Docnotes

Docnotes is my old weblog. Haven't

Docnotes is my old weblog.  Haven't updated it in a long time.  Radio 8.0 is better than conversant .. though there certainly are things that I liked about Conversant.

Now trying to figure out how to import the old site over here ... along with the (very) old blogger stuff too.

I have a few patients

I have a few patients on Serzone. There is a new warning about it that I think you should read. I'm gonna get my patients off of it. You should too. Just in case.

What is a family

What is a family physician?

Lots of misunderstandings about this. 

Like most days, I helped some of my patients understand what it is that I do for a living. 

If my patients don't know ... I'd be surprised if my colleagues do.  My colleagues in Orthpaedics, Ob-GYN, internal medicine, pulmonology, gastroenterology, hematology, etc.

Why don't they know?  Because many of them never took a family medicine rotation in medical school.

To parents of my very young patients, they are surprised to learn that I care for adults.

To my pregnant patients ... they are surprised to learn that I care for men.

For my "old-man-with-diabetes-and-high-blood-pressure" patients .. they are surprised to learn that I deliver babies.

 ... and everyone in-between.

Long day at the office

Long day at the office today.   I'm getting the hang of it again .. and indeed I find it very enjoyable.  Lots of bronchitis.  No antibiotics! ..

Lots of babies today too.  Jessie is 6 months old.  So inquisitve.  Life is a big journey ...he's DISCOVERING .. as we all are .. but it seems so much more clear when he does it.  Very cool.

Several new patients.  I keep hearing that "no doctor has ever really LISTENED to me before" ...

I do try to listen to my patients.  Seems so necessary.  I can't imagine NOT listening.     Don't we need to HEAR what our patients tell us.

Yes, it gets time consuming.  Marian Stuart writes a great guide in The fifteen minute hour.  Yikes.  $72 on Amazon.

 

Antibiotic overuse remains a problem

Antibiotic overuse remains a problem in most outpatient practices.  A recent article in BMJ suggests that handouts .. to provide good information about the condition and about appropriate antibiotic use ... DO reduce antibiotic prescriptions. 

There are a few handouts I use often.   

1. Bronchitis - from the American Academy of Family Physicians
   
2. Acute Otitis Media - from the New York State Hepartment of Health

.. more tomorrow ...

Evelyn was born so peacefully

Evelyn was born so peacefully yesterday morning.  As she emerged, we quietly dried her off and handed her to her mom ... who was, of course, glowing.  The exhaustion and exhiliration of childbirth always amazes me. 

What a privilidge it is to be able to witness such important events -- to be invited into these most intimate moments.

Intimate, too is the other end.  Josphine was only 72.  Last week, Jennie called me.  "Mom's not looking so good.  She's decided that she wants to come to the hospital."  Jennie and I had talked the day before.  Josephine had pneumonia and had preferred to stay home.   Until now.

I met them at the hospital.   I think it was about 11:30.  Josephine looked tired, but she was clearly relieved to be in the hospital.  She had lost weight since the last time I had seen her.  Wearing two hooded sweatshirts, and a pair of sweatpants,  her small face poked out from the hood like Nanook on the tundra.

We talked for a long time that night.   Longer, I think, than we had in the past.  She told me she was happy that she came to the hospital.  She felt safe.  She didn't want to die yet.

Chuck sent an e-mail out to family and friends over the weekend.  He sent a picture too.  There she was in the hooded sweatshirt.

Josephine's spirit was alive.  Her mind was clear, and focused, and bright.  She wasn't ready to die.   But  She hadn't been the same since she went to the hospital in September.  Not eating enough, not doing her physical theray exercises  .. she was simply too weak to fight off the pneumonia.

It is these times of high-tech medicine, we physicians often find ourselves ordering tests and using expensive tools (?toys?) to treat our patients.  Yet the special moments are what makes it all so valuable.  Michael Murphy, in his recent book on Dying and living, clearly outlines how important and how valuable all of the facets of our life experiences are -- including death.