52 Years: What I Learned
This is one pretentious title, but I want to get some things off my chest and then maybe I can be more analytical.
I find fault with myself for not having been a good student, not having leareed as much as I could, having empathy when a patient touched my soul and being provocative and argumentative when I did not like patients. Yet I think my heart was in the right place. I believe Yale Medical School did a survey on my class, the class of 19369 and found that the number one reason for becoming a doctor was to seek prestige. I believe if a survey were conducted today, it would reveal a quest for money.
My grievance is that the entire medical profession, nay, the entire culture revolves around acquiring riches. The pursuit of knowledge, well being of our fellow man, sophistication, comraderie and harmony have been relegated to a lesser goal. The doctors , the pharmaceuticals, the para-medicals, the hospitals, and above all the money-power thirsty politicians who line their money with contributions from health generated wealth have little regard for well-being. Especially so if we consider the lower middle and lower class.
Doctors and physician extenders in particular promote the most expensive drugs to treat patients, even if their predictive results are paltry. For example, consider topical antifungal solutions for nail fungus. They have prohibitive costs with cure rates ranging from 5-30%. Simply filing the surface of the nail daily followed by application of athlete foot over the counter creams has an equal or better cure rate with a necessary duration of treatment which is the same as expensive treatments including oral medication which has potential severe side effects.
So here are some everyday experiences which empower patients (do patients need to rely on doctors every time they have a medical problem) and save huge amounts of money.
Childhood eczema: up to 85% of children can be effectively treated with ceramide fat containing emollients and oral consumption of 3 glasses of green tea daily. Antihistamines have been shown to cross the blood brain barrier and are associated with dementia in adults . Do we need to expose our children to that? Topical steroids create a dependency on doctors, pharmaceuticals, can be cost prohibitive. Is this appropriate for 85% of children who could have been treated with products that can be purchased without a prescription.
I have already mentioned nail fungus which costs $5.00 for the nail file and 9-15.00 for the cream.
Chronic hand eczema is also modified with ingestion of green tea, 3 cups /day. (the tea must be prepared with sufficient concentration as follow: boil 2 qts of water. Suspend 3 green tea bage steeped for 30 minutes. Pour into a pitcher and refrigerate and flavor to taste.
There are many combination potions for acne but in reality up to 70% of teen-agers are improved with short contact benzoyl peroxide therapy one minute per day. Most of the rest are improved with topical retinoic acid applied one pea sized drop to each cheek with possible addition to the mid forehead. Female patients, especially over 20 years of age are usually controlled with spironolactone 100 mg /day with a few patients needing 150 mg /day. This is inexpensive and safe compared to antibiotics which alter the GI flora and probably the immune system a sa consequence. Accutane is a miracle drug when used correctly in selected patients, but it is not infrequently used in small doses for cosmetic control in self absorbed females who ignore possible long term adverse sequelae.
Keloids can be controlled with shave excision followed by cryotherapy with liquid nitrogen and intralesional kenalog 40 mg/cc. This avoids disfiguring surgery, frequent recurrences, and disillusioned patients.
I have concentrated on dermatology because I am a dermatologist but the same is true of most or all specialties. Dermatologists concentrate on cosmetic procedures because it makes a lot of money. Hospital emergency rooms perform unnecessary procedures such as a chest Xray to R/O a pulmonary embolism in an asymptomatic patients which will not be diagnostic regardless. Plastic surgeons who are self-promoting and disfigure patients while promoting the excellent results. This is the obvious case of the emperor and his new clothes. Rod Steiger did an episode of Twilight Zone where a girl who was beautiful was distraught because her plastic surgeons could not reconfigure her face to look like them They, in fact, had faces identical to pigs. Unnecessary biopsies which create an income stream rather than promote health and most egregiously unnecessary surgery. And I have not yet mentioned fraudulent billing which amounts to many millions of dollars per year in the U. S. alone. And then we read the complaints of doctors burnout, doctor overwork, doctor battery by attorneys. Yet in committee doctors behave not unlike their lawyer counterparts and harass competitors when they come from a different specialty.
In truth there are many good doctors and heartwarming stories of patient survival but in the community that may not be the case. Universities now create clinics or partner with clinics by selling their name for kickbacks in the form of patient referral or publicity.
