Gotta love the girlfriend’s job, especially when she tells stories that end like this:
“…so then we had to call poison control. Oh, and we also realized that he had crapped in his pants.”
Another important life lesson July 29, 2009
If you happen to be a young person enjoying a night out in a club, and you happen to see someone that you have a problem with, and that person happens to “just walk up out of nowhere” and punch you in the face a few times, ask yourself these questions:
Did I lose consciousness? Do I have blood pouring from my nose? Did I just bite a giant hole in my lip? Does my entire face hurt like a sonofabitch?
If the answer to these questions is yes, go to the ER. Don’t wait a week and then walk in to see your friendly nurse practitioner with a complaint of “headaches and facial pain.”
Important life lessons July 26, 2009
This week I learned (or was reminded of) some important life lessons from my patients:
- A drunken backflip into a kiddie pool WILL result in severe bodily harm.
- If your therapist looks frightened when you talk about your suicidal feelings, find a new therapist!
- If a horrible rash doesn’t respond to 2 weeks of twice-a-day antifungal cream, it’s not a fungus.
- A month of vaginal bleeding after 10 years of menopause IS something to worry about.
- There is such a thing as a testosterone-secreting tumor. Which could possibly explain a very high testosterone level.
- If your back hurts, wear sensible shoes. Platform heels do not count as “sensible.”
Special “new intern” haiku July 25, 2009
Intern, are you gay?
Or just a fan of the short
hair and manly pants?
Only been a month–
Too soon to be an asshole.
Earn some respect first.
Battling the burnout July 18, 2009
A few weeks ago I was having a series of very bad days. Dozens of unfinished notes, news from the powers-that-be about increases to our patient schedules, constant talk about “productivity” and the seemingly endless needs of my patients had left me feeling crazed. For a day or two I even imagined what it might feel like to start looking for another job. I decided that something had to give. So for the past week I’ve been working on writing crappier notes. Not crappy notes, mind you, just a little crappier. There has to be a happy medium between the beautifully detailed–nay, lyrical–documents that I usually produce and the piece-of-shit-not-even-enough-documentation-to-satisfy-an-insurance-audit notes that some of my colleagues write. I’m working on it. I’m tossing out the description of patient’s social situations, substituting things like “significant social stressors” or “grief” in place of stories. Detailed neuro and ortho exams? Forget it. History of complex medical conditions? How about “See previous notes” instead. Does it feel good? Not particularly. But does it feel good to leave on a Friday with 8 notes pending instead of 28? It sure does.
My other anti-burnout strategy has been to farm out more work to the medical assistants and nurses. I’m sure that this has not increased my popularity in the office. Everyone likes the providers that do most of the scut work themselves. And I know that patients appreciate a nice phone call about a lab result or medication change. Sorry, everyone, the nurse will be doing that now. The nurse will be refilling your meds, calling to reschedule your appointment and letting you know that your potassium is low. I’d love to talk to you myself, but…you know how it is. Too busy!
It’s unfortunate that I am working in a system that prizes the number of patient visits over the quality of patient care. It’s unfortunate that the number of times I hear “How come you can’t be my doctor?” in a day has no impact on my salary. It’s unfortunate that I have to cut corners in order to keep myself from losing my mind. But it would be more unfortunate if I had to leave my clinic because of burnout. So I guess I’ll keep trying to be just a little less of a super-nurse.
Do’s and Don’ts of a bad economy July 12, 2009
Yes, times are hard and extra cash is scarce. Here are some tips I’ve gleaned from the patients in my clinic:
- Do buy the Family Dollar brand Loratadine for $2.50 for a box of 30 tablets. Cheap!
- Don’t buy the strawberry scented douche from Family Dollar. Douching is bad for you…and why does anyone want to have a strawberry scented vagina?
- Do use your disability check to pay the co-pay for your Spiriva
- Don’t use your check to pay for a pack of cigarettes (or even worse, a carton of cigarettes)
- Do be creative with your fundraising
- But…Don’t sell your narcotics on the street outside the clinic
- Do drink water from the tap
- Don’t spend your money on those terrible little barrels of “fruit punch” that sell 10 for $1
The questions that came out of my mouth today: July 8, 2009
- “Why were you carrying $400 worth of narcotic medications in your purse?”
- “When did you first notice the sore on your vagina?”
- “Why are you asking for GoLytely as a daily medication?”
- “Has anyone talked to you about the bad effects of overusing laxatives?”
- “Do you know your blood sugar is over 500?”
- “Have you checked your blood sugar at all in the past month?”
- “Has anyone ever told you not to cut out your ingrown toenail with a knife?”
Something’s burning… July 6, 2009
That toasty smell I’ve been catching whiffs of for the past few weeks is the smell of my own impending burnout. I knew this day would come, but does it have to come so soon after going into practice? I’m barely 2 years out of the starting gate, and yet I’ve already had wistful thoughts of abandoning my practice and fleeing this sad little city.
The 3-day holiday weekend has helped rejuvenate me a little bit. But the past few weeks sucked. I’ve worked in social services long enough to recognize the signs of burnout as they develop. Chronic fatigue? check. Sense that nothing I do makes a difference? check. Desire to tear up my unfinished progress notes and run screaming out of the building? check. Inability to listen to patients talk about their terrible lives ad nauseum without feeling annoyed? check! What’s a community-health minded girl to do?
Last week one of the physicians at my practice stopped by my office to say goodnight. He informed me that he had seen 20 patients that day. Were his notes finished? Sure they were. Incredulously, I asked him how he had managed to finish them all on the same day. I work on notes until my eyes bleed, and I never get down to zero. “Simple,” he said. “Quality suffers. I have to sacrifice something, and it’s not going to be my family.” Wow. It’s so sad, and so true. I am perpetually behind because I refuse to spend my entire visit typing on the computer. I also refuse to dismiss patient’s concerns during the visit if they are relevant, and I refuse to write shitty notes. This makes me a superstar from a patient care perspective. But from the perspective of someone who hopes to one day have a family (which would preclude me from working 60 hours a week), this is unworkable. I’m going to have to figure out which piece of quality care is going to suffer. Hopefully it can be the documentation and not the face-to-face interactions. I should also take up yoga again. Too bad I’m perpetually fatigued. (Please, don’t tell me how doing exercise will invigorate me and give me extra energy–it’s always hard to drag my ass out of bed earlier than 6a.m. Yoga doesn’t make it better.)
