Tag: patient

Why does my period hurt so much?(Primary dysmenorrhea debunked) The pain is real guys!

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So, what the heck is primary dysmenorrhea? Primary dysmenorrhea is defined as significant pain during your menstrual cycle without a specific or identifiable cause. To me, this is a bit misleading because there is a cause for the pain, and we will explain that in a bit. I think it should say without a specific anatomical or additional pathologic cause outside of the normal biochemical reactions in our bodies.

Dysmenorrhea can interfere with our quality of life and our daily activities and performance. You know what I mean. We all know women who have to miss work or school because of their severe cramps, pain and bleeding. Dysmenorrhea is the most common gynecologic condition affecting women. The percent is reported anywhere from 17% to 90% depending on what you read. Sometimes the pain is minimal but sometimes it literally stops the woman from being able to function. Current statistics state that up to 15% of women that have dysmenorrhea actually miss work or school or functioning in general with regularity. Even for those women that do not miss work or school, the pain is often enough to reduce focus and productivity. In the United States, it is estimated that there are about 600 million hours of productivity lost to dysmenorrhea. This translates to about 2 billion dollars annually. I think that deserves our attention. Just keep it in mind the next time a work or school colleague has to stay home because they are in pain with their period. This stuff is real folks!

So, what causes this pain? What is primary dysmenorrhea? Primary dysmenorrhea is pain with menses that has no underlying pathology. Dysmenorrhea is called secondary if it caused by another condition like endometriosis, fibroids, pelvic inflammatory disease, or interstitial cystitis. For the purposes of this blog, we are going to focus on primary dysmenorrhea.

Primary dysmenorrhea usually starts at the onset of ovulatory menstrual cycles. Usually women do not ovulate for about 6 to 12 months after menarche( the onset of menses for the first time). Sometimes ovulation does not start for up to 2 years. The pain is usually crampy, comes and goes, and increases in intensity. It starts just before the bleeding starts and lasts up to 72 hours. There can also be nausea, bloating, diarrhea and vomiting.

Who is at risk for primary dysmenorrhea? There are multiple factors: 1) body mass index less than 20, 2) smoking, 3) longer menstrual cycles, 4) irregular or heavy flow, 5) history of sexual assault, 6) menarche younger than 12, 7) age younger than 30, and a family history of dysmenorrhea. Usually it gets better with age and after child bearing

Here is the pathophysiology of primary dysmenorrhea. The pain is probably due to the increased prostanoid secretion. So, what the heck is a prostanoid? Prostanoids are prostaglandins, thoromboxanes, and prostacyclins. And what are those things? Basically, all we need to know is that these are chemicals that cause cramps. So, the process goes something like this. When we ovulate, our progesterone stabilizes something called lysosomes, which are like storage containers full of inflammatory chemicals. At the end of the luteal phase of our cycle, our progesterone levels go down and the lysosomes break down and release something called phopholipase A2. Well this phopholipase starts the cyclooxygenase pathway, which then causes production of the prostanoids that I mentioned before. Then voila! Cramps! The main prostanoids that concern us in dysmenorrhea are the prostaglandins. They are the compounds that cause uterine contractions that restrict blood flow in the uterus. Because blood flow is restricted, there is less oxygen. Because there is less oxygen, metabolites are produced that stimulate pain receptors. In addition to that, some of the prostaglandins lower pain threshold because they actually sensitize the nerve receptors. And, if that weren’t enough, the prostaglandins are also responsible for all the gi symptoms we know and hate. There are other compunds that are involved in this process as well but since the prostaglandins are the main culprit, we are going to focus on those for the purposes of this blog.

As if the prostaglandins weren’t enough of an issue, it has also been documented that women who suffer from primary dysmenorrhea actually have an altered pain sensitivity in the first place. Altered pain perception in dysmenorrhea has been studied all the way back to the 1940s. This altered perception is part of central sensitization syndromes. These syndromes are all associated with pain hypersensitivity without documented tissue injury, inflammation or an actual nervous system lesion. This include several disorders such as low back pain, tension headaches and irritable bowel syndrome. All of these conditions lead to amplified sensory input. These result in the patient having more pain with less stimuli.

