People die without love: Why I prescribe the love drug

People die without love: Why I prescribe the love drug

As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the corner while the younger one jumped all over the playroom despite his contracted and painful limbs. Why? The younger boy’s family kept hugging and kissing him. The older boy had no visitors.

People die without love.

My friend, Dr. Patch Adams, discovered that less than 3% of his patients have self-esteem. And less than 5% have any idea what a day-to-day vitality for life is about. The fact is most people are in pain. So what do we prescribe for pain? Painkillers, of course.

Recently, I attended a training on the safe use of opioid painkillers where I learned that the United States is 4.6% of the world’s population, yet we consume 80% of all opioids. But painkillers don’t seem to be killing our pain. Why?

In America, we overprescribe opioids while under-prescribing the most potent drug of all: love. And love IS a drug. How fabulous you feel with it. And how painful life is without it.  So why are we so stingy about prescribing love?

The antidote for hate, neglect, apathy, misery, even sorrow is love. No prescription pad needed. No risk of overdose Love is my preferred potion. I give patients heart-shaped balloons. And hugs. Yes, I even tell patients, “I love you.” Some leave with my kiss on their forehead.

You don’t need a medical degree to say, “I love you.” Just three simple words can heal more wounds than all the doctors in the world.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • Dr. Drake Ramoray

    I shall take a survey. How many people would like me to post all my responses with a picture of myself in the bathtub or pictures of my lips with my tongue out all glittered up? Pro-tip: I don’t look like Dr. Drake Ramoray.

    http://a.espncdn.com/i/magazine/new/jason_alexander.jpg

  • Kristy Sokoloski

    Dr. Pamela,

    Very moving piece. I always love the way that you write even when it’s a very serious subject such as about the rate of physician suicide in this country. I was thinking about you a couple of days ago because of something that occurred back on Wed. My relative’s regular PCP is no longer at the clinic that we go to so she made the decision to go ahead and start seeing mine. Well, on Wed after the appointment was done he told us that he loved us, but in particular the message was meant for this relative. Well, as it turned out this was the second time he did this. I thought it was very sweet, and thought to myself “now if only Dr. Pamela could see this. :) “. Keep up the good work.

    • PamelaWibleMD

      There is such a taboo on professional closeness, emotional intimacy, and even (surprisingly) artistic displays of the human body in medicine. I find it is useful to break through these barriers and allow doctors and patients to be fully human. That is healing.

      • Kristy Sokoloski

        Dr. Pamela,

        I agree with you about there being such a taboo on professional closeness, emotional intimacy, and yes that ever surprising thing that you mentioned the artistic displays of the human body in Medicine. We definitely need to break these barriers and allow the relationship to be fully human. To be fully human also means being able to let others know that it’s ok to show empathy as well as sympathy within Medicine to further the process that allows for healing. Doing this also lets the patient know that they can feel safe with their doctor.

    • Suzi Q 38

      I agree.

  • DoubtfulGuest

    Dr. Wible, for a post talking about little kids…perhaps a different photo?

    • PamelaWibleMD

      I getcha Doubtful guest, but I am reminded of my favorite quote by Bertolt Brecht:

      “Art is not a mirror held up to reality, but a hammer with which to shoe it.”

      • DoubtfulGuest

        I grew up around creative people and have some of my own interest in art, so that interpretation is not lost on me. I have quite a high tolerance for the unconventional. But what are you trying to accomplish with this photo? At some point, it seems like if we’re really confident in our message, we don’t have to try to shock people, or “hook” them, as you mentioned in a previous post.

        • PamelaWibleMD

          Honestly, for people to read articles they like photos. My partner is a professional photographer. He recently mentioned that when he posts photos of landscapes or even men, nobody will comment, but post a photo of a woman (any woman – net necessarily a pro model) and the public takes interest. Notice how products are marketed. With a woman draped over the gun, car, or toothpaste.
          Actually, I find this fascinating and a bit sad. To be honestly, it makes me upset that worthy messages are often not heard or blog posts not read unless there is some dramatic photo (usually of a woman).

          • DoubtfulGuest

            Darn right, it’s sad. So why should we play into it? Women can keep talking about things that are important to us, without showing compromising photos of ourselves, or even any photos of us at all. My glamour shot to the left is some detail of a boat at the World Expo in Shanghai in 2010. Your profile photo is lovely — Also a great, appropriate option.
            The crappy thing about social change is it’s hard. That may mean no comments or attention sometimes. But slowly, the change happens. I think a lot of people would listen to you because you have really important things to say.

          • PamelaWibleMD

            And I spent most of my life in Texas dressed as an Amish woman. My mom always made fun of me because I dressed like I was on “Little House on the Prairie.” Why? Tired of all the objectification of women. I would much rather have people admire me for my brain, not my outfit or whether I can put on fake eyelashes or not. Really disconcerting what people pay attention to.

          • DoubtfulGuest

            I understand. I’m not actually so stuffy, and it can be fun to express ourselves with clothes, makeup, and even behavior to some extent. But we can make people pay attention just with the strength of our message. It may take a bit longer to sink in, but it’s more consistent that way.

          • PamelaWibleMD

            I have often felt like an artist trapped in a doctor’s body so I am certainly not doing anything that is not consistent with the true me.

          • DoubtfulGuest

            I meant, how does the message add up with the delivery? How does the photo illustrate love? Hearts are cute, but love takes work, self-sacrifice, and time. It’s not a drug, and why would we want it to be?

            As a patient, I wouldn’t like my emotional needs to be described that way. In fact, I don’t like anyone telling me how I feel. That’s my job, to say what my feelings are. Probably all of humanity has deep unmet emotional needs and suffering, but people don’t need to be told that they do. It can be sort of objectifying. The other thing is people may be lonely or whatever, but they know there’s a limit for bringing that to the doctor’s office. So, it can be very strange for a doctor to sit us down and tell us they “know” all this about us, when what we need most is your medical expertise.

          • PamelaWibleMD

            We are doctors of medicine. Most visits likely end with an Rx. Too bad we can’t put love in a pill because it’s what so many people really need – to feel loved.

          • DoubtfulGuest

            Or, as a society we could all get better at having actual relationships?

          • Patient Kit

            While I understand Dr Pamela’s good intentions of wishing love came in pill form and love potions have long been a fantasy of many, I’m with you on this — as a culture, we do need to get better at loving each other.

          • PamelaWibleMD

            I was kind of just making fun of the notion that Americans want things quickly in a pill.

          • Patient Kit

            I wouldn’t call your photo a dramatic photo. I would call it a needy, self-serving, attention-seeking, unprofessional, non-patient-centered photo.

          • Patient Kit

            I don’t think we actually know how many people are reading the various posts here on KevinMD, do we? We only know how many responded/commented and how many agreed or disagreed with those comments.

        • Patient Kit

          I’m no prude and I come from a pretty unconventional, creative background. This OP and photo is not about being unconventional and creative and changing the world via art. In fact, it’s a little scary and makes me think of bad Hollywood films in which the psychiatrist, not the butler, did it. What’s next? A piece on endoscopy titled “Deep Throat”?

          • DoubtfulGuest

            And in view of all the medical journal papers about inappropriate patients, for crying out loud?
            “Patient B kittenishly extracted a piece of glitter from between her teeth (Ptooey!), leaned forward with a winning smile and intoned: ‘Didn’t we talk last time about ordering that muscle biopsy?’”
            It doesn’t work.

      • ninguem

        Maxwell’s Silver Hammer?

  • buzzkillerjsmith

    Dr. W.,

    Will you please giive us one reason to not thin that you have gone completely around the bend?

    Kevin,

    Reel her in, please.

    • buzzkillerjsmith

      give, think

      • ninguem

        Perioral glitter and tongue jewelry, fine.

        But those Circus Peanuts……Pam I still have nightmares involving the Philadelphia lockup and Circus Peanuts.

        • PamelaWibleMD

          I know. Those are really the worst. Ummm . . .thank for your support ninguem.

    • DoubtfulGuest

      Embrace the hopelessness, Sir?

      • PamelaWibleMD

        Oh, and by the way, this is not a essay that I submitted to KevinMD. It was on my persona blog (with lots of favorable comments). Kevin chose to run this and the photo. Fine. Yes, a conservative medical audience may not always enjoy these humanistic medical pieces as much as the general population. Sometimes docs can be out of touch with what patients really want. Honesty, many patients value transparency, authenticity, and professional closeness Unfortunately, many physicians are uncomfortable with the emotional, spiritual, and even physical needs of their patients. Reductionist medicine values and pays for flow sheets and data, not hugs.

        • DoubtfulGuest

          I’m no conservative, Dr. Wible. I’m a patient telling you that this kind of thing would seem like –disinhibition (as a medical sign), if anybody who is not a doctor came across this way. Are you feeling alright? Can no one disagree with you without being accused of being emotionally stunted? You don’t seem interested in how you come across. You don’t seem to value input from your colleagues who you’re trying to help. The only thing I know to do is stop reading, sorry.

          • PamelaWibleMD

            the focus of my writing and photos is to start conversations on taboo topics or areas that are usually not discussed so by all means please disagree. State your points. I enjoy a good debate.
            Ad yes, I am feeling well.

          • PamelaWibleMD

            And, of course, my writing is my opinion. I am not discounting anyone else’s experience or opinions. We all have right to self expression. If I have bashed anyone else’s opinion, let me know. I am not the type of person who does that. We can agree to disagree with civility. Right?

          • DoubtfulGuest

            Okay, thank you. I really do admire your work. I just feel like people may have valid reasons for disagreeing with some of your portrayals and it doesn’t mean they’re unfeeling. Or even conservative.

          • PamelaWibleMD

            Yes true.

          • DoubtfulGuest

            Possible points for debate: What is the role of love in the doctor patient relationship? And what are the most appropriate ways to show it? I’d say I feel a form of love for my doctors. But what I look for is evidence-based medicine, basic courtesy, and compassion.
            I get concerned about this whole “what patients *really* need” business. In rare cases, that could lead to one party or the other taking advantage. Contrary to what some people believe, it really could go either way. What’s much more common probably is the doctor feeling emotionally drained. I’ve had lots of doctors assume I was there primarily to get emotional needs met. Nope, I needed them to crack open their biochemistry books and do some science-based medicine. We all want to be treated kindly, of course.
            Should we ever pay anyone to love us, really? But then doctors used to be valued members of the community. You could argue that there was love involved, when doctors made enough money to live comfortably and folks were glad to compensate them. It’s an interesting problem.

      • buzzkillerjsmith

        Thanks I needed that.

    • PamelaWibleMD

      See Bertolt Brecht quote.

      • ninguem

        “Will you please giive us one reason to not thin that you have gone completely around the bend?”

        No I agree with buzzkiller before the spell correct.

        I thin you gon round the bend

        I thin I’m gonna call a physaciatrist.

        i1.ytimg.com/vi/IPy9-zVEhVY/hqdefault.jpg

        • PamelaWibleMD

          Why do people keep comparing me to Lucille Ball?

