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Gaggy and Googley-eyed…or…the joys of hyperthyroidism

For a long time now since my chemotherapy ended, I have endured the effects of hypothyroidism because my poor thyroid was chemically destroyed with little hope of its recovery. The thinning hair, the dry skin, the ridiculous fatigue and the inability to lose weight have become a part of my daily routine, despite constant medication dose adjustments, doctor’s appointments, etc. Don’t get me wrong. I am extremely grateful that my liver and kidneys recovered. I can’t live without them, but this thyroid stuff is still a bummer.

Well, just when I’d settled in with those symptoms, my thyroid decided to take a turn and launch me in the opposite direction…..hyperthyroidism. Let’s talk about how it is different.

Hyperthyroidism can result from four main causes. The first is inflammation/thyroiditis of the gland due to viral infection, medication side effects, or pregnancy. The second is Grave’s disease. The third is taking too much thyroid medication. The fourth ( although very rare) ifsfrom non-cancerous growths of the thyroid or pituitary gland.

Here are the symptoms. There are so many, let’s break them down into categories.

Whole body- excess sweating, hunger, fatigue, heat intolerance, restlessness, weight loss, diarrhea, warm skin, weakness, tremor

Mood- mood swing, nervousness, panic attacks

Heart- abnormal rhythm, palpitations, tachycardia

Sleep- insomnia or difficulty falling asleep

Menstrual- irregular periods or periods that are very short and light

Behavioral- hyperactivity and irritability

Eyes- puffy eyes or protruding eyes

It all sounds fabulous doesn’t it? Nope! I was looking up risk factors for hyperthyroidism. The most common ones are family history of thyroid disease, pregnancy, chronic illness like pernicious anemia and adrenal insufficiency. I haven’t really seen my reason in many resources: the chemo destruction of the thyroid, but I can tell ya, it exists and is very difficult to treat.

All of these symptoms sound pretty annoying but not life- threatening, right? Wrong! Hyperthyroidism needs to be treated! If you have any of these symptoms, you need to see your doctor. Let’s look at what happens if hyperthyroidism goes untreated.

It can lead to weak, brittle bones and osteoporosis. Our bone strength depends on the amount of calcium and other minerals in them and too much thyroid hormone vastly decreases our calcium absorption.

Thyroid eye disease can develop. This affects the muscles and tissues around the eyes leading to bulging eyes, gritty sensation, pressure and pain in the eyes, retracted eyelids, red eyes, light sensitivity and even double vision. These untreated problems could even lead to loss of vision.

It can lead to a dermopathy that causes the skin to change color and swell. The swelling is often so significant that the skin on the shins and feet literally shins to the eye.

The most dangerous potential complication of untreated hyperthyroidism is a thyrotoxic crisis or thyroid storm. This requires immediate emergency care. Symptoms can include fever, tachycardia, nausea, vommitting, diarrhea, dehydration, and even delirium.

The first step in getting diagnosed is to go to the doctor. Get a thorough history and physical exam. The doctor will look for signs like tremor, overactive reflexes, moist skin, rapid pulse, eye changes, etc. They will examine your thyroid. labs will be ordered like T4,T3 and TSH(thyroid stimulating hormone). Make sure you are fasting when you get these tests. Also make sure you are not taking any b vitamins like biotin for at least 3 to 5 days before. If your tests are positive, you will probably get a thyroid usn.. If there are nodules, you will probably have to have a radioiodine scan.

How do you treat hyperthyroidism? Anti thyroid medicines are one option. They prevent the thyroid from making too many hormones. They usually take several weeks to work. Beta blockers are a symptom treatment option because they can bring down the rapid heart rate and tremors. They don’t do anything to the thyroid hormone levels though. Radioiodine therapy is an option. This makes the gland shrink and usually makes it underactive. This can lead tro hypothyroidism, which also needs to be treated. The most drastic option is removal of all or part of the thyroid. This is reserved as a last resort if meds , iodine etc are not an option or did not work. There are risk to this surgery which include,but are not limited to damage to the vocal cords and the parathyroid glands.

