Lies, lies,lies

I had a patient today, who admittedly has some serious but old spinal problems, tell me he is almost out of his pain meds that were prescribed by another provider a week ago.  " I maybe have 2 days of meds left" he tells me. This fella had seen me for his initial visit and subsequent visit  but then his claim was denied. So he had to go to the ER for his pain meds. I had to dig but he fessed up to going to the ED on several occasions while his worker's comp claim was adjudicated to get pain meds for his train wreck of a neck. So, since he told about all the visits I had dug up and investigated so I gave him an Rx for #60 oxycodone and put him on a narc contract.  He new what it was before I even mentioned it.  He signs it and went off to fill the Rx. I get a call from the pharmacist telling me that this fine gentleman just had an Rx filled 2 days ago for #120 oxycodone.  I told the pharmacist to rip up my Rx and to tell the patient I asked to do so.  The patient just called as I type this telling me he went back and counted all of his pills and he 68 left and that the pharmacist is wrong and that he got the Rx filled 4 days ago.  These are the kind of patients that make me question what I am doing.  I am sure it isn't as bad as I feel it is, but it seems so many of patients don't want to get better.  It seems so many of them lie.  Shit, I wish I didn't care but I do.

Love my co-workers

The doc I work with just moved a new injury to my schedule from her's so she could purchase holiday decorations for her office.

One of the things I do at work is perform dept of transportation physicals. With a healthy patient this goes smoothly and takes 10 minutes. I had one the other day that took 30 minutes. Keep in mind that truck drivers in general have poor health. They spend all day seated with almost no physical activity. When they stop driving for the day they eat whatever is available at the truck stop. These choices are almost never healthy. In their free time many have been known to undertake risky behaviors. They also are never at home and so they do not see a healthcare professional unless it is urgent These are not just stereotypes. When I worked in health insurance all but one of the companies I worked for refused to underwrite policies for over the road truck drivers. Flat out. No consideration, no negotiations.

So back to my 30 min DOT physical. This guy in his 50's comes in having been on Xanax for 20 years. His psychiatrist is weaning him off of if by putting him on another benzodiazepine. Since he stopped taking Xanax his blood pressure has shot up to 170s / 110s. This blood pressure is incompatible with driving commercial vehicles in the US. Furthermore, taking benzos on a daily basis is also - they are too sedating. Now he's been driving for 20+ years while taking Xanax daily. I certainly never saw him before but this apparently never concerned any of the examiners who cleared him medically in the past. So, now it is up to me to tell this guy that I can't pass him. Now he can get these forms filled out by his specialist providers stating that, in their professional opinion he is not at risk and the medications he is taking won't make him take a nap at the wheel. If he does and comes back with a slightly lower blood pressure I can give a three month card. Well he proceeds to complain that I am taking away his livelyhood and then starts calling everyone he knows. But he won't leave my office. He calls his daughter who works in healthcare and she tells him to go somewhere else and not tell them about his medications and conditions. He calls his employer and complains to them. They run through every scenario; when will he get his Rx for his BP filled? How long can he drive on his current card? Who's going to pay his bills? Why won't I accept some 8 word note he brought in from his PCP stating he is under his care? Then he tries to call everyone of his providers to get them to talk to me so I will sign off on his med certain card. Only it's ten to five so he can't get ahold of them. He complains how I am taking away his livelihood by not clearing him and that all he wants to do is drive his truck and make a living. I explain to him that I want to continue to make a living as a PA and that if he were to wreck his truck i could loose my PA license. He turns to me and asks:"what's a PA"?

Becoming a PA doesn't change your life

Today things seem to have caught up with me all at once.  Nothing really significant if taken separately.  But their cumulative effects have me feeling worn out today.  Work just isn't fun.  It's not miserable, as it had been a couple months ago - it just isn't enjoyable.  I find myself filled with dread when I see certain patients on my schedule. I feel drained by my patients at times - almost never energized by them. The computers are slow and my boss isn't great. Since I work with women I have very little socializing to do - I don't care about cute tops or the size of my butt. I spend 2 hours a day commuting which would be more tolerable if I were commuting to something I looked forward to doing. Plus, with my glass half empty right now I see that time as lost - I would rather have an extra hour a day so I could ride my bike or paint or something.  As it turns out I almost no time for myself now. Between commuting and work, 12 waking hours are accounted for 5 days a week.  When I get home my son is there asking which game or toy we should play with before and after dinner.  After playing with my son I put him to bed, which with reading stories and brushing teeth and whatnot, takes me to 8:30. By then my wife is well into another episode "Housewives of XYZ" - she likewise has similar feelings of time poorly spent and needs to unwind in a way that works for her. I really cannot stand to watch these shows so I usually stay upstairs and read email or facebook or play games on my ipad for an hour or two and go to sleep.

On the upside I have a car to get me to a good paying job where have to do nothing more than think most of the time. I have a beautiful son who wants to spend all the time he can with me. I have plenty of food to eat and a decent house to live in. I have an ipad for goodness' sake. In the whole scheme of things, my problems seem pretty trivial and I am sure there are literally tens of millions of people who might like to be in my shoes. However, these are the problems I face and they do bother me. The thing that bothers me the most is feeling like I am in a rut or that I am on autopilot all the time. I continue for ways to break the cycle.  I long for exercise and activity and creativity.  I search for ways to get these things back.  In the meantime I vent to strangers. 

Got me an iPad!

