When your Doctor Srews Up

Bad things happen. many times they are outside our control. Often patients ask me, "Why did this happen to me?". Many times the answer is quite simple. Bad luck.

Unfortunately for many patients that bad luck continues when they step into their doctor's office. Many of us have long held to the notion that all doctors are created equal and that the profession is filled with many competent and intelligent people who are all equally qualified. Not true. Unfortunately many doctors do not all practice the same level of care. There are many very competent and thought leading physicians and there are many who are not. How do know which one you have. You don't. And you almost never will until it is too late. Checking their credentials will not help. Checking their academic background or board certification will not help. Checking to see if they have ever been sued will not help. Asking your neighbors will certainly not help. Nothing will help. It is really just luck.

When a doctor screws up, bad things happen. Just ask Stephanie. Her true story blog appeared earlier on these pages. Stephanie had all the classic signs and symptoms of Bipolar Disorder. But her doctor missed it. Missing bipolar disorder can be catastrophic and I am certain that in this situation it directly lead to Stephanie becoming an addict. If it had been recognized earlier I firmly believe that Stephanie's life would have been drastically different in a very powerful way.

Don't be afraid to challenge your doctor and ask questions. The smart and confident ones will welcome the questions and answer them thoroughly. the bad ones will be insulted and will blow off your questions.

A good doctor will save your life. A bad one may destroy it.

I Choose Happiness!

WE really do have a choice that we can make. I choose happiness. Unfortunately many do not. We are bombarded by pessimism everyday. Negative thinkers who often say that they have no control over the "basd luck" that dominates their lives. However i believe that bad luck is often the by-product of poor decision making and negative thinking that creates negative action and outcomes in our daily lives.

Positive thinkers are happier people and happier people live longer and healthier lives.

So I choose happiness. It is a conscious decision that all of us can make. No matter what the circumstances are there is still a choice. We live currently in the most challenging socio-economic era since the Great Depression. Financial uncertainty is the rule, not the exception for most Americans. And yet we still have a choice. You can still by the TV watching news shows and following the daily turmoil of the stock market or you can choose to worry only about the things that we can control and take everyday for what it has to offer us. To laugh with your children; to enjoy the wonders of nature as a new spring comes to full bloom; to hold your wife; to cherish your friends; to read a book; to do anything at all that brings us peace and serenity and happiness.

It all sounds so simplistic and I am not suggesting that it will pay the bills. But neither will worry. As I write this blog my 4 year old is running in the back yard with her friends. Her world is small and concentric. her needs are few. Perhaps we need to shrink our world. To think and laugh and play like a child.

It is possible. We can choose happiness. Think about those around you who do make that choice and those around you who don't. Who would you rather be with?

It's just my Opinion

Everyone has an opinion. The problem is quite simply this; most are not qualified to share that opinion. Medicine, unlike virtually any other field, draws opinion like ants to a picnic. Many doctors don't even have the opportunity to stay as current as they should when it comes to the overwhelming body of medical information available. A mountainous swell of information is released on almost a daily basis. Yet, as difficult as it is to stay current at least doctors have 8 years or more of medical training to fall back on. So today when one patient told me that they disagreed with my diagnosis and another told me that they know more about what they needed than I did, well you will just have to forgive me if I disagree with them.

Nothing gets in the way of treatment more than the uneducated and unfounded opinions of patients. Why is it that a patient with absolutely no training or experience feels that they have all the answers while at the same time their board certified physician just simply does not know what they are talking about? I have no answer to that question.

Now I will admit that doctors are often inappropriately paternalistic. And there are clearly times in which the doctor/patient relationship should be a partnership. but more and more patients are trying to take control of their healthcare and they are suffering dearly for that decision.

do yourself a favor and defer to an expert if indeed you have faith in your doctor to be that expert. If you have no confidence in your doctor then get a new doctor. Just don't be that doctor.

Double Standards

Several years ago during an episode of the hit show "Ally McBeal", Ally is running through a litany of problems she is having and extolling the severity of each problem. Her colleague looks at her and asks, "What makes you think that your problems are more important than my problems?" Ally looks her colleague straight in the eye and says, "Because they are MY problems!"

This sort of parochial view of our world is what often leads to double standards and having double standards, while being uniquely human, leads to all sorts of problems. Everyone openly admits that insurance fraud is wrong and leads to a global inflation of rates, yet at the same time doesn't everyone ask the local auto repair shop to find a way to "cover my deductible". People think that our country is too litigious until they slip in WalMart.

Double standards exist in the world of addiction as well. We judge people who are ticketed for DUI as evil,careless, and reckless individuals. yet at the same time we have all driven under the influence. We have all at some point in our lives gotten behind the wheel when we should have called a cab. What is the difference between us and those who have a DUI on their record? Luck. Obviously that is not true for someone who just got their third DUI. They are evil, careless, and reckless.