The bottom line is that hyperthyroidism needs to be taken seriously because serious complications can occur. So, if you have any of those symptoms, please seek a doctor’s care right away.

Dr. Katz

“I don’t mean to overshare, but”…..the words every Obgyn loves to hear.

What does it mean to overshare? To overshare is to reveal an inappropriate amount of detail about one’s personal life. I think it is somewhat subjective to determine just what is inappropriate. I think it’s different for everybody and even somewhat situational. In my profession, it is just a way of life.

I just heard these words the other day. “I don’t mean to overshare..but”. I am never sure what the point is of leading with that statement. Does the patient expect me to be shocked? Ask them to refrain from saying what they were going to say? Heck no! My usual reaction is to just buckle up and lean in closer. I can’t wait to hear what they have to say. Usually it is something pretty juicy and intimate….my orgasm was mind blowing from that treatment you did, I had the best sex ever after I started that medicine, a very personal description of a vaginal sensation, etc, stuff like that.

Why worry about saying stuff like that? If you can’t tell the gynecologist stuff like that, who the heck can you tell? My very profession is all about oversharing. It’s not like you can just blurt out stuff about your pelvis just anywhere. But you can here! The best way for me to help you with any of your concerns is to know everything!…every…last….detail. There is nothing embarrassing about it. If you tell me everything, we can either celebrate it or get to the bottom of the problem together. It is a win win. So, c’mon. Let’s start sharing.

Dr. Katz

It’s time to talk about something serious

I don’t think there is a dry eye or a non-stunned heart in the house when it comes to thinking about the recent sudden passing of Stephen “tWitch” Boss. We are all saddened and stunned. We are all wondering how we missed the signs. We are all asking the question ” How could we prevent this from happening?” Instead of continuing to ask these questions after the fact, it is time to talk about it and get educated for the future. I know I need to.

I recently read an article from the CDC about suicide. I realize that a lot of you may not put value in anything that the CDC says right now, but I am using this as just a resource for some definitions, etc.

First of all, let’s define what suicide is. Suicide is defined as death caused by injuring oneself with the intent to die. A suicide attempt is defined as when someone harms themselves with an intent to die, but they do not die as a result of their actions. It is a serious, devastating, personally intimate, and also public health problem. It is the leading cause of death in the United States, causing up to 45,979 deaths in 2020. This literally translates to one death about every 11 minutes. The numbers of people who think about suicide or attempt it is even higher! In 2020, approximately 12.2 million Americans thought about suicide, 3.2 million planned an attempt, and 1.2 million actually attempted.

Suicide does not discriminate for age. It affects all ages. It was in the top 9 leading causes of death in 2020 in people ages 10-64. It was the second leading cause of death for people ages 10-14 and 25-34.

These statistics are overwhelming. Suicide causes emotional, physical and economic devastation. Survivors may have long term injuries or suffer long term depression. It affects friends, family, co workers, and the community at large. Emotional distress pervades the lives of the victim’s family along with shock, guilt, depression, etc. Sometimes family members can begin to think about suicide. Suicide is also devastating from a financial standpoint. in 2019 suicide and non-fatal self harm cost about 490 billion in medical costs, work loss costs and quality of life costs.

So, what can we do about this? Is there anything? Let’s talk about that. I have been through this before with a friend in high school. We did not reach her in time and I have missed her ever since. I remember being wracked with guilt and self blame, on top of the sadness. Why didn’t I see this coming? What should I have done? The questions kept coming and still do. Let’s talk about some strategies that might help. We’ve got to try something.

It is said that suicide is preventable. I am not sure that is true in every case. I worry that this kind of statement may only lead to more self blame for everyone left behind. Having said that, I do truly believe that everyone has a potential role to play to save lives. We need a comprehensive public health approach as well as a family and friends approach.

The CDC has developed the Suicide Prevention Resource for Action https://www.cdc.gov/suicide/resources/prevention.html

This resource explains strategies to reduce suicide with the best evidence that is available at this point. The intent is to help states and communities to prioritize suicide prevention strategies that could potentially have the most impact. The strategies it focuses on the most are 1) strengthening economic supports, 2) Creating protective environments 3) improve access and delivery of suicide care, 4) Promote healthy connections, 5) teach coping and problem-solving skills, 6) Identify and support people at risk, 7) Lesson harms and prevent future risk

Let’s break each of these down.

