Saturday, February 15, 2014

To the 10 children...

I'm sorry we failed you.

I'm sorry we thought "It was out of our hands and thisisallwecando."

I'm sorry we saw the writing on the wall and chose not to read it.

I'm sorry you were trapped.

I'm sorry in a land of abundance and help and intervention and freedom and hand-outs you were eating and living and breathing and starving and freezing as if in a third-world country.

I'm sorry your "father" was an obvious son-of-a-bitch, good-for-nothing, no-count, coward and lazy-ass who likely has taken better care of dogs than he did you.

I'm sorry there is no foster home that could take all 9 of you.

I'm sorry you had to know about your 16 week sibling buried in the back yard.

I'm sorry a complaint of "no prenatal care with 8 other children at home" isn't enough to get an investigation started.

I'm sorry that you likely had a mom who maybe cared...but she was probably trapped as well.  I'm sorry she knew that there was probably help out there, but if she reached out for help, that she would be held liable and you all would have been taken anyhow- but that is not an excuse.

I'm sorry she'd rather see her children starve than have them taken away.

I'm sorry we can't fix it.

I'm sorry we can't undo it.

I'm sorry if you felt you weren't (or aren't) loved.

I hope you can break the chains and the cycle.

I hope there are hugs.

I hope there is love.

I hope there is hope.

I am sorry...and I hope.

What to do...and NOT a patient.

I'm not trying to be facetious with this post. Some posts like this can be cynical and demeaning to patients. I will try my best to honestly say what can help and hinder a person from getting the most out of their visits to the doctor.

Things to do:

1. Think about your symptoms and have your story down. Some people are better at story-telling than others, but it makes it so much harder for the doctor to diagnose you if you don't have your story straight. Has it been 3 days or 3 weeks? What does the pain feel like? What makes it better or worse? Does this remind you of something else? So on and so forth. I know patients try, but it is amazing how many cannot help me by telling me what is going on when I ask.

2. Let me know what you are worried about. Neither of us will leave a visit feeling satisfied and complete if your deepest, darkest concern wasn't addressed in the visit. If I don't ask what you are worried about, tell me.

3. Bring in your actual medication bottles. It helps me to know what you are taking- over the counter and prescribed. Sometimes, we can actually FIX problems by stopping meds...novel idea, huh?

4. Know your medical history.  Sometimes this is the fault of the medical system, I know.  We should be arming our patients with their own histories and speaking the diagnosis in a way that can be understood by anybody. But still, you should be able to remember when your last colonoscopy or heart cath was...and the names of your most important doctors.

5. Request your medical records ahead of time. If you are transferring care, ask your old doctor's office to send records- or go to the new office and ask to sign a release and have them fax it to the old doctor. It helps get your first visit moving along if the old records are already there.

6. Keep your chronic health follow-up appointments. We need to have visits just dedicated to your diabetes, heart disease, high blood pressure and high cholesterol. Those visits shouldn't be intermingled with "Oh by the way, I have this strange spot here that I just wanted to see if you could take off today." Sometimes our agendas need to match up...and sometimes my agenda should trump yours-but not too often.

7. Ask for office policies, hours, and how acute issues are handled. If I don't tell you these things ahead of time, it empowers you as a patient to know.

8. Use the same pharmacy for all of your prescriptions.  Pharmacies often call to make sure I know that this can interact with that or the doctor across town who is a specialist had already given you that drug that was related to the one I just sent.  They are another safety net in our messed-up healthcare system, but if a patient runs to 3 pharmacies for different things, nobody has the true picture.

Things NOT to do:

1. Don't call the office asking to be seen for every cough, cold, or sniffle. If it seems you are in the office too frequently with self-limited and common complaints, it is hard to know when you are truly sick. Kinda like the boy who "cried wolf" too much.  If it seems like the common cold, it probably is.  I take people who only come to the office when they are feeling poorly much more seriously when they DO come in than people who come with every ache and pain.

2. Don't barrage your doctor with more than 3-4 complaints. Honestly, my brain can't effectively take care of more than 3 or 4 things at a time. Either I will focus on one and ignore the others or glaze over them all and do a poor job with all of them. I want to be able to be thorough, and I have limits. Identify your top few concerns and don't be upset if I ask you to make another appointment to address the other things.

3. Don't mention a serious health concern when I think that we are wrapping up the visit.  Like, for I am reaching for the door knob to leave, please don't say, "Yesterday, I had this crushing chest pain that came on after I climbed the stairs."  DON'T DO THIS! I feel like most people should know better than to just casually mention something like chest pain, but they do.

4. Don't go to the ER during office hours.  Unless you think you have broken something, or think you have had a stroke, or are bleeding out, or think you are having a heart attack. There are probably a few other reasons that would make it ok to go to the ER during office hours...but not many.

5. Don't go to the ER in the middle of the night.  Unless you think you have broken something, or think you have had a stroke, or are bleeding out, or think you are having a heart attack.  You get the picture.  There is usually an on-call doctor or an after-hours service that will answer phone calls...and often can save you (or our government) an expensive ER bill.

6. Don't call asking to be worked in the same day for things that aren't acute issues.  Ok, your kid is supposed to be starting football tomorrow but hasn't had a physical.  Since when does an urgency on your part make it in emergency on mine? What better lesson in responsibility and planning for the future than telling your kid you messed up and failed to plan and so they are going to have to sit the bench?  Your wrist has been hurting for 2 months? Don't be mad that it is going to take another week to schedule an appointment.

