Slippery Slope...

Seen it all now...did a vag exam on a lady (STD check) and she had a tattoo in her inner thigh that read "slippery when wet" REALLY??? That's almost as bad as what I saw in Residency - a lady with genital warts and the tattoo on her thigh reading "phat kat" with a pic of a cat...smdh

Nasal FB

So I a sitting in the Living Room talking to my husband when my 3 year old came up to me and said so calmly and matter of factly "Mommy, can you help me get the bead out my nose?" I slowly turn my head to her in absolute disbelief and say "What?" And she again just as calmly says "Can you get the bead out my nose?" My husband and I look at eachother. I tell her to come close. In her right nostril is a bead. I try to press it out from posteriorly with no success. I tell my husban to get something - anything to help me get it out. She starts to fuss and cry. I tell her to stay calm and I find something similar to tweezers and, like magic, I get it out. I comfort her and am glad that I avoided an ER visit. Doctor skills or mommy skills? Maybe both.

Oh, and I started a new blog. I just found out last week that I am pregnant! So I have a blog completely dedicated to that journey at http://secondpeanutexpecting.blogspot.com/.

Doctor Mommy

My 2 y/o has asthma. One day, she was wheezing pretty bad. I told her "Sweetheart, you are wheezing. Let's give you your breathing medicine." Then I gave her a breathing treatment via her nebulizer. After her treatment I listened to her lungs, having her breath deeply. Then I said, "Wow, your lungs sound soooo much better!" with great enthusiasm. She looked at me and said, "Thanks Doctor Mommy!"

Grown-up Juice

I love being a Mom! And my dear daughter says and does the cutest things. Aside from asking to trick or treat a few times a week because she had such a blast Halloween weekend, she's a comedian! The other day, we were eating dinner and I had a glass of wine. She said, "Mommy, can I have some?" I said, "No baby, drink your apple juice." She said, "But mommy, I want your apple juice!" I said, "Oh, no honey, this isn't apple juice, it's....grown up juice!" She said. "Oh. There's grown ups in there???" I just LOVE my lil' diva.

Perscription Fraud

Okay, so I work in a very small town. It's just me, the Receptionist and the RN most times. We have funding for a medical assistant. Had a great one for a few months who became really sick with her pregnancy. Then we had a new girl. Lets call her Ms. Hyper Viper. Very enthusiastic, hardworking, gets the job done type. Almost overly enthused always asking "What can I do? Can I help? Can I do anything else" type of personality. We'd joke with her about her being on speed or needing something to calm her down. It is so great to have a medical assistant to spread out the work load since we do a lot of patient assistance programs and various other programs requiring lots of documentation for funding and grants - takes a lot of stress off of our nurse.

Today the MA came in looking kinda sick - tired. I asked if she was okay and she said she was. Soon after she said she was throwing up so we had her go home.

I got a call from a pharmacy in one of our neighboring towns calling to validate a perscription that was written over the weekend. The name? Hyper Viper. It was for 2 controlled substances, one of which I NEVER perscribe, each with two refills. Had "my" signature (forged), but the wrong DEA #. I told the Pharmacist that I did not write that and not to fill it but he said it was done over the weekend (when he was not there) but he would cancel out the refills and tag her file. They faxed me a copy.

I feel so violated and betrayed. She must have practiced my signature because it was close. She no longer works here of course. I wonder if she's done this before. I wonder how many blank scripts she may have and how many pharmacies she may have gone to. I'm so upset right now.

And Today I Was A...

The one thing I continue to LOVE about family medicine is the variety - you never know what you're going to get.

This afternoon, I was a Psychiatrist. I extensively counselled several people with depression - restarted meds on one lady who stopped taking them for religious reasons after explaining how depression is truly a disease, much like high blood pressure...explained the role of serotonin, and if treatments exist, I believe there is no sin in taking them especially since in her case it had worked well before. I handed another patient kleenex as she talked about her hardships. I diagnosed one with Panic Disorder after ruling out other causes of her spells.

Yesterday I was a Pediatrician. I saw rashes, ear infections, URIs, kiddo with a boil, I even got to take a GIANT wad of paper out of a 4 year old's nose!

Earlier this week, I was a Gynecologist. Pap smears, breast exams, diagnosing BV, STDs, setting up Mammograms, discussed Breast Care (which ran out of funding for the year BTW), etc. I even had a case where a 15 year old and her mom came in - the girl with dysuria and noticing blood when she wiped. The Urinalysis did not look like infection, but I explained that I'd send it for culture and treat until the culture came back and see if anything needed to be changed. I just had this feeling, so I tacked on a gonorrhea and chlamydia lab to her urine. Sadly enough, the chlamydia was positive. Had to counsel her today...

Anyhow, I still love it. Family Practice is like a box of chocolates. Each day, you never know what you're gonna get.

Dr Medicaid, when is your next appointment?

So I have a patient with Diabetes which has recently become poorly controlled. She was on Glyburide / Metformin 2.5/500 BID and her blood glucose was in the mid 300s. HgA1C was almost 9. She tells me how she is drinking 6 or so sodas daily and not eating right. I advise her on healthier eating habits and have her double her pills for the next few weeks (2 in the am and 2 in the pm - I don't like for my patients to waste pills every time a dose is changed). She comes back for follow up a few weeks later. I review how she is eating and taking her meds and she has been doing as advised for the most part, however, her accucheck was 400. So I write a script for the higher dose of Glyb/Met (so she no longer has to double her previous script) and give her samples of and write a script for Januvia - another diabetic med.

No sooner is she out the door that we get a call from the pharmacist - her insurance requires prior authorization before filling the Januvia. Basically meaning I have to get permission from the insurance company before I can treat the patient with this med. So my nurse calls Medicaid and answers their 'screening questions' only to be told that they will not cover that until she has been on the glyb/met 5/1000 BID x 3 months. I am livid! They don't even include the past few weeks of her doubling her pills because it didn't show up in their system since it wasn't an official script.

So now she has to run around with blood sugars in the 300-400s for 3 months before they will pay for her med! And if she has to go in the hospital with DKA or hyperosmolar nonketotic diabetic coma, her insurance will have to pay way more for that hospitalization!

I wonder if I can set her up with an appointment for Dr. Medicaid's clinic since they can so easily dictate patient care. What is the point of having doctors if we cannot even treat the patient without permission?