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Sep 17, 2009

Family Med

Prepare yourself, this is a Rant.

Oh, my friends, family medicine is killing me.

There have been some really excellent moments, like last week when I helped deliver a baby or this morning when I scrubbed in on a cesarean section or any of the OB check ups or, to be honest, most of the well child visits, but OH LORD the rest of the days are so awful I could poke my eye out with my little PDA pencil that I use to keep track of all the patients I see.

It does not help that I have been working 12 hours days in addition to driving 45 minutes each way, all of which add up to never seeing my baby because I am gone long before he’s awake and get home well after he’s gone to bed. On “easy-peasy” Family Med. But the real things that’s got me in a fit is the work.

In the five days that I have worked at the clinic, I have seen 87 patients. 59 of them had diabetes, high blood pressure, AND cholesterol problems. Yes, that was an “AND”. 59 out of 87 patients were there for check-ups on ALL THREE OF THOSE PROBLEMS.

Hey, I have a radical idea on how to fix the health care system! LET’S ALL TAKE CARE OF OUR BODIES. Then we wouldn’t have to go to the doctor as much, we wouldn’t have to take as much medicine or have as many lab tests or treatments, saving gazillions of dollars, and we’d all feel better, look better, and be happier.

The doctors, in turn, could take care of people who actually need care instead of people who don’t care enough about their health to make any changes besides adding another drug to their day. Doctors could trust that patients were actually invested in their own health and wanted to get better. People who needed to see a doctor could get an appointment right away because the spots would not all be filled with the incessant and unending follow up appointments for diseases causes by people’s lifestyle choices.

Today I walked into a 6-month old’s well-child exam to find the child’s mother feeding him a Hostess Cupcake.

I was told the other day that 15 beers a day is not really that much and the people who can’t hold their alcohol should try harder and practice more.

More than half of the OB checks have involved trying to convince people that drinking alcohol is not good for the baby. Neither is smoking, riding on ATVs, or using cocaine.

Maybe the most depressing part is the staff who see these problems and their effects a dozen times a day order pizza and brownies for lunch three times a week from drug reps.

I know this rant is laden with bile and far-flung saliva but I am fed up with seeing these problems. I don’t know how family practice docs can do this all day. Five days of seeing the way people treat themselves, their spouses, and their children is enough to make me move to the desert and never talk about other people’s health again. While I strive to be eternally optimistic and never to be judgmental, I can’t help but think that the things people do to themselves should be a criminal offense.

8 Readers rock!:

Anonymous said...

That is ABSURD. I cannot believe that you're having to deal with people like this!

Apricot said...

2nd year medical student already dreading encounters like the Hostess cupcake one. What do you SAY to a patient like that without coming across as condescending?

It's a loose connection at best, but I read the other day that 29 percent of American adults have an undergraduate college degree. I cannot think of a single one of my friends and close acquaintances who does not. It really reminded me what a specific subset of the population I'm used to interacting with, and how much my interactions will broaden once wards start.

So what did you do? Just give the "Let's talk about weaning...4-6 mos...rice cereal, mashed bananas...then 10 mos...fruits and veggies...one at a time for food allergies" talk? Do you have time to do that for each patient who needs it? And does it change anything?

I really want to be able to connect with patients...and I've never even eaten a Hostess cupcake.

Janka said...

First, you are right.

But how family medicine actually becomes tolerable is when you start to get to know these people, and understand their lives, and understand how their minds work, and sometimes you can actually help them take care of themselves. Not for everyone, but each case of someone's life becoming not only healthier but also happier is very well worth it.

Unfortunately, in many places, there is no room for the old-fashioned family doctor.

Janka said...

Oh, and at Apricot: you say "I do not think that it is good for your baby to feed him *those*!" It is nice to try and be nice, but honesty is more important. You cannot let your patients hurt themselves (or their children) and not tell them your opinion.

What they *do* with your opinion is their choice, and you *have* to respect that, but you need to tell them *yours*. That's what you are paid for.

~Ashley said...

wow, it's insane that you have seen that many patients! wow. i hated that as a student because like somebody above said, it's more about knowing people--and as a student, especially in clinic, i always felt like a "doc in a box" because there wasn't continuity for me.

regarding the 6 month old--
we had a patient who was 8 months old, the dad asked us if he could "water down pop or something to put in his bottle so that he'd have something that tasted good to drink" and this same dad said he'd heard "blowing smoke" (presumably cigarette) into the baby's ears would help with ear infections.
another parent wasn't giving a little girl her asthma meds because he felt "they would burn up her lungs" but he was fine with smoking inside...
oh, and i once saw a no more than 2 year old unscrew the top off of a pop bottle, take a swig, and then screw the top back on.

never ceases to amaze...

Long Family Chronicles said...

Katie -- your family medicine described my previous clinic job. I spend 40 hours/wk with ONLY high cholesterol, HTN, DM, and anticoag patients... most of which could care less about their health. What never ceased to amaze me was the fact they kept coming back (paying copays) to here me gripe at them for their HORRIBLE lifestyle.. you want to scream ... "you are the reason this system is broken, you are robbing good healthcare from people that really need it... shape up buddy or ship out to another country!" I could rant and rant and rant FOREVER!!!

ps. i think i would have died with the 6 month old... i thought giving sophia a few bites of my "big person spelt bread" or my yo-plus natural yogurt was a big deal!! guess not HUH?

Martha said...

OK, from the social work perspective regarding a very broken system. Yes, there is diabetes and high cholesterol and a myriad of problems and poor choices...
But a lot is due to the cycle of poverty. How do you afford healthy foods when you only get $200/month of food stamps? You can get enough mac and cheese and ramen noodles to feed the family for that, but vegetables and fruit? forget it. Most of these families depend on the free lunch program to feed the kids those items. Believe me I understand your rant, I feel like if I could have started 3 generations back the kids might stand a chance. Also don't discount genes. I am diabetic. I try to watch what I eat and I have lost 50 pounds but like my exercise daily, oatmeal chugging sister we both got a lousy deal from the deck and we run high levels despite our precautions. I know its incredibly frustrating but try to remember that it may be a case of ignorance rather than stupidity. That education and encouragement can help these people make choices and change. That's where we come in. Also we have to go where the clients are. We have to walk in their shoes. They have not have the privileges we have had. And we have to accept rather than judge. Most of all we have to learn to live with the unanswered questions. I feel for you. You too are going into a heartbreaking field. But there will be rewards. And they will be like diamonds among the stones. Love and Peace to Katie. Keep the faith. Fight the good fight.

Katie! said...

Thank you all for your comments. After a few days off and away from the office, and strengthened by your perspectives and thoughts, I am ready to step back into the ring. You people deserve a medal. xo.