Bread and Butter.

I’m not talking about food, though is there anything better than warm bread slathered in salted butter?


What I am actually referring to is the “bread and butter” of family medicine.  The day-to-day stuff that brings home the bacon.  Hmm…. bacon.  (Never mind me, I’m just hungry).

Colds, flu, back pain, anxiety, depression, high blood pressure, anxiety, work stress, anxiety, depression and well baby visits.


This is the bread and butter of family medicine.

Did I mention anxiety?

I’m not even half-way through my work day and I’ve already seen 3 patients with anxiety.  (You may wonder how I have time to blog?  Lunch baby.  Lunch!)  I do NOT work through my lunch.  I eat. I blog. I digress.

The bread and butter often comes in lumps — some days there is nothing but back pain, other days everyone’s got a sinus infection.  It’s very strange.  After 7+ years in practice, I still haven’t figured out why that is.  Perhaps I never will.  It’s one of the mysteries of life.

When it rains…

… it pours!  Such a cliche but it’s true, especially in family medicine. There are a handful of issues that family doctors see on a regular basis, what we call the “bread and butter” of family medicine – hypertension, diabetes, heart disease, chronic back pain, depression/anxiety.  Sometimes the “bread and butter” are clumped together.  Some days it’s one newly pregnant woman after another; some days it’s one newborn after another; some days it’s nothing but back pain, other days nothing but bladder infections.  It’s a strange phenomenon.

Part of my job is reviewing blood test results.  There are days when the results are boring, and others (like today), when almost is abnormal and I have to deal with it immediately.  For example, there’s the late 20-something new mom who hasn’t seen a doctor in 10 years, whose laboratory results show she is severely hyperthyroid.  Then there’s the 50-something man being treated for bladder cancer whose hemoglobin has suddenly taken a nosedive for no apparent reason (ie, he’s not bleeding, has no change in bowel habits). And finally, a gentleman with human immunodeficiency virus (hasn’t seen me in 3 years), comes to see me for something completely unrelated and I note he needs a number of routine screening tests.  He agrees to the prostate screening test, after much counsel regarding it’s limitations, and his level comes back today –  it’s the highest I’ve ever seen.

Patient 1 needs to see an endocrinologist but she refuses because she wants her naturopath to handle it.  Patient 2 gets referred to a gastroenterologist to rule out another malignancy. Patient 3 gets to see a urologist for a potentially painful prostate biopsy that may or may not be positive for cancer.

I’m glad it’s almost the weekend.