Abnormals I like to see
Thyroids, B12s and Vitamin D
I view with compunction
High liver functions.
I just hate hepatitis C.
One of my medical school classmates said, in 1978, that he didn’t want to go into primary care because he didn’t want to just take care of sore throats and runny noses.
Just before bed last night I logged onto the lab queue. Six patients blinked in red from the icon at the lower right corner. A seventh blinked in black.
Vitamin D deficiency is rampant, and of the six patients with abnormal results, five had low Vitamin D levels, one critically low at 7.5, the lower limit of normal being 33. One set of lab values gave a new diagnosis of rheumatoid arthritis, another a case of hepatitis C.
I see so many people who just don’t feel good that twelve years ago I specified a group of lab tests: CBC, sedimentation rate, B12/folate, thyroid, Chemistry 14, and hepatitis C; I named the panel the GFMP (Gordon’s fatigue and malaise profile). I put it together right after I’d gotten a lot of propaganda from the Hepatitis C Foundation. Three years ago I started checking Vitamin D levels. In all that time I picked up exactly two cases of hepatitis C, and both of them were found by sleuthing down abnormal liver function tests. In this new case, the liver functions were normal, along with the rest of the panel.
Of historical note is that hepatitis C didn’t even get identified till after I’d finished residency. There was nothing to do about it for years; now we’re running a 50% cure rate, cutting into the number of people needing transplants.
I sent emails to the phone nurse pool, to be opened up in the morning; get viral load and viral type on the Hepatitis C, send the rheumatoid patients’ lab work to the rheumatologist, and start all those Vitamin D deficieny patients on bold doses of the sunshine vitamin.
I get a call at about 9:30 AM from a hunting buddy who is connected to me at least three ways. A friend of his has bad migraines and isn’t getting very far with the other docs and would I be willing to work the friend in?
I ignore the fact that I have had bad consequences because I don’t say No well, and I say yes.
I find a hole in my schedule at 11:30, and I tell my nurse.
Three other holes that don’t exist get filled before 11:30 and I don’t start with the new patient till 12:20.
Ninety percent of my migraine patients get successfully managed with life style modification. For all you migraine sufferers out there, here goes: Eliminate nicotine, caffeine, alcohol, Nutrasweet, cheese, and hotdogs. Get into a rigid, effective sleep pattern. By the time I individualize details for this migraine patient (for example, move the TV out of the bedroom, quit smoking with Chantix, and taper down the caffeine) it is ten minutes to one, when the afternoon patients start up, and my documentation is 12 charts behind.
Oh, yeah, and I arrange an MRI for her because she’d never had one and her headaches are getting worse.
I bolt my lunch in five minutes and I’m hacking away at my computer, putting in documentation.
Eventually I hope to get control of my schedule, but I know that it won’t happen till I start saying No.
I’ve gotten better. Four times today when patients tried to put more than four problems on their list I gently made them put together a realistic agenda, and encouraged them to come back at a later time. I didn’t tell them how trying to pour gallons into teacups strains me, puts me behind so the other patients get mad. I just said boy, that’s too much for one day, but it’s really important, can you come back Tuesday?
I still fall into unrealistic time management thinking more than once a day.
I still finish with a joke.