Another Dermatologist Fails the interview

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First I apologize to any readers who are dermatologists but damn!

The next convention you attend you need to let your colleagues know how flakey your profession seems.

Let me explain.

I’ve been to dermatologists whose offices looked like the photos I’ve seen of Illegal abortion clinics.

That visit… the Dermatologist in question was allowed to use Liquid Nitrogen but under no circumstances allowed to breach the integrity of my skin. I don’t think that their sterilization practices were lax, but I don’t know that for sure.

(As a rule, if someone is going to work on me with sharp instruments I’m a hell of a lot more comfortable if they tear open the sterile wrappers in front of me. When an instrument has been Autoclaved it’s usually in a paper bag and that bag has a stripe that changes color when the bag and contents have been exposed to temperatures high enough, long enough to sterilize the contents.)

Even at the dentist, I feel more comfortable if they have to tear open the bags to get to the tools. It’s just good hygiene and since I know what I’m looking at, I’m immediately at ease because I’m unlikely to get some horrific disease from the instruments.

I’ve been to dermatologists that cancelled appointments at the drop of a hat.

Ya know… it’s really nice Doctor, that you have a competition sailboat however I worked a ton of overtime so that I wouldn’t be docked for missing the time I’d intended to see you, My GP, The Dentist, and the Eye Doctor on a very tightly and carefully worked out plan in a single day.  Your arbitrarily canceling appointments so you can go play on your boat kind of throws a monkey wrench into my works. 

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Had this doctor done this only once I’d have been ok with it. But the Doctor in question did this 4 consecutive appointments over a period of 6 months.

During that 6 month period I actually got to see this particular doctor exactly TWICE. But it cost me 2 days off at work. Thanks Doc!

Even accepting her staffs proposed reschedules I still got cancelled on.

The NEXT Dermatologist I got to see twice, of the 6 visits four of those visits were with a Physicians assistant.

Great! But I’m paying to see the damn Doctor and honestly the P.A.s range of treatment options were confined to creams, ointments, and unguents.

All of them SLOW to work and as a guy, the last thing I want to deal with is some crap I have to apply 3 times a day and have a patch of skin that’s chronically damaged, tender, and is now a serious sunburn issue.  

Especially when I know damn well that the problem could have been dealt with in 30 seconds with liquid nitrogen or a freaking scalpel.

On the occasion when I got to see the Male Doctor himself that’s how we handled it. 30 seconds and DONE. Next!

All of which leads me to todays debacle. New guy about my age.

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Paperwork is usual, how are you paying? Can you pay? Will you be paying? I provide the insurance crap, and they get a little snippy when I don’t provide an “Emergency Contact” Who doesn’t live with me. They’re really pushy about this and start asking for my Mother or Father even if they live out of state.

This is RED FLAG #1

If I’m frothing at the mouth twitching on the floor and we’re not having sex… an out of state “Emergency Contact” isn’t going to do them a whole lot of good now are they? My Mother has been accused of being a Witch, but even HER broom isn’t supersonic.

This is about nothing more or less than money because nowhere in their paperwork have they asked for my spouses name. They’re trying to get another datapoint so that IF I skip out on the bill they’ve got someone else to lean on for the fucking money. 

I tell the pushy lady that my family is deceased. She replies thats inconvenient, I reply “Yeah especially for them!”

My appointment was for 10:15. I was on site at 9:55 with all the paperwork filled out. At 10:05 I’m ushered into an exam room, where I’m asked to fill out yet another piece of paper.

This paper asks questions like where were you born, how long did you live there, how long have you been here? Have you been exposed to pesticides? My response was, “Who hasn’t?”

The perky nurse who led me into the exam room takes my Weight, BP and Temp. then leaves. Then comes back in asks a couple of questions then leaves, then pops in asks a couple of questions, then leaves, then pops in asks a few more questions then tells me to take off my shirt.

It’s 10:20 I can hear the doctor doing dictation in the room next door.

I know it’s him because of the descriptions of the conditions and I know it’s dictation because he’s saying things then speaking the punctuation. “Patient X needs to get a life(period)”

I’m sitting there with my shirt off, nipples hard from cold a meatpackers freezer would envy and I wait. 

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At 10:55 I’m not cold anymore because I’m well on my way to being angry. I can hear the doctor dictating away in his office next door and I’m sitting in the exam room hearing everything he says.

Stuff like him talking with someone about lunch and arranging a tee time. 

At 11:00 am I’ve decided that for the sake of thoroughness I’m going to wait another 15 minutes. Then I’m leaving. 

