As the clock ticks down towards October 3 (my return to work), I have started to refresh my memory on the common stuff that patients come into the office for. You know – birth control/family counselling, back pain, high cholesterol, diabetes follow-up, new baby/well-baby visits, depression/anxiety – the bread and butter of family medicine. Medicine is constantly evolving, there are always new guidelines that need to be reviewed, new updates on the treatment of such and such. It’s hard to keep up with it all. I often find myself looking something up while the patient is in the office with me. Some docs might think that’s the wrong thing to do (gotta make sure we don’t look like we don’t know something!), but I think the patient actually appreciates it when you’re honest about stuff like that.
Anyway, here are a things that I’ve reviewed:
1) new immunization schedule for infants/children:http://www.health.gov.on.ca/en/public/programs/immunization/docs/schedule.pdf
2) enhanced 18 month WBV: http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/enhanced_18-month.aspx, with information re: Austim screening tools
3)Osteoporosis guidelines (these actually came out late 2010, I’ve been procrastinating a bit): http://www.cmaj.ca/content/early/2010/10/12/cmaj.100771.full.pdf+htm
I have to question the wisdom of the new changes to the immunization schedule, mainly the change back to giving one dose of MMR at 12 months and the second at 4 years (when it has been given at 12 and 18 months for the last few years). How does one explain this to parents? More importantly, will parents think this change is due to the increasing paranoia in the mass media regarding MMR and its purported links to Autism? (Note: that theory has been officially debunked in the scientific community; google “andrew wakefield fraud”, “Lancet retracts Wakefield”). And while I’m on the subject, can I just say how much I hate it when parents tell me they are going to delay “certain” vaccines until their child is older. I have yet to have anyone give me an adequate, sound, evidence-based reason. If there is one out there, please, would someone kindly comment and tell me?
As I’ve mentioned before, generally I am looking forward to getting back to work so I can reconnect with all my patients and get my “doctor groove” on. But there are a few folks that I am already dreading to see – the so-called “heart sink” patients. My fellow physicians out there will understand who I mean. These are the patients, that when you see their name on your day sheet, your heart literally sinks. You know it’s going to be a painful visit. For these are the patients that whine. Life isn’t fair to them. Their pain is beyond their control, “I need more oxy’s doc”. Then there’s the patient who just can’t cope – she needs “stress leave” for a bullying boss. Then there’s the one who has environmental illness and is allergic to everything- no, wait, she left my practice, didn’t think I had enough time for her. Riiiight. This coming from the woman whose 15 min appointments always lasted 35-45 minutes.
Sigh … so yes, I am looking forward to returning to work. It’s time. If nothing else, it’ll force me to get off the Internet during the day (except for this blog, of course), to be present in the moment with my patients, to affect change in those who are willing and able. But overall, to provide for my family.