Internal Medicine with a Minor in Psychology

My clinic doth run over.

Officially each office visit should take 45 minutes of my time. Recently, however, this has not been the case. Instead I will have three or four 50 minute appointments and one drawn out and draining 1 hour and 15 minute one. This is not because I am just that thorough and kind hearted. But rather because my patients all seem to have a touch of the crazy.

Sometimes it's fibromyalgia with the patient reporting pain here, here, and here. Some pain there radiating back to the first here and sometimes becoming the second here. And that place over there has two types of pain. Oh and my hair hurts.

Sometimes it's chronic fatigue syndrome. Or myalgic encephalomyelitis as my patients like to call it. Or yuppie flu as I like to call it. They aren't the actual patients, their sick relatives in need of custodial care are usually who the visit's for, but patients' families can just as often be as much part of the problem as part of the cure.

Then there's the standard old major depressive disorder. Patient wants to kill himself, doesn't want to talk to anyone about it, and doesn't want to leave the exam room. Of course he didn't come in for depression. No, you cannot get a medicine appointment for a psych complaint. Instead you gotta be sneaky crafty. Don't want to ruin the surprise.

And lastly there's the undiagnosed bipolar patient talking incessantly, not answering questions, and generally providing no relevant information about his ailments to do either of us any good. Feel free to leave before I return from consulting with the staff physician about your diagnosis. It's not like you came to the clinic for medical care because, actually, I am still not sure why you came to the clinic today.

All in all it makes clinic interesting and for me leaving the hospital at 1900 or 2000 at night. The immediate frustrations aside I do not mean to convey that I dislike psychiatric patients -- and two of the disorders aren't even psychology related really. Crazy people are people too after all. It is just that I don't have enough time to take care of all the problems which actually threaten life and limb let alone the hours extra needed to take care of the problems brought about by bad humors and forest gnomes. I am training to become an internal medicine physician but to date it seems my end expertise will be that of a psychologist / orthopedist who occasionally dabbles in the diabetes and the common cold.

***As a general disclaimer: though I in general like to try and be an honest guy, with all the rules these days and the rise of the HIPAA fascist state I must resort to vagueness, generalizations, and outright lies when it comes to recounting my patient stories. Don't want to breach any privacy here and I definitely don't want a summary execution without trial.***

Saving Lives, For Profit

Leaving the office last Friday after four weeks of outpatient medicine at a local private practice I felt as if I had been liberated. Not necessarily from the work as the work was not terribly difficult or demanding, but rather from the commitment. Although I was allowed to sleep in to a rather late 7:15 in the morning every day, I usually did not return home from work till about 7:00 at night. I may not have minded the job, but I minded the fact that all I did was my job. For almost 28 days I felt like I was less enjoying life and more listening to senior citizens tell me in as ambiguous terms as possible their various minor ailments. I am told once you hit your career days you are no longer supposed to enjoy life, and to an extent I acknowledge that that's true, but nevertheless I'd like to live in sweet denial for as long as possible.

Aside from the fact that 60% of my patients were 70 year old men and women telling me about their terrible shoulder pain which they hadn't even bothered to take any tylenol or aspirin for, I have other grievances. For one, my physician had me research a new topic every evening thereby limiting the little free time I had even less. For another, the man had not the worst handwriting ever, but easily the 5th or 6th. Since he still had paper charts that meant that I either had to try and tweeze out a coherent history from my half-senile elderly patients or desperately try and put together an idea of what happened from the studies he'd ordered and the correspondence of other physicians he'd sent the patient to. Of course those other physicians remembered to send copies of their notes only... oh... 40% of the time. The rapidity of the encounters at not only this clinic but many clinics I have been to either as a patient or a student have also convinced me the average American probably gets only mediocre care at best. There are certainly some great physicians there who actually devote enough time to a patient to provide great care as well, but I am pretty sure they are anything but the rule.

Though I like to complain there were some good sides too. My physician was, generally speaking, a fairly nice guy and easy man to work for. His nightly assignments, though painful, -- especially when they consisted of diseases that don't exist like "hand and foot fungus" -- were moderately educational. His office staff were also a friendly bunch. The patients were as a whole very grateful, and aside from a few Spanish speakers who mumbled their speech, I enjoyed most my visits. Though I have no desire to return, I do not consider it a bad rotation. Just a not very fun one.

One last thing I noticed was that with such rapidity of care the work up of patients becomes less well-thought out consideration of the applicable science and more the following of whatever whim or algorithmic pattern the particular physician seems to have acquired at some point through whatever means. I would imagine -- and so it seemed at this clinic -- that this makes such physicians ripe for the picking by anyone willing to provide a little bit of already digested, helpful medical advice. And of course since few things in life are truly free, this educational charity work is largely done by pharmaceutical representatives. Perhaps such industrial parasites are a necessary evil, but judging by the drugs prescribed the pharmaceutical industry does well by sending out their drones. All their blahbety blah blah aside, though, the drones did usually provide pretty delicious lunches. (Except for Crestor, I will never prescribed Crestor to my patients -- even if they need it. They're jerks.)

As a final note: a public service announcement. Beware the small tubes at Schlitterbahn. They may look like fun, but from first hand experience last weekend I can confidently say they only lead to bruised elbows and cervical spine injuries.

Oh and here's an unrelated photo from my previous stay at the Delevan homestead....