Sunday, November 27, 2011

Breaking up is hard to do...

When is it time to break up with your doctor?  It can be a tough decision to make.  After all, if you don't like your experience at a store, you shop somewhere else next time.  If you go for a haircut and hate it, you find someone else.

With your doctor, it's a bit different.  This is someone who might know some of your deepest, darkest secrets.  There is a history to that relationship.  Logistically, it is also a bit of a pain in the butt.  All of your records are with your doctor.  You might need to have a chat with your insurance company.  Then you actually have to go through the process of finding a new doctor you like.  So, when is it worth it to take the plunge?

First things first- try to articulate to yourself why you want a new doctor.  Did you have one really bad appointment, but otherwise have had good experiences?  If so, you should probably talk to your doctor about your concerns before you jump ship.  Your doctor might have just been having a bad day.  Not that that's an excuse, but it is an explanation.  Doctors are people, too.  We get sick.  We have worries about kids and family.  However, if you repeatedly have not been satisfied at your appointments, you might want to seek a new doctor.

Is it a personality issue?  Do you and your doctor just not "click?"  If that's the case, you probably are better off finding someone else.  You need to be able to completely trust your primary care doctor, and if you can't be comfortable with him/her, it's not going to work.

Is it the office staff?  Is someone at the front desk always rude?  Do you always get put on hold for 20 minutes when you call?  For these issue, I strongly suggest that you talk to your doctor.  Here's the truth- since we're not patients in our own offices, we often have no idea of what's going on up front.  Sad, but true.  However, we can easily remedy many of these issues if we know about them.  So, don't switch for these reasons.  Talk to your doc first, and give it a bit more time.  If there is no improvement in services, then it's time to make a move.

Now the harder stuff- care issues.  By this, I mean that you have concerns about the level of care that your doctor is giving you.  This is a very tough one, because unless you are in the health care field yourself, you might not be able to accurately assess this.  The internet is changing this, however, and more and more people are reading online and educating themselves about their health conditions.  This is a good thing.  However, just because your doctor is treating you one way, and you read about a different treatment online, doesn't mean that your doctor is wrong.  The practice of medicine is an art, and highly individualized.  If you have concerns, you must talk to your doctor.  You might even want to get a second opinion from another doctor.  A reasonable doc should never be angry about you getting another opinion. If your issues about the level of care you are getting are legitimate, you should definitely find another doctor.

Lastly, whenever you think of switching doctors, I ask you to look at yourself, too.  Have you been to doctor after doctor after doctor, never finding one who has satisfied you?  The problem might not be your doctor.  Nothing strikes dread into the heart of a primary care physician like having a patient say, "I've been to ten other doctors and no one has listened to me/been able to help me."  Are your expectations of your doctor unrealistic?  I have one patient who left my practice because she wanted a personal phone call from me with all of her lab results.  Now, I do send out letters for all results, but I can't make calls to everyone.  I review about 50 lab results a day.  If I called everyone personally, that's all I would be able to do.

So, it's a complicated subject.  However, I hope I've gotten across the one recurring theme...talk to your doctor.  The worst that can happen is that you mutually decide to part ways.


Monday, November 21, 2011

Behind the scenes- thanks for the suggestion!

We have a suggestion box in the waiting room. We've gotten some very helpful comments in it. Some, though, well...judge for yourself.


Now, we actually do have a television in the waiting room. We play a DVD that shows nature scenes and has soothing background music. The box that the DVD came in claims that it is clinically proven to lower blood pressure, but clearly it did not work in the case of this particular person.

Tuesday, November 15, 2011

Cook for a day, eat for a month

It can be tough to get a healthy, well-balanced meal on the table every night.  We all have busy lives, and too often that gets in the way of us eating right.

That's why my family is trying this for the month.  I'll freely admit it- I love Rachael Ray.  I don't watch her show or anything, but I've tried out several of her 30-minute meals and they always turn out well.  The idea behind cooking for a day and eating for a month is this:  you make large quantities of five "building block recipes"- in this case, tomato sauce, pulled chicken, pulled pork, roasted veggies, and rice pilaf.  You use these starters in various combinations in all the recipes, with some additions.  Pretty cool concept.

We cooked the starters this past weekend- it was not particularly difficult or time consuming- and froze everything.  So far, we've made two meals from the starters, spanish rice with shrimp and fusilli pasta with chicken.  Both just took a few minutes of prep and cooking time.  They were pretty tasty, too.  Plus, there have been leftovers for lunch the next day.

