family practice issues and general life events

Archive for June, 2011

The Human Spirit

Sometimes as a doctor, you get to meet a patient that makes you just stop. And with this stop, you think how terrible to go through, and yet they still have a positive attitude. Many of these have suffered through disease processes and injuries that would crush a lesser person. This is not to say that they don’t suffer, that they don’t get depressed, only that they still try to be positive for the whole world to see.

At the same time, you also see the opposite a lot. patients who let the slightest thing push them down. Patients that work harder to get on disability than they would work on the average job. It is as if they are afraid of hard work. I am not saying that what I do in anyway compares to working on the farm,or digging ditches. Let’s be honest I spend my day in an air conditioned office, moving from room to room, occasionally doing a biopsy, occasionally popping a back, ordering shots and lab work, and prescribing medications. I work hard,but not physically.

Somewhere in life there is something that happens to put people on one pathway or the other. Is it there parents? At least partially, but that cannot account for everything, otherwise siblings would be identical in their work ethic. I cannot explain what happens to cause the entire difference between one who lifts you up, and the one who believe the world owes them something.

I get to see people in all stages of life, both good days and bad. it is those bad days in which you get to see what a person is truly like. Pain can make one miserable, but it is how you react on those days that indicate your true character. It is how you treat people, that reveals your soul.

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Pregnancy tests

Pregnancy tests are the most terrible things to have to discuss with a patient.  I know it seems odd, but all other diagnosis are either good or bad, or not such a big deal.  A pregnancy test on the other hand is life changing, and the results good or bad depend on the person whose test it is.

We have waited on tests hoping for the sake of the young girl that it is negative, hoping for positive results in a patient who has been trying to have a baby.  Hoping that they didn’t decrease in levels on a threatened miscarriage.

And then there are the cases you don’t know if it is a good thing or a bad thing.  Those that are in between, that may have been trying for a baby, or may not have been.  So you never know how to say the results.  Is a cheerful congratulations in order, or is a positive test not the desired result.

Almost the worst is the 16 year old girl who has come in with their parent after having 5 positive tests at home.  They are there hoping that I can tell them differently.  In fact, when told that based on their story, she is probably pregnant you almost always get the I was hoping you wouldn’t say that.  And with positive test results there are always tears.  Tears of joy, tears of regret, but almost always tears.

While babies are a wonderful thing, the positive pregnancy is the first life changing event in the bringing a new baby into the world.  Prior to that consequences are in the future.  However, with that test the future can no longer be denied.

Guitar lessons

I feel for my son who strives for perfection on the first attempt. He wants to play the guitar, but he is not the most coordinated of children. However, he likes math, and music seems like a natural fit, and sometimes he is able to.

However, as I sit here during his guitar lessons, he has become so frustrated because he is not perfect. And tht imperfection upsets him. I struggle to find a balance between him finding acceptance within himself, but not kill e strive for perfection. I think the desire for perfection up to a point is good. However when it becomes obsessive it biomes a problem.

However, by the middle of the lesson, he was actually starting to sound ok. We are not talking about Mozart here. (I don’t even know if you can play Mozart on a guitar). I think he is having fun. Unfortunately for him the line between fun and frustration is so slim, it is hard to tell.

We are also doing these lessons at the end of the day. Way pass the time we is at his best. though he seems interested in the fact he can make two notes sound the same and that he can tune his instrument through that.

Unfortunately his attention Span is so short it leads to frustration for both him and his teacher

Dinosaurs and other matters

Sometimes my children just amaze me.  I know all parents say that sometimes, but today my oldest just floored me.  While waiting for my youngest son’s Tae Kwon Do class, he was forcing us to play “Guess which Dinosaur I am!”  Those of you without children might wonder how can a 40 pound, 5 year old force you to play a game, well you have never met my son.  He is super persistent, and just sure that facebooking on my iPhone was not what was supposed to be going on.

Any way back to “guess the dinosaur” he was on all fours.  And since I was not paying attention, I guessed a dog.  (Like I said I was not paying that close of attention, and actually thought we were playing guess the animal).  Both boys turned to me and said, “No mommy, we are playing guess the dinosaur.”  To which Spencer added, “I am really big.”  So I guessed “Brontosaurus.”

Spencer said “No, mommy.”

“Brachiosaurus?”

“Your right mommy.”

“Mom, there is not a dinosaur called a brontosaur.  That was a mistake, they put a different dinosaurs head on the wrong body, so there is no such thing.” said Trevor, my oldest.

“Are you sure?  Who told you that?”

“My teacher, Ms. Julie.”

