More Musings (of a Distractible Kind) - Latest Comments

Re: More Changes is More the Same — Musings of a Distractible Mind

Osama Hashmi — Fri, 11 Oct 2013 00:39:00 -0000

The design of both your blog and your practice are starting to look more and more awesome! It's inspiring to see.

Re: Musings of a Distractible Mind

Rhonda — Thu, 10 Oct 2013 03:31:37 -0000

Like your new digs. Didn't know you were a meatloaf sculptor, too. Nice to have a fallback trade. :)

Re: Telling a Good Story — Musings of a Distractible Mind

Rhonda — Thu, 10 Oct 2013 03:22:31 -0000

I think you're on to something!

Re: Musings of a Distractible Mind

Dr. Rob — Wed, 09 Oct 2013 21:21:40 -0000

Still some bugs to be worked out, but I kind of like it.

Re: 365

medrecgal — Thu, 03 Oct 2013 20:36:48 -0000

Your comments about communication reminded me of one of my own more "traditional" physicians, who nonetheless has no problem picking up a phone when it's necessary for the benefit of his patients. Technically I guess he's a "specialist" (as an Ob/Gyn), but he has a style that I really appreciate in a way sort of like you're describing in this post (i.e., better at connecting than other docs I've known over the years). My primary has asked me on more than one occasion why I still have this doc around since the problem I saw him for is quiescent, but how do you explain that kind of rapport in a way that would make sense? I have seen my primary for more than my share of things over the years, but I like my GYN, too, and he does a damn good PE (while asking questions about all aspects of your health, not just those particular parts). There are just some things that fall under what I call "if it ain't broke, don't fix it". Having two providers causes me no problems, and the insurance co. doesn't care what kind of MD does my yearly. Oddly, these days I often connect with my primary over the computer, because I have access through working for their practice and it's a lot easier than other ways of connecting. I think you really hit on something important here....keeping the human aspect alive amidst the technology.

Re: A Letter to Patients With Chronic Disease

Patricia — Thu, 03 Oct 2013 08:05:25 -0000

Dr Rob,

Thank you for being humble enough to write this post. I love you. I'm someone who avoids medical doctors because I've yet to meet one who admits to not knowing everything, and frankly I don't adhere to the palliative approach to medicine. The doctors I encountered when my baby daughter was gravely ill did more harm than good. She's a thriving 26 year old now but only because I took her health in my own hands and found an alternative practitioner who treated her whole being instead of as a series of symptoms.

It makes my heart sing that you've embraced a health care model (as opposed to the normal sick care model). I know that you'll be spending some time on studying how your patients can stay healthy because that isn't covered in the pharmaceutically funded medical training of doctors these days.

I haven't read all your posts so you may already be familiar with the work of Dr F. Batmangheidj

I think the knowledge that he has brought to the world goes some way to help enormously with treating chronic diseased patients. It's a different way of thinking but so important. http://www.watercure.com . As Dr F. Batmangheidj said "Your not sick; you're thirsty. Don't treat thirst with medication."

I know it doesn't reverse all conditions but an amazing amount of painful conditions can be relieved by hydrating the body with water and a good balance of mineral salts. The majority of the population are chronically dehydrated because they don't understand the importance of it and that not all liquids hydrate (even some types of water). So the knowledge of the will probably be an important step in helping your patients remain heathy.

Reading his book will give lots of information and a basic understanding of why water can actually cure so many conditions. It also highlights the misunderstandings medical doctors have regarding water retention.

Medical training is funded by the pharmaceutical companies and so is skewed towards using medications to treat symptoms when in fact the body is able to heal itself when given the optimal conditions.

Another breakthrough is the understanding of how the emotions and energy coursing through our bodies can affect our physical bodies.

Donna Eden's energy medicine is an amazing insight into how the

body can heal itself. http://innersource.net/em/

Emotional Freedom Techniques (EFT) is another amazing tool. It works on the premiss that dis-ease has an emotional cause. It's a wonderful tool for the chronically sick because it helps the person come to terms with the situation they are in, it helps to relieve pain without the side effects of medication, it can be self administered, and even improve the health of the patient. You can learn about it and how to do it here. http://www.towards-happines...

Re: A Letter to Patients With Chronic Disease

1desperateladysaved — Wed, 02 Oct 2013 23:41:54 -0000

So think that a patient/doctor combo that really cares about each other, will eventually get to the bottom of the problem.
30 years of celiac patient. Finally to the root!

