I’ll be Damned.

I have a decision to make.

Do I vote yes and be complicit in accepting a 4 year agreement that knowingly under funds health care and continues to reduce my income;  or do I say no and be subject to further unknown unilateral fee cuts for the foreseeable future.

Not so easy a choice is it?

Better to be screwed facing your attacker? Or better to be blindsided from behind?
Because that’s essentially what the physicians in my province are facing.

Damned if we do. Damned if we don’t.

I am not political. Never have been and really, never want to be.  But I just can’t stay quiet on this any longer.

I am being asked to trust a government that has grossly mismanaged health care for years now and wastes taxpayers money on scandal after scandal.

I am being asked to help manage utilization of health care resources.  What does that mean? Do I tell a patient that they can’t have that ultrasound because we have exceeded the budget for that month?  Do I close my office one day a week because I am exceeding the budget for that month? Do I tell my staff to take an unpaid vacation day once a week because I can no longer afford to pay them for 40 hours of work anymore?

My head hurts.

Changes.

It’s been a while!

Hard to believe it’s almost the end of June. There’s been a lot going on in my world, most of it pretty good.

My dad is on the mend from his kidney stone issues and has remained pretty stable with respect to his memory and the Alzheimer’s disease (AD).  Two rounds of infection, two general anesthetics, mild delerium and his memory testing was the same!  Unbelievable really. The thing with AD is that the patient kind of remains oblivious to the reality around him.  He recognizes that his memory has declined but he doesn’t understand anymore the impact it has on everyone else, his wife especially.  If there is any blessing with AD it is that the patient loses their higher executive, frontal lobe functioning early.  It is quite the opposite for the family.  My mom is a strong woman though and she is managing pretty well; she goes to her weekly support group, my brother works from their place once a week and she visits the kids when it gets too much.  I wish there was more I could do for her and for my dad.

As for me,  I’ve done two races this month with decent results, given how awful the winter was with my running.  I have another 10K race this weekend and I am not expecting to do any better than 1:15 but that’s okay.  It’s an opportunity to have some fun, run on the highway and get a cool T-shirt and medal!

I’m starting a new part-time job next month in addition to my family practice.  It is an opportunity I sought out and I am excited about. It is an opportunity to grow as a physician, learn about a different model of care and will be a great change of scenery for me.   I’ll be a lot busier, working 5 days a week (instead of 4) but I think I’m up for the challenge.  The future of primary care in my province is looking hazy right now and I am a little worried. We have been without a contract with our Government for over two years and they are planning on implementing change to how primary care is delivered without consulting the front line workers, ie me!  I felt it was time to start looking at other opportunities where my work is actually appreciated.

I’ve missed the blog.  I hope you missed me too.

 

Sympatico

“Hi Doc,” she said, in a hoarse voice.

“What brings you in today?”

“Wow, you sound terrible.  Are you sick?”

“Oh, you know, ’tis the season.” I cleared my throat, turned to cough in my elbow, then returned to the patient. “So, what’s going on with you today?”

“I lost my voice a few days ago and it’s just not getting better,” she said.

After a thorough exam, I diagnose resolving laryngitis.

“It’s a viral infection and will get better over the next 5-7 days.”

“Can you give me something to speed up the process?”  she implored me.

“No, I’m afraid not,” I said, turning to cough again. “It’s a virus and will run it’s course.  Drink plenty of fluids, get some rest and you should be better in about a week.”

“Oh, okay I guess.  You probably shouldn’t be working, you sound terrible.”

Uh huh.

Thanks.

And you don’t need to see me for a cold either.

 

Busy Bee.

It’s been two whole days since I took myself off a couple social media sites and I am doing surprisingly well.  It certainly doesn’t hurt that work has been insanely busy and there have been lots of letters to write and forms to fill out for patients.

I also volunteered earlier in the fall to be a file reviewer for a medical school admissions program and had forgotten all about it until an email arrived this week advising me that the files will be sent to me in the next few days.   I am very excited to have been given this privilege of helping review files of prospective medical school candidates.  It really does put a lot of things in perspective for me.

I am also attending an all day course this weekend, so will be busy learning all the things I need to be taught again.  This break from social media is good for me and so far hasn’t been nearly as hard as I expected it to be.

Perhaps the withdrawal hasn’t quite kicked in yet.