How about how we treat those who are famous when they fall under the spell of addiction or alcohol. Some how this seems to only serve as boost to their celebrity while the rest of us are demonized for our behavior.

Perhaps the simplest solution is simply to "do unto others.... It is perhaps too simplistic and even a bit naive to a assume that one would step back from a situation and say "what if?" before they judge. If they could the world would a different place. More tolerance. More patience. More understanding.

Sounds nice.

Insurance Reform; The Time is Now

What is the real purpose of health insurance? Who is the one who should benefit the most? Isn't the purpose of health insurance to ensure that a patient is cared for in the most complete and thorough way? But insurance companies clearly get in the way of everyone's health. The problem lies in the fact that insurance companies are in it for the money. Doctors have always been accused of allowing money to cloud their decision making when it comes to patient care. I will be the first to admit that that has been and occasionally continues to be true. However, the one thing you can say about that situation is that the patient always benefits. The doctor makes money by providing services that improves their health care. That is not the case with insurance companies. Insurance companies make money by not spending that money on patient care. If they spend money on patients that simple make less. That situation never benefits the patient. It is impossible to provide good healthcare and save money at the same time.

health insurance companies not only block our access to healthcare, they also block our access to insurance and inhibit our utilization of our benefits. It has happened over and over when a patient is seeking health or life insurance and a company simply says no for no good reason. They tell us that there is too much risk. That we are too unhealthy. Insurance companies are notorious for taking a condition that is not pathologic and telling you that this condition prevents you from getting coverage. They want to ensure that the population that they are insuring are not the neediest but the healthiest. The same is true of life insurance.

Heaven forbid that you should accurately try to use your insurance. You will be branded with all sorts of labels that you will never walk away from. Try to use your addiction benefits and tell some insurance company 10 years for now that you are in recovery and in perfect health. They will make you pay, literally and figuratively.

We need health reform in the US. The first step is to take the power away from insurance companies. Make them not for profit. the only person who should profit is the patient.

Medical Opinions: Everyone has one

Physicians go to medical school for 4 years. Following medical school, which even on quiet weeks requires 60-80 hours of work, they enter more specific and demanding training in their chosen specialty for anywhere from 4 to 8 years. that's a total of 8-12 years after 4 years of college to hone their skills and begin to independently care for patients. their education does not stop there. Physicians are dedicated and mandated to continue their education for the entirety of their professional careers. good physicians learn to blend compassion with science in order to make the best decisions possible to provide the highest level of care for their patients. And what do they get for all of this effort? They get the opportunity to defend their practice management decisions with patients who have absolutely no qualifications to challenge those decisions. Somewhere, somehow along the way patients develop medical opinions that they often hold in higher esteem than those of their physician.

Where do they get this information that they use to develop these opinions? The internet is a very frequently accessed source. Is it reliable? A study from Harvard Medical School recently concluded after an extensive review of internet information that up to 70% of medical information on the internet has some level of medical inaccuracy. Books are another source. Recently a family told me that they did not want to use medication to treat their child diagnosed with ADHD because a book they read was strongly against it. they said that it was the opinion of the author that medications increased the risk of a child with ADHD becoming an addict. Not only was the book written by a Chiropractor who had no training in either ADHD or psychopharmacology but he had his fact backwards. the overwhelming body of evidence proves that treating children early with ADHD PREVENTS the development of substance abuse. Other sources include parents, friends, relatives, people in the grocery store and Starbucks, or just anyone who is willing to listen to your story. Everyone will always share their opinion whether they are qualified or not, even if you don't solicit it. A patient told me yesterday that her Mother is positive that the shortness of breath she is experiencing cannot under any circumstances be anxiety but is in fact asthma. "Wow", I said to myself, "She's good." Not really.

I do not believe that every physician should be completely paternalistic in the practice of medicine and make every decision for their patients. I believe that practicing good medicine is a partnership between physician and patient and that it is the duty of the physician to guide their patients when their are reasonable options for their treatment. When there is only one clear path to take we should encourage our patient to take it. But when there are several reasonable paths we can provide highly educated guidance to help our patients make a choice that is their best interests.

We defer to all sorts of experts when we need help. Everyone from tradesmen to professionals. Don't let your medical opinions get in the way of your health.

Squeeze Life

"Don't waste any days." "Stop and smell the roses." "Don't sweat the small stuff." "Life is short."

