family practice issues and general life events

Archive for October, 2011

Busy days ahead…

Here it is the end of October- and I find myself, well not overwhelmed, but close.  Flu season has yet to begin, and yesterday, I saw 36 people.  Now some of it is caused by the fact that next week I am going to be in Orlando at the AOA convention for both CME and to give a speech.  A bit nerve racking really, that people would want to listen to something that I would have to say.  I am not a born speaker, and I have not discovered any great treatment for diabetes, hypertension or cancer.  Instead I just happened to with my husband receive the first electronic medical record incentive in the country.  Funny thing is that a year ago when we started the process to apply for the bonus, we didn’t actually believe that the Centers for Medicare and Medicaid services would actually follow through with their proposal.

So now next week, instead of seeing patients, I am speaking, obtaining CME hours, networking, connecting/reconnecting with friends and colleagues, going to Mickey’s Not So Scary Halloween, and who knows what else.  However, that talk remains in the back of my mind.  It has been there for about 5 months.  Since I first agreed to do it.  I have made two or three power point presentations, not happy with any of them- the basic knowledge is there, but I have a tremendous fear of being that boring monotone professor that no one wants to listen to.  That is probably why I can’t sleep, well tonight anyway.  But it is almost morning now- so I don’t plan on trying until after my day is done tonight.

It is funny how for the past several months, it has been there.  But it wasn’t until the first of this month that the talk hit me.  It was this month.  They want us to help to inspire other doctors, that the check is real.  And how we went about obtaining it.  Which I can tell, I was there.  I have the big check in my office to prove it.  But it seems funny all the same.  So the next two days at work will fly by.  Trying to get all of the routine appointments in before we leave town.  And then Saturday, the drive to DFW and the flight to Orlando.

Funny how public speaking can make some of us frightened out of our wits.  I am sure that they won’t tar and feather us- or at least I hope they won’t.  Though if they do- at least it is Halloween and I can pretend that it is my Halloween costume.  I could be a huge bird.  Sorry my attempt at bad humor.

It is however, important that I do this, mostly for my children.  So they can see the importance of presenting yourself calm and confident.  They need to see that despite fears, we can present a public appearance of knowledge and no how.  Maybe it will help them the following week at their science fair.  Maybe they will see everything that they can be, or what they can do if they have the desire to do so.  And maybe, I can give hope to other physicians who have no idea if they can even achieve what the government has decided is meaningful use.  Though I don’t know if they will all get a YouTube video of themselves produced by CMS

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The Power of Positive Thinking

I know it is cliche, but there really is something to thinking positively.  That point hit me in the face yesterday- though in reality I notice it most days.  People who dwell on the bad, tend to appear to have more chronic problems, while those that say life is good, seem to be healthier.  Or at least they seem to deal with even chronic illness better.  That is not to say that everyone is not entitled to having bad days, but if every day is “the worst day of your life”  well people are not going to want to be around you.  And that will include those that have to, family, physicians, etc.

 

I have patients, that literally spend their entire visits complaining about every aspect of their lives.  That is fine, it is my job to at least listen.  But those visits are exhausting, and if it is an every visit event, after a while, I will start to dread their visits.  Sorry but I am human.  This is not just someone who complains about their aches and pains, but their sons and daughters, who have moved away, and everything in life is against them.  That is how they view the world.  That it is against them, and that they don’t have this or that.  They focus on the don’t haves.  How exhausting it must be to go through life focusing on what you don’t have.

 

The other side at least attempts to find some good.  It may not always be easy- trust me once you tell a patient about their cancer, nothing else that visit matters.  But usually if they are a generally positive person they will undergo treatment a little easier.

 

Looking through the internet, trying to find out what is wrong with you, while their may be some legitimate cause to do so, focusing on diagnosis that you may or may not have, not only hurts your emotional well being, but it also will eventually hurt you physically.  Not to sound like a pharmaceutical commercial but depression does hurt.  Usually leads people to the doctor for pain, not depression.  Rarely does anyone come in and say “I’m depressed.”  Sometimes a spouse will drag them in saying that they are depressed, but usually the presenting complaint is “I’m tired.” “I hurt” “I have no interest in anything, anymore.”  It is true that pain can lead to depression, but it is also true that depression can lead to pain.

 

Life needs to be something to savior, to experience, not something to dread.  If you aren’t happy where you are in life, figure out what you should do to fix it.  No one will do it for you.  While I hesitate to tell anyone to leave their job today, remember that if you are looking for a new path in life, it is you who must sell yourself.  Anyone hiring for jobs that require customer service, don’t want to hire the negative person with all the qualifications.  Though if you do hate your job, find something outside of it that is your calling that gives you joy.  There is not a pill for happiness, it has to come from within.  Find out what it takes to be the best you that you can be.  It doesn’t have to take much, baby steps will go a long way.  And see if with time you start feeling better, start having better health.  While it will not take care of everything, having a positive outlook will go a long way towards better health and prosperity.