I think we have now effectively established that primary dysmenorrhea sucks. So, what can we do about it? There are multiple options. Right now we are going to focus on the non-surgical ones. The goal of each option is to interfere with the prostaglandin production, decrease muscle tone in the uterus, or inhibit pain perception with analgesia. Before we go into these options, it is important to remember that the real key to success and compliance with any regimen is SHARED DECISION MAKING between the patient and the doctor. Have the patient be an active part of deciding on treatment, after discussing side-effects, efficacy, etc and this will help greatly. If the patient is invested in the option, it is much more likely to be helpful.

The first category of options is hormonal. Combined( both estrogen and progesterone) birth control pills are number one in this category. They are effective in about 70-80% of patients. They inhibit ovulation and prevent multiplying of endometrial cells, which decreases prostaglandins, progesterone and vasopressin. This applies to the pill, ring and the patch. Extended use( skipping the placebos) seems to be the most affective. There is a possible risk of blood clots with this method, although this risk is very small in low risk, non-smoking patients.

Progesterone only contraception like Depo Provera or the Mirena Iud. They also inhibit ovulation and eliminate menstrual cycles. Sometimes these methods can cause irregular bleeding. Since this bleeding is still anovulatory, it is not associated with dysmenorrhea. The risk of blood clots is lower with this method. Sometimes there is weight gain reported, but this can usually be avoided with proper nutrition monitoring. Depo Provera itself has been associated with decreased bone density, which seems to be completely reversible after stopping it. While this sounds concerning, it has not been deemed enough of a reason to discourage patient from using it.

There are non hormonal options as well for primary dysmenorrhea. NSAIDS( non steroidal anti inflammatory drugs) are a first line treatment and are effective for the vast majority of patients. They work by inhibiting the cyclooxygenase enzyme we were talking about earlier, which then suppresses prostaglandin production. It’s like stopping the cramps before they can even be created! They also have a direct analgesic effect at the central nervous system level. There is not a lot of evidence to say that one is better than the others. Usually medications like Motrin, ibuprofen, Alleve, and Anaprox are among the first choice options. More expensive medications like Celebrex are reserved for second options. Ideally, these are taken as needed only. One suggested regimen is to start the medication 2 days prior to the onset of menses and continue for the first 72 hours of the menstrua cycle. The key is not to wait until the pain has already gotten started and try to catch up to it, but to act proactively.

Another possible non hormonal option is Magnesium. Magnesium appears to reduce the amount of prostaglandins in menstrual fluid. It is also a muscle relaxant and causes blood vessel dilation. This sounds logical but there is not a lot of data just yet.

Calcium channel blockers like Nifedipine can cause muscle relaxation and decrease prostaglandin production and possibly reduce uterine contractions. More data is needed here as well. I personally would feel hesitant to prescribe a blood pressure medicine for cramping.

Vitamin E, in some small studies has been shown to reduce dysmenorrhea. It has been shown to increase oxygen delivery to uterine cells, decrease prostaglandins production, and inhibit cyclooxygenase. This should result in reduction in pain and cramping. Unfortunately, so far the majority of this data is in the mice population.

Ginger also inhibits cyclooxygenase activity and decreases menstrual pain. The added bonus to ginger is that it is also an antiemetic( anti nausea) so it may help with the gi effects as well. Thus far the doses studied have ranged from 750 to 2000 mg a day with the same efficacy as NSAIDS. Go Ginger!

There are some other proposed non hormonal options for dysmenorrhea as well. All of these require further study but they are interesting prospects. The first is transcutaneous electrical nerve stimulation(TENS). This is hypothesized to work in three ways. 1) it sends electrical impulses to the nerve root, elevates the pain threshold, and the pain sensation is not felt. 2) It stimulates the release of endorphins which reduce pain. 3) It increases dilation of blood vessels in the uterine muscle and reduces hypoxia which also reduces pain.

