Wednesday, April 21, 2010

Monday in Family Medicine

"Oh Monday morning, you gave me the warning of what was to be..." Mommas and the Poppas 1960's.

First patient "Diabetes and lab review"
BP 100/68, P 56. frequently lightheaded, cardiologist just added amlodipine to metoprolol and isosorbide but letter from her doesn't clarify why. Hmm. If it was me, I would stop the amlodipine. Do we wait until she sees the cardiologist, call the cardiologist (time is a big problem with dr to dr connection), ask the patient to call the nurse at cardiologist office to clarify w/ cardiologist if she can stop the amlodipine to get higher BP (generally not a cardiology concept)? Some control confusion since cardiologist seems to relate to her BP, but I'd rather manage that and the lipids myself, and I'm already managing the diabetes (patient is with my input-and she has great "numbers"). Not usually a problem, but this patient had a cardiologist in another hospital system before she became a patient of mine. I've never met her cardiologist. Etc.

2. Three call in notes from patients: "Not feeling well, would like us to order a blood test." Hmm. A diabetic who doesn't test glucose isn't feeling well, wants a blood test instead of appointment. I scribble response: What is blood glucose? schedule two visits- one for sickness at which we'll determine what blood tests are needed for the sickness and/or for the chronic disease management and prevention that we'll relate to at second visit.

Next note: "Forgot to get three meds refilled at recent visit" which was scheduled as an acute illness, but pt added desire to deal with three chronic diseases while he was here. Please write the prescriptions for him and mail to him. Hmm. Another person with diabetes and Htn, drinks six beers daily, recently decided to start checking glucose. Finally went to see oft recommended dietitian. Is his goal to avoid the cajoling and hugs from the doctor that might realign his health with his stated health goals? Don't have time to write rx now, recommend visit in one/two weeks to f/u diabetes and what wasn't covered by dietitian.

Next note: Pt with MRSA infected crush injury of a finger, "can't get car running, should pt continue antibiotic?" Hmm. Dangerous car that could lead to disastrous infection. Quickly review last visit date and recommend pt continue medication and follow up tomorrow to review and re-evaluate.

Now, I get to see the second patient (or is this my fifth patient of the day? Might I now be a bit behind schedule?)

Time for "California Dreaming"?

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