Third week in Nebraska, and it’s a great gig.


The stuff I see is acute
But there’s chronic and puzzlers to boot
I’m not fussing or kicking
And not cherry picking
And everyone knows how to shoot.

b>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. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Right now I’m in western Nebraska. Any patient information has been included with permission.

I have a pretty good gig here.

Most of the patients have a relationship, direct or indirect, to the agricultural sector. Most patients, male and female, respond if I choose to strike up a conversation about hunting, firearms, or archery.

Yesterday I had a really excellent patient age range, from 93 years to 9 months.

I take the overflow from the permanent docs. I see a lot of colds, coughs, sore throats, rashes, aches, pains, workman’s comp, anxiety, headaches, and depression, so, to a certain extent, I am doing Urgent Care.

But the workload is such that if I see a puzzling case, I get to start the work-up and see the investigation play out. I can recommend non-antibiotic treatment and tell the patient to call in 48-72 hours if they don’t improve. So I find out when I make a good call and when I make a bad call, and my life-long learning proceeds.

So far I’ve avoided the frustrating parts of chronic care, diabetes, high blood pressure, and high cholesterol. That triad starts with bad lifestyle choices having to do with diet, exercise, alcohol, and tobacco, and leads to hardening of the arteries, arteriosclerotic vascular disease. Which in turns leads to the country’s biggest killers, heart attacks and strokes.

And my practice partners, so far, don’t mind. They feel relieved that those folks calling for same-day appointments get taken care of.

Still I feel like I get more than my share of instant gratification. I don’t like the analogy of cherry picking when it comes to taking the easy stuff in medicine; I’ve done it and I know it’s hard work. I prefer to say I feel like I’m skimming the cream, which, of course, I’ve never done so I can’t speak to its difficulty.

The lab, x-ray and nursing staff do their jobs, and I haven’t run into any passive-aggressive behavior.

I have to use the Electronic Medical Record (EMR) now, which I don’t enjoy. When I get a scribe, which I sometimes do, my life gets a lot easier.

The town has everything that I want, including a selection of Chinese restaurants.

We have a lot of non-Spanish speaking Hispanics here, and I don’t know why.

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