I tell people that I am not a big social media guy but that really is kind of a lie. No, I don't use Twitter and I don't tell the world ever little thing I am doing at all times of the day. "I just picked my nose and wiped it under my couch". Through the Placebo Journal I do have a Facebook page but I find that site too casual and social. LinkedIn, however, seems more professional. It allows people to connect to each other for professional favors and opportunities and that is a good thing, especially in this economic climate. Since the Placebo Journal has brought together people to laugh and commiserate about common things, I thought it would be a good idea to find a place on http://www.linkedin.com/. I highly recommend you check it out and join and see if we can't all help each other out. Like everything else, we shouldn't abuse this opportunity but I think you will be amazed how well people are connected and how that can help you in the future.
FOLLOW THIS LINK TO COMMENT ON THIS STORY
This video is not for those under age 16, those with weak stomachs or those without a sophomoric sense of humor. It also may be pulled soon as there for reasons I may discuss in the distant future. Watch it now or forever hold your....peace.
Check it out here:
http://www.youtube.com/watch?v=IrvqMgrurAQIt can also be seen clearer and more synched at: http://blip.tv/file/1864903PLEASE TRY TO RANK OUR VIDEO AND GIVE SOME COMMENTS! IT IS MUCH APPRECIATED. Sorry to those I have offended with this bit.
Here in California we had a legislator propose legalizing marijuana and taxing it. What a commonsense thing to do when we have "medical" cannabis shops galore. In San Francisco, they have more cannabis clubs than daycare centers. One cannabis clinic is even advertising on our local NPR affiliate here in Sacramento. Recently, I learned about the "Medical Beer" initiatives during Prohibition which many doctors supported. Alcohol obviously causes many social ills but was probably better medicine than what was available in the 30's. Why do we have synthetic Marinol FDA-approved but natural THC puts a person in jail...and if we are really serious about drug testing, why are "Urine Luck" and "The Urinator" readily available to beat drug tests? Obviously, you can be an Olympian or a President, but you can't drive a forklift. Marijuana is not a harmless drug. It leads to laziness and addiction for some, but many people use this responsibly. If you drive while on marijuana and go to work while intoxicated you should be arrested or face the consequences with your work -- just like with alcohol. That is what a legislator is promoting. It got two days of coverage, and now everyone is back to whining about cutting social programs and job loss. I don't get it. It was recently Dr. Seuss Birthday so this is my celebration poem.
Oh the Taxes You’ll Pay!
Oh the taxes you’ll pay
The taxes you’ll see
To help our poor Economy
Oh the taxes you’ll pay
The bankers you’ll spoil
With luxury Whatsits
That make your blood boil
They’ll tax your car
They’ll tax your gas
While sitting on their Flumberbass
Oh the taxes you’ll pay
On your bread and you’re poodle
They’ll even tax your Wackadoodle
But don’t fret and whine
Don’t cry and mope
Though you may feel a first class dope
Your house worth less than a Flippertyfloap
There is one thing they will not tax
Not even to save jobs from the ax
Not never. No how. No way Jose
There is one tax we will not pay
No matter how much it may help
Reduce our crime and build our wealth
In deference to the mighty Flabertysnot
California will not tax your pot.
5. Placebo Journal Update
We are finishing up the last of the April issue. Remember you have until March 30th to make get your subscription in so hurry!!!
- TriLickthis - the buttery triglyceride medication
- Realistic Week of a Part Time Doc
- Goodbye to Stupid Pharm Trick
If you want something that is all humor and guaranteed to make you a little incontinent then:
"I think that the process is self-serving; it has a multiplier effect - the higher some consultant says [an executive] has got to be paid, the more he's in demand," Grassley said in an interview. "People ought to be paid for what they're really doing."
What is so ironic is that Grassley is basically saying that the whole "pay-for-performance" should turn its light on the CEOs as well. Heck, we physicians are tortured by it so why not the administrators. Their response:
Lynn Nicholas, CEO of the Massachusetts Hospital Association, said most hospital boards already follow a thoughtful and transparent process to determine executive compensation. They need to compete to keep talented leaders with the skills required to deal with community concerns, government regulations, and complicated payment relationships with doctors, she said. "I think the jobs are grossly underestimated in their complexity," Nicholas said in a telephone interview yesterday. "You want the best and brightest running these institutions."
In case you don't speak "administralian" that means, "No thanks. Who do you think we are? Stupid physicians?"
A recent AP article discusses the
controversy over patients rating doctors. This issue will not go away. The author pits the owner of RateMDs with the doctor who started Medical Justice (who makes patients sign waivers not to post online comments about doctors). The latter group can get the site to remove offending opinions if the patient author is known but RateMDs uses the cloud of anonymity for their postings. In other words, it really doesn't matter. As the old adage goes, "opinions are like a*&holes, everyone has got one". The winner in this article is John Swapceinski, co-founder of
RateMDs.com, who gets to have a national forum for a day or two. Heck, I am mentioning him here as well. Millions of people will now get to go to his site and many an angry patient will get a chance to "give it back" to his or her doctor. Then we will all forget about John and his site again. No one really reads these things, anyway.