  • Lisa

    I don’t want my doctors to tell me they love me, or to kiss my forehead. I want to have a professional relationship with them. I want my doctors to pay attention to be clear in what they have to say to me, to listen to what I have to say and to be willing to answer my questions. I want their prescriptions (if any) to be appropriate. Telling me you love me won’t help me a bit. Giving me a script for physical therapy might well be helpful.

    This is one of the silliest articles I have read.

    • PamelaWibleMD

      And some patients do better with less emotional and spiritual contact. This is the art of medicine. It is up to the physician to understand what a patient really needs. The older burned boy in the “silly” essay above needed love. It’s obvious. Maybe you would prefer a review of your labs and a discussion of the pros and cons of a particular therapy. Maybe, in your case, a hug is not what you need. I think of most of the elderly patients I see and they are starving for affection and human contact. Many admit coming to the doctor just so they can have human contact. So it is up to the doctor to fully understand the chief complaint – even when it is not stated. Medicine is not a one-size-fits-all profession.

      • DoubtfulGuest

        I’m not confident that this one is about the *patients’* needs.

        • Patient Kit

          That was my exact first thought when I read this OP (and saw the accompanying photo).

          • PamelaWibleMD

            By the way . . the photo makes even less sense now that KevinMD retitled this essay. It used to be titled: Why I prescribe the love drug.

            And honestly (you have to admit) it would be great if we could prescribe love in a pill instead of Prozac. Those among us who are uncomfortable giving hugs and kisses could just write the script without getting out hands dirty. Plus . . .
            It’s true: People die without love.

          • Patient Kit

            I don’t debate at all that people need love. But as a professional, where exactly is the line between you and your patients beyond which you won’t go to both give and get love? I do want compassion and caring and respect from my docs. I want us both to be human with each other. But I don’t want them to lick me.

          • DoubtfulGuest

            I expected someone to post a Gene Simmons pic hours ago. Seems like a missed opportunity.

            And I too, want to know where the line is.

          • Patient Kit

            This post and photo, besides putting Roxy Music’s “Love is the Drug” in my head, has me re-visiting my Rocky Horror Picture Show days. “Come up to my lab and see what’s on the slab.” says Tim Curry’s Dr Frank N Furter with liberal use of his tongue. I wonder if I still have my old RHPS “Don’t Dream It, Be It” t-shirt somewhere. ;-). I was never into KISS but I do like The Rolling Stones. LOL! What a tongue tangent!

          • DoubtfulGuest

            I had been planning to hold my tongue this time, but wasn’t successful.

          • Patient Kit

            I’m slightly sorry that I didn’t hold mine.

          • Dr. Drake Ramoray

            I didn’t think of Gene Simmons. I almost posted Borat in his Mankini instead of the Jason Alexander pic

          • PamelaWibleMD

            Yes. I like my patients; I don’t lick them.

          • DoubtfulGuest

            Patient Kit asked you a serious question.

          • PamelaWibleMD

            “Where exactly is the line between you are your patients beyond which you won’t go to give and get love?”

            I keep things professional at all times. I do not have deep personal friendships with patients though I do have friends-aquaintances as patients. Absolutely no physical relationship outside of medical exams. That being said, I have done house calls and brought patients medication, get well balloons,and even hot soup when they were sick. I have given patients rides home when cars broke down. I’ve invited a group of patients’ to my home for dinner once.

            As far as receiving love, patients have given me car rides, taken care of my pets when I’m on vacation, and brought me surplus garden veggies. I have been invited to patients’ homes for dinner. Nothing too out of the ordinary.

            Somehow, I feel that the way my patients and I interact must be how things have always been between docs and patients in small towns in the good old days.

            Does this answer your question Patient Kit?

          • DoubtfulGuest

            That all sounds nice, I don’t see a problem with it. I recall now and then from books I read as a kid, that a doctor would be invited over for dinner by the family, just like they’d invite their schoolteacher or their minister. I have a lot of respect for your independent model of practice. I’m also in agreement that doctors’ feelings and quality of life are important. I just don’t understand the delivery, or “packaging” of all this sometimes.

          • PamelaWibleMD

            I think I should bring a videographer into my office to show how a small clinic operates. It is hard for people to imagine how this works without seeing it with their own eyes.

          • DoubtfulGuest

            As long as patients can give informed consent to be featured or not, I think that’s a wonderful idea. I’ll keep my eyes open for it. And I think the logistics of running the clinic would be of interest to lots of people.

          • Lisa

            It seems to me that interactions you are describing above are quite a bit different than what you describe in the article. What you are describing seems more like the relationship you would have with neighbors revolving around mutual respect and friendship.

          • PamelaWibleMD

            Yes neighborly love would be a great way to describe this.

          • Marie Noybn

            i can see if your patients are generally either geriatric or pediatric how the hearts and flowers and kisses “medicine” might fly better, just be sure you see to their physical needs as WELL as their emotional ones. Your article seemed to be indicating we should take away pain killing and life saving medicines in favor of a kiss on the forehead, which is why i initially responded the way i did. My doctor is very kind, gentle, and understanding, and i love him for it, but he knows what i need medically and does the best he can to provide it (and no he isnt my pain doc, my pain doc sees me once every couple YEARS and just writes scrips through his nurse practitioner the rest of the time because i am a low maintainance patient who only needs her meds adjusted every couple years as the tolerance grows, so he keeps his time for those who need him i suppose. Would it be nice if he spent a bit more time making sure i was doing well? Sure, but making sure i am in a lower degree of pain than without the meds so i can somewhat function (he never gives me enough to take me out of pain, just balances on the fine line between not enough to frack with my liver, and just enough to dull the pain) and take care of my family day to day is much more important to me, so i leave him be and he leaves me be. I consider him a pill dispenser (or patch dispenser, whatever) while my GP is my “real” doc even though he is not able to deal with my pain issues. All in one would be better, treat the whole me, but, meh, it doesnt happen much these days.

          • Patient Kit

            Yes, thank you, it does. And that all sounds great. It’s just not the impression you created with your original article and, especially, the photo you posted with it. The tongue photo didn’t make me think of patients and docs breaking bread together around the dinner table. I think the photo was attention grabbing but, unfortunately, created a different impression than you were going for. But I’m all for all of us staying human with each other.

            Funny story that you might enjoy: I live in this little town called Brooklyn, NY. We have a population of 2.5 million out of NYC’s total of 8+ million. And yet, I still once found myself lap swimming, showering and sitting in a sauna at the local Y with one of my GYNs. There was an initial awkward moment but we handled it with mutual senses of humor and continued to cross paths at the Y. It was actually kind of funny and humanizing to see my doc in only a towel. It kind of leveled the playing field a little, although not that much. Nothing we did at the Y matches a pelvic exam. ;-). But at least my doc saw firsthand that I really do workout. I remember feeling a smidge competitive with her. Like no way was I going to swim fewer laps than her. I don’t know if she felt the same way. But a few times when we were in the pool together, we both swam for an unusually long time. :-) Brooklyn can actually be an amazingly small town sometimes.

          • DoubtfulGuest

            That’s hilarious, Patient Kit. Especially the competition part. She’s thinking “I can’t have my patient getting the impression that I’m a slacker with exercise, or she’ll tell ten friends”.

          • Lisa

            I see two of my doctors at my local climbing gym on a regular basis, and have climbed with one of them at our local crag on occasion. It is sort of funny to me when I see them in a professional capacity. I have to do a bit of a mental switch.

          • PamelaWibleMD

            When I first moved to town and worked at the big multi-specialty group, I was assigned to another doc to kinda look over me and gel me get established. (kind of a big sister role). Well, she took me to this clothing-optional hot springs where we soaked naked in on a mountainside in the woods with a bunch of other random people. One just happened ot be a local cardiologist. I thought that was a very interesting way to introduce me to the other doctors in town!! Very different that my time in Texas or Arizona. Oregon. Wow.

      • Lisa

        The older burned boy in the essay may well have needed love, but I think a doctor couldn’t offer enough in the time available. In a hosptial setting, the nursing staff spends (or should spend way more time) with the boy. More than the doctor, they have a chance to see the interaction between the boy and his family. They can encourage the family to be more affectionate and can involve other resources to give the boy what he needs.

        That isn’t to say his doctor shouldn’t be affectionate, but what the doctor can offer is a drop in the ocean of his need. The same thing with elderly patients. There is nothing wrong per say with being affectionate, but if they are truly starting for affection and human contact there are better places to get it than the doctor’s office, imo. And if the doctor recognizes that need in patients, perhaps they could steer the patient toward activities that would increase their contact with other people.

        • PamelaWibleMD

          Maybe I’m unusual. I’m sure some folks think so. I used to spend my evenings (after work) as a med student holding sick kids. I also was the student in college who preferred spending Saturday nights volunteering at the women’s shelter rather than going to frat parties.

          • Lisa

            And such activites are wonderful things to do.

          • Kristy Sokoloski

            I don’t think you are unusual at all. I wish more doctors were like this, but I know everyone is different. I just want all of us to find doctors that can help us the way we need to be helped when it comes to our health.

      • Kristy Sokoloski

        Dr. Pamela,

        I remember having read that before about those that are elderly make appointments with their doctors on a regular basis because they just don’t want to be alone and need the contact that they starve for. And I agree with you about that Medicine is not a one-size-fits-all profession. Too bad so many want to follow a cookbook full of recipes when it comes to this profession.

        I hope that this because a topic that you do for another TED talk if you do another one in the future. I am still in the middle of watching the one you did about How to be Naked with your Doctor. I found it very impressive so far. I look forward to finishing to watch it.

        • PamelaWibleMD

          Ah . . .please share the TED talk. There are so many ways to practice medicine. Sometimes we are held hostage by our lack of creativity and imagination. Just pushing the edges a bit:
          https.www.youtube.com/watch?v=5cvHgGM-cRI

          • Kristy Sokoloski

            I watched the entire talk. Very good job. I hope you do more because the way you explain things is easy to understand.

    • Kristy Sokoloski

      Lisa,

      It’s ok if you don’t want your doctors to tell you that they love you or to kiss your forehead and just keep it strictly professional without that emotional rapport. Like Dr. Pamela said some patients do better with less emotional and spiritual contact. I am one of those that I need a bit of that emotional contact with my doctors because of my journey down the road of dealing with chronic illness. It is very stressful at times.

      We must all do what we find works best for us on this front when it comes to our journey through the healthcare system. I am glad you found a way that works for you.

      • Lisa

        Kristy, I honestly don’t know how to respond to this post. I feel like you are being patronizing.

        I don’t think emotional conact is achieved by having someone telling me they love me or kissing me. Emotional contact is achieved over time. If you make a new friend, you talk, you do things together and you learn about it each other. Real closeness doesn’t usually happen instantly, no matter how much you like someone. If you see a medical professional for a period of time, you do develop a relationship with them and part of that relationship is emotional. But I would prefer that component of the relationship be based on mutal repect and understanding, rather than declarations of love.

        • DoubtfulGuest

          Couldn’t have said it better, Lisa. It’s difficult because there has to be a tiny bit of an instant connection, in that patients are supposed to trust the doctor and tell them all kinds of personal stuff. But what I really need from the doctor at that point is concern for my welfare. There are still very strong boundaries early on, because I’m telling them for the purpose of diagnosis and treatment only. People can just say they love someone and get all gooey, but it can be quite shallow that way.