Strengthening economic supports- This means strengthening household financial security and stabilizing housing

Create protective environments- This means reduce access to lethal means among persons at risk for suicide. Create healthy organization policies and culture. Reduce substance use

Improve access and delivery of suicide care- This means we need health insurance coverage for mental health issues. We need more providers in underserved areas. We need to provide rapid and remote access to help. We need safer suicide care.

Promote healthy connections- Focus on healthy peer norms and engage members of a community in shared activities that are positive.

Teach coping and problem-solving skills- This means teach parenting skills to improve family dynamics. Support emotional resilience through education. Support social and emotional learning.

Identify and support people at risk- The first challenge for this is to be able to identify who is at risk. We will talk about that in a minute. We need to be able to respond to crises and have safety plans and follow up after attempts. OUr job is not done after an unsuccessful attempt. Multiple therapies must be available

Lessen harms and prevent future risk- Again, our job is not done after an unsuccessful attempt. Postintervention is extremely important to prevent future attempts

Now that we have talked about these strategy categories, lets talk about what contributes to risk of suicide. What are we looking for? We need to keep in mind that suicide is rarely if ever caused by a single event or circumstance. It is a range of factors at all levels: society, relationship, community, and individual.

Let’s look at some individual risk factors.

History of depression or other mental illness

Previous attempt

Criminal or legal problems

History of child abuse

Financial or job problems

Violence victim or perpetrator

Hopelessness

Chronic illness or pain

Aggression

Let’s look at Community Risk Factors

Suicide cluster in the community( a pact, etc)

Community violence

Discrimination

Lack of healthcare access

Historical trauma in a community

Let’s look at Relationship Factors

Bullying

Loss of relationship

Violent relationships

Social isolation

Bullying

Family history of suicide

Last, but not least, let’s look at societal factors

The stigma and labels attached to getting help for mental health issues

Unsafe media portrayal of suicide

Easy access to lethal methods

So, what are the warning signs? Look for things like someone talking about being a burden. Look for isolation. watch for increased anxiety. Listen for talking about unbearable pain or feeling trapped. Mood swings are a concern. Watch for too much or too little sleeping. Listen and pay attention if someone talks or posts about wanting to die. Watch out for increased rage. People that are at higher risk include veterans, people in rural areas, mine workers, and construction workers. The LGBTQ population is also at higher risk of suicide.

When we see or hear those warning signs, what do we do? We can use all the strategies we already talked about above: financial support, better access to care, create protective environments, connect people with each other and their community, teach coping and problem solving, identify those at risk and prevent further risk. More immediately, if you think someone is at risk, talk to them. Have them contact the 988 Suicide and Crisis Lifeline. There are two options

Call or Text 988

Chat at 988lifeline.org

This is 24 hour, confidential support with a trained crisis counsellor.

The bottom line of all of this is, keep an eye on the people you care about. Ask questions. Have frank discussions. Seeming OK on the outside does not always mean they are ok on the inside.

Dr. Katz

It’s today it’s today.

As my lymphedema gently nudged me awake from my slumber this morning, I suddenly realized that today is a huge mental load. Today is exactly two years from the day I bolted awake with a feeling of dread, a big lump on my neck and the unconfirmed knowledge that something was horribly wrong. Even though my diagnosis was not confirmed until about two months later, that is where my journey truly started. I should have realized it was coming. On the surface, I was suppressing the memory, but my body knew better. I haven’t felt like myself in days. I had some random panic attacks. My fibromyalgia was flaring like nobody’s business and I got my first migraine in a long time. Now it all makes sense. I was refusing to acknowledge my internal ptsd out loud, but my body was doing it for me.

