equipment (the more they learned, the techier it became. Did I invent another word?).They could also take outdated equipment and playfully create works of art.

Using whatever equipment you have available, and trying to make a diagnosis is similar. It CAN be done with the most expensive toys found in any hospital. Trust me, they won't be in your local clinic. It can also be done through listening to a patient carefully and doing a thorough physical examination. The use of extra tests usually serves to verify a good physician's suspicions. A bad physician will run batteries of tests to arrive at something. Anything. There is an old saying in medicine that if you run enough tests, eventually you will find something abnormal.

Abnormal. What if there was a test that created "abnormals" that were ill-defined and vague. How do you interpret that and how do you treat that? Aurora Health Care in Southeast Wisconsin discovered how to do that AND make money doing it: http://m.jsonline.com/features/health/113541984.html?dc=smart&c=y&ua=blackberry. We heard of these tricks Aurora was pulling when an ostracized cardiologist came to our clinic and repeated to us what he saw with his own eyes. When he complained about it, he was let go unceremoniously and lives with the bitterness of knowing that there is no "Employer Retaliation" protection against whistleblowers in the state of Wisconsin. The state brags there is. Believe me, there isn't.

I will be parachuting for the first time next week. No, I will not have a Golden Parachute like the ex-CEO of Aurora whose termination package amounted to more than $20 million. Ironically, the company stopped construction recently of one facility because they were $20 million behind in projected costs.

So the take home message today is this: hospitals are not the hospitals our grandparents and even parents knew when they were younger. They are hospital systems and their bottom line is profit. Second in line, image. Third, helping people get better. A physician's and nurse's bottom line is making people better. Profit should come second. Sometimes job security or the security of a steady paycheck has more pull than pure profit. Sometimes profit wins but really, it is patient care.

Say a prayer for me on the 23rd when I sky dive for the first time in my life. I hope my knees can take it.

CRAZY IS AS CRAZY DOES

Charles Knotbrite came to our first garage sale and introduced himself as a Christian who was interested in our mission work. For everyone's reference, we consider ourselves on a mission from God to bring quality health care to underserved areas of the world. Our primary purpose is to serve, not necessarily to "convert." This runs counter to what many in evangelical circles consider "mission work." Our drive comes straight out of Matthew 25 (NIV):
                                
³⁴ “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. ³⁵ For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, ³⁶ I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
³⁷ “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? ³⁸ When did we see you a stranger and invite you in, or needing clothes and clothe you? ³⁹ When did we see you sick or in prison and go to visit you?’
⁴⁰ “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

Asides aside, Charles wanted to know where our mission work was taking us. "Well, Nicaragua for starters" I replied. "Nicaragua? Good luck with that. Ortega is a crazy man." Which was a conversation-stopper.

Unlike Jenny Wai, at least Charles Knotbrite knew where Nicaragua is. I worry though that he is not only making political judgments based on listening to radio commentators but also making medical diagnoses without enough real information. Part of my training was in psychiatry and the two top diagnoses during my clinic years were psychiatric diagnoses. Yet I would not dare make a diagnosis of Ortega's mental status based on what I read in newspapers or hear on the radio. Mountain-making out of molehills? Maybe a little but I really resent having my dreams belittled by people who have never even left their home states. At some post in the future, I will go over psychiatric diagnoses and the importance of the neurological basis for psychiatric disorders. For now, I want to take the bible quote above and show you how we tried to follow Christ's commandments when it was easier to donate money than it was to physically serve.

1. Feed the hungry: local food pantries; Hunger Task Force (http://www.hungertaskforce.org/)
2. Give clean water to the thirsty: Water Missions International (http://www.watermissions.org/)
3. House the homeless: Habitat for Humanity (http://www.habitat.org/)
4. Clothe the naked: Salvation Army (http://www.salvationarmyusa.org/usn/www_usn_2.nsf)
5. Visit prisoners: Voice of the Martyrs (http://www.persecution.com/)

Although not listed in this part of Matthew, Jesus also commanded us to take care of orphans and widows which has also been a significant part of Judaism since Moses' time. Today I would like to give a shout out to Ark of Hope in Florida which has done one of the best jobs of taking care of neglected and (sadly) rejected kids that I have ever seen. Visit them at www.arkofhopeforchildren.org when you can.