I’m dressed in Jeans, a T-shirt, and flip flops. Thats the easiest way for the Doctor to see any and all problem areas. I’ve had Dermatologists want me to be in nothing but my boxers and had them check me for funguses, Skin cancers, and all manner of issues. I honestly  do make an effort to be attired in a way that minimizes any waste of time.

At 11:08 the Doctor breezes in, “great” I think. Now that I know his business and a significant portion of other patient information including the spelling of their conditions he’s finally seeing me.

He launches in to a well rehearsed spiel that is clearly based on the form I filled out almost an hour ago in that very room. 

RED FLAG #2

Without examining me he’s already assumed I’ve got sun damage. With a glance he tells me I have grovers disease. Uh, no, I’m having a problem with a soap I just switched to. I’ll change soap and this will go away in a couple of days. 

“No he says, that’s a disease for which there is no cure.” 

I’m thinking to myself “WTF? I know the cure, stop using the soap sitting in the windowsill of my shower.”

Diagnosing Grover’s Disease

A dermatologist might make a diagnosis of Grover’s disease based upon the appearance of the rash associated with it. A skin biopsy is may be needed in order to confirm the diagnosis. Grover’s disease presents a characteristic appearance under a microscope, with separated cells called, ‘acantholysis,’ either with or without, ‘dyskeratosis,’ or abnormal rounded skin cells, being present. The majority of cases of Grover’s disease last less than a year, although the condition might occasionally last longer, come and go, or present with a seasonal variation.

From www.disabled-world.com

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What we have here is a disease that can only be guessed at based on visual diagnosis. The medical community isn’t sure what causes it, why it manifests mostly in middle aged white guys, or exactly how to deal with it. 

In my book that’s not a disease, it’s a condition and it’s easily dealt with for me by making sure that I watch the kinds of soaps in my world.

Certain laundry soaps, and bath soaps will cause a breakout. Other soaps will let my skin heal and I’ll be fine for years until someone changes the formulation.

I, as the occupant of this body know it’s habits, quirks and what makes it happy or sad. 

This guy wasn’t accessing my internal diagnostics, and we weren’t building a relationship.

He was blowing it and didn’t even know it.

As readers of this blog know, I whacked my big toe back in the fall. Well the nail didn’t actually come off but it’s clear that the damaged old nail is being replaced by new growth.

The damaged nail had blood clotted under it and that permanently discolored the 1/4″ strip of keratin that remains. Big Deal. 

The next words out of this guys mouth are “Lets talk about that foot and nail fungus”

I reply “I don’t have any of that.” 

“Yes you do.”

“No I really whacked that nail in the fall and this is normal regeneration.”

“No you’ve got nail & foot fungus”

As he’s looking between my toes, I tell him “A man that doesn’t take care of his feet is a man that doesn’t take care of himself.” 

The Doctor is looking really hard for nonexistent fungus. He finally admits that there is not any fungal infection and tries to move on, but is clearly off his game now and desperately trying to recover the “Arrogant Doctor High Ground“. 

RED FLAG #3

Doctor tosses around another term, ichthyosis. To which I said ” If only, That might help with my SCUBA” 

He stumbled then. He didn’t laugh, it was more of a hiccup in his spiel.

Icthus means – fish.

osis in medical / biological parlance means – condition, process, action.

Therefore icthyosis means literally “fish condition”

Thank you Dad & Mom for making me learn Latin / Greek root words. 

Problem is, that while this condition can be very serious and debilitating in the more extreme of the 28 varieties. It can also be a very nice catch all for dry skin. 

I have a couple of very dry patches of skin on my shins.

I’m sitting in this exam room wondering if this Doctor is trying to intimidate me, terrify me, or get me to sign up for a series of extended, expensive, and annoying procedures.

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To be sure… He had no sense of humor.

RED FLAG #4

Doctor says “I know what I’m going to say to everyone before I see them. Everyone is sun damaged, everyone is the same.” 

11:15 Doctor hands me papers talking about sunscreens, soaps, and moisturizers and is out the door.

No “I want to see you again in a year”, nothing at all. It was like instead of being a DOCTOR he was just cashing in. He said nothing else to me, he just abruptly left.

I pulled my shirt on, grabbed my shit and headed for the reception area. After checking with the reception lady that she didn’t want to collect a co-pay today,  I was gone.

Mind you, all I wanted was a few minutes to deal with any pre-cancerous lesions that I might have. I, like most children of the ’60s am sun damaged, I know this it’s not a revelation or news to me.

I’ve been through the process of preventative skin cancer treatment before, its simple.

Locate any odd spots, freeze odd spots off, swat patient on ass, tell them to go play, and remember their sunscreen. That is all I wanted, a simple yearly check & prophylactic removal of anything questionable. 