It occurs to me, now, two years later, that I really need to change my strategy. I have made it my mission since cancer to just keep swimming and pushing and to let nothing hold me up or get in my way anymore. I am always in motion, even if I don’t feel well. I sometimes ignore the need to take a break, because I am afraid that it will slow me down enough that I will start to dwell even more on everything that has happened to me. I also spend too much time chastizing myself for my own thoughts because I assume that my trauma clearly wasn’t as severe as a lot of other people’s.

And where is that getting me? NOWHERE! That gets me panic attacks and prolonged fibromyalgia flares and even more missed time doing what I love. I’ve got it all wrong and I need to change my strategy from constant movement to actual acknowledgement. I need to process and acknowledge/accept? what has happened. Otherwise I cannot really move forward. I read a great article in GoodTherapy magazine from May of 2011 written by Susanne Dillman, PsyD. She said that true acknowledgement of trauma is absolutely necessary for healing to begin. She points out that there is no real hierarchy of pain. Trauma is not scalable. This is a belief that is more flawed than accurate. So, me trying to downplay my trauma and compare it to others is getting me nowhere and I need to stop. She says that trauma lies at the utmost extreme of human experience and there is nothing ordinary or expected about it form the individual’s perspective. You cannot compare the danger, horror and fear involved, regardless of the content. The experience is your own. Once something is extreme, trying to rank how extreme it is is useless.

She also points out that you are literally blocking your healing journey by not acknowledging your trauma because you are denying yourself any sense of self compassion. Healing is the only way to truly detoxify trauma. I don’t think she is talking about sitting back and completely wallowing for weeks at a time. She is just saying that you need to realize that it is real and allow yourself to feel in order to get truly past it.

Dr. Katz

December 12th is coming and I’m freakin out!

Dec 12th…..Dec 12th 2020. It’s where it all started. The morning I woke up feeling like I was choking with a voice yelling inside my head to get up and look in the mirror. Whether it was my own gut instinct or my late father I will never now. That morning changed my life. I did get up. I did look into the mirror. I saw the lump on my neck and off I went. It was the beginning of a battle of fear, frustration, and anxiety as made my first steps toward my cancer revealing itself and everything that followed.

Well, that was almost two years ago. I thought I was getting better at letting it go. I really did but nope, here we are. It’s less than a month away and suddenly the panic attacks, the anxiety out of nowhere, the wondering about every little symptom is all back. It is PTSD at its best/worst. I can’t really believe how long it took me to figure it out. I guess I had to waste time beating myself up for having anxiety first. We all do. Then it hit me! Of course. The anniversary of one of the most traumatic times in my life is coming up! What normal brain can completely let that go? That trauma gets stored and buried, with significant effort from me. But, even I can’t hold it back all the time. Lord knows I try.

So, what do I do? I can’t keep fighting to suppress it. That will only keep me prisoner to it longer. I have to acknowledge it! I have to embrace that it is real and that it happened and that it affected me in ways that I still don’t fully process. I have to actualize my own feelings about it. The only way to be free is to go forward through it when the feelings flood me. The only power I have is the power to see it for what it is and decide how I want to proceed. The choice of direction is actually completely up to me. I could allow a day( or two or three) to break down and crumble. I could stop functioning. Or, I could move forward and use the experience for good. They say that the final stage of healing occurs when you are able to use what happened to you to help others. That is what I have chosen and continue to chose. I have written my books. I am giving my talks. I am helping other cancer patients. I help other people “get their mind right” for the battle ahead. I share knowledge every day to help give people some sense of control as to what is happening to them. These are the battles I chose to fight every day. These are the battles I want to win. I realize that my past trauma is still with me. I cannot change that, but I can chose to change what I do with it.

Dr. Katz

Taking Ownership

How many times have we all waited for someone to take care of something for us? How many times have we been stalled in a work project, waiting for someone to finish their part? The frustration and loss of time in doing this makes no sense. I say forget it! Let’s try a different strategy. It’s time to take ownership.

So, what does that mean? According to the Harvard Business Review, one of the most egregious momentum killers is waiting for someone else to act, take initiative, or take charge. Most of the time, no one is coming. So, why do we do it? If help isn’t coming, let’s liberate ourselves and take responsibility and move forward. Start believing in yourself as an individual and take stock of the fact that it is, in fact, your responsibility for the quality and timeliness of an outcome. This applies even when you are working with others. It doesn’t mean that you are always in charge of everything. It doesn’t mean that you shouldn’t collaborate with anyone. It just means that you take ownership of your part and the results.