My lovely wife got me an iPad for our anniversary. Pretty cool, huh? For what I do now, I really don't need much else. I just need to figure out. How to get my Microsoft documents on here so I can edit them and email the out. By the way I got her a necklace from me & ro. My son is doing well and looking to wrap up his second week of kindergarten.

Work is going fine. Recently I saw an amputated distal index finger, a bunch of lacerations, a fractured great toe, a completely torn ankle, a couple hot water burns to the eye, a few dental injuries, and some miscellaneous fractures. This is on top of the multiple rotator cuff strains and tears, carpel tunnel, and a ton of low back injuries. Just a reminder...never twist and lift, never reach out and stoop while pulling or lifting heavy weights and use your knees!

I got one!

I had a patient who came in last week with a very sore, very firm calf after running to respond to an emergency earlier in the day.  No injury really, just pain after resting a bit that was worsening to 10/10 and a lot of swelling.  Other than the swelling he looked fine really and was handling 10/10 pain like a champ.  Well. I sent him to the ED because I had concerns for compartment syndrome.  Turns out he had a major case of compartment syndrome and had an emergency fasciotomy the same day!  He has second surgery to remove 2 fist sized blood clots the next day. He came in today for follow-up with his mom and wife and they were all so grateful for my help. Well needless to say the works of thanks lift up my soul today and the fact that I caught a gravely serious condition gave me a boost of confidence.  

A challenge around every corner

I have worked for a lot of companies and had many bosses.  A few were stellar, most mediocre, and a couple were just plain bad.  Without going into detail things are less than cozy between my boss and I.  Mostly along the lines of - I am the doctor and you are not - kind of crap. I like my job and my patients are, for the most part, great to work with.  It would be nice to get some training, but as it stands, I have had none since I started seeing patients.  No feedback on care or charts or anything.  

I know, this comes off as me complaining again.  Life is rough at times, I know this as well as anyone, believe me.  Maybe I don't write enough about about the highs.  Well, here goes.  My wife and I are working on things and it seems to be going better.  My son is awesome and at five is reading, riding his bike w/o training wheels and swimming, albeit at very much a beginner's pace.  He is a Star Wars fanatic and asks me constantly about the nuances of all the story lines and the scope of power of a Jedi versus the Hulk, for example.  He has a great imagination and loves to draw - much like me at that age.  I will follow his lead and return to art earnestly now that my schedule is under control.

Happy 4th!

Arrrrgh!

My computer is still out of service. Maybe I'll just buy a new one. Thank goodness for the iPhone!

I just had an interesting talk w my SP. I had anpatoent the other day with a pretty obvious MCL tear, probably grade 2. Before he came to me he had been to the ED and had spoken to his supervisor and both told him he NEEDED an MRI and probably surgery. Through my training I know that regardless of what an MRI might show, the treatment for a torn MCL or a sprained MCL is the same. The almost never need surgery and almost always heal on their own. I explained this him as well as the need to reduce the effusion in his knee before an MRI should be obtained. I thought I had his buy in on the treatment plan. Well he called later that day to cancel his PT and follow up here for a second opinion elsewhere. I was informed By my SP that his employer wanted an MRI stat and that in most cases if the employer is willing to take the hit on their workers comp insurance they can have whatever studies they want, even if all medical guidelines indicate otherwise. So now I have been told by my SP to ignore my training and provide whatever studies this employer wants even if it isn't warranted. I feel like a burger king employee again - you can have it your way.

And the beat goes on...

Still posting from my iPhone as my computer sits awaiting an attempt at repair. Still seeing a ton of ortho and neuro. Had a pt with a focal infarction only effecting his occulomotor nerve for his left eye as the result of CO poisoning. Reattached a partially amputated finger in office. Long stretches of the mundane punctuated by some cool shit. I seem be working late every night while my SP does not. If I don't have a question for her I may not even talk to her on a given day. I seem to be doing well though my 90 day review. I even bonused recently...a whole $10! Overall I am happy with the job. I realize there will be difficult or annoying people anywhere and that no place is truly perfect. I like being able to pay my bills and have some money left over. I like being mostly on my own at work.

My beautiful boy turns 5 soon and I am amazed at how great he is. I will mourn the day I am no longer cool in his eyes and have come to appreciate his constant requests to play light sabers or cars. Looking back I cannot remember my dad playing with me. I am working hard to make sure my son won't have the same non-memories when he is older.

PA school was so tough yet it seems like a distant memory now. How is it I can remember getting a string of cellophane-wrapped lollypops from the German couple who lived next door to us in Berlin when I was 2 so clearly, yet trying to recall any particular day in PA brings back only whirls and blurs? I wish I saw my classmates more. We went through it together and only they can relate to that experience and those I have now at work. Sometimes I wish life wasn't so much about moving on.

Computer...is......dead

My computer died so I have held off posting anything. It has been too long so I am taking a break from work to use my iPhone to post. I am pretty busy at work and am essentially on my own unless I have a question. I have gotten really positive feedback from my supervising physician and patients. I can now get through a full physical exam in ten minutes. I have seen some interesting things and some even more interesting patients. My personal life continues to be a roller coaster with more flats and up hill pushes than enjoyable twists and turns. I was hoping my wife would be happier with me being employed and well paid. It seems she continues to find fault with me, our house, our stuff and our lack things and activities that meet her standards. Will a new house make her happy? Will our son's admission to a good kindergarten make her happy? More vacations? A new job? A cleaner house without clutter? Newer diets? Better exercise plans? Going vegetarian? Losing 40 pounds. Will Having a husband who only wants to do/watch/eat what she likes to help her to be happier? At least I can pay a lot of our bills now!