More Random Reader Questions and in Which I Give Some Real Medical Advice Without Fear of Being Sued

(Actual questions from actual readers. -PB)

I know you don’t like chiropractors but what are we supposed to do for chronic back pain?

For chronic back pain I recommend back strengthening exercises, instruction in correct lifting and posture, weight loss, physical activity, judicious use of NSAIDs, and occasionally just sucking it up.  For serious back pain which may be the result of a herniated disk, tumors, or occult fractures, I recommend imaging to assess the possible source of pain and such medical or surgical therapy as an orthopedic surgeon may suggest. I’m certainly not sending somebody with a lumbar fracture or ankylosing spondylitis to a chiropractor which would be like going to the barber to have your transmission serviced.  It just makes no sense.  Most back pain is usually self-limiting, however, and resolves in a few weeks without intervention of any kind.  With this in mind, what’s your chiropractor really doing for you?  Nothing.  Neither is the doctor who enables your narcotic addiction, especially when he writes you a prescription for vicodin just to get you out of his hair.

I am becoming seriously zero-tolerance for handing out narcotics for chronic back pain.  It’s your primary care doctor’s job anyway and I’m not really qualified to do it.  Oh, and I don’t buy the bullshit stories about allergies to Motrin and other non-narcotic pain medications.   A patient who is allergic to everything but Dilaudid (essentially legal heroin prescribed by a physician) is a drug-seeker, period.

What is the secret to good health?

Don’t smoke, don’t stuff dangerous recreational drugs into your body, if you drink do so in moderation, eat a healthy, varied diet without resorting to fads and supplements, and exercise as regularly and as vigorously as your health will allow.  Also, get outdoors into the fresh air whenever you can, have an interesting hobby or two if your job doesn’t fill your need for creativity, and get regular sleep.

The rest is just marketing.  You don’t need to eat organic foods or make a fetish out of being “natural.”  Additionally, all the fish oil and vitamins in the world probably won’t make a bit of difference to your health and if they do, the effects will be marginal and not worth the effort and expense.  Good health is mostly common sense, inexpensive lifestyle choices, and genetics.

Eat a fucking steak every now and then.

What do you think of Emergency Department “Super Users?”

The reader is referring to a recent story detailing how just nine patients made 2700 visits to Central Texas Emergency Departments over the course of six years.  That’s roughly one visit per week per patient for six years.  First, I assure you that this sort of thing is not confined to Texas.  I work at two different Emergency Departments and I see my share of “frequent fliers,” some who I have seen multiple times at both departments and usually for what turns out to be either nothing or a minor exacerbation of a chronic medical problem for which they are also seeing their primary care doctor  (although to be fair I have intubated one guy seven times in the last three years).

The next question is why do these people keep sucking down medical resources?

The answer is: “Who cares?”   Are many of these Super Users mentally ill?  Sure, some are.  Do they have real medical problems?  Of course they do.  But what does it matter, really?  If they are so sick and so crazy that they suck down a million apiece in medical care, most of it wasted and money that is not available to people who need it, then they need to be institutionalized for their own good because they obviously can’t handle life in any rational manner…except of course they are rational enough to know that they can never be turned away from an Emergency Department and structure their lives accordingly.  I say this because every proposal suggested to correct the problem of Super Users does not address the real underlying problem, namely that personal responsibility and civic virtue are no longer required of any citizen and, despite being a nation  of a million little rules and regulations, no effort is made to enforce even the slightest amount of common-sense based decency.

In other words, the solution to the problem of Super Users is not to coddle them even more by coming up with yet more government initiatives to essentially beg and bribe the parasites on our system to pretty please stop wasting more medical resources in a month than most people have used in their whole lives, but instead to cut them off at the knees; something that we could easily do, perhaps placing a limit on Emergency Department visits after which you become an automatic Get The Hell Out, except the legal environment is such that it has now become a right to squander as much of the public treasury as you possibly can.   It is one of the biggest ironies of American life that while on one hand the productive sector is now supposed to be collectivized, subordinating their rights as individuals to the benefits of their labor in order to provide a living to the non-productive sector, to suggest on the other hand that citizens engaged in criminal abuse of society by essentially stealing collective money should be punished will bring out the usual braying from the defenders of irresponsibility, now screaming about the rights of individuals and how collectivization of responsibility is unacceptable.

Tea Party Update

I was surprised at the turnout.  I live in a small Midwestern city of about 100,000 and there must have been 20,000 people at the Tea Party.  It was a very nice, enthusiastic, but well-behaved crowd of mostly what looked to be working class and professional people with the odd scattering of Viet Nam veteran bikers who are obligatory at this kind of thing.  Very few freaks and the few I saw were actually very nice college kids who dressed like goth punk rockers but were quick to assure me that they were College Republicans at our local Big State University.

There was no counter protest, at least none that I saw.  One had been planned but I think the people who showed up for it saw the size of the crowd and said to hell with it.  I did talk to two well-dressed, well-spoken law students who, they said, had been sent by ACORN to “infiltrate” the rally.  The people around us laughed good-naturedly at this as not only did nobody care but the place was so packed a mouse couldn’t have infiltrated too far.  They tried to debate and then got sort of haughty, brandishing their superior academic credentials as proof that we were all misguided but within ten feet of me were two other doctors, a chemical engineer, and couple of lawyers so that generated more polite laughter.

