Disclaimer: these are my own thoughts and philosophy and not to be construed as “medical advice” for legal purposes. Always check with your own doctor before undertaking any new health measures, as all of us have unique health conditions that may exclude or risk-stratify a particular change.
I am a 48-year-old female physician with an unrestricted licensed to practice in the state of Texas.
But that doesn’t tell you very much about me at all. It would be the same as looking at your chart and seeing a 48-year-old female diabetic on insulin.
This doesn’t tell me much about you other than lots of assumptions… and as the old saying goes, assume = making an ass out of you and me.
These days, it seems that “medicine” is all about, well… “medicine.” Pills, that is. Loads and loads of pills for every conceivable thing from memory loss to constipation.
And along with the medicine, out rolls the red carpet of tests. We poke you, prod you, bleed you, cut you, sample you, expose you to radiation, monitor your breathing, your heart rate, your blood pressure, how much you eat, how much you drink, how often you poop or pee, your mental acuity, and build a bubble around you that we call “medical necessity.”
And the whipped cream with the cherry on all of this is the paperwork–piles and piles and piles of documentation that bury every patient and every doctor in the vaults of the insurance companies and the government. Statistics. Or as Mark Twain would indubitably agree, “Lies, damn lies, and statistics.”
I developed the Five Pillars of Health for a Community Medicine Project, and it grew and grew, and the longer I have held to it, the more evidence comes out from scientific sources as well as from human beings and the stories of their lives, that it is just plain true.
Health should not be something out of touch for anyone, regardless of age or income. And health is not a perfect state but an evolving place of balance. Understanding the simplicity of 5 things that are essential for good health leads to your individual ability to steer your health in a helpful and constructive direction, knowing and understanding what may make a difference.
Fear. The fear of illness, pain, insanity, and death. The fear of lawsuits, the fear of business catastrophe, the fear of government investigations, the fear of saying the wrong thing, of wrong diagnoses, of angry violent patients, of angry abusive doctors, of judgement by patients, by peers, by investors, by neighbors. The fear of not being politically correct, of offending, of being offended. The fear of distrust. The fear of big pharmaceutical or other corporations who may turn the “Eye of Sauron” on you and destroy your reputation and career forever. Because they can. Because your valid questions cost them money. Fear of being human, of being fallible, of being able to admit imperfection or lack of knowledge.
And when you go to the doctor, you will often find your doc in a hurry to see a long line of patients, a doc who is trying to minimize face-time (and I don’t mean the social network) and maximize billing, who may be under pressure from the Corporation or from the Government to meet quotas, work fast and furiously, and often with a thinly-veiled bitter contempt for everyone, starting with the Government, moving to the staff, then the patient, and ending with themselves.
Does your doc smile? Does your doc look you in the eye, sit down with you and listen? Does your doc touch you at all? Does your doctor joke?
You will see in most group clinics an army of medical assistants and office staff and may be presented with a pile of forms to fill out with 20-questions (well probably 100 or more questions) that you will try to fill out painstakingly, only to be glossed over by the medical assistant and the doctor. You will bring your 20 pill bottles with you, and still your medical record will not have the right prescriptions documented. And when you leave, you may be left unsatisfied, with a lingering feeling that you didn’t get what you really needed.
You will choose to wait for hours at the walk-in Urgent Care clinic, because you have given up on your primary care doctors, the ones who should know you and should be able to see you when you need help, but whether it is availability, cost, hours, distance, convenience, or a sense of distrust you don’t go there. Or simply your insurance company (or lack thereof) chooses who you are able to see, and you give up.
And then… you will complain that you had to wait for two hours for a prescription for an antibiotic, and when you get home, you are mad because you are still sick and it is… inconvenient to be sick. And you will blame your doctor that he or she did not fix you.
I don’t want to be that doctor, and I don’t want you to be that patient.
So back to about me. I’m an Osteopathic Physician (D.O.) which is the other flavor of fully functional physician in the U.S. The Allopathic Physician is the M.D. Our training is basically the same, except that Osteopathic Physicians learn a bit extra about the neuro-muscular-skeletal components of health, and learn how to use manipulations as an adjunct to other treatments. We operate from the principle of mind/body/spirit balance, and many of us become family doctors and internists, while the rest go into specialties.
I’m also a mom, a stepmom, a wife, a daughter. A photographer. A writer. An audiophile. A person who likes bad jokes and dislikes austerity. I do believe that love and laughter is the best medicine of all. It is the first pillar. I love people. I am tolerant of difficult personalities. Non-judgemental.
