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Posted Jul 01 2010 5:26am
The morning seemed benign enough.  A little of this and a little of that, it was all good.  Looking forward to the afternoon I could see a couple of challenges along the way, but overall patient volume wasn't terribly overwhelming.  It was looking like a typical day at the office.  Then somehow all hell broke loose.  I got crushed.

1:00--Diabetic male in his late 60's who has already had bypass surgery and still doesn't understand that a blood sugar of 220 isn't "normal for him."

1:20--Relatively new patient, an older woman in her mid-80's, who has had frequent urinary tract infections over the last few months.  Complicating matters is that she believes she has had anaphylactic reactions to sulfa, penicillins, cephalosporin, and the quinolones.  I admitted her once just because the only thing I could treat her with was gentamycin for a simple bladder infection.  Finally got her to see an allergist.  Her only true allergy is to sulfa.  She seemed happy, yet disappointed when I explained this to her.

1:30--Another non-compliant diabetic male who I don't care for in particular comes in for unrelated issue.  On a fairly routine CBC an acute leukemia was picked up.  Breaking bad news is tough even if you're not crazy about them.

1:40--Apparently I was running about 20 minutes behind at this point (a rarity for me) and the mother of a 16 year old is angry that I'm late to see her son's acne.  Be polite and bite your tongue, bite your tongue.

2:00--New patient, a young woman in her 30's, who is in tears that her previous doctor at the tribal clinic up and left without any real notice.  She has a huge number of what seem to be legitimate medical issues including various autoimmune disease, PTSD, and diabetes.  When new patients call the office our staff screens them to let them know we're not taking any new chronic pain patients.  She lied.  She's on a boat load of OxyContin too.

2:20--Guy with some asthma and allergies.  Probably easiest case of the afternoon.

2:30--Developmentally delayed guy in his 40's whose diabetes isn't as well controlled as it has been.  Should be a quick tune up on meds, but there are huge family custody issues over him including disputes over his medical care and lately he has been obsessed with how I'm spending my holidays.

2:50--Baby with a cold.  Mother's convinced it's something serious.  Can't anything be easy?

3:00--Toddler with relatively sudden onset of abdominal pain and fever comes in sobbing.  My level of concern is up on this one.  Surgical abdomen?  Appy?  Finally mom and I get the kid to settle down and I get a good exam.  I think he'll be okay.

3:10--Teenage fastpich player gets spiked with metal cleats.  She'll be okay.  "Oh, by the way, my allergies, asthma, and eczema are all out of control since I'm spending so much time outside with fastpitch.  What can we do about that?"

3:30--Middle aged guy hurts his back on a quad.  He'll be okay. 

3:40--Simple case of tennis elbow in a middle aged woman?  Yeah, right.  Spent more time discussing her daughter's depression and why the psychologist she's seeing is full of it.  How do you bill for that?

3:50--No show on a recheck for depression--thank goodness.

Was that really only 12 patients for the afternoon?  Seemed like 30.  Runny noses and physicals is all us family doctors do, isn't it?

The Country Doctor
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