Re: Washington, We Have a Problem

Dr. Rob — Tue, 01 Oct 2013 08:43:28 -0000

I think the culture ultimately has to change at the root level: stop paying for problems and procedures. While I've always striven to be sane in prescribing and test ordering, it was only after changing to my new payment model that I have been able to go a few steps further in the process.

Still, I do think that the "choosing wisely" campaign is a good start. The goal is to educate doctors on what not to order. Still, this is an uphill battle when CMS and the insurers continue to pay for unnecessary procedures, medications, and tests. Cut back on that now and many will cry against quotas. Let's encourage saving money and improving care, not the opposite.

Re: 365

Diane Bailey — Tue, 01 Oct 2013 05:49:42 -0000

I enjoy reading your posts. Love your mission and wish you the greatest success. Most of all wished you were located in SE Lower MI!!!

Re: Survival

Dr. Rob — Mon, 30 Sep 2013 07:39:12 -0000

Sure. Email at rob (at) doctorlamberts (dot) org

Re: 365

Jim — Mon, 30 Sep 2013 05:37:13 -0000

Listening + talking = healing .

Re: 365

Rhonda — Mon, 30 Sep 2013 04:40:07 -0000

Congratulations! Very inspiring to see what all you've done. And I'm reminded of this quote, "“A ship is safe in harbor, but that's not what ships are for.”

Re: Survival

Sharon McCoy George MD MPS — Mon, 30 Sep 2013 01:39:00 -0000

Rob,
Thanks for responding. Hope you get to come.
I got to speak to family docs at the AAFP Scientific Assembly in San Diego last week and it was heartening to see how many doctors are interested (and surprising how many did not know what a direct primary care practice is).
Would enjoy doing a podcast with you sometime to let others know what you are up to. Would you be willing?

Sharon

Correction to link: www.MDMentors.com

Re: Survival

Dr. Rob — Sun, 29 Sep 2013 13:38:17 -0000

Just noticed that this message went to spam. Not sure why. Sorry about that. I want to go to the meeting (and still may), but it's a money thing right now (spending for airfare, the meeting, and a hotel is hard to do when I am still getting up to the point of making a salary and paying for silly things like mortgage.

Re: Washington, We Have a Problem

pupmom — Sun, 29 Sep 2013 12:36:52 -0000

I found your blog after searching if I should take another Z pack for a sinus infection. Ok, I will try "breathing". !!My question is this....how do we change the culture? My brother had one bout of angina and found himself getting a bypass even though he was told of the new treatment of diet and medication. The doctor suggested the bypass and we all know why. My mother was on insulin at the age of 90 and had a hypoglycemic event and fell and broke her neck so spent the last 6 months of her life in a neck brace. What the heck? At least I had talked her out of starting cholesterol lowering meds. I am an RN and try to keep up on everything, but even if I do make suggestions, it is hard to compete with "the doctor". If the culture is motivated by the health care industry, how can we turn it around?

Re: Washington, We Have a Problem

tooearly — Sat, 28 Sep 2013 22:02:49 -0000

the present system works remarkably well from the perspective of health insurers,big Pharma and specialists! What is not to like?

Re: Washington, We Have a Problem

Fran — Mon, 23 Sep 2013 19:23:42 -0000

yeah so prevent all my disease please and take away all my medical problems. I would rather be problem free in the health care department and never have to call your office! and certainly take you off speed dial

Re: A Letter to Patients With Chronic Disease

Suzi Q 38 — Sat, 21 Sep 2013 01:35:03 -0000

Thank you for this!
I had nerve problems after my hysterectomy and my surgeon did not want to face that it could have been his surgery. I was willing to explore that it could have been coincidental, so just treat me for nerve problems.
My legs slowly and insidiously got weaker, then I had bowel and urinary function problems. Hands and feet were very cold. Anyway, I overexerted myself in Europe and could barely walk by the time I got home. I was in pain every night.

The doctors finally found spinal stenosis after a year and a half of doing little to treat me. I needed cervical spine surgery stat.

