What a great read! It seems a lot of doctors today are jaded and overworked. Some seem to be indoctrinated by what they learned in medical school as opposed to thinking outside the box so to speak. It seems like that's something you do. When you retire some day you can always write! Sabrinalabow.substack.com
EMS uses "doorway impressions" as the 1st assessment. What you can see, hear, observe about environment as you enter a patients home cannot be understated. After asking "what made you call today" can reveal another nugget of info as you observe their speech, focus, breathing, posture, skin, attitude/mood...and that's before you begin any hands on assessment. More information gained from this brief period than any monitor/equipment would reveal in the same amount of time. This skill improves with experience. Why did I enter healthcare? So i would not feel helpless in an emergency and my natural curiosity about people...its never been boring and always in need.
There's a small part of me that doesn't want to know because exactly what you said...boat load of tests. They try every which way to milk you. If nothing comes up instead of saying "let's get to the bottom of this" you get a "I don't know...good luck...come back if it gets worse!" Or a "Oh these drugs didn't work...sorry boutcha! Thanks for the BOATLOADS of money you wasted on me!" Mine started out I was waking up swollen head to toe, but hands were worse! I started taking off my rings at night and loosening my watch! I started with OTC water pills which helped some. I started drinking ALOT of water. Started iodine drops, liver detox, magnesium, Tumeric and Krill Oil supplements. I also put Native Path collagen in my coffee every morning! Things are ALOT better (I feel more thanks to Krill Oil) and just my first joint on my middle finger is swollen, hot, and pops funny. I get the Krill Oil and Tumeric from Native Path and I HIGHLY recommend them!!! I hope your situation gets better! I'm like you in my 50's and don't plan on slowing down if I don't have to! Off to mow! It's only 96 today as opposed to 106 yesterday! 🤪
Sensible medicine to me is a healthcare provider’s powers of knowledge, intuition and observation that is held in check with a non-judgmental (ideally non-dual) awareness that acknowledges the potential for intrinsic, extrinsic and systemic bias.
Marie, while potentially correct, was projecting her own struggles with autoimmunity and chronic steroid use onto the patient. Her greatest strength is also a weakness. And has the potential to widen the aperture of misdiagnosis.
Thank you for sharing your story. I got into nursing late in life. I took all my pre-reqs, one class at a time, as my boys were growing up. I went to nursing school with the sole goal of becoming a NICU nurse. My firstborn was a preemie and watching the nurses who cared for him and me lit a fire in me to pay it forward to other terrified parents of premature babies. I have been following my passion for 14 years now and I still celebrate every tiny milestone with families as they walk thru the life of a NICU Parent.
Yep, I remember when my grand daughter made it to three pounds. I remember when she went from slowly sucking and getting too tired to take in enough nourishment to suddenly sucking down the whole 5 ounces and looking for more.
I studied psych and premed but discovered the ability of NP and PA to be care extenders and rethought crushing debt of psychiatry not worth the return on investment. I see a DO who treats the whole patient not just the hole in the patient. It’s in their training to even understand the value of spinal manipulation though I never had the need. I did however treat a woman in Vermont who fell on her coccyx and it was out of alignment for 15 years. She had no comfortable positions and was on opioids for that time. X-ray was supine and did not show it. She needed a coccyxgyal adjustment and I thought it best to refer to a female chiropractor in town who did a simple but invasive adjustment and she was cured. She asked me to meet her there and be with her for it she cried for joy. Territory wars have hurt medicine too.
PT can help reduce this need for a pill or another test. I’m glad to be able to spend an hour with my patients and educate them as well as treat them to improve their dignity and life.
She needed a coccyxgyal adjustment and I thought it best to refer to a female chiropractor in town who did a simple but invasive adjustment and she was cured. -- Claire, would you kindly share the name and/or contact information of this chiropractor? Thank goodness I healed on my own from something similar, but have a colleague whom would be interested in this too for an active condition. THANK YOU for sharing!
My apologies but it was 30 years ago and I don’t recall her name. You can ask a local chiro if they understand what that procedure is, or if they know a clinician that has experience or would feel comfortable assessing and performing such a procedure.
As a massage therapist I am a great believer in chiropractic. My former partner Paul was a brilliant chiropractor who healed countless numbers of suffering people.
