Dying of Embarrassment

I was asked to write about some of the embarrassing medical conditions that women may conceal from their physicians, things like facial hair, body odors, etc. Having done this job for 20 year I’ve heard it all from bad breath to old tattoos.

But the one issue I definitely want to put forward, because it’s proven to be more than embarrassing, is the often-mortifying experience of urinary incontinence. Over 20 million American women (and several million men as well) silently suffer from this health issue! Many lay people are already aware of the problem of leakage after childbirth or surgical trauma to the pelvis. The woman with this problem (stress incontinence) must be careful every time she laughs, coughs or sneezes for fear of a bit of urine getting away. However, this only constitutes about one fifth of the problem. A different form (urge incontinence) affects over 15 million ladies and can cause the untimely emptying of the entire bladder!

The cause is neurological and progressive, beginning with a sense of urgency to find a bathroom and progressing to a complete inability to hold back the voiding reflex. Sleep can be terribly disrupted and depression is common. Many of these patients become withdrawn and isolated and the death rate soars from a variety of medical and social dysfunctions. And the terrible truth is this: urge incontinence is the easiest of all to treat. They say that nobody ever died of embarrassment, but they're wrong. Lonely, isolated women do so every day, it's just a long, slow process.

The problem is believed to be the loss of the inhibitory signal (part of the sympathetic autonomic nervous system) that descends automatically from the brain to the bladder, to keep it from emptying on its own. We all take this inhibition for granted even though it was something we had to develop during our potty-training years. Patients with spinal chord injuries rediscover that the bladder is happy to fill and empty on its own if it can no longer talk to the brain.

Treatment goes after both legs of the problem, the psychological/social and also the medical. Often these patients have developed neurotic habits around going to the bathroom, knowing the location of every place-to-pee in their world, or habitually going to the restroom every half hour or so to avoid getting to the point of feeling any urgency. Medication helps to restore the balance between the sympathetic and parasympathetic arms of the autonomic system and is remarkably effective in many cases. If you or someone you know is concealing a urinary incontinence problem, get to your doctor today. Surgery is seldom needed and relief may just be a simple medicine away.

Vaccination Guidelines Get It Right With HPV

The CDC reported that one in four women has HPV, further supporting guidelines from major health groups calling for the widespread vaccination of 11 and 12-year-old girls.

I believe these guidelines are well thought out and target those patients where a concentrated effort at vaccination will do the most good, both for the individuals receiving treatment and for the future population of adults that these adolescent ladies will become. One often-overlooked benefit of individual vaccination is this: the greater the percentage of people immune to a viral disease, the harder it becomes for the virus to spread. It is possible to actually wipe a virus out of existence by only vaccinating “most” people.

The FDA has approved the vaccination for girls and women between the ages of 9 to 26, but it is best to vaccinate the patient before they become exposed to HPV, that is, before the onset of sexual activity. True, many women in their 20’s are not yet infected, but the risk jumps up with every new sexual partner, especially since this is a largely invisible infection in both men and women. This vaccination covers the four most common/destructive strains.

My daughter and a friend are slated to receive the first injection next week. We will be paying cash for it as it’s not covered by our insurance. No matter. We are just thrilled that this wonderful breakthrough exists. The benefit is more than worth the price.

How is Burnout affecting health care at our local doctor’s office?

Burnout seems rampant throughout all of our healthcare specialties. As a general internist in a large primary care clinic, we are seeing the effects of two things: Family doctors and internist are retiring earlier than expected due to dissatisfaction with the lifestyle and work environment that now defines medical practice.

In choosing which specialty of medicine to enter, the deal was that family practice and internal medicine would offer less money but you’d get higher satisfaction from knowing your patients well and having a reasonable work day and work week. These were the fields for people who valued lifestyle and career. But that deal has been broken,

It would seem that medical practice is now owned and operated more by the insurance companies and government agencies like Medicare, who have imposed large, expensive and time-consuming bureaucracies on what was once a simple relationship between caregiver and patient.

The result is that the average medical practice, which employed 1.8 office workers per physician in 1980, now must hire between four and five employees to push paper. They must bill, re-bill, request permission for treatments and dozens of other functions that are not directly related to patient care.

So the physician must see his or her first dozen patients of the day just to cover the fixed overhead of being in business. Salary only shows up After that, through the extra patients that must be crammed in to an overfull day. This is why the average patient visit has gone from a half hour down to ten minutes in a typical office.

Burnout comes from the mountains of paperwork after the clinic closes that keeps physicians from getting home at a reasonable hour, and from the unsatisfactory experience of rushing through patient visits. Let’s face it, if the patient is rushed, the relationship becomes strained and it’s more common to have an adversarial relationship between the clinic and the office instead of a collaborative one. This gets very old, very fast.

We’re looking at a doctor shortage of unprecedented size and scope. While politicians dictate what Medicare will and won’t pay and talk about imposing a one payer bureaucracy on us doctors, they forget that this is still a marginally free country. They can’t force us to practice. They are going to drive the best and the brightest further away from the practice of medicine, at a time when the baby boomers will need doctors the most.