Boards

The neurology boards are coming up on March 24. I have to take those every ten years. They test me to make sure that I'm a competent neurologist.
Hyperkalemic Periodic Paralysis is a channelopathy in which there is a problem with sodium channels whereas Hypokalemic Periodic Paralyis has a potassium channel defect. Thomsen's disease (Paramyotonia Congenita) has a chloride channel problem. The other one is something something with myokimia. It is a calcium channel disorder.
I can bet my house that I will never see any of these diseases. I can bet my car that there will be at least one question asking one of those facts. So I've memorized it. I have to read twenty books that are between two hundred and three hundred pages and memorize most of them for this very annoying test. About 30% of it will be about these types of things. The other 70% will be about things like Stroke, Epilepsy, Neuropathy, Parkinson's and other things we actually see in practice.
The people who become very prominent academicians do research most of the time. They spend their entire lives researching something like Periodic Paralysis. So they find it kind of hard to imagine that someone exists who doesn't know the details of it. It's hard to ask them not to write any questions about it.
It's annoying to study for this test though.
One thing that no one wants to accept is this: it's pretty much impossible to figure out which doctors are good or not. You can "board certify" us. But that really only means that I'm pretty good at memorizing these twenty books. It doesn't mean anything about how good I am at what I do. You can measure patient satisfaction. It's been shown that this is a valid measurement. But that doesn't tell you anything about diagnostic accuracy. You can measure if people follow guidelines or not. But guidelines have been studied and shown to not necessarily reflect best medicine. (Guidelines don't take into account patients, which may have multiple conditions). I guess there is some degree of satisfaction that there is some minimal degree of competence if a person passes a test. But the problem is that people don't really know how well the test reflects the quality of care someone can provide.
How are we supposed to know if our doctors are any good? It's a really vexing question. As "consumers" (patients) we're really not in a very good position to evaluation this because we can't judge the fund of knowledge required. There isn't a consumers report either.

Yesterday

JF was here first yesterday. She is doing so great. She came to me about six months ago, I think. She had very severe pain. She was truly upset and very anxious. She was calling me neally every day. She was on pain medicin (narcotics) and xanax and high dose anti-depressants. She has a very strange variant of trigeminal neuralgia. I got her somewhat better with an anti-convulsant. I was trying to wean her off the xanax with great difficulty. I got her off the narcotics. One of the psychiatrists who is amazing saw her and told her to just stop the xanax. She did, and she was great. Then, she had a reaction to the anti-convulsant so we had to change that to another one. Now, she is doing even better. It was a great joy to see her improvement. She is truly a "new person". That was my first patient yesterday.

DT came second. She was told by Dr. M that she shouldn't drive due to cognitive problems. She went for a driving evaluation with an OT who specializes in this and said that she shouldn't drive. So she came here. She is here only so that I will let her drive. I did a thinking test which shows decreased attention and information processing speed. The OT who said she couldn't drive said she lacked attention, especially with divided attention (requires speed). DT may have Alzheimer's because her MRI shows some hipoccampal atrophy. However, the thinking test is still pretty good. I told her that she needs to come of two medications: Paxil and Ambien which could be contributing to her decreased attention levels. Then, we can re-evaluate her thinking test and if the attention and speed scores increase, we could repeat her driving evaluation. I thought that was great. She didn't. She just wants to drive. She doesn't really care about anything other than the fact that she feels she is capable of driving. I asked her if she thought that both Dr. M and the OT were incompetent. She thought they were just wrong. So I asked her how we know that she's not wrong. She just repeated that she just thinks she can drive. She doesn't really want to answer the question about how much certainty we need to have in order to have her drive. She didn't want to answer what she would do if she killed someone after the question of her capacity was raised. In this town, when you can't drive it really ruins your life. The public transportation exists, but that's really about all I can say for it.

LD was here. He's worried about the economy.

I saw a new patint, DF. I have no idea what he has. It's some kind of really unusual sleep problem. He is truly fascinating. I e-mailed a friend of mine who specializes in Sleep medicine. I don't think he's ever heard of anything like this either. It's exciting to see something that no one has really described before. Maybe I'll be able to make him feel better.

BS came. He is 96. He goes to the YMCA to work out four times a week. He lives alone in his house independently. He isn't happy.

RK came. He has been a patient for about a year. He told me that his sister was burned to death. He thinks that her husband killed her, but that was never proven. He raised his two neices. It's surprising what happens to people.

LL was a new patient. He is a retired accountant. He worked as an auditor. He doesn't think very highly of some of his colleagues.

I got very behind on paper work yesterday. I ended up staying at the office too late.