Clinic Quick Tips: A Patients Guide To Medical Care - Chapter 1

Welcome to...

Clinic Quick Tips: A Patients Guide To Medical Care!

The goal of this guide is to help you, the patient, navigate our complex, and often challenging healthcare system by giving you tools, tips, and advice to make the most of your next clinic or doctors office visit.

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Please note that this guide is not meant to substitute the advice of your healthcare provider, who should be consulted before you attempt any of the advice listed in this guide.

If at any time while reading this guide you begin to experience any of the following conditions:

• Chest pain
• Shortness of breath
• Numbness or tingling
• Nausea
• An erection lasting for more than 4 hours, especially in women
• Bubble guts
• Decreased libido
• Increased libido
• Excessive floppiness
• Bad credit
• Blood in your urine or stool

Please immediately stop reading this guide and call your primary care provider or nearest walk-in clinic, yell incoherently, then proceed to a different medical facility, preferably in an entirely different medical system, for care. When you arrive there, complain loudly about them not being prepared for your arrival, even though you called ahead of time.
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Chapter 1: Preparing For Your Appointment

So you have finally made an appointment with your primary care provider to have that rash that's been bothering you for the last 7 years, good for you! Although the appointment is on Monday, and today is Friday it's been raining all day, so since you're bored you might as well head down to the walk-in clinic and ask them to fix you up!

• Tip #1: Before you leave your house make sure you're prepared for your appointment. Showering and changing your clothes will only delay your care; just like in CSI your medical team needs to see you in your original state! So make sure you don't give your child anything for their fever, change the underwear you sharted in, or even brush your teeth, or else it might obscure valuable diagnostic information!
• Bonus Tip: If you suspect that you medical condition might require a sample, try to obtain it before presenting to your clinic. While most medical and lab personnel will make a big stink over "sterility," all that really means is, "extra clean," so sending that old yogurt cup or baby food jar through the dishwasher before placing your urine, feces, mucous, or mysterious anal clot inside is perfectly OK! Make sure you place it on the desk while checking in so they know you were savvy enough to bring a sample with you.
• Tip #2: When checking in for your appointment make sure you use obscure language or codes to convey what you want to be seen for. Reception and Patient Registration Staff are exhaustively trained in order to decipher just exactly what is wrong!
• Don't have any codes or anachronistic language to describe your cough or urinary tract infection? No problem! Just describe a problem that is the exact opposite of what you want to be evaluated for.
• Examples: Urinary tract infection = "problem down below," cough or minor chest congestion = "chest pain and can't breathe," vomiting and a little dehydrated = "throwing up dark urine," crushing substernal chest pain that radiates to your left arm, with difficulty breathing, and profuse sweating = "minor chest cold."

• Tip #3: While waiting to be called back for your visit, get comfy! Using multiple chairs can help to make your wait far more comfortable. Can't hear the TV? Turn that bad boy up as loud as you want! You pay the salaries of the people here after all, and if they ask you to turn the TV back down, just remind them of that! Also, feel free to write on, tear up, or even keep any magazines or other literature that is in the waiting room, it's there for a reason!
• Bonus Tip: When your name is finally called, take your time responding and getting up. This, combined with loud sighs, and complaints about how long you had to wait let the medical staff know that you're important! Didn't have a long wait? Doesn't matter! The same techniques can be used to make sure the clinic staff keep a move on and don't slow down your day!

Chapter 2: Making The Most Of Your Visit        ...COMING SOON!

So You've Decided To Go To A Walk-In Clinic...

A Primer To Navigating Modern Medicine

   Well, here we are. You've finally decided that the crushing sub-sternal chest pain that radiates to your left arm or the rash you have had for 4 years finally needs some doctorin'. Good for you! Below are some tips, tricks, and pointers to make your next visit to the Walk-In Clinic or Urgent Care a satisfying and successful one!

Let us know.

1. When checking in with the receptionist, try to keep your complaint as vague and misleading as possible. For example; if you feel like you might be having a heart attack, try saying, "I just don't feel well, I think I have a cold." And if you feel like you have a cold or maybe strep throat try saying, "Oh god!  I'm dying! I can't breathe! My chest hurts!"

 You're the boss!

2. Make it a point not to step on the scale when the nursing or ancillary staff ask you to. They only ask so that they can make fun of you later. Your deeply held belief that despite being 5'1" and 385lbs, you're only fat if you step on the scale is absolutely correct.

Go crazy!

3. The Walk-In and/or Urgent Care setting is absolutely the correct place to have your long-standing and complex mental health problems managed. If possible, try not to bring a medication list, the name of your psychiatrist, or a friend or family member who can assist. Please remember to try being as combative as possible.