It is the little things that matter

It is too easy in medicine to overlook the simple things. Or what you think is not that big of a deal. With the never ending media around you at all times, it is hard to escape people talking about how doctors are greedy, people committing fraud, new rules and regulations, potential cuts of 29.4% from Medicare. It is easy to forget why one might have gone into medicine. And not the joke reason I told people the summer before medical school started as to why I was going to medical school either. I didn’t really go to medical school so that I could marry a doctor. I was just really annoyed by what seemed a ridiculous question at the time. (though that proved to be a self-fulfilling prophesy as well)

But really is it a ridiculous question? It is not about the money, and those that tell you it is, well there are easier ways to make a lot of money or to make a comfortable living, and I would not have gone over $150,000 in debt to do. Most of us go into medicine at least on some level with the desire to help people. Sure there are those that might have gone into it for the prestige or some other less noble reason, but for most at the core, it was probably the desire to help people. However, for those of you applying to medical school, everyone says some variation of that answer, so you might wish to find a more eloquent way to do so.

However, in the hustle and bustle of a medical practice it is easy to forget why. Even though that very reason is sitting in front of you wanting some reassurance, wanting answers, wanting, well some not knowing what they want, only that something is not quite right. And sometimes all they want is the what or a name for whatever is ailing them. And sometimes they want more than you can give them, answers you don’t know, or if you find them for them you have to send them to a specialist. And sometimes they come back from that specialist with a smile and a thank you, and sometimes with tears.

As a family practice doctor, I get to tell all kinds of news from pregnancy (which is hard to decide whether it is good or bad the day you are telling them) to cancer (which I really hate) to maybe they are being overmedicated and some of their side effects are due to medication that they are on. So why don’t we stop some medications, those are one of my favorites. But I get to share with them in everything. They still come back to me after they are told they need back surgery for my opinion. Sometimes I wonder why (on really bad days) but mostly it is flattering. Or sometimes, I find them a second opinion from another specialist especially on a major procedure.

I get to be silly with kids who are frightened because they don’t want a shot, and get to see the relief in a parent’s eyes when their sick kid starts feeling better. My day is filled with highs and lows, and my attention is constantly stimulated, which really helps my ADD more than any medication could. And most of the time I am just an ear, especially with my older patients. There are visits, I have no idea why I saw the patient when I leave the room, other than maybe they are lonely, and that is ok too.

Medicine is a calling where people let you into their most intimate moments, though sometimes drag you in would be the more appropriate way to describe it. IT is an honor to be there for them, even when giving them the bad news. And as computers continue to enter/invade the field of medicine, there is something to be said about the human touch, the compassion that a machine just cannot give.

Judgement calls

Sometimes the correct answer is a judgement call.  Whether or not to take off a cast, whether or not to admit to a hospital.  There are more, but I am not going to name them all.  That is why practicing medicine is sometimes called the art of medicine.  Attempts to streamline or make it into a cookbook system of 1,2,3 will fail because human beings are well human.

 

People will point to statistics that having basic routine orders for pneumonia, COPD, acute MI have led to better outcomes overall, and while I do not disagree with that (makes it easy to not overlook the simple things) when was the last time you saw two patients with diabetes who were exactly the same.  Heck, it is common knowledge in medicine that different races react differently to the various blood pressure medications.  Is it racist to make your determinations of which medication to start with at least partially on one’s race?  No it is just good medicine.

 

There are quality control measures that do improve outcomes if you attempt to follow them, but there are also times that the variables should be allowed and are in fact required.  A patient who comes in for a cast check, and their x-ray shows healing, well then it is a judgement call as to whether the healing is enough to take it off.  A kid who is rough and tumble, you might decide leaving it on longer would be better, another patient who suffers from psoariasis who states that it is itching badly.  Well you might want to take off that cast and take a closer look.  Skin breakdown may require you to take off a cast earlier than you would have like.  All of these are judgement calls.  Which is correct, well both, but a different choice on the first might not result in significant consequences.

 

Judgements are made everyday in medicine.  People don’t even present for the same disease with the same symptoms.  As several of my mentors told me while in school, “They don’t read the textbook.”  And those that come in with all of the said symptoms like they did read the text book, well they are either a gift.  (Or sometimes not, sometimes they are just people who spent too much time on the internet)

 

The age of computers in medicine is great.  There are many ways they can help.  I find it most helpful in the case of drug interactions and drugs in certain disease states.  But as of yet, they don’t replace the actual human contact and the senses of the physician.  And I use four of my five senses routinely on a patient.  (Don’t remember ever using taste, glad we no longer live in an age where tasting the urine to check for sugar is necessary)  Touch, smell, hearing and sight.  People need that.  I refuse to diagnose over the telephone.  Rashes are rarely accurately described.  As cameras on computers get more definition, sight over distances may improve, but removing the other elements from the exam will not lead to better patient care.  It will remove the necessary human contact to understand what is going on.  A practice of medicine with less human contact and more automation?  Doubtful it will improve outcomes, and least in the near future

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