home
RSS
Why doctors shouldn't treat family members
January 9th, 2012
09:55 AM ET

Why doctors shouldn't treat family members

Anthony Youn, M.D., is a plastic surgeon in Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

Imagine you are a highly skilled surgeon. Then imagine that your grandson gets into a terrible car accident and suffers serious internal injuries.

The injuries are so severe that he needs a physician to operate on him immediately. Even though a qualified surgeon is ready, willing and able to perform his surgery, do you ask that surgeon to step aside and operate on your grandson yourself?

This was a dilemma that a colleague of mine encountered several years ago. At this moment of crisis, he faced the choice that physicians face all the time: Do you give medical care to your family members or leave it up to other doctors?

Not wanting to put Joey’s life into another surgeon’s hands, Dr. Sanders decided to operate on his grandson himself.

Joey died several hours later in the operating room.

A 1991 study published in the New England Journal of Medicine found that 99% of the 465 physicians surveyed received requests from family members for medical advice, diagnosis and treatment. Eighty-three percent prescribed medications for a family member, 80% diagnosed medical illnesses, 72% performed physical examinations, 15% acted as a family member’s primary doctor, and 9% performed surgery on a family member.

Bottom line: physicians often treat family members. But does that make it right?

Not according to most physicians and physician associations. The American Medical Association’s Code of Medical Ethics: Opinion 8.19 states that “physicians generally should not treat themselves or members of their immediate families.” The American College of Physicians Ethics Manual states that “physicians should avoid treating themselves, close friends, or members of their own family.” William Beaumont Hospital, where I operate and act as associate professor of surgery, forbids surgeons from operating on family members.

As physicians, we are taught to hold the doctor–patient relationship sacred and to keep a proper professional boundary between us and our patients. In this way, we can prevent emotions from clouding medical judgment.

Obviously, emotions play a role when it comes to family. I react very differently when one of my children gets hurt than I do when I see an injured patient in my office. I can easily fall into my nervous “Daddy” mode and step out of my confident “Doctor” mode.

In an extreme case such as Dr. Sanders and his grandson, any less-than-acceptable medical outcome can do more than strain the doctor-patient relationship. It can tear a family apart.

Yet, so many physicians - including plastic surgeons - insist on treating family members. I know of many male plastic surgeons who have performed breast augmentations, tummy tucks, and facelifts on their wives. I suspect there are several reasons for this.

First, as surgeons, we are supremely confident in our training and skills and worry that another surgeon might not do as good a job as we would. Second, performing the surgery ourselves can save a lot of money. Third, and most disturbing, some plastic surgeons use their spouses as living billboards for their work. To them, there is no better advertisement than showing off their fifty-year-old spouse who now kind of resembles Pam Anderson.

Yuck.

Full disclosure: Other than removing a mole or two, I’ve never operated on my wife and I never will. I consider myself a highly skilled surgeon, I’ve been known to be a teeny bit frugal, and I’ve purchased advertising for my practice in the past.

However, the potential risk of a devastating situation like Dr. Sanders’ is reason enough for me to avoid performing surgery on my wife. Well, this and one other major factor - I have no desire to see her insides.

I’ll leave that to another doctor.


soundoff (99 Responses)
  1. c s

    Probably the most important reason not to treat your spouse: you really need the insight about how much it really cost to be a patient. Most doctors have almost no sense of the cost of their treatment. Only when they are the receiving end of the bills do they begin to understand what their patients have to pay after treatment. Doctors are the most part totally isolated from the cost of their services. Patients have to have medical insurance and sign a contract to pay the bills regardless of what their insurance does or does not cover.

    January 9, 2012 at 11:40 | Report abuse | Reply
    • EEE

      Actually, one of the main reasons their prices are so high is because they have to be able to afford medical malpractice insurance. It costs a lot of money, and doctors have to ensure that they aren't going to be sued for millions of dollars because of an ignorant patient.

      January 9, 2012 at 14:16 | Report abuse |
    • slice of the pie?

      At the same time, physicians do not receive very much of what patients pay. It's absolutely correct that physicians aren't aware of their patients' bills because the financial personnel handle billing and sort out all the costs from what's left over to make payroll.

      January 9, 2012 at 14:22 | Report abuse |
    • StellarRat

      Not true. Studies have shown that insurance and legal costs only add about 5 – 6% to the overall cost of medical care. We need to look at the whole system and figure why it costs so much even in comparison to other Western countries that have as good or better patient outcomes.

      January 9, 2012 at 16:04 | Report abuse |
    • Dr Otheym

      Insurance and Administrative costs run to 30% of the cost. Insurance companies pay at most 60% of charges. Medicaid and Medicare only pay 30% of charges. Malpractice insurance boosts costs even higher. Doctors don't collect anywhere near their gross charges are.

