Monday, June 20, 2011


I am ending the rotation next week. It's been a great rotation for many reasons- FP is a nice sorta gig, as you can actually follow up and try to help a patient change their lifestyle so they might enjoy healthier living.

So, for the first week... My pt. (and this is the generic pt's- and believe me, there are a zillion just like this.)  DM-Type 2, NID, HTN Stage 1, add a bit of elevated BMI, a bit 'o drinking on the weekend- and maybe the weekdays. Maybe they smoke. Um. and the cardio they have (and this counts to them) is walking from the car to the door of their office.

So, you know that smoking (fill in the rest of the blanks) causes X,Y Z.
Yes, I do. I have tried many times to stop. I just can't.
That's great! Keep trying. You can do it! There are ways that we can help you...(fill in the blank)
Yeah, I got that patch/Pill/Gum once before. I stopped for a month/3 months/6 months and then started again.
Okay, well, I think that's great! Now, the next step is to try again.
That sounds good.     Yeah, maybe I can do it.
Wow- that's great! So, comeon' back in 4 weeks, and we will talk again.

Fast forward 5 weeks:
So, how are you doing?
Well, I tried x,y and z and I cut down to 19 instead of 20 a day.
Well,, what can we do to help that move along faster for you?
Well, I am not sure.

So, reality is this: When they are motivated to change, they will. I hope that I motivated some one person to change their lifestyle just one smidge to make their lives healthier. But I am not sure. I admit my conversations now lean towards

Do you smoke?
yes, about a pack a day
Okay, you know you're going to get the lecture. You know it's bad for you and I want you to know that when you decide to quit, we are here to help you in any way we can. Until you want to quit, there really is nothing I can do to help you.
Thanks. I've heard it all before.

We all know that we shouldn't smoke. Should drink in moderation. Should exercise. Should not eat junk, but eat at home, healthy foods filling our diet. But we don't- okay, some do, and I admire them. But I know I don't always. This past year is a great example. I have been a sitting, unexercising, icecream eating slob. I swear that this will change- when?

When I am darn good and ready. But it's HARD and its internal. I know all the reasons to be good- including feeling better. But, other than that. it comes from an internal place that just don't have the ability to tap right now. So, developing the knowledge that it's hard- yet still mentioning it at each and every visit is essential. I also have to say I bring it up in my ED conversations (the joys of being a student- no clock on my head).  I hope to make an impression to my patients with advice on healthy living- and I'll keep trying to be an example.

That road to hell is well paved

Nick is officially a college Freshman, Jas has come and gone, and I have 2 more official FP days with Dr. B.  Hard to imagine that I am almost 15% done with the year. Um...really?

I don't know enough. That is what I know the most. The rest is just mush in my brain, and I am hoping at some point in time it clicks. As for now, Thank God for Epocrites and my other iPhone programs. I use them  a lot, and am ever grateful for the quick glance to make sure I "get" it- and hopefully get it right.

I had one day that I found difficult. A pt came into the UC facility that I was working with. He was young, and had 3 small children with him. There was no other family with him, and the kids were, well, kind to say, un-disciplined. Now, I give my kids (or rather gave...sniff. No more kids for me! One all grown and one ready to be an adult....) a fair amount of free rein. But, there were certain things that they knew crossed the line. And perhaps I might have flown off the handle a few times, who knows...(they might and I do), but overall, I was never horrified by them in public.  Actually, I have to say they usually made me proud.

So, this situation was tough for me. These kids needed to behave- Dad was in pain, sick, and needed a bit of a "best not to go to soak in the lake after getting a huge 'tat on your arm...and if it looks hot and inflamed and has smelly stuff oozing out of it- might be a good idea to head to your friendly ED/UC without your kids, before you have a full-blown abscess or 3 in your arm" kind of talk that you give to all your patients that come in. Well, maybe not exactly that, can imagine something like that might be said to a supposed pt that might be presenting to you some day.  Just sayin'.

So, there was that line of pt needing my attention, and the kids demanding my attention. Kids won for a bit, only because I was afraid that they might end up needing a head CT from them bashing each others heads into the walls....

So, I left, and felt bad. My job was my patient- not the kids. My job was to take care of him, not his kids. My job was to treat him, not judge his parenting. For the first time, I felt that I learned something- from the patient, not a book. There is a great video...Every Person has a Story that says it better than I can- a training video from Chik-F-La. I have NO idea why that day I did not remember that important part of caring is...caring, but I am sure to remember from this point on. I have no idea what or how these kids got to be there, but surely they deserved more of me.

I would never have thought I'd have needed a lesson such as this- usually I am the one that points this out to others. But, in a very nice, yet direct way, someone showed me, and I appreciate it.

We learn more by being at the bedside than we learn from books. I am grateful...always.