I saw them drift away looking perturbed.   Liberals sometimes live in air-tight bubbles and I think they were a little surprised that the crowd was not composed of toothless hicks clinging to their Bibles and guns while waving the Stars and Bars.

Incidentally, if ACORN is now getting federal money, what were they doing proselytizing at a political event?

16 thoughts on “More Random Reader Questions and in Which I Give Some Real Medical Advice Without Fear of Being Sued

  1. Thanks for supporting the Tea Party on your blog. My family and I attended the one in Provo, Utah and it was a blast. Hopefully in 2010, the people will realize that we do have the ability to take control of our country.

  2. I’m sorry if I don’t quite believe the 20,000 number. The largest # I’ve seen from an independent source is 7000 in Atlanta. I went to one down here in the South, in a city no less, but it seemed to have brought a whole different demographic than what you saw. It seemed to have brought all of the rednecks out of the boonies. From what I saw, it doesn’t bode well for the Republican party in the near future. (And don’t say it wasn’t a partisan event, b/c that’s what it became)

  3. Ya, you know how those rednecks always bitch and moan about supporting climate change research and subsidized digital TV coupons with the money they could be using to purchase their own health care, or upgrading their children’s school choice.

    They really are a whole different demographic from the smooth urbane Acornists and their impoverished claque standing in line from the White House to Sacramento holding out their palms, waiting for a payday.

    The boding goes the other way, pal. Right through you to your kids.

  4. I had only one small issue with my local Tea Party. It was held 11am-1pm on the 15th. Tax day, yes. Federal holiday, no. You want a strong conservative/libertarian turnout and you stage a rally on a WEEKDAY?

    We’ve got jobs, some schedules less malleable than others. The “low turnout” numbers speak for themselves.

  5. I am starting medical school an I wanted to know if there is any physician organization that supports the views you espouse in your blog. I believe in being politically active, and if there is something I can do to help educate future doctors, and motivate them to be active as well then I am willing to do it.

  6. Definately not AMSA. It’s pretty much the antithesis of everything on this blog. Don’t let the pretty “free Netter’s atlas” drag you in, i constantly wish i could get my money back from them (I signed up without looking into it at all. Big mistake.)

  7. Oh Wise and Mighty Doctor Panda Sir,

    I understand that you have only recently returned to blogging. Please for the love of God and all that is holy, don’t ever stop. You are an awesome writer, and your vitriol* is really appreciated.



    *please don’t ever turn your vitriol on me.

  8. “Eat a fucking steak every now and then.”

    Now, that has to be one of the best pieces of advice I’ve seen in a long time. 🙂

    As for your other suggestions for good health, it’s amazing how little they differ from the advice that has been offered for decades, if not centuries. Looking through a 1938 Reader’s Digest, I saw an article called “Health for the Having” by a William R.P. Emerson, M.D. “If ever there was a golden cure-all,” he wrote, “here it is: Fresh Air and Sunlight; Proper Food and Eating Habits; Regular Exercise; Adequate Rest.”

    Dr. Emerson then proceeded to elaborate on each point. He began the section on “Regular Exercise” thusly: “No horror artist could adequately portray the flabby degeneracy — muscular and organic — that has attacked the modern man and his mate. I once saw a middle-aged woman on the operating table; to reach her appendix the surgeon had to cut through pendulous layers of yellow goose-like fat, approximately four inches thick! One third of this human creature was sheer grease — impeding circulation, laying a frightful burden on heart and liver. No operation could ever make that woman healthy; no cathartics could possibly relieve her constipation. What she needed — what 50 million Americans need — is a rational system of exercise which will call into function the degenerated muscles and organs of their inert, comfort-smothered bodies…”

    (This does not make me want to eat goose any time soon, but that steak is sounding better all the time.)

    Keep in mind that the above was written 72 years ago, long before the obesity rate was as high as it is today.

    But all that commonsense stuff is not enough for most people, and maybe it never has been. And that, of course, is where all the marketing comes in.

    So now the big question for me is: ribeye, T-bone, or New York strip?

  9. That’s some pretty funny stuff. “One third of this human creature was human grease” and a whopping ” 4 inches of abdominal fat”. By today’s standards, that woman probably barely tips the scales into the obese category…and undoubtedly some poor man is willing to date and or sleep with her…

  10. Panda–

    You gotta post more often

    If you are ever in the market for getting together with another blogger who might be willing to offer day-yo-day commentary while you editorialize…or do some combo deal…give me a ring…

  11. I’m a research scientist about to start medical school this fall. Just wanted to say thanks – your blog gives a perspective on medical training in the US that’s hard to find anywhere else. I appreciate the honesty – thanks again.

  12. first if you sent someone to a chiro who has a fracture, well why would you? They can’t do a damn thing for that, not even legally. you said, “For chronic back pain I recommend back strengthening exercises, instruction in correct lifting and posture, weight loss, physical activity”…and so would a chiropractor. Only difference is that a chiropractor will adjust you instead of telling you to take NSAIDs which isn’t legal where i live. There is a plethora of pro-chiro research out there on this topic: chronic back pain. And this research says it works.

    And your right its good to eat a fucking steak now and then.

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