      January 9, 2012 at 17:03 | Report abuse |
    • Sarah Harper

      In most countries in Europe issues around treatments are decided on the basis of whether they are medically necessary. Money doesn't come into it. That's because we are decent and civilised people. Deciding whether to treat someone on the basis of cost is shocking and one of the many reasons why we think of Americans as immoral . Gun laws are another example.

      April 21, 2019 at 14:46 | Report abuse |
    • rational doc

      A nice reasoned set of arguments that overlook a couple of issues.
      You are talking about surgery in many cases or other serious conditions. I do routine exams. There many interesting and complex issues that can arise, but usually don't. All my family members have pretty healthy eyes, so the exams are routine. If a surgery or complex consult is required, I would refer out.
      Second, you are in a high density population area. What about a rural doctor, say in the far reaches of Montana or Alaska. Similarly, not all doctors are in the US. If you are living in Somalia and your wife develops appendicitis at your rural charity clinic, you may have different criteria. Nice article none the less.

      May 27, 2019 at 01:28 | Report abuse |
  2. MGOBLUE

    I have to disagree with your comment. In this day and age of cutbacks in every aspect of healthcare, most doctors are very aware of the cost to patients. I speak from personal experience as a physician. We know the cost of the procedure, the anesthetic, the prep, etc because it is in our best interests to know. The days of blindly doing things and letting insurance figure it out are over.

    January 9, 2012 at 12:10 | Report abuse | Reply
    • Laura

      As a patient, I agree with this comment. Even though I have insurance, every visit with my doctor has a "how much does this cost" discussion, and I don't approve the procedure until I have a firm cost.
      And I generally turn down treatment because I can't afford it, even though I have been diagnosed with "likely MS" – I can't afford the tests to confirm. And this is even though I have insurance. Only in America do we pay three times, first in over-priced insurance, then in taxes, and finally out-of-pocket.
      Only in America can you go in for a 2-day hospital stay, WITH insurance, and walk out with a $30,000 bill.

      January 9, 2012 at 12:39 | Report abuse |
    • c s

      I respectively disagree. My son went to a doctor and was told that a procedure would cost X dollars. When he received the bill, it was much more. So my son had to pay the higher amount. He complained to the doctor but was told to pay the bill. I am sure that this a very common experience. If you are a doctor, the next time you see a patient ask the patient if the cost was higher than expected. I understand that doctors should be concerned with treatment but handling the payment of the service also affects a patient's health. Over 2/3 of bankruptcies in this country is because of the cost of medical treatment. In this issue of CNN is an article about a couple who fell from the middle class partly due to medical crisis. Their names are Alan and Andono Bryant and she had a $47,000 medical crisis. Our medical system has a severe medical problem and only doctors have the power to fix it. Patients have to accept what happens to them.

      January 9, 2012 at 14:32 | Report abuse |
    • StellarRat

      Some doctors have no idea how much things cost even in their own business. Our system is totally messed up.

      January 9, 2012 at 16:06 | Report abuse |
  3. Katie

    "Apart from removing a mole or two" – excuse me, that IS treating your wife as your family. I suspect this was done for the sake of convenience – why send her to someone who will see her for a get-to-know-you appointment so she can then come back and have the thing removed and possibly have to come back for a little check up on it – when you can just remove it yourself? Save time and hassle, money and paperwork. No harm, no foul. How about giving other people the same treatment – no you say? Other people have to set aside three different days for appointments?

    January 9, 2012 at 12:25 | Report abuse | Reply
    • Laura

      Hahahaha! So true....

      January 9, 2012 at 12:40 | Report abuse |
    • Christine

      So he should treat everyone for free?
      I am pretty sure my mechanic takes care of his own car on the weekend, why doesn't he take care of mine on Sunday morning, for free? And the lady who prepares my taxes, why can't she do mine for free like she does hers, after hours? And the teacher who mentors his own kids for free? Or the babysitter who takes care of her own kids for free?
      If you want free treatment, become or marry a physician. If you want free car maintenance, become or marry a car mechanic. We all get free stuff from family, that is what family is for. We all pay for everything else.

      January 9, 2012 at 14:15 | Report abuse |
  4. Yinka

    But you drive your child to school, don't you? And there could be an accident and something bad could happen. I am not so sure there is a logical, non-sentimental rationale to this argument

    January 9, 2012 at 12:29 | Report abuse | Reply
  5. portland tony

    For superficial bruises, aches and pains, maybe even setting a broken limb. For minor surgery probably yes. For major invasive or ER work no. But then again if your dad is the world's top brain surgeon, why settle for number 2?

    January 9, 2012 at 12:51 | Report abuse | Reply
  6. Yinka

    Portland Tony, well put!

