Tag: advice

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

Takin it easy is not the same thing as being a prisoner.

Oh man am I having trouble with that distinction lately! First of all, limitations have never really been my jam to say the least. I have been a patient more than I care to admit in my lifetime. You know, multiple surgeries, medical emergencies, accidents, time off work, the whole nine yards. I am usually the one who is walking the halls just hours after emergency surgery. I am not a stay tied down kind of person. Now that the universe decided that cancer with chemo plus a pandemic was a good idea, I am looking at a whole lot more than just some temporary limitations. There is no way around it. I feel like I am looking at house arrest for months. Let’s face it, I will be immunosuppressed, on top of having cancer, in the midst of an ongoing pandemic. I can’t afford to take chances so I need to suck it up.

Yes, I exaggerated. I won’t exactly be on house arrest. I am going to work when I can. I will need to leave the house for doctor appointments. I just won’t be going out of my way to go out to dinner or take unnecessary risks. I probably won’t be doing any hospital procedures either. It’s just being smart. To be honest, it won’t be that different from what is going on now, except for the fact that the chemo I will be on shoves me from the mild risk category to the top of the highest risk category when it comes to death from infection and Covid. Yippee! This is not the kind of line that I wanted to cut to the front of.

In my rational moments, it all makes sense. There is no point in fighting hard to dodge the cancer bullet if I am just going to open myself up to the Covid one. That would be ridiculous. The restrictions are in place to help keep me safe and see this thing through to the end. I choose to follow them. I know that. And, it’s not as if there isn’t enough Netflix to go around to entertain me.

There are other things that I worry about though. Yes, believe it or not I worry about being bored, even though I am working on a book, a podcast, a blog and I try to post daily updates. I worry about having too much time to think which runs the risk of being counterproductive and focused on worrying with nothing to distract me. I worry about resenting my family and friends as the pandemic restrictions lift and life resumes again while I watch vicariously through a proverbial window. I worry about being consumed with guilt from letting people down. I realize that everyone is being tremendously understanding now, but everybody has their limits. See! I wouldn’t have so much time to overthink all of this unless I was on restrictions!…lol

Oh who am I kidding? No one really has to enforce my restrictions. My body takes care of that nicely. I never know which version of me is going to lift her head off the pillow in the morning: the one that is raring to go for several hours or the one that gets short of breath after about three steps and has to sit back down. It is a real Wheel of Fortune going on around here and I am definitely not the big winner the majority of the time. I am kidding myself to think that I could really change that even if I wanted to right now. It is what it is. The only real choice that I get to have control over is my attitude and my willingness to accept the advice of my doctors. I have to realize that this is not their first rodeo and that they do actually know what’s best based on experience, knowledge, and training. Like I am always saying, I need to be a team player in my healthcare. If coach says I need to sit on the bench for a bit, well then I better just sit.

Dr. Katz

I am a physician not a magician.

A family practitioner colleague of mine used to say this all the time to patients. ” I am a physician, not a magician.” Initially it always made me laugh because I am generally a fan of quippy sayings. But then, the truth of it really began to sink in…….A truer statement was never uttered. We are physicians not magicians. We are here to guide and provide evidence-based recommendations to attempt to better the lives of our patients. We are not here to bully or coerce. We cannot force anyone to do anything. The only time that I really get bossy is when it is a matter of life or death, which I feel is reasonable…lol When we take the time to advise a patient on their next move, it is essential that we are not in the game by ourselves. There needs to be a team effort relationship between the doctor and the patient in order to be successful and mold the desired outcome. This holds true for every type of patient that I care for: aesthetic patients, addiction patients and obgyn patients. In order for the doctor patient team relationship to remain stable and fruitful, there has to be personal investment on both sides. For me, that is guaranteed. I would not be in this profession if I were not invested in every single patient in every single scenario. That is the whole reason I got into the practice of medicine: to improve and save lives and to help as many patients as my faculties allow for as long as I can.