I don’t know about the rest of you, but I had never heard that before in my life.  And I LOVED the brontosaurus in my youth.  To learn that it never existed, well that is one more item to the list of facts from school, that were not only inaccurate.  I did look it up by the way.  He is correct.  Here is the link explaining the whole fallacy

http://www.unmuseum.org/dinobront.htm

Apparently even while they were teaching it to me in the 1980s, it was known to be incorrect since the early 20th century.  Though the head issue did not come to full light until a controversy was sparked by stamps issued by the US Postal Service in 1989.    Additionally, the lifestyle of the Apatosaur/Brontosaur  we were taught we completely wrong.  This is due to the putting the wrong head on the wrong body.  Until today I had never heard of this.  I learned it from my almost 8 year old son

Construction the hard way

Our local hospital is undergoing construction to remodel the ER to meet federal guidelines.  Simple enough concept in itself, and something you think would have involved some thought and planning.  This is not saying that there was not any thought on the part of the architect, but more thought on how to decrease the effect on actual patient care.

When I walked in the front doors, there were arrows on how to get to the ER which was on the completely other side of the building, and whose entrance was blocked. Sounds simply enough, but I saw arrows leading to the ER going in two different directions.  Both ways can lead you to the ER, but one goes through the doctors lounge, or as I discovered when I tried to eat my lunch there, what was formerly known as the doctors’ lounge.  In their defense, I got a memo the next day stating that the doctors’ lounge was now the ER walk through.

When administration was asked, why didn’t you put up construction tunnels to minimize the displacement of patients and inconvenience the remodeling would cause, the looks were that of amazement.  Apparently, that had never even crossed their minds.

In this case, you can almost imagine a bull dozer just showed up one day and  started knocking down entry ways and blocking doors.  It was apparently drive by construction.    I understand that there will always be inconveniences when there is construction, but seriously, some preplanning can decrease it dramatically

when did it become acceptable to lie?

As I write this, I know some may think it is in reference to the recent news, but it is not.  While that may have made it more apparent in my mind, I have noticed over the past few weeks, how many people have started to think that it is ok to lie, and when caught in that lie, tell another one to cover it up.

 

In my daily life and practice, it is important that my patients tell me the truth.  I need to know what medications they are on, what medical conditions that they have, and if they are seeing other doctors.  There is no other way around it.  If you tell me you are an alcoholic, who has no intention of giving up drinking, well I will try to get you to stop drinking, but will continue to care for you as I do for any other patient.

 

However, in the past two weeks, I have caught more new and established patients in lies, who then lie again to attempt to cover it up.  This makes it impossible to be their physician.  I had one patient, who claimed to not have seen a doctor in many years, but I had information that said otherwise.  When asked about it her story changed twice, and when I asked why she was lying to me, she responded that she didn’t want me to feel bad.  How is the fact that they went to another doctor before ever seeing me going to hurt my feelings?  The fact is with her body language and the ever changing story, I told the patient that this relationship was not going to work.  You cannot start any relationship with a lie, and expect it to be successful.

 

What my parents taught me to be wrong, is being used throughout society as ok.  If you do something wrong, don’t admit to it, lie and cover it up to see if you can get away with it.  Then if there is no way out, confess your sin and apologize and all will be forgiven.  What kind of message is that sending to our children.  The fact is that it is not acceptable to me to lie.  In fact, my children usually get in more trouble for the lie that they tell covering up there bad behavior than they often do for what they are attempting to cover up.

 

Today issues that probably are personal, and maybe should be dealt with behind closed doors, blow up because of these lies and cover ups.  How can we ever expect our children to grow up into moral individuals, when the examples out in the world are continuously changing their story to make themselves look better.

The start of a new day

Few things are more complicated in a primary care physicians office than a new patient visit.  No it is not brain surgery, but in the day to day, it causes more irritations than you might expect.  Well a brand new healthy baby, is fairly easy, as is the cough and cold, who has no real medical problems.  The problems arise from arise from the patient who has chronic medical problems, and it is not all their fault either.

 

In my office, we became record keepers for a physician who left town.  It seemed like a simple enough thing to do,when we agreed to it.  Since we have their records, many of her patients followed.  Easy right?  Wrong.  First we are working with two entirely different systems, and while the government has the idea that one day all of these systems will talk to one another we are probably 5 years from that with the most ideal systems.  And our system seems to be light years ahead of the other system

 

Since we have this other set of records, the new patients are grumbling about having to fill out new patient paperwork, and say that they didn’t bring their medication lists because they thought we had their records, or they may know what medication they are on, but not the dosages.  All of these lead to frustrations and complications as we try to establish a new relationship.

 

You might ask, well if we have the records why not just look at the old charts?  While that is an excellent idea, we found that all of the patient’s medications they have ever taken are in that chart, and all of the dosages, and the dates, well they are difficult to find and match up.  So we call the pharmacies, and they have become our nurses’ best friends.  They have the closest list, except if the patient filled somewhere else, or got samples, etc.

 

However, there are good things about new patient visits.  The medications are viewed with fresh eyes.  Sometimes physicians get tunnel vision, and with perfectly good intentions, the patient ends up with 20 different medications.  And some of those medications are for the treatment of side effects of other medications.  I would like to say that I had never done that, but I know that is a lie, and I do have some integrity.  But the new physician, can question, “Why are you one this medication?”  “Do you feel like this medication is working for you, or can we try to decrease it?”  And with those questions you get smiles.  And it is a whole new beginning, and maybe this will be their new home.

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