    January 9, 2012 at 12:54 | Report abuse | Reply
  7. Joel

    The ethical conundrums about treating your relatives are new. Decades ago, unless you were a psychiatrist you wouldn't give it a second thought. The ideal was to be close to your patient, not to develop so much distance. Even today, retired physicians often keep a limited medical license to treat their family members.

    The idea that a physician should have distance from his patients is a mistake. And you know it every time a patient asks you, "what would you do if I were your mother?" Please, treat your family. And then try to treat your other patients that way too.

    January 9, 2012 at 13:03 | Report abuse | Reply
    • distance is required

      I disagree. A great deal of illness is caused by poor behavioral choices. Patients need someone with enough distance (immune to emotional blackmailing of doctor by patient) to tell the patient how it is, why it's that way and what they need to do to fix it. If the patient chooses not to comply, the doctor won't take it personally. Doctors can't force patients to listen or comply so they should maintain the emotional distance to not be upset when patients do stupid things. Patients frequently do stupid things including pressuring doctors for opiates when they are just addicted. Family members fall for that, doctors shouldn't.

      January 9, 2012 at 14:30 | Report abuse |
    • Matt

      I think doctors have a pretty good ability to keep an emotional distance. If they can deal with drug-seekers and other manipulators, they can deal with well-meaning but confused family members.

      January 9, 2012 at 16:21 | Report abuse |
    • bloopy

      hi

      May 24, 2016 at 13:56 | Report abuse |
  8. Cheryl Carter

    There was a bill passed in Congress, believe it or not, that doctors could not charge more than what the insurance would pay if they accepted the co-pay from you. It is illegal for them to charge additional charges. It the doctor says they will not treat you unless you agree to pay the additional expenses be sure that you write on the agreement that you are signing under duress and threat of refusal to treat. A doctor can not refuse to treat because you can not pay the bill it is illegal.

    January 9, 2012 at 13:13 | Report abuse | Reply
    • portland tony

      HA.....See you in bankruptcy court!

      January 9, 2012 at 13:38 | Report abuse |
    • insurance paradigm of care

      Unless a person is dying, physicians can absolutely refuse to treat. Insurance companies are in business to make money so they low-ball practices to reimburse for as little money as possible and therefore insurance companies make as much as possible. When the profit margin (read: ability to pay building rent, payroll and benefits for staff) is reduced to next to nothing, practices simply go out of business and now the community has fewer physicians to treat the citizens. Cheryl, your money is being sucked up by insurance companies in the form of "medical insurance" for you and "malpractice insurance" all physicians have to pay because people treat their doctor like a lottery ticket. Don't fight your doctor, fight the insurance paradigm of health care that's bleeding our nation out. Pay your provider, not an insurance company.

      January 9, 2012 at 14:36 | Report abuse |
    • Nathan

      Cheryl,
      I understand things differently. A doctor is not allowed to bill a self-pay patient less than an insured patient would be billed. Bililng has to be consistent from patient to patient, so one price is set, but the price is set knowing that various insurance companies will only pay a small percentage (different for each insurance company, mind you, so the law as you described doesn't make sense). The effect is that we know more money is being paid to the physician from self-pay patients than insured patients (and it's often collected up front as many practices can't consistently afford self pay IOUs). The law was written in favor of insurance companies. They are worried doctors will try billing a patient with "different insurance" less, giving others preferential treatment.
      If there is recent legislation, I'm unaware. Please inform.

      January 9, 2012 at 16:01 | Report abuse |
    • Honest, hard-working physician

      That is NOT the law. There are situations where you must be notified (via an Advance Beneficiary Notice, aka ABN) if a service is not covered and you will be fully liable for the cost. You can't balance bill Medicare patients for more than the Medicare rate. There are restrictions that you may agree to as a condition to becoming a participant in a plan, e.g., BC/BS participants typically agree not to balance bill beyond the BC/BS fee schedule. There is certainly no federal law that does what you describe.

      January 9, 2012 at 16:14 | Report abuse |
    • Doc

      I don't make patients pay more than what insurance pays. I don't have them sign a contract. I really have no say in what I charge, as I am an employed physician (I work for a large group of academic physicians) and some administrator in our group negotiates the rates for different services with each insurance company usually as a factor of medicare payment. Ie, 1.3 times medicare, or 1.5 times medicare etc. Medicare typically pays only 20-30 cents per dollar billed.

