ER

So my rotation this month is in the ER. What a gross missuse of health care dollars. I am amazed.... amazed and disturbed. I have seen some terrible things, some cool things, but mostly have seen downright stupid things. I wish that I had an answer for the healthcare crisis that America faces. But I don't. One of the major problems that I see is people come to the ER for their primary care. You would think the answer to that would be easy, just get a doctor. But the reality is that these people who have no insurance pay less to go to the ER then they would to go to a family doc. What's more is that there is such a supreme shortage of family docs that they probably wouldn't be able to get an appoitntment for weeks as a new patient and for days even as an established patient. Leaving the natural choice of the ER. So why don't more people go into family medicine? Lots of reasons really. Money. We are at the low end of the physician totem pole as far as salaries go. Don't get me wrong, we still make a good living when all is said and done, but when you can work less hours and make 4x as much as a radiologist or dermatolagist... well you do the math. Respect. Family physicians are often considered inferior by their colleagues... their patients may love them but within medical society... its often another story. Part of this, I think, comes from the fact that family medicine is not a highly sought after residency. Across the country spots go unfilled in the family medicine match... this leads to taking less qualified applicants, international grads (some of whom are 5+ years out of medical school or boards) which leads to a general feeling of inferiority about Family residents. But I think some of it is more deep seeded. Afterall, didn't we all go into medicine with a family doc as our initial impression of an ideal doctor? I think that people forget that family med is a different sort of medicine. You don't have to know everything in family med... you just have to know enough. In fact it would be impossible to know everything about everything. That's why subspecialties evolved... the medical knowledge expanded and created a need for specialized physicians in specialty fields.... to be contiued...

happy Halloween!

I have to say that Halloween might be my favorite holiday. Is it because when I asked a 6 year old patient today what he was going to be for halloween and he replied "I can't dress up, its the devil's day"? No... but it is because it is the one day of the year that people can be someone or something they aren't. Its always a suprise to see who dresses up and as what. You might never suspect that underneath the gory Michael Myers costume is a demure, and even prissy girl. And its still got the mystery of a masquerade, if you go to a party you could spend the entire night talking with someone and having a grande olde time, only to find out that your conversation was with someone you thought you didn't like. Its a chance to shake stereotypes at least for one night... Also, its centered around candy so who wouldn't love that. =) Happy halloween everyone!

The problem with....

I have decided that the problem with medicine is the patients. I'm sure this is not a very popular opinion, but hear me out. When you apply to medical school they always ask you why you want to be a doctor, and its always some altruistic image of helping the less fortunate. Filled with some childhood fantasy of filling a great void in an under served population we apply in spite of mounting financial pressures on physicians, lack of time and an increase in back pain directly correlated with an decrease in job satisfaction. We are trained in history and physical taking and diagnostic skills. We marvel at the intricacies of the human body. We experiment with different specialties and we make a decision. For me that decision was family practice. It seemed like a natural choice. I enjoy seeing children but I like the variety of problems an adult patient brings. We start our training, we are thrilled when we sign our first real prescription. We marvel at the correct diagnoses we make and we are terrified if we almost missed something. But creeping into the scene, imperceptibly, at first are the time-sinks, the people who refuse to listen, the people who carry some axis II (personality disorder) who make you want to tear your hair out (called trichitilomania by the way). You counsel, you order tests, you lecture, you listen, you plead, you threaten... the patient remains steadfast. In the medical world of today, physicians no longer have the luxury of saying "I tried." With pay for performance on the horizon we have to prove that our counseling, or threatening, our tests are not only cost-effective but productive. In the medical world of today, patients want to be an active participant in their care. They want to know the options, make an informed decision regarding their plan of care. Sometimes this means that what the physician wants to do or thinks is appropriate is dismissed by the patient. Don't get me wrong. I think that one of the greatest things I can do for a patient as a physician is to listen and respect my patients decisions and sometimes a patient feels better just knowing that they have some control over a diagnosis that is scary... even if that control means choosing to ignore treatment. But now the pressure is to treat, to cure, to show standard of care. Even if that standard is against the patients wishes. When such a situation arises, say in the care of a diabetic patient. The patient is for whatever reason unwilling to start insulin. The physician has diligently discussed the ramifications of this decision including potential dialysis, amputation, death, neuropathy, etc. But the patient is steadfast. Checking their blood sugar 4 times a day and then giving insulin injections is not worth the potential prolongation of life. IN the pay for performance world, this means a reduction in your reimbursement... and often that the patient is dismissed from the practice for non-compliance. As a physician I cannot "help" these people because I have to worry about the bottom line...But more frustrating are the patients who just don't care. They don't listen to you, they come and complain and then refuse to try your treatments. Again, as physician I am dissatisfied because I cannot "fix" them, I cannot even help them. And I went into medicine to help...