Acupuncture( needles) and acupressure( firm pressure) stimulate designated locations to relieve pain. There are specific sites on the body on the auricle of the ear, the medial calf muscle, and near the medial malleolus of the ankle that have been identified as possible beneficial treatment areas for dysmenorrhea. There are no specific regimens that have been backed up by studies to recommend with confidence at this point. So far, the range varies from a once a menstrual cycle treatment to daily for 7 days during the menstrual cycle. More to follow later here.

Let’s not forget the good old heating pad applied directly to the suprapubic region. Local heat improves tissue oxygenation, dilutes the levels of prostaglandins and increases blood flow. All of these effects can lead to decreased pain as well. A lot more evidence is needed, but it makes sense.

Apparently exercise and yoga play a role here as well by increasing endorphin release, lowering stress and anxiety, and increasing blood flow. I am here to tell you that as good as that sounds, the thought of jumping on the exercise bike or doing some aerobics in the middle of a crazy period sounds a little daunting to me. I get that there is some moderate quality evidence that this helps over the long term, plus the other health benefits of exercise, but I still think I would have a hard time putting it into practice. I am going to opt to continue to follow how that plays out.

There are a number of herbal and complimentary remedies that have been suggested as well. Rose tea, fish oil, krill oil, sweet fennel seed, low fat vegetarian diet and decreased dairy intake. So far, there is no high quality evidence for any specific dietary supplement. Still, the side effects are minimal so they may be worth trying.

The bottom line is, dysmenorrhea is a real thing that affects millions of women and costs billions of dollars in lost productivity. Beyond that, it can really affect quality of life and daily function both mentally and physically. It deserves our careful attention with a thoughtful plan tailored to the patient’s specific needs and risk factors.

Dr. Katz

Do NOT apologize for advocating for yourself!

To advocate is to publicly recommend or support. In terms of healthcare, it means speaking up for yourself and feeling more confident about the choices you make with your doctor. It means not letting someone else make all of your health care decisions without your input. It means being an active player in your health care team and helping drive your outcomes in a positive direction. It means asking questions when you don’t understand. It means keeping track of the course of your care. It means knowing your history and your family history and any other details pertinent to your health. It means following through with your doctor’s recommendations and taking your medications as directed. It means emphasizing an honest, team-oriented relationship with your physicians. It means being honest about your preferences or concerns. Let me clarify. This does not mean being rude or inappropriate or deliberately obstinate with your physician or constantly being on the lookout for a mistake that you can capitalize on. It is exactly the opposite. That kind of behavior really does nothing but insure a negative outcome.

You get the picture? Advocating for yourself requires action! You are representing you! You are the only one who knows you intimately and is with you 24 hours a day. This is something that you should never have to apologize for. For me personally, I love it when patients ask questions and get involved with their care. It shows me that they are actually interested in getting better. I have some colleagues that would strongly disagree. They hate it when they have to spend extra time answering questions. They view it as more of an act of belligerence or a personal attack, doubting their expertise. To me that is just a sign of their own insecurity in their recommendations. I say ask away and don’t leave the office until you feel comfortable.

Did you know that studies show that people who advocate for themselves are healthier and tend to live longer? Sounds like another bonus to speaking up if you ask me. Self advocacy is important because it helps you to be able to make your own decisions. It helps you gain self-respect and self-confidence. It helps you form an alliance with your physician. It helps you be a part of the doctor patient team relationship. It helps you learn to express yourself properly to attain the goals that you want. From what I can see, there really isn’t a down side so speak up why don’t ya?

