Wow. Almost four months away until I am done with school and on to the next phase of my life. But right now, I can really only think from day-to-day tasks.
We have to get 300 clinical hours from June to August, so that roughly equates to almost full time at the clinic. So I have been really getting not only a medical but also a social education.
A little background: I'm in the South Bronx, in a pretty economically depressed area. Pretty much EVERY patient I have is Dominican or Puerto Rico, African American or Jamaican, or a mix of the above. Pretty much everyone speaks Spanish as a first language, but about 80% also speak English quite well. High blood pressure, diabetes type 2, smoking, obesity, asthma, lower back pain, are pretty much part of everyone's medical record, with many also struggling with drug use (heroine, cocaine, marijuana, benzos, percocet). There's also a smattering of other problems: anemia, cancer, neurological disorders, etc, that we see on a daily basis. So that's a pretty broad overview. But now, to be more specific:
Fridays at the clinic. We are all so tired. Those who have full or part time jobs outside of this clinical requirement are even more so. So Fridays, after having been there all week, have a tendency to become somewhat of a s*&tshow. Today was no exception.
The patient flow was continuous, from the time the doors opened at 8am until we cried "We give up!" (not really) at 4:30pm. This week, I had drug-seeking patients ("The pain is so horrible in my (fill in the blank) and percocet is the only thing that helps! Also, I'm allergic to aspirin, ibuprofen, motrin, toradol, acetaminophen, so you HAVE to give me percocet!")When I started in January, wide-eyed, bushy-tailed, and incredibly naive, I would think, "Oh, this poor person! Here you go, here's some incredibly addictive and very-high-in-street-value opiates!" Not really, but I have become infinitely more credulous in the almost nine months I've been there. I've heard every excuse in the book, and some are even so creative that I have give props where props are due.
Now, that's not to say that all are BSers. There are people with legitimate pain out there, but anyone who is a regular at the clinic know our policy about not writing for addictive pain meds. Especially since one of the major things we do are drug-addiction rehab initiation and following.
Today, we were all absolutely fried, and it was only 8:30 in the morning. My first patient was one of my favorites. I got a frequent flier, I'll call her Lucinda, who is there probably 4-5 out of 7 days. So really, every day. It's pretty much a joke now, because I'll see her standing outside when I get to work in the morning, and say, "Hey, _____, haven't seen you in forever!" and give her a fist bump. She'll laugh. And she'll come in with some BS request or complaint which we'll address, and send her off, knowing that she'll be back tomorrow for something or other. One day, she wanted a prescription for an air conditioner. Seriously.
Yesterday I had a guy, just out of jail, who wanted to get started on our suboxone program for heroine addiction. Suboxone is a much better detox drug than methadone, and is easier to titrate down until the patient is not craving opiates any longer. While taking his history, he tells me he has a history of doing heroine for 25years, but hasn't done it in the past 2 weeks. But I'm still in withdrawal. Hmmm. Wait, no heroine, no cocaine, nothing in the past two weeks? And your urine tox report will show that? Yes ma'am. Okay, but you have to be actively in withdrawal before you can start on suboxone, otherwise it isn't safe for you. Oh I am, I am. Okay, but if you haven't had any drugs in two weeks, you'd already be through physical withdrawal. Psychological withdrawal, undoubtably, but not physical.Hmmm. So I go get Dr. D to suss out what is going on. Then he tells Dr. D, after a few repeated questions, Yes, I've done 6 to 7 bags a day of heroine for the past two days. What the heck???? It blows my mind why he'd lie to me, but tell the doctor the truth. I'm here to help you buddy, and I can't if you are giving me a line of baloney! I was ticked.
Also of note, we code all of our services (ie. complete physical, drew blood, gave vaccinations, etc.) with something called ICD-9 codes which make it possible to bill insurance companies, Medicare, etc. Well, one of my fellow students found an ICD-9 code for "falling off a gangplank", no kidding, which is E382. My career goal is to have a patient that has fallen off of a gangplank and being able to code for it. Even better, if I can differentiate between how it happened: saber-point, rifle, musket-point, blind-folded, due to attempted mutiny, etc. Man, why don't we have more pirates at the clinic? I'm over all of the hypertensives:)
I feel like this post is rambling; I am too tired to write anything more coherent. But it was an insane week, full of unbelievable patients. Man, I need a vacation.
