What to say when you don't know?

How about "I don't know"?
It seems simplistic but its not. A few years ago Medchi, the Maryland malpractice insurer sponsored a course to teach physicians how to say sorry.
I don't think most patients realize how hard it is for many doctors to admit when they don't know the answer.
Part of the problem is that the doctors feel they are not living up to the patient expectations and so cannot admit they don't know.
In my opinion there really is only one way to proceed. Admit you don't know, explain to the patient why there is a question and come up with a strategy for resolving the issue.
As we all know you can not fix a problem until you identify what it is. This may require a second opinion or additional tests.
The problem comes sometimes when the expert opinion suffers from the inability to say "I don't know".
For example this often occurs with dermatology, a patient may have been sent to try to get an exact diagnosis but often a biopsy is done and the report comes back without one.
At this point the dermatologist should return the patient to the primary care doctor and say honestly "unfortunately, I don't know what this is. Here are some suggestions as far as possible therapies or management".
Great. Thank you very much.
This is better than trying all kinds of products and therapies, having the patient run from pillar to post and paying high copays to no avail.
I have a patient at the moment who walks around with a scarf to cover her face because she is so embarrassed by her skin.
We had cleared her skin of all the acne but she had one spot with an ingrown hair that she kept picking. It got bigger and bigger.
I sent her to the dermatologist to get the hair removed with laser. It went well initially, but after that area was done she and the dermatologist decided to do a wider area for hair removal and start using different products. When she reacted to those, they decided to try some others. That did not work so after 4 more products she sought out a second opinion dermatologist who wanted to try more stuff.  Now her face is a disaster.
After 3 dermatologists she recently came back to see if I can get her back to where she was before she went to the first dermatologist. After that, we shall work on the scars.
What makes it harder for some doctors with big egos to admit they don't know, is that patients comb the internet and act like they know everything. This can be a slippery slope, for both doctor and patient especially when accepting on speck that the patient's own diagnosis is correct.
I am absolutely an advocate for patient education and information, so I encourage patients to learn as much as they can but beware of self diagnosis without expert input.
A patient told me the other day that she had read a woman's blog where the person claimed to have developed invasive cervical cancer within a year of having a normal pap smear. She now wants to have two pap smears done a year just in case. I told her that would not be appropriate. All I can say is that based on the pathology of cervical cancer that sounds next to impossible.
I know nothing about the writer or her motivation and I told the patient so. "But why would she write it if it wasn't true?"
I answered truthfully: I don't know.

Women will soon rule the world!

Women will rule the world, this is no longer a utopian notion but a real fact.
What an exciting time to be a woman!  For some reason the impact of this just hit me recently.

I grew up in the 50's and 60's when 'being a lady' was highly valued and encouraged.  Women who were loud, boisterous, pushy, or too intelligent were looked down upon.
The stereotypes told us we can't be both smart and attractive or you have to act like a man to get ahead.
I now realize that  despite being a self employed physician for 30 years,  I too have had these subliminal messages embedded in my brain.   I have wondered if perhaps a woman at the top of a major industry could cut it the same way a man would, I have basically doubted a woman's ability to compete.
But all of a sudden that myth has exploded and the glass ceiling along with it!

We need to give this message to our daughters (and sons).

What was the change? I'm not sure, but I do know that after watching Oprah on the Golden Globe awards, it finally dawned on me that there is nothing holding women back except these old fashioned notions.
So if we look at it, a woman like Angela Merkel is the leader of Europe's most popular and economically powerful country. She has been running Germany since 2005 and solidified the reunification of the two Germanys. No easy feat. She has been the most pivotal figure in the European Union, the most powerful and the most respected leader in Europe. Another powerful woman that comes to mind is the director of the International Monetary Fund, Christine LaGarde.

There are now more females  than males in medical schools  and no one  questions their abilities, at least not sensible people. And so the realization has come to me that not only are women as good as men, they are actually better. Hence, women will end up ruling the world.

Why are women better? Well, there are so many reasons but here are just a few:
First of all, no woman in power has ever been toppled because of sexual harassment i.e an inability to maintain her sexual decorum.
Women can do everything a man does and then so much more, just by virtue of their physiology.
There is nothing a man can do that a woman can't do unless you talk about brute force. Yet there is a lot that a woman can do that a man cannot.
Women often preserve their principles while maintaining the instinct to nurture that is inherent in our make up (thank you oxytocin! :)
Women are just as smart and focused, and that's why women will rule the world. Look at what has been achieved in spite of traditions and glass ceilings and now the genie is out of the bag. There is nothing to hold us back.

Oprah said her speech was to inspire 'little girls', ..... too late she snared a big one too! And no, she doesn't need to run for president to make an impact. Her gifts and talents have made so much more impact on her fellow man than just being a 'celebrity' ever could have.

When I look at cultures that are still suppressing women and maintaining them in a subordinate position, I understand why it was necessary for men to do that because they could not afford to let women realize their power. They work to make women think they are inferior.
So for men it is more about self preservation, but little by little with globalization this too will expand and the realization that it is totally a new day for women will be universal.

'Tis the season for flu! Check out these remedies

Is it the flu or just a cold? Whatever it is, it's bad this year.  The good news is:
If you got the flu shot even if you got infected by a different strain you have a better chance of not becoming too sick. I get mine in the fall every year.

