a thought to consider

What exactly differentiates a flaw in personality versus a quirk in personality? 

Someone who is introverted - we can just call that part of her personality. But if it is to the point where it is detrimental to social interaction or making relationships or whatever, is that flaw?

Are there even such things as "flaws in personality"? But surely there are some things, otherwise how can there be so many "improve yourself" books. 

People who say, oh I'm just truthful -- can very well just be an asshole without empathy. Truth is not always right at certain times.

People who say, oh I just have a hard time keeping up with old friends -- can very well just suck at making lasting, deep relations with people. We can call that social butterfly, or social ease. Not actually a "flaw", but wouldn't it be "better" if you were able to keep up with old friends? And if the positive if better, then isn't the lack thereof a negative? 

People who say, oh I'm just quiet and slow to warm up -- or could just be socially awkward. Again. Isn't it better if you could easily warm up to people?

Not necessarily, of course. And this is probably all touchy subject because who wants to be told that they have a flaw in their personality? Or eh, it's fine - that's just the way I am. Or eh, it's actually a positive because [we need truthful people to call out things, quiet people to understand how to listen, etc etc etc].  

Making peace

Not a rant today.

There are good things about family med.

You do get to see a variety of patients. Pediatric to geriatric. From acute to chronic. Mild to life threatening.

There is much to learn, much to say, much to do.

In this place, you decide how far you want to go with a patient. Take the time to talk about prevention and explain the disease behind it all and walk through the medications with the patient? Or just diagnose, write a script, and discharge them. There difference is potentially so, very large.

Can't you see how easy it would be to burn out here?

The continued raging against family med

Changed clinics, so I am no longer at the poor continued care clinic that lost its grant funding to pay for uninsured patients. Now I'm at an acute care clinic, which makes it oddly like weird mutt of the family medicine and emergency medicine breed. We only care about acute complaints, but we don't mind seeing you again in a couple of days.

Yeah. I am frustrated and sad and disappointed in what family med can do for patients. And it's at this clinic too. So what does that even tell me? Is it just these two clinics? Gosh. Just gosh.

A Malaysian lady comes in for generalized pain all over her body and tells us it's been going on for almost a year, unexplained weight loss of 10 kgs, general malaise, etc. (I mean, hey kinda suspicious for cancer, or I'm thinking maybe a little fibromyalgia or something even though that's by exclusion). Not good stuff, y'know? But she says she got all her labs done in Malaysia, etc etc. I go back and tell my attending. Doc and I walk in and he just has to clasp his hands together and tell her that we need to repeat all the labs and imaging because she's not in the US system. But, she stares at him a little blankly, I had all the labs done.
But not here, he tells her.
I am just standing. A medical student. A bystander. It's like watching a car crash.
They go back and forth saying the same things.
I know the results.
But I can't do anything without the standardization here. To another doctor's eyes, it would look like we haven't even checked all the basic labs.
But I've done all of the basic labs.
I know. But not in the US.

I don't know what to say. How much more silently can I stand? What could I say?

My gyn checked by blood and hematocrit and he always does an ultrasound of the kidney.
Did you bring the results?
No... but they came back normal. And he always does it. I had them done in June.
Your gyn is in Malaysia, right?
Yes...
Ma'am, every country's lab standards are a little different. We would still have to repeat them even if they were normal there.

It seems like no one will give. But then she says:
How much would it cost?
He hesitates but says, for a CBC, a thyroid test, you would definitely need a colonoscopy, and a mammogram for the lump on your breast, we would want a CT.... $5,000?
She gasps.
She turns and looks at me incredulously.
I am sure I look like a stupid medical student just standing as if I could become a potted plant.
Each of those were $50 in Malaysia!
I know, ma'am. But we would need to go off data in the US.
She is silent for a long time, just twisting her fingers together and apart.

They exchange a couple more words, and he leaves her with a hope of getting a free mammogram some way through some charity and a written order for a colonoscopy that she might have to go back to Malaysia for. And I follow him out the door.

The strength in her smile that she gives me as I walk out is heartbreaking.

....
Now you see... I don't think I wrote the doctor justice. His tone as he spoke was not callous. Nor was it frustrated or mean or spiteful or anything of that sort. It was just "my hands are tied and what can I do, here is the information i have" sort of tone. And I feel for him. What could he have done? No doctor that wants to defend/justify their treatment plan would treat without some sort of labs or imaging. What could he have done?

But I am just so tired of feeling such sadness for the patient. What could she have done?

These questions hurt so much.

The doctor who says helplessly: What can I do?

and the patient who says in pain: What should I do then?

WHY IS IT LIKE THIS? Tell me, why is it like this?

Trust

When do you decide that it's okay to trust this person, that it's safe?

It is a leap of faith. A leap between silence and spoken words.

I don't trust enough.

I think I have trust issues.

Maybe this is why I hate being dipped.

Idle Thoughts

1. I think the older I get, the more and more I appreciate my parents. (Or it that distance makes the heart grow fonder? not sure.)

2. I'm sick to my bones of studying. Woke up at 8:30 on a long weekend because that's how my body rolls now. There's an infinite amount that you can study. It is never enough, to be honest. I will always be behind. 