No soap? No worries!

4. Had a hot day working outside? Covered in cow or other animal feces? Not a fan of bathing? Then come on down! The staff would be more than happy to take a look at and treat your 4 year old plantars wart, chronic hemorrhoids, or crotch rash!

Secret Agent man!

5. No need to give up your name for a number! Feel free to thoroughly explain to any staff around how everything from the scale to the thermometer, to the question "Do you feel safe in your home?" is all part of a vast government conspiracy! Not a patient? Not a problem! You can accompany your family member or friend to their appointment as well! The Man isn't going to get one over on you!

MoneyMoneyMoneyMoney... Money!

6. Any fool knows that all medicines and medical care are free thanks to Obama, and you're no fool! Make sure you let everyone from the receptionist to the nursing staff to the cleaners know that you're not happy about your $5 co-pay and $1 prescription. It's a well-known fact that if you complain about it often enough your visit will be completely free!

Closing Time! 

7. Just like how restaurants only give out the best food five minutes before closing, you can beat the rush and get better care if you show up just a few minutes before the clinic closes. This is especially important if you have a complex and time-consuming medical problem that has been plaguing you for months! Those turned off lights, empty waiting rooms, and locked doors just mean that you're getting exclusive and premier medical care!

   And there you go! Hopefully these tips will help you to get the most out of your next medical experience. They are tried and true measures that will lead to a happier, healthier, and more narcotic-possessing you!

Armchair Shrinks and Monday-Morning Psychiatrists: Why Google and Amazon don't make you a professional.

No shit, there I was; having lunch with someone who shall remain nameless when the topic turned to my schooling.

That Guy: "How's school going?"

Me: 'Pretty good, I'm one class away from completing my degree, but I still have a few other classes to take as pre-requisites for PA school."

TG: "Cool, got any professors you like?"

M: "Yeah, they're all OK for the most part. There's one who is kind of a dick. A bit abrasive and at times a little condescending or over bearing, but he at least knows what he's talking about about."

TG: "Oh, man, Classic Ass Burgers!"

M: "Huh? What the hell is that? Is that what you're ordering?"

TG: "No! Your professor sounds like he has the classic symptoms of Aspergers!"

M: "Oh yeah? What makes you say that?"

TG: "Well, he's rude and doesn't seem like he understands other peoples emotions, lacks empathy, but is very intelligent. Classic!"

M: "..."

TG: "What?"

M: "You know you're in absolutely no way qualified to make that diagnosis, right?"

TG: "Oh, and I suppose you are since you are almost done with a psychology degree? College isn't everything you know! I've read plenty of articles and I have a copy of the DSM-IV!"

M: "Oh, man, Classic Syphilis!"

TG: "What!?"

M: "Sounds like you have the classic signs of neurosyphilis! You're forgetful, have depression, and are obviously irritable."

TG: "So that means I have syphilis!? You have no basis for that! How would you even know?!"

M: "Well, I have access to the internet and to a variety of texts on diseases. So I've decided that's what you have."

TG: "You aren't a doctor, you have no idea!"

M: "College isn't everything, you know."

 TG: "Whatever."

   This conversation wasn't out of the norm. In fact, TG and his associates tend to hand out psychological diagnosis like they're free candy. Candy coated in SSRI's and anxiolytics, probably. They do it often enough that I'm surprised TG doesn't carry a pocket guide on him so he can quickly reference which disorder he intends to foist upon the next unsuspecting person like an overly aggressive store clerk... who also tells everyone that you're autistic. What a terrible store.

   Psychology (and to a lesser extent, Psychiatry) hasn't been a science for terribly long in the grand scheme of things. It also isn't considered a "hard" science in the sense that there are unfortunately few lab coats, no beakers, and usually very little in the way of fire or explosions. All of this tends to foster a view that Psychology is somehow a "lesser" science, with little in the way of hard facts, rules, or laws. And if that's the case then nothing can truly be "wrong" since its almost impossible to prove anyway. Add in the dearth of pop psychology articles, poorly conceived "psychological thriller" movies, and all of those fucking e-mail chains about how "you only use 10% of your brain!" and you can start to see why, while no one will watch a few episodes of Breaking Bad and try to be a chemist, all sorts of pricks will read a few headlines and promptly go Freudian on your ass.

   So what does it matter? Well, it matters because wandering around telling people that someone has a mental illness when they don't is the same as running around screaming that they have herpes. You don't know, you have no business knowing, and if you had either of those you wouldn't run around doing that because you'd be a fucking doctor, or you'd have herpes yourself. Maybe both.

