There are many days when I feels satisfied to have chosen primary care as my field. I can brush off questions like "are you JUST a family doctor?" and "aren't you going to specialize?" with ease and even a touch of primary care pride. However, feeling like any medical ailment COULD be within my domain also causes a bit of anxiety for this newly minted family doc attending. Of course, there are limits, but in prison I might be the only doctorly eyes that see a patient for sometime.
Uncertainty in medicine has always bothered me. I want to know the answer to every question, even the mundane ones. I'm beginning to make a list of the scourges of humanity, problems which plague my patients and, therefore, are plaguing me because I can't answer them with a snappy diagnosis. White lines on your nails? Excessive hair loss? Numbness "everywhere"? Dizziness? Eyelid twitches? Well, that's clearly... hmmmmm... Don't sweat the small stuff, right?
Prisoners also often try and cram as many vague and random complaints as possible into a single visit to avoid being charged for multiple visits, which is not unlike patients on the outside. I have to set limits with the number of things I'm willing to address but that doesn't always go over so well. A lady earlier in the week got huffy because I wouldn't refill her prilosec or talk about her GERD after we were wrapped up her visit on pelvic pain. She was bad mouthing me all the way out the clinic. Why battle over prilosec? Well, I don't want to, but you can buy it on canteen -although pricey- and the visit was over by the time she brought it up. I felt my usual chocolate heart turning a bit stony. Perhaps I should attend the upcoming Swedish CME about maintaining empathy...
That's an interesting way to describe problems that plague your patients as "scourges of humanity". I would think poverty, tuberculosis, malaria, parasites would be scourges rather than white lines under their fingernails. You say you are plagued because you don't know the instant answers. You are not alone and it's not because you are not a specialist. A specialist elects to shrink his domain of expertise perhaps because he or she is more interested in a group of diseases rather than treating a broad age group or wide range of diseases. You have had excellent training to this point and for the rest of your life experience will be your teacher. But that experience will teach you gradually. If you were to come back to prison in 20 years to work, it is natural to expect your 20 years of additional experience to give you some more answers to those vague and random complaints. The problem is that many of those vague and random complaints may not really have answers or explanations and they shouldn't make you anxious. Making a list of them sounds like a good idea. Calling them scourges may be hyperbole. Don't maintain excess empathy just strike a balance.
ReplyDeleteDid Dad just call you out on your use of hyperbole? A huffy attitude is the scourge of humanity! Theologically speaking... ;)
ReplyDeletePS I appreciate your desire to provide the utmost doctorly care.
PPS Chocolate is a good cure for anything. Can you prescribe the women chocolate? What's the dark chocolate supply like in prison?
I would miss your blogs if you became a "regular" type doctor. I need your adventures to jazz up my dull life.
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