People that don't take the flu shot have all kinds of theories about why they don't need or want it and I respect that. When you get sick please come in early.... for your sake.

One thing is for sure, it is a really bad season this year.
Now, we knew this was going to happen in the fall, for one thing Australia had a bad flu season. They get the same vaccine as us and their season precedes ours. So from the Aussie experience we knew that this year's was a very severe strain of flu and the vaccine didn't have full coverage for it. Some people use this as a reason not to get the flu shot...don't.
In my experience this year, one symptom stands out as almost pathognomonic of the flu (meaning it can differentiate the flu from a 'cold') and that is body aches. I find patients may have no other symptom but body aches and I quickly start them on treatment. One lady told me she just hurt all over. Another one said the muscles of her eyes hurt.
Be seen as soon as possible. In the meantime:

What can you do at home?

1. Steam: Inhale steam with your mouth wide open. This can moisturize your airways and kill the virus in your airways. This will decrease the total viral load. Sauna and Steam showers are good too.
2. Take an anti-inflammatory with food as needed. This will cut down fever, body aches and make you more comfortable
3. Try the OTC homeopathic remedies while you are waiting for your appointment.
4. Viral Mix
5. Air Defense two capsules three times a day
6. Mucinex DM
7. Benedryl to sleep
8. Start the prescription medication as soon as possible
9. Lots of fluids, nothing colder than room temperature and finally:
10. Chicken soup :)

DO NOT:
Take Theraflu if you have high blood pressure or glaucoma
Take Nyquil
Take Aspirin products

Prevention of the flu:

Flu shot
Air Defense: one daily
Vitamin C 2000 mg daily
Hand sanitizer
Hand washing
Cough into your elbow and teach your kids to do so
Stay home!

Please share this blog and let's slow down the epidemic.

Which diet is the best?

Question: Which diet is the best?
Answer:  The one that works!

There is always a brand new diet. Last night I heard  one on the news, they were talking about the diet which requires a period of fasting daily. Basically you do not eat after 2 pm every day. This gives you an extended fast from 2 pm until the next morning. The lady that was on the news said she had lost 50 pounds and the fat had just 'melted away'.

Every time you hear  about a new diet it sounds pretty convincing because there is always someone who has lost weight on it, whether it be the Atkins or cabbage soup or whatever diet. There are also people who say you must eat breakfast or you won't lose weight, how does that correlate with another diet encouraging you to have long periods of fasting? Can you not make your fast period that where you skip breakfast and don't eat until 2 in the afternoon?

Obviously, there's nothing that works for everyone, however I have NEVER seen anyone who hasn't lost weight on the HCG diet. The big question really is whether they have the discipline to keep it off.

The HCG diet has a longer-term, higher success rate than any other diet I've seen INCLUDING stomach stapling. It is always disappointing to go through surgery and have your internal anatomy permanently changed to find yourself back at your former weight 3 to 4 years later. This is why I caution people before they go for surgery: It is not a magic bullet.

Having said all that we know the benefits of weight loss:

Improvement of energy level

Improved sleep

Increased longevity

Less likelihood of developing diabetes and cancer

Improved self esteem

Improved lung capacity and endurance

Improvement in overall mood

Less cellulite

Less debility from arthritis

Better physique and cosmetic changes

It's a New Year, let's get it done! Whatever works for you is what you should do. I am here if you need my help.

Feel free to share this post with friends.

Dr. Tuakli

#getitoff

Happy New Year!

It strikes me that we give this greeting every year but does it actually mean anything? Can you control how happy you may be today or throughout the year, and does someone saying that to you necessarily make any difference? Probably not.
On the other hand I really do want you to have a wonderful year. So how can we improve the odds that you will? Well, good health is obviously one factor and that is something everyone can work on.
The resolutions to exercise more and lose weight are undoubtedly valid, year in and year out. But what else?
Have you charted your family history yet? Ask everyone questions about the health of your relatives and predecessors you may be surprised how much you don't know. Be sure to write down all the verified information, sometimes this can give you a footprint of possible health concerns within your family so you know what to work on. Armed with a chart of your family history you can design a preventative strategy for living longer and better.

Check your health records and go ahead and schedule your health maintenance exams for the whole year, now, while you are thinking about it. Things like physical exams, pap smears, mammograms, blood work and colonoscopies can all be scheduled up to a year out. Schedule your dental and eye visits as well.

Throughout the year I am going to be discussing the importance of different vitamins so you can see if your regimen needs to be adjusted. You can also do a blood test to completely evaluate your vitamin status, if you like.

Have you already had your flu shot? If not, forget the rumors and get it out of the way. When you get ill in the winter, you miss time out of work feeling lousy and unproductive. You have to drag yourself to the doctor and may spread germs to other family members. It can also lead to more serious consequences like pneumonia. Almost all insurances cover the flu shot now. However, even if they didn't it would still be a bargain, by the time you factor in your co-pay and how much you spend experimenting with over-the-counter products that may or may not help.

I believe the most important aspect of being healthy is being informed.  Patient education is by far one of my most important jobs as a physician. So please continue to read my blog and ask questions. Let's prevent ill health before it starts ............ together.

Have a healthy New Year, and you will be happy!

Sincerely

Dr. Tuakli