My gyn surgeon called me frantic when he realized that the year and a half of my complaining about troubling symptoms was not made up. I was not lying, and I wasn't a hypochondriac. I "told him off" for two hours. Ironically, it was the only time when he truly listened to me. There was a sad resignation in his voice.
he was begging me to have surgery STAT. I could not trust his words, since he did so little to help me in the months prior, and I told him so. I was so angry. I told him that I no longer trusted him, and that I hated that feeling. I told him that he needed to listen to his patients. I am a teacher, and I hated having to "teach" him this, at my physical expense. I was supposed to be the cared-for patient. I thought I hired the best. I guess I was wrong. It was one of the saddest phone conversations of my life.

I have had my c-spine surgery, and i can walk better, but a far cry of how I was at the start of my complaints.
If he had acted sooner and gotten me treatment I would not have had permanent damage.

Understandably, I was angry for several months.

At my last visit I had come to realize that he is fairly young (about 40), it was not his speciality (all the more reason to get me a referral quickly) and he understood what he had done.
I imagine the physician inside of him is feeling bad about his laziness and misdiagnosis that caused me permanent damage.

I am trying to forgive him, without telling him I forgive him. I realize that he was a little scared and too busy to care.

I have since done the patient- physician break up, since I think that any future visits may not only be awkward for me, but for him. He should not have me as a reminder of how bad he screwed up.

I was at another Gyn-oncologist's office the other day....in a city an hour away. "Small world,"this new doctor knew my first one!

I just told her the truth without disparaging the first doctor too much. I tried to "cut him a break."
She could see that I was barely walking and had difficulty standing up straight. I told her that the first doctor and I had to "break up" because for whatever reason, he didn't listen to me for about a year. That he probably is a good physician for someone else, but not for me.

I asked the new physician not to tell the old physician about me, because he would probably be embarrassed that she knew what happened to me.

She said she was surprised, but understood.

Re: My Side

laratterman — Sun, 15 Sep 2013 19:59:27 -0000

Dr. Rob, I really want to applaud you for what you're trying to accomplish here. It is TRULY a constructive thing you are doing!

I was diagnosed with Chiari Malformation in 1996 following a car accident, in which I received a severe whiplash with herniated and bulging discs in my neck and back. (I have since been diagnosed with several others that tend to go hand-in-hand with CM.) My pcp was a FABULOUS and COMPASSIONATE human being. He also suffered personally from MS. After sending me to multiple specialists (NS and NL), he was just as frustrated as I was with regard to what what going on with me. In fact, due to some similarities in the symptoms we were both having, he even had me tested multiple times for MS! We were being told by these specialists that the finding of CM on my MRI, as well as the diagnosis of cavernous hemangiomas on my spine, were "... benign findings that would never cause me any problems." Several of these doctors accused me of needing psychiatric care (the symptoms of CM are wide spread, as it affects the brain stem and spinal cord, so it affects the ENTIRE nervous system!) Others accused me of being a "pill seeker" (which I called them on the table immediately and told them to call my pcp and ask HIM what I thought of narcotic drugs! I wouldn't take them!) These doctors were WAY out of line! What's worse? I had to PAY these people!!!

After 4 years and a LOT of out of pocket money for specialists and tests, I finally gave up on going to doctors and just suffered silently and did the best I could. In 2008, I absolutely couldn't take it anymore... and after leaving work (a job I loved, btw) I started in with doctors once again. I endured 3 surgeries... discectomy and fusion at C5-6 (after numerous injections and tests), carpal tunnel release, and finally shoulder decompression. All to no avail. In September of that year, my psp and I put our heads together trying to recall what it was I was diagnosed with back in '96. When we found it and looked it up on the internet, we were amazed and disgusted at the same time. As it turns out, ALL of the symptoms I had been experiencing were right there in black and white! So much for the NS and NL... the so called specialists! I'm sorry, but they WERE worthless and didn't care at all.

It IS frustrating to pay the doctors who are bad. Consider this... if you were attorneys, we would have a FREE initial consultation... to see if we could work together after getting an understanding of what we would be dealing with. IMHO, I think it should be the same way with PCPs and specialists. That's just from the years of BAD experience.

BUT... on the other side of things, there are wonderful individuals such as yourself, and my Dr. H who make us FEEL that at least someone has the care and compassion to TRY and help us, and other doctors, understand our conditions. Dr. H didn't hesitate to receive from me the 3" thick three ring binder of information that I was able to get from the internet for him to review. THAT is working together... and care and dedication to a patient. (And he soon found out that I was not going to be his only CM patient! So when others came, he was informed! :) )

I appreciate what you're trying to convey to us. It is useful and constructive. I also want you to understand that sometimes it's not YOU we are aggravated with, but the other doctors we have had to see who have done nothing. We KNOW that you aren't a specialist... so we don't expect YOU to fix us. In this we are as frustrated as you are. But never forget... we DO want to be fixed! We don't really want the "bandage" of drugs.

