ADHD and E

I saw a kiddo today who was diagnosed by the local mental health facility with ADHD and was sent to me for monthly perscriptions since he lives close to our clinic. At one point when talking to mom, she said "He went from making A's and B's to making D's and F's" and he quickly and enthusiastically added "And E's!!!"

Sex, Lies, and Madness!

Case 1: 24 y/o female presents to clinic for lab review. She had her annual exam and pap smear last week. Very sweet girl, in a long term relationship with her boyfriend of 3 years. On birth control.

Tested positive for gonorrhea.

"I don't understand how that happened..."

Unprotected sex. Case closed.


Case 2: 16 year old female presents to clinic with nausea, vomiting, stomach virus' x 2 weeks. History positive for smoking 1ppd and occasional marijuana use.

Last menstrual period: 2 months ago.

"Do you think you could be pregnant? Did you take a pregnancy test?" I ask.

"I did a few weeks ago and i was positive, but turned negative so I figured I wasn't pregnant."

"Well it is positive today. Congratulations."

She looks at me stunned.

"Do you think you can stop smoking?"

"Yes, I want to do all I can. I don't want to have a miscarriage like last time."

A tear falls from her eyes. I hand her kleenex.

"Is everything okay?"

"Yes it will be, just a little stunned."

"Is the father still in the picture?"

"No we broke up a few weeks ago."

I proceed to counsel her and give her a script for prenatal vitamins and some recommendations for her morning sickness.

Case 3: 55 y/o male presents to clinic with pain during urination. Urinalysis is negative for urinary tract infection.

While getting the basic history, I ask if he is sexually active. He looks down and says, "I lost my wife a few years ago and was not sexually active...until a few weeks ago. I met this girl and we really clicked. I thought we'd be together for a while. We did not plan to have sex but it just happened. Since it wasn't planned, we did not use protection. We are not together anymore. Do you think I may have caught something?"

So we test him for gonorrhea and chlamydia. A few days later he returns for results - he is positive for chlamydia...and treated. "I have learned my lesson" he says. I certainly hope so.


Sex, lies and madness. Sex can be such a beautiful precious thing - but boy can it be dangerous and life altering.

As always, some details are changed to maintain confidentiality.

A New Chapter Begins...

It has been almost 3 months since I completed my Residency in Family Medicine and started my new job - a small town Family Practice Physician. I absolutely love it! I work in a town with a population of about 1500 people, but services about 3000 including surrounding areas - and just 20 minutes from where I live! Staff of three at the moment, a nurse (RN), the office manager / receptionist, and...me.

I enjoy the patients - variety of ages and pathology. Ofcourse the bread and butter of medicine - Diabetes, High Blood Pressure, Heart Disease, but even the rare like a young girl with Phenylketonuria, a teeager with Von Hippel-Lindeau, and a few with Lupus, Rheumatoid Arthritis, and other ailments. The staff is absolutely great. And at the moment, I am doing clinic work only with no hospital call which has many benefits! I have a regular consistent schedule, enough time for a few activities with the church, and time to spend with my young daughter.

I am in the process of applying for hospital privileges so that I can follow a few patients in the hospital (20 minutes away but in the town where I live), but I won't have to take call. A new chapter in my life has begun.

Oh, and I passed my Family Practice Boards! Yay!

So professional wise things are going great. The family and I are preparing to move to a nicer neighborhood in the next few weeks. We closed on our first home a week and a half ago.

And my baby girl is just getting bigger and bigger! 18 months old now! Excellent speech skills and overall a very bright baby - of course I am biased. But even the daycare workers say so. She knows her body parts, even her eyebrows. She can say her name, knows her age and she is sooo loving and playful. She is my absolute joy!

My Baby Girl

My lil girl is growing up so fast. It seems like just yesterday she was a tiny little thing, wiggling, sleeping, nursing, crying, etc. I can remember being up late nights to nurse her and as we lay, I'd thumb through the channels...stopping on The Cosby Show and A Different World. I didn't even know that show still aired!

Now, she is 13 months old. She just started walking a few weeks ago. She can say "Mamma, Dadda, Bah-bah (for bottle), No, Ah-ah, Dop (stop), iper (diaper)" and she can point to her nose, ears, make a 'pretty eyes' face (squints her eyes), and her fro (hair) lol.

I just love her sooooooooooooo much!

I so love clinic!

So yesterday was my first day back at my family practice clinic after a month of being away for a rural rotation and I had so much fun!

First there was a lady who after we addressed her complaints, she said how she kept clearing mucous out of her throat and she demonstrated it over and over with the most wierd sound that I just cannot put into words and she kept saying "like this" and doing it over and over again for the rest of our encounter.

Then there was the guy who pulled a muscle and told me every detail except how it happened and after I asked he finally said he pulled it during sex.

Then there was one of my patients who is always trying to get me to prescribe diet pills to no availe, bless her heart. She tells me about her eating habits and exercising and adds how she already told one of my colleagues "You know, the scruffy one!" as she gestures a beard. He grows a beard every hunting season. She makes the wierdest face and says "Did he shave that yet?" I was laughing so hard. He and I are always teasing so I've got to tell him.

