Primary Care Potpourri

A few of the daily challenges:

53 year old morbidly obese, wheelchair bound, non verbal woman being cared for entirely by her 73 year old mother. How this woman is transported from her bed to her wheelchair, cleaned after bowel movements, or rolled over in bed is completely beyond me. This is a new patient to me (of course), without any records (obviously). When I inquire as to why they changed primary care providers, I get a tight lipped response from the mother having to do with accusations that the mother was secretly taking her daughter's chronic pain medications. The mother states repeatedly that she never did such a thing, proceeds to show me all the empty pill bottles for the opiates (not prescribed since they left the other doc in October), and insists that her daughter being off the pain medications is the best thing that has happened to both of them. I'd like to blindly accept all these facts, but I have to admit the whole scene smells fishy to me. Luckily the mother/caregiver is not asking for any pain meds (yet). I have her sign a release of records ensuring a stack of medical records soon to thud onto my desk for my review. Then I wonder how I'm going to go about examining her backside (complaints of skin problems).

58 year old deaf Cantonese male for a routine check up. He is accompanied by his sister who supposedly communicates with him via American Sign Language. She, though, only speaks Cantonese. So the lines of communication are as follows: Me (english) to sister (via Cantonese interpretor) to brother via ASL. Halfway through the visit, and in the middle of my explaining why he needs a colonoscopy, the sister confesses that she doesn't actually speak ASL. She explains that her brother created his own system of signs that no one can really interpret. She says that communicating with him is nearly impossible, and doesn't think he'll ever understand the instructions for a colonoscopy. I wondered why when I signed the few ASL signs I know they all gave me blank stares. The old pen and paper trick won't work too well unless I start writing Chinese characters.

47 year old Vietnamese male for follow up. You might recall this patient as the one who was told by DSHS to get his alcoholism and severe depression taken care of by February 2011 or else he will lose his benefits. Well, uh... I'm trying. Two weeks ago I prescribed an SSRI and counselling. He took a whole 2 days worth of the SSRI before deciding that it wasn't helping. But he doesn't want to talk to me about that. No, today he wants to talk to me about body aches, stomach ache, back ache, malaise, fatigue that has been going on for 4 years. A classic case of a pan positive review of systems. This means that no matter what symptom you ask this patient, even the most far-flung, implausible symptom, you will be met with an emphatic yes. Sometimes, in these cases, I find it is better to let the lab results do the talking.

I just got an email from a fellow family doc sweating it out as a doc in a state prison. She mused, "Don't you ever just wish you were a dermatologist?"

Oh, dermatology? Well, funny you should ask. I nearly forgot that enormous scalp cyst I removed today (hoping not to cut down to skull, hard to suture back up when the suture is the same color as the hair), the cases of zoster I saw (two on the forehead, V1 distribution, one with scary eye involvement and vision trouble), the huge ear keloid I'm going to remove shortly ("But it will very likely return, maybe even larger," I say. "I must wear my hair in a ponytail!" She replies.)

Truth: most of the time I like the variety. Other truth: a wee bit of the time I do pine to be a specialist. If only primary care docs were compensated as well...