PRACTICE DIARY

Chapter 63

 

Fam Pract Manag. 2005 Apr;12(4):71.

Great toys

Mark, my physician patient with bladder tumors, had just returned from his bi-annual scoping. Rather than seeing his local urologist, he opted to visit Dr. Yamagushi, a university urologist.

“How did it go?” I asked Mark in the hospital hallway.

“It was different,” he said. “My local urologist works without a nurse and uses a rigid cystoscope. At Yamagushi’s office, there’s someone to take your insurance information; a nurse brings you back to the procedure room, preps you and instills some viscous lidocaine; and then you lie there on the table with your legs up in the stirrups and a clip over your urethra waiting for him to come in with his assistant. We shook hands over the sterile drapes. It was all business. He asked me a few questions, and then he scoped me. You should have seen his scope. It was a flexible, fiber-optic job, and I saw my urethra, ureters and entire bladder wall on a monitor, in color! He even took pictures.”

I asked Mark which type of medicine he preferred: down home and personal or the factory production model.

“I like having a relationship with my physician,” Mark said, “but nothing compares with state-of-the-art equipment and being able to see everything your physician does. It’s incredibly reassuring. I don’t know why all docs don’t have the best instruments available. That rigid cystoscope is medieval.”

“Well, I’m more of a cognitive practitioner,” I told him, “but I do have two mercury column sphygmomanometers hanging on my walls. That’s the gold standard for taking blood pressure.”

“Yeah,” Mark said, “but your ECG machine is older than you are, and you’re still using Q-Tips for cryosurgery.”

He was right. We family physicians should treat ourselves to the best toys available. We use them every day, they give us more reliable information, and they make doing procedures a pleasure. Heck, we deserve them.

Jury duty

Hardly a week goes by that I don’t get a request from a patient to exempt him or her from jury duty. Their excuses run the gamut, from bad backs to weak bladders. I’ve heard it all.

Truth be told, I don’t have much sympathy for these folks. I think of Tony, a former patient of mine, now deceased, who used to serve on the county’s grand jury, which entailed a thrice-weekly drive to our county seat – 100 miles round-trip. Tony was morbidly obese, had diabetes and heart disease, and was oxygen dependent. He was on no fewer than 12 medications and could barely walk. But he loved doing his public duty.

I wasn’t thinking of Tony, though, when I got my jury summons several months ago. I was thinking of who was going to write me a letter of exemption. I already had taken one postponement and feared a $1,000 fine for a no-show, so I made arrangements with Teresa, my nurse practitioner, to cover for me. But the night before, my office manager called to say she was sick and couldn’t come to work the next day. Now I had a dilemma. Teresa couldn’t see patients and run the office. I tried calling the court the next morning to explain, but all I got was a recording. So I canned the trip, saw my patients, ran the office and prayed I’d be forgiven.

In an amazing coincidence, Jim, an attorney, was on my schedule and assuaged my conscience. His pro bono advice was: “Write a letter. Keep it simple. Tell them you had patients who needed care. Ask for another date. Don’t bother calling. They’ve heard it all before too.”

DNR

Old Blue, our beloved 1986 Ford F-150 truck, was ailing. Most of the time, it would start up fine, but sometimes it just wouldn’t turn over. I never knew when it was going to act up, so I couldn’t take it anywhere and turn off the engine. I already had to tow it twice – once from the dump and once from the car wash. Old Blue had become unreliable.

I suppose I could have junked it. After 225,000 miles, it owed me nothing. But my family grew up with that truck, and it had sentimental value. Besides, I needed a beater to haul firewood, and fixing it would allow me to observe a master diagnostician at work: Bobby, my mechanic.

“What do you think it is?” I asked him.

“I won’t know until it fails,” he said. “Why don’t you leave it with me for a few days?”

A week later, I called for an update. “It took awhile, but eventually it failed,” he said. “It had a bad starter, so I replaced it. Then it wouldn’t fire. That was a bad ignition module, so I replaced that too. Now it starts just fine, but you’ve got a transmission cooler leak. How far do you want me to go? This could get expensive.”

My truck was deteriorating before his eyes. “How about seeing if you can get an after-market cooler, and let’s leave it at that,” I said. Putting any more money into Old Blue would be akin to keeping it on life support.

Bobby called back the next day with some good news: “I called the transmission shop and they said we could bypass the cooler, so I did. As long as you’re not hauling heavy loads any distance, you should be OK.”

Old Blue had escaped the automotive graveyard, if only for a while.

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 medicine has to offer. No real patient names have been used.

Conflicts of interest: none reported.


 

Copyright © 2005 by the American Academy of Family Physicians.
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