Family Med Rotation

Cancer, cancer, cancer. That was the name of the game today. Two probable prostate cancers (one of which had a PSA of 287!!! Normal is less than 4.0), hepatocellular carcinoma where the patient decided not to show for his appointment with the oncologist following a biopsy, and a prolactinoma (typically benign, hormone producing tumor in the sella turcica). One of the men with prostate cancer just stopped seeing his oncologist years ago when he didn’t like chemo and is now showing up to us because he isn’t doing well… Who would’ve thought? It’s tough to see that this guy isn’t likely to make it just because he wouldn’t go through with treatments when it could actually be treated. We had a few train wrecks to start the morning but then this 47 year old black male came in for a diabetes follow up. He had gained a considerable amount of weight and his HbA1c had spiked. I figured this would be the typical interaction we have with a DM (diabetes mellitus) patient where we just beg them to exercise, diet a little, and do the things that everyone knows to do. But this man shocked me by saying, “Look doc, I’ve been really struggling with my weight. I know what I’m supposed to do, and I’ve done it before. Is there any way I can come in and see you once a month just so I can have some more accountability?” I just sat there stunned; this is exactly the type of patient that people go into primary care to see. Of course I get irritated with patients when I see them eating and lounging themselves to death, but when someone is really willing to try, I’m going to do everything I possibly can and then some to help them.

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