family practice issues and general life events

Posts tagged ‘medicine’

Attitude is everything

Or my self serving whiny post, which does nothing, teaches nothing, and is merely in existence for no other reason than it makes me feel better.

Sometimes I have days like today. Where when I walk into the room, and ask the patient how they are doing, and today is the worst day of their life. If it is one or two, well that is well not ok, but feasible, because at some point you will have the worst day of your life. This morning however, it seemed like it was everyone’s worst day ever. It improved somewhat this afternoon, in that only half of the patients were having their worst day ever, the rest just have multitudes of complaints

In reality, dealing with a couple patients who view everyday as the worse day ever is tiring, a whole morning is exhausting and mind numbing. It is enough to wish for a fully stocked bar in the office. (I said wish, I rarely drink, so much more that a glass or two of wine would make for a bad idea, especially in the middle of the morning, er I mean the afternoon.

Anyway, it is in those patients you realize how important one’s attitude is to their health. Patients who believe that everyday is terrible never seem to be getting better, and while it might be my doctoring skills, I have patients that seem to improve. So that gives me some hope for my skills. I have patients who have their diabetes under control, their blood pressure looks good, and sometimes walk in and say “I am all better.”

And then there is the others. The ones that despite running ALL the possible tests, you still cannot find a reason for their worst day ever, which by the way is worse than their previous visit that was also the worst day ever. They have pain that is a 12 on a 10 point scale where 10 is being caught on fire currently. And then the mention a random surgery were half of the bowels were removed 15 years ago, that they forgot to mention previously. (Not really, pretty sure I would have seen that scar) But there are unmentioned surgeries, medications, and dietary factors that they neglect to mention. Or other doctors that are prescribing medication. (Sometimes the same medication and sometimes one causing side effects that you are treating.)

And then when you do the workup for a condition, you find out that even though their symptoms scream gallstones, they had that removed 5 years ago, and well they didn’t think it was important to mention. I mean after all they no longer have that organ so how can it be the problem? Though I have been told that they didn’t mention it, because they thought that it might have grown back.

Back to the attitude mentioned in the title. Those with an overall positive outlook in life really do seem to heal better, they are healthier. They try, they are not hoping for a magic pill to cure all. And some of them have significant medical diseases. They have the belief that things can get better, that there is something in life worth living for. And they are living life. This does not mean that they don’t have pain. They may, they might not, but they are trying to experience and live. There is some purpose to their lives.

It is not that they don’t have pain in their lives, some have significant tragedies. Death of spouse, child, fighting disease, but they are looking for a greater meaning. They accept that bad things happen, and maybe just maybe these events help you to appreciate the good times. The understand the need to experience everything that life has to offer. And just by seeing them, you feel better. They make your world better just by them being in it.

Attitude is not the end all, cure all. But it is a necessary component to improve one’s life. It helps with healing, it helps to give strength and motivation. It is what makes one successful in life.


Why I really like electronic medical records

As a physician, I am not supposed to like electronic records. Or at least it seems that way. That doesn’t mean that I think that the is one ideal system. There is not one that’s perfect, but I think overall they are a good thing. I know regulations are forcing them on the providers and there is a natural resistance to that, but I believe that the market would eventually switch to electronic health charts. It would be a slower process and would probably be easier, but it would happen.

Why you ask. That is say, doctors graduating from medical school grew up with computers in their home from birth. While I am old enough to remember the Apple2 and riding with my dad to take a pile of punch cards to a mainframe there are those now graduating who never heard of such a thing. They grew up with a personal computer in there home and Internet. Probably dial up for the current class, but there are high school students who would not believe that someone would use dial up

But as to why I like them… Do they make me a better doctor? As far as diagnostic skills, no. Computers don’t improve bedside manner, and in many cases hinders it. At least in some cases, especially during the install or conversions. But it does help with drug interactions, it helps remind that the patient is due for certain steps, and everything is there. And it is legible.

That is probably the best thing. I have specialists that have terrible hand writing. I get a report or a copy of their visit note and I cannot read it. So despite having their notes, it doesn’t help since I cannot read it and still have no idea what it is.

It also has helped with coding. Since converting I am coding visits higher than I ever did by hand. While you still have to look at what the codes say, because I am responsible for whatever I code or the computer does, it has been accurate and for the most part increased my reimbursement. My software includes everything, scheduling, billing, chart notes, so once I sign off, it gets billed and sent off to a clearing house and then to the insurance companies. I don’t have to fumble through charts, cause it is all threat my fingertips.

I have a system that reminds me to look for test results, consults and other items after it has been too long. So the reminds in itself is nice

As for the theory that patients don’t like their doctor turned around typing with their back towards them,well I wouldn’t either. I have tablet, that at one point had a pen, so there was little difference between writing on a chart or writing on a computer tablet. And if I would prefer to type, well I can do that too.

Overall, I think that electronic records are great. There are bugs that need to ironed out, and some of the requirements from CMS are pain to meet, but the concept itself is a winning one. And as technology continues to advance so will these systems, which will help to take better care of patients.

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.

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