August in Family Medicine: Heat, People and Stress

In August, it's hot and humid in Ohio, more this August than last.  That means more office visits to the family doctor for breathing problems for our people with emphysema and asthma.  The ragweed pollen levels in the air increase daily until around August 15th, which I call Ragweed Day (and we're already proudly in the fourth worst allergy area in America-Dayton, Ohio).  Patients often don't notice the breathing becoming more difficult before they notice the chest tightness, which might generate increased concerns about heart problems and further cloud their insight about lung symptoms.  The decreased breath sounds on physical exam may generate a both diagnostic and therapeutic nebulizer treatment with albuterol. The patient notices relief of the chest tightness and the family doctor hears the louder breath sounds and notes the comfort of the patient with breathing.  Many of these patients get an EKG as part of the evaluation to rule out  a cardiac component to the chest tightness.

It's satisfying for me to be able to help people breathe easier and to understand their symptoms, especially when I can reassure them to relieve some worry.  Malfunctioning organs in the chest are often associated with worry, since they can reduce the patients ability to accomplish their daily tasks and raise their concerns about serious disease.

High school sports start in August with conditioning and practices. Heat is a concern there, too.  If the coaches, trainers and athletes are aware of the heat rules for sports and limits of the human body, they are usually safe.  If not, there could be a disaster with a heat stroke, respiratory or renal failure.  Risky business- sports.

Parents seem very interested in school starting.  Students seem interested in being with friends and texting.

Many are losing jobs or running out of savings since losing the job and the value of their investments.  Others are working in the wrong job for their physical circumstances due to employer mandated position change within their company.  We see them for overuse syndromes, sometimes desperate to get physical therapy to buy time to get their old position back or make it to retirement.  A lot of people are very stressed.

The family physician needs to respond to each of these people, families and situations with skill, insight and understanding.  Most of the "pain plus stress" situations take more than the allotted time, since the stress may not have seemed to be a problem until they start to disclose it.  Often, that's a component of their treatment- venting and being with someone who will listen and respond to their feelings.  The human to human validation is an important element of the patient -physician engagement.  People need to know that someone will listen and respond, even though the problem may not be solved (which is hard for physicians, who are prone to want to solve the problem).

August- hot. People- matter.