Science or Magic: Please choose one--and stick with it.

My job is difficult—there is too much authentic medical knowledge to keep current on. To make matters worse it’s now becoming necessary to try to follow the trends/fads in “alternative medicine “

Our local community is especially rife with pseudo science & faith healers of every sort. My neighborhood is quite typical of southern Utah, we enjoy a:

1- Pathologically happy ‘Ward Shaman” She will merrily convince you that childhood immunizations cause autism, and asthma. Flu shots kill the elderly, cause migraines and are a form of government mind control.

2-The pungent smelling family (do they swim in essential oils?) This family lives on raw vegetables and green tea. They have no body fat. They don’t smile, they grimace ---and appear like Bataan death March survivors. They distrust the Federal Government and see black helicopters everywhere

3-More chiropractors per capita than ants on a dropped lollypop. These untrained magicians now specialize in any ailment you can imagine from Hemorrhoids to Cancer.

In counterpoint to my profession, our local quacks rely on hype & testimonials to sell their cures.

Do full page adds in the newspapers and flashy salesmanship “educate” the populace better than dry evidence based research...You bet it does!

Here is something to think about as you sample magic juice form Polynesia, or as you clench your teeth holding in that herbal enema!: Please realize the person offering this unorthodox treatment is SELLING SOMETHING. Yes, though they seem to care more than a boring M.D., nearly all these shamen rely on multilevel marketing to sell their cures—often using friendships & ward contacts for sales. (Note: this is an especially wicked form of priestcraft which originated in Utah valley.)

Occasionally I used to question our modern snake oil salesman. “Has your product been subjected to real scientific testing?” (e.g. A blinded study with large enough sample size to be statistically significant), they initially look confused then quickly recover and glare at me like Moses looking down on the golden calf! They then reply; “I’ve read accounts of 5 people who have had their lives completely changed by Tonga Juice 10!”

Interestingly this “magical group”   is also  quite narrow minded in its attitudes and beliefs, for example:
 1-They feel that prayerfully listening to Glen Beck will save America & the constitution.

They  also LOVE conspiracies:

 2*“Obama is secretly a practicing Muslim”,
 3*“The AMA has a cure for cancer but keeps it hidden”
 4*“The Air Force has a saucer & a collection of dead aliens at area 51
 5*“This tree bark extract will  help you live to 200! But big Pharma has bribed the FDA into refuting our claims” ---so we have to market it as a ‘Food Additive”


Sadly, once reputable big companies have jumped on the pseudoscience bandwagon: Ignoring the line between fact & fantasy they now market products that “Promote Colon health” and “support your immune system!” -- using obscure claims can’t be proven or disproven.

It is Ok by me if you want to believe in magnetic bracelets, crystals, healing blue light, chiropractic or energy alignment. My only request is “Don’t show up at my workplace and expect to me to buy into your beliefs, my profession is not magic based!

Here are a few frustrating examples of my workplace interactions with this crowd:

1-Hypertensive man; this intelligent appearing 55 year old man arrived in the ED one night complaining of two years of headaches. I note that his blood pressure is an impressive 200/145. When I remarked on this finding he stated, “Oh it has been high for years”. My Physician initially tried me on several different medications but all of them have potential side effects. He then smiled and stated” Then I found Dr Bill (Chiropractor) He is wonderful, I have been taking his natural medications for years no side effects.”—I sighed inwardly.
 After a medical evaluation I stated that the headaches were probably due to hypertension and that he was at risk for heart attack or stroke. He smiled and rolled his eyes in disbelief “Dr Bill said you would try to frighten me”. After my careful explanation of hypertension treatment in the 21st century he again scoffed and said “Dr Bill also said you would try to give me  toxic pills”. In frustration, I finally asked him “Why are you here in the ED wasting both our time if you distrust mainstream medicine??? He angrily stomped out of the department.”  ( I hope Dr Bill will treat this guy after his stroke)

2-Cancer Woman. This skeletal and jaundiced patient also presented in the middle of the night. She was short of breath and frightened. She told me her story: About three years previously she was diagnosed with early stage breast cancer. “Friends” warned her about the “Medical Conspiracy, ´ They also told of the painful surgery and the very unpleasant chemotherapy that would follow. They then introduced her to an Alternative medicine cancer clinic in Mexico. This clinic boasts of exclusively holistic treatments and achieves a near 100% cure rate. Sadly, it was now three years and $100,000.00 dollars later and she looked and felt terrible. I felt my throat tighten in pity as I stared at her jaundiced and emaciated form on the gurney. The cancer had metastasized throughout her body affecting nearly every organ system. I offered her referral to an oncologist but knew at this late stage she would be offered only palliative care. Even worse, her husband angrily took her home when I began speaking of hospice care. Three weeks later, I saw her obituary in the newspaper---I know hospice could have made her last weeks on earth much better but she was denied even that by her ignorant husband.

