Angry Birds

The other day I was fuming (internally of course) after battling with a toddler to examine him during a well child check. He proceeded to scream and flail the entire visit, even when I was safely out of his 3 foot personal space bubble and ignoring him entirely. Apparently my mere presence in the room was enough to send him into a full blow fit of rage unlike any I had ever seen before. I thought that was the worse possible well child exam I had done in a long time, but after this morning's well child patient I'm not sure. Is it worse when a 4 year old girl does not look up from a game of Angry Birds the entire visit (even when repeatedly asked to by her mother and her doctor)? The only response we could elicit was the soft "wheeeeeeee" of the birds as they flung themselves towards their evil swine targets. Kids these days.

Another cause of frustration: writing prescriptions for things that are over the counter. Roughly 85% of the prescriptions I write a day are for over the counter things. I understand that at times medical coupons make these medicines cheaper, even if they are available without a prescription. But with 15 minute interpreted appointments and a jam-packed schedule, it gets tiresome, without a doubt. And most of these are for children (love the weight based dosing!!) adding further prescribing hassles.

And then there are the requests for the ever-popular and ever-powerful Letter from a Doctor. I've mentioned this before (remember my Alaskan patient who needed a letter asking the government to provide him with a moose for the hunting season?), but it never ceases to give me pause (not to mention slight frustration). Today the request was a note exusing a patient from an entire quarter of school (for something completely benign that probably caused her to miss 1-2 days of school). Recently I got a request from a patient who I have never seen before, and hasn't been seen in clinic for months saying he needed a note to excuse him from the 4 days of school he missed last month. No further explanation from the patient provided. Today I also had a request for a prescription for whole milk (no medical reason why this child needs whole milk, she just likes it better). This request was from a patient of mine (the child was not even seen today or any time recently) who I am concerned has preeclampsia (a bad ailment of pregnant women, serious, and more important than milk). I'm trying not to let my negativity get the better of me this morning, but really. Milk? MILK? Get thee to the dairy aisle! And now let's talk about your real health issues, please. And let's not get me started on the pregnant patients who request (and we're talking in their 1st to 2nd trimesters) a letter excusing them from working at all during their pregnancies (and hoping for unemployment benefits or some sort of payment for this leave). For completely healthy women with low risk, uncomplicated pregnancies. Just because they are tired. Seriously?

Yes, someone has not had enough sleep. I've had some killer OB calls recently. Last week I had a completely sleepless shift with 3 deliveries, and yesterday I had another 24 hour shift that was action-packed. One precipitous vaginal delivery (her second baby, flew right out), one moderately paced VBAC (victory! I love a successful VBAC - vaginal birth after having had a c section), then a 4 am admission of another quick vaginal delivery. I'm pooped. I'd like a letter from my doctor saying I don't have to work today. Any takers?