Diary from a Week in Practice



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Am Fam Physician. 2001 Aug 15;64(4):597-599.

Monday

ASW has long known the importance of a good history for accurate diagnoses; what she didn’t know is that even animals can sometimes assist in this process. She recently saw a woman with allergic rhinitis whose symptoms started shortly after the purchase of a talkative and friendly parrot. In just a few weeks, the patient had become quite attached to her parrot. One morning, she noticed that the bird’s vocabulary had changed to include a noise that closely resembled sniffles. As she tried to figure out the meaning behind this new sound, she realized that she had been constantly sniffling for days without noticing it. Her pet’s subtle hint that perhaps her owner should get treatment for her allergies prompted a medical appointment. ASW was glad to reassure the patient that her new winged companion could stay in the home as long as the patient took her medicine as prescribed. The patient left with a smile on her face, stopping at a pet shop on her way home to get a thank-you gift for the parrot’s help in diagnosing her problem.

Tuesday

A lot of talk has been circulating these days about the recertification test we all take every six or seven years. This year, JRH took his examination and was glad when the “period of trial” was over. There’s sympathetic yet anguished support when the rest of us see the telltale chart review materials getting ready to be mailed. As stressful as this is, we all know it is necessary. We try to prepare for the test bit by bit. “Who’s sitting for boards this summer? You, John, or you, Jose? Here’s a question for you: ‘What is a Pel-Ebstein fever?’” “Why do you want to know, anyway?” comes the retort, trying in vain to cover up momentary ignorance. “Oh, just wondering,” JRH replied, covering up his ignorance as well. The answer eventually was produced: variable episodes of fever punctuated with periods of normal or low temperatures. “Oh, that! That’s a fever that goes up and down. I knew that!” We all laughed.

Wednesday

The many benefits of breast-feeding newborn infants are emphasized to all the obstetric patients in our practice (we are blessed to have a lactation consultant, Leticia, in our office to provide further support), yet the work we do in our office to prepare expectant mothers for breast-feeding can be undermined by well-meaning labor and delivery or newborn nurses. All too often, JTL has found that nurses caring for newborn infants encourage mothers to give the infant a bottle within the first hours of life, particularly if the infant has not yet demonstrated a keen interest in nursing. Additionally, mothers intending to nurse their newborn immediately following delivery are frequently frustrated by nursery nurses who insist on completing their newborn assessment, including Apgar scoring, before returning the infant to the mother. JTL was pleased to discover that the American College of Obstetricians and Gynecologists has prepared an educational bulletin (Educational Bulletin No. 258, July 2000) on the topic of breast-feeding, which thoroughly outlines a strategy for optimal breast-feeding, including the statement, “newborn eye prophylaxis, weighing, measuring and other such examinations can be done after the [first] feeding.” JTL plans to share this bulletin with the nursing staff and hopes its recommendations are implemented.

Thursday

Our lunch meetings include time for business and time for sharing our triumphs and frustrations as we care for our many patients. From births to funerals, we are privileged to share our patients’ lives at their most critical moments. ASW feels blessed to be working among physicians who deeply care for their patients. She has seen JTL leave his home in the middle of the night to comfort the wife of a fragile man who died of renal failure in a nursing home. She has seen JRH run out of the office to deliver a baby and then attend a patient’s funeral during our lunch break and share with us the moving eulogy. She has seen the nurses compassionately reassure grieving patients that they will not be alone during their transition to a new life without their loved ones. Last month, ASW diagnosed a private and stoic gentleman with leukemia. After his initial visit with the oncologist, he came back to see ASW for some added reassurance. As he cried with her and shared his fears, she reassured him that he would not be alone, and that he would not be in pain. He smiled and said, “That’s all I wanted to hear.” Carefully listening while providing comfort and companionship, sometimes referred to as the “sacrament of presence,” is often the best medicine we have to offer, and it’s exactly what our patients need.

Friday

Every so often, the shoe gets placed on the other foot. Recently, JRH received a call at 4:30 a.m., only this time it wasn’t from a patient. This call was from his mother in Michigan with the news that his dad had been admitted to the intensive care unit. On a busy holiday weekend, JRH was able to catch a flight and be in his hometown of Marshall to be by his father’s side. Rising early the next morning to catch the doctor on his rounds, JRH felt the worry and the anticipation of just what the doctor would say. When the diagnosis of a mild heart attack was delivered, JRH was thankful for the warm compassionate way in which his colleague in this northern city had spoken to his dad and his mom. In just a moment, the doctor summarized the situation, calmed their fears and listened to their concerns. For this, JRH will be forever grateful. It was reassuring to know first hand that his dad was in good care.

Saturday/Sunday

At times, the most valuable “pearls” of wisdom for family physicians come from unexpected sources. Today, while visiting with his aunt who had worked her way up from bank teller to vice president at a New York City bank, JTL shared some of his challenges making difficult decisions with regard to patient care. His aunt shared one of the acronyms she has found useful in the world of high finance: HALT. The acronym serves as a reminder not to make important decisions when one is Hungry, Angry, Lonely or Tired. JTL finds this particularly relevant, given his own tendency to be less patient with his difficult patients at the end of the morning or afternoon office hours when he usually finds himself hungry or tired.

This is one in a series by John R. Hartman, M.D., Amaryllis Sanchez Wohlever, M.D., and John T. Littell, M.D., three family physicians in private practice in Kissimmee, Fla.



Copyright © 2001 by the American Academy of Family Physicians.
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