That’s not what I got… In fact I feel very “Ripped off”! Needless to say, I won’t be going back to that doctor ever!

I was a little pissed off. What a waste of my time, but better to know I’ll need to keep searching for someone that I get along with and who is reliable.

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I keep asking myself if my standards are too high. I really need to have a relationship with a physician, I can’t be just another piece of meat to them. I don’t think it’s too much to ask…

After I left the Doctors parking lot, I headed to a shooting range I’d been wanting to check out.

My crankiness at the crappy and I’m sure horrifically expensive medical exam evaporated upon my hearing the familiar PoP pop POP of pistols being fired. 

The shooting range redeemed the day and I might just become a member of their organization.

Strange, the things that give us comfort.


Here’s a short update.

The one & only piece of advice I got out of the visit with this jerk was to check out a product called AmLactin

I’ve been using the Ultra Hydrating cream for about the past month. This stuff is really great and has cleared up the dry spots I mentioned on my shins. I’ve also used a little of it on my knuckles and seen really impressive results correcting the splitting there. If you wash your hands a lot you’ll notice that most of the soaps suck the oils right out of your skin.

I had a case of “Street Fighter” knuckles to beat the band & the AmLactin has fixed me right up.

This stuff is pricy but it works and you don’t need to use huge amounts of it.

It’s mostly odorless and soaks in fast without leaving you feeling greasy. I don’t know a guy who likes having a greasy feeling on their skin all day… (A couple naked greasy hours fine… but all day? Not naked? NAH)

Just figured I’d pass on that little bit of information to all the guys in internetland.

Ughhh! I hate Doctors Appointments

I just remembered I have a Dr Appointment today. I hate doctors appointments, I always feel so… violated.

Well I’ve already had coffee with sugar so there goes the cholesterol screening.

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Oooopps! Oh well.

Been thinking about a lot of things where the Doc is concerned.

I like him a lot but he’s too busy. He’s also recently (within the past year) gotten some new help and frankly they’re snotty little bitches.

Again we go back to the basic question of “Who is the Customer and Who is the service provider?” 

It’s funny how often issues boil down to that simple question.

From Politicians to Physicians, Lawyers to Mechanics, Educators to Customer Service people, it’s always the same. If they forget that you’re the one paying the bill it’s time to remind them.

You can do that by finding someone else or by working your way up the chain of command. All too often we forget that simple truth.

I’ve been contacted more by the satellite company recently than in the previous 10 years I was their customer. All because I told them exactly why I was pulling the plug. I guess $1400 a year gone from a customer that was no trouble and who paid their bill on time due to crappy customer service got their attention.

I know my place. Apparently these new people at my Doctors office don’t know theirs.

I’m asking myself do I want to expend the energy to train them? Or do I want to expend that energy to find a new physician?

In a typical year I see a Doctor only once or twice.

Like most men, It’s gotta be arterial bleeding before I even think about going to a Doc.

Because of that when I fucking call with a problem I don’t want some smart mouth little bitch giving me more attitude than that Snookie woman from Jersey, or one of the Kardashian sluts.

I want straight answers and if I leave a message for the Doc to call me back… He damn well better get the message. 

I’ve been nice and polite and gotten nowhere.

I had hives from something he told me to take last year. I had no idea Hives could be dangerous. I thought they were simply an annoyance. Didn’t matter, I never got a call back from the Doctor. It was the pharmacist at my local Rite Aid who clued me in and helped me out.

I think the Doctor and I are going to have a little discussion about my expectations.

If he can meet those expectations great! if not… I’m going to be looking for a new Doc.

I’ve approached this health thing as a partnership if I’ve become another piece of meat well then we have a major problem.

On the plus side… I’m going to go drinking with some buddies I haven’t seen in a long time. That should be fun.

Maybe then I won’t feel quite so violated…

Free I’m free at last!

Today marks the first day of freedom from Express Scripts.

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Can I get a hallelujah!

No longer will I be forced into using generic drugs if I don’t want to. It’s once again my choice to manage MY own prescription world.

I once again can go to the LOCAL pharmacy. Where I can ask a pharmacist questions and know that I’ll actually be talking to someone that knows what the fuck they’re talking about.

No more talking to a moron on a telephone who obviously couldn’t give a shit about what they’ve sent, where they sent it, or that what they sent isn’t the right shit in the first place.

The down side is that I’ll be paying through the nose but that’s better than having to fight the fucking insurance company every time I need something.

