The magical mystery land of community health

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

I can tell we have a lot of work to do August 3, 2009

Filed under: Uncategorized — lesbonurse @ 1:21 am

Me, looking at office glucometer: So your blood sugar is 395.

Patient: Oh. I think it’s probably high because I’ve been stressed a lot.

Me: Last time it was 400.

Patient: Yeah. I don’t know why! I barely eat anything at all. Why does this happen to me?

Me: Tell me what you had to eat today.

Patient: Nothing! Only water!

Me: Really? It’s 4 p.m. Aren’t you hungry?

Patient: Well, I had some coffee this morning. With some crackers.

Me: Ok. Well, the crackers could make your blood sugar go up a little bit.

Patient: Oh yeah, I also went to Taco Bell with my daughter. But don’t worry! I had something with chicken in it.

Me: Like a burrito? A taco?

Patient: I don’t know. But it had chicken. Chicken is healthy, right?

Me: Well, it depends what’s…

Patient, interrupting: Oh, I forgot! Then I went to Wendy’s with my nephew.

Me: You went to Taco Bell and then to Wendy’s?

Patient: Yes, but don’t worry. I only got a shake!

Me: A shake has a lot of sugar in it. A LOT.

Patient: It wasn’t the biggest size.

Me: How often do you eat at Taco Bell and Wendy’s?

Patient: Oh, not that much. I usually eat at better places, like the Olive Garden.

Me: Do you eat the breadsticks?

Patient: I get a salad.

Me: Do you get the pasta?

Patient: Sometimes. But also the salad!

Me, weeping a little inside: Have you ever seen our nutritionist? She could really help you figure out which things to order when you go out to eat.

Patient: I don’t think I need to see her.

Me: Everyone can use a little reminding about how to eat a healthy diet. I think it might be good for you to see her a few times.

Patient: Ok, I’ll go.

Me, conscious of the fact that we have vastly exceeded our visit time already on discussion of a different issue: Great! I’m doing the referral right now. Take this up to the front desk. I’ll see you in 2 weeks. Bring your glucometer, ok?

It is a huge bummer to know that this patient needs about 10 hours of intensive diet and diabetes education, and I can provide less than 20 minutes of that. And the 20 minutes also included a discussion of leg pain, psychosocial stressors and a skin infection.  Sigh.

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3 Responses to “I can tell we have a lot of work to do”

  1. Knifemouth Says:

    Buuuuuuullshit.

    Here’s a wild concept for everyone: PERSONAL RESPONSIBILITY and active participation in your own health EDUCATION and your LIFE.

    Ten hours? That is how much mental health therapy my medical benefits covers in a year …if I’m lucky.

    You believe he deserves and is somehow ripped off for not getting ’10 hours of diet and diabetes education’ from you.

    Maybe, if there is any health care reform at all, we can have a lovely future that someday includes places where people can go and congregate, have educational materials aplenty, rooms where people with the same conditions can have support groups where they share recipes and scoff at the drive thru. They may even break it down for him: iceberg salad-meh, romaine salad-hm, uh oh: !yay!-SPINACH SALAD! Dressing time? Well Ranch, no. Thousand Island, I don’t thinks so, but you know maybe if you’re not swimming in it. Ya following me? The Healthy Salad, Mister …follow that trail where it leads!! Usually it aint handed out a drive thru window…

    Um, until then – this guy has the library, online sites, existing support groups, HEY!! Creating a support group inside his own fucked up shit-eating family would be GENIUS.

    Him “I don’t think I need to see her (nutritionist).” basically means ‘that sounds like hard work and change which I don’t really want to do. I want to get the fucking FROSTY at Wendy’s, the New Chicken Burrito from the Bell cause I like to think OUTSIDE MY BUNS (slightly disingenuous but a pale imitation of politeness:) thanks so much anyway, Lesbonurse!’

    You think 10 hours is going to change this dude? He’s totally fucked up and he’s taking his beloved beautiful daughter to eat shit at FAST FOOD joints and then his other beloved kinfolk child to eat shit FAST FOOD at some other greasehole.

    Hey, don’t tell me it aint hard Mister Onset of Coma, cause I was pulling teeth getting that kid in my apartment off his ASS the other day to cook some fresh food with me- OMG he didn’t just sit on his jeans in the drive-thru, slumped over with the iPood on / playing his PS14 acting like the world doesn’t exist. No: he cooked, he participated. (Why? Cause he was hungry and that was his option. The day before he would not so he stayed prone, stomach grumbling while I made my own food: yum yum. Next day? Well hey! Participation!)

    Seeing as I always read these in order, I can’t wait for this guys follow up visit!

    Did he see the nutritionist?? Did he learn what a carb is? Does he know how to spot ’em & count them now? Is he still mawing down the curly pasta with the cheesey sauce, 7 breadsticks and oh maybe 12 bites of a salad…do you think it’s the Iceberg Wedgie / Bacon Bits & Bloob Cheeze – Carby croutons?

    Or does he come in with a toe missing, or a whole foot…

    Or does he start to take charge of his life like we all do or suffer the damn consequences. You can lead a patient to their diagnosis but you can’t ___________________.

    (Too many, gotta run.)

  2. lesbonurse Says:

    Sure, you can bash someone for eating fast food instead of healthier options, but this patient literally does not know any better. She really thinks that because “chicken” is healthy then any fast food item made with chicken is automatically a good choice. Before we can get mad at people for making bad choices, we have to make sure that they know what the choices are. Surrounding my clinic is a fast food burger place, a Chinese restaurant, a liquor store and a few bodegas–it’s hard to make good choices when you’re starting with that selection. Especially if you never finished school and you’re functionally illiterate.

    • knifemouth Says:

      Lacking a high school diploma and/or being somewhere on the scale of literacy or lack thereof doesn’t mean you are lacking common sense, nor does it mean you are stupid.

      Based on your comments, your patient is not finding this out for the first time, you’ve talked to them at least once about the glucometer and blood sugar & I’m thinking back then maybe as a good health care provider you might have pointed out that eating fast food and 7-11 big gulps of soda pop is BAD – just in case they missed the media saturation. I cede your chicken point, but some folks aren’t taken in by vitamins shoved into Twinkies & deep fried either. Just a note for the future. (Where do they get all this money for fast food 2 or 3x a day- especially the Olive Garden? Hello, recession!)

      To go from “ate nuthin, coffee, oh! crackers, aw shucks taco bell, then to a 2nd trip of ‘just grabbing a nutritious milk shake’ and following all of that with ‘no thanks to your nutritionist’ means they are either not willing to change or they aren’t that bright.

      It’s a lot more polite where I stand to be honest about someone’s intelligence & their challenges challenges and have an honest discussion from that start point than it is to cloak it behind some condescending, liberal hand-wringing ‘poor soul never stood a chance with that lack of algebra/geology/sentence structure and Phys Ed classes – much less not being able to read at their age, no wonder they were ‘drawn to the pretty picture of a Wendy’s Frosty on the menu board to appease their appetite when they know they are sick with this shit’ …while you were choking back tears.

      But don’t insult people who lack a diploma or are illiterate to make them sound like helpless children who are in a trance by the chum-chum buildings surrounding your clinic.


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