Once a year, the government of Canada would like you to see your family doctor for a preventative health visit. In fact, they would like it so much that they will give your family doc a bonus for filling out the "annual health check" forms.
This is good for many reasons.
1. The annual health check asks the same questions of everyone. It standardizes things so you get the same level of care, regardless of who your doctor is.
2. It creates a framework that can be compared from year to year so you can monitor chronic conditions.
3. Your family doc needs a donut fund so that every day (and not just Friday) has a desk-donut.
The drawback is this: The annual health check asks the same questions of everyone.
My 80 year old patients laugh when I ask them about their libido & recent sexual partners. (Or more disturbingly, they TELL ME DETAILS.)
My 20 year old patients look horrified as I ask them about chest pain, urinary incontinence, haemorrhoids & erectile dysfunction. (But again, there's always one...)
Honestly, the questions that bother me the most are related to drinking.
I feel totally confident saying to my 45 year old patients, "You need to have a maximum of two alcoholic drinks per day and at least one alcohol-free day per week."
But when a 29 year old says, "I don't drink regularly, often go up to a month without drinking, but then I drink 5-10 drinks in one night", I pause.
This is, clearly, unhealthy binge drinking.
This is also my exact answer.
I don't know anyone in my peer group who doesn't drink like this. The days of a drink before dinner and a nightcap before bed are gone. People in my age group (scientific polling of my friends, n= 20) have big nights, pub nights, dinner parties, etc where alcohol is consumed in mass quantities, but they don't drink between occasions.
As a result, I don't know what to say to my patients. I cop out. I read them the spiel of 1-2 max. I suggest that they alternate water with their alcoholic beverages. I vigorously counsel them against drunk driving, unprotected sex, walking alone, and risk-taking behaviours. I give them fistfuls of condoms and test them for STI's & liver damage. I try to explain why they should stop. But I can't tell them to stop without being hypocritical.
As a result, I do not go for my annual health check. Which means that somewhere in Toronto, there's a doctor without a desk-donut, all because I am a hypocrite. But everyone else is doing it...
Tuesday, November 22, 2011
Tuesday, November 8, 2011
Turn Into
I had a mother-daughter encounter last week. The 19 year old girl has been having "heart pains" for some time; they're associated with meals, especially eating fatty foods. They cause cramping pain that lasts for up to an hour, sometimes accompanied by nausea & vomiting. The pain is 10/10 when it happens, but there is no pain between attacks.
(Buzz in now if you know the answer.)
The mother was understandably concerned that her daughter was unwell. She sat in the corner of the room and shouted out answers as I asked questions.
"She works too hard! She never stops and takes rest!"
"Her diet is very poor - she never eats vegetables"
"She shouldn't be drinking, right Doctor? Alcohol is bad for young women..."
(It should be noted that these were responses to the questions "How, what, where & when")
At the end of the consultation, as I explained the likely diagnosis and arranged for some tests (Buzz in now for extra credit) the mother stood up and grabbed me.
"You have to tell her she can't drink on the birth control pill. It will kill her."
I actually laughed. I turned to the daughter and said, "If you smoke while you're on the birth control pill, there is a chance it could kill you by causing a blood clot to form and flick off into your lungs. Unfortunately (to her mother) drinking does not increase your risk."
Her mother was not impressed.
It reminded me of my parents. They used to imply that every drink I had was one step closer to my grim death vomiting in an alley somewhere. That staying up past 10pm would lead to clinical depression. That high fat foods would actually stop my heart on consumption. Parents want their kids to be safe, to slow down, to eat well and live good, clean lives.
I am up early, doing homework before heading off to Seaton House. I have eaten a balanced breakfast. I ran yesterday and I am not drinking this week. I caught myself saying to my bf, "It's not that you drink too much, it's that I worry that one day you'll die of cirrhosis of the liver or get permanent brain damage..."
I have turned into my parents. Sigh.
(Buzz in now if you know the answer.)
The mother was understandably concerned that her daughter was unwell. She sat in the corner of the room and shouted out answers as I asked questions.
"She works too hard! She never stops and takes rest!"
"Her diet is very poor - she never eats vegetables"
"She shouldn't be drinking, right Doctor? Alcohol is bad for young women..."
(It should be noted that these were responses to the questions "How, what, where & when")
At the end of the consultation, as I explained the likely diagnosis and arranged for some tests (Buzz in now for extra credit) the mother stood up and grabbed me.
"You have to tell her she can't drink on the birth control pill. It will kill her."
I actually laughed. I turned to the daughter and said, "If you smoke while you're on the birth control pill, there is a chance it could kill you by causing a blood clot to form and flick off into your lungs. Unfortunately (to her mother) drinking does not increase your risk."
Her mother was not impressed.
