It’s now the start of the season
With the coughin’ and sore throat and sneezin’
And then there’s the nose
From whence mucus flows
And the smokin’ brings on the wheezin’

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center, where I worked for 3 years. I left last month because of a troubled relationship with the Electronic Medical Record (EMR) system. Now back from a road trip to visit, and take in Continuing Medical Education, I’m helping to fill in at a clinic not far from home.

I drove east on a Friday morning, into the rising sun, listening to a Continuing Medical Education program and my GPS, Samantha, to an outlying rural clinic.
The town qualifies as small. People don’t lock their houses or cars; local funds built the library, and nobody can claim the traffic made them late. I parked in the alley behind the clinic.
A short tenure in a health facility doesn’t justify the expense and pain of setting up an Electronic Medical Record (EMR) system account when the doc just fills in for a few weeks. Thus I got away with dictating my records as I’d done for the first couple of decades of my career. I passed 15 minutes determining that neither of the ancient micro-cassette recorders could be rendered functional. And then the nurse told me my first patient awaited.
Seventy-five percent of the patients I saw had respiratory problems. I spent a lot of time explaining why I wouldn’t prescribe antibiotics and felt relief when a patient with sinusitis (who had been better and then got worse) needed amoxicillin. The pattern for almost everyone started with high fever, resolving within hours, followed by a severe sore throat lasting less than a day, and a main complaint when they arrived of cough and stuffy nose. I quoted Star Trek twice by doing my best Bones imitation of “Why, Jim, I can no more do that than I can cure the common cold.”
On three occasions, I asked the patient, “On a scale of 1 to 10, how ready are you to quit smoking, where 1 means you want to die with smoke in your lungs, and 10 means you quit an hour ago?” As always, I had to coax a numeric response, and then I asked, “Why not 2? Tell me three good things about smoking.” I listened and repeated, but I didn’t belittle or make fun of the response. After all, everyone knows the dangers of smoking, everyone has been told to quit, and shaming hasn’t worked. To capitalize on their ambivalence, I sought only to make them think about their habit.
For many, the worst symptom came down to a stuffed-up nose. Ipatroprium effectively relieves that problem, but I prescribed so much that the town’s pharmacy called before 11:00AM to say that had run out of it and couldn’t I please prescribe something else.
After being away from clinical work for weeks, I reveled in the tasks, the patient contact and the conversation. I got to talk with farmers and cattlemen. I established rapport with pediatric patients by playing with my yoyo. I successfully examined the ears of an 8 month old without using force.
I got to eat lunch, then I used a phone-in dictation line.
And I finished early.

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