Death of the Handshake

Physicians have been taught about the power of touch. Look a patient in the eye. Give them a strong handshake. Good patient care has shown that patients have a better experience when you sit down. They often report that a physician spent more time with the patient if the physician was seated and was close to the patient. Physicians were called healers before medical schools existed. The laying on of hands and healing has been known for thousands of years. Touch is one of the senses that is controlled by many different areas of the brain. For years I have checked every patient’s pulse myself to begin the process of laying on of hands.
The laying on of hands has been slowing going away. My mentor taught me every physical exam skill that existed. They all had names from the McMurray’s and Rovsing’s and no one will forget the Dix-Hallpike. But we have worried that these skills are diminished in younger physicians. Because of more lab tests and MRI’s and CT scans. As opposed to a thorough history and exam we just scan bellies at this time. We need to preserve these skills and the art of touch.
Or should we? The coronavirus is here, and our lives have been changed. We immediately have started doing telemedicine. We will see patients in the office by only if they are not sick. If you have a fever or cough instead of an exam trying to find a cause, we have transitioned to encouraging patients to hide in their basements. As an outpatient family physician, we are trying to treat the ill while staying healthy ourselves. Hospital based employees are out there everyday seeing sick patients while in PPE trying to get minimal touch/exposure to the patients they are seeing. It is hard to look at someone closely with a mask and goggles on.
The handshake is dead. A pandemic killed the handshake. Likely for the better. But hopefully the laying on of hands will return. It has been hard times, but I am excited for the day that I can hug a patient that is struggling. The handshake may be dead. But hugs will last forever.

The Doc Is In

Do as we say. Not as we do.

As a physician I spend a lot of time discussing sleep hygiene. Which is similar to our regular hygiene but somehow harder to pull off. Every morning I floss, brush, shower, deodorant and then coffee. I have the routine down to a science. But sleep hygiene has hard for patients to get consistent with. This is the idea of doing things in a routine to promote restful sleep. Go to bed around the same time. Put your Iphone away. Turn off the TV. Make sure you are in a cool dark room. Before getting married make sure your partner does not snore or will at least wear a CPAP.

Yet physicians often have the worst sleep hygiene. It starts in medical school and then gets worse in residency. We have to be at surgical rotations at 5 AM. And I worked 30 hour shifts as a resident physician. After a 30 hours shift you were then expected to sit through a lunch time lecture. Here we are preaching sleep hygiene but treating ourselves like machines that do not need sleep.

I work in a practice with 4 physicians. Which means I am on call 25 percent of my life. I tell patients to put their phone away and hide it across the room. Yet I turn my ringer up so that I wake up in case of an emergency. Doctors do shift work. I have heard of emergency room doctors making separate walled in rooms with special walls to reduce noise so that one can get good sleep during the day.

It is time for self care. The CDC recommends that all adults try and get 7 hours of sleep. We need to make changes. I am going to turn off my computer earlier and make sure I get to sleep at a good time. Luckily hours have been changed for residents trying to get them more sleep. Physicians overall are known for pushing themselves but we need to realize that a well rested physician is a better physician. Sleep deprivation can affect our focus, mood and productivity.

We need to realize that there is only so much we can do in one day. But sleeping 7 hours should be one of our first priorities. I am done now. Going to take a nap.

The Doc is In

Debates

Debate Club

I was not in the debate club during high school but I have learned the art of the debate. And no, I am not running for office. I enjoy a good discussion but it is difficult to debate issues that are not debatable.

During my day my main goal is to be a good listener. Process symptoms and develop an evidenced based plan. But at times I debate. I explain why a Zpack is not needed for a viral upper respiratory infection. I discuss the issues behind opiates for back pain.

Patients at times want extra tests and imaging that is not needed. I try to explain the evidence and risk/benefits behind tests but they do not always care. No, I do not need to check your for systemic Candida or your thirteenth Lyme test. Yes I realize that you are tired and are having trouble losing weight but there may not be some rare hormonal imbalance that we have missed.

I try to remain evidenced based. I listen and process all the information. Then I present my assessment and plan. Then, at times, the debate begins.
But in one respect I have given up. Debating the flu shot. No it will not give you the flu. Yes, a coworker of yours may have gotten the flu shot and then died a year later. But is was not from the flu. But at the end of the visit when I ask if you want the flu shot I do not have the time in my day to debate. Not the flu shot. There is no debate. The flu shot helps save lives. I have had almost one patient per year die of the flu.

What I need is more time. I want to debate . Not politics but why everyone over 6 months should get the flu shot. In medicine we have so many things to discuss and document it has limited our time to debate.

Differences with my wife and the Flu shot. Two things that I will not debate. Get your flu shot.

The Doc is In

Juicing

The medical world always has a new answers to old questions. We are given recommendations to get a certain amount of fruits and vegetables daily to stay healthy. But it is hard to get them in. That is until we decided that we could just shove them all in a JUICER.

Is juicing healthy? We know that drinking too much fruit juice is not healthy for you. Fruit juice is packed with simple sugars. They refer to athletes that are taking steroids as being juiced. Also probable not that good for you.

But juicing can be a healthy alternative. It is basically meal replacement. We can add a little kale, broccoli, strawberries and apples and there you go. You have a nutritious meal replacement. Diet companies have been selling “healthy” meal replacements forever. If you make the decision to replace breakfast and/or lunch it could very well be a good replacement. If you prepare yourself a juice for breakfast that is full of veggies than it is absolutely a better alternative to a breakfast sandwich or donut.

