gas

Last night I waited in line for gas at $2.49/gal. Today it is $2.69--likely cheaper than most places I suppose.

good acting or not?

The thing I struggle with the most when it comes to patients is their pain. Everyone is in pain. When I see a "chronic painer," I have difficulty deciphering whether someone is a well acting drug seeker or whether they are the real thing. We are told we can't judge someone's "6th vital sign," but when there's a medical license to protect, it's hard not to be defensive.

Today a person I saw 2 weeks ago who I gave a one month supply of vicodin to for chronic pain secodary to lumbar stenosis adamantly told my LVN he ran out and needed a refill. Tough, I'm not giving it to him. I have no contract with him and I've only seen him once.

Again today, a patient who I saw for a colleague who is out for 3 months for maternity leave, badgered our triage nurses because he wanted a refill of Darvocet. When I saw him a week ago, his med list had darvocet and vicodin on it. I told him I would only give him one prescription with no refills. The next day, the pharmacy called to say that one week prior to that, another physician filled a one month prescription of vicodin. I then only allowed a quantity of 20 of this other pain medication and told the pharmacy to relay that it wouldn't be until a month after the initial prescription was given that I'd refill his prescription.

For my last patient of the day, I saw yet another one of the same colleague's patients, a 38 yo female with chronic pelvic pain previously from endometriosis, but now status post hysterectomy 2 years ago. She cried. Having gone through what I had already been through that day, I was reluctant to emphathize.

And that's how you get jaded as a physician.

One patient I admitted 2 months ago told me he would buy vicodin and xanax off the street. He noted that since people get 3 medication from Medicaid for free each month, many people would get a prescription from their physician and then sell it off the street.

Yet another reason that physicians have a hard time believing someone's pain.

Everybody is different and I guess I should take that into consideration. However, sinnce the character and personality of each person is molded by their experience, my experience has made me less empathetic. Sorry.

the grind

I worked for 2 weeks now and it hasn't been that bad. Fortunately, they have started me on 50% of my patient panel which is less than what I saw as a resident. The following week I was at 75% and I'll be at that this week as well. Next week, I'm back down to 50% since we're transitioning over to an electronic medical record.

The other day, I saw my 11th patient for the half day and I felt that familiar "rush" that I would get as a resident. It's this substernal race against time. We are booked a patient every 10 minutes and of course, many patient visits take longer than that. In between sessions I bill, write prescriptions, find my medical assistant if she isn't around, write consults, write X-ray/procedure referrals, etc. There is a pressure within me--within all docs-- to be efficient with patients yet give them quality care. The pressure gets worse when I get a walk-in with chest pressure or a fracture or who is just really sick and needs an admission.

Can I do this till retirement?