A Doctor You Can Talk To

Hurry up and complain [Dr. Fater]

The cover of Newsweek magazine this week highlights an article titled "The End of the Doctor-Patient Relationship".  It caught my eye.

Some disturbing information includes the statistic that patients are given, on average, 23 seconds to speak before the soctor interrupts.  That is, if the patient was even asked what was bothering him or her.  The erosion of the doctor-patient relationship has not stood us in good stead.  As a nation, we spend way out of proportion on technology and pharmaceuticals.  Yet our lifespan is not even close to being the longest among developed nations.

Studies have shown that a compassionate medical professional with good clinical decision making can increase the health of his or her patients while costing much less.  A simple urinary tract infection can cost $1,000 in an ER.  Or it can cost a phone call and an inexpensive antibiotic when the doctor and patient know each other. 

Patients are much more likely to follow instructions if they understand them.   That cannot happen in the current environment when docs spend, on average, 1.3 minutes in explanation.  As insurance companies crush payments to doctors, we are forced to see more and more patients just to make ends meet.  Doctors are, more and more, employed by larger entitiies.  The mantra to them is "Just see one more patient every day."  That's not supportive of good care.  Meanwhile, primary care doctors have had a 10% decrease in inflation adjusted income from 1995 to 2003.  

The article includes some opinions from Dr. Vikas Saini, who practiced in Hyannis for several years before moving uptown to the Lown Cardiovascular Group, a high tech, cutting edge cardiology office that recognizes the therapeutic value of relationship.  Dr. Lown, celebrated cardiologist, inventer of cardiversion, wrote a book in 1996 called The Lost Art of Healing.  I don't think the situation has improved since 1996. 

I have hope.  We are all human.  We will all be patients sooner or later.  Relationship and trust are central medical care. Get yours.

Vagina Dialogues [Dr. Fater]

Dialogue with a health care professional may be helpful

Many problems in our bodies fix themselves.  Some things require a little help.Many problems in our bodies fix themselves.  Some things require a little help.  If a woman has an irritation in the area we in medicine like to call "down there", there may be any of number of imbalances or infections.  Some issues that can cause irritation can spontaneously resolve.  Some can improve with minor support and some require more intervention for complete and timely resolution.  It is in those tougher cases that dialogue with a health care professional may be helpful.

The vulva and vagina are amazing in the delicate balance that they maintain most of the time.  A healthy vulva and vagina will not itch incessesantly or have copious or foul smelling discharge.  (The vulva is the area around the opening to the vagina and the urethra.)  One of the basic principles of our bodies is that each and every hole makes its own "chapstick".  We should be careful not to scrub off the chapstick.  That can let infections and imbalances occur more easily. 

Intense itch and white discharge might be a simple yeast infection.  Over the counter medicines can treat a yeast infection.  If a round or two of the over the counter treatments does not fix the discomfort, it may not be a yeast infection at all.  That is when the dialogue should begin. 

A fishy odor with yellow or greeninsh discharge might be a different kind of imbalance or infection.  Bacterial vaginosis or lactobacillis vaginosis are caused when the normal balance of bacteria is upset and one or another of the regular bacteria in the vagina gets overgrown.  These are not STDs.  Sometimes a simple rinse with an over the counter medicated or bakng soda  douche can reset the system and get everything back in balance.  If it doesn't, then the input of a professional should be sought; a vagina dialogue.

Don't scrub off the chapstick.  Don't wash out all the normal flora and fauna with aggressive cleansing.  No soap.  Be gentle.  If you've had a high risk exposure, ie unprotected sex with a new partner, or if things don't correct easily, get some professional help.  Have a vagina dialogue.

Take charge of your afterlife [Dr. Fater]

I wrote about making sure our loved ones know how we want to be treated as we approach death in a posting in March 2011.  Recently, it has become clear to me that, if possible, we should do even more.  Leaving decisions about what to do with our bodies after we have died to our grieved family and friends is unnecessary. 

I hear people say "I want to be cremated." or "I don't care what they do with me after I'm gone."   So, if you know what you want, arrange it.  If you don't know what you want, just pick something and arrange it.  Pay for it and be done with it.  I spoke to Larry Bennett at John Lawrence Funeral Home.  Apparently, this is done all the time.  But not frequently enough, if you ask me.   At a time when they least want to do it, people are left making decisions, doing paperwork and worrying about costs.