      Remember, most of the costs to the patient for an inpatient hospital stay are the Hospital bills, which have nothing to do with the physician. I might perform a long complex brain surgery fixing your aneurysm that takes me 8 hours. I bill based on a pre-set value for that type of surgery based on RVUs (Relative Value Units) that every procedure has. So in this case, the RVU's might be 100, where a typical office visit might be 1-3 RVUs. That might be $3800 (about $38.00 per RVU). Now, this payment is divided into three parts... one is the work RVU (wRVU) which is to reflect payment for the doctor's time and difficulty of the task. The other two parts are supposed to cover the doctor's overhead (office space, payroll of his employees, etc ,as well as the malpractice insurance). As a result, the wRVUs for that procedure might be around 50. At $38.00 per RVU from medicare, I would collect about $1900 for that procedure that would theoretically go towards my salary. Now for that same patient, their total hospital bill including costs for all doctors and services might be along the lines of $50,000-$75,000. I'd only be getting $1900 of that. Are you starting to see that the doctors are not really the problem when it comes to the high cost of medical care? My practice would be getting about between 5%-7.5% of the total cost of the hospital stay, and I'd personally (theoretically) be getting about 2.5%-3.8% of the total amount owed for the procedure and hospital stay.

      Also, RVUs don't necessarily reflect time spent. I could spend 8 hours in clinic seeing 30 patients and bill only about 30 RVUs if they were all short visits with limited problems. Or I could spend 8 hours operating on an aneurysm and bill 100 RVUs for that time. The RVU's go up not only based on the time it takes to do the task, but also based on the perceived difficulty/effort involved as well including risk etc. Additionally, that one time operative fee also includes ALL of the inpatient follow-up with the doctor, as well as all of the office visits for the next 3 months. If you come in for a post-op check to the office 1 month after surgery, the doctor cannot bill for that visit.

      And, time for my original reason for replying.

      Yes, a doctor can refuse to treat you. As long as you are not suffering from an emergency, a doctor can refuse to treat you if you do not provide payment. Now, he may have made a deal with your insurance company, that he will treat all of X insurance company's patients and collect only what they provide regardless of what he bills. Then he would not be able to refuse you because you wouldn't pay the extra amount he charged on top of the negotiated rate with X insurance company. He could refuse to treat you for other reasons (difficult patient-doctor relationship, patient is drug seeking, personality conflict etc). But he would have to provide you with information of another doctor who would be able to handle your problem, so that you could schedule yourself an appointment with that other doctor. A doctor is not allowed to "abandon" a patient. But he can replace himself with another doctor. If it is a non-emergent situation, he can expect you to do the legwork and make the phone calls to have that happen if he provides a list of names and numbers etc. If it is an emergent situation, the doctor would be obligated to find someone else to treat you immediately if there was some reason he could not or would not provide the treatment.

      January 9, 2012 at 17:45 | Report abuse |
    • KJC

      It is true that they cannot "balance bill" a patient. This is because doctors sign a contract with each insurance company agreeing to what the member of that insurance company will pay for various services. If they agree that the member will pay $100 for a particular type of exam, they are probably "billing" more than that. So they may bill $200, but at most, they have legally agreed to collect $100. So maybe the insurance company pays $80 and the member pays $20. But they cannot then turn around and demand the additional difference from what they billed. Physicians know well in advance what rates they have agreed to pay versus what they plan to bill.

      January 10, 2012 at 13:14 | Report abuse |
  9. ondeck

    So right about out of control health care. My husband wrecked his motorcycle. He was really just scraped up not seriously hurt but was hospitalized over night. With Blue Cross Blue Shield insurance and our auto insurance, we are still making monthly payments a year later – after having already done $4000. out of pocket. YES I SAID WITH INSURANCE – 2 KINDS
    healthcare is out of comtrol. Really hope nothing serious ever happens or we're screwed.

    January 9, 2012 at 15:27 | Report abuse | Reply
    • KJC

      Most people have NO IDEA that a typical one-night stay in a hospital ranges $1500 – $9000, depending on the intensity of the care and the contract the hospital negotiated with the insurance company. And the hospital probably bills twice that much, but the insurance company has negotiated a better rate for their members. And this is just for a regular night's stay. Now imagine if you have some type of surgery in which the hospital "specializes." You may be paying $50,000 for a cardiac surgery with a two day stay....yikes!

      January 10, 2012 at 13:17 | Report abuse |
  10. drew

    It is also well known in the legal field.....he who represents himself, had a fool for a lawyer....lol

    January 9, 2012 at 16:18 | Report abuse | Reply
  11. Matt

    If your doctor wouldn't want to treat his own relative, find out what doctor he would suggest instead... and go to her!

    January 9, 2012 at 16:22 | Report abuse | Reply
  12. Dr.J

    All treatments are not the same. As a physician, yes I treat my family for minor illnesses or injuries. But something that has long term effects, it is unethical to treat without objectivity-whether it be a family member, friend, or colleague. Reimbursement issues are not what the article was about.

    January 9, 2012 at 22:23 | Report abuse | Reply
    • KJC

      I agree. I don't think it's a big deal for a doctor to diagnose their child with the flu and prescribe a cough syrup, rather than pay to go a clinic. That seems a bit silly. But I would consider it unethical for them to perform a major surgery. Totally different.