        • Kristy Sokoloski

          I was trying to assure you that it’s ok as to what works for you. I am sorry you misunderstood that intent. Again I apologize. And I agree, that real closeness usually takes time to achieve.

          • Lisa

            Kristy, I don’t need that assurance – that is why your post came across to me as patronizing. That said I don’t think you meant to be, so no worries. I think it is hard to read tone in on line conversations.

          • Kristy Sokoloski

            I agree with you about that it can be hard to read what the exact tone someone had in mind when making a comment when it comes to online conversations.

            And no I truly didn’t mean it that way. I am sorry if I misunderstood the tone of your message as well. But yes, it most certainly did take time for the kind of relationship that I now have with my PCP to build to where it has. It did not happen overnight and I would never expect it to happen that way with any of my other doctors.

            I do enjoy the discussions with you even if it’s something that we may not agree on.

      • Patient Kit

        I’m finding it a bit insulting that you seem to be implying that those of us who disagree with the details of Dr Pamela’s approach somehow must do better with less emotional and spiritual contact. Genuine love and emotional intimacy must be built over time between any two people, including doctor and patient. I think it’s fairly safe to say that we all want that. But do I trust a doctor who is advertising and selling InstaLove? No, I do not.

    • buzzkillerjsmith

      So I should cut down on the rolfing in my practice?

      • Lisa

        :-)

        My rolfer has never told me they loved me, not once. But she has helped me deal with chronic pain issues and I love her – of course, as a professional.

    • Anne-Marie

      I think our culture tends to equate love with eros, or sexual love. What Dr. Wible seems to be addressing are the other types of love – philia, or friendship; storge, or affection; and agape, unconditional love. Y’all can read C.S. Lewis for a more complete explanation.

      Eros between a doctor and patient would definitely be inappropriate, but friendship? Affection? It seems to me that the ability to connect with others is what makes us human – something health care needs more, not less.

      • DoubtfulGuest

        Anne-Marie, please go read some bioethics papers on different aspects of the doctor patient relationship. If you act like only the unquestioning Dr. Wible followers know anything about love, you are actually hurting her cause more than you can imagine.

        • Anne-Marie

          I’m sorry? Either I wasn’t clear or you have completely misunderstood my point. I have no idea what you’re trying to say.

          • DoubtfulGuest

            I don’t know either, Anne-Marie. I don’t want to fight. It’s just that your comment appears quite condescending.
            “Y’all can read C.S. Lewis for a more complete explanation”.

            OF LOVE? As though people are somehow against it or unaware of it? I’m familiar with C.S. Lewis anyway.

            Your second paragraph is fine, and I agree with it. Although some doctors want to be friends with patients and some don’t. That’s okay.

            But your statements indicate that you didn’t bother to read or understand any of our points before disagreeing. We actually said some of the same things and are just looking at different sides of the issues.

            Would you please go read some bioethics papers? It will make more sense then. Thanks.

      • Patient Kit

        I’m sure we are all very aware that there are many kinds of love — not just sexual and/or romantic love. But let me ask you this: If the tongue photo was posted with an article about the love shared by parents and their children, how would you react to the same photo? And please ignore my admittedly bad comparison of the parental-child and the doctor-patient relationships. I would certainly never treat my docs like they are children. ;-)

        • PamelaWibleMD

          Again, the photo was about taking a “love pill.” See original blog with all positive comments I might add here: http://www.idealmedicalcare.org/blog/why-i-prescribe-the-love-drug/

        • PamelaWibleMD

          And Patient Kit – why do you think the general population (including med students and even a nurse) would have such an overwhelmingly positive response to this blog on my page and then when posted on KevinMD so many would have such a hard time with the photo?

          Multiple choice:

          A) The crosspost retitled by Kevin made the photo confusing. The photo makes more sense with the original title: Why I prescribe the love drug.

          B) Medical folk on KevinMD have more trouble with the concept of love, lips, even glitter. Docs might be out of touch with the general population.

          C) KevinMD readers/commenters are more conservative than the general population.

          D) All of the above.

          E) None of the above.

          Feel free to write in your own response. I think this is absolutely fascinating, btw.

          The original post (well-received) here: http://www.idealmedicalcare.org/blog/why-i-prescribe-the-love-drug/

          • DoubtfulGuest

            E) None of the above. Readers on your blog self-select to your type of posts. Readers on Kevin expect deeper issues-based discussions including ethical aspects of the doctor-patient relationship.

            I will skip the next one. All the best to you, though.

          • Lisa

            I tend to agree with you on this response. I think the audiences are are very different, in part because the readers of Kevin MD are more involved in things medical, while the readers of Dr. Wilble’s page come from a wider spectrum.

            And clearly the readers on Kevin MD like to debate. It is what makes it interesting.

          • DoubtfulGuest

            Also, about choice B). This is where you’re alienating your colleagues, Dr. Wible, and coming across like you think you’re better than they are. You don’t listen to them at all and you just make fun of them for not liking glitter. And you think they know nothing about love? You think they don’t have many patients who are perfectly happy with their care? Besides, even if patients want certain things, it doesn’t mean we should get it. Why are patients so intrusive with their doctors sometimes and why do we have such high expectations for emotional care? And why won’t anyone talk about that?

          • PamelaWibleMD

            Not trying to alienate anyone. Just curious about widely divergent views on blogs. When I led town halls and invited citizens to design their own clinic I realized how some patients feel a disconnect from doctors and stop going to allopathic physicians. I am trying to bridge the divide between patient (gen population) and docs. There is no one way to practice medicine. I never, ever thought or said I was better than any other doctor. In fact, I was in the middle of my class academically and jealous of all those super smart classmates – some never needed to study and made all As. Wow. Impressive. We all have our strengths.

            Never said others know nothing about love. Never implied other docs don’t have happy patents. Some patients are intrusive with their doctors because they have emotional needs that med school wasn’t great at training us to handle. I went to a residency that had a focus on behavioral health so I got more training in this area as an FP.
            And I had more of an interest in psychosocial issue than procedures.

          • DoubtfulGuest

            What about asking society to have more reasonable expectations of doctors? To redirect emotional needs appropriately? Instead of this kind of thing?

          • PamelaWibleMD

            Some doctors are more comfortable with emotional and spiritual content in office visits. Some docs and patients who share the same faith actually hold hands and pray during their office visits (and bill insurance for it – another can of worms)

            Doctors are obviously overextended with the sheer quantity of their work. So best not to ask a doctor who is emotionally drained to help you with emotional needs that may be better met by your pastor or your therapist.

            I am little by little trying to educate patins in the proper use of medical services. This is exactly what I wrote about here on the proper use of ERs:

            http://www.idealmedicalcare.org/blog/how-to-save-90-on-medical-bills/

          • DoubtfulGuest

            I really liked your post about the ER. I think it would be extremely helpful to have similar public education about the different types/training of doctors and how to work with different doctor personalities.

            We often don’t find out about a doctor’s personal preferences until it’s too late. On top of that, misunderstandings are very common. We often get something opposite of what we’d expect. Sometimes, a doctor will ask lots of psychosocial questions in an angry way, even if there’s no reason to think it’s the cause of our complaints. Primary care doctors especially are all over the map with their preferences.

            Sometimes a specialist will ask lots of emotional-type questions, too, and if we just want to stick to medical facts, they may feel we don’t like them or trust them. Others will freak out or shut down at the mention of any psychosocial concerns, even if their prior behavior seemed to welcome it.

            Have you ever seen this blog? It’s really sad and funny at the same time. It explains some things well, even though I think it puts too much responsibility on the patients:

            (There is some bad language…your prerogative to read or not)

            http://askanmd.blogspot.com/2011/06/what-to-do-if-youre-bad-patient.html

          • Patient Kit

            I agree with DG on this — none of the above. The regular readers of your blog probably are self-selecting to your style and main message. I find your B suggestion to be extremely insulting to the participants on KevinMD, both doctors and patients. That’s a pretty arrogant theory: That we have trouble with the concept of love (and the implied you know more about love and have no issues). And frankly, in our interactions, I feel like you don’t really listen to or hear what I’m saying. Your communication style seems almost like you are campaigning (on the Love Party line perhaps.). My point being that truly listening is an essential part of relationships and, therefore, of love. I would have thought that someone who professes to know so much about love would know how to listen — and hear.

            As for your C theory, I can’t speak for the other peeps of KevinMD (I imagine we run the whole spectrum). But I can tell you that I’m pretty much the opposite of conservative, both politically and sexually. I’m sure the peeps I hang with in NYC would more than match the liberalism/progressiveness/free spirit (whatever you want to call it) of Eugene, OR. Seriously, I don’t have
            problems with “the concept of love”, Dr Wible.

            I think k our interpersonal communication issues are far more serious than disagreeing about a photo.
            I

          • PamelaWibleMD

            I’m sorry if I offended anyone. I think what I have noticed in my medical training is that professional distance can blunt the free flow of emotions and some patients are looking for that connection and some doctors do not feel they have the time, emotional reserves, etc . . . to deliver what patients seem to need (and often do not say). Heck, I have not been able to do this either. There is a point when one is emotionally spent.

          • DoubtfulGuest

            This post is mainly not about patients’ needs.

          • PamelaWibleMD

            Then what would you say the post is about DoubtfulGuest?

          • DoubtfulGuest

            It appears to be an expression of a doctor’s conflicted emotions.

          • PamelaWibleMD

            About . . .?

          • DoubtfulGuest

            About patients’ emotional needs. About having trouble balancing their needs with your needs. I sense some anger in the post and the photo together, even if it’s also a pop culture riff of sorts. And some venting. Venting can be okay, but it seems kind of under the surface here. I interpret this post and the “intimacy” post together as a theme. The photos come across as “acting out” in a way.

            I read this post as “My patients have a lot of non-organic complaints. I love them, and I really want to help them, but I get tired. I don’t always know where I end and they begin. How can I give them what they need, but quick and easy? Like a pill?”

            Of course, one reason for a quick fix, is if someone is really hurting, you want to heal it sooner rather than later. That’s a good reason. But long-term impacts are also important. And what are the side effects of love in a pill?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Oh, I do not feel anger at all. I absolutely LOVE my work. I enjoy my patients. I have overextended myself in the past in a few cases. And I have neglected self care so IF I have been angry (very rarely) it has been with myself for skipping lunch or not having the sense to take care of my own needs so I can be fully present for others.

            So to be clear, I do not have or feel any expression of anger in these bogs. I see them more as a celebration of loving my work as a physician.
            And my blogs are really conversation starters.
            I think that has been successful here. (from 0 to 250 comments in 3 days – shocking really)

            Hope that makes sense.

          • DoubtfulGuest

            I never doubted for one second that you love your work. My interpretation is based on this post, the photo, a couple of your videos, and at least one previous post. Plus what appear to be dismissive responses to several other people’s legitimate concerns.
            I tend to believe you when you explain things. And I can’t see what’s in your heart. But something doesn’t add up here. My guess is that there are some negative feelings mixed in with the good ones. They don’t diminish the positive ones in any way, but they seem to be largely unaddressed. Maybe I’m wrong, but I don’t like how whatever it is, has hurt some other people reading your post.
            Best,
            DG

          • Suzi Q 38

            Dr. Wimble,
            Your thought was in the right place.
            Acknowledge that not everyone will be happy.
            Your transparency and openness is refreshing.

