Tough Talks


Being a family physician we get to hear about the good things going on in patients lives but we also are there for the bad.  I have done my best to take care of patients yet no one lives forever.  On every patient note I write I try to include a little interesting tidbit about each patient.

Because patients die.  I am often involved with their health as it takes a down turn or am surprised and trying to find out what happened to their loved one. I have said the wrong things a few times and insightful things at other times. Here is my guide to talking to a grieving family member.

Ask questions.  How are you coping?  Is there anything you need?  For a husband and/or wife that lost their loved ones I ask how they met?  Where was their first date?  People realize their loved ones may have died but they do not want them to be forgotten. 

Remind them of a funny/interesting interaction you had with their family member.  Like I remember the time I gave your husband a cortisone shot in his knee so he could compete in his bowling tournament.  Or how excited someone’s recently deceased mother was when she went to her granddaughters wedding. 

Leave out the negatives.  This is not a time to remind a woman that her husband had cheated on her years back.  Or that his kidneys failed because he did not take his blood pressure medications.  There is no need to bring up the past at this time. 

Continue to ask about how they are doing.  It could be 6 months or 6 years but people grieve for different amounts of time.  Do not avoid the topic.  Widows want to talk about their husbands that have passed.  Unless they are there with their new boyfriends. 

Take notes on patients.  Learn about their lives.  Because no one will be here forever.  And everyone hopes to be remembered by someone.

The Doc Is In

Cobra Kai

They made a show about the Karate Kid that takes place 30 years later.  And everyone seems to love it.  Everyone in my generation remembers rooting for Danny LaRusso to use his crane kick to save the day.    But Why?  Because humans overall are nostalgic.  We love things that are familiar.  We love a redemption story.  As a physician I realize certain beliefs that I have now may be scientifically proved different in the future.  I am accepting of realizing that more data will change my thoughts.  I have changed my thoughts.  Johnny is down on his luck and training a young crew of adolescents in the art of karate. Danny is wealthy and successful. Some would even say he is the bully 30 years later. I am now rooting for Johnny Lawrence in Cobra Kai.

Patients come to see me after ER and hospital visits for specific visits called transitional care management visits.  They often complain about the food and communication.  I take my time and review the diagnostic tests.  We discuss any medication changes.  Rarely after these visits do they complain about me.  Why do you ask?  Nostalgia.  They know me.  I know them.  This cannot be quantified.  I do not always have to be the physician making the medication change or ordering the CT scan but I will the familiar face discussing the plan. 

There are new medications coming out all the time.  New imaging tests have also arrived on the scene.  Elastography for fatty liver and CT calcium scoring tests for coronary artery disease screening.  Lots of new medications with X’s and Y’s and Z’s.  Some medications have all of these letters.  Like XYZAL. Yet I still reach for amoxicillin and lisinopril and ibuprofen.  My favorite diagnostic tests are still EKGs and CXRs.  Why?  I have nostalgia.  My favorite guidelines, medications and exam techniques go back to the good old days of residency.

Medicine is inspiring and ever changing.  It trains your brain to have to always question and ask for more data.  I love everything I learned in training but realize that I am open to new things.  Coumadin was used all the time.  Now DOACs are here to stay.  I never checked Vitamin D. Then I checked a lot.  Now I almost never check.  Mild ear infections do not need antibiotics. My mind is blown.  But it is ever changing.  We can love nostalgia yet be open to changing our minds. 

Some beliefs never die.   But some of our beliefs should.  I am open to change while loving the past.  Even Johnny Lawrence went from saying “Strike first.  Strike Fast.  No Mercy” to realizing that those are only words on a wall.  Cobra Kai.  Never die.  Keeps patients alive. 

The Doc is In

Unsolved Mysteries

Growing up I loved Unsolved Mysteries. But I think we all did. The super creeping music followed by Robert Stack’s deep thundering voice. It is a show that does re-enactments of different mysteries. Often times it is a murder, a kidnapping or a questionable suicide. We were all drawn in and by the end of the show everyone has a thought as to what happened. Quickly we are invested and want to help find answers for these families. The reason for episode is that the team investigating does not have the answer.