      January 10, 2012 at 13:20 | Report abuse |
  13. dr dude

    I can understand not treating major issues, but my wife and I are so busy running a clinic neither one of us can afford to take the three hours off that it takes to get in and out of a Dr's. office. I dont prescribe controlled substances to family but have no problem with orher minor things. The issue is having good judgment. Only 20 percent of american physicians belong to the AMA. It became a political creature a long time ago that no longer represents us. We no longer accept anything the AMA says including their policy to ban handguns and boxing.

    January 10, 2012 at 09:26 | Report abuse | Reply
  14. grist

    The main reason why physicians should not treat our familyis that our judgement is very poor when trying to our family. Even worse when trying to treat oneself. A physician who treats himself, has a fool as a patient.

    January 10, 2012 at 09:37 | Report abuse | Reply
  15. Steven Bulcroft

    Yea, but what about when a physician's wife is being treated by another doc and then dies because of mistakes this other doc made and you know you could have done better? It's quite a dilemma as in rural areas there are not enough MD's and finding qualified highly skilled ones in these areas is tough and your a doc who is highly skills> what do you do? Let someone you don't think is that good take care of your wife when you are better qualified? Not an easy decision either way and there are possible negative consequences with both decisions.

    January 10, 2012 at 10:15 | Report abuse | Reply
  16. Mel

    I found this article because I am a future medical student and I would love to sit in on my father's surgery but I am thinking I should sit it out.

    I trust the surgeon immensely and she has taught me so much but I just worry about my father. Plus, the procedure itself is interesting and the perfect educational opportunity. I worry emotions might cloud my ability to focus on the procedure and view my father as any other patient I would encounter.

    Thanks for writing this post!

    January 24, 2012 at 14:22 | Report abuse | Reply
  17. Dolly

    'I know an aged person. He has  so many physical problems but he is not a rich man. Some times it is very difficult for him to arrange money for  treatment.  He has a nephew who is a dentist. Now I understand why he doesn't go to his nephew for treatment.'

    April 23, 2012 at 08:03 | Report abuse | Reply
  18. Dolly

    'I know an aged person. He has so many physical problems but he is not a rich man. Some times it is very difficult for him to arrange money for treatment. He has a nephew who is a dentist. Now I understand why he doesn't go to his nephew for treatment.

    April 23, 2012 at 08:07 | Report abuse | Reply
  19. Federico

    Woah! I'm really loving the template/theme of this blog. It's simple,
    yet effective. A lot of times it's difficult to get that "perfect balance" between user friendliness and visual appeal. I must say you've done a awesome job
    with this. Also, the blog loads extremely fast for me on Chrome.
    Exceptional Blog!

    November 18, 2012 at 05:24 | Report abuse | Reply
  20. Angel

    I respect your views. I particularly treat every patient as my family member, with the care, love, compassion, I would give to my immediate family member, my own parent, my own brother or sister or child. There have been times as an anesthesiologist, I have fought with the surgeon who is clearly doing some ethical behavior to protect my patient.

    I have learnt over years withy regular meditation practice to control my emotions. My wife has put it in her advance directives and living will that I be her anesthesiologist for all her surgeries as needed.

    I know she trusts me and I trust myself.. I don't see what's wrong with that..

    October 23, 2015 at 19:42 | Report abuse | Reply
  21. poopyassrat

    Do you have a daughter? Cuz im comin for her! <3

    May 24, 2016 at 14:05 | Report abuse | Reply
  22. Shonta Minugh

    structured water

    http://www.ggNrRfBMCD.com/ggNrRfBMCD

    October 2, 2016 at 11:00 | Report abuse | Reply
  23. Daya

    My second cousin is a PA, but I don't think family members of any stripe should treat other family members. She'd probably have the necessary boundary between her and my mother because they're not blood and don't know each other that well, but since she's my favorite cousin, it's better to leave off.

    January 23, 2017 at 22:14 | Report abuse | Reply
  24. vinay

    wt is the process of not treating our family members called....

    February 2, 2018 at 13:13 | Report abuse | Reply
  25. Les Jarvis

    I must say you have done a great job.Also if you want to find the best doctors near me in NJ then visit https://bit.ly/2OX4Lsu

    January 3, 2019 at 01:17 | Report abuse | Reply
  26. reidkevin1686@gmail.com

    thanks for sharing this blog.its simple but effective.. for availing different medical web services visit https://bit.ly/2KtFsfF

    January 11, 2019 at 03:01 | Report abuse | Reply
  27. raberba

    I think for major surgery, it is better to have a non-related doctor perform it, especially if it is their field of expertise. As the author pointed out, the most fundamental reason is the consequences if the procedure goes wrong and it is directly the doctor's responsibility. I can't imagine the potential level of guilt and grief the doctor may feel. Even more, what kind of strain and adverse effects would that place on their other familial relationships? I particularly like the idea, of "who do you go to, if you didn't treat yourself?" It's kind of like where would a restaurateur go for lunch, if they didn't want to eat at their own place.