I have to say, there's a lot to be said for not having to think about meal planning for the rest of the month.  If you're pressed for time and trying to feed your family a healthy dinner, I encourage you to check this out!

Tuesday, November 8, 2011

Marathon memories



Anyone else watch the NYC Marathon this past Sunday?  It was pretty incredible, with course records being smashed right and left.  It made me want to go out there and do it again...

Running the NYC Marathon was one of the most incredible experiences of my life.  Just to be clear with everyone, I wasn't always a runner.  Actually, up until residency, I basically despised running.  I remember moaning and complaining about having to do a one mile run in gym class in high school.

However, during my residency time was short and stress levels were high.  Running provided the best bang for my buck for fitness and stress relief.  I started running during my intern year, but I can't say I enjoyed it.

During my second year, 9/11 happened.  My experience with that is a post for another day.  I will tell you this, watching the NY marathon two months after that was amazing and powerful, and I vowed that I would run that marathon one day.  I stated running on a more regular basis and I joined the NY Road Runners.  I ran my first race (a 10K) that January, and racked up enough races over the next few months to guarantee an entry into the 2003 marathon.

Training for a marathon during residency is...interesting.  I was basically working seven days a week, with several overnights a month.  Marathon training requires a minimum of 40 miles of running a week.  I remember some days getting up at 3 AM so I could complete a 20 mile training run and make it to the hospital in time for 7:30 AM rounds.  And yes, Mom and Dad, I'll tell you now that I ran in the dark in NYC by myself!!!!  And lived to tell the tale.  Looking back, it sounds a bit...nuts.  However, I've always been pretty determined (my family has been known to call it stubborn).  It was all worth it on marathon day.  Running into Central Park, with the crowds cheering, knowing that I had just run 26.2 miles...it was amazing.  However, the real reward was knowing that I could truly do anything I set my mind to, and that I had found an activity that I loved.

I've continued to run since then, but I haven't done another marathon since the Disney Marathon in 2005.  Pregnancy and motherhood have gotten in the way a bit.  Right now, time with my boys is so precious that I don't want to spend four hours on a weekend running when I could be playing with them.  In the future, though...there are plenty of races left to do.  I look forward to getting out there again, sometime soon!

Wednesday, November 2, 2011

Why I won't just "call something in."

I often get calls from patients, either during office hours or while on call, requesting that I "call in a prescription." It is usually a request for antibiotics.  Usually, the message is something like this.  "Hi, this is So and So.  I've has a cold for a week and I'm coughing up green stuff.  Can Dr. Nicholas just call in a Z-pack for me? It always works.  I'm  too busy at work to come in for a visit/don't want to pay for an office visit/in Florida on vacation and can't come in."  Or it's "Hi, I think I have a bladder infection.  Can Dr. Nicholas just call in something for me?"

The answer to these questions, invariably, is no.  Here are the various reasons why.

1.  There's an almost 100% likelihood that your cold is viral.  That means that antibiotics will not do anything for it, other than give you a yeast infection or antibiotic-associated diarrhea.  The reason that the Z-Pack "always works" is because the cold would have gotten better on its own.

2.  If your upper respiratory infection is not viral, I need to figure out what it is.  Is it sinusitis (which usually doesn't need an antibiotic!)?  Is is pneumonia?  Different antibiotics treat different bugs.  It's not one size fits all.

3.  Maybe it's not an infection at all.  People mistake allergies and asthma all the time as a "cold" or "bronchitis."

4. More often than not, my patients who have self-diagnosed themselves with a UTI don't actually have one.  I've seen sexually transmitted infections, kidney stones, bladder cancer, and even acute liver failure in people who were convinced that all they had was a UTI.

5.  Antibiotics need to be treated with respect.  They are horribly overused and we are paying the price with antibiotic resistant infections. If you are sick enough to need an antibiotic, you are sick enough to need to see a doctor.

6.  It's just plain bad medicine to treat a patient without seeing and examining them.  So much is gained just by laying eyes on someone.  I can't tell you how many times I've "forced" a patient to come in for an evalution- only to know within about 10 seconds that they need to be in the hospital.

So, patients, I'm not trying to annoy you.  I'm not trying to waste your time.  I'm not trying to rake in the big bucks from an office visit.  All I am trying to do is provide top-notch care.  I want the best for all of my patients.