RE: Do you ever have those days?

[Guest guest]

Wow, Annie.. Of course a day like that would happen after the holiday. .Well, at least you are able to fill some of those needs. Imagine if you had only 10 minutes: you might shove those patients off to someone else. I have become convinced that some harassed MDs are purposely failing to do more than the required minimum amount for some of these patients, because that way the high maintenance patient will go away. And I do not know how they can sleep at night. Congratulations for surviving. What you need now is a few patients who are not so very sick. JoanneAnnie Skaggs wrote: . Eight patients

today: 1) New patient. 23 years old, 300lbs, irregular periods, has a beard. Scheduled for “headache”. Says no doctor has ever asked her about any of the above… 2) Mother who witnessed her 13 year old son’s sudden cardiac death 6 weeks ago from what turned out to be long QT syndrome. He survived ACLS and now has an AICD. She is having panic attacks. Duh.. 3) Adult ADD on boatloads of Adderall and Wellbutrin. “OBTW do you think this is broken? Showing radius/ulna with new 30 degree angle …about 2cm proximal to her “other wrist” 4) 82 year old lady whose husband just came home from 2 months in the unit and 3 open heart surgeries. She “had chest pain all last night so I want an EKG, and I had a TIA last Thursday so I want ultrasound of my arteries, and you have to do one of those swabs of my vagina because I feel a little funny there again and I peed in a cup already because you need to make sure there is nothing wrong with it and I need you to help me find someone who will clean my house because the Home Health nurses are so messy and they won’t help at all……..” 5) 70 year old lady with extreme paranoia associated with her Alzheimer’s is acting out and tried to throw a chair at her husband, probably gave herself a lumbar compression fracture in the process….She couldn’t hit me this time because she is moving pretty slow, but she refuses any imaging test…. 6) Diabetic smoker already s/p left AKA now with dusky foot all around her non-healing foot ulcer despite all maximal revascularization efforts by the vascular surgeon, and refusing further treatment by anybody but me because she just got a $14,000 bill from her last catheter based cryoplasty and stenting intervention…Like I can work miracles.. 7)

Thank God! A simple sinusitis! 8) New patient: “My doctor is nice and all, but she doesn’t try to find out why: I am tired all the time, I hurt all over, I can’t sleep, I have a headache the time, my arms are numb, I’m constipated, I have irritable bowel and reflux, I can’t breathe, my white blood cell count is always high, my mother dropped dead

of a heart attack last summer, nobody has ever checked my cholesterol, I need albuterol 4 or 5 times every day, but all it does is make me shake and I want to know what causes all this.” All this from a 36 yo lady with a BMI of 23 who didn’t want me to do a fundascopic exam because it would mess up her mascara. 9) And this one wasn’t even on the schedule: Owner of a local shooting range who carries concealed weapons, dropped by to express her anger that I sent her a reminder about the colonoscopy she never went after I referred her in the fall because of rectal bleeding and a family history of colon cancer. She is angry that I “bothered” her about that when she was just found to have metastatic melanoma. I had just gotten a note from the surgeon last Friday (a couple weeks after the reminder went out), and she hadn’t called me when she developed inguinal nodes on the side from which her primary was excised 3 years ago I

would say “just shoot me”, but that last lady probably would. I think I will just crawl under a rock.. As an IMP, I can do this stuff and feel at the end of the day as if I have been beaten up, but at least (I think anyway) that I have met the extraordinary needs of these “high maintenance” people. I don’t know how anybody who sees 25 or 30 patients a day can deal with a panel like this….I sure couldn’t Anybody got a cigarette? Annie _,___ __________________________________________________

[Guest guest]

Wow – you had a stacked deck of

high-need difficult to work with pts – good job keeping your head on and

taking care of them!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From: [mailto: ] On Behalf Of Annie Skaggs

Sent: Thursday, December 28, 2006

6:23 PM

To:

Subject: Do

you ever have those days?

..