Dr. Katz

Sometimes it’s hard not to get jealous

Being a cancer patient definitely has it’s challenges. I think we all can agree. Feeling sick, fatigue, nausea, loss of appetite, hair loss, shortness of breath are the things that we tend to think of first as the top issues that cancer patients face. However, there is another challenge that insidiously creeps it’s way into your life: envy and resentment. It’s not good. It affects your mood and your relationships. It is just as unpredictable as the cancer itself. It can make you wallow in self pity, even when you don’t mean to. It can make you lash out at the people that care about you and are trying to help you. What am I talking about exactly? I am talking about that feeling of jealousy and resentment that creeps up on you over time that you misdirect toward anyone in the way. What do you become jealous and resentful of?: anyone that is living a full life and doing what they want when you can’t! You become like that puppy dog at the window hoping to go for a ride in the car somewhere, anywhere. The real you spends your time encouraging everyone around you to keep living and do what they love, even if you are sick. Then the other you starts muttering under your breath, crying and cursing them as they leave you. It is completely ridiculous I know and it’s unfair both to you and the people in your life. It basically boils down to emotional abuse for all of you. Nothing good can come of it. I have done it myself.

However, as I sit chastising and judging myself for doing it, I also have to realize that some of these confusing emotions have to come with the territory. It is only natural for you to feel out of control emotions in a pretty out of control situation. I mean c’mon, the cancer is already unpredictably calling most of the shots when it comes to day to day physical living. Why wouldn’t your emotions be all over the place? I think the key is not that those emotions are there, but what you do with them. You can’t erase your feelings, but you can try to control yourself so they don’t run other people over like some kind of freight train. Don’t bite the hand that feeds you. Don’t lash out at the people trying to help you. That won’t help resolve the feelings and only leaves you feeling bad about yourself. That certainly won’t help you heal any faster. Here is where therapy has come in very handy, at least for me. I highly recommend it and I think every patient facing serious illness should have it. It is a much better option to let out those feelings to a paid professional who is trained in how to help you deal with them, rather than blasting your family who is only trying to help you. It might just save your relationships.

Dr.Katz

Some Patients are More Fragile Than Others or, the Importance of the Healthcare Team

Doctors and health care teams listen up! I have something to say! Some patients are more fragile than others. What the hell does this mean? It means that you have to be extra careful what you say to them. It means that you have to be extra thoughtful before you speak to them. It means that you need to do your research before you open your mouth and accidentally freak them out. You as the physician are part of a team and the whole team has to communicate with each other so that everyone has the same information. The patient does not need to hear different and/or conflicting information from each source. This only leads to potential panic and confusion and makes it difficult for the patient to follow through and get the care that they need. To you it may seem like a simple oversight. To the patient, it can seem like the end of the world.

This really applies to all patients, but the group I have in mind at the moment are cancer patients. This group of patients literally has their lives in your hands. They hang on your every word. They are depending on you to help them get to the other side of their illness with an intensity that is greater than patients with other diseases. You have a direct impact on their physical AND mental health, both of which are key to their survival. Think about it for a second. Anything you say to them is regarding a disease that could kill them. You tell them if they qualify for clinical trials. You tell them what chemo or radiation they will get. You talk about costs. You have to talk to them if their cancer is not responding like you hoped. Sometimes you have to tell them they are going to die. Every word out of your mouth carries the weight of their future. One bit of discouraging news may not just mean a bad day for them. It may affect the rest of their lives. No. I am not exaggerating. It is really that important.

The bottom line is that the healthcare team has to be a cohesive, thoughtful, compassionate, comprehensive unit. Patient’s lives, mental health, and physical health depend on it.

Dr. Katz

Every day CAN’T be a good day. It’s just not statistically possible.

Boy is that the truth. I have been priding myself on having a good day, good attitude, and positive mojo as much as possible with everything going on….even when I’m gasping for air and unwinding like a clock or repeating a test for the 100th time. But sometimes, I am just mad and frustrated and over it. Sometimes I have a bad day. I really can’t afford to beat myself up about it like I do. Just another something to work on. For me, I have to realize that a bad day is not purposeful or the result of something that I did. They just happen sometimes. I have to just let it roll and move on. Dwelling on it won’t help me or anyone else.