What we DO want, are the specialists you send us to to LISTEN and not JUDGE us... we don't want DRUGS, we want FIXED! I know that CM cannot be cured. So do what you can do for me and give me medications that won't leave me drooling in a corner somewhere - this happened to me for almost 4 months! {Dr. H finally told me that he would have to put me on morphine and some other really strong meds JUST TO GET ME OFF OF the ones I was on. At that point, I made the decision to cut the "bad" meds in half and start decreasing them myself until I was off of them (I was on 9 meds at the time!) I made a choice then that I wasn't taking any of these long term anymore! (i.e. I DID take Percocet after my CM decompression surgery for a short time. Sometimes you DO have to have the strong meds... sometimes you just can't get around it.)}

Don't just try and medicate me to shut me up and keep me from sitting in your exam room... that is only making my situation WORSE... and in some people's cases, you have merely replaced one serious condition with another... ADDICTION to prescription meds. THAT should never be allowed to happen.

We understand that you all are human... and that you don't have ALL of the answers right there. For even if two of us have the same condition, we are all still different... and what works for one of us may not work for the other. In short time, yes... we have the internet and we educate ourselves. Please understand that we HAVE to do this! (For 8 years I trusted the words of the specialists that CM and CH weren't anything to be concerned with and weren't what was causing the problems I "supposedly" had. Trust me, I am VERY WELL educated now! And not by doctors!) Some conditions are scary when we're told about them... or if those diagnoses are ignored by our doctors and not explained to us, we want to know! We HAVE to be our own health care advocates! If we aren't, who is? You already have your hands full, as we know we aren't your only patient. But wouldn't if be beneficial to read up on something you're not familiar with, even though it requires a specialist?

Thank you, Dr. Rob, for trying to bring understanding to the doctor/patient relationship. I agree whole heartedly... it is one of our most important relationships! I hope we can find some constructive suggestions to go both ways... and who knows?... maybe we can get them put together and sent around to ALL of the doctors and specialists in the U.S.! I know some would still ignore it. THOSE doctors will always look at themselves as "Dr. God". Nothing we can do about them except to STOP SEEING THEM!

Let's keep trying to share constructive conversation!

Re: Survival

Dr. Federico Pedernera — Fri, 13 Sep 2013 16:07:18 -0000

Dear Robert

I came to your Blog by a friend's recommendation of this post.
As a doctor I agree 100% with you, it's about go back to the roots. And as a specialist in Medical Informatics I've been working along with other colleagues to creat a product/service to meet step by step with your espectations, our espectations. Thus we created a startup to offer a Web-based solution focused on doctors needs.
So thank you again for spread in a such good way what we've thinking.

Best regards from Argentina
Federico Pedernera.
www.epicrisisweb.com

Re: Survival

WWWeaves — Thu, 12 Sep 2013 13:22:46 -0000

The guy doing NOSH seems to have the same idea.

Re: A Letter to Patients With Chronic Disease

mary — Thu, 12 Sep 2013 13:06:25 -0000

So well written. Thank you for taking the time to do this. I will definitely share.

Re: A Letter to Patients With Chronic Disease

Coronary Microvascular Disease — Thu, 12 Sep 2013 10:19:46 -0000

Very important to gain a good communication with your doctor and reading this perspective, understanding this point of view is crucial as much as them understanding us. Thank you. I am sharing this on my info page for CMVD, an often misdiagnosed misunderstood heart condition.

Much love and light. This is a most appreciated share!!!
AP

Re: Survival

Kevin Brady — Thu, 12 Sep 2013 08:06:51 -0000

Dr. Lamberts,

Great posts -- and great blog. I'm President of Physicians Angels, and we provide virtual medical scribes to clinics throughout the U.S. ("virtual" means remote, off-site). We work with over 50 EMRs now. We're also deep into developing a new and better EMR, along with a PHR, for the U.S. and certain international markets. Would love to speak more with you. I'm at < kbrady at physiciansangels dot com >.

Regards,
Kevin Brady

Re: A Letter to Patients With Chronic Disease

sarcy — Tue, 10 Sep 2013 20:49:19 -0000

even more flies with sh-t !!!