The past few months...

...have been without much to note for me. The community I work suffered a horrible tragedy in the theater shooting. Strangely, we seem to have missed only a few beats and are predictably normal ways. The fires have mercifully subsided and given way to snow of late. I am still busy at work. Folks can't seem to help but get hurt at work. Friday is always the busiest and last Friday was no exception. I had three new injuries walk in 30 minutes before close. One fellow fell from a ladder 16 ft onto concrete. Another had a hernia for which he already sought treatment in the ED. The last sustained a concussion and had an interesting, albeit not unheard of presentation. His mechanism of injury didn't match his complaints but I still sent him to the ED for urgent imaging. I find myself questioning my patient's motives frequently. Perhaps they want a few days off from work. Maybe they want to get back at there boss or employer for some perceived or real injustice perpetrated against them. Often they have some pathological need for attention. Some feel this is there best chance at a big payday. Most of my patients are honest and recover as expected. There are some that I know, after their first visit, that they will not get better any time soon. We'll see how Friday's patients shake out.

Life

My home state is on fire. Colorado is burning, homes reduced to ash, the sky filled with gray stinging smoke. People are looting burned out homes. Tens of thousands of people have been forced from their homes, due to these infernos, some of which may have been intentionally set. My family and I haven't been directly effected other than not being able to go outside at times due to the smoke. Politicians have started their latest round of attacks on each other. It seems like I am the one they are attacking at times. They certainly spend more time appeasing single issue voters and fighting each other than they do taking care of the country. The healthcare system, my livelihood remains in flux. The world around us, our neighbors and distant countries suffer in violence and hate. Innocent people in this country go without, or worse, are forced into needless suffering by those in a position to help. Today we celebrate the independence of this great country. The greatest liberties known in the history of mankind are held close to our hearts here. But I feel we are not finished with OUR work. Rather than a masterpiece to be held in highest esteem however, our grand republic is simply a work in progress. WE are not done with the work started centuries ago. There are problems. They punch us in the face nearly every day, challenging us to step up and do something. But I am just a simple, middle-aged family man. Smart but not brilliant; relatively fit but fat and tired. My obligations are so consuming, yet so seemingly trivial. But I can do something to keep MY amazing country on the tracks laid by our fore-fathers. Maybe you can too. Whatever you do, do it well. Keep your interactions with others positive. Perhaps if our leaders and we followed one simple but profound piece of advice, we wouldn't have to work (fight) so hard to keep this country between the gutters. Granted we won't find a cure for cancer or build great industry by following this mantra, but I am convinced these and others will come easier if we all simply lived and worked by first Do(ing) No Harm.

New job

I just finished the second week on the new job. My time so far has consisted of training with some patients here and there. The clinic I work in sees occupational medicine patients primarily but we also see urgent care patients as well. This is abig deal for me and I am very happy to have any chance to practice an expanded scope of medicine. I am truly excited to have three day weekends for the forseeable future. That is huge benefit and worth at least $10k per year to me. I am amazed that I work 40-43 hours per week without call, have been out of school for less than 2 years and now make six figures before any bonus! I realize this is not the rule but rather a significant exception. When I interviewed for a family medicine job a couple months ago they wanted me to take call and work 50 hours a week for $75k. I never went into this for the money to be honest, but I am so happy it seems to coming for me anyway. Occ med is seen by many as the dregs of medicine and I have felt that way at times. I would love be in the hospital rounding and patients and managing grave illnesses. But the reality is that what I do is very important although no one will make a medical drama about it. I heal people so that they can work and earn a living and keep they economy running. Not glamorous. There is a shit ton of BS at times. But you know what, there is BS with EVERY specialty I can think of. So, my job is not ideal and will be complaining about on this blog, I know it. But, there are a lot of really good things about it too.

I guess it's a good thing they are mad?

I have been getting the cold shoulder from the higher ups in my small company. Those folks who use to come by and ask me how I am doing and toss around some small talk can only be bothered to say hello to me now. Nothing more. Not a "sad to see you go" or ' i wish you luck in your future endeavors." This wouldn't 'bother' me except these folks have publicly wished the same for every other employee who has left since I started there. I guess it's a good thing they are mad I am leaving rather than being all cheerful and upbeat. Even though I gave them the notice they requested in their employee handbook and have gotten pretty darn good reviews, I don't think I would ever be welcomed back.

My last day in this clinic is 5/10. I am moving to a job much closer to home that will allow me to work 4 10-hour shifts and will pay me $14k/year more to do it. I will still be doing Occ med but will also be doing urgent care as well and the possibility of seeing peds and the flu has me giddy. Well, i guess i'll have to wait on the flu. by the way, did anyone catch the flu this season? I heard so little about it I thought we might have found a cure. So much has happened in the clinic lately that I felt it was time to get out. front office staff turnover is bad. If they do stay they are not terribly great. a new office manager means that all the processes that kept my going smooth flew out the window. Referrals aren't getting placed in a timely fashion and patient care is starting to suffer. Patient's complain to me that the ladies up front are rude and don't answer the phone or return phone calls. I have seen a patient for a month and not have a single referral placed. I ask for the same things over and over, but I still get sub-par work from them. I have let the higher-ups know of these problems but my concerns went mostly unanswered. At best answered but ineffectively. So now I going to work with a big company with lots of resources and talent. I'll be working in a very urban environment as opposed to a semi-rural environment now. I hope things go well there - i think they will. Wife has been pushing for a new home so it looks like we will be getting a new home. It will of course be much larger and twice the cost of home now. The homes where we live now aren't that great in terms of quality and size until you get close to $500k. God i wish we didn't have to spend that much. Looks like we will though. I must get some space of my own to play the drums or paint - I've done neither in more than a year.

It has been a while

I feel that I am maturing as a PA. I recognize and pain over my shortcomings. I try hard to correct them and bemoan my failures. Right now i am working very hard to be fake. Let me explain. My personality and approach is to tell it like it is. If you ask me what I think I will tell you what I think. I will give you an honest and straightforward reply. Some of my patients like this. But many do not. I find that my SP, while she may feel the same about any given patient as I do and often does, she sugar coats everything. She is very, very friendly with every patient, even those that were caught in lies, are faking injuries or are simply not very good people. While I am never rude, I rarely ask the malingering, lying, and rude patients how their holidays were and I certainly won't chat with them about their personal life if it doesn't pertain to their treatment. She will go out her way to be nice to a patient that she feels is, in her own words, a "piece of shit.". I know what you are thinking. How dare he call another human being a piece of shit?! Just who does he think he is after all? I get it. It is not right to think this way. But from time to time we do and for pretty good reasons. Back to my point. Why waste the energy to go out of one's way to be extra nice to someone who, by most accounts is simply gaming the system and doesn't deserve it? It just makes the day easier if you do, that's why. A spoon full of honey helps the medicine go down damn it. These patients make less of a fuss and waste less of your time with BS if they *think* you like them and believe them. to call them on their shit only makes them work harder to convince you -to bring up glaring inconsistencies in their story only forces them to act out a grander tale. Being honest hurts these people and causes them to spill their pain onto all they deal with. So now I realize this. I realize that being this way is not in my genetic makeup. I realize that the days are getting difficult. I realize I need to find a way to make them go by a little smoother. I realize I need to try harder.