I could give many more examples of individuals who turn to science save them after magic has failed...

I’m now at peace with naive patients & magicians
 I firmly believe all people have a right their own belief system.
But my request is simply this: If you pick magic, please stay with it. We the mainstream medical community are overwhelmed and overburdened with legitimately ill patients in need of  help…we simply don’t have time for you magical thinkers. See your chiropractor, see your shaman, drink your grass juice and stay out of my #*&?@^% ER !

XOXO
 Dr Who

Southern Utah—Where it’s always Pioneer Day!

When I was little, we celebrated statehood day on July 24th. Our small town hosts games in the center park and sports a small  parade. We all dressed as 1847’s style pioneers. Men attired in long sleeved cotton shirts and women in long flowing neck to ankle dresses. Years later as a teen visiting St George, I was surprised to see a battered Chevy suburban pull up in front of Wal-Mart & 20 dusty “Pioneers” pile out & quietly march into the store. I pointed out this spectacle to my mom. She lowered her voice & whispered “ther'e not in costume, that’s the way they always dress...They’re polygamists from the border towns. 
Now  40 years later, I still see these odd pioneers –but they are now a too common sight.

Working in a busy southern Utah ER, these “Pioneers” are difficult patients and cause me & my co- workers to sigh in resigned irritation.
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 These “Pioneers” have multiplied like only a polygamist group can. Tour busses now slow so clients can view this local phenomenon. When the guide points out a cluster of women with long braided hair and billowing pastel dresses, yesterdays viewing of the Grand Canyon is quickly forgotten. 
Note: These “Pioneers” tend to congregate most at Wal-Mart, Costco & the Fabric stores but can also be seen occasionally at Shoney’s restaurant...

I recently had a European tourist ask me about these odd people. He said “they are like the Amish...yes?”
 I nearly choked on my tongue & said emphatically no! They are not!
And here are a few reasons why:

1-The Amish nurture & watch over their children. Their children are clean & well nourished. While they don’t send a lot of children outside the community for higher education they generally make certain the children receive a good primary education.

Our local “Pioneers” on the other hand are extremely neglectful of their children. Although they are numerically a small part of our community—nearly all our pediatric trauma comes from their small towns. It’s often a case of a 10 year old child who has been put in charge of minding twenty 2-6 year old children. ATV’s Horses, & open fires abound in their communities and with no adult supervision this is a recipe for disaster. Routinely an ambulance call from this community’s goes: “we are in transport with a 3 year old male who fell out of a moving truck, obvious head injury…” 
Once the patient is in our emergency department it is often difficult to identify the child’s mother from among the many “sister wives” that fill the trauma room (Hint: it’s often NOT to most concerned appearing woman)
CPS (child protective services) has given up on adressing these very frequent accidents as they get completely stonewalled when they go out to investigate.
Finally... through no fault of their own, these poor children have a  dramatically high incidence of birth defects, and metabolic diseases.  Consequently, many children from these communities suffer from profound mental retardation & seizures disorders. These rare diseases can frequently be attributed directly to the fact that the child’s parents are often 1st, or second cousins. Women marring an  uncle  is not unusual in this culture. There are very practical reasons most US States forbid these types of marriages!
Adding insult to injury, the “Pioneers” current leader has virtually shut down the local public schools. He decreed secular education "wicked".— thus making it nearly impossible for the undamaged children to get an education..

2-The Amish are independent & strive to make their communities self sufficient. Our local “Pioneers” practice nearly the polar opposite. From their Federal Government funded million dollar airport to their shiny new $50,000.00 ambulances—these people survive on Government Grant programs and subsidies. They have also cleverly figured out how to feed & cloth their large families without using their own finances. For example: Only the 1st wife is civilly married to the “pioneer” husband. All the subsequent “sister wives”, are  married "spiritually" to the family patriarch. These women then collect food stamps & receive State Medicaid funds. Legally this group of women  is regarded as impoverished single mothers of very large families. (Note: the State of Utah is currently trying to crack down on this abuse)
 You would logically think that these would be very patriotic communities. However, like ungrateful children, these “Pioneers” are resentful & suspicious of the very government that supplies their life blood.

In summary: Since their founding in the 1950’s, the leaders of our local  ‘Pioneers" have successfully indoctrinated its members, repressed its women, neglected its children. It teaches all its followers  that the outside world is  sinful and evil. (Can anyone say whabbieism!)

In conclusion dear european visitor, our local so called  "pioneers" are nothing like the Pennsylvania Amish!

Dr Who?