    May 9, 2019 at 01:45 | Report abuse | Reply
  28. sergeyigorev

    Hello google

    October 5, 2019 at 08:09 | Report abuse | Reply
  29. Hanssen Tulia

    Great job! Do you outline all of your blog posts? I've read a few of them now and they are way higher quality than other blogs I've read.

    October 31, 2019 at 03:36 | Report abuse | Reply
  30. lindsay

    This spiritual helper restored my marriage few days ago, Thanks to robinson.buckler @ yahoo. com .....^*"*.

    ———————————————————————————

    November 9, 2020 at 15:17 | Report abuse | Reply
  31. WWW.XMC.pl

    Fantastic article ! You havemade some very astute statements and I appreciate the the effort you have put into your writing. Its clear that you know what you are writing about. I am excited to read more of your sites content.

    http://www.xmc.pl

    November 23, 2020 at 13:37 | Report abuse | Reply
  32. Tanowc

    Do our cells grow proportions as we grow

    Cells are each day would units that make up our body, So how are you affected to them when we grow do they get bigger? based on one expert who spends his days looking closely at cells, the answer then is generally no, occasionally the price yes.

    "There are exceptions to the rule as there is no one rule fits all in biology, Says Associate Professor Vincent Williams of Curtin university or in Perth.

    The dozens of cell types that make up our body range in shape and size from small doughnut shaped red blood cells that are just 8 micrometres across, To long skinny nerve cells that can grow to over one metre.

    by and large, We grow to our full adult size via an increase in the number not the size of our cells.

    But some of our cells can change size which is for healthy or not so healthy reasons.

    Fat and muscle cells can get bigger and shrinkFat cells can get repeatedly bigger whenever we put on weight, And muscle tissue expand when we bulk up at the gym.

    When we eat too much or do not get enough exercise, Our fat cells grow by storing more triglycerides and cholesterol in that person. When we drop a few pounds through diet or exercise, These fat cells greatly reduce again.

    Work out at the gym and muscle cells get bigger because they have to contain more machinery for producing energy especially mitochondria and glycogen fuel reserves.

    having said that, If you break a leg and end up lying in bed for six weeks then these same cells will shrink again.

    And it's not just our skeletal muscle cells that change size when a woman is pregnant the smooth muscle cells of her uterus get larger to guarantee the growing foetus is protected.

    Cells change with age and illnessThe cells of many organs change size and/or number through our life stages, As a result of bodily changes of ageing.

    After menopause the cells of a woman's uterus shrink to one third large those of a pre menopausal woman.

    But the prostate gland in ageing men enlarges because of an increase in the number of cells as hormone levels change.

    another gland the thymus, active in the childhood immune response is big at birth but almost disappears completely by the age of 16 as the cell numbers dwindle.

    Diseases or medical conditions that put an extra workload on our tissues and organs can cause cells to grow bigger in size. for example, A person who has plaque in their blood vessels will have larger cardiac muscle cells for much stronger pumping, providing them with an enlarged heart.

    And a person who loses the use of one kidney ends up with larger cells and a lot more them in the other kidney, to make up.

    Many cells also get bigger in size as they how to tell if a chinese girl likes you undergo repair following soreness and infection.

    And cancerous cells are usually considerably larger than their normal counterparts. This is as they are working hard dividing and proliferating uncontrollably.

    November 24, 2020 at 03:42 | Report abuse | Reply
  33. Yipbzy

    believe mannerisms articles created

    the significance of using nonverbal communication to draw young ladiesThis articles will explanation motive using truly can offer a few recommendations regarding import and to use your to create a suggestion how to purchase your wife region good and how. the strongest kind of connection creating is with an neuro-linguistic programming utilisation of the identified as moreover reflecting nonverbal communication. It is using the point of view that girls can also almost never disguise how they experience a man even though she doesn express it explicitly. learn take advantage of touch and body speaking skills with regards to the famous people and you peer beautiful instantly. to consider what type of gesture all women determine advisable that you simply simply must render to help use leader guys arouse to a female. useful body gestures will provide your company's social skill-sets and as well,as well as the smaller business an excellent turbocharge. currently, DBL development in many cases can monitor to the site sat nav with the person that by per take a look at together with incorporate this data straight into a customer relationship management model. If you take time to study the main body speaking skills you holds an unfounded advantage over the same several other affiliate marketers. using the vision on the way to manipulate young women is a primary system using leader guy mannerisms. when using little brown eyes that can seduce a woman the greatly important technique for using alpha dog male body gestures. defending 55% latamdate.com however communicating, Your nonverbal message can be your key to the kingdom or even fasten pertaining to your lonesome mind jail phone. how to use incredibly good nonverbal communication towards seduction with this short article. body gesture, if and when somewhat improved, aids one remain confidently coupled with pass along the others in absolutely ideal tactic. precisely why? this is usually a communication as well as lovely women tells you whether they realise it or otherwise. See how this can be used to your advantage to know what data he or she was posting you. to acquire more information, barely continue reading.