Even if I was paying for a prescription out of pocket… I ended up wasting time (mine and the pharmacy staff) because I’d call in a prescription and the insurance assholes would override my request.

Then I’d go to the pharmacy and have to have the pharmacist take back the generic shit that doesn’t work on my body to replace it with the shit I wanted in the first place and was willing to pay cash for.

Generic drugs, with a different chemical make up aren’t the same as the real deal. Generics may work in a similar fashion but maybe not as well, that’s often why the generic was superseded in the first place.

Remember having to take an antibiotic 6 times a day? Now it’s not unusual to have a prescription antibiotic that you only have to take once a day and the new drug doesn’t give you the shits either.

Let me see… I have to take a handful of pills 6 times a day and I’ll need to have a diaper or I can take one pill a day and go on with my life without scoping out where the nearest toilet is.

UHH let me have option fucking B!

Now I can choose generics if they make sense and they’re effective otherwise I can pay for non generic and know the shit will work.

Yaaaahhhhooooo!

I’m fully aware that I may not be so thrilled the first month I get the bill. But at least I have freedom of choice instead of being told cheerfully that since a generic version of the drug I’d been taking for years was now available I would be forced to accept the generic. Oh and you’ll have to have your doctor jump through hoops to get that prescription filled.

With Express Scripts in my rear view mirror perhaps at least one portion of my life will get a little simpler.

If your HR department happens to mention Express Scripts as an option during your next open enrollment… Tell them in no uncertain terms you refuse.

Believe me if a conference room full of people say something like “We’re quitting if you force us to deal with that prescription coverage company” your HR people will probably listen.

In my case, I asked questions but the majority of the folks in the room just wanted to get through the presentation. After 3 years dealing with Express Scripts those same folks welcomed being laid off. We’d all had similar stories of horrific dealings with Express Scripts.

The classic was the guy whose meds had to be kept cold. Express Scripts sent his stuff in an uninsulated paper envelope in February to Los Angeles. At the time it was in the 80s and the drugs were ruined.

When he called Express Scripts asking for a replacement and explaining what happened the Express Script people told him its Winter, “We don’t ship in insulated packaging in Winter.” After Express Scripts had screwed up 3 consecutive shipments they finally sent him to his local pharmacy.

Good riddance to a fucked up company with a shitty customer service philosophy. Hello to freedom…

Bad habits

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I used to smoke. 

Yeah, I was a smoker. I was the evil puffing bastard everyone has come to hate! I put your children at risk! According to the nanny state I should have been taken out and shot.

Not to put me out of my misery but out of yours.

I quit years ago and I still miss it.

Now theres an un-PC admission in this day & age!

I’m glad I quit and everything, but I liked the nicotine rush! I also liked that it killed my appetite and it was a lot easier to stay skinny.

The health benefits outweighed the desire to smoke and so I was able to leave it, albeit with regret in my past.

I quit because my best friend asked me one day how it was that I could justify going to the gym 4 days a week and still smoke when I came out of the gym?

It was a good question and as usual his logic was completely irrefutable.

I quit that day…

I still miss it.

I miss smoking when I’m drinking at a bar. You can’t smoke at bars in California anymore but I still miss it.

I miss smoking after sex. I miss the ashtray on my belly, the red cherry of my cigarette glowing in the darkness and me thinking quietly about what I’d just done and knowing that I was going to do it again when I stubbed out my smoke. I miss having my arm wrapped around my partner, their head on my shoulder while I smoked that in between fuck cigarette.

I doubt I’m the only man who feels that way.

I miss getting up from my desk and walking outside to have a smoke and bitch with my co-workers about the boss or the latest political fuck-up in the company.

I smoked because I enjoyed the taste, and the hit. Not because I was lured into it by unscrupulous corporations. (Their ads were enticing, who didn’t want to be the Marlboro Man?)  I knew damn well what I was doing.

My Dad smoked. It killed him, you’d think that I wouldn’t wax lovingly about cigarettes.

I didn’t start smoking until I was 18. Near the end of my smoking days, I was doing almost a pack a day.

The nicotine was one thing. I think I was self medicating a bit. Nicotine acts as a stimulant and because it’s a stimulant it has a very specific effect on persons who happen to have been treated in their childhood with drugs like Ritalin.

The child may have outgrown the reasons they were put on Ritalin but their bodies will always have an affinity for stimulants in general.

I’ve known more than one smoker who had been on Ritalin in their childhood, of those more than a few who really liked pharmaceutical grade stimulants. 

Interesting thing is that if their Doctor was smart and recognized certain traits they’d end up back on Ritalin and suddenly they’d stop smoking.

