Left-sided trauma, skin infections, paperwork for income, and a surgical emergency at the end of the day

I will not belittle or curse

Nor whine when it comes to my purse

     I won’t cry or scream

     I work on a team

And I can delegate to the nurse.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand and working in Wellsford, Matakana, and Snell’s Beach.

Today I attended twenty-seven patients.

Four asked me to fill out paperwork so that they would get an income from the government.  One denied any medical problem so clearly that I suspected some agency had recruited a patient to try to trap me into bad practice, and I refused.  For the others I advised lab investigation, retraining, and lifestyle modification.

Nine patients had superficial skin infections.  I heard the term “school sores” applied to a painless blister that rises, then drains pus, and starts to spread.  I prescribed a lot of mupuricin (Bactroban).  Three patients had fungal skin infections, and I prescribed clotrimazole, available back home over-the-counter as Lotrimin.

The vast majority of the trauma I saw happened to the patients’ left side, and included fracture, sprain, bruise, cut, and contusion.

I learned that cigarettes go for $12 per pack of 30, and that those smokers who protest they can’t afford medical care don’t like me getting out the calculator any more than the smokers at home do.

I calmed three children by playing with my yoyo.

Freezing off warts, a simple operation that requires about fifteen minutes of training, pays obscenely well at home because our system rewards procedures more than cognitive-based actions.  Today I had the delight of sending a patient with warts to the practice nurse, who was happy to apply liquid nitrogen.

I sent two patients to the Ear Clinic for wax removal.  I’ve written other posts about the satisfaction that comes from getting out a really nasty hunk of cerumen, but I never detailed the occasional frustration and back pain that goes along with it.  The frequency of ear wax impaction justifies dedicating a nurse three days a week.

I checked patients’ blood pressures today.  For twenty-three years I could say, “Vital signs?  That’s the nurse’s job,” but I’m in a different framework here.  The nurses have a lot more responsibility and power.  They do a good job and free me up for other things, and I don’t mind if I pay the price of collecting all the vital signs I want.

At five, as I settled down to complete my documentation for the day, a nurse asked me if I’d see a patient.  The doctor on call had stepped out.  Not a problem, I said, and saw an opportunity to demonstrate good team work. 

I can’t write any of the specifics of the case because I didn’t get the patient’s permission. But I can say that the nurse did a good workup and that I had the satisfaction of going one layer deeper to uncover a true surgical emergency.

I had seen a couple similar cases a year ago, and even in my own clinic and zone of comfort, my emotions ran high.

Currently, I have limited access to the Internet. 

Tags: blood pressure, ear wax, yoyo, warts, RN, superficial skin infection, nurse, delegation, left-sided trauma, vital signs, cerumen, liquid nitrogen, mupiricin, Bactroban, Lotrimin