Archive for April, 2019

Health choices could obviate doctors. Mostly.

April 16, 2019

The winter left gravel and sand

On the roads all over the land

Back home the snow’s pelting

In the north, here, it’s melting.

I’d call the Alaska spring grand.

 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, western Nebraska and Canada.  I have now returned to southern Alaska.  Any identifiable patient information has been used with permission.

I ran into a patient last week not much different in age than myself, who gave me permission to write more about his case than I have.

Every doctor should tell every patient 8 things (not necessarily at every visit): nicotine, caffeine, alcohol, diet, exercise, sleep, seatbelts, and marijuana.  Most of that advice goes unheeded; docs work with people living in the real world making real decisions.  If people did what they know they should, 3 out of 4 physicians would be out of a job. 

This patient, however, has lived his life as an example of a healthy life style.  He loves his wife, he loves  his work.

The medical part of the visit did not last long, dealing mostly with the inevitable consequences of living a half-dozen decades on a planet with gravity.  We had the chance to chat.

He manages dozens of workers in a handful of departments.  I made the comment that I love my work and I don’t have leadership skills.  He told me that’s exactly that kind of person he wants as a department head: the ones who don’t think they’re leaders can make the best leaders.

As the conversation progressed I could tell that I’d love having him as a boss.  Though I aim now at a place on the organizational chart at the same level as the janitor, I could see that with his kind of encouragement I could rise in an organization, and probably love it. 

I have to consider the possibility that lots of people have happy, healthy lives, and thus do not need to see the doctor often.

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Snow melt left all the local paved surfaces covered with sand.  Cars kicked up dust till the street sweepers swept away winter’s detritus, which made the town dusty for about 10 days. 

Two weeks ago, coming back from fishing, a machine on the highway raised a column of dust that could have guided the Children of Israel.

Now most paved surfaces, including sidewalks, have been swept.  Parking lots have lost tons of sand and pea gravel, but almost all have a shrinking snow pile at the edge leaving a thin trickle of melt water draining to the gutter.  When gone, they leave behind more sand and gravel, and the flotsam of winter: hats, gloves, and socks.  It’s spring in Alaska, daytime temps don’t go over 45, freezing nights leave a coat of ice on vehicular windows. 

And back home, in Iowa, they’re still waiting for the last snow fall. 

 

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Literature, gold, and fishing: building rapport with patients.

April 3, 2019

We agree that fishing is fine

What a joy to have one on a line

On a fish charter fling

The salmon are king

But they get away, some of the time.

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, western Nebraska and Canada.  I have now returned to southern Alaska.  Any identifiable patient information has been used with permission.

I arrived here 2 weeks ago.  Yesterday, I saw 3 patients, my peak day until today, when I saw 5.  With one exception, every patient I’ve seen so far has been male.

The youngest patient to date used to teach English.  Of course I gave my undivided attention, and in short order recommended Beryl Marham’s West With the Night, along with Ernest Hemingway’s posthumously published True At First Light.  We had an excellent discussion about the joys of traveling and working, and exchanged tips on slowing down.

I try to get advice from my retired patients about successful retirement.  All so far have recommended the local senior center and lots of fishing.  One had retired from full-time fishing guide to fishing when he wanted to.

Another of today’s patients mines gold by panning.  It gives him a good deal of exercise (which I always advise), he loves it, it challenges him intellectually, and provides him with an income.  But he wouldn’t say how much.

Most of the time, I ask the patients if they fish (they all say yes here), but today some I treated beat me to the question.  At which I dug my phone out of my pocket and showed off some salmon pictures from the weekend.

king salmon x 4 march 19 Homer Alaska

Friday, Bethany and I,  off on a fishing charter, caught 4 king salmon, and we got another on Sunday.

salmon winter king 2019 March

The king are the  largest of the salmon species, those caught outside of the summer breeding season have the most fat.  Salmon have the healthiest fat of any animal on the planet.

Of the five, our skipper estimated four would come in between 20 and 24 pounds, and the smallest about 16.   My patient admired the photos but in short order admitted he holds a record for one of the nearby rivers at over 60 pounds.

A fish that big, once hooked, does not go quietly into the boat.  The fight that ensues can wear out a person’s grip; the successful catch requires constant line tension.  The fish that charges, making the line go slack, has a good chance of getting away.

Over the weekend we also caught rock fish (sometimes called sea bass or rock cod), ling cod, and kelp greenling.  The captain referred to them as trash fish and threw them back.  None of them weighed more than 4 pounds.  Each one brought its own thrill to the day.