Friday, February 27, 2009


Alright, girls and boys, I need help. I'm wasting countless hours looking for a blogger layout. Luckily, I have nothing else better to do with my day. However, I'm also getting pretty frustrated. Every time I find a template I like, I attempt to upload it, following the directions exactly. And, yet, every time, I get an error message, alerting me that I obviously have no clue what I'm doing.

So, what is a girl to do? All I want is a cute little blog that is all my own. Any suggestions, clues, hints, comments, insults? I'll take it all!

Wednesday, February 25, 2009

But, doc, what will we do about my pain?!?

Anyone that has suffered through an internal medicine or family practice residency has likely had the unfortunate experience of working in clinic. (Sure, I realize other specialties do this as well, but an urology clinic is gonna see a different subset of patients than I do).

So, what is a medicine clinic like, you ask?!? In a nutshell, a complete and utter nightmare.

Basically, the clinic is comprised of patients without insurance or with only Medicaid who are seeking free or nearly free healthcare. Each patient is afflicted with multiple ailments, most of them chronic in nature - none of which they are motivated to manage.
Maybe it wouldn't be so bad if....

1. Patients were compliant know, they took their medications, came to their appointments, knew what their medical problems were and how they were being treated

2. Smokers insisted they couldn't afford their $4-per-month medications

3. Patients actually took responsibility for their own healthcare

4. Patients would lose that sense of entitlement so many of them seem to have

5. Patients didn't come in asking for pain medications by name ....(..."the ER gave me this prescription...hmmm, it started with a V...and that really seemed to work, doc. Can I have some of that?!?). I mean, seriously, what kind of idiot do they think I am?

Ok, so maybe I'm being a bit harsh. I have great relationships with a few of my patients. This month, however, I'm focusing solely on clinic and I'm frustrated.

A perfect example why:

Middle-aged white female with history of anxiety, ADHD, chronic pain (RED FLAGS, RED FLAGS!!!!) presented at 4pm on a Friday afternoon (my last patient of the day, of course). Chief complaints of worsening anxiety - she lost her psychiatrist-prescribed klonopin prescription - and pain, of course. And, can she have a prescription for either klonopin or ativan or some other benzo...just to get her through. And, of course, some vicodin. So, I explained all the reasons why I was not giving her either of these things. She proceeded to throw a complete and utter temper tantrum. She cried, she screamed, she advanced on me.

Now, listen, I didn't become a doctor so that I could supply people's habits. I certainly didn't do it so that people could sell my drugs on the street corner. And, there is evidence to believe that this is exactly what this lady was doing. Selling her klonopin and vicodin. Thirty-two providers had fallen for her story. Actually, more likely, thirty-two providers got sick of her antics and wanted her the hell out of the office/ER/urgent care center, so they gave her a prescription for 5 or 10 pills and sent her on her merry way. Dealing with patients like this make my head hurt. And, people wonder why I'm a cynic already.

Luckily, I then see the 77 year old woman with no medical problems and slight ankle pain - and all she wants is reassurance that she can continue to volunteer at 10 different organizations, carry cases of food to the food bank, and visit with her grandchildren without further injuring her ankle. It's these patients that give me hope and warm my heart.

Tuesday, February 24, 2009

Men in England would LOVE you!

Don't you love the backhanded compliment? You know, the one, when taken at face value, seems harmless and sweet and makes you gush forward thank yous? But, then hours later, when you truly sit and think about it, you realize the "complimenter" just delivered the perfect one line insult?

That's what "Men in England would LOVE you!" was for me. It followed a conversation about how I was trying to drop a few pounds with Weight Watchers and how my hair was a unique color. Here, let me set the stage for you. My adviser and I were having a pow-wow in her office. Now, I loved her. I still do. She would bend over backwards to help me or any of the other students in my class. However, she always made me feel like maybe I wasn't quite good enough. This was likely due to her own insecurities about herself. But, I digress.

So, we're chatting and she was inquiring about my love life, my outside interests, and my hair color. I told her I had no time for a boyfriend. My outside interests were mostly non-existent - I was a med student AND student government president, for God's sakes! Unless outside interests include drinking wine and and an instant messenger addiction? However, I had recently began Weight Watchers and had started visiting Wellworks, the wellness center across the street. My adviser, a long time follower of Weight Watchers, became very excited and shared her tips, recipes, and thoughts about the amazingness of the program. Now, truly, WW is a miracle. Anyone who has followed the program for any length of time will agree to that. WW is actually what I recommend to my patients. Anyway, she gushed on and on about WW, emphasizing that I should try to lose weight to be more HEALTHY, not just to look better. Ok, fine, I agree. But, c'mon now, who doesn't want to look better and have a sexy, bikini-ready bod?!?

Anyhow, somehow, this continued into a conversation about my hair. Now, I have strawberry blonde hair that rarely hangs below my shoulders. It's thin and difficult to manage. Most of the time, it's in a boring bob that is too short to pull into a ponytail, mostly because if it is long enough to be pulled back, it will be. I would love to have thick, shiny, luxurious, long hair that cascades down my back. You know, the kind that you see on the Pantene commercials. But, I've grown attached to the color of my hair - it's unique, it compliments my uber-pale skin, and it looks great with the colors that I love to wear. Anyway, my adviser proceeded to tell me how I should dye my hair a darker shade of red. I have NEVER dyed my hair. I'm terrified to for multiple reasons. I told her this. Then, she says, "Well, you're beautiful just the way you are. Men in England would LOVE you!" Awwww, thanks, adviser lady! What a nice thing to say! I left her office smiling and feeling better than I had all day.

A few hours later, while on the elliptical machine, I replayed the whole scene. Ok, wait. What? I'm beautiful just the way I am. How is that? A chunky red-head with big hips? And, why would men in ENGLAND love me? What about men here? Why do I have to skip countries to find men that would love me? What is it about me that would only attract English men?

Sigh. Why couldn't I have just left it alone? Instead, I did what I always do - I dissected, overanalyzed, and stored it away in the "things I can't believe she said" folder.

HIPAA who?!?

I've thought about blogging for a long time. I hear and see a lot of outrageous things in my line of work that would be a lot of fun to share. But, then, I wondered, would it be a HIPAA violation to share my stories? What if one of my patients stumbled upon my blog and realized my ramblings were about them? Then, I realized most of my patients can't even afford electricity (although, they, of course, are able to afford their cigarettes and acrylic nails), let alone a computer and the internet. And, as long as I keep identifying information out of my stories, it's not a HIPAA violation. So, let the tales begin.