Monday, April 6, 2015

Family Medicine

OK, its been a while. It seems I start all my posts this way. I am busy with work and family so sue me. I now work in family medicine. It's been nearly 5 years since I graduated PA school. A few things I've come to learn, Number one: Patient's don't listen. Or they listen but do they do not process what they just heard. Well, most of them don't. A few will do exactly as I ask of them and they tend to do fine. Some hear chest cold and leave thinking pneumonia. Many patients come in wanting, no expecting, a certain treatment based no past experience. The last Dr. I saw gave me Augmentin and I felt fine in 5 days, I want augmentin again. They don't listen to what I have found during their exam and why I think they have xyz. Mostly because Dr. Google or a friend told them they have ABC. They stop taking their antibiotics once they are feeling better, saving the remainder for a rainy day, despite out talk about antibiotic resistance. They don't agree with the diagnosis - they want to have something nasty so they can take antibiotics for a week or week two not knowing what antibiotics are even used to treat. Or, in the case of the ubiqutous head and chest cold, if they aren't healthy in a week, they are back in my office expecting an instant cure, something they imagine I have been keeping on a special shelf, for only the worst cases and most important patients. This is despite the warning that I gave them initially that it may take 2-6 weeks to get back to normal, but as long as they aren't getting worse, they be fine eventually. They come in with 9/10 right lower quadrant abdominal pain, anorexia, nausea, vomiting and diarrhea and wince and moan when I palpate their belly. I tell them I think they could have appendicitis, and explain why I think this is the case and the need to obtain more diagnostics to determine if this is true. I explain that, while I can't look into their abdomen, their history and physical have me concerned enough that I want to get a CT. I have my staff drop everything to schedule the CT for today, and ask the radiology unit to call me on my cell phone with the results, whenever they come back. I send the patient off with direction and instructions for the upcoming scan and explain to them that while it could be many other conditions, this could be a life threatening condition and that we may have to admit them if the CT shows something serious. They leave the clinic armed with verbal and printed information and instructions for their pending diagnostics. I spend the next few hours slightly worried, curious as to their condition and diagnosis. The next couple of hours after that, I consider the reasons why I haven't yet gotten a call from the radiologist. Surely the CT is done by now. I get a call just before bed. It is the radiology tech. She informs me that my patient never showed for their scan. I spend the next few days trying to follow-up with the patient, but their phone goes unanswered. I send a certified letter asking them to follow-up as we had discussed. No reply is ever received. Then a 3 weeks later I see a notice on the EMR. It indicates a patient of mine is in the ER. I open to see that my patient, the one I had worked so hard to get a rapid and accurate diagnosis, has been worked up and will be sent emergently to the OR for a ruptured appendix. The same appendix that I suspected was causing a problem 3 weeks earlier.

3 comments:

Unknown said...

Very interesting post! Your frustration sounds very similar to the frustrations my mom (who is a primary care doctor) always complains about! Is this post a reflection of your dissatisfaction with the profession or just venting after a trying experience??? I am considering PA school, and I am desperately trying to get some stories about personal experiences to help me make up my mind. How do you feel overall now that you have been practicing for 5 years??? Thanks for all of your thoughts- I really appreciate it!

-p- said...

I enjoy being a PA. I don't want to do anything else. However, dealing with people is challenging. The general public is relatively uneducated about basic health and wellness, have many unreasonable expectations about what modern medicine can and should able to do for them, and frequently view their interactions with their healthcare providers as a simple exchange of money for a prescription/procedure. A transactional relationship, if you will. In some cases it feels like they view their visit with me as they might when they'd go by a new cell phone expensive dinner: "I paid all this money, I expect to get what I want." Patients cuss us out, lie, manipulate and sometimes steal. It simply reflects, in my opinion, the extent that our society has devolved. IT reflects the present state of human nature. By far, most are decent and appreciative, but the unreasonable, know-it-all, or entitled ones seem to stick in one's mind.
-p-

Unknown said...

I don't think you have enough respect and empathy for your patients, appendicitis case excluded. It's attitudes like these that make me feel desperate to become a provider and make a difference. Patients need to be respected and educated and *listened to.*