Latest YouTube Parody Star
Okay, not technically the star. But dancing and twisting and writhing around (and decorating a model of DNA like a Christmas tree) in the background is a very stealthy NinjaBaker: (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - December 15, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Source Type: blogs
Customizing Communication, or Which One I Sent
It’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient (also here.) The general consensus, unsurprisingly, was that the first was far too cheeky — not to mention insulting — to effectively convey the necessary information. The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send the first.
Let me explain.
I’d like to begin by quoting myself:
I find it amusing to intentionally adopt a far more curmudgeonly attitude here than I would ever dream of displaying in...
Source: Musings of a Dinosaur - December 5, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Which One Did I Send?
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yadda yadda yadda.
Oh look: a few years back I diagnosed you as hypothyroid and gave you some Synthroid. Are you taking it?
Nah; I stopped that. I just didn’t want to take it.
Hm. Send some blood work. Low and behold: TSH is 7. That’s high, and it means her thyroid is underactive, which is probably a big pa...
Source: Musings of a Dinosaur - November 23, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Define “Old”
Chief complaint: “I’m concerned about my balance.”
Further questioning reveals a subjective complaint of “wobbliness.” Has never fallen. No vertigo. Romberg testing is negative (standing with feet together and eyes closed sways only a little). Neurologic exam is normal.
I gently suggest that he try using a cane, mainly for reassurance while walking.
“Oh, Doctor. I don’t want to do that.”
Why not?
“It’ll make me look like an old man.”
Uh, sir: you’re 88. I think that ship has sailed. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - November 18, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Assume Nothing
Patient with multiple medical problems (diabetes, COPD, hypertension, hyperlipidemia, headaches, arthritis; you know, your basic Baby Boomer) comes in with a new symptom: food gets stuck going down. It’s been going on for a while now and getting worse. Liquids are becoming problematic as well.
I’m worried. Esophageal cancer is the main concern here, so off he goes to endoscopy.
Good news is that there’s no cancer. Bad news is that brushings show infection with candida. It’s a yeast infection of the esophagus. Treatment begins, but now we have another problem: Why did this happen? Esophageal candidi...
Source: Musings of a Dinosaur - November 16, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Good News, for a Change; More Followup on Timing
More followup on my post about intentionally not calling a patient with bad news on a Friday afternoon (and my karmic suffering at not receiving timely feedback after the disclosure the following Monday).
It was a 15 cm* primary malignant tumor…that turned out to be completely encapsulated! No evidence of malignancy anywhere else (and there were ten pathological specimens sent, as is customary in cancer surgery)! Stage 1! A little chemo to mop up some leaking fluid (that was still pathologically negative) and the patient will be fine.
Rarely have I experience such elation reading a path report.
The patient stopped by...
Source: Musings of a Dinosaur - October 22, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Guidelines be Damned
The urologists have done it again:
Patient’s [non-prostate-related urological issue] is resolved. Annual prostate cancer screening with PSA and DRE emphasized. [sic] Re-check in one year.
Prostate cancer screening guidelines; FOUR of them: from the American Cancer Society, the American Urological Association, the American College of Physicians, and the United States Preventive Services Task Force. Go ahead; click through; read them.
Central to EACH AND EVERY ONE is the concept of “shared decision making,” recognizing that “[t]he benefits of screening with the prostate-specific antigen (PSA) test are...
Source: Musings of a Dinosaur - October 19, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Silver Practice
Twenty-five years ago today, I hung out my shingle.
That’s a long time. Not quite half my life ago, but getting closer to that benchmark every day.
Twenty-five years. Wow. Every time I think about it, that’s all I can say.
In many ways, my practice today is more like it was in the beginning than ever before. I’m back down to just one staffer, two exam rooms, same number of phone lines, even some of the same patients.
In many other ways, my life has morphed into one that, twenty-five years ago, I could barely have fathomed in my wildest of dreams. My kids are all grown, all employed, all homeowners…...
Source: Musings of a Dinosaur - October 3, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Medical Source Type: blogs