Trust me, I want to be a role model for myself and for patients. I want to be the one to bridge the lack of adequate communication gap between the patient and the doctor. This is who I truly am. But sometimes, I am just a patient who doesn’t know what the hell she is doing because I have never done this before.

This experience has made me realize even more how poorly we communicate the details of every day care. I want to be part of the solution in helping patients through the tough stuff the right way. I am already thinking of ways that I could participate in facilitating change in the care of cancer patients.

The first thing that I would change is to provide all patients with a navigator to help them wade through this process, not just the ones in a study or with a “more popular” cancer. It goes with what I have said before. All cancers matter. All cancers are scary. All cancers could potentially kill you.. Every patient needs someone to help them through outside of their family.. The more appointments and doctors get added to the team, the more confusing and potentially convoluted things get. Our family members are the ones closest to us and they love us,but they have never done this before either. They don’t know how to instruct us and they can’t really understand what we are going through. I hope to God that they never have to.

This brings me to the second change that I would make in the cancer patient process. I would assign each patient a mentor….someone who has been through it before..someone who can really understand first hand. I know it helps me when I ask a question about a symptom I’m having if I can speak to someone who actually had it and made it through. Actually those conversations have more impact on me than asking my doctor about it. I realize that there are cancer support groups out there, but I am talking about one on one mentoring.

Another thing that I would like to change in the process is to provide mental health support and counseling to every patient. We always say that attitude is everything and that quality mental health has a positive impact on healing. It seems logical then that each patient should have their own counselor or therapist to talk to regularly. It just makes sense.

I guess that even on my bad days I am still trying to do something productive. I really can’t just let it go. I know that things are not always going to go the way that I want and sometimes I won’t accomplish a darn thing besides survive to the next day. It is just so hard mentally to think about letting some illness get the better of you, even for a day. I guess the better way to think about it would be to realize that your body is telling you that you need a break today so you can get to the next day. After all, it’s a marathon,not a sprint. Ok. I’ll work on that.

Dr.Katz

” The Good Kind” of lymphoma

Today’s the day. Today I go for excisional biopsy of the lymph nodes around my neck so they can study it and determine if I have ” the good kind” of lymphoma, Hodgkins, or the aggressive kind, diffuse large B Cell Non-Hodgkins. Good kind? Bad kind? I am just not sure what to root for here. Isn’t all cancer “the bad kind?” My doctor also told me with a smile that he has never lost a patient with Hodgkins. Awesome! But wait! What about Non-Hodgkins patients? He meant to be reassuring. Instead of taking that as good news, I immediately panicked that he had somehow over bragged to the universe and karmic retribution had to be on it’s way.

Sorry, I couldn’t help a bit of sarcasm there. I know what the doctors mean. One kind has really high cure rates and one not so high and tougher to get through. Yes. Of course I understand. However, it is tough for a patient to embrace the clinical perspective right after hearing a diagnosis. Sometimes they just need a minute to try to start processing before they are able to realize whether they are actually “luckier ” than they thought or not. The moment you hear the words “we think you have cancer”, everything kind of stops. No other words have a chance to register. That dirty C word just hammers in your ears like an obnoxious bell and your mind starts racing. You need to just let it sit a minute before you start comparing stats and trying to tell them how to think about it. I know this first hand. I do it too as a doctor. I am always trying to temper my need to tell a patient that it’s not so bad and flood them with good statistics to reassure them with their need to just sit a second and take in what I said first.

