Saturday, May 3, 2014

Friday in Family Medicine: The Spring Brings Smiles and Mucous

Return to full work, it says in the chart.  A form.  I write too slowly- patient brought up two more problems while I copied the codes written on the last form.  A drum beat tells me I'm behind.  Literally, we use a Remo Buffalo drum for the staff to let the Dr know that too much time has elapsed with a patient.  I own the place, so I can take the drum under advisement instead of racing from the room.

Smiling patient with lots of problems- has none today, except the one they made the appointment for- a rarity these days.  "I read the book you recommended (Wheat Belly) and I don't have migraine any more.  I am wheat free.  My pain is a lot better, too"  I see the smile again.  The relief.  On Friday. Nice.

No pain in the next room, either.  Patient who always has fatigue, aches, painful urination.  "I don't know if I need to be here.  I don't hurt any more."  "Why not?" I ask.  "Could it be the vitamins?  I've only been taking them for six weeks. I sleep well now."  (Methyl B12 and L Methyl Folate).

Next- a physical to satisfy an entity.  Entity and patient satisfied.

LDL 51.  Too low for me.  You are at higher risk for violent events with the super low cholesterol.  Consider dropping the statin to 25% of current dose, from 40 to 10 mg.  With known coronary disease- we have one in 64 chance of preventing a non-fatal heart attack with the statin.  "It may not be in my best interest to take the medicine."  "You get to decide"   "Well, the cardiologist talks about it every time I see him, and I say I'm worried about the side effects."  "Good news and bad news is that you get to decide"  "What else would you like to know to make your decision?"  "I want to start by taking the lower dose and retesting."  OK.

"I've been coughing since I got back from Paris.  It's worse outside."  "Are you allergic to Ohio?  We're in one of the top ten worst allergy cities here in the Dayton area..  Mucous is the state bird in Ohio, we have so much."

On to the next patient(s)

"When's the baby due?"
"How's your mother doing?"
"What are you doing with all that money now that you've quit smoking?"
"Welcome to spring"
"Did you get the new dog yet?"
"You look miserable"
"You have your spring hair-do"
"When is your daughter's graduation"
"When is your prom?"
"Congratulations, your blood pressure looks like it's back in Ohio.  How did you do that?"
"I think they're all cured, all the rooms are empty."

Spring is here.

1 comment:

  1. Great encapsulation of a family doc's day! (Especially love the patient-centered decision making regarding the statin dose...)