I find fault with myself for not having been a good student, not having leareed as much as I could, having empathy when a patient touched my soul and being provocative and argumentative when I did not like patients. Yet I think my heart was in the right place. I believe Yale Medical School did a survey on my class, the class of 19369 and found that the number one reason for becoming a doctor was to seek prestige. I believe if a survey were conducted today, it would reveal a quest for money.
My grievance is that the entire medical profession, nay, the entire culture revolves around acquiring riches. The pursuit of knowledge, well being of our fellow man, sophistication, comraderie and harmony have been relegated to a lesser goal. The doctors , the pharmaceuticals, the para-medicals, the hospitals, and above all the money-power thirsty politicians who line their money with contributions from health generated wealth have little regard for well-being. Especially so if we consider the lower middle and lower class.
Doctors and physician extenders in particular promote the most expensive drugs to treat patients, even if their predictive results are paltry. For example, consider topical antifungal solutions for nail fungus. They have prohibitive costs with cure rates ranging from 5-30%. Simply filing the surface of the nail daily followed by application of athlete foot over the counter creams has an equal or better cure rate with a necessary duration of treatment which is the same as expensive treatments including oral medication which has potential severe side effects.
So here are some everyday experiences which empower patients (do patients need to rely on doctors every time they have a medical problem) and save huge amounts of money.
Childhood eczema: up to 85% of children can be effectively treated with ceramide fat containing emollients and oral consumption of 3 glasses of green tea daily. Antihistamines have been shown to cross the blood brain barrier and are associated with dementia in adults . Do we need to expose our children to that? Topical steroids create a dependency on doctors, pharmaceuticals, can be cost prohibitive. Is this appropriate for 85% of children who could have been treated with products that can be purchased without a prescription.
I have already mentioned nail fungus which costs $5.00 for the nail file and 9-15.00 for the cream.
Chronic hand eczema is also modified with ingestion of green tea, 3 cups /day. (the tea must be prepared with sufficient concentration as follow: boil 2 qts of water. Suspend 3 green tea bage steeped for 30 minutes. Pour into a pitcher and refrigerate and flavor to taste.
There are many combination potions for acne but in reality up to 70% of teen-agers are improved with short contact benzoyl peroxide therapy one minute per day. Most of the rest are improved with topical retinoic acid applied one pea sized drop to each cheek with possible addition to the mid forehead. Female patients, especially over 20 years of age are usually controlled with spironolactone 100 mg /day with a few patients needing 150 mg /day. This is inexpensive and safe compared to antibiotics which alter the GI flora and probably the immune system a sa consequence. Accutane is a miracle drug when used correctly in selected patients, but it is not infrequently used in small doses for cosmetic control in self absorbed females who ignore possible long term adverse sequelae.
Keloids can be controlled with shave excision followed by cryotherapy with liquid nitrogen and intralesional kenalog 40 mg/cc. This avoids disfiguring surgery, frequent recurrences, and disillusioned patients.
I have concentrated on dermatology because I am a dermatologist but the same is true of most or all specialties. Dermatologists concentrate on cosmetic procedures because it makes a lot of money. Hospital emergency rooms perform unnecessary procedures such as a chest Xray to R/O a pulmonary embolism in an asymptomatic patients which will not be diagnostic regardless. Plastic surgeons who are self-promoting and disfigure patients while promoting the excellent results. This is the obvious case of the emperor and his new clothes. Rod Steiger did an episode of Twilight Zone where a girl who was beautiful was distraught because her plastic surgeons could not reconfigure her face to look like them They, in fact, had faces identical to pigs. Unnecessary biopsies which create an income stream rather than promote health and most egregiously unnecessary surgery. And I have not yet mentioned fraudulent billing which amounts to many millions of dollars per year in the U. S. alone. And then we read the complaints of doctors burnout, doctor overwork, doctor battery by attorneys. Yet in committee doctors behave not unlike their lawyer counterparts and harass competitors when they come from a different specialty.
In truth there are many good doctors and heartwarming stories of patient survival but in the community that may not be the case. Universities now create clinics or partner with clinics by selling their name for kickbacks in the form of patient referral or publicity.
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