Posts Tagged ‘benzodiazepenes’

Another last week

October 5, 2014

Quite early to work I did sneak
To start when no one would speak
I will sing and I’ll praise
These last final days
And be done at the end of the week

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center. I did two short assignments in Petersburg, Alaska. On Sept 2, I turned in my 30 days’ notice.
My last week with the Community Health Center started with a really fantastic Monday. Away from the clinic for ten days for a hunting vacation, I looked forward to patient contact, but dreaded the crunch that comes from being away. So I arrived an hour early, and attacked the 35 items that had accumulated on my electronic desk top, mostly expected normal lab and x-ray.
Three thyroid items came unexpectedly normal, a welcome set of results for a family with no resources and no insurance.
Four items had to do with one of my buprenorphine patients. I had to get a special license to be able to prescribe this narcotic to narcotics addicts, and this particular patient had done well with counselling and meetings for 7 months. Despite warnings to the contrary, the quartet of ER documents confirmed that the patient took an off-the-street benzodiazepine (the drug class that includes Xanax, Valium, Librium, alprazolam, lorazepam and diazepam) and lost the will to breathe, which in this case necessitated CPR and an ICU admission.
Two of my other buprenorphine patients came; they have done well with the medication and watching them maintain jobs and families encourages me. That medication, however, like any other in my profession, lacks 100% efficacy. In fact, if I hit 20% with this particular disease state I count myself lucky. No drug does any better. I had to arrange for subsequent care for both.
No-shows kept my patient flow well within reasonable limits; I kept up with my documentation along with the steady influx of results and reports that have to be personally reviewed by the doctor. Also the numerous emails that accompany the end of employment.
I flew down the stairs to Human Resources to sign papers and learn about my benefits. I spent most of my exit interview talking about the stuff I love about my job.
Then I enjoyed a rare luxury: lunch. I ate my sandwich, smoked salmon salad with fresh basil lovingly prepared by my wife. For twenty minutes I savored the goodness without trying to work at the same time.
One of my schizophrenic patients came in for the monthly Haldol injection, and expressed sadness that I’d be leaving; we share an interest in history and frequently we surprise each other with our details. Well children alternated with diabetics, depressives, and hypertensives, and the afternoon slipped into evening.
And just when I started to wallow in how reasonably the day had gone, to barely start to wonder about my decision to leave, the computer froze, and I remembered why I turned in my 30 day notice 27 days before. I fumed. I muttered bad Navajo words under my breath. I had fantasies of throwing my computer out the window.
I left the office before 800PM to go to the gym, with only 5 documents left undone.

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Blog end: I’ve reintegrated

January 16, 2012

I had a great time, it’s a fact

My life had been so out of whack

I flew cross the sea

From Barrow to Leigh

Now I’m home and it’s good to be back.

I received an email from a doc who went walkabout to New Zealand for a good deal longer than I had, and asked me questions about my reintegration.  I asked for permission to post the original missive, but three weeks later haven’t heard back.

I replied: 

It’s interesting that you emailed me six months to the day after I started back into work here in the States, and if it’s OK with you I’ll use your email and this return as a post.

I’ve enjoyed reintegrating to US society and the medical care system.  I’m back doing hospital work, which, strangely, I really enjoy.   I know my consultants on a first-name basis and I like the camaraderie in the hospital.

It helps that I’m working for a Community Health Center.  For a lot of reasons, our patient population gets sicker earlier.  The pathology load weighs heavy on them.  At any one time, half of our twenty to thirty hospital patients also appear on the nephrologists’ list because of chronic renal failure and dialysis.  Usually we have three people in active DT’s and three others in liver failure. 

I have had to get used to the paranoid reality of defensive medicine.  Our patient population has made the transition easier because many have no money and no insurance and hence can’t pay for procedures that probably weren’t needed in the first place.

For those with insurance, I worry that I overuse medical technology.

Getting labs back the same day, like glycohemoglobin and TSH, makes patient management easier, as does having in-house x-ray.  

I liked MedTech32, the electronic medical record (EMR) system that makes documentation so easy throughout New Zealand, and the hardest part of coming home has been dealing with Centricity, whose software engineers remain isolated from any contact with this particular end user; for example, I have to click through five data fields to make a back to work/school slip and I have no way to fix it.  My productivity has gone way down; eleven patients in a morning or afternoon taxes my resources; not that I spend more time with each patient but I spend more time fighting the computer to enter data.  And about half the problems could be fixed easily.

I miss the way I always started on time in New Zealand because I brought my own patients back from the waiting room, and I miss the way the patients (mostly) respected my time.  In my current situation I limit the patients to three problems per visit.

Narcotics seeking remains a problem here as well as everywhere.  I’m building up a reputation in the street-drug community here, just like I did in the South Island, as parsimonious with opiates and benzodiazepines. 

Still, my practice swells with new patients every day.  I like pediatrics, and I find that a new practice attracts young people and young families, even with an old practitioner.

In the long run, most people either fit into the category of wanderers or homebodies, and I am definitely a homebody. 

But man, did I have a great time.