From the patient side, however, nothing is guaranteed. I have many wonderful patients that seem to value my advice, attempt to follow it to the best of their ability and actually are able to achieve the outcomes that they want to a reasonable extent. These patients are truly a joy to care for. They are the kind of patients that you reflect on to get you through a tough day and remind you why you are doing this in the first place.

Then, there is the other subgroup of patients. These are the ones that come in after years of absence and personal neglect with high expectations that you will be able to wave your magic wand and fix all of their issues with a single sweep of your arm. These are the morbidly obese diabetics who have never even attempted to modify their lifestyles or their mental relationships with food and demand that you refer them for a gastric bypass and are outraged when you hesitate. You try to explain to them how important it is to change their mental views about food and stick with some sort of weight loss plan and even psychological counselling for six months to increase their chances of success. This just further infuriates them since they are already frustrated and blinded by their quest for a quick fix for a problem that is many many years in the making. These are the patients that request CoolSculpting ( a non-invasive fat freezing procedure) thinking that it will shrink them from a size 24 to a size 2 with absolutely no effort on their part in terms of diet and exercise and then get angry when you advise them against it, because you are not out to take their money by doing something that you know won’t work. Shame on you right? Wrong. These are the kind of patients that frustrate you, make you second guess yourself, and leave you questioning if you will ever be able to make a difference in their lives. Every interaction with them is like walking an agonizingly fine tightrope. Fall off on one side and you may satisfy them for a second, but you compromise your ethics. Fall off on the other side and you have done what’s right but they may leave and never come back. Either way someone loses, whether it is you or the patient.

The bottom line is that the doctor and the patient have to be a team. It makes sense doesn’t it? Both parties should have the same goal: the well-being of the patient. It is ideal if both parties are on the same page, but not always possible. However, even if both sides are not in agreement, goals can be achieved as long as there is a personal investment on both sides. Both parties have to play an active role in order to achieve the desired outcome. The doctor has to be actively engaged in researching and recommending solutions for the patient and the patient has to be willing to take the necessary steps to attempt to follow those recommendations in order to achieve their goals. The doctor cannot wave a magic wand any more than the patient can just sit and wish for change without taking any action. It just won’t work. Have a great day everyone.

Dr. Katz

“My mom’s a gynecologist, so she knows.”

This title is a direct quote from my now 15 year old to another child when she was correcting her on the proper terminology for body parts, at the ripe old age of 4 or 5. To be fair, she may have butchered the term gynecologist a bit and made it her own, due to pronunciation difficulties. Nonetheless, the message was the same. As I think about it, I am quite sure that growing up with a gynecologist as a mother has presented an intricate balance of advantages and disadvantages…for both sides. It has definitely made life interesting, to say the least. I remember thinking, before I had children, that it was going to be sooooo amazing to be a gynecologist mom. I couldn’t wait to have daughters so that I could be the best information resource ever about all things “sensitive.” I was convinced that we would share so openly about sex and biology and all things gyn that my kids would never want for knowledge and certainly would come to me with ANY questions or concerns they might have. Well, this hasn’t exactly turned out the way I had hoped.

Let’s start from the beginning. From the time my kids were little, there simply wasn’t room for any body part baby talk in our house. There were no weewees or hoohoos. There were penises and vaginas, right from the start. I was determined to give them the proper terminology, thinking I was starting off right in removing the taboo. After all, I wasn’t teaching them swear words or anything, just basic biology terms. What’s the harm right?

