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Tag: Rob Lamberts

Rearranging Chairs

Rob Lamberts seriousI have been asked by patients, readers, family members, and by fellow bloggers what I think about the bill  passed by the House of Regurgitants Representatives yesterday. I resent this. I have tried hard to remain neutral as possible, finding equal cause to point and sneer at both conservatives and liberals. It’s much more fun to watch the kids fight than it is to figure out which one is to blame.

But given the enormous pressure put on me by these people, as well as threatening phone calls from Oprah and Dr. Oz, I will give my “radical moderate” view of the HC bill. My perspective is, of course, that of a primary care physician who will deal with the aftermath of this in a way very few talking heads on TV can understand. The business of HC is my business, literally. So, reluctantly, I take leave of the critic’s chair and take on the position where I will be a target for any rotten fruit thrown.Continue reading…

The Tale of the Fancy Sea Creatures and the Pipes

Once upon a time there was a land on the ocean. The people lived off of the food from the ocean and were very happy. But as they grew bigger, they had a problem: they made a lot of waste! Yuk! Nobody likes waste. What could they do about all of this that stuff that nobody liked?

Some said that they should find a way to make less waste. They said that the people of the land were not smart and should be making less waste. But most of the people in the land didn’t like to change what they were doing. It’s hard to change. So they built a large pipe that pumped the waste into the ocean.

The land was clean again and the people were happy!Continue reading…

Stressed Out System

I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients’ charts. I suspect the percentage of patients who are “stressed out due to insurance” is fairly high.

My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, “I can’t afford to see you, doc. You’re expensive.”

Expensive? A $20 copay is expensive? Yes, to people who are on multiple medications, seeing multiple doctors, struggling with work, and perhaps not managing their money well, $20 can be a barrier to care. I may complain that the patients have cable TV, smoke, or eat at Taco Bell, but adding a regular $20 charge to an already large medical bill of $100, $200/month, or more is more than some people can stomach. I see a lot of this too.Continue reading…

The Look

“He gave me the look,” the patient said to my nurse as he walked out of the exam room.

My nurse laughed and said, “I had a feeling you’d get it today.”

What were they talking about?  ”What look?  I didn’t know I had a look!” I asked my nurse.

The patient tipped his chin down and looked at me over his glasses.  My nurse laughed, pointing at the patient, “That one!  Exactly!  You give that look to me too!”

I was mystified.  I don’t like lecturing people or acting like their parent.  Patients do no harm to me when they gain weight, don’t take their medications, or eat a lot of Little Debbies.  My job is not to get them to do everything I say, it is to give them enough information and motivation to do it for themself.  I am the coach; they are the ones who have to go out on the field and play.  I may be disappointed when they mess up, but it’s not my job to patronize them and wag my finger.

So I was vexed when I learned about “the look.”  I’m honestly not sure how much of it is just a product of a guilty conscience on the parts of my nurse and the patient, but there is usually at least a grain of truth in this kind of revelation. I do know that I mysteriously intimidate new employees at our office.  The longer-standing ones think this is funny – realizing the softie I really am.

I’m also not sure if it is so bad that they don’t want me to look at them over my glasses.  I have had patients (and probably employees) assume my silence on an issue was a tacit approval.  ”He never told me I shouldn’t smoke,”  ”He never said I needed to lose weight.”  I’ve had people use my lack of lecturing as an excuse to continue behavior they already know is bad for them.

I also never told them it was bad to hit themselves in the head with a hammer.  I hope that omission isn’t resulting in head trauma.

I saw another patient recently, who said to me before I could sit, “I am sure you noticed I gained 6 pounds.  Christmas and Valentine’s Day were bad for me.”  I hadn’t had the chance to check the chart, but returned a remark about how there is a clear correlation between eating too much and gaining weight.  I could tell he had a guilty conscience, so I didn’t say anything more.

As I wrapped up the visit he asked me, “Aren’t you going to say something about the six pounds I gained?”

I smiled, realizing that he was expecting “the look” from me.  I told him that it was not good to gain weight and then looked at him over my glasses.

We’ll see how much power it has.

ROB LAMBERTS is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

Coming Short with Thinking

I am mad at congress.

I don’t care if they are Democrats or Republicans, I am sick of healthcare being treated as a political football. How much more of a crisis do we need before we actually start working on a solution? Why does each party have to sit on its side of the aisle shooting spitballs at the other? Each side has its pet issues that are tied to contributors, supporters, and lobbyists. Each side will work to see the other side fail even if the other side is right. Each side seems unable to do anything unless there is political value in it. Power is more important than service, and power is a short-term project.

The real problem is that congress is thinking of short-term political gain while sabotaging the long-term. It’s like the publicly traded company that works to maximize quarterly profits even if it damages the corporation in the long run. Our society thinks in the short not in the long, and our congressmen are doing so in a way that harms all of us.Continue reading…

The Cost of Fear

I was talking to a fellow physician about a mutual patient. I had
information  that would help him in their  care and he was taking the
unusual step of asking me for my information.  I was impressed.

“Could you fax me those documents?” he asked.  ”Here’s my fax number.”

I scrambled to get a pen to write down his number.  Then I had a
thought: “I could email you those documents much easier.  Do you have
an email address?”

Silence.

After a long pause, he hesitantly responded, “I would rather you just fax it.”  He said no more.

This is a typical reaction I get from my colleagues when suggest
using the new-fangled communication tool called email.  The palms
sweat, the speech stumbles, and the awkwardness is thick in the air.
It’s as if I am suggesting they join me in an evil conspiracy, or as
if I am asking them to join my technology nerd cult.  There is a
culture of fear in our healthcare system; it’s a wall against change, a
current of stubbornness, a root of suspicion that looks at anything
from the outside as a danger.  Instead of embracing technology, doctors
see it as a tool in the hands of others intent on controlling them.
They see it as a collar on their neck that they only wear because
others are stronger than them.

It’s the only reason I can see for the resistance of a transforming
technology.  It’s the only way to explain how they would favor a
non-system that hurts their patients over a system that can improve
their care immensely.  After all, what good is it to embrace a
technology – no matter how good – if it will take away their ability to
practice medicine?  ”It’s good for you!” they hear from politicians and
academics, but they see it as a poison pill.

Continue reading…

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