Domestic Goddess

I am a domestic goddess! I made my son's Halloween costume from scratch and it is fantastic (pictures to follow when I finally upload them from my digital camera!) It all started last year when I found the cutest little dragon costume and decided it would be funny to have a family theme, so I was the princess, my husband the knight in shining armor and my son, the ferociously adorable dragon. So this year I had the wonderfully punny idea to dress my son up as "King Tot" and I could be his mummy and my husband our servant. The problem, no one had king tut costumes. So in a moment of domestic brilliance I went to the fabric store and bought two yards of gold satin fabric and some black felt and went crazy with the glue gun. Alas, my domestic brilliance has been somewhat curtailed by the fact that my two year old son is afraid of the headdress. Oh well, for the two seconds we conned him into wearing it, he looked fantastic! I am also a domestic goddess because I made an amazing Frankenstein cake and mummy cookies. Ahhh, I am basking in the glow of success!

A little off

Do you ever get the feeling that you aren't living the life meant for you? I do. It's strange to because this is the life I planned for myself. I mean, I have known since I was a kid I was going to be a doctor, a wife and a mother. At 27, I am all of those. The thing is...sometimes I love my life, and sometimes... Well, lets just say, sometimes I worry I was so focused on getting those life goals accomplished that I missed something on the way. And then there are the people that you meet... and you think, if I was at a different point in my life, would this meeting have gone differently? I think life is all about timing. You can meet someone and fall in love, and you can both be madly in love with each other... but if the timing is wrong... if one of you is ready to committ and the other isn't, then... goodbye. But when the timing is right, you open yourself up to the committment, you let yourself fall in love. Then there are the people who are so desprate for it to be the "right time" that they convince themselves they are in love to fill some void, some personal defect, some repressed abandonment. But in the end, its about timing and luck, and probably fate... The invisible hand pushes you to the situation where you meet someone, the timing is right so you strike up a converstaion... The rest, as they say, is history....

The guy on the plane

So, you might be wondering what prompted this soul search? And if you aren't, then bear with me anyway. I think its been brewing beneath the surface for a long time now (more on this in future posts) but what made me act on it... the guy on the plane. You see, my husband, a friend and myself recently when on a trip to California. We had a great deal on plane tickets which basically meant we were scatttered all over the plane. I ended up sitting next to a comic book artist and randomly another young family practice physician and her baby. I came prepared with Sudoku and Pride and Predjudice but the conversation flowed easily and the four hour flight seemed to last minutes. Subjects ranged from why anyone would want to be a pathologist to why I should visit Idaho. I walked off the plane feeling refreshed and rejuvinated intellectually. This faded when I realized that the most stimulating conversation I have had in a year was with complete strangers whom I could never hope to see again. More importantly, it left me craving more conversations like this, and had me nostalgic for college when these conversations were the norm.

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The reason for the insanity

So, let me give you some background information about me before I start. I am 27 years old, married with a two year old son. I am in my residency training for family medicine in my second of three years. Time is short in my world, and yet I find myself on the brink of adding more "to do's" to my list without actually crossing any off. I am, I think, at one of the crossroads in my life. I find this weird because there are natural transitions in life: high school to college, college to professional school/real world, marriage, children, etc. But I am not at any of these points. However, I have recently been made acutely aware of the fact that I am growing up. I wanted to share my navigation of these turbulent waters with well, really anyone. Although, I basically knew I would be a doctor since I was five years old, I majored in English in college because I actually enjoy reading, writing, and even analysis and figured that was the time to indulge, the rest of my life would be filled with biology, physiology, and other sciences. As I've grown up, moved, studied, my circle of friends has changed to those who share my career. Our conversations are mostly medical. "Did you read that study?" or "Did you hear about the patient in the ICU with syndrome ______?" And while stimulating in a professional sense, I have come to realize I miss the variety, the intellectual, philisophical conversations I had in college. I don't know if its the further I travel from academia, or the further immersed I become in a profession, but I have fundamentally changed.... and so I find myself here, trying to gain insight into my own self... the reason for the insanity.