It was at this time I realized that I loved collecting information to help solve a problem. Robert Stack inspired me. I love playing Clue and think that Ms Scarlet should never be in the Conservatory with a rope. I went to a murder mystery and many thought I was the murderer because they did not believe I was actually a physician. This is the world of diagnosis. We collect information, focus on history, follow up with an exam and then order labs/diagnostic reports to try and figure out the answer.

Thankfully Netflix has brought back Unsolved Mysteries. It quickly rose to number one on the Netflix list. Why? Because we as humans are problem solvers. But this show is helpful to young physicians. The premise of the show is to get a great history, present it to the world and see if others can help add information to come to a final diagnosis. From Agatha Christie to Robert Stack to Anthony Fauci we need problem solvers.

I see patients with symptoms and complaints that have not been diagnosed. But I will not give up. Robert Stack never did. But the show has inspired and helped influence my training. Hear the history again. Bring patients back for another visit to hear how the history has changed. Ask colleagues for advice. Ask the patients what diagnosis they are concerned with. Examine a patient more than once. Order tests that fit your differential diagnosis. Patients are not like test questions. You do not need an answer after a 15 minute visit. Do not give up. Listen and learn. At the end of the day you may realize that Mr Green fell in the kitchen while holding a knife because his neuropathy was due to Charcot Marie Tooth.

The Doc is In

Magic Mouthwash

Of all words that we should not use in science magic is at the top of the list. Yet we still are prescribing magic mouthwash. Sore throats are a common complaint in the office. So why do some of us decide to add a little magic mouthwash in the mix. What is magic mouthwash anyway? It depends on who you ask. In my world it is a prescription of viscous lidocaine. Some physicians add Maalox while some add Benadryl but some get crazy and add both.

Yet sore throats happen. Most are from viruses but some come from bacteria. Most of us have had Strep Throat at some point. This needs antibiotics. Luckily it still responds to penicillin. Not many illnesses still respond to regular penicillin. Strep throat and Syphilis. The antibiotics help prevent the bacteria from spreading to heart valves but they do not treat the pain. This is where the magic comes in.

Yet we still pretend like there is magic in medicine. Supplements are magical to patients. I start my days on time yet magically end up behind every day. I had a patient who said that a magician made his Vicodin disappear like a rabbit. We discuss the art of medicine. We know there is an art to performing card tricks.

But if your throat is really hurting you should reach for ibuprofen or Tylenol. Leave the magic mouthwash alone. Put the supplements down. Or if you have kids grab some popsicles. They do seem to magically make their sore throats go away. Because they are magically delicious.

The Doc is In

Jason Voorhees

That guy was scary. Almost everyone that is currently in their 40s had a nightmare after watching Friday the 13th. You would run from Jason as fast as you can. Yet he would take his time walking through the woods and still catch his prey. It is amazing that any of us ever wanted to go to summer camp after watching any of these movies. What else made him scary? His mask. The goalie mask. I blame Jason for making masks scary.

Halloween is one of my favorite holidays. A chance to be creative. To change into another personality or character for at least one night. There are different ways to do Halloween. Using your own clothes to create a character. There is a grown man that I see in the world and every time I just remember him from the Halloween that he was Miley Cyrus. But often we wear masks. Scary masks. Hide under leaves and jump out to scare the trick or treaters with your ghoul mask and then will run for cover. Like Jason Voorhees is chasing them.
Facial expressions are also masks. Everyone has had a bad day at work yet put on the mask of happiness to help make it through the day. We can present ourselves in a certain way by wearing our own masks while exploring the world we live in. Some of us are better than others but we all have our own version of daily masks.

Now masks are everywhere. People are making cloth masks. Health care professionals are discussing the differences between surgical and N95 masks. Yet some people do not want to wear masks. I am not angry with them. I am trying to be understanding. Masks have been a sign of danger for years. But we are at a time in humanity that the meaning of masks has to change. They should start to feel reassuring. When I see someone wearing a mask I appreciate that they care about others. I wear my mask to protect you from myself. Make masks beautiful.

As a physician I have had friends/patients ask me if “I am scared of the coronavirus?” My answer – It is more frightening than Jason Voorhees.

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