What'd you do today, Mommy?

One of my patients died last week after struggling with Hepatitis C and end stage liver disease. The family mentioned me in his obituary and I am still so touched by that. It caused me to really be thankful for my job and the power I have in people's lives - for good and bad. I thought it would be interesting to document the patients that I saw today so when I am old and retired, I can reflect back on the work that I did.

Here is a snapshot of my day.

I arrived at work at 8 am. There are 15 patients on my morning schedule - one every 15 minutes. We have about a 30% no show rate, so I'm not too overwhelmed (yet). I load my templates into the patient charts and try to briefly look over them so that my CA (Aime) can do some extra work before I walk into the room if needed.

47 year old white female with lab follow up. We talked about her Diabetes, I started her on a statin for her cholesterol and adjusted her medication for her restless leg syndrome.
49 year old Hispanic female with lab follow up. All labs are normal - she has been having some numbness in her cheek that I think is stress related. She is Spanish-speaking only, so I do my best to communicate effectively.
60 year old white male for a physical. We review his labs (elevated cholesterol) and I perform a physical. At the end of the appt, he mentions a lesion on his tongue that looks like cancer so I initiate a referral to ENT. I am concerned. . .
82 yo White male with right sided hearing loss that turns out to be wax. I talk him into a pneumonia vaccine while he is at the office and my nurse, Bea cleans his ear out.
65 yo White male who is a long-term chronic pain patient of mine. Someone recently revealed to me they saw him selling his narcotics, so I had to have a difficult discussion about my no longer being able to give narcotics/benzos. We also discussed his abdominal pain that I think may be his gallbladder - I refer him for labs and an abdominal ultrasound. He will need to follow up with me in one week.
48 yo Hispanic female here for a well-woman exam. She has had some heavy menstrual bleeding so after I collected a pap smear, I discuss the need for a pelvic ultrasound and endometrial biopsy. She is Spanish-speaking only - I do my best!
57 year old Hispanic male (Spanish-speaking only) with diabetes and elevated lipids. His crestor and tricor are too expensive so I switch him to pravastatin and gemfibrozil and tell him to get labs and follow up with me in 2 months.
73 yo Cuban male - I cannot understand his Spanish, so I have to get Aime to come in and help me interpret. He has diabetes, rash, hypertension, and depression. We spent some time talking about his depression and I increase his medication. Thankfully I know him well so we can focus on one problem at each visit.
26 yo African female with galactorrhea and prolactinoma. After much discussion with the Seton Health plan I finally get approval for the medication that she needs to start taking for this problem. She will follow up in 4 weeks after labs so we can adjust her medication.
46 year old Hispanic male here for a physical after labs. We discuss his labs and I have some concerns about his anemia so I refer him for a colonoscopy. He has a rash on his hands that has been there for some time not that responsive to creams but I think it may be a latex allergy but decide to refer him to dermatology anyway. And I give him non-latex gloves to try.
45 year old Hispanic female with recent septicemia just completing her PICC line course of IV antibiotics. She has really been struggling with anxiety and depression since her illness. I had started her on Buspar but decide on a short course of Ambien as well after a long discussion about dependence to this medication. We also briefly discuss her diabetes and hidradenitis supurativa that is acting up. I adjust her insulin and start her on doxycycline for the skin infection.
52 yo old Hispanic (spanish speaking only) patient with vision loss in the right eye. Has seen an eye doctor and has been told she needs to see a neurologist. I initiate the referral and also discuss her very uncontrolled diabetes and elevated cholesterol. I start her on insulin.

That was my morning! I finished around 1 pm, ate quickly at my desk while I did refills, signed off documents and quickly went to a meeting about clinic operations. The afternoon starts at 1:45 pm.

My afternoon was much of the same except I saw a 63 year old man with hepatocellular carcinoma that needed a referral to Heme/Onc and had been told that he could not be seen. So I got on the phone and spoke with the doctor directly who agreed to see the patient. I find that a lot of my day is advocating for patients that do not have a voice. And if I can only speak to the doctor, most of the time they will graciously agree to see my unfunded patients without insurance. It's all about getting to the right person.

At the end of the day I am so glad I listened to God's prompting for me to pursue medicine way back in 1997! It is such an honor.