What to do about Grandpa.
As the only sentient life on this planet, there are a few topics we humans refuse to think about
1 -Our own inevitable death,
2- Our parents having sex
3-What to do about Grandpa!

Grandpa is now 89 years old. He is mildly deaf, moderately demented & now he can’t get to the bathroom on his own. A Home health aide comes twice weekly to  bath Grandpa—but it’s not nearly enough help. Grandpa’s dementia is worsening &  he often keeps Grandma up late into the night with his confused ramblings. Grandma has health problems of or her own  is getting worn out! She needs help. Her children call often but live far away and can offer only moral support.

I meet poor, frazzled Grandma at 2AM on a Sunday night when she brings Grandpa to the Emergency Department. On exam he is pleasantly confused, has a wet patch in his groin area, and  has dried food in the corners of his mouth. Grandma is exasperated and  tearfully states “I simply can’t take care of him any longer!”—and” I refuse to take him home!”
 Unfortunately this is a very common scenario in our retirement oriented community. We get at least one such “case of Elder Ditch” per shift!

I do a medical workup on Grandpa & find no new medical problems except slowly worsening dementia. I call the Social worker for help. She & I both agree grandpa needs to be in an assisted living center. Now comes the ‘Catch 22”-Care centers are very expensive (in excess of $300.00 a day) Medicare will pay for up to 6 weeks in a care center BUT ONLY AFTER A 3 DAY HOSPITALIZATION. (medicare could save 3 days hospital charges if they dropped this rule)  Me and the Social worker  search diligently for an admission diagnosis (Medicare will refuse payment, or sue the hospital for fraud if we can’t find a FIXABLE PROBLEM for our diagnosis) the other option is to send Grandpa directly to a care center—private pay (most care centers will want a $1000.00 check from Grandma upon arrival)
The social worker reveals: “Grandma doesn’t have that kind of money”
The Primary Care Physician says: “Grandpa has no infection, no new stroke, no new heart attack etc. An admitting diagnosis of Weakness, Incontinence, or Worsening Dementia won’t fly with Medicare as an admitting diagnosis”.

Bottom line—Grandpa needs a care center & he & grandma have no money for this obvious necessity. Where are the children? Wisconsin, California?

At this point in the scenario I wish my back molar were a cyanide capsule and I could just bite down….

Dr Who?

Tort Reform in America –too little, too late

The shopping cart example: A young mother is in a supermarket when her 2 year old child accidently falls from the shopping cart. The child strikes his head, momentarily looses consciousness, but quickly awakens & cries inconsolably for about 5 minutes. The child soon calms and is acting normal. The Mother appropriately takes him to be examined by a physician.

The European Physician: Carefully examines the child. Sees the bump on the forehead. He notes that the child looks & acts fine in all other aspects. The Physician knows that even in a well appearing child there is still a 1 in 1000 chance the child may have a skull fracture or brain hematoma. The physician is also aware of the evidence that radiation in a CT scan (Standard of care) can be dangerous to children The Physician realizes that he would have to irradiate 999 children to find that one fracture he may miss. He turns to the mother, explains the risks, and reassures her. He gives her a list of signs to watch for. In his country the legal system and the lay population know that the standard of care has been followed. His countryman also realize that because annually several thousand kids fall out of shopping carts and….statistically a fracture/hemorrhage will be missed.

The American Physician: Carefully examines the child. Sees the bump on the forehead. He notes that the child looks & acts fine in all other aspects. The Physician knows that even in a well appearing child there is still a 1 in 1000 chance the child may have a skull fracture or brain hematoma. The physician is also aware of the evidence that radiation in a CT scan (Standard of care) can be dangerous to children; he realizes that he would have to irradiate 999 children to find that one fracture he may miss. He knows however, that American’s demand 100% certainly in all aspects of medical care. If he doesn’t order a costly CT of the child, the mother will be angry or feel that “the doctor didn’t care enough.” She may even write an angry letter to hospital administration. The physician knows that 100% accuracy is expected of him and ANY missed fracture will result in a costly lawsuit. The physician sighs & goes ahead & orders the CT scan of the well child.

It is not just greedy attorneys that are the problem, it is a matter of national perspective & psyche:

The European: see’s fat people and blames it on Junk food & Lack of exercise. The American: blames McDonalds

The European: sees the space shuttle disaster as a tragic accident due to the very technical & inherently dangerous exploration of space.
The American: wants to close NASA down until a completely safe shuttle is available
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Lightning strikes a man golfing. “Bad luck!” says the European. The American says ”Let’s sue the weatherman & find a way to hold god himself accountable”.

Until Americans “get real” & stop getting their medical knowledge from unrealistic television programs, tort reform won’t change the very broken medical system we now “enjoy”