          • PamelaWibleMD

            ok.

          • PamelaWibleMD

            Hey Patient Kit ~ hard to discuss some of these things well online. I bet if we shared a cup of tea together and had a live in person discussion we’d get a long great and probably see eye to eye on things, ya know. . .

          • DoubtfulGuest

            Patient Kit is right, though. I’m frankly quite confused by your approach. You like to dish out provocation, but you don’t like to take it. I made some points elsewhere, stuff for you to think about, and you breezed right past. This is a very painful topic for me, but I’ve made a sincere attempt. So, please don’t come back on those comments with brief platitudes, okay? I give up.

            Perhaps something is missing because it’s not in person. But I feel it’s really unkind to try to provoke people on such emotionally charged topics, and then keep it light n’ fluffy, never let it get past a couple levels of analysis. It’s like the word that starts with p- and ends with -orn. Solicit attention, manipulate people’s feelings, but there’s really no there there.

            Then your supporters come on here and say we don’t get it about love. Why not just call anyone who disagrees with you subhuman? You can’t get much worse than that.

            I can’t understand it because you have many worthwhile things going on that people would love to learn more about. But they need nitty gritty details of how things work, and that doesn’t carry the emotional arc of the kind of things you like to post instead. It might do more good in the long run…but it’s not clear what you’re truly going for.

          • PamelaWibleMD

            Please ask me anything. I will give it my sincere effort to answer comprehensively. Sometimes when I am responding between patients I do not have the time or energy to leave a comprehensive answer, but it is 9:00 pm and I am not going to bed for 3 or 4 more hours. You’ve got me now.

          • DoubtfulGuest

            I don’t want to keep you up late. I can understand your time constraints. I haven’t known how much time you had available or wanted to devote to your posts. I’m glad everyone else has had fun. I just can’t anymore.

            I don’t think anything that Patient Kit, Lisa or I brought up in good faith has been addressed respectfully. Maybe I’m the problem, that I can’t deal with the topic because of the way I was treated. I didn’t actually do anything wrong, the doctors just assumed I was going to because they couldn’t figure out how my symptoms fit together. A brief review of cell biochemistry would have explained it for them, but they decided to attack my character instead.

            This is not your fault, of course. I just think doctors need to be careful when making assumptions about patients’ emotional needs, and I don’t see you being careful.

          • PamelaWibleMD

            I’m sad that you feel that way. I try to answer everything presented to me.

          • DoubtfulGuest

            I don’t want to make you sad. I’m feeling pretty cruddy as well. PK and Lisa have their own concerns. I appreciate all the time you put in responding, there are just usually so many unanswered questions. The other doctors who answer are very clear and more in-depth, even if it’s just one long reply. Even if I don’t agree with them 100% I can at least see where they’re coming from.

            One thing I didn’t see addressed here (and maybe I missed it because my Disqus is hiccuping since yesterday) is, I know you got a lot of positive feedback from patients on your photo, but how do you really know if they’d feel they can tell you if it makes them uneasy at all? Maybe it’s unanswerable? But if a patient is dependent on a doctor for medical care, particularly for a life-threatening illness, it’s hard to disagree with the doctor. The stakes are really high for patients, even if you don’t intentionally hold that over their heads.

            That’s the kind of thing I would need to see considered if I’m going to be involved in future discussions of professional closeness. At least, if you showed some awareness of it would really help.

          • PamelaWibleMD

            Yes, Some patients may not feel comfortable to confront their doctor with an opposing opinion. Most of my blog comments are not from patients, but from the general public. Hope that helps.

          • Suzi Q 38

            I am fairly conservative.

            I enjoy your posts. They are different, and your pictures are good. I can appreciate the marketing and thought that it took to stage a picture designed to garner attention and debate.

            What fun!

          • PamelaWibleMD

            Aw thanks! I just got back from another photo shoot. No lips. No glitter. This time farm animals. I think the message is pretty darn good. Coming soon. Title: “The Shocking Ingredient in Natural Medicine.”

          • PamelaWibleMD

            On my personal blog you can read “The Shocking Ingredient in Natural Medicine.” And no intimacy and boundary issues in this one:

            http://www.idealmedicalcare.org/blog/the-shocking-ingredient-in-natural-medicine/

  • EmilyAnon

    If anything, Dr. Wiebel’s posts always generate a lot of comments, which you all have to admit, can be fun to read.

    • PamelaWibleMD

      Ah . . . you just like watching doctors squirm.

      • Kristy Sokoloski

        And showing a human side at times. :)

  • Patient Kit

    I checked my calendar and it’s March — not February or May — and, therefore, not a sweeps month at KevinMD. On the plus side, thanks to this OP, I now have Roxy Music singing “Love is the Drug” in my head. I love Bryan Ferry’s voice. Now I’m flashing back to dancing and drinking on a soccer field in Barcelona at a Roxy Music concert.

  • DoubtfulGuest

    This sure took awhile to post. I guess the word “beach” was potentially NSFK (Not Safe For Kevin)?

    • Patient Kit

      LOL! When two of my responses on this thread failed to show up, I thought I was being censored by KevinMD for the first time. I wonder if the other missing one was deemed too something.

      • Suzi Q 38

        Censoring happens.
        I feel that we should not be censored.
        If the doctors aren’t censored, why should we be?

        • DoubtfulGuest

          They are, I think? They complain about blocked/removed posts all the time.

          It’s funny what makes it through and what doesn’t, sometimes.

  • Patient Kit

    LOL! When two of my responses on this thread didn’t show up, I thought I was being censored on KevinMD for the first time. I wonder if the other missing one was deemed too something?

  • JR

    I think this article and comments beautifully illustrate that doctors have different approaches, and patients have different needs, as we are all individuals.

    The question is: ]how do we connect the right patient with the right doctor?

    • PamelaWibleMD

      Patients do not want cookie cutter doctors or cookbook medicine. Assembly line medicine fails when it creates a homogenized experience for everyone.

      • JR

        I’ve had providers treat me like a human being, with compassion, and others who treated my body like they were a mechanic performing an oil change*. I know which one I need.

        *from your blog, love it.

        • PamelaWibleMD

          Did you know that medical clinics and hospitals often employ Toyota manufacturing principles?

          • JR

            The first time I heard “Six Sigma Green Belt” I assumed it was for martial arts.

          • JR

            I’m hoping your “doctors are afraid” post gets posted here later.

          • DoubtfulGuest

            The vagina one? I was hoping not. Again, the issue can be addressed, but I don’t think that was the best way to do it.

            The women in the photos look like really nice folks. But it seems like a fairly sensationalized take and I’m not sure it’s going to change anyone’s mind.

          • PamelaWibleMD

            It’s all about having conversation on some difficult topics.

          • JR

            The first time I saw the cover of Pet Goats and pap smears I thought it was horrendous. But I’ve changed my mind.

            Getting a pap smear isn’t like getting your throat checked. I appreciate the recognition that there is a sexual aspect to pelvic exam, and just trying to pretend to be “professional” and ignoring it doesn’t make it go away, it’s just this big elephant in the room. For me I’d rather treat it like the big deal it is.

            A pap party? LUDICROUS. But now I see it’s about taking that uncomfortable and awkward experience and making it as low key and comfortable as possible.

            I think I’ve been lured to the dark side.

          • DoubtfulGuest

            I’m glad you brought this up. I’ve been wondering…how do the pap parties fit in with a possible cervical cancer diagnosis for one of these nice young women?

            I had less of a strong reaction to the cover of PG&PS, although maybe I am getting more “prim” in my old age. I can hear my Grandma saying: “Well…that’s…different…The goat is nice, anyway…”

            I can appreciate your point of view. People are just so different about this stuff. That’s one reason I tend to be more reserved. Because everyone is different, it’s easy to step on someone else’s toes. I never found pelvic exams to be a very big deal to begin with (and after a hysterectomy, they’re really quick!).

            I compartmentalize a bit when I go to the doctor, for exams of any kind. I don’t mind the “auto mechanic” aspect, because for me it just means that the doctor is concentrating on doing his/her job right and I’m maintaining some privacy. That doesn’t mean negating any aspect of my life. I’ve had the disrespectful version of the auto mechanic doctor, too, and that’s horrible, I agree.

          • PamelaWibleMD

            1) “after a hysterectomy, they’re [pelvic exams] really quick!” + “the doctor is concentrating on doing his/her job right.” Umm . . assuming you had a total hysterectomy, why are you getting pelvic exams? Hope you are not getting Paps.

            2) Pap parties just help people have the comfort they need to actually come to the doctor and get screened. I don’t care if they show up in a party hat with mardi gras beads and a goat as long as they are getting proper screenings. A true PCMH would allow for this.

            3) Post a pic with your cardboard sign please. Helps me not feel so alone.

          • DoubtfulGuest

            1) No pap tests anymore. Annual exam to check for signs of recurring endometriosis (pain or anything abnormal that the doctor could feel). Mine was quite aggressive, didn’t respond to Lupron, so my gyn surgeon is being cautious. No symptoms or problems = really quick exam.

            2) I don’t have a problem if other people like it and there’s the option to have the fuddy-duddy exam instead.

            3) Sorry, my policy is to attempt to maintain some internet privacy. I don’t want you to feel alone, however, because I am supportive of a lot of what you’re doing. Hmm…perhaps I could just make the sign be my profile photo…I’ll have a think about it.

          • JR

            I’m surprised someone could find this picture sexual and pelvic exams non-sexual.

            Besides patients, many medical students (and even some practicing doctors!) find pelvic exams disturbing. This is an overview from a med student about the way it was taught at their institution, and why they dropped out of medicine all together:

            http://patientprivacyreview.blogspot.com/2011/07/medical-education-modesty-concerns.html

          • DoubtfulGuest

            How does one go about receiving or giving care for a problem in the pelvic region if one can’t be involved in a pelvic exam?

            Please don’t *marginalize* my viewpoint, or misrepresent my comments on the blog photo.

          • JR

            Patients can self swab for hpv testing (more accurate than pap) and self swab for stds and other infections as well.

            In studies, bi manual pelvic exams have shown to have no use in diagnosing un-symptomatic women, and aren’t even performed in many other countries (like in the UK). Even the ACOG confirms there is no evidence confirming the value of the exam but that the decision should be left between a “patient and their doctor” depending on the patient’s personal perspective and values.

            What about a woman with symptoms? In one study I read, they performed a bimanual exam on women right before surgery (easiest to feel masses when the woman is not awake) and then compared the findings to the surgery. The results were dismal. Worthless for diagnosis or ruling out a problem.

            There are a lot of studies about digital rectal exams being useless for abdominal pain and other problems as well.

            I’m comfortable declining such exams based on the evidence. Other women are feel to make their own choices.

            Obviously, some doctors need to be able to do them as there are cases where it is warranted. But not all med students should have to learn to do them, just like not all med students learn to do colposcopies.

