I have neglected my diary here - all my time taken up with doing the Boards and doing a summer service at the local Unitarian “church”  (on “who’s Responsible for your Health surely not me?”).

But the incessant noise goes on in the office. We continue to be a refuge for little old ladies as I see it. I caught some flack in a local newspaper article for writing about the business side of primary care. I noted that the epitome of what slows you down is ” little old ladies with diabetes, high blood pressure and heart failure and on a dozen medicines - and especially when they do the laundry list trick of throwing in a whole bunch of other things they want to consult you about at the end of the appointment”.

     Two LOLINAD’s visit the office

I was only using this as the worst case scenario - not meaning to imply that I hate little old ladies. But I do get paranoid sometimes that we are getting all the LOLINADs (Little Old Ladies In No Apparent Distress - as Mrs. Gagg tells me the Rescue squad so sensitively refers to them) while the multiple mushrooming Urgent Care clinics that are popping up all around us are getting all the gravy - the sore throats, the sinus infections, the quick, easy stuff that you can charge almost as much for and take about a tenth of the time to deal with than some of these more complex patients who are literally on 15 medicines or more.

It is the time in the calendar that I think of as New Year. Not what the Chinese do. Not what our celestial time keeper tells us. But it is the beginning of the school year - which brings with it panicked parents who’s children have not got their sports physicals or their necessary shots. What ‘s that old adage about “lack of planning on your part does not constitute an emergency on mine” - or something like that. So the office tends to be full of pushy, agitated parents and screaming children.

The hills are alive with the sound of music - sort of.

Lack of taking care of health matters ahead of time is what my summer service to the Unitarians was about - and noting such quirks as there’s nothing like having a heart attack to motivate people to stop smoking.

Of course there are some who even that won’t motivate. Mr. C., the epitome of a curmudgeon, wild beard like the Unibomber, “Get ‘er done” baseball hat, in and out of jail - one time for taking a kick at the judge, he is status post myocardial infarct and coronary artery bypass graft - but continues to smoke like a fiend (and drink like a fish). Sounds like he’s going to give his slightly naïve cardiologist a heart attack. The consultation letter reads ‘I spent 30 minutes . . . I have been very blunt with him but my bluntness does not seem to be having any effect on him, I am really at my wits end”. You can lead a horse to water. . . . . . .

Then Mr. W. is doing better. He had a bypass as well. What seems to be getting him better is the Cardiac Rehab. He has never exercised before in his life - his pendulous gut bears witness to that. Now, because he’s got to the point of end stage disease, he is eligible for rehab, which is basically supervised exercise and is just doing what he - and all of us - should be doing anyway. Wouldn’t it make so much more sense to be able to get people into such a program before they’re in crisis? But that would prevent cardiac arrests and CPR and racing ambulances and dramatic scenes in the ER and would require insurance companies to show a modicum of common sense - and wouldn’t make for such good TV.

Whenever you see a doctor on the TV, isn’t it always a scene in the ER or the OR? Hero’s and heroines racing around in scrubs - except perhaps Dr House, but even here his team is always doing some dramatic life and death test (man I need assistants as versatile as them - who can do any test/procedure/investigation and not have to leave it to that whole army of very highly trained technicians that you normally need to do MRI’s, spinal taps, bone marrow’s, needle biopsies, ultrasounds, craniotomies etc etc).

My beef is we grunts don’t get recognized. In the field of heart disease for example, all the glory and most of the money goes to the cardiac surgeon (the ones at the local hospital are like royalty) - not to we peons in the trenches who practice prevention and save the system zillions of dollars, and our patients untold morbidity, by controlling their blood pressure/cholesterol/blood sugar etc. But we’re just a bunch of dowdy old “Dr Gaggs” and not sexy enough to be on TV. 

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