Tuesday, May 26, 2015

Safe Zone

When I first began the practice of medicine, I used to think of the entranceway to the exam room in mystical terms.  How else could I explain my patient's willingness to suspend all social rules and norms upon passing through those magical doors?  They would sit down in front of their baby faced-doctor and talk about things.  Private things.  Scary things.

Conversations occurred that would be unthinkable if two strangers were to meet in the outside world. I learned of abuse and infidelity, pain and yearning, secret joys and countless regrets.  I bore witness to the inner pain and struggles that often were hidden from one's closest friends and family.

People undressed.  They replaced their clothes with unflattering gowns.  They demonstrated their body parts unabashedly.  Pointing to that which looked out of place.  Wincing from pain induced by my clumsy touch.

The exam room became a safe zone.  A place where judgement was replaced by support and understanding.  A place where one's darkest secrets could be revealed but not allowed to consume them.

When I abandoned my traditional practice for home visits, I feared that something important would be lost.  I often wondered if there was a certain element of depersonalization that came with such sterile environs.  Maybe my patients revealed their inner needs and fears because the institutional setting of the exam room was a sufficient departure from normal life.

Then there was the question of my lab coat.  The wizard's frock symbolized a certain otherness that separated me from the rest of society.  Again I conjured up visions of a magnificent veil that allowed me special access of a most personal nature.

It's been almost two years now, and I have visited countless homes without the comfort of the exam room nor the lab coat to hide behind.  My fears, of course, were completely unfounded.

My patients still tell me their triumphs and tragedies.  They still pull their shirts up unashamedly to show me a rash or lump or bump.

And I have come to realize that it was never the sanctity of the exam room nor the long gray coat that droops from my shoulders.

With both great awe and humility,

I have come to the conclusion that it is me.

I am the safe zone.

Friday, May 22, 2015


We walk into the hip burger joint for dinner.  It's not like what we had when I was growing up.  Not exactly a greasy-spoon, and not fast food either.  We sit on stools which pull up to butcher block tables.

The television above us is playing Ferris Beuller's Day Off.  The volume is muted and a radio blares When Doves Cry by Prince.  A mother sits in front of us with her two teenage children.  A boy and a girl.  She mouths the words to the radio as her kids bury their heads in their mobile devices.  Her face is animated, and her body sways with the music.  I understand.  Because that's exactly how my body responds when I am transported back to my childhood.

The woman and her kids leave, and a young college-aged couple takes their place.  Their faces are fresh and soft.  She blushes as she coyly looks into his eyes.  He moves closer when they talk.  Their bodies almost touch.

The music on the radio has now changed.  Adam Levine is singing Lost Stars.  One of my current favorites.

The burger is dressed with chipotle ketchup.  The fries have more pepper than salt, and are served with blueberry mayonnaise.  The flavors are different than what I grew up with.  Yet I like them all the same.

The crowd is heterogeneous.  A group of older ladies huddles against a counter in the corner.  They talk softly and sip craft beers.  My wife and children, sitting beside me, have stopped talking.  They are too busy inhaling the delicious food in front of them.  A few young kids chat amiably at tables dispersed among the other restaurant goers.

And I realize that I am neither retro or new.   I am neither young nor old. I am caught somewhere in the middle.

In the great in-between.

Thursday, May 21, 2015

Good Grief on Voice America

My interview with Cheryl Jones on Voice America regarding my book: I Am Your Doctor And This Is My Humble Opinion.

Monday, May 18, 2015

Do Our Words Hit The Mark?

Loitering in the hallway of my son's school awaiting his parent/teacher conference, I completely forgot that the woman introducing herself and shaking my hand was an alcoholic.  I forgot that she had visited me in the office a decade prior for a consultation.  I forgot all of it.

What I remembered is that we had gone to high school together.  We had grown up in the same city, in the same neighborhood, on the same block.  We were never compatible socially.  She was gregarious and popular, and I quiet and introspective.  We may have nodded familiarly or said hello if we passed on the street, but nothing more.  We were acquaintances by proximity.

We exchanged pleasantries in the school hallway for a few minutes.  Our kids were of a similar age.  She looked happy.  Healthy.  I glanced at my watch and prepared to enter my son's classroom when she stopped me, and asked the question that I assume hand been hanging on her lips the whole time.