It reminded me of my parents. They used to imply that every drink I had was one step closer to my grim death vomiting in an alley somewhere. That staying up past 10pm would lead to clinical depression. That high fat foods would actually stop my heart on consumption. Parents want their kids to be safe, to slow down, to eat well and live good, clean lives.
I am up early, doing homework before heading off to Seaton House. I have eaten a balanced breakfast. I ran yesterday and I am not drinking this week. I caught myself saying to my bf, "It's not that you drink too much, it's that I worry that one day you'll die of cirrhosis of the liver or get permanent brain damage..."
I have turned into my parents. Sigh.
Tuesday, November 1, 2011
controversy
There was whispering at the nursing station.
"17 weeks? We can't take her!"
"But 4A says they don't know what to do..."
"But it would be cruel!"
"Medical ward might be worse. They don't know what to do with pregnant women."
"But she's 17 weeks..."
The thing is, legally, if a fetus is less than 20 weeks, it can still be terminated (the medical term for induced abortion). Thus, a woman is not pregnant until she reaches 20 weeks. A woman with a 17 week-old is not pregnant. The labour ward only accepts women who are pregnant.
This is the first problem.
The second problem is that this baby was dead.
The woman and her husband had been sent in after an ultrasound showed that their baby had no heartbeat. (And yes, since this was a wanted pregnancy, I will call it a baby). The couple had been sitting in emergency for 2 hours while the wards bickered about who had to take them.
The medical ward refused, saying they didn't know what to do with a pregnant lady.
The labour ward refused, saying the woman was not pregnant, so should be treated medically.
Luckily, the Obstetrician overheard this (we were in the tearoom).
He arranged for the woman to be put in a quiet corner of the L&D ward, away from any newborns.
He arranged for medication to induce uterine contractions so the dead tissue could be expelled.
He arranged for the couple to have a space to grieve for their lost child. When that child was pushed into my hands, he helped me to clean and wrap it, so the parents didn't have to see why their baby couldn't have lived.
I was responsible for checking on the couple overnight. I slipped into their room around 2am and found that the husband had crawled into the narrow hospital bed beside his wife. They had fallen asleep together, his arm across her chest, her arm across her belly. I let them sleep.
I fully and truly believe in a woman's right to choose and easily access termination. Birth and babies are too harrowing and permanent to experience against one's will. But the legal definitions of fetus vs baby are arbitrary. 20 vs 17 weeks vs medical vs obstetrical...
Thank goodness my preceptor stepped over all this and took care of his patient.
"Above all, Samantha, we treat the patient, not the numbers."
It was my last night of obstetrics and I am now thoroughly traumatized. Luckily, I'm back on Family Med now. I talked to a patient about his rough sex practices for 30 minutes. Back where I belong.
"17 weeks? We can't take her!"
"But 4A says they don't know what to do..."
"But it would be cruel!"
"Medical ward might be worse. They don't know what to do with pregnant women."
"But she's 17 weeks..."
The thing is, legally, if a fetus is less than 20 weeks, it can still be terminated (the medical term for induced abortion). Thus, a woman is not pregnant until she reaches 20 weeks. A woman with a 17 week-old is not pregnant. The labour ward only accepts women who are pregnant.
This is the first problem.
The second problem is that this baby was dead.
The woman and her husband had been sent in after an ultrasound showed that their baby had no heartbeat. (And yes, since this was a wanted pregnancy, I will call it a baby). The couple had been sitting in emergency for 2 hours while the wards bickered about who had to take them.
The medical ward refused, saying they didn't know what to do with a pregnant lady.
The labour ward refused, saying the woman was not pregnant, so should be treated medically.
Luckily, the Obstetrician overheard this (we were in the tearoom).
He arranged for the woman to be put in a quiet corner of the L&D ward, away from any newborns.
He arranged for medication to induce uterine contractions so the dead tissue could be expelled.
He arranged for the couple to have a space to grieve for their lost child. When that child was pushed into my hands, he helped me to clean and wrap it, so the parents didn't have to see why their baby couldn't have lived.
I was responsible for checking on the couple overnight. I slipped into their room around 2am and found that the husband had crawled into the narrow hospital bed beside his wife. They had fallen asleep together, his arm across her chest, her arm across her belly. I let them sleep.
I fully and truly believe in a woman's right to choose and easily access termination. Birth and babies are too harrowing and permanent to experience against one's will. But the legal definitions of fetus vs baby are arbitrary. 20 vs 17 weeks vs medical vs obstetrical...
Thank goodness my preceptor stepped over all this and took care of his patient.
"Above all, Samantha, we treat the patient, not the numbers."
It was my last night of obstetrics and I am now thoroughly traumatized. Luckily, I'm back on Family Med now. I talked to a patient about his rough sex practices for 30 minutes. Back where I belong.
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