The AMA did much to nearly destroy the field of osteopathy. Osteopaths do exist but many of them have become PCPs and once they become PCPs they no longer touch you or give spinal adjustments. I found this out when I purposefully chose a D.O. when Ifrom the list of PCPs when I got my medical insurance. But when I got there I learned that he doesn't touch people!! He's a D.O. in name only and this is true of many of them who are in this system and that's a crying shame.
This reminds me of something that happened to me over 30 years ago.
I was in my early 20s, sick, and went to my family doctor, who was teaching a group of family practice medical residents at that time. They trooped into the exam room, my doctor put my chart (it was all still paper back then) on the table, then asked me what brought me there that day. I reeled off my symptoms: headache, ringing in my ears, stuffy nose, sore throat with post-nasal drip, upset stomach, no fever, losing my voice, all of which had persisted for over 3 weeks.
My doctor turned to the residents and asked them, "Okay, now what do you do?" Every single one of them started recommending a dizzying array of diagnostic tests and specialists, ranging from a CBC & head CT scan to consults with a neurologist and an otolaryngologist (ENT doctor).
My family doctor turned to me and asked "What do you think is wrong with you?"
I told him "I think I have my annual fall sinus infection."
Not one of them tried to examine me first, something my doctor was quick to point out. My family doctor then led them through the exam, and had all of them take turns looking in my ears and nose, feeling the glands in my throat, applying pressure to my facial sinuses (less than pleasant, but they needed to learn and I'd agreed to be their lab work). My doctor then says to them, "Okay, that's a sinus infection. What do we do about it?"
After being called on not examining me before recommending lab work, they were all looking at each other with that "uh... do you want to go first?" expression, and I had to take pity on them. I volunteered "I think you're going to prescribe 500 mg of amoxicillin 3x/day for 14 days because I've been getting these every year since I was 3, but for any other patient you'd probably only do 10 days of antibiotics because you don't want to overprescribe them."
My doctor then picked up the chart - -which had been totally ignored until that point - and explained that it was all in there, including the years I'd spent as a pediatric patient at the ENT specialist and the tests the allergist had run - and that aside from my physicals, this was the only thing I'd needed to see him for since my pediatric days.
My doctor's "moral of the examination" was twofold: examine the patient and read the patient's chart before ordering or prescribing anything. It is amazing to me that those two simple starting points seem to be missing from medical school.
Yes...HELLO!! thank you. I hope you have found better remedies now than antibiotics and sought to uncover the root cause of your annual sinus infection so as to prevent the condition that caused them in the first place!
Homeopathy and Functional Holistic Medicine could be helpful in this regard.
Things don't come out of the blue; they come out of the oblivious. Every effect has a cause. If you can tap into and uncover the root cause and address that, your symptoms will cease.
Thanks for sharing this very illustrative experience. Always more to the story that Western medicine is missing because they're not asking "WHY?"
YEARS ago at a sick visit to our PCP, I had agreed to see "the other doctor" on staff because ours was booked solid. When Dr. Ricci walked into the exam room, he talked to me for over 20 minutes before ever laying a hand on me. It was obvious from his questions that he had read every page of my medical history (a very long and complicated one at that). He also appreciated that I didn't just want a prescription but a solution/cure. That chance visit changed my families' course and he became our new PCP. We followed him every time he switched practices. In our years of seeing him, he was always running late but I never complained because I knew he was spending whatever time was required with the patients before me and would do the same with me. Two years ago, he began doing concierge medicine and unfortunately, that priced him out for us. It was a difficult process to find another doctor like him (he set the bar really high), one who would LISTEN, one who would ask questions, one who wouldn't immediately reach for the prescription pad. That kind of practice/medicine is a lost art.
Yes it is a lost art but it needs to be found again! Because unless it is, doctors today are simply not practicing true medicine. You were so blessed to have Dr. Ricci as your doctor and I'm sorry that this had to stop because of money. That's another problem but that's a whole other conversation!! Thanks for sharing.
