When it comes to care of the heart

The doctor must always play smart

Though I’m working for free

I’ve no EKG

And Urgent Care only offers a start

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, where I’m working for an Urgent Care company. Any patient information has been included with permission.

I carry my stethoscope in my car for a reason.

In a town where I’ve been a medical community fixture for more than a quarter-century, people frequently seek my advice, whether or not I have an office

At a place of business which I visit weekly on average,  the person at the counter asked me to help someone.

The patient opened up with, “I don’t know, I just can’t describe it.”  It took skills honed over 30 years to develop a useful history, always the first step to making a diagnosis.

After a good discussion and a brief exam, I could definitely not make a diagnosis.  But I could say, especially from recent experience, that cardiologic problems don’t belong in Urgent Care.  Diagnostic options there include the essential electrocardiogram.  If abnormal, the patient needs to go to the ER.  But a normal EKG doesn’t mean the patient shouldn’t go to the ER; it means that more investigation must follow, and the ER uniquely has the tools to take the process further.

Urgent Care does a lot of things well, but Urgent Care needs to leave heart problems alone.  Since the summer began, I’ve sent all patients with chest pain to the ER.  Along with those who called their chest pain “back pain” or “abdominal pain.”

I phoned a longtime colleague at the ER, gave the condensed history and saved him the use of an interpreter.

I also spared the patient a useless trip to Urgent Care, but I fear I didn’t do much more.  Still the store owner insisted on comping my purchase; I insisted on not making a charge.

I thoroughly enjoyed using my medical and linguistic skills.

When I arrived home, my email included a note from Canada; I will not possibly start working till December.  This information comes as no surprise.

Bethany and I talked it over, and in the course of less than a minute decided to go back to Navajoland, but this time to the western part of the Reservation, so as to be reasonably close to our daughter in Prescott.


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