The Grim Reaper

December is not a good month to be a family doctor, or any doctor for that matter. I have lost count the number of bad diagnoses I have had to give before Christmas.  What an incredibly shitty way to end a year.

“I’m so sorry to have to tell you this, but that lump in your groin is lymphoma.” 

“The biopsy has confirmed it’s malignant melanoma.

“Unfortunately, your baby stopped growing around 9 weeks of pregnancy.” 

“The lump in your breast is suspicious for cancer.” 

January is sometimes even worse. Who wants to start a new year with bad news?  

Every year I feel like I’m back here lamenting the fact that it’s supposed to be a magical time of year, these “holidays”, and I’m forced to give more people more bad news.  Can’t I just have one year where everyone is healthy? Is that really too much to ask for?

Seventh Kid

This past week my older son has been unwell with a fever but no other symptoms.  Maybe he had a mild cough but otherwise seemed okay.  A few nights found him coming into our room and the heat raging of him indicated to me he’d had a fever.  The inevitable phone call from the school telling us that he was sick came and he ended up staying home just one day and actually seemed pretty good that day except for not having much of an appetite.

So imagine my surprise when I go to pick him up from school the other day and his teacher (who knows that I am a physician) tells me that six children are away with strep throat.  Six!  I thank her for the information and immediately turn to my son, take out my phone, turn the flashlight on and look in his throat.

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The white spots on his tonsils are pus, or exudate. Probably from a strep infection.  He hadn’t had much of a fever in 24 hours so I decided to wait to get him tested.  This morning he woke up with no fever, but complained of his tummy hurting every time he tried to eat something.  Husband and I wondered if it was his throat that was actually causing him pain.  Kids are kind of dumb when it comes to being able to tell you where it hurts, I find.

Anyway, husband worried that our son had already had the infection for a few days and would be more susceptible to complications (post-streptococcus auto-immune diseases) so I took him to my office in the hopes of getting a rapid strep culture done.

Now, it’s hard enough to take a throat swab for a 4.5 year-old patient in the office, imagine trying to do it on your own son? I had to bribe him with a cookie his grandmother made.  When he saw the how long the “Q-tip” swab was he panicked and covered his mouth.  I told him it would be really fast and that we had to do it or he wouldn’t get the cookie.  “Oh fine,” he said.  So he opened his mouth and I was able to get a really, really, really quick swab of that tonsil.  After lots of crying and “Ow! Mommy, that hurt!” there was no way he was going to comply again.  Looking at the swab, I could see I had gotten a bit of that junk off, so I proceeded with the test.

The rapid strep kit really helpful in the office.  Normally a throat swab takes 48 hours to get results.  With these rapid kits I can have an answer in 5 minutes. I also really like doing them because it’s like a little science experiment I can do right in the office!  It definitely makes a typical day more interesting.

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Very much like a pregnancy test, one line is negative for strep and two lines is positive.

My son’s test had a very faint second line.  Given the history of six other children in his class with strep infections, his on and off again fever, lethargy and lack of appetite, not to mention the tonsils looking the way they did, I elected to treat him.  Yes, I should have taken him to his own pediatrician but I didn’t.  After a couple of doses of Amoxicillin, he is already looking better.

Sometimes it’s really convenient being a doctor mom.

A-Z Bombs

Day 19 – National Blog Posting Month

In the span of about 36 hours I told a patient she was miscarrying; I learned an elderly patient had biopsy-confirmed metastatic cancer; I told a 42 year old woman she likely wasn’t going to have a child  (thanks to a blood test called AMH), and I accurately deduced that a middle-aged woman is leaving her husband … for another woman.

Oh, and my  7-year-old daughter knows how to conjugate the “F” word. I blame the playground and not my own potty mouth. 

Could this week please give me a f&$ing break? 

What? 

 

A Little Worried.

Day 12 – National Blog Posting Month.

Being a doctor who is also a daughter has its privileges. I can navigate the system on behalf of my parents. I can advocate on their behalf and ask for tests and referrals. I can attend appointments and understand what is being discussed.  I can find out results before they do.

It is fraught with disadvantage as well. With their permission, I am privy to tests results before they are. I understand what their diagnoses mean and if I don’t, I know trusted resources to educate myself.  I understand in general terms what “illness trajectory” means. Specifically, I have seen what illness trajectories look like.  I also know what the end may look like.

I am the one my family looks to for advice and comfort.  I have to be strong and composed. I can’t let them see that I’m worried.