Rural Doctoring

Another Reason Why Family Medicine ROCKS!

Here's an article about doctors from my residency alma-mater who provide free care to the homeless in Salinas, CA. I did a rotation at the free clinic when I was a second-year resident, and reading this article makes me homesick for those days.

It's always good to remember where you came from.

Case: My Life on the D-list

Today I worked up a 50-ish man who was admitted with altered mental status, cystitis and acute renal failure. He'd been in the hospital for just over twenty-four hours without much improvement. He wasn't hallucinating anymore, but restless, agitated, strange.

A Doctor's Guide to Being Human

When I was a senior at Stanford, my ambitions for my final year of college were terminally derailed by a geological event called the Loma Prieta earthquake.  The temblor caused so much damage in my residence that everyone had to be relocated to other dorms. I was the resident assistant (RA) for my house, meaning I was the problem-solver and support person for the rest of the students who lived there. This was a paid position and was something of an honor, and I took it seriously. Within minutes of the earthquake I was back at the house to account for the whereabouts of all the residents. I lost my wallet during the chaos and had to walk around for two weeks with nothing but some loose change in a paper bag. As the days went by and the damage to the building was being evaluated, all of us suffered from various symptoms of post-traumatic stress. I remember diving under the nearest table whenever an aftershock struck. I didn't sleep well. I had no appetite. It was hard for me to concentrate. I looked like something out of an Edward Gorey illustration.

Windows Into the Soul

Via a link on Scalpel or Sword, I read a post by Catholic blogger Dawn Eden which summarized a post by a medical student blogging under the name Pudu Overload who felt unnerved after observing abortions at a Planned Parenthood clinic.  Pudu Overload apparently identifies herself as a supporter of abortion rights, yet felt "incredibly freaked out about the whole thing and [I] don't know how to think about it.  It simultaneously seems like a small and an enormous thing."

Diplomacy is Not My Strength

My mini-retirement is scheduled to begin this Thursday. Last night I received a request to fill in hospitalist shifts from Thursday to the following Wednesday. This was a last-minute scheduling crisis which, in my opinion, could have been foreseen weeks ago. The following is a lightly-edited excerpt from my response to a friend and fellow hospitalist:

Honestly, I don't want any of those dates. My 6-week "mini-retirement" begins on 10/2 and I am not interested in working AT ALL.

One of the reasons for the mini-retirement is to teach myself the discipline of saying NO to unwanted work and to stop involving myself in every f***ing solution to every f***ing crisis at [the hospital].

So I'm saying  NO

Protecting time off is a skill you can only learn from experience.  Although I'm a firm believer in being available to help my colleagues if they are in a jam, I am learning--the hard way--that this kind of team spirit rapidly deteriorates into a false impression of willingness to work all the time.  So I'm drawing a line in the sand.

Even if I have to use the F-word to get my point across.

Doctoring in Style

Question: Which of the following people looks like a physician?

The man on the left is Pablo Gonzalez Casanova, a Mexican national and social critic, known for defending the Cuban Revolution. A very distinguished man, but not a doctor of medicine.

On the right is me, baggy-eyed rural family physician, attender of births, overworked hospitalist, and ever-hopeful blogger.

I post these photos, not for self-promotion (ha!), or even to promote the ideals of Professor Gonzalez Casanova, whose photo I chose for his distinguished mien and formal dress, but because I have lately been pondering a question: How important is a doctor's personal style?

The Efficient Rounder: Response to DB Medrants

At Medrants last week, Dr. DB raised several questions doctors ask themselves while rounding on patients:

1. Are we certain of the diagnoses - or do we need more diagnostic information?
2. If we are treating, is the treatment working?
3. What are our goals, or where are we going?
4. What are the patient’s goals and are we meeting them?
5. Does the patient understand the diagnosis, or the diagnostic workup?

Becoming a Rural Doctor, Part 8: Welcome to Your Rural Community

In the last post in this series about becoming a rural physician, I'm going to discuss joining your new community. By this point in your training, you've already explored the rural experience in medical school and residency, and you've also found a job in a rural community you like. But once you get there, how do you start life and medical practice?

A young professional can find dozens of how-to guides on how to hire movers and pack boxes, how and when to cancel utilities at your old home and install them in your new one, and how to forward your mail. But there's more to moving than relocating your coffee maker, your garden gnomes and your lava lamp collection. You have to become a part of a new community, and for a new doctor, there are some special tasks to complete and considerations to make.

Becoming a Rural Doctor, Part 7: Ideal Professional Qualities

Over the last several posts in this series, I've discussed the training and education of future doctors. This week, I adopt a slightly different perspective and address some professional qualities I believe are important for all doctors to develop, no matter where their practice setting may be. In my experience, I've had to work especially hard at maintaining the following qualities when I'm on the job, because living and working in a small community tends to magnify a doctor's personal failings and can damage her reputation quickly indeed.

The Hospital Yadda-Yadda

Scene: A charting room on a medical-surgical unit in a community hospital. A hospitalist enters and consults a computerized patient census.

HOSPITALIST: [counting patients] "Two, four, six, eight, ten, twelve--shit--fourteen, sixteen--"

NURSE 1: [approaching Hospitalist] "Dr. Chan?"

HOSPITALIST: [Still looking at computer] "Hi, what's up?"

Firing a Patient

I have only terminated a patient twice, but it is a step I would not take without considering my motives carefully. Sometimes a patient's attitudes and beliefs create an insurmountable barrier to the doctor-patient relationship.  Has you ever felt this way?