Then the couple. The guy has COPD and is coughing and wheezing so I gave him a steroid shot and an updraft and as he takes the updraft he leans his head back and squints his eyes pretending like he is smoking weed and getting high and his wife is like "Stop that!!" He says how when he coughs, his forehead hurts so bad and she is like "It's probably those devil horns trying to poke through"

I love my patients. LOL. Welcome back.

Rural Medicine - LOVE IT!

So this past month, I had the wonderful opportunity to work in the rural community which I plan to practice in about 25 minutes from my hometown and I LOVED IT! I love the clinic! The staff, though small (only an office manager / receptionist, a nurse, and a medical assistant) was very friendly and helpful. The physicians that I worked with were nice and the people, and I enjoyed taking care of the patients. A great deal of the time is spent not just treating the patient, but helping them in all aspects. Not just prescribing the drug of choice, but checking if they had an insurance that would help cover, seeing if they qualified for a patient assistance program to help with costs, and / or trying to choose medicines that work for their illness and are on the $4 list - taking care of the whole patient, not just their ailment.

I am really excited about it.

I have turned in my paperwork for the job at this community clinic as they have physicians covering on different days, but no full time physician. The only issue now is that a different community under the same management became available and they are trying to get me to go there as that physician is leaving in July. But someone has a contract to start there in 1 year and if the place I want to go finds someone else, I may be left to find a different job altogether after only one year of work! (I have a rural obligation because my loan-sholarship for medical school paid a great portion if I agree to work in a rural area.) I am supposed to meet with him Friday and hopefully we can work something out. I fell in love with that place!

The Pharmacist from Hell

Okay, maybe I am taking it a bit far. But let me tell you what happened.

The other day, when I was on call, my father asked me to call in a script for something to help dry up his cough. I told him I would when I got some down time. While I was at the hospital rounding on patients, I saw one of the patients I was on was taking Guaifenesin Long Acting (LA) 1200mg every 12 hours. Then I remembered my Dad's request. So I called in that very script for my Father. Yes, I know it is pretty much the same as Mucinex, but Mucinex comes in so many doses and types. Plus, if it is a perscription, many times insurance will help pay for it (unlike if you get it over the counter). So I called it in.

Later that night, my Dad calls me very upset. He said he went to the pharmacy (drive through) to pick up his script and at first, the lady said she did not see / could not find the order. So she went to get the pharmacist. He comes to the window and says "Oh, well that doctor must not know what she is doing! You can get this over the counter..." He gives him Mucinex 600 mg and tells him to take 2 every 12 hours. My Dad wanted to say something but my mom stopped him.

Now, sometimes my Dad can embelish a story, so when I talked to my mom, I asked her did that really happen and she said, "Well, yes, that pharmacist did say that 'that doctor must not know what she's doing!' They are not supposed to say that, are they sweetie?" "No" I replied. Kind of hurt. Quite upset.

Initially, I figured I would let it slide seeing as I am a Resident (though third year) and it's not like I have my own practice in the town or anything...yet. But the more I thought about it, the more it seemed that something should be done.

The next day, I talked with the Pharmacist at our clinic about the situation. She was quite enraged at him and said that there was nothing wrong with what I did and what he said was absolutely inappropriate and unnecessary. She urged me to talk to the Pharmacist and added that maybe he was having a bad day or something and just said something he didn't mean. And maybe, just maybe, he'd apologize.

So, I called and this is how it went after he got on the phone.

"Hello?"

"Hi, ____, this is Dr. ___ how are you?"

"Oh, I'm good and you?"

"Oh, I'm good. I just wanted to talk to you about something."

"Sure, sure, go ahead."

"Well, Saturday, I called in a script for Guaifenisin 1200mg Q..."

"...Yes, yes, I know. I took that order."

"Okay, well, I understand that when the patient came, you told him that 'That doctor must know know what she's doing, you can get this over the counter'"

"Oh, no, I was just saying that Guafenisin is the same as Mucinex and he can get it over the counter"

"Yes, I know that, but I wanted him to get a specific dose which is one reason why I called it in.that, but I also understand that you said that 'That Doctor must not know what she is doing'"

"Well, yes I did because we have not had that dose available for quite some time now and the manufacturers no longer make that dose"

He sounded very argumentative.

"Well, I am not trying to start an argument or anything, but I just wanted to say that I think for you to say that about a physician to a patient is very unprofessional"

"Well, I think it is unprofessional for Doctors to order doses of medications that we don't have"

"How am I supposed to know that when I look in my pharmacopea and uptodate.com and it says that that dose is still available? As a matter of fact, that dose is still readily available in this hospital. Patients are getting that dose as we speak. And just so you know, that patient that you told that to was MY Father with MY Mother and MY little girl in the car. So I would appreciate it if, in the future, this would not happen again. Because I wouldn't do that to you! Okay?"

"Okay, thank you."

"No, thank you."

I told the outcome to our clinic pharmacist and she was absolutely appalled as was I. He was such an A-hole to me! And ofcourse he did not apologize or even seem to care.

I discussed this with my parents. They have done business with this pharmacy for over twenty years. Needless to say, they don't do business there anymore.

For what it's worth, my mother called the head pharmacist there who is his supervisor and who she has known for years and he had heard about the incident and apologized profusely.

Too little, too late.