Bad news is never easy to deliver, even when a patient is expecting it. I don’t really think that there is one best way to do it. I tend to vary my presentation depending on my knowledge of the patient and what I think they can handle. I was expecting this news, based on everything that I knew, but I still wasn’t instantly ready to prioritize and tier the possible types of cancer and how one was better than the other. I just needed to take in the fact that I could have cancer. That was as far as my mind could go at the moment. For me as a physician, if I know that I have to deliver bad news, I deliver the news and then I am quiet for a minute. I deliberately try to let the patient be the first one to start the next part of the conversation. I have just told them something that may soon launch them into a life-changing scenario in which they have little control. I figure that the least thing I can do is let them have control over how the conversation goes in the next few minutes. If I let them speak first before bombarding them with statistics or trying to mold how they should perceive the news, I can more clearly gauge how to tell them more and what to tell them. I think that it is really important to let them at least take control of this initial conversation. It may be the only decision that they get to concretely make for awhile. Sometimes I can’t reassure them right away. Sometimes they just aren’t ready. They are scared, angry, and confused. Sometimes you have to let them be for a minute.

I think it is tougher for my doctors to let me be for a minute. They know that I am a physician too and they figure that I can handle all the stats and details. They care almost too much because they know me. They know that I can understand the information. They know that I am interested in being my own advocate. I get all that, but sometimes it is a little too much. This time, I am the patient. I am not in charge, although I am trying to act like I am. I am putting on a brave, calm, collected face. Sometimes I think I am doing that more for others than for myself. I don’t feel very calm and collected when I am sitting in my bathtub, overreading about lymphoma and trying to give myself an anxiety attack…lol. I want to be Wonder Woman, but right now, I am just me, Laura Katz, the patient. I am waiting for news just like everybody else. I am waiting to see how my life is going to change. That will have to be good enough.

Dr. Katz

Be your own advocate, but DON’T be your own doctor.

These are words to live by right there. I am always encouraging patients to advocate for themselves. I think that every patient should be master and commander of their own destiny. It is so important that you listen with your eyes and ears open at every doctor’s appointment. Take notes and read everything that your doctors give you. At least attempt to understand what your doctor is telling you or ask questions until you do. Insist on clarification if you don’t. Pay attention, even if you don’t like what the doctor is saying, especially if you are getting news that you don’t want to hear. If you are getting any kind of unfavorable news, it becomes even more important to buckle down and concentrate so that you can be a part of your own management plan. If you disagree with your doctor’s diagnosis and plan, communicate that, in the right way, and talk about it together. Make sure that you have given him or her ALL the necessary information that you can think of, even if you think it doesn’t matter. Ask questions! I never understand when my colleagues complain about patients asking questions. I am like bring it on! I love questions! It means that you are actually interested in your own health and what I am telling you. I am actually more concerned if you don’t ask. Plus, if I have a problem with a patient asking questions, that poorly reflects on me if anything. So, please ask away.

So we have discussed how to advocate for yourself as a patient. Now let’s discuss the difference between advocating for yourself and trying to be your own doctor. When a patient advocates for themselves, they are being an active participant in their own management. They are agreeing to a team participation relationship between themselves and their physician. They are vested in their care. This is a good thing. Sometimes, patients cross the line and try to be their own doctor. This is when things get tricky and potentially harmful. Show of hands: who has done this before? I think we all have at one time or another, myself included. There are many different strategies that we use. 1) We self- diagnose with the aid of our friends or Doctor Google and seek our own treatment. 2) Sometimes we use left-over medication instead of seeking help or advice. 3) Sometimes we are so set on our own self-diagnosis that we call the doctor’s office and insist on a particular course of treatment and refuse to come in because we are sure that we are right. Then we lash out at the doctor for not instantly responding to our requests of convenience and daring to ask us to come for an appointment. 4) Sometimes we convince ourselves that nothing’s wrong and delay our treatment because we are either afraid or “don’t have time to bother with it.” I think that physicians in particular are guilty of this last one. We spend so much time caring for others that we don’t make the time to make sure we care for ourselves. It really is self-defeating because, if we don’t take care of ourselves and assume a patient role at times, we won’t be around to care for others.