          • DoubtfulGuest

            I didn’t say all med students should be required to do them or that all women should be required to have an annual exam…

          • JR

            And I’ve never said a patient should bust down their doctor’s personal barriers (which are coping skills they use to deal with their professions).

            But I am planning to ask my doctor what his philosophy about the doctor/patient relationship is at the next appointment. I think I know but I figure I should ask, maybe I’m wrong.

          • DoubtfulGuest

            You might give the poor guy a break, JR. Are you familiar with “external considering”?

          • JR

            I just did a quick read on what that is, and I would call that “empathy”. I have always avoided rocking the boat and tried to be a “good patient”. That is my problem. I’m told I need to be more assertive, so I’m working on being that way. It’s been working out just fine.

            And, now that you are stooping to personal attacks again, we’ll stop the conversation.

          • DoubtfulGuest

            It’s not about being passive or avoiding rocking the boat. My statement about doctors’ boundaries was not about you. Maybe next time you could ask me if you’re not sure what I was saying? It was meant to be supportive of doctors who may not feel comfortable with Dr. Wible’s approach.

            You attacked my personal views based on my personal experience and values. You twisted my statements instead of asking for clarification. I showed respect for your view. What keeps you from doing the same for others?

          • JR

            You sent me, hmm 4 or 5? comments last time DEMANDING I RESPOND TO YOUR QUESTIONS.

            Frankly, you’ve misjudged me and my character. You’ve created this idea in your mind of who I am. You’re completely off the mark.

            I’m not here to talk about myself. I’m here to talk about others. I’m here to change the system. It’s time to provoke some change.

            Please stop asking personal questions, like asking about my relationships with others. It’s completely inappropriate, and contrary to my purpose here. It’s also a derailing tactic.

          • DoubtfulGuest

            JR, you don’t have to answer anything personal. You make statements, sometimes people are going to ask you to elaborate out of interest. Everyone talks about themselves sometimes, including you. I apologize for misunderstanding you.

            My main concern about Dr. Wible’s post here is the complete lack of acknowledgement of ethical issues. I also made many supportive statements.

            Any time it seems I’m attacking someone, please feel free to jump in and ask me to reword my statements. I find online discussions very challenging, but they seem worthwhile here so I try.

            About last time, I think people generally try not to carry over bad feelings from one post to another. We have agreed on some things in the past, and perhaps we will again one day. It’s funny to see how people line up, like being at one another’s throats about racial discrimination, but having the same views about patient care.

            I also felt bad about the way our previous discussion ended up. I have to step out for awhile, but maybe we should go back to that post and continue the discussion until we both feel happier with it. I’ll have some time later today and would gladly respond. It’s my turn, I think, but I’d let it drop because I thought you were quite done with me.

          • PamelaWibleMD

            I don’t mind discussing anything relevant to the article. But could you please elaborate on and ask me specific questions based on your comment:

            “My main concern with Dr. Wible’s post here is the complete lack of acknowledgement of ethical issues.”

          • DoubtfulGuest

            Okay, thank you very much.

            I feel that if a patient presented most doctors with an image similar to your photo (let’s say they show up at the doctor’s office with glittery lips, or they show the photo and say here is my artistic statement about the doctor-patient relationship), it would not go over well. In fact, I suspect that any such patient would find themselves with one of several diagnostic labels, whether or not that would be fair or accurate.

            1) What are your beliefs about the ethical obligation of a doctor toward one’s patients to maintain clear and consistent boundaries, uphold the fiduciary relationship and maintain objectivity?

            2) How do you adapt your care approach to patients with different values (e.g. religion, culture) especially regarding sensitive topics?

            3) What do you believe is your responsibility to your colleagues regarding your public statements e.g. blog posts?

            4) Same as #3 except for the public, laypeople in general including your patients.

          • PamelaWibleMD

            1) I provide office policies with my expectations of my patients and my responsibilities to patients. If either of us feel we are not a therapeutic match that it is in the best interest to end the relationship (rarely happens). I have patients read my book so they can make sure that they want the kind of care I provide. I want them to make an informed decision about whether we are a match. I pretty much get along with everyone. The only patients I have not had success with (and had to fire) are manipulative liars and angry men who won’t stop screaming at me after I attempt to redirect them after say 3 or 4 visits.

            So yes, a doctor should make clear his/her boundaries and be consistent. We all have different comfort levels on boundaries. Yes, uphold the patient-physician relationship and maintain objectivity. If the relationship is failing it should end for the benefit of the patient.

            2) First patients self select me. They would not chose me (or any other doc) if they were not hopeful about being comfortable with the doc – me. I try to offer treatment plans & care that is in alignment with my patients’ values. Example: I do not suggest porcine thyroid to a Jewish woman.
            I am fine with allowing my hippy patients to wear party hats during Pap smears. I do not ask patients to get screening tests like mammograms if the tell me they do not want them. I believe in patient autonomy. I am merely a consultant.

            3) I am responsible for speaking, writing, expressing the truth of my life. I love my profession. I take on challenging topics if necessary (physician suicide, emotional intimacy). My therapist once called me the “Dr Kevorkian of medical taboos.” I don’t feel we can solve a problem without identifying it. Not always popular. I feel a responsibility to improve health care, working conditions for doctors, etc . . I understand that I may offend a few along the way. My main responsibility is to tell the truth.

            4) See #3

            And (as you know) it can be unpopular to tell the truth:

          • DoubtfulGuest

            Thank you for your time. My issues are:

            1) Quite a few people perceive that you give mixed messages. Some other patients felt you blew off their concerns.

            2) You seem to have an agenda (Truth with a capital T) instead of looking for points of consensus and ways to make progress in a group. You sometimes talk at folks instead of with them. I do wish your colleagues would relate to you in a more positive way. I haven’t been around long enough to know if they tried it before and became frustrated as I have. But really, Dr. Wible, do you think your detractors on here don’t want many of the same things that you do? They’re each quite different from one another. You guys could have really constructive discussions.

            3) I like the taboo topics. I think they could be handled in a less divisive but still compelling way. As you’ve noticed, I try to push the envelope on discussions, too, with little success, probably because some lawyer is involved somewhere. My own agenda is to get doctors to stop accusing patients of doing things that they’re not doing. Particularly when there’s no evidence of wrongdoing.

            4) My first concern here was not about you having a double standard for yourself and your own patients on artistic expression. It’s about how I feel doctors should conduct themselves when representing their profession. You may be practicing off the grid, but you sometimes send patients to specialists, right? There’s still some engagement between you and the conventional health care system? So I feel you have some responsibility there, not to present a double standard of appropriate behavior to patients at large.

          • http://www.idealmedicalcare.org PamelaWibleMD

            1) I try my best with online communication. I think it is difficult (at least for me) to have some of these in depth conversations in cyberspace. my apologies for missing any questions.

            2) Ah . . yes, I am less of a team player and more of an independent thinker. Kind of like that George Carlin quote on team players. (Google it) A caveat – I am absolutely not interested in hurting anyone one by expressing the truth of my experience as a doctor. I think most of us on the planet (including doctors and patients) want the same things.

            3) Yes I see your point. My approach may work for some and may rub others the wrong way. Personally anything that moves us away from apathy and into critical thinking (even if it is thinking critical thoughts about me) is excellent progress.

            4) It may seem I am practicing off the grid but I am told that I am actually very conservative in my practice. You would not notice much of a difference from any other medical conic except it is smaller, more personal, and I offer 30-60 minute appointments. I am board certified, I use specialists, I order labs, I do everything other docs do. You (and others) only know me online from a few blog posts so you do not have the full picture of who I am. I think it is hard to know anyone well online.

            Hope this helps.. Have a great Friday DoubtfulGuest. :)

            Pamela

          • DoubtfulGuest

            1) Thanks, Dr. Wible. Yes, online conversations are hard. It just seems like biting off more than you can chew, with some painful fallout for other people who have legitimate concerns. Not just me, as you can see elsewhere in the thread.

            2) I’m with you on this, but there’s a difference between a CorpMed “team player” and what I was suggesting. You don’t actually have to give up one in order to have the other.

            3) Conversation is great. I feel this could have been an excellent discussion if it had started off more honestly about your feelings. I think health professionals here can and should vent a bit more about how hard it is to keep giving, so patients can see it and adjust their expectations accordingly. The focus needs to be on doctors’ feelings and experiences. It can be a respectful conversation that doesn’t burst through anyone’s boundaries or treat patients’ vulnerability in a cavalier way. You know I’m not the only one who felt this was happening.

            4) I apologize for my poor choice of words with “off the grid”. I just meant your Ideal Clinic, and independence from CorpMed. I had no doubts whatsoever about your credentials or qualifications so I apologize if it came across that way. I also meant no personal criticism. My expectation of appropriate behavior is the same for all doctors. I’m sure that I don’t understand you well, I wish I did, and I don’t mean to be disrespectful in any way. I meant all the positive things I said before.

            Best to you,
            DG

          • http://www.idealmedicalcare.org PamelaWibleMD

            Agree. And rather than off-the-grid I would call it back-to-the-basics medicine. I’m just practicing in the style of most docs pre-1965 (while embracing all the technological advances of the 21st century)

            Not sure if you were the one who wanted to see photos of my office or of my patients over my house for dinner. Maybe it was Patient Kit. Well here is the slideshow that the patients created that night at my home when they came for dinner. They recorded this:

            http://www.idealmedicalcare.org/community_vision.php

          • DoubtfulGuest

            Yes, more like back-to-basics is what I meant to say, and I apologize. Yes, that was me. I like your video a lot.

          • PamelaWibleMD

            The hazards of online communication. I think we would all get along quite well in person. And likely agree on most topics.

          • PamelaWibleMD

            We need more boat-rocking patents and doctors.

          • PamelaWibleMD

            No offense meant to anyone here.

          • DoubtfulGuest

            None meant to you, either.

          • DoubtfulGuest

            I would like to see the med-mal lawyers do something useful. Like fix all of us a nice lunch to keep up our stamina. And stay out of our way.

          • Patient Kit

            My ovarian cyst that turned out to be ovarian cancer was found during my annual pelvic exam. I had no symptoms and didn’t suspect that anything was wrong when I went in for my annual well woman visit. After my GYN found the cyst, she ordered a vaginal ultrasound to get a better look. It looked suspicious so she ordered a CA125 blood test. It was elevated. I was referred to a GYN oncologist who did my surgery. Now he is monitoring me every 3 months for recurrence with, among other things, a pelvic exam. That’s right. For 2 years, I get a pelvic exam every 3 months until we go to every 6 months for 3 more years, then back to annual. You get used to it. And I now associate it as something that helped save my life.

          • JR

            I’ve had three different doctors all unable to feel my ovarian cysts or uterine fibroids. Both were “incidental findings” on an imaging scan 10 years ago. Doctor at the time was insistent I go to a Gyn for futher workup, I decided not to go.

            I mean, I could follow up with a vaginal ultrasound, CA125 test, etc – but truthfully, the only way to know if I have cancer or not is to have my ovaries removed and tested. Everything else is just risk/benefit management, but not conclusive.