My wife and I can't seem to avoid the remote diagnosis syndrome. She, a retired CNM, and me, a long-term scientist, have seen enough patients in our time to be pretty good at it, too. I didn't have the opportunity to go to medical school but that didn't stop me from years of medical research, and even some significant clinical exposure. While medicine should have been my lifelong career, science, in a variety of fields where I've been pretty successful, had to substitute. And a poor substitute it was. Retired now, I'll continue keeping up with CME, my reading, and acting as an epidemiologist for a rather large not-for-profit. My work's helped keep the volunteers in that organization a little safer by providing them evidence-based data on COVID, and providing answers to their questions.
Thank you for the essay. I found it touching in all the right ways.
Very interesting. I think observation and diagnosis lacks in so many doctors today. My dad was a great diagnostician he is long gone but was a urologist and surgeon. I remember talk at the fing table about patients of his. As an adult I’ve been subjected to as wide range of doctors in general practice or internist I’ve had two good ones. My current doctor however just dumped me or I chose not to pay her concierge $$ as I’m very healthy and have limited retirement income. Now I’m on the search for one like you with acute observation skills and can diagnose properly! Good for grandmother teaching u these skills. Oh that more had grandmother’s like yours.
Thank you for mentioning the word diagnostician. Two of my favorite shows are HOUSE and Doc Martin!
we should all be so lucky to have brilliant diagnosticians like them although the bedside manner could stand a little improvement lol
I have been chronically ill for a long long time; decades, and now much worse. No doctor I ever go to in the Western medical system has ever been able to touch it and they seem annoyed because I do have a long list of symptoms and they won't even listen to all of them in my " physical" in which they nevwr examine me. They just stare at the computer screen and cut me off saying, "it's too much.. you'll have to talk about that when you're on your next visit" when it's all part of the same condition.
I just wish that a doctor (and this wasn't even a doctor; it was a nurse practitioner. Good luck even getting access to a doctor nowadays at least in the health system I'm a part of). but I sing the praises of a good nurse practitioner or a physician's assistant! In my experience they have been far superior to the doctors I have seen over the last 10 years.
But still, I never feel heard. I never feel that anyone is really interested in how I feel when I go to these PCP offices.
They're not listening and they're not LOOKING.
I might as well be talking to robots!
All they know how to do is order blood tests and x-rays etc but you practically have to be dying to get a referral to a specialist and then they make you jump through all kinds of hoops before they let you. it's all about insurance insurance insurance.
I feel like I have to sell my PCP on the fact that I'm sick!. they put a lot of pressure on me and I feel very stressed. As a matter fact my blood pressure shoots through the roof the second I walk into a medical building because my anxiety kicks in automatically. I always tell them to take my blood pressure at the end of the visit and they do and it's always normal but at the beginning of the visit it tends to be high because of the anxiety i feel laying myself open to an inhumane, discompassionate system that really doesn't care about me.
I just started with a new one last week and she was definitely better. She spent a longer time with me (you know over the 10 minutes they allot you normally) lol but no physical exam.
I don't even know what she looks like because of the huge mask she was wearing. Sigh…
I'm obligated to point out that most difficult diagnostic challenges are not solved by a single, brilliant if troubled diagnostician, but by working with a competent team, and knowing when your knowledge isn't sufficient to answer all the questions. House isn't real life.
initially I felt I was demoting my self, or squandering my degreed knowledge just working for a couple of ortho surgeons in a busy practice, but! People are unique. Ortho surgery is complex for each patient. I did love that job very much, I worked directly with the patients and knew them. All of us have a struggle
This is a fantastic reflection.
From my own personal multicultural competencies: Bellissimo and Dziękuję
What a great read! It seems a lot of doctors today are jaded and overworked. Some seem to be indoctrinated by what they learned in medical school as opposed to thinking outside the box so to speak. It seems like that's something you do. When you retire some day you can always write! Sabrinalabow.substack.com
EMS uses "doorway impressions" as the 1st assessment. What you can see, hear, observe about environment as you enter a patients home cannot be understated. After asking "what made you call today" can reveal another nugget of info as you observe their speech, focus, breathing, posture, skin, attitude/mood...and that's before you begin any hands on assessment. More information gained from this brief period than any monitor/equipment would reveal in the same amount of time. This skill improves with experience. Why did I enter healthcare? So i would not feel helpless in an emergency and my natural curiosity about people...its never been boring and always in need.
