On seasonality of medical care

Here’s a thing I have come to know

It’s September, before the first snow

There must be a reason

For the pace of the season

For the flow of the woe to be slow.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral a bicycle tour of northern Michigan, and cherry picking in Sioux City, I’m travelling back and forth between home and Pennsylvania. Any patient information has been included with permission.

In the days when I owned part of a clinic, we noted a definitely seasonality.  Cold and strep season started up as the weather chilled, six weeks after school started.  That business increased at Thanksgiving, with a big jump after Christmas.  Influenza generally provided a lot of work till spring, when the athletic injuries started up and would last most of the summer.  School physical season would start about July and ran through August..

But things slowed down in September.  Warm weather, open houses, outdoor activities, and sunshine discourage the spread of respiratory infections.

For years I worked long hours in the summer while my partners vacationed, but I went on hunting trips during the slow business month.

People don’t come in at nearly as brisk a pace now, as summer slows into September.  The school sports physical season has almost finished.  We see a good number of those with sore throats, but the people with “summer colds” (really allergies) have diminished in number.  Folks suffering from poison ivy, half my business in June and July, now show up about once a day, and not nearly as severe as before.

I didn’t have a chance to care for a patient till after 9:30 this morning.  We got in a good number of people needing drug screens for their employment.

The memorable patients today (more than one) had heart problems, thankfully, not requiring ambulance transport.  I explained several times that the way a person’s hand describes the pain provides a valuable diagnostic clue.  The open hand next to the breast bone more often describes heartburn or anxiety, but the closed fist or clawed fingers usually describes blocked arteries.

But two-thirds of the electrocardiograms told alarming stories of drama and irony in squiggling lines.  For all three patients I made calls to facilities with expertise and options outside our Urgent Care scope of practice.

In the middle of the day, with plenty of time permitting, I took a chair out the back door and ate lunch al fresco.

Through the day I kept wondering when I’d see something I’d never seen before.  Because it happens every time I see patients.  Seven patients checked in after 7:35PM.  Closing time came and went.  Staff, understandably, wanted to go home.The PA and I slogged our way through.

Then, the very last patient had a physiologically inexplicable finding.  The PA had never seen anything like it, either.


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