Life got crazy for a bit there and I had no time to write! Alas, I’ve missed a few days, but the show must go on! Let’s begin with our day of chronic care. I’ll call my doctor for this rotation the Friar (not sure why I went with that… he’s definitely not a fan of religion… but the name seems to fit). So the Friar has a bit different approach to medicine than Dr. Leonidas and certainly a different environment medically. Where I have been seeing uninsured people for the most part in my family rotation, in chronic care I see extremely wealthy people that never really worry about the costs of medicine. It’s a private setting and patient satisfaction surveys and the need to keep patients drive the doctors to overprescribe medications such as antibiotics and narcotics (I actually haven’t seen the Friar prescribe narcotics without good reason but just trying to make a general statement). He told me that the antibiotics that he prescribes are not needed 1/3 of the time but if he didn’t prescribe them the patients would simply go to an urgent care, get the meds, and would be lost to his practice. This really disappoints me. I know it is an extremely common theme in medicine to overprescribe so I’m not down on this doc at all but more on the whole medical system and the flippant mindset so many have towards antibiotics in particular. Doctors who prescribe like this are unfortunately increasing the rates of antibiotic resistant bugs and this trend towards hitting viruses with a Z pack is going to lead to billions of deaths in the long run. We study this stuff for 8 years and then go through more training with residency and fellowships oftentimes, yet we let our patients who have used google all of 2 hours tell us how much of and what medicine they need… yeah right. If a surgery isn’t necessary, don’t make the first cut. If it is possible to use steri strips rather than sutures, use the tape. A cardiologist was recently destroyed legally (I actually think he may be in jail) and barred from practicing medicine after it was found that he was doing unnecessary caths for financial gain. How is a doctor that is prescribing an unnecessary medicine in order to keep patients (and thus financial gain) not also barred? Again, not down on this particular doctor but the whole system that teaches doctors to do this. This is when those lectures we slept through on patient education are vital. I think about half of docs may really agree with what I wrote and half would be pretty pissed off (and listing three reasons why I’m wrong), but it’s how I feel and research shows that unnecessary meds increase mortality – Primum non nocere – First, do no harm.
To go on with patients and what this blog is meant to talk about, I saw a guy (in chronic care with the Friar) who had been in the hospital for an incredibly severe bout of pancreatitis and is now insulin dependent. He was a pretty solid guy who no one would ever have guessed was an alcoholic. Great family and job, exercises daily, doesn’t smoke, and just a flat out cool guy. He’s one of those you would want in your clinic but everyone has something, some struggle, some temptation that comes at them again and again and is too often hidden in the shadows. Unfortunately, this temptation almost cost him his life. He is now completely off of alcohol and is getting back into regular life again thankfully with a lot more help and honesty about where he is at. It’s incredible when someone gets hit with something like a month in the ICU and then changes their life. All the time that the nurses and docs worked on him was worth it. I’m hoping to follow him as a patient and see what happens and how he grows. In the family med clinic, I sewed up a guy that chopped his foot with a machete. Practical takeaway point – don’t hit foot with machete. We told him it would cost extra to sew his shoe as well haha. It was nicely sutured and I felt proud of this one. I’ve been doing paps and pelvic exams lately like a master and feel like I’m really helping the whole office. We’re halfway through and hopefully I will improve as much as I have in the next three weeks as the first.