3. Dancing

- Okay, lots of thoughts here. But I think I really, really enjoy two stepping because it's a partner dance. They talk about it like it's a conversation. And that's just so interesting. Movement as words, intentions in the pressure of the hand, preempting movements, waiting and receiving, what you do if you misread a cue. It's a conversation of body movement and I love it. And the most interesting thing is just how different each person can dance. It's like intonation of your voice, or an accent, or the pacing of your sentences. The verbage that you choose. Do you slide or shuffle? A hitch to the right or a swagger of the hips? A strong grip? Sure, it's all the same dance, but it's different with each person. 

How well can you lead? How well can you follow? A firmer touch? Or a refusal to follow? Nobody is "right" or "wrong", but you can definitely mess up a step. Who's fault is it? Maybe nobody's. 

It's all about timing and being receptive to cues. 

I had a fantastic time trying to lead for a little bit. It kinda screws with the head a bit because you're playing opposite day and going with the other foot, other hand. But also your cues need to direct! It is definitely harder to be a guy in this case.  

--

continued:

4. Yoga is very calming.
- My favorite quotes:
"I don't need to do this out of hatred for my current self, but out of love for who I want to be."
and
"Everything is practice. You are exactly where you are supposed to be."

5. Cooking
- going to try moussaka because of S-. I just might have to go and try to make all the mother sauces for different recipes at this rate!

6. Profound Loneliness
- I think loneliness is a creeping thing. There was a poem that captures how I feel better than I could put in words:

"do not
put
your hand
in the mouth of loneliness.
it’s teeth are soft
but it will scar you for life."

(Nayyirah Waheed)

The conversations that say nothing at all make me lonelier than silence and being alone.

 7. Keyboard. I really, really want a keyboard with me right now. But I don't know if I can justify dropping 200+ just to satisfy a hobby/desire. Ugh money. It's weird because I am really starting to see where people put there money and their importance/priorities. Lesson for me before I start making any money. 

Family med take two

Can't sleep so might as well blog.

I can overwhelmed by frustrations. Maybe it's just where I am, the kind of clinic that I'm at right now - because one of my classmates is at a private, well to do clinic and is loving it to the point where she's considering it for residency. But on the other hand, she doesn't have the same problems as my clinic. 

The phrase that makes me want to cover my eyes: "I don't like taking medications so I stopped. Can you fix me?" 

I mean. I have all the empathy in the world for disliking meds. I grew up in a very "meds are only for highly cannot bear this at all I feel utterly horrible moments". I'm super wary about NSAIDs even now. But how can I get the point across that YOU ARE DIABETIC AND PLEASE TAKE YOUR MEDS! Please please please! All I want to do is see your glucose come down and you to be happy and healthy and I know meds suck, but please take them!! Or blood pressure. Or mood stabilizers. Yes please take your mood stabilizers. 

I just don't know what to do at this point. I almost want to ask, what are you expecting of us? Not in an accusatory way. Just a genuine curiosity, almost desperation, if you won't take our (highly) recommended medications, what are you expecting...? 

I will listen my heart out if that is what you want. Or we will try another med? I just don't know. I just don't know. 

Money. How much can I say that I hate America's health care? Because I loathe it with every single cell of my body. I was just horrified. No, maybe just disappointed or sadly surprised, a few days ago. Patient comes in with what is likely to be diaphragmatic pain. Acute, but not life threatening. We sent her to the ER because our clinic doesn't have the tools to do further diagnosing. We can't do a CT, no imaging here except for KUBs which she doesn't need. I am just shaking my head. My roommate went through ER last rotation and was saying how all the ER docs hate it when the patients come in like its primary care. Yeah. Well I'm IN primary care right now and we sent the patient to the ER for something that is not at all meant for the ER as it ought to be used. She will probably have to wait there because it's not life threatening. She already took hours to go through our clinic already. I am just so upset. It's so useless and broken and we can't even diagnose/treat this?

The attending was telling me this: that a lot of the doctor burnout rates are due to doctors progressively dealing with issues that are not medically related. Fighting tooth and nail with insurance companies, trying to schedule follow ups with patients who disappear. And I believe it. Even in these few weeks, I am already sick of this stuff and I don't even have to deal with the meat of the problem. 

On a tangential side note. I am so frustrated at myself that I did not learn Spanish in high school or spent more time with it in college. A patient started crying in the middle of the visit, and I felt so helpless just sitting there with a box of tissues and squeezing her hand. And all I could think of was que pasa or dolor? Or ayudar. Trabajo difficile? All of which do not fit the situation, are wholly incorrect, and are completely useless and insufficient - and one word which I'm pretty sure is French. I mean. Que es la problema (is that even correct?), but how does one comfort in a language barrier? I am not a touchy sort of person, but I had to give her a hug before she left. And I am still sitting here feeling helpless and wondering what could I have said or done differently. 

I am just frustrated. It is not "difficult" per se. But I am emotionally not happy with this rotation so far. I feel like family med is so useless. (I know, I know it's not). But it FEELS that way right now. And the worst thing is we need more family med docs right now. But who would want to go through this every day? 

Inconsequential complaints

1. I made real food, but there's ice cream in the fridge and all I want for dinner is mint chocolate chip ice cream :(

2. I forgot my coffee in the car. And I know I am literally two minutes away from going back to my car to get it... but I already sat down with my books and got comfortable. :(

3. I finished probably 80% of my work, but now I really, really don't want to do the last 20%. :(

4. I have such a good schedule right now, but I'm still tired.
... mostly because I'm staying up later than I know I ought to. :(

5. I'm trying hard to be a positive, upbeat person... but I just want to complain :(

Obviously my life is good enough right now to complain about stupid things. So there's that :)