Once in awhile, something happens that really reminds me why I'm doing this.  I've been getting extremely frustrated with healthcare and my practice in particular.  I didn't even realize it had been so long since I've been on this site.  I took my Pediatrics Boards 2 weeks ago, and they were hell.  Most (intelligent) peope take their boards immediately after residency, but no, not me.  Although I did take my Internal Medicine boards the months after residency, it has taken me 3 years to get around to the Pediatics ones.  and no, I'm  not exagerrating when I say they were true hell. 

Anyway, back to the point.  Yesterday, in clinic, I saw a small infant, 1mo old.  Looked pale, breathing funky.  Nothing else seemed wrong.  Gaining weight, eating, sleeping, no fevers.  Spot blood check was normal.  He was doing all those typical one month things.  I think this is where the "art of medicine" comes in.  Although by the book this child was ok, there was that gut feeling of oddness.  Couldn't shake the feeling that something was off.  So sent him and his mom packing to the ER.  Lo and behold, kid's in emergency surgery today to fix his heart.  This is why I'm here.  It feels really good.  I'm going to check up on him and his mom tomorrow.

Too often, I come home frustrated and upset, feeling like I've done nothing to improve anything for the day.  I have too many patients who want to get better, but don't have the insurance or money to get better.  I also have too many patients on welfare who shouldn't be, and who aren't bothering to get better.  No way in hell is this much of the population truly disabled because of back pain.  One of my favorite patients is a working mechanic who is supporting his family, his in-laws, and a brother, I think.  No insurance.  He's just over the Medicaid income level.  Now I have to tell him that I'm really worried about his heart and he needs stress tests and meds to keep him going.  May need a catheterization and definetely needs to start seeing a Cardiologist.  He just looks at me.  I can see in his head he's running the numbers, trying to figure out how he'll make this work.  His daughter is supposed to get married next month. 

I don't know what the answer is to this.  I truly don't believe in socialized medicine, but I don't have a good alternative.  I think a lot of people need to be kicked off of Medicaid.

Anyway, here's my rant, several months in the making.  Next time, I'll write happy stuff  ;)

Yeah right.

I am constantly amazed by the human need for bandaids - not the plastic kind that cover cuts, but the pharmacological kind.  Whether it be alcohol, drugs, or, what I see tons of, prescription drugs.  I have multiple patients who have complaints of chronic pain.  These patients usually request various types of narcotics.  Now I'm not necessarily talking about the people who have an addiction to the drugs and come in with as many symptoms as possible in order to get the drugs.  Instead, I 'm thinking about the people who do not necessarily recognize what they're doing.  Many of these patients have pretty severe depression, often times refuse to take any type of anti-depressant, and have very vague (but in their minds, very severe) pain.  I see a lot of stomach pains, headaches, or back pains that I suspect are just referred pain from something they're not dealing with.  These patients are very difficult to treat because they truly feel the pain they're describing.  And many times, they really need the pain medication to treat the pain.  However, they're usually unwilling to consider the possibility of anxiety or depression as the root of their problem.  So instead of actually treating the issue, they keep covering it up with band-aids. 

 

 I'm still unsure what my role is here.  Do I prescribe the pain medicine knowing it helps them in the short while and because they truly feel the pain they're describing?  Or do I refuse pain medication since it is a potentially dangerous (and addictive) drug, and let them deal with the pain, until they're willing to meet with a counselor or psychologist to deal with the baseline issue? 

 

Some of my colleagues are very hardline and refuse any type of pain medication unless they can find a physical reason for the pain.  They feel that because of the danger of narcotics, they're unwilling to prescribe them without a clear cut reason.  I'm  not sure I agree with this stance as I know pain is not always seen on x-rays.  I've also come across multiple physicians who readily give out narctoics for almost no reason at all.  Unless the patient is at some point willing to deal with the actual issue, it is near impossible to wean a person off the medicines.  I'm still really struggling with where the line is that I'm willing to walk.

Today I am writing in here for the first time.  I'm not really sure what I will be doing with this blog.  Mostly for my own rantings at the end of the day.  A way to let out some frustrations without letting it affect my home life.  Working in primary care in downtown Indy can sometimes be very trying.  A lot of our patients are unemployed and uninsured and trying to find the appropriate health care for them can be difficult.

 

Today, on my way home, I passed a pickup truck w/ a sticker on the back saying:

Above the sticker, they was another sticker:  In memory of IPD officer... 

I couldn't catch the rest.  I wondered if the person in the truck still felt as angry and frustrated as the sticker communicated.  It made me think of one of my patients today.  D  is young, in her mid-twenties.  She has a child in pre-K, but recently lost a child.  The baby was born still-born the day prior to her scheduled C-section.  She was seeing a high risk OB and had an ultrasound done that morning which showed that everything was ok.  That night, she began having trouble and went to the hospital.  They couldn't find a heartbeat.  This occurred almost a year ago, and she is still trying to get through her grief.  I'm seeing her with a counselor as well.  Today she brought pictures of the baby after it was born.  She told me how she waited for 12hrs after the ultrasound before delivering the child.  Some of the pictures showed her while she was crying and it was so stark.   I almost felt like I was intruding, the pictures were so vivid.  Her grief and loss were just laid out, completely caught in the photos.  It killed me.  I rarely get truly emotional in a patient's room, but I began crying.  I have 2 kids and I can't even wrap my mind around the possibility of losing one of them.  My mind just won't go there.  And yet, I see it, not regularly, but enough.  Watching these parents, my patients, try to deal with that type of loss is excrutiating.  I have no idea what I can do to help them.

 

It's weird as I'm rounding in the hospital on the newborns right now.  Such a strange dichotomy  - to go from healthy newborns to discussing stillborns.  Being a doctor can be so strange sometimes.