The Secret to Primary Care

You know how everyone assumes that if you practice primary care you just end up shuffling between runny noses and eczema? Well, that's true. But the secret of primary care that I'm learning is that you need those common ailments to pepper your days. Why? Because in between mundane complaints the complicated patients are hiding. Yesterday it felt like I was a pendulum swinging between no big dealio patients and very big dealio patients. And it was a light day yesterday (meaning only 18 patients because of some meetings we had that cut into clinic time). For example: Viral uri followed by strep pharyngitis followed by middle aged woman with palpitations recently diagnosed hyperthyroidism, on methimazole, now with a (new) huge goiter compressing her throat. Her TSH went from 0.004 to 95 in a few months. Does she need imaging? Does she need an endocrinologist? Yes and yes. Does her new PMD need to do reading about thyroid disease? Most certainly yes.

Or another interesting progression of young patients: eczema, well child check, 2 week old for newborn check and establish care. I browse through the delivery summary (since it was at another hospital) and my eyes stop on the APGARS (1 at 1 min, 4 at 5 min, 5 at 10 min). Hmmm. Not your average well child, right? Turns out the mom, having had a c section 15 months prior, was scheduled for a repeat section but came in to the hospital in active labor at 9 cm. The patient and doctors decided to see if she could VBAC. Turns out the answer to that question was no, and she proceeded to have a uterine rupture with placental abruption, hence the very floppy and blue baby. The child ended up in the NICU for 2 weeks intubated, etc etc. Does the baby need special follow up? Per the discharge summary they only recommended follow up at the developmental clinic at 3 mos. And miraculously, that baby looked pretty darned good to me, having gained back its birth weight and then some. I said to the mom, "Wow. What an ordeal you've been through. I'm so glad everything is working out ok now." Mom's reply: "Inshallah."

In addition to playing Find the Complex Patient, this week I also played a little game I like to call You Know You're A High Risk Pregnancy When...

1. Your wet behind the ears family doctor is prescribing you lamivudine in your 3rd trimester.

2. You find out you're accidentally pregnant (at 40 yrs old, after your husband had a vasectomy 13 years ago) while undergoing a work up for breast cancer.

I will say this about my new job: It is never boring.