The same article in the Harvard Business Review went on to discuss that there are a couple of basic things to understand about taking ownership. First, I think we need to be able to tell the difference between fault and responsibility. When we finger point at others or at ourselves when something is not getting done, the perception of fault gets in the way of taking ownership of a difficult problem. Then, the problem still doesn’t get solved. Get rid of the blame game and we will all be more successful. Second, taking ownership frees us up to move toward getting results or finishing a project. Last, we can actually help others not just ourselves by taking ownership. Sounds like a win win to me.

The bottom line is, taking ownership/accountability/responsibility for your part can only help yourself, others, and the project move forward. Blame and finger pointing does nothing but waste time and energy. Don’t waste the energy. Put your big girl panties on, take responsibility and forge ahead!

Sometimes you have to give yourself a pep talk!

You know, sometimes you just need a pep talk and there is no one else around. That happened to me this morning. My fibromyalgia was in a total flare. I was in pain. I was feeling tired and defeated. I was all alone in my car. I needed a pick me up just to face the day. What did I do? I gave myself one! I reminded myself that this fibro thing was nothing new and that I even had it before I was sick with cancer last year. I dealt with it before. I told myself in the third person, “Laura. You got this. You know what to do. Hydrate. Get mentally strong. Take an nsaid. Move forward!.” So, that’s what I did. You can too.

So, let’s talk about what a pep talk is. A pep talk is defined as a strong, encouraging, emotional talk to a person or a group, intended to arouse enthusiasm, and increase determination to move forward to succeed. They can build morale, refocus everybody and help to rebuild teams. Did you know that there are scientific studies looking at the phenomenon of pep talks everywhere from the workplace to the ball field. They all say the same thing. A pep talk is the key to bringing new energy to any situation or goal.

Well that sounds fantastic for a group setting, but how about a solo setting? Can you really give one to yourself? You can! I read this great article in Medium from Jan 2020 that describes science-backed strategies for self- boosting. Let’s talk about it.

Dr. Benjamin Rosenberg, a psychology professor at Dominican University, says that “giving oneself a pep talk (self-talk) actually has an advantage over getting a pep talk from someone else.” The advantage is that, for the most part, we trust ourselves over anyone else so who better to pump us up than ourselves? Self-talk has been scientifically proven to have a positive effect on self-confidence and self- efficacy. In other words, it helps us to believe that we have what it takes to get the goal at hand accomplished successfully.

So, how do we go about it? First step: take note of your symptoms. Talk silently to yourself. This can decrease the anxiety side effects that often creep up before we have to perform or do something. This helps us to decrease the cognitive anxiety, negative, or repetitive thoughts.

Second, dampen down the fear by separating it from your task. For example, tell yourself that if your hands are feeling clammy before a speech that you just have a little bit of stage fright. It does not mean that you are going to mess up the speech.

Third, get some distance for yourself. It sounds weird, but one of the best pep talk strategies for yourself is to talk about yourself in the third person. That sounds totally bizarre right? The logic behind it is that we are more comfortable thinking about other people than we are about analyzing ourselves. Therefore if we refer to ourselves in the third person, it helps us control our emotions better. There should be less emotional reactivity.

Fourth, make sure you have reviewed your own plan. This type of strategy breaks down into the motivational (“You’ve got this”) and the instructional (review all the necessary steps before doing them). Don’t let yourself get all jittery because you are not prepared.

Fifth, give yourself compliments and be generous with them! This is not the time to embrace your negative self-image. Tell yourself how qualified you are. Tell yourself that you are prepared. Apparently it works even better if you can do THIS in the third person as well. Honestly, I would just have a reserve of positive things to say about yourself that you can use any any time, for any situation.

Those are the basics according to Dr. Rosenberg. I think they are really on point plus now you have a legitimate excuse any time anyone catches you talking to yourself! Lol. Just kidding. Bottom line is that pep talk really do work. They are not just the fabrication of inspirational movies. They work in real life too and if no one else is around, just do one for yourself! You got this!

