The First week back in Canada

Oh, the joys of that 12th vitamin B

A low makes me dance round in glee

For without scalpel or knife

I can save someone’s life

And the med costs a very small fee.

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

Though scheduled for orientation on Friday, I remembered a good deal of the electronic medical record (EMR), and started in with walk-in patients at 10:00AM. By the end of the day, I’d attended 11 people, as good as my best 8 hour clinic day during my most recent month in Alaska.  Patient flow goes very well here, documentation comes easily.

I carry the title locum tenens, which means that I’m a substitute or a temp, and only the night before did my name fall onto the schedule. Yet I knew 4 of the patients I took care of.

Monday started a very good week. I enjoy patient care, but I know that seeing too many patients in too short a time brings too much stress.  I saw a decent number of patients, rarely ran more than 10 minutes late, got lunch every day, and finished my documentation before 5:30 PM.

Filling in for two docs, at one point I had more than a thousand lab results to sign off.

An unusual percentage of the alcoholics I saw recognized the problem, and an unusual number of smokers had already decided to quit. Although, in fairness, an almost identical number of smokers had no interest in stopping.

I took call on Thursday to Friday morning. I slept poorly as much from the emergency at 3:00AM as from zigzagging time zones.

Friday more than half my patients represented repeat business. The clerical staff informed me that when people learned of my impending return, they waited to schedule with me.

Three of those patients had vitamin B12 deficiency. One of them gave me permission to write about the thrill I get from running the right test at the right time and finding that diagnosis.  I don’t often get to save a patient’s life, and, with B12 deficiency, I get to do it for pennies a day.

B12 deficiency most commonly presents as fatigue. In the past I started the investigation on the basis of depression, anemia, numbness, gait disturbance, erectile dysfunction, ADHD, and dementia.

In other clinics, management has discouraged me from ordering B12 assays in the Emergency Room or Urgent Care contexts. Yet, finding a result in my lab queue with that critical L beside the number brings me disproportionate joy and gives me a goofy grin for the rest of the day.

Which is why I prefer positions where vitamin B12 measurements are appropriate.


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