PRACTICE DIARY

Chapter 48

 


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Fam Pract Manag. 2003 Sep;10(8):70.

Complementary medicine

My son, Gabe, was home for the weekend and anxious to show off some of his newly learned medical skills. He hadn’t given up his day job, auditing for a Big Five firm, but was taking an EMT course on Saturdays to get away from the world of numbers crunching and have some real-life experiences. “Let me take your blood pressure, Mom,” he suggested.

“Hmm,” he contemplated, “It’s 150/100.”

“Let your dad take it,” my wife said.

“He’s right, Sue,” I said. “It’s mildly high. We should get serial readings, and if it stays up there, we should start you on some medicine.”

“I’m not taking drugs,” my wife said.

Sue borrowed my electronic cuff and started taking her blood pressure at home. The readings stayed up, so she gave up her morning caffeinated Earl Grey tea, substituting chamomile instead. An avid walker, she didn’t need to get any more exercise but eliminated salt from her diet as well as wine. Then she went to the health food store to find some alternative remedies.

As luck would have it, she ran into Karen, an herbalist, who gave her a curbside consult on the spot and suggested an infusion of Heart Ease tea, three times a day. “It’s two parts motherwort, hawthorn and lemon balm, one part oatstraw and hibiscus, and half a part rose petal, lobelia and lavender.” She went around the store with a little scooper, making Sue her concoction.

When Sue came home and told me about her experience, I begged for the herbalist’s recipe. “Why do you want it?” my wife said defensively.

“I want it for my column,” I said.

“Don’t you mock me,” she said.

“Hey, if it works, I want my colleagues to know about it,” I said. “I’m not just a pill pusher. I’m open to new ideas. How about you being open to medicine if this doesn’t work?”

“It will,” she said, confidently.

A failure to communicate

It was the next to last week of Gloria’s reign as my temporary office manager while my real office manager was on maternity leave. Gloria got a call from one of my patients who wanted to see me because she was “HIV positive.”

“Oh, Dr. Brown,” Gloria said, “Faith was very upset and said she has had this for a long time but has never seen anyone about it. Now it is interfering with her life, and she wants to deal with it. What a shame. Such a pretty girl.”

I was stunned. Faith was a 35-year-old mother of two who had seen me for some chronic back ailments and once for torticollis from overdoing it with her yoga exercises when she put her leg behind her head, but she seemed healthy enough and had no risk factors for HIV. “I gave her a 15-minute appointment this afternoon,” said Gloria. “She said it couldn’t wait.”

After rechecking my schedule, I said, “Give her half an hour.”

At the appointed hour, Faith appeared looking pretty chipper for someone with a life-threatening disease. She came into my consultation room and sat down, without bothering to close the door. “So, Faith,” I opened, “how are you?”

“Pretty good,” she said. “Did Gloria tell you what this was about?”

“She did,” I said. “How long have you had it?”

“All my life,” she said, “at least as long as I can remember. I think I had it as a kid.”

“As a kid?” I asked, incredulously.

“Why yes,” Faith said. “Isn’t that when most people develop ADHD?”

“So you’re ADHD positive!” I said with a smile of relief.

“I guess you could say that,” Faith said. “I’m forgetful at work and can’t seem to concentrate on my tasks, and my supervisors are noticing. My son has ADHD and is being treated for it. I thought you could treat me too.”

“Faith,” I said, “adult ADHD can be a problem, but it isn’t nearly as devastating as one might imagine.”

I would if I could – but I won’t

The message awaiting me on my return home from dinner Friday night was one I had heard before. “Dr. Brown,” it began, “this is Chuck Sterling. I’m staying at the Hill House, and I forgot my prescription at home. I was hoping you might be able to help me out. I’m in room 111.”

The Hill House was a local inn owned by a patient of mine who had probably given my name and number to his guest, who was careless enough to leave home for a coastal getaway without remembering to pack his medication. I already knew what he was going to ask, and I was already put out. Still, I was courteous enough to return the call.

Chuck explained that he was a Kaiser patient and had forgotten his seizure drugs at home. Besides not having heard of them, I explained that, without him being a registered patient, I simply could not (would not) prescribe drugs for him. “But I really can’t be without them,” he said. I suggested he call his HMO in the morning and speak to whoever handled refill requests. Failing that, he would have to go to our local hospital and see the ER physician.

Chuck was disappointed and nearly testy. “What did you expect?” I wanted to ask him. “Why would you, a complete stranger, even think of calling me after hours for a favor?” Sometimes, I feel I just can’t get any respect.

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.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.


 

Copyright © 2003 by the American Academy of Family Physicians.
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