I have been a caregiver for my grandmother who had Alzheimer’s and my father who had end stage colon cancer. I helped my father-in-law navigate the medical, financial, and emotional mire of end-stage pancreatic cancer. I was a certified nursing assistant. My cousin died from AIDS in the 1990’s. My other grandmother died from liver failure secondary to lung cancer. One grandfather died from a brain tumor, and another died from pneumonia and heart failure. I have had a ruptured appendix, eye surgery, neck surgery, a partial thyroidectomy, endometriosis, uterine fibroids, and more.
I have lived medicine long before I even considered going to medical school, while in medical school and residency, and I chose to take this journey because I made my dying father a promise to do so, and he made me promise, because he was comforted by my care and advocacy and wanted this for others. I was a non-traditional (aka OLD) medical student in my 40’s. I had a 14-year previous career in Information Systems as a Help Desk Analyst. I helped people to fix their computer issues. Now I have graduated to life issues.
I believe strongly in patient advocacy, in striving for quality of life and quality of end-of-life care. I believe in honesty, in compassion, in the body’s ability to heal but also the body’s readiness for death. I believe that most people are basically good, with a few folks who have severe mental issues that drive them to do terrible things. Whether these arise from birth, from negative life experiences, from poor choices, from addictions, is an individual struggle.
I believe that no two people are alike, that medicine is both a science and an art, and that my job is to be a guide, to offer tools, to help people find the right path and work on healing themselves.
There are two cardinal sins in medicine:
- speaking at a level above that which a patient understands
- speaking down to a patient or not providing them with the information they need to make good choices.
Here’s my medical philosophy:
- If a patient is “non-compliant” then perhaps the plan needs to be changed, not the patient.
- You don’t need a pill for everything.
- Most common viruses (adneovirus, influenza, etc.) run about 2-3 weeks from exposure to resolution or chronicity, and day 4 is usually the worst day. That means that if I give you a 10-day course of antibiotics, chances are you will get better, but not because of the antibiotics.
- Testing for the flu is good for statistics but not necessary for change in management. If you have flu-like symptoms for less than 48 hours, you can choose to take an antiviral to lessen the severity or knock a day from symptoms, or have your family do the same, although it is iffy for non-influenza. However the medicine and the test are very expensive (consider $100 each). If it has been more than 48 hours, you will just have to ride it through with TLC anyway.
- Get a flu shot. It is either free or $25. It helps. You won’t get the flu from the shot, but you might feel a little off–why? Because although it is not a live virus, what you are getting are the same signals that the virus puts out in your body that revs up the immune system. The immune system builds up white blood cells and sends signals throughout your body to be primed. These can result in a little fever or flu-like symptoms, but not the full-blown flu. In addition, it takes at least 7 days for your immune system to be fully primed with the vaccine, and it has to be the right influenza strain.
- Testing for strep is similar. Amoxicillin (if you are not allergic) is on $4 list. The test costs $100 plus. If you have a pretty good clinical suspicion for strep: Treat it.
- Antibiotics do not “cure” viruses, but they may be necessary to manage co-existing bacterial infections. Start with the simple antibiotics first. This helps to prevent antibiotic resistance. If you were getting better, and a new fever starts up a week later, you might need an antibiotic.
- A fever is 100.4 degrees Farenheit or higher. Less than that is not consdered a fever, even if it feels like one.
- Antivirals can take the edge off the effects of certain viruses and hasten recovery but only if administered in the correct time.
- There should be a good reason for running a test – and the 2 litmus tests are as follows: if it may change the treatment plan or patient expectations and understanding of their condition, and if the benefits outweigh the risks.
- Medicine should not be just an algorithm or a spot on a chart.
- Evidence-Based Medicine should be taken with a grain of salt: A scientific study may answer a question, but sometimes it is not the right question. And sometimes it is not the right answer, either. It depends on who did the study, how it was funded, the quality of the data, who interpreted it, and who decided to publish it. The larger the study, the less control there may be for other variables. A meta analysis looks at studies that may not have been designed to answer the particular question being asked. Herding cats.
- Good medicine is the essential harmonious partnership between a physician and a patient that leads to improved health.
- It is possible to be healthy and dying at the same time.
- Life is a terminal illness, but also a short opportunity for great joy and experiences.
- Rarely do people have one thing wrong. People are complex, not vending machines.
Dr. Beatrice Taylor, DO