Can one live off of juicing alone? Maybe. But who wants to. We do not get all the fiber and nutrients when we grind down certain veggies into juice. Also too much fruit added can actually make a drink very high in sugar. I like to eat. Food has texture. Veggies have texture.

Being healthy with eating is all about routine. Use meal prep. Stay in a regimen. If you want to juice make it a part of your health conscious. Kale smoothies are delicious but allow the vegetables to be eaten in their normal state at times.

The Doc is In

Kid’s Parties

Let’s all admit it your kids birthday party is terrible. We have a bunch of kids run around Bounce U or some other similar type venue for an hour followed by crappy pizza. We go because we want little Johnny to make friends though. We wander around chatting hoping to find someone to chat with that will not make you feel like a bad parent. What they do not usually have is booze.

There are slides and trampolines and ball pits. Here is the bad news. They did a study in ball pits in a physical therapy practice. What did it find? A lot. It found 31 bacterial species and one species of yeast. Enough stuff to give you pink eye, UTI, upper respiratory infections and even bloodstream infections.

Yet if you invite. We will come. I will allow my kids to jump around the dirt, drool and feces that is lurking.

Not at my house. Not for our party. My kids get a pool party. And open bar. Kid’s parties are terrible. But they do not have to be.

Double Dipper

I am focused on not spreading germs. Most times. I wash my hands all day long. I give out vaccines. I cover my mouth when I cough. And I make out with my wife less when I have a cold sore. But I have a flaw. I am a double dipper. If you have blue cheese or BBQ sauce or veggie dip. I will double dip every time. I cannot control it. So if you see me coming hold your salsa.
The Doc is In

Laughter

If you want to live a healthy life you need to laugh. Laugh every day. Studies have shown that daily laughter may improve overall health. Laughter may stimulate your organs and increase your intake of oxygen. It helps modulate your endorphins and expel the negative energy. Laughter may increase your bodies production of your own endorphins. And it may even improve your immune system over time. Make sure you have funny friends. Or even a funny doctor. You could be lucky enough that your deacon makes you laugh. Watch more stand up or Seinfeld. You should also not smoke or eat at McDonald’s or do heroin. But do not forget that laughter is the best medicine. Unless you have a urinary tract infection. Then antibiotics are the best medicine.

The Doc is In

Doorknobs

Before becoming a physician doorknobs did not mean much. We use them to open rooms. But as a physician we use them to leave a room. Doorknobs often make us think of entering. Entering a world or a home or somewhere you have never been before. In my job it means so much more.

I spend my days trying to listen to patients. Get a complete history. Then examine. Followed by the creation of hopefully a thoughtful assessment and plan. All of this mixed in with clicking and pointing on a computer. Then the visit ends and on to the next patient. Most times I try and complete my note before I leave the room. Until I reach for the doorknob.

As my hand firmly grips the doorknob to leave often there is one last complaint. Often it is a more worrisome complaint than anything we had discussed during the visit. Why did it wait until I was leaving? Do I now have to sit back down and start over? How far behind am I currently?

But do not worry. Either way I will get comfy again and make sure that nothing important gets missed. But please to patients of the world when doctors say “what brings you in for a visit today?” Let me have it. Do not wait until I can hear the wheezing of a patient in the next room to pull me back in.

Yet it goes differently when men have a question as I finally have my hand on the doorknob. I already know your questions. No – We do not have any Viagra samples. Yes – I will send a prescription over to your pharmacy. Maybe – Will it be covered? No – I have not had any recent patients with erections lasting longer than 4 hours.

Doorknobs are dangerous. Whether you are culturing whatever virus/bacteria live on the ones in my office or if as a physician you rush out as a final question is being asked.

The Doc is In

Pride

June is Pride month, where around the country events take place to honor the LGBT community. It is an opportunity to celebrate their dignity and equality while bringing awareness to issues that they face daily.
How does “The Church” or Faith community measure up in how we love our LGBT friend?
Five years ago I had the honor of supporting one of my closest friends as the best man when she married her wife. There was a ton of support from Christians I spoke with but it also prompted plenty of pushback. I prayed and wrestled with this choice earnestly and in the end I have peace that love and Jesus won that day.
I am not writing this blog to defend my choice or to rewrite theology. I have been taking a course put together by The Center for Faith Sexuality and Gender and I feel very encouraged by the approach of Pastor Preston Sprinkle, I promise that is his real name. He says that as a church leader it is more important for me to know and lover real LGBT people and pour into their lives, than it is for me to know every verse in the Bible that mentions same sex relationships. Amen brother.
Do you know how many LGBT people had a connection to the church at some point in their lives? Can you guess how many of them have stories of being hurt, mistreated or outright abandoned by that same church? That’s rhetorical … my favorite viewpoint that Pastor Sprinkle offers is that it is not “the churches theology that needs to change, it’s their posture.”
I believe that we can walk hand in hand with people as they experience life, which includes sexual orientation. The church should be a safe and compassionate place for the LGBT community, not one of torment.
See even though my BFF lights the menorah it’s not our theology that has hurt her, but words from actual Christians that have made her feel like the church doesn’t want her there. I argue that not only do we want her, we need her there. She has loved me when I was most unlovable, and forgiven me at my most unforgivable. Called me out when I was wrong and humbled me in life’s greatest victories. She is a caring, compassionate friend and doting Aunt to my girls. She has shown me the kind of love the Bible says we should show each other.

I challenge fellow Christ followers to pray earnestly to have a heart that honors God and loves people, just like Jesus did.
Love you Bone!
The Deacon Speaks

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