            I already know I would say “no” to having anything removed, so no need to waste money on tests that won’t effect the treatment outcome.

          • DoubtfulGuest

            JR, I didn’t think Patient Kit meant You personally should get used to exams? She was just talking about her own experience and how it helped her.

          • Patient Kit

            Exactly. I know that a lot of women feel that pelvic exams are unnecessary. I was just telling my story to explain why I don’t feel that way about them FOR MYSELF. We all have to decide for ourselves what is best for us, hopefully, with the guidance of a good trusted doctor. I am in no way saying that JR or you or anyone else should make the same choice as me. We all choose which risks we’re willing to take.. There are no guarantees. No one right answer.

          • PamelaWibleMD

            Good question. How would a Jehova’s Witness physician deal with having to give a blood transfusion in the ER. I guess he or she would pas the patient on to someone else who is religiously unopposed to giving transfusions. Maybe this type of doctor should pursue psychiatry or a specialty unlikely to involve transfusions.

            So . . . uncomfortable providing gyn care, then don’t pursue primary care or gyn.

            Reminds me of a bumper sticker. (I hope not to offend here, but I may): Against abortion? Don’t have one.

          • PamelaWibleMD

            This blog written by the medical student above is a real eye opener. Given that I grew up with two doctor parents and spent a lot of my childhood with them at work (including the morgue), I do not find much disturbing. OTOH, looking at medical care and pelvic exams from the viewpoint of someone who culturally/religiously/personally is uncomfortable with giving such sensitive exams to strangers, I can understand that medical training would be traumatic. The sheer numbers of exams we must perform on complete strangers can be disturbing and obviously can make some students physicality ill (as she reports in her blog). We need to do a better job nurturing our future doctors. Our training can be highly traumatic for many.

          • JR

            I have a real hard time with how doctors are trained. I can’t believe this is what we’re doing to bright young people who only want to be heros and help people, but they can’t do that without going through years of hazing.

            Haven’t we figured out hazing is harmful yet?

            I admit – your collection freaks me out. I wish I had some kind of confirmation that even my blood samples were being destroyed after testing and not being kept somewhere.

          • PamelaWibleMD

            I love you JR – you’re my kinda guy (gal).

          • JR

            Gal, lol :)

            User name is a typo – thinking I should change it to something better but people might think I’m being sneaky if I do.

          • PamelaWibleMD

            That should stir things up in case life gets too mellow.

          • Lisa

            The conversations that result would be interesting.

          • Patient Kit

            I got curious and checked out your blog and read your “Some Doctors Are Afraid of Vaginas” and found it interesting. I agree that it is kind of strange for docs to be uncomfy with certain body parts and even to be unable to say their names. It would be interesting to see the reaction to that piece here.

          • PamelaWibleMD

            I have a feeling that piece may be coming soon. And the reactions? I’m sure there will be many.

    • PamelaWibleMD

      To answer your question JR – we allow patients to design the clinics that actually work for them (rather than hold them hostage to what consultants, experts, and administrators think they want):
      https:www.youtube.com/watch?v=4YJz5wvt2bk

  • PamelaWibleMD

    Really? I thought AOA was based solely on academic merit. I was in the middle of my class on academics. No great star.

  • Patient Kit

    I can’t speak for Lisa but I, for one, was not thrown off by the word “love”. I was thrown off by the tongue photo, which, I really think did not convey the kind of love that Dr Pamela is talking about. Personally, I love love in all it’s many forms. I want my docs to care about me and I do care about them as fellow human beings. But seriously, the tongue muddied the waters. If you had only seen the photo and not read the article, would a doctor’s compassion for her patients been the first thing that photo made you think of. Seriously.

    • DoubtfulGuest

      I also thought of lipstick advertisements, fashion magazines, and such. It’s a nice lipstick color, admittedly. But I don’t see how it advances any of the points she wanted to make. The more neighborly explanation made total sense and I bet a lot of people would be fine with that. So, why wait all day to get there? :/

    • PamelaWibleMD

      Photo was meant to make people think. Life is a rorschach test so what people think I can not control. What I thought was that would’t it be a quick fix if there was a little pill that could give people the love they are seeking in life. Kind of a parody on our pop-a-pill culture.

      • Patient Kit

        Okey dokey then. You posted a Rorschach inkblot and I read sexuality into it. You can’t help it if I saw a tongue with a diamond on it that could have been advertising a suggested Valentine’s Day gift or a cheesy “escort” service. Others might see a toddler having a skinned knee kissed or a baby being rocked and lullabied or a child holding hands with an elderly woman. It’s just an inkblot. Read into it what we will. You can’t control what we think when we see an inkblot. Thankfully. If you wanted to make us think, what’s the problem? We’re both thinking and discussing.

        • DoubtfulGuest

          I think the whole Rorschach testing isn’t nice here. My comment addressing that issue is going through moderation at the moment. I carefully avoided the word “beach” so I can’t imagine what the problem is.

  • Lisa

    The photo was what bothered me, more than the use of the word. The photo had more to do with sexuality in my mind than love for your fellow man or compassion. In combination with the photo, Dr. Wible statement that love is her preferred potion does not exactly make me think of agape, but of using physical contact as a way to show compassion.

    I have had doctors try to show compassion through physical contact (such as a hug, such as a pat on the back) and it felt forced. I think the point I was making is that there are ways to show compassion other than hugging or kissing, especially with a patient.

    • PamelaWibleMD

      Compassion can be making a timely diagnosis and calling the patient with lab results right away, It does not have to be a hug. You are right.

    • PamelaWibleMD

      Lots of drug ads show photos of pills going into mouths. Here is one from a fish oil article. Is this sexual?

      • Lisa

        It doesn’t strike me as sexual. No lipstick, no glitter. Just a pill on a tongue; there is a difference.

        • DoubtfulGuest

          LOL, another image of a woman. Sigh…

          The main element missing from this one that strikes me is that there’s no charged statement about patient “needs” or the doctor-patient relationship.

          This lady has nice complexion and teeth from her omega-3 fatty acids.

      • Suzi Q 38

        Good point.

      • Rob Burnside

        Yes, but what’s wrong with that? Much of our daily advertising depends on it. Birds do it, bees do it, etc., etc.

  • DoubtfulGuest

    Agree with Lisa…I’m not sure where you got naysayers out of our arguments. I resent the idea that anyone who doesn’t fall into lockstep with all of Dr. Wible’s statements is somehow ignorant or unappreciative of love.

    I’m not even against hugs and I think they’re occasionally appropriate in a doctor-patient relationship. IF both people are comfortable with it AND all the other necessary elements of a professional relationship are there: listening, dealing with medical facts, mutual respect. I have felt uncomfortable (only in retrospect) with a doctor who was a first-meeting hugger, but turned out to never listen to my symptoms. She kept “listening for” (imagined) “emotional subtext” of what I was saying, but kinda important details like “I get short of breath when walking up stairs” went right over her head.

    • PamelaWibleMD

      This is just my experience. It’s not the only way to practice medicine and it it not the right way for every doctor or patient. Be authentic. If you are more of a serious surgeon who is not a huggy type (and I know doctors who specifically ask me – and others – not to hug them at conferences when we reunite because they are not into hugs) then please do not force a hug or an insincere statement on a patient. Just be you. 100% you is good enough.

  • DoubtfulGuest

    I saw that. The turquoise sequin rhinestone thing is supposed to be a pill. A love pill.

    Did you not read any of our concerns about that? Have you read any of the bioethics papers out there addressing this stuff? There’s a lot to think through about doctor patient relationships. Try it.

    How about next time we get a photo with no possible sexual connotations, and see if she still gets a good turnout for her post. You’re insulting us on two levels 1) to say we’re drawn in by prurient interest and 2) that we have nothing valuable to contribute if we disagree with any aspect of it (“silly little details”).

    Lots of people are getting sick of the “fast food” approach to relationships, okay? Or even just the way the media talks about those relationships. Shouldn’t Dr. Wible trust in her message of community, and independent practice design enough not to post silly photographs to go with it? She’s said she wants to be taken seriously. So, what’s with the Miley Cyrusification of medicine? Or at least the appearance of it?

    • PamelaWibleMD

      The photo by the way was taken for fun and never meant to be part of a blog. We were experimenting with a macro lens. I wrote a piece on love and thought I’d try this photo so it was not really “premeditated.”

      Lots of other pieces have photos with no intimacy-sexuality-human body issues. (Amazing that there is such a taboo around the human body and intimacy) Look at my KevinMD pieces under my name (click on author): 18 articles and 3 with photos of any possible theme of intimacy. And other articles did well. Look at the one on patient profiling which is a 6-month trending piece now.

      • DoubtfulGuest

        My reply is stuck in moderation. We’ll see if it ever makes it through. I’m trying not to get upset here but it’s very hard.

        I thought of another point. I wonder if, do you think you have a higher proportion than average of non-organic situations in your patient population? I read somewhere it’s around 1/3 of all doctor visits. Or maybe that’s just for neurology.

        Because of my own bad experience, it’s become clear to me that many doctors feel emotionally used by their patients. And I think that’s one reason why they are not responding positively to your posts.

        For example, some guy comes in with back pain. A whole long workup ensues, and months, years, many prescriptions later, it becomes clear that — wait for it, the patient is not happy with his mother in law, and that’s causing the pain. Or even false complaints of pain.

        Now, I agree that medicine is too split into mind versus body. I would like to see mental health care better integrated as just another specialty, with no stigma attached. But I can’t blame doctors for feeling manipulated in these kinds of situations. So I get really nervous seeing stuff about patients’ emotional needs.

        Yes, many people go to the doctor because they’re lonely. But should we? I’d be happier with some public service announcements like:

        “Who is the right person to help with your marital problems?

        1) a psychotherapist
        2) a clergy member
        3) your PCP whose own marriage is in the toilet, from too many late nights working, charting, and listening to patients who burst into tears and tell her the REAL problem only at the end of the visit, which takes three times longer than scheduled.”

        • PamelaWibleMD

          Patients obviously need to respect, value, and appreciate their doctors. Docs are generally emotionally maxed out by the sheer volume of work and numbers of complaints coming at them. I have a great deal of empathy for doctors. And for patients. Yes. If you have an emergency go to the ER (see my cat bite post) and if you have marital problems go to a therapist. Think you have strep throat, the call me up. Yes, greater than 33% of my visits have nonorganic etiologies.

          • DoubtfulGuest

            How do you feel about that? Maybe part of my problem is I think I sense some underlying frustration on your end about patients’ emotional needs that isn’t being addressed? I mean, it’s all understandable…life is hard, we all suffer in different ways. But I know doctors resent the deception, even though for most patients it’s not conscious deception. I guess if I were a doctor, I wouldn’t like it either. I love to help people. But I get really upset if I don’t understand what they need from me. One reason is because I feel that I’m more likely to fail them. I don’t like to be lied to, either.

          • PamelaWibleMD

            Q: “I think I sense some underlying frustration on your end about patients’ emotional neediness?”

            A: I was not feeling that right now or when I wrote this blog, but I certainly have felt that way – a lot. Especially in positions where I did not have time to take bathroom breaks, eat lunch, or care for myself. It can be overwhelming.