Dr. Katz

I think I’m addicted to giving compliments.

I really think that this is true. I love saying something nice to somebody. On top of that, if there is an extra challenge factor and the person is grumpy that day, I try even harder! Compliments are great to give and receive. They let us show our appreciation for each other and how much we think things are worth. They help us work together and face challenges productively. One would think you couldn’t go wrong with them. However, there are some fine points to consider.

What does it take to give a good compliment? Well, first of all, you have to actually mean it. Otherwise your facial expression, body language, and tone will give you away. If someone has a shirt on that you think is hideous and you try to say how much you like it, you are gonna flinch somehow. Most people are able to tell when a compliment isn’t sincere. You can avoid this scenario easily. Everyone has some quality to be noticed and complimented on. Just pay a little more attention and pick something else. The genuine compliment will go much farther.

Another key component of a good compliment is paying attention. Give your focus to the details of your surroundings and the people around you. It will allow you to say something nice that is specific enough to really mean something to the other person.

Let’s talk about specificity for a minute. Truly, the best compliments are specific. They zero in on specific characteristics or traits that are individual to that person. When you mention something specific, it shows that you are really paying attention. For example, you could tell anyone that they are pretty. That could apply to a lot of people. However, if you told someone that their gorgeous brunette hair was really flattering, that would probably mean a lot more.

Let the compliments flow when you are making them. You don’t have to stick to just one, unless the other person is visibly uncomfortable.

Last but not least is the thing that I suck at the most. Learn how to receive compliments well! I really stink at this. Somebody says something nice to me and ten reasons why it’s not true come word vomiting out of my mouth. Why God why do I do that? It’s like don’t want anything to interfere with my preconceived negative self-image! No good can come of this! I will simplify it for you. Here is the one time I am going to go against the former “be genuine” advice. Even if you are cringing inside thinking of how it is not true, just smile and say THANKYOU!

Have a great day guys!

Dr. Katz

“I thought the dog was just twerking.”

We had a very full weekend over Labor Day: a house full of kids and grandkids with a side of plenty of mayhem and fun, even though the weather took a crapper. We have always used the no tech at grandma and grandpa’s rule so no tablets, phones, tv, YouTube, etc to allow us more time to talk, bond with each other and PLAY OUTSIDE! It’s a marvelous idea in theory. It encourages ten times more interaction than we would normally have. It is a double-edged sword however, because YOU also have to be willing to put tech aside, pay attention, and engage because you have just assigned yourself the role of main entertainment, which was formerly handed off to a barrage of impersonal, widely variable, non-censored electronic input.

So, now that the kids have your full attention and you have theirs, get ready for some unpredictable fun. When you are fully engaged, you can really get a sense of the full extent of their childhood innocence in some areas, and where they have had way too much exposure to the world in others.

We were sitting around the living room the other day and one of our dogs begins unceremoniously humping the other one. They seem to always wait until we have a full complement of company before they do this. Of course, we yell stop like we have never seen it before. Then my granddaughter says. “You know, I used to think the dogs were just twerking when they did that.” At first I am relieved that her first thoughts at 11 didn’t go to sex as a possibility. But, then I realized wait? She thought they were twerking? Where did she see that? How does she know what twerking is? Maybe her childhood innocence is not so intact after all.

What is childhood innocence anyway? This refers to the simplicity of children, their lack of knowledge and a purity that is not spoiled by the world just yet. They are ignorant of life and death. They are ignorant of sexual relationships, etc. They believe that anything is possible because their imaginations soar unchecked. It is heartbreaking in a way because once it is gone, they can never go back. It is a quality of ignorance that we visciously eschew as adults. We tell ourselves that we must have infinite knowledge and awareness of everything, which leads to depression and anxiety, overthinking and over analyzing.