If the sites really wanted to be fair then personal comments about physicians would be removed. These sites would just have ten or so rating scales that a patient can only click once and then the overall average is given. Kind of like they do for online articles or comments to those articles. When you think about it, why should anyone (other than me) be able to put online a vicious diatribe about someone else? For example, if I make 99% of my patients happy and see 100 patients a week then one patient a week could rip me a new one online. That could lead to 50 really bad comments a year (I do need my vacations) which would make me look really bad. If a drug was 99% effective, though, then it would earth-shattering. So the problem lies in the fact that more people with negative experiences tend to want to share them with others. This leads to a disproportionate and skewed rating. I say if patients are allowed personal attacks on their doctors then the doctor should be allowed to say some personal things about that individual patient. That wouldn't solve anything but it would be a blast to read. And it's all about entertainment, isn't it?
A recent
NY Times article explores a study in the Archives of Internal Medicine about doctors dealing with difficult patients. One in six patients are reported as "difficult" by physicians but when the authors drilled down deeper they found that certain doctors seem to claim a higher number of "difficult encounters" than others. They also found that there is a propensity for those docs to be younger and female and they are 12 times more likely to burn out. The older, more experienced doctor seems to handle it better. The study also looked at the tougher patients and found that the ones who drive docs bananas are the ones who demand to be prescribed an unnecessary drug, are always unhappy with their care or who hadve unrealistic expectations for their care.
There is an editorial accompanying the study and the authors throw in a recommendation for the obligatory "more training" option for doctors as if that will totally fix the problem. I find this really funny on a personal level. I lecture around the country about how to survive in the healthcare system and how to keep happy in this job. Ironically, I have offered my local residency a free lecture series on "how to deal with the difficult" patient and have been ignored for two straight years!
The editorial also gives the "honor and glory" option for doctors to "to rise to the challenge of working with a difficult patient". I'm sorry but that really doesn't work either coming from people who aren't in trenches giving the King Leonidas speech from the movie 300, "No retreat, no surrender; that is Spartan law. And by Spartan law we will stand and fight... and die".
The truth is that being a physician is not easy. There are thousands of physicians out there on the front lines giving it their all every day only to be overburdened with minutia unrelated to actually treating a patient. There is so much that goes on outside the patient's room that the doc can be on edge even before he starts talking to the patient. I am not going to make this blog a primer on how to deal with tough patients but there some ways to survive and enjoy this job. Interestingly enough, I have gotten some major heat for letting
Reader's Digest use my top ten list of "secrets doctors never tell their patients". It's even referred to in the comment section of this NY Times article.
The reason that older docs can handle these patients better is that they have been around the block. They have learned defense mechanisms to let tough encounters slide off their back. They can laugh at it all and use humor in an appropriate manner both with their patients and with their colleagues. Humor and sharing stories of these encounters is healing and that is what forms the basis of the
Placebo Journal. The younger docs just need seasoning or they will realize that this job isn't for them. That is just human nature. My fear is that patients will take away the wrong idea from this study. I bet that if you reversed the study you will find that one in six doctors are difficult as well. Some doctors are just jerks who are socially retarded. Doctors are human. If you cut them they will bleed like everyone else (and then need a series of blood tests followed by a three drug combination of retrovir, epivir, kaletra twice daily).
Tough patients will always exist especially as our society becomes more expedient and self-centered. Dealing with all patients, even the difficult ones, is an integral tool that makes up the art of medicine. That doesn't mean doctors have to "rise to the challenge" and keep them all. I have always felt that if I have to reach for the Prevacid from the sample closet after seeing the patient then I have to convince that person that he or she needs to find a better doc than me. There is no reason to suffer with certain people you don't click with because it will only affect your other encounters that day. On the other hand, people sometimes have bad days and need a little leeway or forgiveness. That goes for both patients and doctors. I have always been amazed at the patient who comes to me after firing a doctor who I knew to be wonderful just because he snapped a little at their last encounter.
Not every patient will like every doctor and vice versa. These type of studies are fraught with controversy because patients wonder whether they are difficult or not and then get defensive and strike back at all physicians in general. Most patients are fine just like most people. You must remember, however, that the same person yelling at the poor checkout girl at the supermarket over nothing is the same one yelling at my nurse for not calling back within three minutes.
As Voltaire said, "we can't let the perfect be the enemy of the good". We all can be a little more tolerant with each other. We all can be a little more patient with each other. We all can be a little nicer to each other. And we all need to laugh a little more.
This headline is from a Police song and directly relates to the moronic recommendation by researchers at the Dartmouth Medical School.
They want the FDA to adopt fact panels to be placed on the advertisements for medical drugs. These numerical tables would "quantify the benefits of taking a drug compared with a placebo as well as list the odds of having side effects". Little secret, they all have side effects. These same researchers are going to present to the FDA their thoughts as well as a couple of studies that show most people presented with comparative risk and benefit information "were able to identify the more effective of two drugs". Geez, man, can we take the doctors more out of the loop? Trust me, the pharmaceutical companies would salivate at the chance to show the studies on their ads because they are all positive ones or else they wouldn't have been approved by the FDA in the first place. It would give more credence to the advertisements and make their ads look more official which again would bypass the doctor. Think I am crazy? Here is another quote from the NY Times article that was in their
media and advertising section: "At least one executive involved in drug marketing said he agreed with the Dartmouth effort and was enthusiastic about the prospect of the public’s knowing how well a drug works and the odds of having side effects". Pharma execs don't get enthusiastic about proposals that would hurt their product. Don't get me wrong, I am all for an educated customer (patient) but Ivory tower researchers don't work in the real world and this effort ironically may muddy the waters even more. By the way, the next line in the Police song is:
Too much information driving me insane
