I think a lot about how I'm going to practice medicine. I'm very enamored with "ideal" medicine -- money isn't an issue, patient visits last as long as they need to, everyone's needs are addressed and met, and everyone is happy. If primary care worked that way, I think I'd like it. As it is, I can't help but think I'm going to end up a hospital-based physician (hospitalist, ID, ER, ICU) or a specialist, because primary care, though noble and calling to me, sucks. I know, I know: "You can be the good one!" I've been told (about both surgery AND primary care, actually), but it's really difficult to imagine. Anyway, here are some NY Times articles to ponder.
At Trial, Pain Has a Witness
A pain management physician from Northern Virginia is on trial for prescribing opioids to patients who were using them illegally or diverting them. This is a tough issue; pain is a completely subjective sensation, and lots of people are in serious pain. If you have a policy to not prescribe opioids at all, like the witness Dr. Hamill-Ruth, you're not going to address the needs of your patients. If you over-prescribe, like the defendent Dr. Hurwitz, some patients are going to take advantage of you.
Treating the Awkward Years
*Side note: I still think, 16 years after losing a spelling bee on the word "awkward" (spelled it without the second w) that the word "awkward" looks really awkward. What's funnier is the girl who went after me, who had to spell it correctly to advance: she spelled it wrong, the exact same way I did. Idiot.
It's well-known among medical professionals that children are not simply small adults, and now we learn that adolescents are not large children. Adolescent medicine is apparently very needed but underserved. This article makes it sound so nice; when I read it, I think, "Yeah, I could do that. It would be great to work with teens to make sure they transition well between childhood and adulthood." Then I think about MY adolescence, and I'm not sure if I could stand talking to someone like me.
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2 comments:
What the heck is a "hospitalist"?
Adolescent medicine is important - I think some of mine are underserved because they will NEVER open up to their pediatricians and if their other option is the family doc, they might feel weird about that if their parents are also patients. I have a few that seem REALLY unhealthy - a lot are obese and sedentary and some are scarily skinny. This could also be the place to recognize depression and anxiety and lead to professional mental health help.
But, yeah, they can be truly ugly people. Today I seriously wanted to wring a few necks.
Hospitalists are hospital-based physicians. They are internists (if we're talking about adults) or pediatricians (kids) who do not have offices or work in private practices, but instead take care of sick patients admitted to the hospital. In the olden days, if you got sick and had to be hospitalized, your primary care doctor would come see you in the hospital and maintain control over your orders and hospital course, which usually meant coming in at 6 am and 6 pm, bracketing his/her regular office hours. Now, more and more primary care physicians use hospitalist services, so if you get sick and need to be admitted, the hospitalist, who only sees hospital patients, takes care of you, and (usually hopefully) sends a report to your primary care doctor to keep him/her updated and informed about what happened. Some primary docs use hospitalists for all cases, others still like to pick and choose which patients they might see in the hospital.
Anyway, the pros of being a hospitalist are (generally) a more reliable paycheck (probably salaried from the hospital rather than directly dependent on patient payments, and seeing sicker patients (which may or may not be a pro). Cons are not having any continuity in patient load (and that could be a pro as well).
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