03/07/2017
The Stitch Elf has given me permission to post My Medical Notebook in his office. Thanks, Stitch Elf.
First Note, March 7th 2017
Doc King’s Ole Reliable Notebook of Medicine
This scribbling came from experience of the years September 1960 to the present time.
The recommendations and notes of this notebook are not in any chronological order. These notes are thoughts of wisdom : ) garnered over the many years of my medical school and medical practice experience. And what an experience it has been!
In medical school, In my case The Medical College of Georgia in Augusta from 1960 until 1964, we were taught that 50 % of what we learned would be obsolete in less than 10 years. I was skeptical about that until starting practice. They lied! As soon as I started practice, 50% of what I had learned was already obsolete! All I had to do was to figure out which 50% was obsolete.
One thing was glaringly obvious: the practice of medicine changes, but people, the subjects of medical care, do not change. There are still only two models of people, male and female, each model with two sub-models: growing up and grown up. That simple fact made it somewhat (but not much) easier to decide the best treatment for most patients.
Patients? There is a movement afoot to designate the folks doctors treat as “clients”. Proponents who designate doctors' patients as “clients” consider the designation “patient” to be “politically incorrect”, as being demeaning. The catch all phrase “politically incorrect” (or “politically incorrect”, as the case may be) is one of the concepts this ole doc despises. I'm gonna speak my peace honestly, not in mush-mouthed, overly cautious babble. The people I care for are patients, not clients. A client is someone who seeks the expertise of a professional for problems ranging from business to manufacturing to design. There is usually no emotional attachment for “clients”. But I love my patients, I care for them. There is something about a patient / doctor relationship that transcends the usual sterile, mundane, basically business relationship of professionals with a client. As a physician, I know my patients’ lives intimately. I know their families, their associates, their joys, their sorrows, their health, their minor sicknesses, and their life threatening medical problems.
One of my practice problems became how to medicalize patients’ genuine health problems using treatment systems that are constantly changing. As a corollary to that problem, I learned that medicalizing people for all health problems was not always in their best interest.
Withholding treatment from some patients sounds odd, but some do better if not treated with potentially dangerous nostrums and procedures. As one of many examples, take the case of a homeless man in his thirties who developed cancer of the pancreas. With surgery and chemotherapy, his life expectancy was six months. Being homeless and having no income, he was eligible for the Georgia State Cancer program. He refused the state program and all other therapies! I prescribed good ole habit forming Lortabs for his inevitable pain. I expected him soon to need the much stronger morphine before dying. He requested a new prescription of just Lortab only every three to four months, which was quite surprising: pancreatic cancer can be very painful. So this poor guy had no known treatment for his cancer, and his pain level was quite low. He continued to live out of his ole dilapidated car. Surprise of all surprises! He went on to live for a year and a half, three times his predicted survival.
Another example of “not treating” some patients is ear infections. When I was in medical school, the doctrine was to treat all ear infections with antibiotics. We have since realized that many ear infections are due to viruses, not bacteria. Antibiotics do not help virus infections. Treating a virus with antibiotics leads to development of resistant bacteria. Both The Academy of Family Practice and The Academy of Pediatrics now recommend that if the child has no symptoms suggesting bacterial infection (fever, chills, sweats, vomiting, diarrhea, etc.) that no antibiotics be given. The child is checked again two days later, and then if not improving, antibiotics are prescribed.
From time to time, I'll post new medical notes. The Stitch Elf and I hope they are helpful.
I am "semi-retired". I see some patients in my home, or if they are shut-in, their home. If you want a prescription, call me "Dr. King". If you see me during a social encounter, call me "George".
George C. King, MD