Such an enjoyable read! Thank you for sharing this story of your journey.
Thanks so much. I am glad you enjoyed it.
Adam
There's a small part of me that doesn't want to know because exactly what you said...boat load of tests. They try every which way to milk you. If nothing comes up instead of saying "let's get to the bottom of this" you get a "I don't know...good luck...come back if it gets worse!" Or a "Oh these drugs didn't work...sorry boutcha! Thanks for the BOATLOADS of money you wasted on me!" Mine started out I was waking up swollen head to toe, but hands were worse! I started taking off my rings at night and loosening my watch! I started with OTC water pills which helped some. I started drinking ALOT of water. Started iodine drops, liver detox, magnesium, Tumeric and Krill Oil supplements. I also put Native Path collagen in my coffee every morning! Things are ALOT better (I feel more thanks to Krill Oil) and just my first joint on my middle finger is swollen, hot, and pops funny. I get the Krill Oil and Tumeric from Native Path and I HIGHLY recommend them!!! I hope your situation gets better! I'm like you in my 50's and don't plan on slowing down if I don't have to! Off to mow! It's only 96 today as opposed to 106 yesterday! 🤪
Sensible medicine to me is a healthcare provider’s powers of knowledge, intuition and observation that is held in check with a non-judgmental (ideally non-dual) awareness that acknowledges the potential for intrinsic, extrinsic and systemic bias.
Marie, while potentially correct, was projecting her own struggles with autoimmunity and chronic steroid use onto the patient. Her greatest strength is also a weakness. And has the potential to widen the aperture of misdiagnosis.
Looking forward to this series! Cheers
Thank you for sharing your story. I got into nursing late in life. I took all my pre-reqs, one class at a time, as my boys were growing up. I went to nursing school with the sole goal of becoming a NICU nurse. My firstborn was a preemie and watching the nurses who cared for him and me lit a fire in me to pay it forward to other terrified parents of premature babies. I have been following my passion for 14 years now and I still celebrate every tiny milestone with families as they walk thru the life of a NICU Parent.
Yep, I remember when my grand daughter made it to three pounds. I remember when she went from slowly sucking and getting too tired to take in enough nourishment to suddenly sucking down the whole 5 ounces and looking for more.
Beautiful...💗
RuthAnn, you are an angel
I studied psych and premed but discovered the ability of NP and PA to be care extenders and rethought crushing debt of psychiatry not worth the return on investment. I see a DO who treats the whole patient not just the hole in the patient. It’s in their training to even understand the value of spinal manipulation though I never had the need. I did however treat a woman in Vermont who fell on her coccyx and it was out of alignment for 15 years. She had no comfortable positions and was on opioids for that time. X-ray was supine and did not show it. She needed a coccyxgyal adjustment and I thought it best to refer to a female chiropractor in town who did a simple but invasive adjustment and she was cured. She asked me to meet her there and be with her for it she cried for joy. Territory wars have hurt medicine too.
PT can help reduce this need for a pill or another test. I’m glad to be able to spend an hour with my patients and educate them as well as treat them to improve their dignity and life.
She needed a coccyxgyal adjustment and I thought it best to refer to a female chiropractor in town who did a simple but invasive adjustment and she was cured. -- Claire, would you kindly share the name and/or contact information of this chiropractor? Thank goodness I healed on my own from something similar, but have a colleague whom would be interested in this too for an active condition. THANK YOU for sharing!
My apologies but it was 30 years ago and I don’t recall her name. You can ask a local chiro if they understand what that procedure is, or if they know a clinician that has experience or would feel comfortable assessing and performing such a procedure.
God bless you for this great story!
YES!!
As a massage therapist I am a great believer in chiropractic. My former partner Paul was a brilliant chiropractor who healed countless numbers of suffering people.
The AMA did much to nearly destroy the field of osteopathy. Osteopaths do exist but many of them have become PCPs and once they become PCPs they no longer touch you or give spinal adjustments. I found this out when I purposefully chose a D.O. when Ifrom the list of PCPs when I got my medical insurance. But when I got there I learned that he doesn't touch people!! He's a D.O. in name only and this is true of many of them who are in this system and that's a crying shame.
A sweet story, many of us can relate to. Thank you.
