Diary from a Week in Practice
Am Fam Physician. 1998 Jan 1;57(1):54-56.
The joys of family practice are immeasurable. JRL has received a few gifts that several of his patients bought for him while they were on vacation. He was particularly amused with several of the gifts. The first was a piñata, which one of his patients brought back from Cozumel, Mexico, following a diving expedition. The second gift was a grass skirt, bikini top and plastic flower, which one of his patients brought back from Maui. A week before the arrival of these gifts, he also got a postcard from another patient in Maui. JRL is constantly amazed that someone who is on their vacation would remember their physician. Thus, this day was definitely a day to be truly blessed with a sense of gratitude toward his patients and the bonds they have developed.
Like many of you, we dictate our notes and correspondence. Realizing that our transcribers can get pretty bored with the daily drone of our physiciantalk, our afternoon yawns and our penchant for high-speed ramblings, we occasionally interject some personal message to the person on the other end who will be listening and dutifully transcribing the proceedings. Because this was the beginning of January, just past the holiday season, JRH inquired at the beginning of the day's work whether the transcriber's true love had sent her 12 drummers drumming to accent his admiration for her. To his surprise, the reply that returned was as follows: “In answer to your question on the tape from January 6—No, I did not receive my 12 drummers drumming! But, you have to remember that I have a four-year-old son who is always trying to karate-kick the dog, stab the cat with his play sword and still finds time to make a drum out of anything he can find. Thank goodness Santa didn't bring the drum set he asked for but instead brought a swing set!”
We have patients who are self-treating their depression with the herb St. John's Wort. Studies in Europe have found it somewhat effective as a treatment for depression (there are two discussions in the August 3, 1996, issue of the British Medical Journal—one an overview and meta-analysis of randomized clinical trials [pages 253-8] and the other an editorial [pages 241-2]); however, now comes a timely warning for us and our patients (in Prescriber's Letter 1997;4:1) that the wort boosts serotonin levels and other neurotransmitters in a manner similar to a monoamine oxidase inhibitor or a selective serotonin reuptake inhibitor. Patients who are receiving prescription antidepressants shouldn't combine them with this herb. However, MAO activity is thought to be weak. Lastly, patients should be queried about what herbs or vitamins they are taking. Surveys indicate that up to 34 percent of the population in some areas is taking these supplements, and most patients will not tell their doctor unless asked.
“Mommy, can I help feed the baby?” was the cry of a three-year-old girl, as she reached up to her mom to be held. JRL had been following this mother through her pregnancy. She was at approximately 34 weeks of gestation. To allow her daughter to become involved with this pregnancy, she encouraged her to talk and sing to the baby in utero, which seemed to help lay the groundwork for the baby's arrival. However, the mom recounted that one day while she was lying down, the daughter came up and placed a green jelly bean in the mother's bellybutton. When the mother asked what she was doing, the daughter stated that she was helping feed the baby. JRL just had to laugh. It reminded him that as physicians we should include the older brothers and sisters in the prenatal care of their new brother or sister.
Sometimes it is amazing how helpful an investigation of psychosocial stressors can be in making a diagnosis. SEF had been seeing an 11-year-old girl with complaints of daily headaches for the past six months. In the past three months, she had gone from a student who received A's and B's to one with D's and F's. At previous visits, the mom and the patient both had stated that there were no problems at home or in school. She had a normal work-up but was not responding to standard treatment for tension headaches. Today, the patient presented with her father instead of her mother. The father was more willing to discuss the family problems than either the mother or the patient had been, and it soon became clear that the problem was stemming from the patient's reaction to the continuous tension and stress between her parents. Hopefully, now that everyone is aware of the problem, family counseling will not only help with the marital discord but also with the child's headaches.
What do you do when you are a doctor on call, the mom of two kids and you have a potential medical emergency at home? TBS faced this dilemma this weekend. While giving her twin daughters their usual Saturday evening bath, TBS picked up a cloth from the bathtub and was just about to wash one of the girls when she suddenly felt a sharp burning, stinging sensation in her finger. Looking down, she saw a small scorpion fall into the water. Grabbing the scorpion, she threw it out of the bathtub and then looked at her finger, which immediately began to redden and swell. TBS ran her finger under the cold water and yelled for her husband to take over bathing the twins. Not being familiar with Florida scorpions, TBS called the physician in the local emergency department and was relieved to find out that Florida scorpions are not poisonous, and treatment with a little Benadryl and ice was all that was needed. This was a painful learning experience, and TBS still doesn't know how the scorpion got in the bathtub. However, now she does know what to tell patients who experience these stings.
This is one in a series by Walter L. Larimore, M.D., John R. Hartman, M.D., Theresa B. Shupe, M.D., Jonathan R. Lim, M.D., and Stephanie E. Frisbie, M.D., five family physicians in private practice in Kissimmee, Fla.
Copyright © 1998 by the American Academy of Family Physicians.
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