Stop the madness!!!!!

[BtmBearDad]

I may be old school, but I carry and use a hankie. Old school parents (and grandparents) taught me that a gentleman always carries two (2) clean hankies - one for himself and one to offer a lady should she need one. I still do this - tho in the summer, I add one more to mop the brow as needed. I've never used a hankie to blow my nose (yuck!) mostly to sneeze/cough into and occasionally dap a runny nose. If I can't reach my hankie in time (as happens) then I do sneeze/cough into my elbow, my jacket, somewhere other than my hand, but I'm sorry @seaboy4hire, I am guilty of sneezing/coughing into my hand on occasion as well. If its any consolation, I do wash my hands regularly during the day (especially getting to the office or home from the subway). I sympathize entirely with you though -- in the salad days of my youth, I worked many jobs where customers handed cash to me and where they carried their cash was often nasty - bras, shoes, underwear. Nothing like cash damp with bodily secretions from all parts to make one shudder!

[+ Gar1eth]

Close:

http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m6434a4fbox.gif

 

Source:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm

 

 

I just went to establish care at a new doctor (actually an NP) yesterday. It was interesting. While the aide took my vitals, the NP never physically touched me. I didn't know they could charge without doing an actual exam. Because of this discussion, I did ask for the PPSV23 even though I'm not even 60. I have a touch of obstructive lung disease or asthma (no I never smoked) which has never really been formally diagnosed. But it's obvious on pulmonary function tests and doesn't seem to respond significantly to either bronchodilators or steroids although I occasionally take them when I'm symptomatic just in case they might give some small relief (like right now. I got worse after my appointment-now I'm home with cough, runny nose, upset stomach-no real muscle aches. So I doubt it's the flu.).

 

Gman

[+ purplekow]

I just went to establish care at a new doctor (actually an NP) yesterday. It was interesting. While the aide took my vitals, the NP never physically touched me. I didn't know they could charge without doing an actual exam. Because of this discussion, I did ask for the PPSV23 even though I'm not even 60. I have a touch of obstructive lung disease or asthma (no I never smoked) which has never really been formally diagnosed. But it's obvious on pulmonary function tests and doesn't seem to respond significantly to either bronchodilators or steroids although I occasionally take them when I'm symptomatic just in case they might give some small relief (like right now. I got worse after my appointment-now I'm home with cough, runny nose, upset stomach-no real muscle aches. So I doubt it's the flu.).

 

Gman

Unfortunately the days of the physical exam are coming to an end. Do you have a new heart murmur? Perhaps previously unnoted carotid bruit? A lymph node that is not quite normal feeling? And enlarged thyroid? My philosophy after many years of walk in care is this:

 

I am not there to diagnose 99 colds in a row, I am there to find that 1 person who comes in with a cold and is unaware of other problems. Any idiot can take a history and say most likely you have a cold. The exam is done not to confirm that, but to make sure something findable is not missed. You can make the argument that there are more appropriate ways to find those things and that this is not cost effective. I am not advocating every person with a cold see a doctor, but once the patient is there, you ought to do what you can do within the general scope of the purpose of the visit. After all, who knows if and when that patient will see another doctor. So that NP should have looked in your ears, your throat; palpated the sinuses; felt the neck; listened to the heart, the lungs and if you are of an appropriate age, listened to the carotids. It takes a minute, it will probably yield nothing, but when it does, it may be significant.

Assembly line medicine can be stopped by practitioners refusing to treat patients like so many pieces of candy on a conveyor belt.

[+ Gar1eth]

I must preach better than I actually act. I live alone, and at home I often don't cover my mouth. Really when you are coughing every few seconds it's not like coughing into your arm is going to catch everything.

 

Gman

[+ Gar1eth]

Unfortunately the days of the physical exam are coming to an end. Do you have a new heart murmur? Perhaps previously unnoted carotid bruit? A lymph node that is not quite normal feeling? And enlarged thyroid? My philosophy after many years of walk in care is this:

 

I am not there to diagnose 99 colds in a row, I am there to find that 1 person who comes in with a cold and is unaware of other problems. Any idiot can take a history and say most likely you have a cold. The exam is done not to confirm that, but to make sure something findable is not missed. You can make the argument that there are more appropriate ways to find those things and that this is not cost effective. I am not advocating every person with a cold see a doctor, but once the patient is there, you ought to do what you can do within the general scope of the purpose of the visit. After all, who knows if and when that patient will see another doctor. So that NP should have looked in your ears, your throat; palpated the sinuses; felt the neck; listened to the heart, the lungs and if you are of an appropriate age, listened to the carotids. It takes a minute, it will probably yield nothing, but when it does, it may be significant.

Assembly line medicine can be stopped by practitioners refusing to treat patients like so many pieces of candy on a conveyor belt.

 

 

It was a thirty minute visit. But we still couldn't touch on all my problems (they are legion). Follow-up visits are only about 10 minutes each. I have trouble saying hello and I'd like to talk about .... in 10 minutes. By this reckoning we will have covered all my current problems sometime in the year 2525.

 

Gman

[BabyBoomer]

in the year 2525.

 

Gman

 

Great song.

 

~ Boomer ~

[Guest]

Unfortunately the days of the physical exam are coming to an end. Do you have a new heart murmur? Perhaps previously unnoted carotid bruit? A lymph node that is not quite normal feeling? And enlarged thyroid?

 

Sorry, but none of the physical interventions you mentioned are recommended. The USPSTF specifically advises against screening for carotid bruits, because the evidence shows this intervention is harmful.

The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population. D recommendation.

 

http://www.aafp.org/afp/2008/0401/p1006.html

 

Yes, if you have a lump on your neck that doesn't go away in a month, you should let your doctor know about it promptly. But that's not a reason to encourage people to come in with colds so that the doctor can go on a scavenger hunt. The patient with the cold is just going to spread it to other patients, often patients who may be in poor health.