Thanks so much. I am glad you liked it.
Adam
This reminds me of something that happened to me over 30 years ago.
I was in my early 20s, sick, and went to my family doctor, who was teaching a group of family practice medical residents at that time. They trooped into the exam room, my doctor put my chart (it was all still paper back then) on the table, then asked me what brought me there that day. I reeled off my symptoms: headache, ringing in my ears, stuffy nose, sore throat with post-nasal drip, upset stomach, no fever, losing my voice, all of which had persisted for over 3 weeks.
My doctor turned to the residents and asked them, "Okay, now what do you do?" Every single one of them started recommending a dizzying array of diagnostic tests and specialists, ranging from a CBC & head CT scan to consults with a neurologist and an otolaryngologist (ENT doctor).
My family doctor turned to me and asked "What do you think is wrong with you?"
I told him "I think I have my annual fall sinus infection."
Not one of them tried to examine me first, something my doctor was quick to point out. My family doctor then led them through the exam, and had all of them take turns looking in my ears and nose, feeling the glands in my throat, applying pressure to my facial sinuses (less than pleasant, but they needed to learn and I'd agreed to be their lab work). My doctor then says to them, "Okay, that's a sinus infection. What do we do about it?"
After being called on not examining me before recommending lab work, they were all looking at each other with that "uh... do you want to go first?" expression, and I had to take pity on them. I volunteered "I think you're going to prescribe 500 mg of amoxicillin 3x/day for 14 days because I've been getting these every year since I was 3, but for any other patient you'd probably only do 10 days of antibiotics because you don't want to overprescribe them."
My doctor then picked up the chart - -which had been totally ignored until that point - and explained that it was all in there, including the years I'd spent as a pediatric patient at the ENT specialist and the tests the allergist had run - and that aside from my physicals, this was the only thing I'd needed to see him for since my pediatric days.
My doctor's "moral of the examination" was twofold: examine the patient and read the patient's chart before ordering or prescribing anything. It is amazing to me that those two simple starting points seem to be missing from medical school.
Thanks for sharing your story. "What do you think is wrong?" is easily on of my favorite questions.
Yes...HELLO!! thank you. I hope you have found better remedies now than antibiotics and sought to uncover the root cause of your annual sinus infection so as to prevent the condition that caused them in the first place!
Homeopathy and Functional Holistic Medicine could be helpful in this regard.
Things don't come out of the blue; they come out of the oblivious. Every effect has a cause. If you can tap into and uncover the root cause and address that, your symptoms will cease.
Thanks for sharing this very illustrative experience. Always more to the story that Western medicine is missing because they're not asking "WHY?"
YEARS ago at a sick visit to our PCP, I had agreed to see "the other doctor" on staff because ours was booked solid. When Dr. Ricci walked into the exam room, he talked to me for over 20 minutes before ever laying a hand on me. It was obvious from his questions that he had read every page of my medical history (a very long and complicated one at that). He also appreciated that I didn't just want a prescription but a solution/cure. That chance visit changed my families' course and he became our new PCP. We followed him every time he switched practices. In our years of seeing him, he was always running late but I never complained because I knew he was spending whatever time was required with the patients before me and would do the same with me. Two years ago, he began doing concierge medicine and unfortunately, that priced him out for us. It was a difficult process to find another doctor like him (he set the bar really high), one who would LISTEN, one who would ask questions, one who wouldn't immediately reach for the prescription pad. That kind of practice/medicine is a lost art.
Yes it is a lost art but it needs to be found again! Because unless it is, doctors today are simply not practicing true medicine. You were so blessed to have Dr. Ricci as your doctor and I'm sorry that this had to stop because of money. That's another problem but that's a whole other conversation!! Thanks for sharing.
Wonderful way to start this Substack. Thank you for sharing your story!
Thanks so much Anne. I am glad you liked it.
Adam
My wife and I can't seem to avoid the remote diagnosis syndrome. She, a retired CNM, and me, a long-term scientist, have seen enough patients in our time to be pretty good at it, too. I didn't have the opportunity to go to medical school but that didn't stop me from years of medical research, and even some significant clinical exposure. While medicine should have been my lifelong career, science, in a variety of fields where I've been pretty successful, had to substitute. And a poor substitute it was. Retired now, I'll continue keeping up with CME, my reading, and acting as an epidemiologist for a rather large not-for-profit. My work's helped keep the volunteers in that organization a little safer by providing them evidence-based data on COVID, and providing answers to their questions.
