Family Medicine part 2

I like family medicine. I have a good practice with pretty darn good co-workers for the most part. I am liked and respected for the most part by my colleagues. I have patients who really like me and I've seen some who don't care for me one bit. I have my own standards and can stick to them. If I don't want to prescribe XYZ, then I don't have to. I am getting great experience and exposure to myriad conditions and pathologies. I actually get a paid lunch hour to eat and complete admin tasks. I only have to drive 15 minutes to work now instead of an hour. My pay is a little low, I have to work a night or weekend here or there and I have to take call without compensation. My stress is very low now. I have a great MA now. I have actually saved patient's lives. I like family medicine.

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.

In the groove

It's been a while, a long while since I last wrote anything. I wasn't really feeling it and felt I had said most everything I wanted to say. Days blend into days and months ooze on by. My new job is going well. There are always changes - providers leave for greener pastures, staffing cuts are inflicted and efficiencies are scrutinized. I am seeing 20-30 patients a day and really feel like I know what I am doing. That's not to say I know everything. But I ask questions when I need to and trust my instincts. I can assess back or shoulder injury quickly and correctly and can sew a finger tip and nail back on like that. I can run through an exhaustive and complete physical in under 10 minutes. I still make mistakes but I make sure they are small ones and that they only occur once. I learn from other's knowledge and mistakes and try to make their experience mine to the extent possible. I continue to learn from my patients and take pride when they ask for over the physicians I work with. I am humbled when I overhear my supervising physician tell a patient or employer that I am just as capable and skilled as she is in handling their injury or concern. I am fatigued, annoyed and reinforced when support staff bypass other provider, including senior physicians, to ask a question. I get pissed when I hold others to my own standards - I have given them and myself some room within these standards and this has made my day go much smoother. I am really happy to read the comments on this blog knowing that someone, somewhere has taken away something positive from all of this. In terms of being a PA, I am in the groove and I feel good about that.

Stay healthy

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-P-

Sent from my iPhone

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.