    November 24, 2020 at 11:26 | Report abuse | Reply
  34. plumbing contractors directory

    A person essentially help to make seriously posts I would state. This is the first time I frequented your website page and thus far? I amazed with the research you made to create this particular publish incredible. Excellent job!

    http://maps.google.gm/url?q=https://goo.gl/maps/AqAES3B1xiUBQdFZ18

    November 26, 2020 at 18:48 | Report abuse | Reply
  35. browse around this site electrician san diego

    I’ve been exploring for a little for any high-quality articles or blog posts on this kind of area . Exploring in Yahoo I at last stumbled upon this website. Reading this info So i am happy to convey that I've an incredibly good uncanny feeling I discovered exactly what I needed. I most certainly will make certain to do not forget this website and give it a glance on a constant basis.

    https://cse.google.li/url?q=https://rapid-electric.webnode.com/

    November 27, 2020 at 03:15 | Report abuse | Reply
  36. ed treatment tablets

    erectile dysfunction reviews
    solving erectile dysfunction without meds
    erectile bleeding

    November 27, 2020 at 07:46 | Report abuse | Reply
  37. Boscoihw

    do you own your misery

    work with this brief 18 a doubt on the website robotic questions that can assist you latamdate scam analyse if you might need to see a mind doctor to get examination since remedy for sadness, or administering their panic attack as well as vibe all the time.

    tutorials: you should pattern a climb outside or just presume via internet, making use of it weekly to trace your own feelings. It also might be familiar with show your medical professional how your implications get hold of swapped out in visit to another location. our degree not necessarily designed to generate a diagnosis of misery on the other hand take the place of a quality professional diagnosis.

    all of the signs and symptoms of melancholy can be found seen as a five (5) Or more of the following, by simply individuals constantly higher days than not at all over on the least a two week episode: loneliness perhaps despondency that is certainly prolonged, virtually no effort, a sense of hopelessness, horror stories about feasting (not enough or associated with), blunders regarding in bed (sufficient or increased), problems with concern potentially amount, damaged all affinity for programs which unfortunately sooner served a buyer satisfaction also known as enjoy using, a huge burden feelings about sense of guilt or possibly a wthlessness, on the other hand beliefs together with suicide passing of life.

    a sense hopelessness is usually by simply most people who depressive disorders the opinion which experts claim very adware and spyware can do determines his or her's outlook or perhaps a reactions. panic attack will be dangerous in how it takes away just-about a determination and / or energy levels to conditions, furthermore direct to the point such thinggs as showering to a stressed.

    learn more: depression Symptomscould appropriately prepared, in most cases most effectively achieved with a mixture of psychotherapy and even antidepressant meds. quite a few individuals determine to ditch treatment solution with being a simply just taken mao inhibitors from their medical doctor or doctor. for the other hand, This is by and large not suggested, mainly because antidepressant drugs on his own most likely is not an adequate amount of that well cope with clinical depression.

    lots of other methods for treatment options properly as. uncover more about these great options in our in-depth article about the advantages and disadvantages of every option with.

    find out more:

    existing with clinical depression

    It not easy for some to tolerate gloominess, that's why possibly becomes more of a lingering situation. our very own full look at managing this disorder can assist look into typically daytime techniques to be more successful in battling this affliction.

    find out more: completely take a look panic attack

    our psychiatric affiliation. (2013). analysis and then record guidebook of most thought complications (5th education.).

    November 28, 2020 at 08:14 | Report abuse | Reply
  38. plumbing services near me Read Full Report

    I’ve read some good stuff here. Definitely worth bookmarking for revisiting. I surprise how much effort you put to create such a fantastic informative web site.

    http://maps.google.com.mt/url?q=https://citysquares.com/b/ace-contractors-plumbing-heating-and-air-23140292

    November 28, 2020 at 11:17 | Report abuse | Reply
  39. discover here electrical contractor

    We're a group of volunteers and opening a new scheme in our community. Your site offered us with valuable information to work on. You've done an impressive job and our entire community will be thankful to you.

    https://google.com.ar/url?q=https://goo.gl/maps/AioN3ZGik36xSLob194

    November 29, 2020 at 13:39 | Report abuse | Reply
  40. Rory

    Hi there I am so excited I found your site, I really
    found you by error, while I was browsing on Bing for something else, Nonetheless I am here now and would just like to say thanks for a fantastic post and
    a all round interesting blog (I also love the theme/design),
    I don't have time to browse it all at the moment but I have book-marked it and also added in your RSS feeds, so when I
    have time I will be back to read more, Please
    do keep up the awesome job.

