Posts Tagged ‘demographics’

Time off from clinic for Canada Day

July 6, 2017

They celebrate the First of July

Canada’s birthday, that’s why.

On the way back from there

We saw two black bear

And gave Tim Horton’s a try

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Canada Day, this year representing the 150th anniversary of the Confederation of  colonies Nova Scotia, New Brunswick, and Canada, passed largely unnoticed in the US, but well celebrated here in Canada.

Bethany and I slept in and strolled over to the Rec Center for the free barbecue, the third so far this summer. But the demographics of the gathering, not the free food, impressed me the most.

Canada can boast the world’s most ethnically diverse population. We saw a lot of Native faces, and a good mix of Chinese and South Asians.  Everyone got along with the famous Canadian politeness.

This part of British Columbia sports a younger-than-provincial-average population. We saw easily a hundred children with almost as many strollers as baby bumps.

Consider how this mix contrasts with southwest Iowa.

Iowa, the grayest State in the Union, has the highest percentages of septuagenarians, octogenarians, nonagenarians, and centenarians. Within the last year, during my two assignments in the southwest quadrant of my home state I had the daily privilege of taking care of a lot of very old, very spry people.  They had wonderful stories to tell.  A few had survived the Great Influenza of 1918.

We eyed the line for the burgers and brats, then strolled over to the skate park to watch youngsters ride bikes and skateboards around obstacles including ramps, stairs, railings, and benches. One young cyclist took a spill.  He got up and tried to ride the bicycle but couldn’t.  He walked it over to his parents , whom we recognized.

Bethany looked over at me and asked if I wanted to fix the bike. I smiled, and we walked over to the trio and explained I had fixed bicycles professionally through premed.  Sure enough, the brakes wouldn’t let go.  I quickly realized the front wheel had done a complete 360, twisting the brake cables, easy enough to rotate the other direction.

The day after Canada Day we took a drive to mile marker 0 of the Alaska Highway in Dawson Creek.   Highway 97 winds through pine-and-poplar forests, over rivers large and small.  I hadn’t seen any agricultural development for a hundred kilometers.  But we crossed a mountain pass, with tortured rocks exposed in the road cuts, and came into a valley on with lush meadows, herds of cattle and horses, an occasional flock of sheep and the odd goat here and there.  From time to time we saw fenced enclosures with hundreds of round hay bales stacked two deep.

Chetwynd hosts the annual World’s Championship Chainsaw Carving contest; competitors leave behind piles of sawdust and exquisite carving. We stopped into the visitors’ centre.

Of course they asked us where we’re from. We explained that most Americans don’t know where Iowa is, having flown over it but unable to name any of the 7 states that share a border.  Surprisingly, the staffers have a friend who goes to University of South Dakota in Vermillion.

In Dawson Creek we took the requisite selfies at the marker for the beginning of the Alaska Highway, 75 years old this year, and lunched on sushi.

On the way back through Chetwynd, we stopped at a Tim Horton’s, a Canadian restaurant chain a notch or two better than McDonald’s, for dessert. We couldn’t stand the thought of visiting Canada without at least trying such a national institution.

We took our time on the way back, curious about the various human installations that appeared out of the wilderness on either side of the highway, mostly to do with the energy industry.

Just 15 kilometers shy of our hotel, two black bears crossed the road, taking their time, but not quite slow enough to get out the camera.



And after one day’s unemployment…

October 26, 2014

I drove a half-hour away
I had a great clinical day
Oh, what a tonic,
I ignored the electronic
And dictated what I had to say.

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.

On Monday this week I drove to Anthon, Iowa for a day of locum tenens work.

Over the weekend, in different social situations, two people approached me for medical advice, mostly having to do with medical care by other docs. For one I later wrote an email to the family, using physical examination buzzwords, expressing my concerns, and, hopefully, getting the patient into a neurologist in a timely fashion.

I made a phone call for the other patient, leaving a voice mail for their other doctor that I wasn’t officially on the case, I had observed certain things, and if the patient took Zoloft and Prozac, perhaps lorazepam could be discontinued?

Monday I left home early for Anthon, a quiet, prosperous but very small farm town. I’ll be working here from time to time for the next couple of months, in the complicated aftermath of a rural doctor’s personal tragedy.

The patient demographics stand in stark contrast to the Community Health Center. Most patients have insurance or jobs or are retired. No one has an accent. I did not see a single patient with major psychiatric illness all day.

Alcoholism, regretfully, stalks the clinical landscape as ruthlessly as everywhere. I applied my recently acquired Motivational Interviewing skills to the situation, and got at least a couple of people to think hard about their lifestyles. At one point, having gotten the initial three minutes of history, I asked very specific questions about the family history and got accused of being a psychic.

The ravages of past tobacco abuse permeated the day. I got the chance to interview one patient about experiences during World War II, and what it was like to grow up on a farm in the 20’s.

I said, as I have said before, “Weight loss in 21st century Iowa is NOT NORMAL and whatever else is wrong with you we have to investigate,”

I prescribed trazodone for depression, chronic pain, insomnia, and appetite loss, noting that the young doctor knows 20 drugs that will treat a disease but the old doctor knows one drug that will treat 20 diseases.

For the second time since I left the Community Health Center, the possibility of Parkinson’s came up.

I ate a leisurely lunch with the staff in the clinic’s tiny lunch room. We finished at 3:15, and I drove back to Sioux City.

I passed the whole day without getting behind in my documentation. The management spared me the learning curve of an apparently very bad Electronic Medical Record system, and I got to dictate my notes. Like in the old days when we had paper charts.