- any foul or filthy substance, as mud, grime, dust, or excrement; earth or soil, especially when loose.
- something or someone vile, mean, or worthless: After that last outburst of hers I thought she was dirt
- moral filth; vileness; corruption.- obscene or lewd language: to talk dirt.
This is a total brag post.
Since getting back to work, I won’t lie, I have felt a bit rusty. I’ve had to look up antibiotic doses and such. I have felt a bit slow but my clinics don’t run that behind (about 30 minutes) so I think I’m doing pretty well. I actually hate running late!
Today was a different story. My clinical spidey sense kicked in and I diagnosed a woman with atypical pneumonia in the office. A few hours later the chest x-ray confirmed it.
I gotta say, it felt great. After 6.5 months of no medicine, having baby brain and crappy sleep, to feel like I haven’t lost “it” is pretty awesome.
And I ended the day with a 5.4km run home, in under 38 minutes.
Since February, I have been plagued by one sort of running injury after another. I’m starting to get annoyed.
First it was the Achilles tendon issue which resulted from too much running in the snow and running hills. Then, as I tried to address that and started running more on the midfoot strike, I developed a calf/shin/soleus issue on the opposite leg. I call it a shin splint (or medial tibial stress syndrome) but it also involves the soleus muscle itself and from everything I’m reading, it’s likely caused from too much mid-foot striking when I run.
Great! (insert sarcastic eye roll here)
So while the Achilles tendon feels much, much better, the left leg felt awful. So I rested, stretched, ran short distances and thought I was over the hump when I went for a short run the day before I started back to work, on March 31. I stuck to the most natural foot fall, the heel strike, and to my amazement, not an ache at all when I ran. And more importantly, no pain a few days later.
And then I ran home from the office for the first time since starting back to work and bam! The next day, the RIGHT shin/calf/soleus started acting up. In the exact same spot as on the LEFT. Seriously, WTF?????
Okay, so maybe I haven’t been resting as much as I should. Dammit, I love running and I love how it makes me feel. I don’t want to stop! Running with my girlfriend last week was amazing! I took Advil before the run and the leg felt great, but it’s 5 days later and it feels awful. I totally masked the inflammation by taking the Advil, I know this. We are supposed to run this week, so today I tried a mini run to the grocery store but had to stop after 50 meters. 50 METERS! God dammit!
I am part of an online running group and a lot of the women there are having issues – one in particular has just been diagnosed with a tibial stress fracture after being plagued with shin splints for months. Now, she’s a half-marathoner, so obviously running much longer distances than I am, but I fear if I keep going I may end up in the same boat.
So, I will try to listen to my body and rest up until this Wednesday. Seven days off should be sufficient time to heal, right? Right???
In the mean time, these will be close by.
Pet Peeves – an irritating experience caused by others in which you cannot control.
There are very few things that annoy me as a physician, so for your reading pleasure ….
- “I had some antibiotics left over, so I just took them for the cold I had last week, but they didn’t work, so that’s why I’m here.”
- “I went to the walk-in clinic (yesterday) and the doctor said I had a virus but I didn’t believe him, so I’m here to see you today, because you know, you’re my family doctor and I trust you.”
- “I made this appointment for myself, but could you look in my son’s ear … oh, and his foot? … and … [looking at her son, "Is there anything else that was bothering you?].”
- Cell phone rings in the middle of an appointment, “Excuse me for a minute, Doctor, I have to take this.” REALLY??
- Body odor.
- Patient calls to find out if I’m running late (I am not!) and then arrives a 1/2 hour late for his appointment.
These all just happened today.
I kid you not.
When I started running almost two years ago, I ran mostly with a few girlfriends, one in particular became my running buddy. It was awesome. But then I got pregnant and stopped running. Now that I’ve started again, it’s been mostly me running alone because I was on maternity leave and running during the day and my girlfriend you know, had a life and was working! ;) I really miss running with her but I hope that we can get back to running by the lake this summer.
A few weeks back, another friend messaged me asking if I’d be interested in a running buddy. This friend hadn’t run in a few years due to injury but was starting to get back into it and didn’t want to run more than 5km. I was a little hesitant at first because I thought I’d just slow her down (she used to do Ironman competitions), but she insisted she wasn’t crazy fast, so I thought “What the hell?” and we made a date to run the following week.
That was yesterday.
She met me at my office and we ran to my house. It’s just under 5 km and she thought it was a perfect start. Little did I know we’d be doing 10s and 1s! I mostly run 5s and 1s and had been doing some steady 35-40 minute runs until my injuries, but I didn’t want to look bad, so I agreed to the pace she set. And then we started talking.
And then I felt like I was gonna die.
Seriously! I had forgotten how hard it is to run and carry on a conversation at the same time. I was dying! By 4.5 km we were just around the corner from my house and I was so ready to quit but she made me run around the block again so that we would complete the 5 km.
I am so glad she was there to kick my butt. It turned out to be a fabulous run and we are going to make it a weekly event.
I am still feeling the runner’s high, though my shin is not too happy with me at the moment.
Where’s the Advil?
From the time of antiquity, healers, physicians, medicine men have treated their patients in the home. In the United States, up until a century ago, a visit to the home was the standard way of delivering medical care. Today, things are much different. A study published in the New England Journal of Medicine in 1997 looked at the frequency of house calls to the elderly. Shockingly, less than 1% of Medicare patients received house calls from physicians. I suspect that this remains the case.