            Q: “Why do we have such high expectations of our doctors to handle all the emotional problems in our lives?”

            A: “Some (in fact many of my patients) have no idea that tree pelvic pain, abdominal pain, headaches etc . . have an emotional etiology.
            We live in a culture that disconnects us from our bodies. So people are not often aware of where there dis-ease is coming from. It may be supratentorial in part or completely some of the time.

          • ninguem

            I knew it.

            Nonorganic life forms in Eugene.

            It explains a lot.

            http://allyourtrekarebelongto.us/horta.jpg

          • DoubtfulGuest

            Try a cardboard sign. Do you need some markers? Also, puffy paint.

  • DoubtfulGuest

    People have complex discussions here. It’s the wrong place for sycophants. The post does come across as InstaLove – in a pill! Like Brave New World or something. Later, she gave us a much better explanation. And we’re wondering why she didn’t just start with that. If she posted a group photo of her and some patients preparing a salad at her house or their house, it would be much more appropriate and it would go over better. This is a medical blog. People look for photos about health and medicine.

    There is also a LOT of middle ground between the two extremes you describe, and it’s very disrespectful of all the other doctors here to act as though there isn’t.

    • PamelaWibleMD

      The photos are meant to be provocative – as in to provoke new thoughts and open minds. As mentioned before the photo made a bit more sense with the original tire of the article on my blog: Why I prescribe the love drug. KevinMD changes all titles of blogs when he cross-posts them on his site.

      Middle ground is actually where the fun is. As mentioned my blogs are just conversation starters, not a comprehensive pieces.

      The best part is the discussion right here in the comment section.

      • DoubtfulGuest

        So…I understand you’re having some fun here, okay? I can see how you like to pull the other doctors’ chains a bit, and yes, make them squirm. I appreciate an edgy discussion, depending on how it’s handled. But if you don’t take into account what people say about the photos not matching your message, then it seems kind of, I dunno, manipulative?

        I would like to read about you and your patients sharing dinner together, complete with recipes. What do you all talk about? Is it awkward at any point? Do any of your older patients have memories of socializing with the family doctor when they were young? Or do they remember house calls?

        What about your close personal friends? Can they see another doctor in town or do they go to the next town over? I don’t want to ask anything too private. These are just some “how does it work” questions that I can see people asking in an encouraging way.

        • PamelaWibleMD

          The recipe was vegan lasagne and a great sale with watermelon daikon radishes. We talk about life, health, anything . . .Not awkward. Older patients and patients from overseas reflect on similar experiences with close relationships to doctors in the past. My personal friends see whomever they like. Some see me. Others chose not to. No right or wrong. I do not think you would think that I was there doctor had you watched our meal on a film. Just some interesting people eating dinner together.

          • DoubtfulGuest

            That’s great. Would love to see a whole post about it.

    • PamelaWibleMD

      Next time a salad photo. Ok.Ok.

      • DoubtfulGuest

        A G-rated salad photo? :)

        • PamelaWibleMD

          I can do it.

  • PamelaWibleMD

    Wow. Times are changing. Good to know.

  • PamelaWibleMD

    The English language limits our ability to express love. In Greek there are 4 or 5 words for love. Eros is romantic love, Philos is love for your fellow human, for example. For the record, I am talking about love as compassion, kindness, humanitarian-type love. Mother Teresa’s love. She wasn’t fondling and making out with people, but she was loving each and every one of those she cared for.

    • Patient Kit

      Ah!, so that was Mother Teresa’s tongue! I confess: I totally didn’t get it. Facepalm.

    • Suzi Q 38

      I remember at a recent graduation ceremony, I told my students that I loved them.

      Few people minded that I said so. Most appreciated the statement and gesture conveyed.
      There were a few Asians from China, to be exact, who let me know that their culture is such that it is not PC to say that to each other.

      One friend went so far as to tell me that he would not even tell his wife that he loved her in person….he would only do so in a letter to her.

      I was fascinated at the thought of him loving his wife, but not able to tell her so. Interesting.

      I had to explain that some people are different.
      “Crossing the line” not only gets attention, but it is refreshing at times.

      I think your stories and posts are fun.

      • PamelaWibleMD

        Thanks. I dated a man once who never wanted to say ‘I love you” and just kept telling me that I should know how much he loved me because of all the great house repairs and yard work he was doing. Some people obviously have trouble with love, with saying “I love you” or with hearing “I love you.” He went so far as to tell me to stop saying I love him so much and to stop saying “I love you” to my foster child who really, really, really needed to hear it.

        • DoubtfulGuest

          http://en.wikipedia.org/wiki/The_Five_Love_Languages

          And there are people who will say it ad nauseam to get what they want, but that underlying concern for the other person’s welfare is missing.

        • EmilyAnon

          “I dated a man once who never wanted to say ‘I love you’, but (he did) great house repairs…. and yard work ….”

          Heck with love, Dr. Pam, this guy is a keeper.

          • Sea Span

            actions speak louder then words

        • JenJen10

          Your friend who is doing yard work for you in a way to show you love reminded me of a book I read: “The 5 Love Languages”, in which a therapist said over 20 yrs he noticed people show love in different ways. One of those was “Acts of service”. He made the point that if a person does not receive the type of ‘love’ act they expect, they won’t feel loved, even if they believe intellectually that they are loved. He writes from a Christian therapist standpoint, but the idea seems very practical to me. He also said a relationship won’t last unless you feel loved. People also tend to give the type of love they want others to give to them.

        • Rob Burnside

          I once read somewhere–so it must be true–that males prefer to demonstrate love (by “bringing home the bacon,” for instance) rather than blurt it out. Women, on the other hand, prefer to hear it, and say it. See Emily A’s comment below.

        • Marie Noybn

          you are a foster parent… my respect for you just went upwards quite a bit. I’m a foster parent too.

    • JenJen10

      You didn’t mention agape, “unconditional love”.

    • Marie Noybn

      dont forget Agape, the greatest love of all.. this is what we all need more of, and increasingly more doctors and scientists are blocking that Source out. I hope you are not one of them, since you recognize that love is essential and the source and summit and essence of Love is God.

  • DoubtfulGuest

    Also, whoa there, that was a bit more specific than any of us were getting. There are lots of ways to step over people’s boundaries without, um, doing any of what you were saying. It’s still objectifying of patients to put them on the spot about their emotional needs. It’s more of an apparent attitude. I’d call it a flippant disregard for patients’ vulnerabilities, from an ethical standpoint. It seems to throw it back in their faces almost like “I know you want me”, with “want” being open for interpretation.

    It should be more like “I know you need medical help, which I went to school for years to learn how to give, so I’m putting on my thinking cap and rolling up my shirtsleeves now”.

    I actually believe she has the best intentions. So, listen when your audience says you’re not coming across the way you mean to,

  • Patient Kit

    The tongue photo that Dr Pamela chose to post with her article implied sexuality, a touchy doctor-patient issue. Dr Pamela even commented that products are sold by draping women over guns, cars and toothpaste. She posted the photo to draw attention to her article. But it backfired because it diluted and muddled her message about love. It’s disingenuous of you to accuse those of us who saw sexuality in that photo as somehow unable to appreciate love and compassion from our doctors or at all.

    • DoubtfulGuest

      Also quite a commercial view of sexuality.

    • PamelaWibleMD

      Not saying that at all. And the photo is more or a rorshack test. People can see what they want. I personally do not see sexuality in it. I like the double hearts. Tongue looks like a heart and so does the “love pill” again this was an experiment with a macro lens with a photographer and had not been planned as a photo for a blog. Made more sense with the original title: Why I prescribe the love drug.

    • PamelaWibleMD

      I don’t think it backfired The purpose of a blog is to create conversation around challenging topics. This blog and photo achieved that. And it was not posted to offend people.

    • PamelaWibleMD

      Patient Kit – I just suggested to Kevin that he return to the origin title of my blog (or at least post the original title underneath) to prevent so much confusion around the photo. He plans to amend the title, That will address the disconnect between the lip photo and the current “people die without love” title. I hope this helps.

  • PamelaWibleMD

    But ultimately the “silly” article led to an interesting discussion. There are some pretty strange pharmaceutical ads out there, but they end up selling drugs. There are upside down laudromat signs, but they get people’s attention. So the photo from the original piece “Why I prescribe the love drug” does grab the attention of people and they get drawn into a conversation. In my mind any conversation is good.

  • PamelaWibleMD

    Yes! Finally . . .

  • PamelaWibleMD

    Photo not meant to taunt anyone. We all see the world through our own lenses. Everything in life (including this photo) is in some sense a Rorschach tests. I just showed the photo to a few patients today to get their impressions. A seamstress told me she thought it was artistic and did not see any sexuality in it. Another older couple who came in for a visit just saw the double hearts and did not feel any sexual message. We all interpret the world according to our experiences. No doubt. No blame. Nothing wrong with anyone’s interpretation.

    • DoubtfulGuest

      Okay, but did you ask anyone not in a liberal part of Oregon?

      I actually found it amusing that the new Disqus dashboards, when you click on trending posts, it shows an enlarged version of each photo. So, your teeth are kind of looming at the top of my monitor. :)

      For me, it’s more that I look for serious issues to be discussed with a bit more…gravitas. Humor is fine, in measured doses.

      The Rorschach thing is offensive for one reason. There’s a lot of medical literature out there that accuses patients of various hidden sexual psychopathologies. Except in the few cases when a patient does something blatantly inappropriate in a medical setting, the evidence is kind of poor. I’m actually not sure how most of it got published.

      I read these papers after a neurologist accused me of secondary gain. He didn’t have any evidence for that, and later it turned out to be quite a bad disease. I thought I’d better read a bit to understand what I was being accused of, and I found all kinds of horrible things. So, that’s why I’d prefer a more careful discussion of these issues. I don’t want to die sooner because some doctor made stupid assumptions about my emotional needs.

      • PamelaWibleMD

        Honestly, I find it challenging to have some of these more in depth discussion online. Really wish we could speak in person.

        • DoubtfulGuest

          Okay, me too. And obviously the discussion here has to end at some point. But you need to take responsibility for your posts. Some bloggers participate in discussions of their posts. Others don’t. If you’re going to be a come-back-and-discuss-er, you can’t belittle people who disagree with you. Or coyly suggest that people are too conservative, or not comfortable with the concept of love, or out of touch with the general population. The reality is that you put some weighty issues out here that are well worth discussing and there are a lot of different aspects that deserve to be thought through. I personally can’t do shallow discussions. There needs to be a point to it.

  • Lisa

    How did this post get past moderation?

    • Patient Kit

      Ironically, my response expressing concern about the above post on insta HIV cure is lost in moderation, I guess, because I mentioned the word “beach” again. LOL! But seriously, the post about HIV cure is just wrong (unlike *** on the *****). ;-)

      • Lisa

        too beaching funny..

        I just want to see what happens if I use that word…

        • DoubtfulGuest

          Dr. Kevin’s team should fix this straightaway. Nah, they’re all lying on a ***** somewhere.

      • DoubtfulGuest

        Really?! Will wonders never cease.

