Twelve Bucks

Like any good doctor, I always take every opportunity to counsel my patients on smoking cessation when I get that chance. This is particularly true when I see patients for issues that are directly related to their smoking.

One winter I saw a patient who had all the symptoms of acute bronchitis. When I explained the diagnosis and treatment plan, she complained that she was sick of taking antibiotics and expectorants as this was her third bout of bronchitis that winter. When I asked how much she smoked, she replied, "two packs a day." I then went into a long explanation of how her smoking made her predisposed to recurrent bouts of bronchitis and that if she wanted to stop having the bronchitis she needed to quit smoking.

Then I launched into what is always the finale of my 'smoking talk' that in addition to the health benefits of quitting, she could also save a lot of money since cigarettes are very smoking. I usually do the math for them to show them how much they would save per day and per month. Just as I did that for this patient, she replied, "well really, that's nothing compared to how much I spend at Starbucks."

"Oh really?" I asked, "what exactly do you get at Starbucks?"
"Well, I get the Venti Caramel Macchiado, and I ask for triple caramel. They say that it uses nearly a third of their bottle of liquid caramel to make my coffee, so they have to charge me extra for that."
"So how much is that?"
"It comes out to twelve bucks for a cup, 363 days per year except the 2 days a year they are closed. And then the day after those 2 days, I'm standing outside waiting for them to open, and I order two of them."
"Wow. I don't know what to say to that. I guess my cost argument for the cigarettes goes out the window."

I then turned to find my patient literature on diabetes.

Different Perspectives

If there's one thing I've learned in my interactions with patients, it's that everyone's perspective can be different. And unless I can see things from their perspective, we're going to have a hard time communicating. Here's a classic example.

I have a patient who has Parkinson's Disease and came in for followup. I asked him how he had been doing since his last visit.
"Terrible. My symptoms are a lot worse."
"Hmm. What do you think changed that made them worse?"
"Well they got worse after I stopped my medications."
"So why did you stop your medications?"
"Because I thought I was getting addicted to them."
"What made you think that you were becoming addicted to your Parkinson's medications?"
"Well, every time I missed a dose of my medicines, my symptoms got a lot worse."

We went through why I thought that qualified more as his medications working and not his becoming addicted, though he still seemed skeptical. To probe his understanding, I asked if everything was clear and if he had any other questions.

"Yeah, doc, just one. What if I'm on a plane, and it crashes in the middle of the rainforest and I'm stuck with no access to my medications for a long time. Do you think I would have withdrawal, and couldn't I die from that?"
"Well, if your plane crashed in a rainforest I think you would have a few more pressing issues than being unable to access your Parkinson's medications, but... Let me try explaining all of this to you again..."

Perspective.

An amazing solo

I have really come to appreciate the beauty of bluegrass music, but even if you haven't you must hear this solo on the dobro by Jerry Douglas. Many people, even outside of bluegrass, regard him as one of the finest instrumentalists of our generation. Watch this, and you'll see why. If you grow impatient, at least watch the last 60 seconds. Amazing.