7. Don't spend 10 minutes describing a problem to me and then not let me do anything to help it.  Sometimes people tell me about one complaint or another and then when I start to suggest what we can do or try, they don't want to do anything. I want to scream at them, "Why did you just waste my (and your) time, then!?!"

8. Don't make an appointment and no-show or call at the last minute to cancel.  At some offices, they charge you anyhow or threaten to "fire you" as a patient. Not at my office...but, when you do that, you are taking the place of somebody who maybe really, really needed to be seen that day.

Monday, January 27, 2014

There are 2 perspectives here...

Yes, I know. I know that without patients, there are no doctors. But that works both ways as well. Hear me out--this will probably sound very conceited and vain of me, but I need to say it. Granted, without doctors, there will still be sick people and suffering, but whomever was suffering without a doctor would not be a "patient." They would be some poor soul, dealing with part of a fallen world that is left to decay and degrade and to go to chaos.  To be a "patient" implies that a person has sought help and is willing to accept some form of that help.  To be a "doctor" implies offering aid and trying to relieve suffering. To me, there is an unwritten contract there. And much of that unwritten contract hinges on respect. Respect from both the doctor and the patient. This, in a way, is my plea for respect.

Many times when I am most frustrated with my work, I feel it is when I am accused of not caring, not being enough, not doing enough, not listening enough, not fixing enough. I know I can never be in that patient's shoes to understand fully, but more often than not, I think I take on the patient's perspective much more than they take on mine.

They don't see the 22 year old me, starting into a life that could take more and reward more than any other. They don't see me crying tears before each test, wondering if I was going to be enough. They don't see me struggling and ready to give up and leave this mess and this trial and this world. They don't see the me who realized I didn't know how to garner self-worth without a test to ace or a professor to awe. They don't see my husband standing by and trying his best. They don't see making futile plans and going days to work and school being sick and worrying about others first while holding your own symptoms back. They don't see the stain of mommy guilt each and every day. They don't see the yearning or the need to connect but not having the time. I sit by, and I listen and I try.

When they see a hurried or rushed or flustered or distracted me, they've not seen that I just spent an extra 20 minutes in a room crying or praying with a woman still raw from the loss of her grown child.

When they see a running behind me, they don't see that I helped get the new mom to latch her baby on after trying two or three or four different times and positions.

When they see an authoritative me, they don't see the flashbacks I have of people not understanding or not listening to my advice and then paying dearly, sometimes with their lives.

When they see a tired me, they don't see that I was taking care of their next-door neighbor late into the night or finishing notes, or waking up at 3 am with my own child for the last few nights.

When they see a happy me, they don't see that maybe I've had a fight with my husband over the same old thing that morning.

When they see an angry me, they don't see that there is sometimes a tiny threatened or intimidated or insecure me hidden deep down inside.

When they see a sad me, somtimes rarely... they may be seeing the real me.

Sometimes I feel like I am the same as just some service industry...come get your oil changed, get your hair cut, or have your house cleaned. But I'm not. I'm not that. I'll try and try- but I'm not always here to please. Sometimes I'm here to chide and to reprove and to instruct and to encourage and, and, and.....

And I am human. I am a human who has lost more sleep, spent more time, thought more thoughts and worried more nights than most. My job is never done. It's never enough. I won't ever be through, because there is always more. I feel the weight of failure and the reward of a good job well done more than any other, and each day, must rise again...brushing off the day before and hoping it won't bleed through too much...or not enough.

Grace of a "Good Job"

The other day, I told my nearly-two-year-old "Good Job."  Simple, say it probably 5 times a day to him. No big deal, really. But then, I noticed his little face.
"Good Job" smeared satisfaction all across his chubby little cheeks. It made an impact. It made him feel important. It made him feel accomplished. And, in one moment, I was both proud and convicted.
Proud --because my little man was starting to feel self-worth and to have understanding of being praised for doing something correctly. This praise left him yearning for more and wanting to hear this phrase again. He craved that attention and the good feeling it imparted.  He wanted to continue to "do a good job."
Convicted--because in that second, I came to understand that being happy about having yourself praised is one of those almost innately ingrained things and essential to our human-ness. I was convicted, because it exposed a deficiency in my life in giving that praise.
Obviously, wanting praise follows us into our adult lives.  And I realize, I am HORRIBLE, absolutely deficient and failing in telling those around me a simple, "Good job."
Horrible at telling my husband, horrible at telling my kids, horrible at telling those who work with me, horrible at telling those who work for me.
I think medicine is especially sinister in this respect. We have a culture of finding fault and worrying about blame and pointing the finger and hoping it is the other guy who gets sued. Instead of saying "It's awesome you did this" it is often "Why didn't you think of that?" With my office, it is always finding somebody doing something wrong or leaving something out or not thinking or, or, or. There is always something to find....but I'm not searching for the right things.
It's no wonder I struggle with problems especially related to work. So much easier to criticize and to antagonize. For me, saying "Good job" at work requires thought. I have to force it. It isn't natural. Sometimes it hurts.  It has to be brought forward from the depths of my unconscious, from the deep, dark recesses of my cortex. I have to grow it up and nurture it and let it crowd out the weeds of my pride before it bursts forth from my lips and bears fruit in my life. It isn't coming from my heart yet...but what my cortex can learn, maybe my heart will embrace.
So I look at my little boy, and I thank him. I am thankful for his big spirit, and his eyes that say exactly what he is thinking. I am thankful that he could shine a light on a part of my life I never would think that a two year old could reveal. But he did, and he did even better than a "Good job."