Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are supposed to be the working partner and I’m supposed to be the consulting partner.My job as the consulting partner is to offer sagely medical advice to the boss (working partner). As a consultant, I’m supposed to help in the making of key decisions, find the appropriate tools to ...
Stewart Segal, MD
The foundation of medicine is care
I recently wrote that "diagnosis is job number one." In sports, there are times when two teams share the number one position. Each team competes to make it to the championship; and, ultimately, one team has to lose its top ranking.In medicine, care and diagnosis share the number one spot, working together toward a common goal: to promote health. Some would say that, without care, the diagnosis is worthless. Certainly, ...
Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease ...
When it comes to smoking, I am a militant
It is obvious to those who know me that I am an avid anti-smoker and work hard to help those afflicted with a tobacco addiction break their habit.Knowing your shortcomings is an important part of being successful. One of my short comings is not knowing when to quit. When it comes to helping smokers stop smoking, I am a zealot. Today, I went to work on one of my smokers, ...
I wish my patients could see what I see
I wish my patients could see what I see. I see through a lens sharpened over 30 years of experience. I see the present and often the future. Yes, I’m a fortune teller! Many times, the picture of the future I see is bleak.It’s my job to predict the future and then try to change it. A friend once told me that he believed life was a movie playing on ...
Dropping out of Medicare will break my heart
I met with my staff yesterday to discuss the effect of a 27% cut in Medicare reimbursement on our patients and our office. I had a really lousy day, explaining to my elders what would happen if Congress fails to act. One of my patients aptly pointed out that Congress has not acted responsibly in the last 20 years and that it would take a miracle for them to get their ...
How medications are like vehicles
I usually cringe when I see a pharmaceutical company ad on TV. I think most pharma commercials do more harm than good. The ads scare patients out of taking medications they need.Actor: Do you have uncontrollable diarrhea? I did, and then my doctor prescribed “No-More-Poop!” Now I feel great and don’t have to worry about embarrassing accidents.Commentator: Clinical studies done at a leading university prove that “No-More-Poop” cures 99% of ...
I eat lunch with drug company representatives and I’m proud of it
Today, I want to review another article I wrote in last year. That article started with a confession: "I confessed that I ate lunch with a representative of a pharmaceutical company."I must now confess that I often eat lunch with representatives of pharmaceutical companies and I’m proud of it. At this stage of my career, I can well afford my own lunch. I could sit quietly and relax over a ...
Doctor, I’m better: What does that really mean?
"Better" is another one of the difficult words I have to deal with on a daily basis."Doc, I’m better" can mean a lot of things and can lead to both misdiagnosis and poor treatment. Does "I’m better" mean you are well? If not, are you really better or is it just wishful thinking? How much better are you?On a busy, stressful day, even the most skilled physician can fall for, ...
The art of practicing template medicine
The art of practicing medicine is dying, soon to be replaced by the art of template medicine.Modern medicine is based on laudable terms: "quality," "outcomes," "cost effective," and "evidence based medicine," which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse.Each of these terms is intent on taking the human factor out of medicine. Each ...
A doctor cannot be on time and take care of your needs
Today’s article addresses a common complaint about physicians.“Freewheel” responded to a previous article by writing the following, “you will not make me wait more than 10 minutes. My time is important, too.” One of the most common complaints I hear is “I waited over an hour to see you!” Waiting for an appointment, particularly when you are sick, is frustrating. Once you have that appointment, waiting for a doc who ...
Sometimes cyber-medicine is fraught with danger
I’m worried about the future. Everyone I know is stressed. Patients fail to follow up as directed. They fail to take their medications as directed. They have too much to do. Their priority lists are in shambles.With all the responsibilities that today’s multitasking society thrust on my patients, they don’t even have the time to pick up the phone and call each other; instead, they text, IM, SMS, and email. ...
Honesty between doctors and patients goes both ways
Yesterday, someone asked me, "Can I be perfectly honest with you?" I wanted to reply, "No, just be dishonest, I like it better that way!" "Can I be" implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.Am I being too ...
Holistic medicine needs to be rescued by physicians
The word "holistic" has been kidnapped by practitioners of alternative medicine and marketers. Holistic has become synonymous with "all natural" treatments and cures. Those who kidnapped the word holistic imply that medical doctors are not holistic. The implication is that docs treat the disease and not the person.According to the Merriam-Webster Dictionary, holistic means, "relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment ...
How your physician is like a chef
I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My ...
Using the emergency room for routine physicals
One of my patients thanked me for saving his life. Apparently, many years ago I had told him that most men’s first complete physical is in the emergency room in the midst of their heart attack or stroke. I have been in practice long enough to have forgotten many of the things I have told patients. I try to capture the pearls I have learned over the last 30 ...
A contract for patient responsibility
I often refer to myself as a fireman pouring water on the flames that are burning my patients. Often, I view my patients as arsonists, pouring gas on the fire I am working to put out. Taking personal responsibility is a critical component of success in any of life’s ventures. While my patients are very responsible business and family men and women, they often take no responsibility for their ...
Defining what health truly is
I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners. Mr. Luban brought up an interesting question, "What is health?"Is health simply the absence of disease? If it is, there certainly aren’t very many healthy patients in my neck of the woods. Most of the patients I take care of have something that’s not quite right. I only know one perfect ...
Money keeps a physician practice running
"Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!"Unfortunately, the money is important. It costs money to keep a practice running. It costs money just to collect the money owed to the practice.So, let’s look at some simple facts. Your physician’s office is one of the few places where you ...
Health insurers have come up with the idea of the century
I have come up with the idea of the century. My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services. I don’t know why no one has done it in the past. It has made the insurers of America countless billions of dollars and now you can profit as well. My only request is that you ...
