PRACTICE DIARY

Chapter 25

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Fam Pract Manag. 2001 May;8(5):48.

Anthony

“Bad news,” Isabel said, hanging up the phone. “Anthony killed himself last week.”

Anthony was a new patient. In fact, I had only seen him twice. He presented concerned about his inability to urinate, which he felt was due to one of his psychotropic medicines. Outwardly, he was extremely anxious and claimed he was mentally disabled and couldn't work. His downward spiral had begun several months earlier with the breakup of a seven-year relationship. He had seen several psychiatrists and counselors and had been put on Serzone, but it did not seem to be helping. I asked him if he could give me a urine specimen and, when he produced one, assured him that he could void and didn't need a catheter. He wasn't eating or drinking much, and upon feeling a non-distended bladder, I suggested that might be the problem. I asked him to take fluids and to let me know if his problem persisted.

The next week he appeared with his ex, who was also his friend and advocate. She wanted me to be his family doctor and coordinate his care. I agreed to do this and set him up for a physical. He was still anxious and not sleeping, so I prescribed Buspar and lorazepam, as needed. Anthony's ex told me they were getting someone to live with and take care of him. When I asked whether either of them thought Anthony was a danger to himself, both said “no.” Several days later, Anthony hanged himself.

I told the story to my colleague, Jeff, on a bike ride. “Maybe I should have done more and insisted that he not be left alone,” I wondered.

Jeff replied, “How were you supposed to know? How do any of us know which of our patients are going to commit suicide? It's not your fault. Don't beat yourself up over it.”

Later that day, I called Anthony's ex and told her how sorry I was. She assured me there wasn't anything anyone could have done, but that was of small comfort. I continue to wonder, if one of my avowed purposes in going into medicine is to “save lives,” why couldn't I save his?

On-the-job training

A federally funded job-training program in my community makes an offer I find hard to refuse. They will place a job trainee in my office and pay for the first 400 hours of training. Being a great believer in on-the-job training (weren't we physicians once trained this way, in the pre-Flexnerian days?), I have used the program twice: first, to train Isabel, who became my best employee ever, and then to train her friend Angie, who now works for a surgical colleague. I take some pride in teaching young people the intricacies of medical office work and placing them in local practices. So, when our office became busier recently with the addition of an FNP, I sought to train Dahlia, Isabel's cousin, in the same manner. But the rules had changed.

Dahlia made an appointment to interview for the program but returned chagrined. “They told me I didn't qualify,” she said. “Now, you have to be either a single mother, a homeless person, a drug addict, a past felon or someone who reads at less than an eighth-grade level to get into the program.”

I was incredulous. “Dahlia, I'm glad you didn't qualify. I'll pay you to train here,” I said. Then, reconsidering the 400 free hours, I added facetiously, “Couldn't we just say you're dyslexic?”

Self-care

If we physicians are to maintain our mental and physical wellness – and practice what we preach to our patients – I believe strongly that we need to develop healthy passions outside of medicine and indulge ourselves deeply. Case in point: Besides dirt-bike riding, my greatest pleasure comes from getting on my mountain bike and searching out new single track. My old mountain bike wasn't giving me the performance I needed, and it was heavy to boot, so I sought out a lightweight, full-suspension bike – and found it! The minute I rode it, I knew it was right. The geometry felt good, it handled superbly and it weighed only 24 pounds. But it cost $2,250 without tax, plus the cost of the new shoes I would need to ride with clipless pedals. I had never paid more than $500 for a bicycle before. Now, I was in a quandary.

It's not that I didn't think I deserved it or couldn't afford it or felt I wouldn't use it, but that was sure a lot of money for a bicycle. Still, I wanted it. I went out at least twice a week for five- to 10-mile outings and had recently begun riding with a group that's even more obsessed with their equipment than I am. Finally, my wife made the decision for me: Buy it. So, I did, and vive la différence. The “Superlite” is the Rolls Royce of bicycles. Twenty-seven gears make going up any hill a snap. Having my feet attached to the pedals translates into pure power, with no wasted motion. Front and rear suspension make it plush, and its lightness does matter. In fact, riding it is so effortless, I sometimes wonder how I am ever going to get any exercise! Oh well, I suppose I can always take up jogging.

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many characters, stories and lessons family practice has to offer. No real patient names have been used.


 

Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


MOST RECENT ISSUE


Sep-Oct 2016

Access the latest issue of Family Practice Management

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free FPM email table of contents and e-newsletter.

Sign Up Now