And let me be clear, what I am addressing here are the home visits by a patient’s primary care physician, not the walk-in clinic doctor opening up a house call business.
The days of your family doctor coming to your home instead of you going to their office, are largely over, I think. Although my colleagues still make house calls, mostly for their elderly and housebound patients, as well as those dying at home, it’s not very often, and I can usually hear them grumbling about it. “Ugh, I have to make a house call.”
I am proud to say that I have made a few house calls, albeit not many, but when I feel it would benefit my patient, I make the effort. Granted, I have a much younger patient population than my colleagues, so the opportunities for home visits are few and far between. I expect this to change as my patients age. I was interested to find out what the state of house calls is in this country, so I looked it up.
In 2010, family physicians in British Columbia were surveyed about house calls. The sample size of physicians who completed the survey was small. After all, who has time in their busy practice to fill out a survey among all the other paperwork? In this study, 73 surveys were completed (250 were sent out). Of those completed, 87.7% stated they had done at least 1 house call in the past year; 31.5% did house calls at least once a month and 16.4% did them at least once a week. What I found interesting was that when the study authors looked at the physicians in two groups – those who graduated from medical school before 1990 and compared responses to those who graduated in 1990 and after, they found:
The 49 physicians (67.1%) who graduated from medical school before 1990 were no more or less likely to have done at least 1 housecall [sic] in the past year than the 24 physicians (32.9%) who graduated in 1990 or later (n = 42, 85.7% vs n = 22, 91.7%; χ2 = 0.53, P = .47). However, 11 (22.4%) physicians who trained before 1990 did housecalls at least once a week compared with only 1 (4.2%) physician who trained in 1990 or later (χ2 = 3.92, P = .048).
Younger physicians are doing about half the house calls their older counterparts are doing and even less are doing them once a week. The tide is turning, indeed. Even more interesting, is the report from the National Physician Survey:
The National Physician Survey reported that, in 2010, only 47.8% of British Columbia (BC) family physicians offered their patients housecalls and 0.9% described housecalls as a specific area of focus in their practices.2
Family doctors seem to prefer to see their patients in the office, not in their patients’ homes. I can understand why – it’s more convenient to stay in the office, travel time in the city can be a nightmare, and remuneration may leave something to be desired. After all, in the time it would take to travel to visit one patient, a physician could see 5 – 10 patients in the office.
A lot can be learned from visiting a patient at home. For example, an 85-year-old woman who has had multiple falls in recent months; she can’t come to the office because she’s in a cast after having broken her ankle. You, as her physician, decide to take the visit to her home. Upon walking in the door, it’s quite evident why she’s falling a lot – the floors are lined with ratty carpets, even you almost trip on your way in!! The patient’s daughter is also present for the visit and instead of discussing the fracture, the visit is spent discussing removal of the carpets!
I made a home visit this week to a patient who is dying of cancer. I called her husband last week and asked if she was well enough to come into the office. She has a team of doctors looking after her, one of whom is a palliative care physician who makes home visits every few weeks. A visit with me at this point is purely supportive in nature as her palliation is being tended to by the specialists. Her husband said that, while they do make it to chemotherapy appointments, and other specialist appointments, it takes a tremendous toll on his wife and he didn’t think she’d be up for an office visit in addition to their weekly outings. I knew he wouldn’t suggest a home visit – most of the time the last thing a patient wants is to impose on their physician. So, I gently asked if she wouldn’t mind a house call. The pause on the phone was telling. “That would be wonderful for her,” he said. “She would enjoy that so much.” He sounded a little bit surprised that I would offer.
Seeing a patient in their home environment is one privilege of family medicine I didn’t expect. Once you step foot into their home, they cease to be “just a patient”. You bear witness to their real life, to the home they have made, to their hopes and dreams, to their sorrow and sadness. My patient and her husband welcomed me into their home, offered me a delicious cup of coffee and we talked. We talked about her cancer and her pain; we talked about how chemotherapy was going; we talked about the cat I saw roaming in the backyard; they told me how they met in Spain thirty-five years ago; and we talked about their four children. I saw the hope flicker in her eyes when she talked about the chemotherapy that helped her pain and maybe, just maybe, is shrinking the tumors. I saw the courage in her husband’s eyes as he tended to her needs and fluffed the pillow she had behind her back. I saw the profound sadness in her eyes as she struggled to find the words to describe what it’s like to plan her own funeral.
Most family physicians don’t do house calls anymore.
I am not one of them.
My regular readers will have noticed by now that the look of The Urban Dr. Mom has changed. I hope, for the better. I felt a change was needed. I wanted to brighten up the look of my blog. I hope you all enjoy it.
Well, as of about 20 minutes ago, I survived my first week back to work.
I’m relieved to have it over and done with. My favorite part of being back is knowing how much I was missed. Ha! Seriously though, I love showing off pictures of my brood and catching up on the lives of my patients.
I won’t lie, I’ve been pretty tired. Thankfully the baby is giving us a solid 7-8 hours of sleep after midnight, so that has been super helpful.
I also managed to run home from the office the other night. I think I am over the hump of my injuries (more on that in another post), and I can’t tell you how amazing that feels. To run for almost 5km and not have any significant pain?! O-M-G! Talk about a little slice of heaven!
Here’s the proof!
Time to go home and have a nap. (Ha!! I wish!)