On top of my pile at the start of the day before seeing my first patient: Someone calling this morning about their child, sick from school but they can't come in and mom wants a note from a physician faxed to the school saying the child can't go to school. What would you do?
Next on the pile, a mom calls about two kids with head lice. Please call in a prescription, is the message. What would you do?
Next is someone calling to say they forgot to get their chronic disease prescription for their depression when they were here recently- acutely ill. What would you do?
I take a call from a hospice nurse who is concerned about a family not yet seeming to be understanding that the patient is going to die. The patient is one day out of an extended care facility after a long hospitalization for severe heart and brain diseases with a terminal situation. There are several medicines ordered for heart and brain diseases. The patient told the family he wanted to be with Jesus. What would you say?
The first patient is here for chronic disease management: hypertension, insulin resistance, hypertriglyceridemia, weight management. We relate about the 3 months of winter being extremely cold. The patient asks how the blood test results look. I give him one copy of the results and point at a few elements on the file copy that look good. "What do you think?" I ask.
"This doesn't look too good," he comments, pointing to the triglycerides of 187. "What is this test?" he adds pointing to the Hemoglobin A1C of 6 which is in dark black ink usually indicating an abnormal lab value. "It's like the cousin of the triglycerides, leaning in the direction of diabetes. Notice that at 6.4 or above, the A1C is consistent with the diagnosis of diabetes. Look at your last test, though and notice your triglycerides of 265 and A1C of 6.2. You are doing something that's pushing back your diabetes potential. What do you think that is?"
"Could it be the mall walking that my wife and I started two months ago? I guess the diet changes are helping, too. And it's been easy to do since we met with the dietitian." "Those are important factors in what we're seeing. How are you doing it?" I ask. He looks up and to his left, "We looked at our life and our health and our weight after the push from the last lab results and decided to act. Now, I'm seeing a smaller me and both my wife and I are looking 5 years younger." What would you say?
I find Family Medicine to be interesting, challenging and personally rewarding. We deal with people and families in all stages of life and all contexts. What do you think?