The magical mystery land of community health

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

How to win over your PCP May 27, 2009

Filed under: Uncategorized — lesbonurse @ 12:50 am

I try hard to be a good PCP.  I apologize when I’m late, I try not to be rude and I respond to medication refill requests in a timely manner.  In return, I’d like to offer a few suggestions for patients.  If you do these things, you will win my heart:

  • Do ask questions.  I’m serious, it lets me know that you’re paying attention and you’re invested in your health.  Any provider who discourages you from asking questions is a douchebag.
  • Don’t spend 20 minutes making idle chatter and then bring up your very serious and important question right as I stand up to leave.
  • Do tell me about embarrassing things like urinary incontinence
  • Don’t bring me a urine sample in a pill bottle.  Margarine containers and baggies are also out.  Put the urine in a screw-top jar if you must show it to me.
  • Do work on your descriptive words.  Is that phlegm brown?  Green?  Thick?  Is the pain sharp, dull, throbbing?  This is helpful.
  • Don’t bring a sample of phlegm in a napkin or a bit of vomit in a coffee can.  This is gross, and I could probably do just as well with the descriptive words alone.
  • Do show me your rash if you think you have bedbugs
  • Don’t bring me a live bedbug trapped in a pill bottle.  They give me the heebie jeebies!
  • Do shower before your pap smear
  • Don’t douche and scrub out your vagina 20 minutes before the exam.  I actually need to see the discharge if it’s bothering you, and I can’t get a good sample for testing if you’ve sterilized your vagina.  I know it’s embarrassing and awkward.
  • Do let me do a rectal or a vaginal exam if I recommend it.   Trust me,  I’m not doing it  for kicks.
  • Don’t threaten to bring a gun to the clinic and blow your brains out if I don’t refill your Ativan.  This will result in a crisis evaluation, not a med refill
  • Do be polite to all of the office staff, not just me.  I can hear what you’re saying at the front desk!
 

Proof that I’m not the only one with a crazy job May 12, 2009

Filed under: Uncategorized — lesbonurse @ 11:36 pm

Me, sitting at my office desk. Phone rings. It’s my girlfriend, who works with children who have developmental disabilities.

Me: “Hello?”

GF: “Hi, Lesbonurse”

Me: “Hi, girlfriend! What’s going on?”

GF: “I have a work-related question. If a child ate some of their own poop, is that a problem? I mean, are there any health risks?”

Me: “Ummm…how much poop did they eat?”

GF: “About a handful.”

Me: “Oh, gee, I’m not sure. I mean, there’s no hepatitis risk. I’m not sure if they can give themselves e. coli or anything. I think it’s ok. Maybe the kid will have an upset stomach or something.”

GF: “Ok, thanks. I called the school nurse and she just laughed and said ‘I don’t do behaviors.'”

Me, already thinking about who I will share this story with 2 seconds after I get off the phone: “Ok, bye, I love you!”

 

Let’s talk dollars and cents

Filed under: Uncategorized — lesbonurse @ 1:30 am

I’ve been looking at my budget a lot lately. The girlfriend is going back to school (yea girlfriend!), but that means that we’re going from a 2-income family to a 1 1/2 income family (the 1/2 income is from her financial aid). I can’t believe how little disposable income we’re going to have! And yet I’m a honest-to-god white-collar professional. It’s a little bewildering…when I got my salary offer after graduation, I danced around and shouted “I’m rich, I’m rich!!” And yet despite my visions of wealth, I am not rolling around on a bed of dollar bills every night. Don’t get me wrong, I’m doing alright. I can pay my loans, the mortgage, the car payment. I can buy the fancy “natural” dog food . I can even go out to dinner on the weekends. It’s actually all ok, until we think about having children. That’s where the budget hangs its head in shame. Seriously, what the hell? Growing up, my family of 4 did fine on a single income, and it was half of what I’m making now. Why do I feel like having a child will bankrupt us? I think it’s really the specter of daycare that is so financially frightening. $1000 a month for childcare is enough to make me wish for a stay-at-home spouse. Too bad me and the girlfriend both have career plans that can’t take a break for about 5 years or so.  And by that time my fertile eggs will have crumbled into dust.

The question on every new grad’s lips is “what’s your salary?” I’ll tell you, because I think that nurses and NPs should talk about our pay. How else will we know if we’re getting screwed? I started as a brand-new NP with a salary of $72,000. After a series of small (ok, tiny) raises, I’m now making $75,000. It’s not a bad salary for community health. Some of my classmates who are working in major metropolitan areas started at $80-90,000 for ambulatory care. Other clasmates of mine make $100,000 as hospitalist NPs. As someone who once pulled in a whopping $18,000 a year (living hand-to-mouth in a major West Coast city, no less), I have no complaints about my current salary. I just wish kids weren’t so damn expensive!

 

You know it’s going to be a long visit when… May 5, 2009

Filed under: Uncategorized — lesbonurse @ 11:16 pm
  • The patient is unfolding a list of questions and number 1 on the list reads “Suicidal Depression”
  • A patient begins his story with “I got shot in New York and the doctor told me I still have some bullets left in my back.”
  • The chief complaint is progressively worsening vocal hoarseness with new onset of hemoptysis…in a 2-pack a day smoker.
  • The patient was referred to you for a pap smear…and she’s 80 years old and has Alzheimer’s (nevermind the fact that the indication for a pap can be decided on a case-by-case basis in women over 65 and a celibate 80-year old does not need a pap!)
  • A patient tearfully describes her chronic body pain while her 2-year old toddles around the room attempting to touch the biohazard bucket.  The HPI is interrupted repeatedly by the patient yelling “NO!  Caca!  Poopy!  Sucio!  NO!”
 

Sunday Night Haiku May 4, 2009

Filed under: Uncategorized — lesbonurse @ 2:12 am

Not a good combo:

Coumadin and alcohol.

Seriously.  Stop.

Sent home by the boss:

Need a return to work note

saying “No swine flu”

New patient seems odd.

Turns out she has Alzheimer’s.

Please, bring family!