Choose your saying. They all add up to the same thing; Squeeze life. This is not a dress rehearsal. You certainly cannot push the rewind button. And there are no second chances to make a first impression. So while I am not saying that we can always get it right every time the first time, I am saying that we should try. There are many things in life that we have no control over and therefore we should not worry about what we cannot control. But the one think we can control, the one area where we always have a choice is our attitude. Our outlook on life, and the way that we approach everyday and everything in that day, is what defines us. It is really very simple. Happy or sad. Positive or negative. Selfless or selfish. Caring or not. Half empty or half full.

Those who are on the negative side of each of the above often say they have no choice. How can they be positive or cheerful. Just look at what is happening in their lives. They have no luck. It is not a matter of luck. It is one of design. consciously or unconsciously these type of people have chartered a course in their lives where there is no other option but to have bad things happen. Why; because negative thinking creates negative action in your life.

Positive people on the other hand have it quite the opposite. all good things come from those who are content. have you ever met someone who was rich and miserable or poor and happy. Of course you have. the difference is outlook and contentment.

With that in mind I would suggest that those who are content and positive and happy waste no days in their lives. Life is indeed short and those around us will be better served in all ways if we choose to live our lives to the fullest. Particularly as parents we can give our children no greater gift than that of a positive outlook and the commitment that we will live our lives to the fullest. That is the greatest legacy that we can leave. Negativity is a cancer and hope is the cure.

If you die today, regardless of your age, will those closest to you say that you were cheated? If the answer is yes--you wasted too many days. You failed to squeeze life.

In With the New...

Now that you have had the opportunity to review the past year and evaluate what needs to be thrown out and what should be kept, it is time to look ahead with optimism for the year to come.

think about positive changes to focus on. Eliminate negative people or situations from you life. A change in the direction of your life starts with a change in your thinking. If you have been unhappy with things in your life then change starts at the top. Literally the top of your brain. You must make a decision that part of what has created an addiction or any other negative influence in your life is your own decision making. It was a conscious decision to maintain a bad relationship, or allow a negative person to influence your decision making, or a boss to treat you badly.

This is your opportunity to change all that. The person whom you have been waiting to change is never going to change. You must change instead. Change your thinking. Change the direction of your life. Positive things only.

Out with the Old....

The end of a year is always a time for reflection. a time to look back on the events of the previous year. Every where we look someone is making a list. Top moments, top songs, best movies, top news stories and of course the polar opposites of those top stories with the worst of all those areas as well.

From a personal standpoint the year end is a perfect time to reflect on the happenings of the previous 12 months. Some of those happenings we can be proud of and for those who are honest enough to admit it, many we would rather forget.

Don't forget them. Own them. Embrace them. Recognize them. Process them. And then put them behind you never to heard from again. Don't beat yourself up over them.

Accept full responsibility for them and learn from them but recognize that we often grow more from our mistakes than we do from our victories. If you allow those moments of defeat to dwell in our minds then we are destined to repeat them. Anyone who says that that have nothing to be ashamed for in the course of the previous year are simply being dishonest with themselves.

Who can figure out procrastinators--Cont.

It was said by a therapist when commenting on last night's blog that the most common cause of procrastination is perfectionism.

I don't believe that. I do not believe that someone does not even start a task, let alone finish that task simply because they feel that they will not perform at a level of perfection. There may be some level of reluctance to initiate or complete a task because they don't feel that they can adequately perform, but I think that occurs even in the absence of perfectionism. I would need to see that this particular individual displays perfectionism in other aspects of their lives before I would concede the point. Even then it would only be on a case by case basis.

I believe that there are many other aspects that more commonly contribute to procrastination. I think most prominent is distractability. I believe that most people procrastinate because they are simply distracted and get side tracked by other tasks thereby letting the task at hang "get away from them". You will hear such things as "I didn't get a chance", I"ll get to it later because I got caught upo in another project", and "Where did the time go". Those who are focused and goal oriented are less likely to procrastinate and are more likely to complete tasks.

People who are distracted are also often overwhelmed. When one is overwhelmed they are less likely to initiate a task let alone complete that task. Together, distractability and being overwhelmed are often traits of those individuals who have ADD.

Procrastinators are often people who exhibit lassitude and a lack of caring. Pessimists are more like to be procrastinators--"why start or finish a project if the results just don't matter"

Clearly there are many contributing factors which lead to one becoming a procrastinator and these factors come in many colors and sizes and shapes. It is never one size fits all--but the end result is the same. that end result often leads to frustration; sometimes to the procrastinator and definitely to the family.
How many addicts procrastinate with regards to their treatment. Who has more inertia than an addict especially when it comes to ending their drug binge and starting a treatment program. Working with a program who understands this inertia and can create the appropriate counter forces is crucial.

Who can figure out Procrastinators

Procrastinators. What is it about them? Why do they do--or should I say not do, what it is they do? Why do they put off what needs to be done rather than just doing it?

I am not sure, but I am going to think about it and get back to you tomorrow.
Or maybe the next day....