Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, December 12, 2008
    Merry Christmas! Please File my Advanced Care Directive

    It's that time of year again. The time of year that primary care doctors get a shower of cards and occasional gifts from nursing home corporations, orthopedists, neurosurgeons and hospital administrators.

    And patients.

    Some patients still bring in gifts and send me cards for the holidays, which I find quite heartwarming. It's nice to get the occasional expression of gratitude. I think this tradition has tapered off a bit in these days of managed care - I remember when my father used to bring box after box of See's Candy home from the office at Christmastime. Most of it was redistributed to friends and relatives, but given half a chance my sister and I would go through the boxes first picking out our favorites. I think perhaps the Starbucks Gift Card has replaced the box of candy as the standard gift, now that caffeine is more socially acceptable than sugar.

    I cherish the slightly off-the-wall gifts I have received in the past, such as the plastic doodad a physical therapy office once sent me. It had four arms all of which ended in knobs and turned out to be a back massager; my secretary demonstrated by grabbing it and running it over my upper back. Yeowch.

    The cards are nice, too. The ones from specialists often come with calendars (especially useful, they go into exam rooms to help me figure out the date when the patient's symptoms started or the date they're scheduled to go back to work). The most touching ones are those with shaky signatures from my elderly patients. Some are so isolated that I may be the only person in their lives to whom they send a card.

    But the funniest one this season has to be the card I got a few days ago, included with the patient's completed copy of an Advanced Healthcare Directive. The message inside? It became the title of this post.




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