    Also visit my web site check out the post right here (https://www.suttonappliancerepair.com/)

    November 29, 2020 at 21:21 | Report abuse | Reply
  41. check my site electricians san diego

    Of course, what a splendid site and revealing posts, I surely will bookmark your website.Best Regards!

    https://google.com.vn/url?q=https://www.quora.com/profile/Rapid-Electric

    November 30, 2020 at 03:59 | Report abuse | Reply
  42. Inga

    кубань фото города

    November 30, 2020 at 20:03 | Report abuse | Reply
  43. Gabrielfet

    https://bit.ly/34GSPFv – Meet, be inspired, communicate and continue flirting! Follow the link

    https://bit.ly/2TBGPyA
    – Flirting in your city

    @@@==

    December 1, 2020 at 04:50 | Report abuse | Reply
  44. Robt

    The desire to be told how to play roulette and win the
    game might be in you when you have been informed of how you can win money instantly merely by following simple steps and guidelines.
    This article will outline the basics of how perform
    roulette and increase your website's traffic
    certain strategies and tips to your advantage.

    It is certainly recommended for amateurs that you try out free lpe88 apk free download options first.
    This way you will be efficient at learn things fast and clear.
    Then you can certainly can have a go at the sun's rays scene.
    Strategy will enable you to make proper decisions and discover the best odds.

    Finding an internet casino should together with a good comparison operation. This means knowing which slots games you want to playing, immediately after which it
    finding an internet casino that can meet wants you have.
    If you are unsure of the things you are doing, invest
    time to sign up and play at various casinos.

    Consumers to think that you a chance to see what each one offers.
    A person have play maybe once or twice you can have a better feel for the purpose you should and
    really doing, and where to spend in long term.

    Either you're rich or poor, there is no doubt how
    gambling was because one of the extremely popular regular past time in globe.
    It boosts our minds and helps us enjoy our time. Its one
    of the remedies that assists us to forget our problems, for a one or two hours or minutes.
    Now, the casino companies even extended their hands
    for the online their communities. The proposal of online gambling became
    successful as the people accepted it.

    Step 1, however, requires some planning because if you pick very
    best online slot games, may not have a memorable
    experience on online slots. You shouldn't.

    However, Semi Bluffing falls between normal betting and bluffing.
    A Semi buff is alike to a bluff, the only difference being that
    you still develop a winning end. So if someone calls your semi-bluff you may still pick out the last
    card to make a winning flush or right.

    Roulette was introduced by Blaise Pascal in the 17th century in France where
    this first completed. Today, the game known to one
    for the most popular European gambling progressive scan games ps2, with Monte
    Carlo in Monaco being a greatly known and famous casino centre for playing live.

    At very same time a person need to are studying about every one of these winners,
    there's always something good also see several sites
    declaring to see the winning method. Which 1 anyone choose?

    December 2, 2020 at 04:48 | Report abuse | Reply
  45. Ad7DeFTHZIxrpjNOyQ5

    3504 powell money hello 7957 z .

    December 11, 2020 at 14:27 | Report abuse | Reply
  46. detectives privados ronda

    detectives privados torrejón de ardoz

    https://www.argadetectives.com/detectives-en-sagunto-valencia.html

    December 11, 2020 at 23:18 | Report abuse | Reply
  47. Marquis

    Hello! Do you know if they make any plugins to assist with Search Engine Optimization? I'm trying to get my blog to
    rank for some targeted keywords but I'm not seeing very good
    success. If you know of any please share. Thanks!

    My web-site: bargainlcdscreendisplays.blogspot.com

    December 12, 2020 at 09:09 | Report abuse | Reply
  48. Melva

    You really make it appear really easy together with your presentation but I in finding this matter to be actually one thing which I believe I
    might by no means understand. It kind of feels too complicated and extremely vast for me.

    I am looking ahead to your subsequent put up, I will attempt to get the hold of it!

    My blog post; see here now

    December 13, 2020 at 15:24 | Report abuse | Reply
  49. Lisette

    Dazzle your guests, for some dollars more, at $11.12 each,
    with 'lucky palace casino in Love' playing card bottle corks.
    Individuals the energy that the theatre holds.
    What excited you about operate and kansas city lasik?

    December 15, 2020 at 06:45 | Report abuse | Reply
  50. Reynaldo

    Quality posts is the secret to invite the users to pay a quick visit the web page,
    that's what this website is providing.

    Have a look at my homepage :: Your Domain Name

    December 16, 2020 at 23:48 | Report abuse | Reply
1 2

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.