I feel like I should add an addendum to my previous post about fibromyalgia. I think that one of the reasons that it is so frustrating to me is that there is very little that I can offer to patients that really helps. Much like mild-to-moderate depression, low back pain and tension headaches, the treatments involve a lot of work on the patient’s part, and nothing is a guaranteed cure. It’s a lot more fulfilling to dispense some Allegra and Nasonex and watch people’s seasonal allergies disappear like magic. For someone who got into healthcare out of a desire to help people have better, healthier lives, it’s upsetting to have so little to offer.
My personal challenge: fibromyalgia November 22, 2008
I have a challenging job, to say the least. I am confronted daily with problems that I will not–cannot–solve in my role as a PCP. I can see the all of humanity’s ills, all of the failures both small and large. Blame capitalism, human nature, illiteracy, poverty, governmental failure, lack of motivation, poor nutrition, abuse, trans fats, t.v. It’s all there in my clinic waiting room. I can take it on (possibly not all at once, but I can try!). But one thing really makes me want to hide in my office. What might that be? “Chief complaint: FIbromyalgia.” Now, I’m not trying to blame the patients for their disease. I do believe that fibromyalgia is a real syndrome that affects how the body processes pain. It has far reaching–and at times disabling–effects. It’s just that Fibromyalgia (and it’s cousin, Low Back Pain) are chronic and basically incurable. Patients that are exceptionally motivated can exercise, stretch and medicate themselves into relatively pain-free functionality (often at a considerable personal expense due to massage, chiropractors, herbal supplements, etc). However, note my use of the word exceptional. By definition, most people are not exceptional. The majority–if not all–of my fibromyalgia patients are depressed, which severely compromises their motivation. Most of them have chaotic home lives that involve caretaking of family members at the expense of their own needs. Many of them have zero disposable income when their expenses are paid. Some of them have addictions that interfere with their personal growth, their judgment and their savings accounts. I know all of this. I feel for my patients, and because of this I try not to be judgmental about their illness. I like to think that I avoid talking down to people, and I don’t believe that anyone should be shamed about their conditions, including psychosocial issues. I have to confess, though, there are times that I want to slam the chart shut and yell at the patients. I envision myself saying non-therapeutic things, like “Look, you’re never going to get better if you sit on the couch and mope all day.” Or, “Can you just go to physical therapy already?”. On a bad day, my internal dialog gets worse. “Stop crying,” I want to say to people, “Do you know how many people have already cried to me today?” Or: “Stop asking me for more medication to fix this! I already told you, exercise, sleep, gentle stretching and anti-depressants are the best treatments! Why won’t you do that? Why? WHY?” I don’t say these things, and I try to keep my frustration off of my face. That’s probably the reason that the patients keep coming back to me. Other providers are not as circumspect. Repeat these visits ad nauseum, and you can see why most providers roll their eyes when they hear “fibromyalgia.” I have no answers about how to fix fibromyalgia. If I did, I could singlehandedly improve about 1000 people’s lives in my community alone.
Transgender Day of Remembrance November 15, 2008
Transgender Day of Remembrance is next week (Nov. 20, 2008). If you have never seen these sites: www.rememberingourdead.org and http://www.gpac.org/50under30/, you should check them out. Just be prepared for some really depressing stories. The sheer depth and breadth of human cruelty is always a surprise and a disappointment to me.
Coincidentally, this week I had a patient that really illustrates the importance of trans-friendly primary care. One of my patients, a transwoman, developed a serious skin infection. She had actually had the infection for a week, but had waited until her scheduled appointment with me to seek care for it. In fact, if she had not been scheduled to see me to discuss her hormones, I’m not sure she would have sought care until it was life-threatening. As it was, I had to bring in an attending physician to assess whether or not we could treat her as an outpatient or whether she needed to go to the ER for IV antibiotics. We decided to treat her as an outpatient (although we did check labs and blood cultures). I saw her again 3 days later to reassess her wound. It looked MUCH better. What had previously been a grapefruit-sized infection had shrunk to tennis-ball sized, the skin was not longer hot and red, and the patient was not longer nauseous and dizzy. She’s continuing her antibiotics and I’m going to see her next week.
So what were the beneficial outcomes here? To begin with, the patient felt comfortable enough to remove clothes to show me the area of infection, which led to her getting treatment before it spread to her bloodstream. Next, the patient was spared a visit to the emergency room (which can be a nightmare for gender-variant folks). Additionally, her insurance was spared the cost of the ER/hospital visit, which is a blessing in terms of keeping costs down. Lastly, her prompt treatment upon diagnosis spared her a surgical debriedment of the area, which is a painful, costly and resource-consuming treatment.
It not only behooves us as compassionate human beings to provider trans-accepting and trans-friendly health care, but it can also reduce ER visits, reduce costs and reduce morbidity. In your face, transphobic healthcare providers!
Election night November 4, 2008
Oh, the anxiety! Please, Obama, please please please be the next president!!
It was a pretty incredible day. All of my patients had voted, except one woman who bemoaned the fact that her citizenship ceremony isn’t until next week. Wow …pretty impressive.
Now to watch CNN until my eyes bleed and bite my nails for the next 5 hours.