Roger Clemens, the BCS, and Lance Armstrong

What did Mama teach us?

Most of us were raised, I think, being told, "Mind your own business!"

Now, I bow to no one in my hope and ideal of drug-free sporting contests--locally, in the pros, in the Olympics.  But doesn't the court system and Congress have better things to do that waste time and resources on sporting contests?

The jury that aquitted Roger Clemens on all counts of lying to Congress probably thought that Congress had better things to do than worry over whether Clemens had ever used performance-enhancing drugs (though the probably had). 

The Bowl Championship Series is held by most sports fans to be a "joke" in terms of truly determining a national  collegiate football championship--but do Texas Rep. Joe Barton--otherwise a very sensible guy--have any business taking time for Congress to investigate and intervene in how college football championships are decided?

The next sports hero to inter the dock is Lance Armstrong--a man with as many chinks in his armor as his numerous good qualities.  Will Congress try to get into this act?  Or maybe the State Department, since the Tour de France titles are involved?

I think the country is in enough of a mess that government officials can overlook the world of sports.

A Doctor Looks at Peterson Regional Medical Center

I invite everyone to look at my post on kerrvillecommentary.blogspot.com for a review of my experience and assessment of care at Peterson Regional Medical Center.

kerrvillecommentary.blogspot.com

When the Doctor is Sick

Gaining Insights into Patient Experience

I don't think that only veterans should be allowed to comment on wars and veteran issues, and I don't think that all heart specialists have to have had heart attacks themselves, but in 36 years of practicing medicine, I have to admit that my personal illnesses have given me great and needed insight into what indignities patients must experience.  Only by being a patient oneself, and bearing the slings and arrows of the medical-industrial complex does one gain this insight.

As a young surgical resident, I developed a need for emergency surgery myself, and was shocked to learn that several tests and procedures which for years I'd assured patients "didn't hurt a bit" were actually somewhat painful. Similar epiphanies came my way over the years with severe lumbar spasm, Type 2 Diabetes, stress fractures, a posterior nasal bleed, cardiac dysrhythmias, and most recently a limb-threatening infection in my diabetic foot.  All were managed successfully.  All made me a better clinician--and a better doctor.

Patients feel pain (the origin of the term patient), patients have fears and uncertainties.  Some need very skilled care.  All need superb communication...and rarely receive it.  I have never "left AMA" (medical jargon for leaving the hospital against medical advice), but I have been tempted to on several occasions.  Never due to a lack of physician skills, but always due to a lack of physician communication.
  
Veterinarian-author James Herriot wrote that he was told by his mentor that the primary rule of veterinary practice was "You must attend!"  That is, the doctor had to be available for communication always.  People need to know what is going on, and they can't know that if they don't see the doctor, or otherwise hear from him, in a timely fashion.  As young doctors we used to be told that the "A's of Medical Practice" were availability, affability, and ability--in that order.  Be there, be nice, and if you know your stuff, that helps too.

Good rules that still apply.

What's a drug of abuse anyway?

Just because the doctor prescribed it doesn't mean it's not abuse

I was recently contacted by an attorney who wished to be assured that if his client came into jail she would be able to receive all of the medication she felt she needed.  The drugs are all prescribed by a doctor, he assured me.  So far, so good.  When I reviewed the medical information supplied by the patient I was pretty surprised:  out of six medications listed, at least four were common prescription drugs of abuse; the remaining two, while not actually abuse drugs, had no relation to the conditions for which she was supposed to be taking them.  Probably this person was weighing a plea bargain choice of a relatively short jail term compared to a lengthy, costly period of probation.  She needed to make sure that her drugs of choice would be available to her inside the jail if she chose that option.  We weren't able to accommodate her requests--all jails and prisons avoid administering abusable drugs.

So who is at fault here?  Doctor?  Patient? Both? Perhaps the patient visited several different doctors, seeking her own drug of choice from each particular physician.  Perhaps she just has an incompetent doctor--maybe the physician is impaired, or just doesn't keep up with medical progress.  Maybe he runs a "pill mill" and routinely supplies local addicts with  any drugs that they request.  It's hard to shut down such physicians.  I recently referred one to the Texas Medical Board for investigation and no action has been taken.

Drugs that come from a nice clean pharmacy in a new bottle can be just as dangerous or wrong to use as those obtained illegally from a street dealer.  Heroin or hydrocodone, cocaine or amphetamine, xanax or marijuana--no big difference.  The effect of misuse on the individual and on society is just the same.

What is the answer?  Drug abuse isn't a law enforcement problem--police, courts and prisons are not helpful but are merely costly, ineffective approaches to a medical problem.  Patients need the right diagnosis, the right medication, and the right care from a physician who cares about them and won't charge them more than they can pay.  They also need to get away from old friends and old patterns of behavior that will entrap them again.  Find a church that welcomes those in recovery.  Find new friends.   And stay away from that doctor who is just as dangerous as a dealer on the street.