The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

‘Real’ disability March 27, 2008

Filed under: Uncategorized — lesbonurse @ 12:04 am

I feel confused about the whole disability form issue. At our clinic we have many patients who come in with state disability forms, asking their PCP to help them get the monthly payment. Of course, this ends up being a philosophical and political issue for the providers. We have a relatively small amount of patients who are completely and totally incapacitated–but a very large amount of patients who report that they have disabling conditions such as chronic pain, anxiety, crippling depression (and, as a few people have claimed, disablingly high blood pressure). In fact, one of the “get off your fat ass and work”-minded residents told me that in a recent chart review of 250 randomly sampled patients, only 10% reported that they were employed. This leads to some questions:

  • Are our patients working under the table?
  • Are our patients really all disabled?
  • Are our patients as lazy as this resident thinks they are?
  • How DO our patients get money?

Despite the fact that this resident pulled out the tired old “If our patients are so poor why do they have nice sneakers and acrylic nails?” argument, I really don’t see that our patients are living the high life. I don’t see gucci and facelifts…I see ratty t-shirts and cheap knockoff bags. And part of me thinks that if our patients feel that getting $600 a month is the best they can do for income, it bespeaks a bigger socioeconomic problem that points to the need for education, literacy and…well, some kind of magical motivational quality that is lacking in our society. And I kind of feel like I don’t care that marginally-disabled people are pulling in 7 G’s a year. As I see it, the problem is that only a few exceptional people can manage to pull themselves up by their bootstraps while juggling family, job and school–yet there’s a societal expectation that everyone will be the exception to the rule. The majority of our patients are either too busy, too depressed, too learning-disabled or too crushed by the unrelenting demands of their lives to achieve greatness. So does a life of depression and crushing poverty justify granting someone disability for their chronic tension headaches?

 

Monday is also haiku day March 25, 2008

Filed under: Uncategorized — lesbonurse @ 1:50 am

Oh no! Chronic pain

I don’t know what to tell you

Sorry I can’t help

Chronic pain’s siblings:

Depression, anxiety.

Can’t help those either.

I’m no counselor

But the therapy wait list

is 4 to 6 weeks

Yes, xanax does help

Too bad it is addictive.

I could use some, too.

 

Don’t lie to me! March 18, 2008

Filed under: Uncategorized — lesbonurse @ 1:15 am

I have a plea that I’m sure is shared by every healthcare provider on earth: please don’t bullshit me! Just admit that you haven’t followed any of my instructions, and then we can both understand why you’re not getting better despite my best efforts!

Here are some of the recent lies I have heard:

  • “The cocaine in my urine test was from the lidocaine patch for my back”
  • “I’ve been using the flovent for my asthma every day just like you told me and it’s not helping at all.”
  • “I quit smoking”
  • “I’m not on any medication for my pain at all” (when I called this patient’s orthopedist I found out that she got a rx for oxycodone 4 days ago)
  • “The other doctor didn’t help me at all” (from a patient who declined to get the recommended chest xray, did not show up for her follow-up exam and was vague about whether or not she was actually using her controller inhaler as prescribed by the NP at her last visit)
 

Sunday is haiku day March 17, 2008

Filed under: Uncategorized — lesbonurse @ 2:19 am

My patient was on

receiving end of sixteen 

gunshots in his back 

Urgent appointment:

Why? Oh, my neck hurt yesterday 

It doesn’t hurt now. 

New patient visit

Lady on fentanyl patch

I need your records!

Patient with cancer.

Awkward discussion about

End-of-life choices 

 

I hate you, documentation March 11, 2008

Filed under: Uncategorized — lesbonurse @ 1:57 am

Right now I shudder to think about my desk at work.  This is because I have 23 charts stacked on my desk.  The charts are sitting, lurking and waiting to torture me with their endless documentation requirements.  This morning I woke up and as soon as my eyes opened I thought “God, I have all those charts to do!”  I do believe that my life would be easier if I didn’t have to use our stupid electronic record system for my notes.  I have the choice of making eye contact with my patients and focusing on them during the visit, or attempting to write my notes on the computer during the visit while mumbling “mmmhmmmm” and simultaneously forgetting whatever the hell they’re saying.  I choose to pursue the avenue of deep eye contact and reflective listening, which inevitably ends with me piling the unfinished charts on my desk and praying for a few extra moments at the end of the day so I can write my notes.  Several of my colleagues have taken the approach of using pre-written templates for their exams.  I recently came across a note for a male physical exam which clearly had been pre-written.  Why do I think this?  Because the genital section of the exam included a detailed description of the patient’s vagina and cervix.  Oops.  I also saw a note from another provider that listed the general appearance of the patient as “obese”–though the patient weighed 90lbs.  Although I feel proud that my notes are always detailed (and frequently feel grateful to myself for writing things down since my memory sucks), I wish they didn’t take so goddamn long.

 

I got the plague March 4, 2008

Filed under: Uncategorized — lesbonurse @ 2:29 am

some poetic inspiration from my illness…

My germy patients

Gave me a terrible plague.

Now filled with sickness

Nausea, stomach pain

horrible, horrible sweat

Do I deserve this?

Over and over

My hands are chapped from washing

How did I get sick?