You can be cremated and have your "cremains", (nice word) put in an urn for around $3,500.  They can even put your ashes in a special container for placement in the ocean, a burial at sea.  You can have a casket and a service and burial at prices starting at about $8,000.  If you go in to your local funeral director, they can help you decide and lock in a price.  If you make arrangements here and die somewhere else, in Florida for example, your funds can be transferred.

If you want to donate your body to a medical school, contact the school and register as an "Anatomic Donor" or "Human Gift" donor.  This is a significant commitment as your body will be used as a cadaver for dissection by students, but it doesn't cost you any money.

If you've ever had the responsibility of making arrangements after the death of a loved one or watched anyone else go through the process, you know what you will be sparing your loved ones if you take care of things while you can.  As wonderful as you are, you know they'll barely be able to breath right upon your passing.  So make it easier on everyone. Take out a small loan or line of credit or cash in a small insurance policy to pay for it.  It is money well spent.  Make sure the right people know that you have been so thoughtful as to have made your own passing as least traumatic as possible. 

PS In my faith tradition, the wishes of the living trump the wishes of the deceased, so try and make sure everyone is on the same page with your decisions, otherwise they may either not do what you want or may feel terrible about having done as you've asked. 

Is Everybody Bipolar? :):

Recently, it seems like the diagnosis of Bipolar disease, what was previously called Manic Depression, has been on the increase.  The word "Bipolar" is being thrown around by professionals and lay people. Family members toss it out at others in the family. Here's the thing.  Bipolar does not mean moody.  It is not emotional volatility or an anger management issue.  It is not PMS.  Bipolar disease is a condition in which the patient suffers serious depression for some time, weeks to months, and then slides into a manic mood for weeks or months.  Not minutes or hours.

Depression is characterized by lack of ambition, extra crankiness or irritability, isolation, inexplicable fatigue, etc.  The manic phase is a time when the patient is abnormally active.  Patients undertake unrealistic lofty projects, spend recklessly, become hypersexual and usually sleep less.  This mania is not a normal good mood.  It is not a moment of levity.  It is an abnormal, dysfunctional period of overdoing.  It is not merely a break from depression.

Since we have new better drugs to treat depression and bipolar disorder, we are diagnosing more subtle cases.  When the medicines are less harsh and have fewer side effects, then it is worth it to treat milder cases.  In the past, when the only medications we had were dangerous and had potentially serious side effects, only the most severe, debilitating cases of bipolar disease were treated.  I am grateful to be practicing medicine in a time when these more refined drugs are available.

In the Jersey Shore-Real Housewives culture we live in, moodiness and emotional ups and downs are accepted.  We seem to have lost the ability to temper our reactivity.  This is not a disease.  It is not Bipolar Disorder.  It is an unfortunate social phenomenon, not a diagnosis.  Please understand the difference and choose your words carefully. 

Soft and Dry; Sex after 60 (Yes, I did)

So, what happens after sixty?  He's soft.  She's dry.  Things get tough. We really need to talk....

I love Dr. Ruth.  She has been my idol when it comes to talking about sex.  It is so important and for some, just about impossible.

When women go through menopause, they can no longer make babies, so the primal urge to mate is gone.  Consequently, the urge to have sex is often diminished or gone.  That, coupled with the natural diminution of vaginal elasticity and lubrication, which can make sex downright painful, can put sexual activity very low on the list of desirable activities.

For men, the desire for sex isn't primally diminished.  They can still make babies.  What often comes to pass is that erections just aren't what they used to be.  They aren't as strong or don't last as long.  The decline of sexual function in men is less predictable than that of women, therefore, a bit more mysterious.  It is part of andropause, the slow fade of testosterone production.  The less than reliable erections sometimes create a performance anxiety, making erections even more evasive; a very destructive cycle.

Regardless of the obstacles, if grown ups want to have responsible sex, they should and they can.  Talk to your partner about your mutual needs and wants.  Talk to your doctor about the issues.  Channel your inner Dr. Ruth.  Be patient.  Keep your sense of humor. 

For a more detailed discussion, visit www.FaterMD.com and go to the Article titles "How to stay married"