Anger

So many of my new patients are so, so very angry at their previous docs. I expected some disgruntled patients, but many of my new patients are incredibly upset. 

Most of them feel like no one has been listening to them. I'm not doing much different from the previous docs, and truly feel like I'm rushing them out of my exam rooms. I worry like crazy that I'm going to eventually become a doc who they think is not listening. It may be that their docs were listening but because I'm a fresh face, now they feel heard. 

They also are angry that diagnoses are missed. For me, it's been easy. I see all the symptoms in chronological order. I see what's been ordered and what's left. I see what's been ruled out. It makes me look like a genius when it just means I've done my homework. 

 Then there's the racist, genderist, homophobic etc. comments that I get as well. I try to stop my patients from talking before they say something I'LL regret because it means that I'll hear it again whenever I see their face. 

No great lesson from all this. Just legitimate worry for my future and trying to figure out why it's like this. 

All I need to know about being a doctor I learned from Buffy

1. We all need friends. Even when we're called, chosen if you will, to enter the medical profession. Probably even more so. We need our Scoobie gang, the people who will keep us grounded, take us toboganning, help us get drunk and dish about sex. Our cheerleaders who make us feel invincible when we need it.

2. Keep your head when everyone is losing theirs. It's up to me to have a plan of attack. I need to slay the demons run the code, even if it's on my friend and neighbour. Even if it's the vampire man I love.

3. Magic and medicine don't mix. Follow evidence based practice, accept no substitutes.

4. Always carry a beeper in case the apocalypse comes. That's fairly '90s though isn't it. Now I make sure that my cell phone is charged and the ringer is on. My colleagues may need help at the hospital, my nurses may have questions about patients. Unless I'm post call, I need my beauty sleep.

5. Get your beauty sleep or you get cranky.

6. Love makes you do the wacky. If you love your patients, you won't have perspective. I'm not saying don't continue to love them, just be aware your brain is wacky.

7. Be confident, even when you're not, or you your patient may get dead.

8. Plan ahead like the good slayer. Faith went dark without a plan. Docs without a plan, without friends, who don't listen will also go to the dark side. They become TOO confident and patients die then too.

9. Wear lipgloss.

10. While not everyone will notice what I am doing, treading like mad under the surface, saving lives, when they do they can be quite gracious. And sometimes will give you a toy surprise.

Things no one tells you about your first year of practice

I've disappeared for a while again. A couple of reasons why. One is that BlogPress's iPad app isn't working. I'm not able to blog on the go like I used to be able to.

The bigger reason is that my practice is getting up and running. By running, I mean running over me while I desperately try to keep breathing, completely giving up on keeping up.

I expected that I would end up with a larger than usual number of patients with personality disorders. I've been shocked though at how many there are. Most of the time in our "meet and greet" appointment is spent putting their supplements, meds, and "medical problems" into my EMR.

Something I hadn't counted on, were the high number of patients who are incredibly unwell but haven't seen a doc in 20 years. These are patients who have had their illnesses slowly progressing so they didn't notice how unwell they were. Some come into my office stating they've never felt better, but I can hear water on their lungs from across the room. Determining the cause of their illness and treating it takes time and all my training.

I've been giving all my new patients questionnaires to fill in before we get started. It helps to guide our first meeting and has been really helpful IF the patient isn't coming in already broken. Rather than being able to be on top of what is happening right away, I've had to hire someone with some clinical smarts to enter all the answers to my questions for me so that I can spend our first appointments dealing with acute medical issues.

Something else I wasn't expecting was needing to put a hold on my new patients while I get the ones that I already have a solid plan. I don't know who half my patients are. I've met them, I have notes in the chart about them, but have no idea what face goes with what name. I wish there was a photo component to the chart to help me with that.

I still think I have the best job in the world, just surprised by how overwhelmed I've been.

Talking to people who are chronically ill

Those with cancer wish that they could spend time feeling carefree. Their entire lives seem to resolve around hospital appointments, medications and their side effects, support groups, and planning for their family's future without them in it.

This is why when I'm around those with chronic disease, all I seem to talk about are silly, frivolous, light hearted things; my kittens tearing my house apart, the recent adaptation of a children's book into movie, the way pink and purple make me feel happy, whatever moment is captured in photos around the room. Not just for the one with the disease but for their family too. Leave space for all of them to talk about seriousness, but give the give of pretending it doesn't exist, if only briefly.

Remind your friends, patients, family what it's like to be care free.

You may be a country doc if

You've been late because you pulled over to help a farmer get his sly sheep off the road. They are damn cute though.


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Oh the pity I felt for this patient

Allergic to bacon!! AND chocolate!! I'm not sure I'd be able to go on living.




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Can I possibly improve my blog? Maybe.

For kicks, I decided to look on PubMed to see if there was any research done on blogging. There is. Actual research done on how docs blog. Cool. But it's Saturday, so I'm only going to look at 2 of them.

First of all, did you know about Web 2.0?? I sure didn't but I've been using it like a mad person for years. Web 2.0 describes web sites that use technology beyond the static pages of earlier web sites.

This article makes a point I've been considering for a while - making my blog searchable in a way that will make it easier to match experiences I've had with my progress in my training and any applicable social aspects. They propose that bloggers use the usual tags they use (my favourite seems to be 'note to self''), they call these folksonomy - plus a diagnostic code from the ICD-11. The blogs that the researchers suggest these tags be used include WebMD, Kevin MD, and CasesBlog. My blog has little to do with these blogs - it's just me, I'm trying to learn more about myself as a physician not necessarily educate others (though I hope that's a happy bonus), and, for the most part, I hide my patients' true diagnosis. If I choose to follow the proposed system in this paper, which frankly isn't terrible, it makes it more difficult to hide my patients' identity. Unless, I use the ICD codes only for my rants on specific topics like suicide and HIV, and ignore the diagnoses of the cases I dissect. Which certainly is something worth looking at.  While I won't follow their algorithm to the letter, I will try to remember to tag liberally.

Another set of researchers looked specifically at learners' blogs. It's like they were looking over my shoulder. They found that learners used their blogs to reflect on their experiences. Their table 2 looks at the analysis of the blogs and what is covered and offers a few suggestions. My absolute favourite is the suggestion to share coping strategies with peers. Personally, I would have put it under "emotional distress" not "interaction with peers". I think that many learners are looking for other learners' blogs to find out how they deal with the big stuff in their lives - exams, residency matching, patient death... Having a fairly anonymous way of talking about things we are afraid of telling each other face to face would be helpful. There are many conversations taking place on twitter and in medical journals about burnout. It seems to me that using each other via the anonymity of Web 2.0 is one way to seek help without worrying about repercussions.

They also found that blogging learners were likely to preach the benefits both of collaborative learning and having a solid support system. Of course they do. Blogging learners rock.

Pinilla et al also makes some suggestions about how medical educators can use their students' blogs to enhance their learning. One suggestions is that the educators look for where their learners are having problems with exams, etc. This creeps me out. If I had any inkling that my teachers were looking at my blog I would have stopped writing. Or at least edited my posts to the point of ruining the point I was trying to make. Random, unknown educators would have been welcome to peruse, but not my own teachers. Looking at broad themes and concerns of the bloggers in general is a great idea. That it might even be an option makes me happy that I've stayed the Imposter.

So, to recap what I've learned:
1. Tag my blog liberally so that finding information in the future will be easy, both for me and for my readers.
2. Encourage the use of blogs as a way to share coping strategies.
3. Blogging learners rock.
4. Educators should not follow their own learners' blogs. It's creepy. But I'm all for qualitative research. Especially when it's done by someone else.