Arrivederci

Busy day today - 26 patients (and I did have a few 1/2 hour slots thrown in there for well child checks, etc). Am really starting to feel that I've-been-run-over-by-a-train feeling by mid-afternoon, usually around the witching area of 3pm. Wish I could still blame it on jet lag.

Had a patient today who was one of my "firsts"- she was a part of a group of patients who came to me after 1) having multiple physicians 2) having multiple medical issues that were not - for whatever reason - being what I viewed as not under appropriate treatment (why? patient compliance vs. personality conflict vs. medical care... it's a grab bag). A patient who walked into the office as a new office visit almost a year ago, and 1/2 hour later, I nearly crawled out of the room, feeling incompetent and completely overwhelmed.

With that being said, she told me she will be soon leaving the practice due to insurance change (err, well a temporary lack thereof) and will not be able to afford the out-of-pocket payment for our office visits.

And you know, when I heard this from you, my initial reaction was disappointment. I was sorry to see her go - not only do I enjoy her, but I looked at her chart and thought wow! Over the course of a year, look where we've come - lipids controlled, blood pressure controlled, new diabetic (controlled!), breathing improved, etc. Granted, I'm happy she is medically in a better place where she was a year ago (or so it appears), but still.... or again, I am sad to see her go.

Bad Patient Day

Out sick - yet again - earlier this week (as an aside, my immune system is shot in this new job/setting/frequent acutes). Back today, only to be sort of, well, bummed by my patients.

Message from a wife of a 25 year old who said that he was abusing the anxiolytics I prescribed him (as a bridge along with his SSRI initiation).

Sixty-some year old female patient who gave one of our nursing staff "attitude" when asking about an Rx to be mailed - and to close her conversation, my patient stated "bang bang" and hung up the phone.

Narcotics. Everywhere today. I am becoming more and more aware of this narcotic issue and I HATE it. Everything is dumped on family medicine - want more meds? Not me, go to your family doc.

Now I am getting a medication agreement on everyone. Hello, I'm your new doctor, please sign this agreement. Me - who delayed getting her DEA until the last possible moment because I despised that so-called privilege... am now becoming more and more paranoid about narcotics. Is it me, as the new doc, just a ton of patients doctor-shopping, oh she's so nice! Patients I trusted.

Who knows. Tonight I'm both disappointed and annoyed. Too much of my energy is spent on trying to determine who is legitimately in pain and who is drug-seeking. Did I really go into medicine for this?!

TGIF

End of day. I am tired - it's Friday, it's been a long week, and well, I'm beat.

End of day. New patient. Best foot forward! Garner up energy! Pull together The Charm!

I am tired.

Mom with daughter. Cute mom, very engaging, very caring, worried about her adolescent daughter - grades slipping, increased irritability.

There were times I wanted to pat the patient's mother on the back and say, don't worry - you don't know how much you are doing by just being concerned. Your daughter is a teenager. Just be there. Support here. Like you already are doing.

Of course in between my engaging laughter and empathetic nods shared with my new patient, I had flashes - or rather, glimpses - of almost sheer terror - who am I to tell this mother what to do? Guide her on her daughter's adolescent angst? Tell her everything was going to be okay?

Yet I try - and that's all I can do, right, is try? You learn medicine is so cut-and-dry, evidence-based, methodical.... There are guidelines for everything. Yet it's the art of medicine that I am trying to cultivate and trying to allow myself to feel.

Everything is going to be okay.