21 October 2010

best and worst

it had been my intention to blog much more often during my weeks in clinic. my patients were great – they taught me so much. i learned better ways to ask questions, tricks for less awkward physical examination, and even once had a 10-minute conversation about Alabama football (shout out to my husband for his help on this one). i got to know people the way you cannot in a hospital setting. i got to see repeat patients. i loved recognizing patients, meeting their family members, finding out how treatments had or had not worked. here are a few highlights i meant to tell as stories:

-removed half of a q-tip from a lady’s ear (that she waited a week to come to the doctor for)

-smoking cessation counseling: “so, ms. so-and-so, when do you plan on quitting smoking?” (without missing a beat) “when i get old, develop alzheimer’s, and forget that i do.”

-middle-aged lady, on getting her throat swabbed for strep: “i’d rather get something shoved up my vagina than down my throat if you know what i mean!” (we can only assume she was referring to a preference for a pap smear over a throat swab.)

-middle-aged gentleman, flies a lot for his job: “you know what they say about birmingham: when you die, whether you go to heaven or hell, you have to go through atlanta.”

-older lady getting her blood pressure taken, as the cuff tightened: “god bless america!!!”

-85yr old lady (with poison oak on her ankles for the 3rd time acquired from her cat who goes outside, plays in poison oak, then flops himself all over her slippers) offering me life advice (i got a lot of life advice): “let me give you advice. don’t try to own the road. i got in a wreck last year because i’m too aggressive. stupid @#$%# GMC. my kia was totaled.”

i had an excellent teacher for most of my time at the clinic. i worked primarily with dr. l. when i signed up for the course, i had asked specifically to work with her – and i got to – but she works only tues, wed and thurs (and spends the rest of her week at home working her butt off with three young kids; her husband’s an MD, too). dr. l is great at instructing and giving feedback, but she also has a humble attitude, something incredibly hard to find in medicine. she advocated for me doing any and all procedures patients needed. i froze warts off feet, elbows, and fingers. i sent patients for x rays, urine studies, and to the lab. i did more pelvic exams/pap smears with dr. l than i did on my entire ob/gyn rotation.

on mondays and fridays when dr. l wasn’t in, i worked with some of the other doctors at the practice. most of them were great. one of them was not. dr. b was not a surgeon with a “god-complex,” nor was he a “know-it-all” resident. even so, each time i worked with him i gained a clearer picture of the type of doctor i never want to become. dr. b is an older man. he had a practice at another hospital in town that went bankrupt a few years ago, thus finding himself without a practice. instead of retiring, he took a job with this practice at UAB. it’s obvious dr. b is miserable, and that he has completely checked out. exhibit a: one morning working with him, i saw his first three patients while he meticulously placed stickers on one of those mail-in sweepstakes return envelopes to the national rifle association, complaining to his nurse that he never wins anything and makes no money compared to his colleagues in surgery and other fields.

one of the most frustrating things about dr. b is that he gives out narcotic pain medications (among other controlled substances) liberally. many of his patient encounters started something like this: “so what brought you in today?” “well, my friend/neighbor/boyfriend told me that you’re a really good doctor for controlling pain. i don’t like what my arthritis doctor put me on, and i want some lortab.” and he would give it to them. even ask the dose. and whatever other controlled substance they asked for. so much so, that the clinic created a policy that requires patients on pain meds to get them from a pain management clinic. what does dr. b do? gives the patient the note with the clinic’s policy with one hand, and the prescription for lortab with the other hand.

seeing a patient before dr. b, i talked to her about the harms of narcotic pain meds. she told me she needed them. we talked about how she could try to use less, how she could try other things long term, etc. i didn’t really think i got through to her, but maybe one day she’ll think back to the conversation we had. i was feeling ball-sy and mentioned to dr. b i had talked to her. “what difference does it make?” he laughed in my face. “that’s how people are.”


so if ever someone says to you
"life isn't fair, get used to it"
then you should say:
"well it might be
if folks like you would let it be"

-the avett brothers, the lowering


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