Saturday, July 31, 2010

Good Sex Bad Sex No Sex

My colleagues asked me to enlighten them about the buzz surrounding

The new drug shot down by the FDA , and the upcoming testosterone gel for women, currently in trials made headlines about this complex topic.

As every gyn knows, this is a daily concern for women. Are they sexy enough? Once they have a partner, how come they don't want to have sex as often as they once did? Why after 43 years of marriage, don't they want to have sex like the first year of marriage? Their partners complain, or have retreated into quiet resignation.

Research shows us that normal women have spontaneous sexual thought about 2-4 times a month. Comparing that with men, its no wonder that we are left to think we are abnormal. We are just different.It is rare that we are allowed to just be, and allow sexual thoughts to creep into our conciousness. We require sexual triggers to get us "in the mood" more often.

Men are like an on off switch.

If there is an opportunity for sex, they are ready. Women are like the control panel of a 747. A bit more complex. The link above is a good reference and explanation of female sexuality. The female sexual response cycle has been remade a number of times, since Master and Johnson's work in the 1950's. Orgasm used to be the height of female sexual response, and the goal of a sexual encounter. Since women are a bit more complex than men, it seems now that concept has backed off a bit to include the emotional connection women desire.

OK then, if that's the goal, and men want physical sex, then why don't we get it? Have more physical sex to get more emotional connection to your partner! Most women tell me it is not their idea to have sex, but once they get started, they respond. Rebuking a partner rarely gets him to be more connected to you.

OH MY! We may have hit this jackpot.

And now you know the secret to being in a couple.

Make sure your man knows the sun rises and sets in his pants,
and you will be a very happy woman.............:)

Monday, July 19, 2010

Service after the Sale

This is a subject that comes and goes periodically. Usually it is when I hear a complaint from a patient whose expectations were not met.

When I have a new patient, I usually tell her that our process for patient communication of lab results is through the mail. Our system, with its Electronic Medical Record, allows us to generate a personalized letter regarding results of tests that we have ordered. Many women are surprised that I am not, nor my nurse personally call them for all their lab results. There is a new patient brochure that they receive that tells them all of this. I am sure they do not read that part.

It takes variable amounts of  time for the tests to return to the doctor, and a typical physician will have somewhere between 60-120 tests to respond to each day. Then there are the autofaxed prescription refill requests from the pharmacy. There are usually a dozen of those, and then the 15-30 patient phone calls that require a response. Since my patients also expect me to run on time, and spend time with them in the exam room, I need to squeeze all of this into my workday. Needless to say, lunch is a fairy tale my mother told me about.  Oh, and lest I forget, a ream of records sent from the old doctor for each new patient, to sort through to see if there is anything in there that is relevant. Did I mention I do ambulatory care, so I don't get the stream of hospital and Emergency Room phone calls?

I do not play golf, and I don't have a four day work week. The fat was rendered from medicine 20 years ago. Managed care and risk sharing saw to that. There is no army of medical secretaries to do this work. It now falls to the physician and nurse to manage the practice. The office staff generally makes appointments and takes the phone messages and forwards them to the clinical staff. The clincal staff (my nurse and me) then sorts through all of this, in between a busy work day of patient care, and responds to the tests, patient calls, and other demands such as " just phone in my prescription, so I don't have to make two trips to the pharmacy" " fax it to my mail order". Nice for you. Did you even bring in the address and phone number of the pharmacy? Find me something else that is cheaper. How do I know what is on your insurance plan's least cost list? It's like buying a car. Nobody pays the same thing for the same item. And I am going out of town so I need it right now.

The joys of dealing with the public.

Managing the expectations of the customer is a critical part of what we do. Much has been written about this subject in the business literature. It is a daily challenge, especially on the front lines of a large organization. The customer ( in this case the patient) has expectations from hearing the name Cleveland Clinic. It is a prestigious academic medical organization almost a century old. It has been in Florida over twenty years. Processes have been in place for years before I showed up. It is up to me, and each new hire to fit into the process and make it successful in his or her own way. Nobody teaches that to you. It is implied when you are hired, that you will become " a Cleveland Clinic" physician. So the trial and error process begins. I asked to help make the onboarding process easier for new physicians, that way they don't step in all of the holes that are out there, there is a map.

In a medical world where qualtity of care and service are determinants of the paycheck, service after the sale is becoming more important.

Tuesday, July 6, 2010

Mothers and Daughters

At some point, I think each young girl wants to be like her mother.

Then the game changes around age 12 and she wants NOTHING to be like her mother. Then at 32,42,52 she sees she is her mother. Hmmm,I have given this subject lots of thought.

I went to visit my mother over the holiday. She is now 84, and wanted to see both me and my brother together. This was THE TALK about where things are, what her final wishes are, and how she would like the end of life to unfold. She is in relatively good health, but figures that with a little of this, and a little of that, the wheels may fall off the bus anytime. She guides me in wisdom yet again.

My brother was all business. He has some paralegal background, and the paperwork of dying was his only agenda. He dictated what jobs he is going to do, and what he wants me to do. Mother really could care less, she just wanted us to know her wishes. I don't think he wanted to hear her real message of wanting to spare us as much pain as possible when she passes. She has lost a husband, and saw me lose one, and knows that these things can happen without warning, and family members can be tortured with the what ifs, if they have not been spoken in advance.

Not all children are trustworthy to fulfill their parents' wishes. I have seen awful fighting, rivalries, and "getting even" at the time of a parent's death. It is so very sad to see that the respect and reverance for a parent are not foremost in a child's mind, but petty egocentric behaviors prevail. Then there is the free for all for the loot. So very very sad.

Not my mother and me. We really are on the same page. I have come to know that I am rooted in her, but am my own person. She will always see me as her child, but then, I always see her as my mother. So we are even.

 I caught myself allowing her to cook and serve me, when it should have been the other way around. I rationalized that this made her feel good. Good and tired I think. I basked in the womb once more.............feeling very much loved and cared for. I know it helped her to feel our connection, which is deep and strong.  This trip, I helped her up and down, got things from the high shelf, and lifted her walker onto the curb. We went to a museum, and then shopping. I helped her try on clothes. It was good to be a helper again. We wore each other out, and left each other with a deep feeling of satisfaction for the visit. The business had been done, and no tears were shed. She still has insight and good advice for me, and made sure I didn't go out with anything dripping from my nose, or forget my lunchbox.

Until next time...........................