  • PamelaWibleMD

    Given the widely divergent interpretations of the photo and whether it is proper or not for a medical blog (glitter and lips OMG), I think the photo (like all of life) is like a Rorshach test. I’m sure this could appear sexual to some:

    • Lisa

      Snorting here . . .

      • DoubtfulGuest

        Someone spilled 7 Up on my favorite Georgia O’Keeffe painting. That’s offensive.

    • ninguem

      Unfortunately it’s a picture of the person in the upstairs apartment right after the store clerk accidentally bumped into this attractive model.

      http://cdn1.kevinmd.com/blog/wp-content/uploads/glock-assult-rifle.jpg

      • DoubtfulGuest

        Cherry Slushy Emesis after putting two and two together.

        • ninguem

          Take a look at that picture again and ask if you want to give her a hard time.

          • DoubtfulGuest

            No coin toss for me, Sir. And I don’t see her.

          • DoubtfulGuest

            Dr. ninguem, perhaps a different way to make your point next time. Someone might misinterpret it.

            JR – I’d rather you not joke around about my getting shot. Thanks.

            Funny, I wasn’t around much for that particular post but I assumed it wasn’t loaded…

  • PamelaWibleMD

    I like your two cents Dike. :)

  • wiseword

    The picture is disgusting and I don’t understand it. If you substitute “human contact” for “love,” I might go along with you

    • PamelaWibleMD

      Original title was about “the love drug” and the photo is about taking a pill.

      • JR

        I remember a co-worker asking me if there was anything exciting going on, and I talked about one of my friends who had just decided to try and get pregnant.

        They said “oh wow, that’s totally inappropriate”.

        I was thinking “BABY!” They weren’t.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Hahaha! Rorshach. People are goon think what they are gonna think. Life is a giant ink blot.

    • DoubtfulGuest

      I wouldn’t say disgusting…but surely out of place and inappropriate.

    • Patient Kit

      To be clear, since I’ve been so vocal here about the photo, I never found the photo disgusting or offensive — just inappropriate to the context of the blog it accompanies.

  • EmilyAnon

    Dr. Pam, Med Page Today has just linked this thread.

    “Could a “love prescription” substitute for painkillers? A guest blog with MedPage Today’s Kevin MD says maybe.”

    • PamelaWibleMD

      Wow. Send the link.

      • EmilyAnon
      • EmilyAnon

        I just added it to the original message.

      • DoubtfulGuest

        LOL at “maybe”…That sums it up. ;)

  • Patient Kit

    I agree. Presence, empathy and compassion are key; they describe well the kind of “love” I want from my doctors. Now, what would be a good way to illustrate that with a creative photo?

    • PamelaWibleMD

      Maybe this? (not sure why photo came up 3 times)

      • DoubtfulGuest

        I see nothing wrong with this. I know quite a few (maybe most?) doctors would rather not, and that’s really okay. My default policy is not to hug, since it’s the doctor’s workplace. I’ve experienced a few exceptions and it turned out very well:

        1) initiated by the doctor, it definitely came across as optional

        2) in an established relationship, so there’s been time to “gauge” one another

        3) while saying goodbye at the end of the visit

        4) mainly on special occasions (I was extra sick or had some good news to share)

        5) in front of other people or immediately before walking out in front of other people

        • Marie Noybn

          only time i needed or wanted a hug from a doctor i got it, and i love him for it. He was my ob and i had just lost my first child, a miscarriage, and was there for my followup. Waiting in the waiting room with all those expectant or post partum mothers almost killed me and he must have seen it in my face cause he walked in looked at me for half a second, then came over and hugged me, then just held me while i cried my eyes out for a good 5-10 minutes. I dont remember anything else about the appointment. This was medicine i dearly needed, so i guess i have to go back on everything ive said so far and say that in CERTAIN circumstances, love is the drug *I* needed. My doc and i were both very gratified when he caught, i would say delivered but caught is really the right term since the baby was coming out when he was coming in heh, a healthy baby boy some time later, this time HE cried :) So i guess in my book OBGYNS get a pass on the hugging thing ;).

          • DoubtfulGuest

            I’m so sorry for your loss, Ms. Noybn. I’m also very happy that you later had a healthy baby. I don’t have kids, but I have friends who’ve miscarried and it’s really a severe loss that goes under-recognized by society in general including some doctors. I’m glad that your OB showed support and caring for you this way. It’s a very big deal and I can only imagine how painful that must have been.

            My overall conservative stance on this thread is because I have personal experience with an abuse situation in which there was punishment for not hugging, or even hugging frequently or “well” enough, as well as failing to be emotionally demonstrative in all the right other ways, at all times.

            I try to put myself in the shoes of doctors who care a lot but just aren’t comfortable with much emotional expression. It’s so awful when people feel forced into it. On one hand, patients sometimes file complaints if they misinterpret something as innocent as a pat on the shoulder. OTOH, some patients become very angry with doctors who don’t “care” about them the same ways their friends and families do. It must be hard for doctors to know what to do. Plus, since they’re people also, it matters what they want/are okay with.

            Unfortunately, your other reply to me was deleted. One never knows what will or will not make it through moderation. Sometimes it’s a seemingly trivial word here and there and it helps to rephrase our comments. If you wanted to try again, I’m interested in what you have to say.

  • DoubtfulGuest

    It’s all a bit unclear, isn’t it?

    • ninguem

      If unclear, you must follow the adventures of Miles Cowperthwaite.

      • DoubtfulGuest

        I’ve been missing out on Miles, Sir. I’ll fix that. I do enjoy some older SNLs.

        What I meant was, this whole phenomenon has been most unusual.

        I guess I was a bit unclear, wasn’t I?

        • ninguem

          Miles Cowperthwaite was 1979, old enough?

          • DoubtfulGuest

            Just barely, but not old enough to remember. I recognized Belushi from the photo and found the transcript, but no luck on YouTube.

            I’ve always wanted to see the one about the Scotch Tape Store. I have fond memories of The Festrunk Brothers, must have seen a rerun because that was ’77?

          • http://www.idealmedicalcare.org PamelaWibleMD

            SNL In the 1970s was the best. I actually did a great Roseanne Roseannadanna routine. But what does that have to do with the blog?

          • DoubtfulGuest

            Sorry, I guess it doesn’t. I thought that was what ninguem was asking me? Glad to remove my comment if you prefer.

            I thought we might be circling back on topic, depending on if I understood his comment correctly. I’m easily confused these days.

          • DoubtfulGuest

            Dr. Wible, I feel it would have been more appropriate to direct your question to Dr. ninguem, OR even to both of us would have been okay. I had already explained that my comment about “unclear” was directed at the blog discussion in general. This is consistent with my thoughts elsewhere in the post. I do apologize for taking the sideline humor further off-topic.

            However, it’s very common in a medical setting for doctors who disagree with one another to get a patient caught in the middle. Patients bear the brunt of many of your frustrations with each other (e.g about whether or not a test should have been ordered). So please address your concerns about one another’s actions directly with that other doctor, even on the blog. I take full responsibility for my part in the distraction. No more, no less.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Ok. Will try my best. :)

          • DoubtfulGuest

            I asked him as well. It takes two to tango. Would be happy to bake cookies or something so you both could have a nice chat…

          • DoubtfulGuest

            I had a thought that comes down on your side a bit. I wonder what would happen if you ever used this photo again, for a post lampooning the pharmaceutical industry?

            I asked myself honestly if I have a double standard for male vs. female docs to use humor to make a point. ZDoggMD for example does outrageous things in his educational videos. And I think all the docs here posting funny images are men? So, I have to admit there may be some unconscious gender bias at work in all these comments. Maybe even mine? :/ Hmm…

            When it comes down to it, the main problem for me was the mismatch in tone between the photo and the post. If you tried an experiment, that might help you get a better sense of people’s attitudes when there’s no question that the photo is meant to be funny.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Good idea!

          • DoubtfulGuest

            Owing to my sincere appreciation for Miles Cowperthwaite and other humorous interjections, I seem to have taken on the appearance of a Human Shield. Your assistance is requested…

  • JR

    I was sure my symptoms were in my guts, not my ovaries. Turns out I was right, I have Celiac. There is a strong correlation between Celiac, Metabolic Syndrome and PCOS. I no longer qualify as having Metabolic Syndrome or PCOS since being treated for Celiac.

    PS – that study said masses could be felt less than 50% of the time in women under 200lbs, and only 8% of the time in women over 200lbs, and this was all in women who had confirmed symptom causing masses and were already scheduled to get surgery. That doesn’t include non-symptomatic masses.

  • DoubtfulGuest

    I think it’s not unusual for PCPs to do pelvic exams, at least for apparently healthy patients as part of their annual physical? But then some women prefer a gynecologist for primary care? You are surely the expert on ovarian cancer here.

    I’m also doing great after hysterectomy/BSO. Getting the hormones right has made a big difference. They were all over the place before surgery. I can see why some women would never want to have it done. For me, it was easier than having my wisdom teeth out. I was never going to have healthy organs anyway, had had trouble since my teen years. They couldn’t even make a dent in the endometriosis with the other treatments we tried.

    I’m glad you’re okay, that must have been scary. There are so many tradeoffs with health and medicine and your life was on the line.

    • Patient Kit

      Thanks! I’m sure I’m no expert on ovarian cancer. But I sure know a lot more about it now than I did a year ago, having experienced it.

      One of the bizarre things about hysterectomy: I know plenty who believe far too many unnecessary hysterectomies are done and an equal number of women who are begging their doc for a hysterectomy but can’t get them to agree to do one.

      Of course I understand why some women don’t want one done under any circumstance. But I also know plenty of women whose lives improved greatly post-hyster. And obviously, it’s better when you have no serious complications or side effects. I’m very comfy with my choice.

  • Sea Span

    as a person who was raised in violence and not raised with gentle hugs kisses and i love yous; a kiss or hug from a doc would kinda scare me. maybe an arm around the shoulder as I leave with kind words would mean more to me. the picture was disgusting and really does not fit with the article. as a child from abuse, getting a hug would have very confusing meaning; asking if someone wants a hugs is appropriate.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes. It is all about respecting the patient. All patients do no need the same things. What would be therapeutic for one, would be harmful to another. The art of medicine is deciphering what people really need.

      • DoubtfulGuest

        I promise I’ll get out of your hair after this one, Dr. Wible. It’s just that sometimes, there’s no cipher to decipher. But it seems like doctors are always looking for hidden content instead of first determining whether or not the patient has trouble communicating what they need.

        That leaves patients who are trying to be straightforward with our doctors, receiving the exact opposite of what we need. Doctors assume either deception or complete lack of self-insight. So, I agree with you but I think there needs to be that other initial step in the assessment process. Thanks for considering my thoughts. Best, DG

  • http://www.idealmedicalcare.org PamelaWibleMD

    A few have asked to see photos of my office. Here is a brief slideshow narrated by my patients. Words are their own. And many images are from the clinic that they designed. What would a patient-centered home look like if patients actually designed it? Here it is:

    http://www.idealmedicalcare.org/community_vision.php

  • Rginsberg2

    Yes. Yes! YES!!

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