If it’s not a problem, it’s not a problem


I couldn’t do any good with medication
I thought I would try education.
I said, “Now you’re full-grown
You can just leave it alone.
Avoid, if you can, operation.”

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 (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and two weeks a month working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.
When I get permission to write about patients, I usually say I won’t mention age or gender, but I like to talk about diagnosis. For the first patient of Halloween, however, I switched. I requested and received permission to mention age and gender and only vaguely refer to the problem.
Just looking at the active 71-year-old gave the diagnosis. But the diagnosis didn’t compromise function, and fixing it would have led to months of recuperation. Doctors only have four things we can do, I said. We can medicate, operate, educate, and manipulate. And none of those will improve your function. And with surgery, we always have a chance of making you worse. If it’s not a problem, I said, it’s not a problem. And trying to fix it will take you out of work.
We had a good discussion on second-stage careers. We both face problems of trying to slow down but not wanting to stop. We both revel in the activity, challenge, and socialization of work. And we both face the challenge of limiting hours in the face of high demand for services. And we both sometimes over-commit.
I recounted my experiences with a patient at another clinic, a mason who worked well into his 90’s. When I knew him, his personal integrity brought such high quality to his craftsmanship that he could charge whatever he wanted for her services. But by then, he didn’t work for love of money. He picked his jobs by the size.
As the day wore on, respiratory infections dominated the diagnostic landscape, with skin problems coming in second. An x-ray showed a fracture, another didn’t. I took out ticks, whole and by the piece. I laughed out loud when a patient referred to a particular horse as a “tick magnet.”
With so much Lyme disease prevalent in the tick population, any engorged tick, or tick bite of unknown duration gets presumptive Lyme disease treatment.
At the end of the evening, I drove country roads back to the hotel, hyper-alert for deer going into rut. When I walked past the front desk, the clerk asked me if I were a doctor today. When I figured out he viewed my scrubs as a costume, I laughed. Yes, I said, I’m a doctor today, and I was a doctor yesterday. And I took chocolates from the bucket on the counter.

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