Mental diseases and disorders are complex things, some we understand fairly well, others we don't, and then there are even more which we once thought we understood, but now realize that we do not. They also tend to be incredibly stigmatizing. Did you know you are 9 times more likely to be murdered by someone without Schizophrenia than by someone with the disease? The fact that you're more likely to get stabbed by almost anyone other than someone with Schizophrenia doesn't change the fact that people with the disorder are treated as ticking time-bombs best left locked up and medicated. Hmm... "ticking time-bomb," why does that description sound so familiar...

Gee, it's almost as if even correct labels can make life difficult for people. And the prevalence of how often psychological terms are used as throw-away descriptors doesn't make it any better. How often have you heard someone say, "Oh, I'm OCD about keeping my desk neat." Really? You suffer from either an obsession consisting of unstoppable distressing and intrusive thoughts regarding the cleanliness of your desk and or feel a physical compulsion to perform rituals relating to such, the absence of which causes you distress? No? Then you don't have OCD fuck-wad. The misuse of these terms may seem like a little thing, but it causes a societal attitude that tends to either be patronizingly dismissive of mental health conditions or so overly-fraught with anecdotes and misinformation that it harms the sufferers of these illnesses.

Psychological and Psychiatric diagnosis is hard. There are few biological markers that are able to be tested in a living human and there are severe limits as to what can be achieved via brain imaging and testing since your average hospital doesn't have the millions it takes to purchase an fMRI let alone the millions more required each year just to maintain the damn thing. And that's not even taking into account the number of times they'll have to scram the magnet because someone forgot that giant super-magnets and ferrous metals don't mix.

The lack of those concrete biological or physical markers for many mental illnesses can often lead to misdiagnosis even by well educated and highly experienced providers. The fact that insurance companies have essentially incentivized giving someone a diagnosis by equating that label with payment certainly doesn't help either, but that's a topic for another discussion.

So if it takes decades of training and experience to become a licensed Psychologist or Psychiatrist, and they can still get it wrong sometimes, then what makes TG think he can pop off a diagnosis simply by reading off a check-list of symptoms from the DSM?

 Personally, I'd blame the Internet and Narcissism, but if my almost-degree in Psychology has taught me anything, it's that I don't know shit about Psychology, and neither do most people.

Intro to Psych Buzzwords, Moral Butthurt, and why being upset about American Sniper says more about YOU than it does the movie.

After hearing all of the talk regarding American Sniper (a movie I have not seen, but a book I have indeed read) I can’t help but think about how America loves her storybook  endings.

Much talk has been given that the movie glorifies war and that Kyle is nothing more than a “hate filled killer”. Others bring up rightful issues with how movies portray the non-special forces/warfare service-members in movies as either being inept, or barely there when in fact they make up the bulk of our fighting forces and always have. But the most I’ve been able to gather has been in comments from individuals; sometimes in person, sometimes on social media and other various platforms. And while the individuals range in age, sex, background, education and a variety of other aspects one thing remains constant: the Hollywood Life Fantasy.

That we as a nation love our scripted storylines isn’t something new or groundbreaking. From the little girl (or boy) who wishes for that feet-sweeping love experience to the disaffected middle-aged office drone who spends their lunch breaks fantasizing about reenacting the most pivotal scene in cinema we love it all. So what else do we love? We “love our troops.” Yes, the quotes are there for a reason.

We love John Phillip Sousa send offs for the rosy-cheeked young lads marching off to defend our freedom, and the only thing we love more than that is the Norman Rockwell homecoming of that same cheerful boy, now a little older and wizened, but still red-cheeked and carefree. What don’t we like? The middle and the end, naturally. (For the current conflicts replace those two cultural icons with Toby Keith and, I dunno, Instagram?)

For the 99% of the nation who has never served in the Armed Forces and the 96% who has never had a close friend, family member, or loved one who served, the scenes of war can only be comfortably approached in a small number of ways. They can either be big budget productions filled with Tom Hanks killing Nazis off-screen in a conflict that took place almost half a century ago, or they can be washed out, unrealisticand half-assed looks at a current conflict where any legitimate scenes of war are flashed by quickly, like a band-aid being pulled off of a child and then everyone has to weep about how horrible it all is.  Not to say that war isn’t horrible. It is, except when it isn’t, of course.

Somehow, in the course of two wars that have seen unprecedented media coverage; reporters filming live firefights, in-depth interviews with the average grunt on the ground, outspoken combat vets sharing their stories, and even interviews with enemy fighters the only thing that has increased in the era of the 24-hour news cycle have been sales of yellow ribbon magnets (don’t want to bother the paint on the minivan with a sticker, ya’ know), and Call of Duty episodes that have multiplied like some sort of first-person-herpes.  Dibs on First-Person-Herpes as an indie-rock band name.