But sure… Ritalin is completely safe for your unruly child, we’ve been using it for 50 years on kids just like yours… (with no or generally undocumented, unproven ill effects.)

Moving on…

I recently had the opportunity to try one of those e-cigarettes. For those of you that don’t know, these are things that look like cigarettes and that provide a nice flavor and optionally a selectable hit of nicotine without the tar, and other nasty chemicals associated with combustion in a “real” cigarette.

It was nice…

Not exactly like smoking a cigarette, but it was pleasant.

Since then, I’ve done a lot of reading and investigation The jury is out about the negative effects of these devices.

About the only consistent thing is that they’re less unhealthy than a cigarette. The “Smoke” is essentially water vapor, there’s no smell, but there is a good taste (at least in the one I tried). You can choose the nicotine leveNewImagel and they’re also a lot cheaper than cigarettes. 

I’m not sure that I’m ready to start up with one of these things all the time but I do like the option.

The only problem I could see is that unlike a real cigarette you don’t know when you’re done. 

I’d smoke a real cigarette in about 10 -15 minutes if I wasn’t in a hurry. These e-cigs don’t burn down so you could find yourself completely losing track of time if you weren’t paying attention.

For someone like me that really enjoyed smoking even when I quit… these things might be a neat option. I could also see how they might assist in quitting for some people.

But I suspect that there will be a larger number of folks who switch over to this option. At least until the government starts to regulate them and drives the prices up to normal cigarette levels.

There’s also the fact that cigarettes used to be, and e-cigs still are cheaper than a monthly prescription of Ritalin.

I don’t know if that’s still the case. I haven’t looked into Ritalin in a very long time.

Ok, I’ve got nothing!

Nothing to say.

Still looking for insurance that I can afford.

THuhhe search isn’t going well.

On the one hand I’d like to be covered, on the other hand I have a fundamental problem paying another mortgage payment to have medical coverage.

The primary problem I have is this, with a mortgage I have something that’s tangible. With health insurance I’m pissing money away to provide for coverage that I may or may not use.

At the rate I’m paying right now for COBRA, if I paid that same rate for 10 years it would come to $72,000 not including interest.

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When the  men in my family break at end of life we don’t typically last very long.

I’m actually fortunate in that as long as we stay active we live a long fairly trouble free life. Our sinuses are for shit but nothing is perfect.

When our time comes we tend to go out like Don Corleone in The Godfather. We’re playing with the grandkids or great grandkids in the garden then we drop dead.

If I’m going to pay the equivalent of another mortgage, I might as well take advantage of the lower mortgage rates and buy another piece of property. At least I could rent it out and have an income, with a potentially higher rate of return.

I was thinking about it and realized that were I to go to a bank to apply for a mortgage for another piece of property they’d tell me I can’t afford to make the payment. Yet our government says that not only must I afford the payment but that they will enforce it under the law.

It’s a lose, lose proposition. If I were still in my 20s I’d be applying for citizenship in other countries. Not because I hate America, I love this country, but because I wouldn’t be able to afford the cost of American citizenship as I got older.

Today if I could communicate with my younger self… I’d say go find a decent country with good people and a system that works. Move there, become a citizen and plan for a decent retirement.

I look at my parents and their retirement isn’t at all what they’d planned for because they trusted in a system that didn’t really protect them. Remember Enron? There were a lot of 401K investments that got wiped out due to them. Then just a few years later you have the housing implosion and the devaluation of their retirement savings has really cut into what they can do. I know they’re on Medicare and Social Security I know they’re paying for health care supplementary insurance I just don’t know how long they’re going to be able to afford it.

I’ve spoken to younger insurance agents who don’t have health insurance because they don’t have an extra 600 – 800 dollars a month in their budgets.

NewImageYet in 2014 we’re all supposed to be carrying insurance and we’ll be penalized for not having a policy in force.

I’m still OK,  yeah I’m using my savings to pay the bills but I can go for a while longer with careful spending. I keep wondering how the hell can people less fortunate than myself come close to affording health insurance?

It really messes with your head. You want to do the right thing, but you can’t afford to do the right thing.

Obviously if you didn’t bother to pay for your housing, and didn’t eat you could afford to pay for health insurance. Then you’d only have to worry about paying for health insurance for a few weeks.

This is seriously wrong. And yet the government is in a position to make us all face this choice.

I’ve said it before. Contrary to what President Obama would have us believe. The problem isn’t that American Citizens are irresponsible about medical coverage. The problem is that health insurance companies and to some extent the medical providers are raping the American People.

If our government was truly interested in taking action on health care they’d address the source of the problem not penalize the victims.

Humm, I guess I did have something to say after all.