All of these strategies have the potential to bite you in the proverbial ass at the end. I strongly advise against it. Mind you, I am all about patients being aware of their own bodies and health history. On top of that, I am always listening when a patient gives me their diagnosis and I take it into consideration. However, the bottom line is, when you are too close to a situation(i.e you trying to diagnose you), it is nearly impossible to always make the right decision. The chances of you being wrong are greater than the chances of you being right. You just can’t be objective. The decisions we make for ourselves are automatically imbued with our own agenda and baggage: We are worried about missing work. We don’t have time to go to the doctor. We don’t have time to stop. There are deadlines that we are worried about missing. We are afraid. When you “let your doctor in” on the decision making process, you bring back the objectivity that is crucial in determining the right diagnosis and treatment. When a patient comes to me with an issue, I am able to evaluate it with a clear head with objective information. My initial job is to get to the root of their issue and come up with a plan. I have the luxury of not having to be preloaded with concerns about their external factors until I have come up with a diagnosis. Let me clarify. I do not mean that I don’t consider their schedules or other life issues, I just mean that I don’t have to let it slow me down in terms of their diagnosis.

Now that we have described what it means to be your own doctor, let’s talk about why it is a bad idea. First and foremost, you just get it your own way. You slow down the path to diagnosis and treatment, if not cure. Second, if you are wrong, and there is a good chance that you could be, it could literally mean the difference between success and failure, life and death, etc. Third, you are not giving your doctor a chance to actually do their job. They did go to medical school after all and it was probably a more thorough training experience that what Dr. Google or your friend has. Let them get their ( and your) money’s worth out of it! Fourth, trying to be your own doctor can be really isolating and frustrating and often you have gone through multiple incomplete treatment options first when you could have just gone to the doctor and gotten the correct treatment the first time. If the risk of wasting time was your deciding factor in not going to the doctor, you just negated it by wasting your own time. Just don’t do it!

I fully realize that doctors need to step it up and not force this situation either. We are not free of accountability here. We need to try to work with your schedule. It’s not always possible though. We need to have same day appointment availability slots if possible. We need to make sure our staff is answering phones regularly when you call with questions when we are busy with patients. We need to make sure that we answer our phones when you have after hours concerns. I get that. It’s not just a one-sided issue. I make every effort to fulfill all of these criteria. But, none of these convenience and safety steps can make any difference unless you at least try to reach out in the first place.

Have a great day everybody!

Dr. Katz

Please tell your doctor everything…at your actual visit and while you are still in the room if you could.

Hello everyone. This is just a quick public service announcement on behalf of physicians everywhere. Everyone knows that it is our sacred responsibility to care for other human beings to the best of our ability. OK great. What seems to elude everyone is that our ability to be able to care for someone is highly dependent upon the information that we receive from the patient….at the time of their actual visit. I am always talking about the doctor patient team relationship and the communication between the patient and the physician is the absolute pillar and foundation of that relationship. There is no way that I can do my best to take care of you without knowing EVERYTHING there is to know about your health history and the details of the concern that you have. You are master and commander of your own ship. I am just the first mate. I help steer but I am not actually in charge of the course. I cannot act on anything that I don’t actually know about. I need you to tell me all of your symptoms and all of your history in order to help you. Every detail is potentially life or death important. Something you may think is trivial could be the absolute key to your health and survival. It is not safe to think of all the physicians that care for you as separate individuals. We are all on one team and we all need to be on the same page with the same knowledge base so that we don’t do anything that could cause you harm. We may be several different physicians, but we are all working with the same individual and everything that we recommend affects you. You can’t assume that everyone has access to the same information. Most of the time, we are getting our information from you so you need to be an active participant in letting all your team members know what is going on with you. The bottom line is: there is no such thing as too much information. Leave it to me to filter out what I need and what I don’t. Don’t self censor. It could cost you your health. And please, try to mention it while we are still talking in the room if you could. Have a great day.

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