Thank you for the essay. I found it touching in all the right ways.
Very interesting. I think observation and diagnosis lacks in so many doctors today. My dad was a great diagnostician he is long gone but was a urologist and surgeon. I remember talk at the fing table about patients of his. As an adult I’ve been subjected to as wide range of doctors in general practice or internist I’ve had two good ones. My current doctor however just dumped me or I chose not to pay her concierge $$ as I’m very healthy and have limited retirement income. Now I’m on the search for one like you with acute observation skills and can diagnose properly! Good for grandmother teaching u these skills. Oh that more had grandmother’s like yours.
Thank you for mentioning the word diagnostician. Two of my favorite shows are HOUSE and Doc Martin!
we should all be so lucky to have brilliant diagnosticians like them although the bedside manner could stand a little improvement lol
I have been chronically ill for a long long time; decades, and now much worse. No doctor I ever go to in the Western medical system has ever been able to touch it and they seem annoyed because I do have a long list of symptoms and they won't even listen to all of them in my " physical" in which they nevwr examine me. They just stare at the computer screen and cut me off saying, "it's too much.. you'll have to talk about that when you're on your next visit" when it's all part of the same condition.
I just wish that a doctor (and this wasn't even a doctor; it was a nurse practitioner. Good luck even getting access to a doctor nowadays at least in the health system I'm a part of). but I sing the praises of a good nurse practitioner or a physician's assistant! In my experience they have been far superior to the doctors I have seen over the last 10 years.
But still, I never feel heard. I never feel that anyone is really interested in how I feel when I go to these PCP offices.
They're not listening and they're not LOOKING.
I might as well be talking to robots!
All they know how to do is order blood tests and x-rays etc but you practically have to be dying to get a referral to a specialist and then they make you jump through all kinds of hoops before they let you. it's all about insurance insurance insurance.
I feel like I have to sell my PCP on the fact that I'm sick!. they put a lot of pressure on me and I feel very stressed. As a matter fact my blood pressure shoots through the roof the second I walk into a medical building because my anxiety kicks in automatically. I always tell them to take my blood pressure at the end of the visit and they do and it's always normal but at the beginning of the visit it tends to be high because of the anxiety i feel laying myself open to an inhumane, discompassionate system that really doesn't care about me.
I just started with a new one last week and she was definitely better. She spent a longer time with me (you know over the 10 minutes they allot you normally) lol but no physical exam.
I don't even know what she looks like because of the huge mask she was wearing. Sigh…
I'm obligated to point out that most difficult diagnostic challenges are not solved by a single, brilliant if troubled diagnostician, but by working with a competent team, and knowing when your knowledge isn't sufficient to answer all the questions. House isn't real life.
You are exactly right. And love how they tell too much next visit. Next patient pls!!! Oh brother. A sad state of our healthcare
It's not healthcare. It's sickness management.
“Come on, you can tell a lot if you really look at people.”
Probably one of life’s most important lessons and likely the most frequently missed.
Thank you for sharing a beautiful story. You were a very fortunate young man indeed.
I fully agree! reminds me of the quote "You can observe a lot by just watching" by Yogi Berra
Thanks so much for reading the piece. I am glad you enjoyed it.
I have developed RA like symptoms this past 18 months since I got that stupid second covid shot.
My mind knew better than to make such a grievous error, but I was forced to get it in order to care for my 98 year old daddy.
So I cant take prednisone foreverrrr?
How are the other treatments less wearing or damaging to a patient, especially these newer drugs?
I took lots and lots of pre med but topped it off with just an RN BA. I mainly worked in ortho surgery for most of my career
I enjoyed reading this
Not “just an RN”!
initially I felt I was demoting my self, or squandering my degreed knowledge just working for a couple of ortho surgeons in a busy practice, but! People are unique. Ortho surgery is complex for each patient. I did love that job very much, I worked directly with the patients and knew them. All of us have a struggle
Ah, the power of curiosity 😀