In a country that aspires to mediocrity, and for which excellence is a dying memory, we have adopted 'perfect' as the standard polite-nothing in service interactions.

"I'd like a twenty ounce mocha, please."

"Perfect".

"With three shots of espresso, please."

"Perfect."

And no foam."

"Perfect."



And all you young kids get off my lawn...

I love you all...

A few weeks ago, I treated a patient for a persistent cough. She's a heavy smoker, but like a lot of smokers, she denies that there was any connection between the two. She did have a mild upper respiratory infection, so I treated her for that and gave her something for the cough.

She's been back in day after day since demanding codeine for her cough, instead of the perfectly appropriate, effective anti-tussive I prescribed for her. As with many other patients, her explanation is "It's the only thing that works!"

Yesterday, I had two of them. One guy said he woke up yesterday morning with the 'worst pain ever' in his left lower back. I examined him, and sure enough, he was spasming pretty badly in the lower lumbar region. I prescribed him a muscle relaxer and a non-steroidal, and advised ice-pack treatment until the symptoms resolved. He got very angry and demanded "Something stronger! Something that works!" When I told him that this was the appropriate treatment, and conformed to standard-of-care, he pulled out a not-uncommon trick of the trade: "Well, I guess I'll just have to go out on the street to get it!" He wasn't happy when he left.

The second guy was less up-front about his desired analgesic treatment, but I had to let him down gently, and prescribed the appropriate treatment.

Thank you for listening. I love you all.

If I posted this in GD, I would be descended on and devoured like a swarm of locusts by a mob of screamers calling me a torturer, a sadist, and a bad medical provider for not giving my patients what they wanted...

It was HUGE!

I had to give the patient 8cc's of Xylocaine to numb up the site. When she was finally numb, one little poke with the blade, and a tidalwave of flocculent splooge spurted out. It took forever to get it all drained out.

Then I had to go in after the cyst capsule, to make sure the cyst wouldn't grow back. I yanked the whole thing out finally, and it looked like a tendon, it was so large.

Well, *dusts hands off* that's done. Packed the site and prescribed her something for when the local wears off.

Whew!

That was the most fun I've had in clinic in a couple of years!

It took me a while to figure it out...

I love you all...

There are hundreds of commonly-ordered lab tests to assess countless medical conditions. So to 'check for everything' is unrealistic and impractical in the extreme.

While there are, to be sure, conditions that in the early stages are asymptomatic, ordering a huge panel of lab tests for anything other than a routine annual physical exam is not likely to be appreciated by one's insurance provider, and therefor one is likely to be declined.

Sorry. Just needed to vent...

Remember in the early days of DU, when new DU-ers would post 'ask me anything' threads in order to boost their post count? Or just to get to know people?

Good times...

Boy howdy! After the week we've had, I need a little altered mental status...