So, if we know this is the ultimate outcome, why are we in such a hurry to overexpose our kids to the world at such a young age? Without supervision, they can access things on social media that would shock me even now! Stuff on TV or in movies is full of violence, drugs and sex. It is a totally un-censored barrage. We need to pay attention to what is filling our kids’ minds. The importance of this cannot be overemphasized. So, let’s all put down our phones, turn off the tv, and put the tablets away at least for a little bit every day. You won’t regret it.

Dr. Katz

So, why did you come in to see me?

Just remember. This is supposed to be funny, but with a side of truth.

You know, my life is full and interesting. I get to help people every day and do what I love. That makes me one of the luckiest people I know. I will never forget that. I used to think, before I actually went into medicine, that every patient that would walk in that door wanted to be there and would be ready to be a part of their own healthcare team. Weirdly, that is not the case. This is true for a large portion of my patients, but for some, I am not so sure.

As I reflect over the last 20 plus years, I realize that there are several types of patients in my practice. Let’s review.

There is the patient that you inadvertently become friends with and become attached to. To some extent, this happens to me all the time. I always try to bond with my patients in attempt to care for them better. I try to get insight into their lives to help them through whatever issues they are trying to solve. They always tell you in medical school never to get attached, but sometimes I can’t help it. In my mind, it is a reflection of the depth of my caring. I am always careful to respect doctor patient boundaries though. It’s not like I go party at their houses or anything.

There is the patient that doubts literally everything you say. I mean everything. For every plan you come up with, they have a counter plan or they doubt that it will work. They question your every move. They constantly re ask the same questions to see if they can trap you into giving a different answer. I realize that most of the time, this has nothing to do with me. Often, these are patients that have been bounced from office to office without actually getting the help that they need. Or, worse yet, they have had a bad experience or suffered malpractice and this makes it very difficult for them to trust any doctor. I try to take that into consideration when working with them.

There is the patient who thinks THEY are the doctor. You know the one. They grew up with family members or friends that are physicians and they know just enough to be dangerous….to themselves and your 16 plus years of schooling are not going to change their mind.

There is the entitled patient, who thinks only of themselves and becomes indignant when attention is not focused on them. These are the patients that become irate when their pap smear is interrupted because I have to run to the hospital to save someone who is hemorrhaging. The “big picture” is somewhat lost on them. They want special treatment and have tantrums when things do not go their way, regardless of the reason. I try to set very clear communication and expectations with these folks, but sometimes they get upset nonetheless.

There is the patient that “never goes to the doctor.” This is the patient that hasn’t been to the doctor in years because they haven’t had any symptoms. This is the patient that doesn’t trust doctors and has to make sure you know it by repeating the first two statements multiple times during their visit. However, if this same patient suddenly has an issue that they determine to be urgent, you had better drop everything and address it right away. Never mind that they have neglected their health for years. It is up to you to fix it….and quickly……so they can go back to never coming in for check-ups.

Let’s not forget the self-diagnosing patient. We all know that with the help of Google, our friends, our family and the chiropractor, we can figure anything out on our own, even before reporting to the doctor’s office. Those are the folks that come in convinced they have a rare tropical disease because Doctor Google said so after they typed in their symptoms. It is often very difficult to talk them out of it, but I try. Half the time, they are apologizing for looking stuff up in Google, as they are insisting that it has to be correct!

There is also the patient with overbearing family members. In my case, this most often presents and the teenage patient with the anxious parent. The parent is often on a covert fact-finding mission to discover if the teen is sexually active or not. They talk over the patient, and try to fill in all the details to show how concerned they are, but then don’t really seem to want to hear what the teen has to say. I get that they want to make sure the patient gets what she needs, but this behavior only shuts down any potential successful communication that I was hoping to have the patient.

There is a final category. This is the one we spend our whole careers hoping to encounter: the patient that reminds you why you went into medicine in the first place. This is the patient that appreciates what you do for them and how you care for them. This is the patient that is nice to your hardworking staff. This is the patient that follows through with what you recommend. This is the patient that talks with you not at you at the office.

The bottom line is that my job offers infinite variety. All of these patient types keep me on my toes and my mind fresh and ready for anything. They each have their own advantages and challenges. It’s not exactly how I thought it would be, but I wouldn’t change a thing.

Dr. Katz