On Monday, I also met Dr. Mitchell Lebowitz, whose business card says he’s Mickey and Senior Medical Quality Director/Endocrinology, Quality Improvement & Dept. of Medicine. He maintained a private practice as an endocrinologist for seventeen years, then came over to quality stuff and wrote “Losing My Patience: Why I Quit the Medical Game.” He still knows more than most physicians about endocrinology and that’s why somebody called him to see me—diabetes mellitus and diabetes insipidus are both treatable by endocrinologists. Theoretically.
So we talk. He asks good questions—actually, what he mostly does is ask a few leading questions and then listen, which is what a good doctor does. If physicians would just shut up and listen to their patients then the future of medicine would be improved by about 290% as far as the patients are concerned. The practice of medicine is supposed to make the patient feel better, not the physician. Too many physicians are practicing to make the patient fit the protocol for health without regard to what matters for the patient. I give you my friend Valerie, with a bad heart, whose physician prescribed a beta blocker, which would have kept her alive and well—as long as she remained in a rocking chair, however, she never again would be able to pick up her grandchildren.
The single most important thing in Val’s life was taking care of her grandchildren so that her daughter could finish nursing school.
What the physician wants and what the patient wants are not necessarily the same thing but on Monday morning when Mickey (he asked if he could call me Anne, so I’m going to presume equality) and I talked, we both wanted my blood sugar to be kept down. Little did I know that it was already too late. We were getting some good numbers in the 100s and one finger stick at 85. Dr. Lebowitz said that finger stick should have been repeated because (a) I didn’t feel like my blood sugar was that low, and (b) it was in the midst of 100s and 200s. It had not occurred to me—or the nursing staff—but of course he was right. When you get one atypically weird number, you repeat the test.
Dr. Lebowitz reported one case of a woman who tested at 20, which is near death, but who was not looking the least bit deadly so they called the lab, tapped a vein, and got a nice glucose level. The bedside glucometer was broken. A large part of practicing good medicine is keeping your mind open and considering all the possibilities. I just watched a show on a female college student who had stabbing pains in her abdomen and threw up every time she tried to eat. Her first doctor said she had irritable bowel syndrome. The second said she had anorexia. The third, fourth, et cetera, did her no good at all. She finally went on-line and discovered that all the tests that had been done were on her stomach and large intestine. She went to another doctor, asked for and got an upper gastrointestinal look-see, and there was the problem: a rare blockage of one vein running into another. She was down to 72 pounds when she found the problem that all the physicians missed.
Never forget that you are an intelligent person and have more time and motivation to search the Internet than does your physician—and it’s all out there.
So Mickey Lebowitz thanked me for a good conversation—which I, too, enjoyed—and took off for a quality meeting. Several more people came and went, then we ended up with the meeting of A Bunch of People in Charge wherein I understood two things: (a) they really did care about me and (b) they wanted me to be nicer to their staff.
I gave some thought to whether I could go back fifty years and re-become my mother’s daughter, without the intervening half century of life experience. The first swear word I ever said was when I was fourteen years old, had PMS, and my junior high school locker door was stuck. I said, “Damn!”—and turned around to see a teacher standing behind me. I was absolutely positively sure that the floor was going to open and I would be sucked into the Underworld, never to be seen again. My mother didn’t utter her first swear word until she was about fifty years old. Her four daughters stood in a circle with their mouths open, utterly speechless: Mom swore!
On Tuesday, Mickey Lebowitz came back, talked about how much he thought about me while he was driving home (he only lives about the standard twenty-minute commute away, but probably accomplishes more thinking in less time than most people) and he offered me two alternatives, being very careful to assure me that it was my life and not his choice. Nice of him to notice.
So the option I chose was to continue the insulin, even if I did start to react to it, and cover the reaction with Xanax. He said he was hoping that would be my choice, then asked me if I knew what Einstein had said about insanity. Yeah, I said, doing the same thing over and over again but expecting different results. I’ve already gone two rounds with insulin without Xanax. So Dr. Lebowitz and I agree that I will take the insulin and potentially bad side effects will be covered with Xanax.
And I go to sleep thinking we have a plan and everything is taken care of.
Silly me. I forgot to factor in the Hospital Equation, which says that unless three people have signed off on it, nothing valid has taken place.