You don't remember, do you?

She had come to my office nearly ten years prior for a routine physical.  It was a mid-morning appointment, and as I listened to her heart I recognized the faint odor of alcohol poorly covered by breath mints.  I waited patiently till the end of the appointment, and then gently discussed with her my suspicions.

She was drowning in new motherhood.  Her job was taxing.  She was fighting with her husband.  The alcohol originally was meant to help her unwind at night.  With time, however, she was consuming more and more.  She was hiding her habits from her family and friends.

She was an alcoholic.

Her words cleared the cobwebs in the vaults of my distant memory. I remembered telling her that she wanted to face her alcoholism now for her children.  That she wanted to be healthy when they grew up and needed her.   I handed her a few brochures, gave her a few numbers, and scheduled up a follow up appointment.

I made her promise that she would get help.

As it turns out, she never came back to my office for the follow up.  But that morning she began a long successful journey toward sobriety.

Now, a decade later, she was thanking me for saying the words that launched that journey.

Years into the practice of medicine, I have spoken millions of words in the exam room and forgotten the majority of them.

I humbley hope that some others have similarly hit the mark.

Tuesday, May 12, 2015

MU With Or Without You

The whole thing was rather awkward.

I have to admit that I was nervous.  I perused the records before he walked through the exam room door.  These conversations were always difficult and felt out of place in the office.  But I had looked at the numbers over and over again.  There was a glaring deficiency that had to be corrected.  I planned to jump in right away, but we got sidetracked..

He wanted to discuss blood pressure.  His cholesterol numbers were slightly off, and we spent quite a few minutes discussing the difference between HDL and LDL.  I  readily counseled on diet and exercise as my mind drifted to the unpleasant conversation that only I knew was coming.  I wondered if I would ever get to my agenda.

During a brief pause, I thought I found my opening.

Unfortunately, he was just building up the confidence to talk about erectile dysfunction,  That's right, I was foiled by ED!  Again, I waited patiently and listened as he described in detail his current situation.   We discussed lifestyle modifications, medications, and finally the utility of blood tests for accurate diagnosis.

When he packed up his things to go, my face turned crimson.  I knew there was no escaping.  I started the conversation tentatively with a question.

I wonder if you could do me favor?

He looked at me quizzically as I tried to explain.  I described Meaningful Use and the reasons the government had enacted such policies.  I directed that he would get an email inviting him to join a patient portal so that he could access his medical information remotely including medicine lists, diagnoses, etc.

I told him that I was being graded on participation, and would suffer economic consequences if I failed to enroll adequate numbers of patients and have them message me through the system.  I begged, nay pleaded, that he would go home and sign up today.

He shook his head.  He had done this once before with the hospital and spent hours trying to sort through password problems before he gave up.  He swore he would never participate in such silliness again.

Besides, I never really look at that stuff anyway.  If I have a question, I just call you and you answer right away!

I have had a patient portal available for 2 years now.  To date, almost none of my patients have signed up for it even though they get email reminders regularly.

The outcry of late has been "No MU without Me"

Apparently what is meaningful to the government and even healthcare advocates, may not be to the average patient.

Tuesday, May 5, 2015

As I Lay Dying

As I lay dying

Open the windows and doors.  Welcome the wayward breeze, biting cold, tendrils of sun, or beating rain.  Worry not of the elements as they caress my motionless body.  Discomfort, after all, is for the living of which I am still yet a part.

Talk as if I am myself.  Even if I don't answer.  Argue and disagree as we are wont to do.  If you offend, I may curse you silently.  Wordlessly.  Or if you bore, I will likely ignore you altogether.

Weep and I will weep too.  Laugh and I will laugh with you. Pray and I will remain solemn.  Joke and my lifeless countenance will become that of the jester.

Place your hands on me.  Caress my fingers.  Cradle my chin and pinch my cheeks if the moment so moves you.

Fear not the skin of the dying.  It remains sensitive even after the rest of the body has long forgotten.

Invite my enemies to peer down upon me.  To dispel the last remnants of venom or perchance to regret.  My family and friends too.  Even those who I have long forgotten or have forgotten me.

Open my doors for all to see.

Except for the indifferent.

They are no longer welcome in my home.