Well, I need to tell you a little story about how this semi-backfired almost immediately. We were sitting in a restaurant one day. It was my husband, myself, our oldest and my two year old. The meal was meh, but the conversation was nothing if not interesting. Right in the middle of her mashed potatoes, my 2 year old suddenly bolts up out of her chair and announces very plainly to us and the whole restaurant in general(cue squeaky high-pitched two year old voice)..” Mommy, my vagina hurts real bad and I can’t sit here any more.” You could have heard a pin drop. The silence was deafening, except for the sounds of every single head in the restaurant snap-turning in my daughter’s direction with a look of horror on their faces. It was as if she just quoted a line from a soft porn movie, complete with cusswords. My oldest was trying to stifle a laugh into her pot pie. My husband was sitting there open-mouthed. My 2 year old was grinning, very proud of herself for getting all the words right. I knew it was up to me to handle this. I stood up immediately and said,” It’s ok folks. It’s ok. I am a gynecologist and I can take care of this.” I turned to my two year old and asked her if she wanted to switch seats. She did willingly. I then asked her if she felt any better. She looked at me and said,( cue toddler voice again) ” Oooooh yes. My vagina feels muuuuccchhh better now. Thank you Mommy.” She then sat down, smiling and proceeded to start in on her mashed potatoes again. Meanwhile, the rest of the room did not seem nearly as relieved that the problem had been solved. Ever the fixer, I felt like I had to address the again. I said,” It’s alright now. She feels better. Problem solved. Everyone please go back to enjoying your meal.” Needless to say we never ate there again.

My now 15 year old took a completely different spin on it. She learned and embraced all those terms with relish early on. In fact, she would correct every child that she came across who dared to use improper terminology for their body parts….all the time! As a matter of fact, she was so keen on all of her little friends knowing the right words to say, that even if the subject of body parts did not come up in polite conversation, she would bring it up so she could have the opportunity to “educate” them. This did result in more than a few phone calls from the school. It was as if we had turned the tide on the terms wee wee and hoo hoo and now they had become the bad words.

My youngest was also always fascinated with what her Mommy did, especially the part about delivering babies. She thought that was really something special.(and hopefully still does) However, I did not really grasp just how special she thought it was until one day when I got a different kind of phone call from school. Mind you, at the time, both of the girls were attending a private Lutheran school, so they were getting their daily dose of religious education right along with their ABCs. I got a phone call at work saying that I needed to come to the school as soon as I could, but that it wasn’t an emergency. I hung up confused, of course and tried to head there as soon as I could. I arrived at the school and headed right to the preschool day care room. As soon as I walked in I noticed a long line of little girls leading up to the play tent in the corner. I asked the daycare teacher what was going on. She smiled at me and said, “Oh you’ll get a kick out of it.” She motioned me over to the tent and there was Katy, dressed like the virgin Mary, delivering each little girl’s baby one by one. She saw me and immediately smiled and informed me that she was delivering their babies just like me. Everyone still had their clothes on and each baby was a doll, but the main objective was still clear. She was very proud. I thought it was pretty clever that she combined her admiration for me and the Virgin Mary all in one. However, all of the other parents did not exactly share my sentiments and thus, the baby tent had to go.

All in all, I still think I did the right thing in teaching the proper terms to my kids. I think we have to stop thinking of body parts as taboo for little children. It is only natural to be curious about them. Psychologists say this starts naturally as young as the toddler age. I think that if we contribute to removing the taboo from the words themselves, it might be a first step in being more comfortable talking to our kids later in life about their sexuality and arming them with useful information and resources instead of shouting about abstinence only or leaving them to fend or themselves.

Yes, i went there. I started talking about teenagers and sex. This leads to yet another tricky aspect of having a mom as a gynecologist. My girls went very quickly from being fascinated with what I do and happy to receive whatever tidbits of wisdom I wanted to impart to being mildly horrified and unwilling to engage in the sharing extravaganza that I had in mind. I learned very quickly that, despite all my efforts to the contrary, they had no problem coming to me with concerns or questions on behalf of their friends, but that it was just too embarrassing to talk too much in depth on a more personal level. Nevertheless, I still continued, and will still continue to encourage open conversation whenever possible. Whatever my girls decide to do, I have armed them with resources and information to help them make safe decisions. Teenagers in general are known for poor decisions and getting guidance from google, their friends, snap chat, and tik tok, but I am hoping that my guidance will help pave the way to better ones. I will always be hoping.

Well, that’s all for now. Gotta get to work. Have a fantastic day!

Dr. Katz