So what’s my point? My point is that to the average American seeing the reality of war, and not just the kind they think they know about from CNN and the Hurt Locker, is almost instantly offensive. And that offense seems to occur whether you’re a rabid Fox News watching war hawk, downing Bud Lite and screaming racial epithets while watching Blackhawk Down. Or a filthy MSNBC loving, Code Pink hippie, splashing bong water and patchouli oil on yourself before the Rachel Maddow Show comes on.  And impressively, both groups are offended for pretty much the same reasons. Although you’ll never get them to admit it.

War is primal. Killing is something we likely figured out around the same time as fucking all those millennia ago and both activities have seen innovative technical leaps and bounds in that time (don’t believe me? Just go to amazon.com and search "55-gallon lube.” It’s truly a great time to be alive). But despite transitioning from the rock we used to bash Ork’s skull in to the thermonuclear ICBM we used to incinerate Ivan’s skull, killing has remained a personal and primal thing. And just like your gas-powered 480hp vibrator, its not something to discuss in polite company.  And war is anything if polite.

America likes the products of wars. Be it hippie or redneck, both groups love the national ideals, freedoms, safety, economic prosperity, technological advances, and other things that war has brought them.  Even if they won’t admit it. But just like I would prefer to not see how my steak is butchered before it’s brought out to me, most people absolutely do not want to know the details of went into bringing them the way of life they know. Why? Because it reminds them of just how primal we are. Because it reminds them that while they sipped latte’s and drove to work at the factory, and sat in class, and slept in their beds at night, their peers were out performing that offensive, distasteful, and terrifying work they don’t want to think about.  Because then they might have to make an uncomfortable assessment of  the true cost of their way of life. And because when you imagine that patriotic young lad returning home from war with a seabag over one shoulder and his barracks cover cocked to the side you don’t want to imagine him slitting the throats of enemy soldiers in hand-to-hand combat in some sweltering shithole before taking cover from incoming mortars and then trying to decide what to put on his ration crackers before catching some shuteye. I’ll give you some insider knowledge: go with the jalapeno cheese spread.

Americans want their stoic warriors who can sometimes cry over the loss of their comrades, but not the same ones who ruck up, reload their mags and bring unholy American death upon those that they’re fighting. Unless it’s been heavily edited to the point of a Disney movie death scene. And they sure as hell don’t want to be confronted with the knowledge that the average fighting man or woman might not feel bad about their kills. Because if that twenty-something soldier, sailor, Marine, airman, or hell, even Navy SEAL you went to high school with doesn’t feel bad about killing the enemy that tried to kill them. And he or she is supposed to represent the best of our nation, then how far removed from it are you? And if they’re more like you than you thought then it stands to reason that they’re considerably less like the Saving Private Ryan’s, Green Zone’s, and M*A*S*H’s you’ve been lead to believe.

People hate when their set ideas are challenged.  Service-members exist as one-dimensional sound bites who can be either loved or pitied, but almost never hated.  Our enemies too are one-dimensional characters who do “evil” and most certainly enjoy it. After all, they’re foreign psychopaths who talk funny and dress weird.  So when confronted with a reality that makes our poster boy and girl military members seem both human, relatable, and have characteristics we only want to ascribe the “enemy” what happens? Remember, the enemy kills because they enjoy it, and we only kill because we have too, and at no time are we supposed to celebrate our victory over someone who wanted us dead, even if psychologically and realistically, it’s a perfectly natural thing to do. Hell, we aren’t even supposed to hate out enemy, not really. I’ve heard more than my fair share of freshman Intro to Psychology graduates prattle on about how “You must have to dehumanize your enemy to mentally protect yourself and blah, blah, blah, I watch too much Dr. Phil.” Of course I’m being a little hyperbolic. Those types would NEVER say they watch too much Dr. Phil.

So what’s the result?

Snooty articles on The Guardian and bitchy Facebook comments apparently, made by armchair generals, Dr. Phil stalkers, and the “morally superior” who hate that they’re being made to see a reality that they’re supposed to be carefully insulated from.

If you didn’t understand, or were offended by American Sniper, then this movie isn’t for you. It’s for those that fought, those that sacrificed, and those that understand the saying by Richard Grenier; “People sleep peaceably in their beds at night only because rough men stand ready to do violence on their behalf.” The book, and the movie is written by and for those rough men and women. And while you can and should hold your personal opinions, you should, at the same time, be honored to catch a glimpse of what it looks like to sacrifice for the greater good.

Now drink up and go celebrate.