Eight patients today:

1) New patient. 23 years old, 300lbs,

irregular periods, has a beard. Scheduled for “headache”. Says

no doctor has ever asked her about any of the above…

2) Mother who witnessed her 13 year old

son’s sudden cardiac death 6 weeks ago from what turned out to be long QT

syndrome. He survived ACLS and now has an AICD. She is

having panic attacks. Duh..

3) Adult ADD on boatloads of Adderall and Wellbutrin.

“OBTW do you think this is broken? Showing radius/ulna with new 30 degree

angle …about 2cm proximal to her “other wrist”

4) 82 year old lady whose husband just came

home from 2 months in the unit and 3 open heart surgeries. She “had

chest pain all last night so I want an EKG, and I had a TIA last Thursday so I

want ultrasound of my arteries, and you have to do one of those swabs of my

vagina because I feel a little funny there again and I peed in a cup already

because you need to make sure there is nothing wrong with it and I need you to

help me find someone who will clean my house because the Home Health nurses are

so messy and they won’t help at all……..”

5) 70 year old lady with extreme paranoia

associated with her Alzheimer’s is acting out and tried to throw a chair

at her husband, probably gave herself a lumbar compression fracture in the

process….She couldn’t hit me this time because she is moving pretty

slow, but she refuses any imaging test….

6) Diabetic smoker already s/p left AKA now

with dusky foot all around her non-healing foot ulcer despite all maximal

revascularization efforts by the vascular surgeon, and refusing further

treatment by anybody but me because she just got a $14,000 bill from her last

catheter based cryoplasty and stenting

intervention…Like I can work miracles..

7) Thank God! A simple sinusitis!

8) New patient: “My doctor is nice and

all, but she doesn’t try to find out why: I am tired all the time, I hurt

all over, I can’t sleep, I have a headache the time, my arms are numb,

I’m constipated, I have irritable bowel and reflux, I can’t

breathe, my white blood cell count is always high, my mother dropped dead of a

heart attack last summer, nobody has ever checked my cholesterol, I need albuterol 4 or 5 times every day, but all it does is make

me shake and I want to know what causes all this.” All this from a

36 yo lady with a BMI of 23 who

didn’t want me to do a fundascopic exam because

it would mess up her mascara.

9) And this one wasn’t even on the

schedule: Owner of a local shooting range who carries concealed weapons,

dropped by to express her anger that I sent her a reminder about the

colonoscopy she never went after I referred her in the fall because of rectal

bleeding and a family history of colon cancer. She is angry that I

“bothered” her about that when she was just found to have metastatic melanoma. I had just gotten a note from

the surgeon last Friday (a couple weeks after the reminder went out), and she

hadn’t called me when she developed inguinal nodes on the side from which

her primary was excised 3 years ago

I would say “just shoot me”, but that last lady

probably would.

I think I will just crawl under a rock..

As an IMP, I can do this stuff and feel at the end of the day as if

I have been beaten up, but at least (I think anyway) that I have met the

extraordinary needs of these “high maintenance” people.

I don’t know how anybody who sees 25 or 30 patients a day can deal with a

panel like this….I sure couldn’t

Anybody got a cigarette?

Annie

_,___

[Guest guest]

RE complex pts.

Ah-- point is with organization (preferrably point of care EMR), you don't NEED more than these pts to make your practice work.

Biggest effort will be to agree with each pt which things you feel are the most important compared with what PT feels is most important.

If you don't address what the pt feels is most important, then you won't succeed, no matter how "right" you are medically.

Otherwise -- don't forget the power of the pt to say "no" and as long as you feel noone else could do better, you can "agree to disagree." In writing, and pt to sign it.

Thankfully, I usually don't get as many complex pts all at a time, but there are days...

Be smart, communicate, bill for your services!! And, be careful what you wish for, looks like you've got it (enough pts and complex ones to keep you busy for quite a while).

Dr Matt Levin

FP, solo since Dec 2004

Residency completed 1988

Do you ever have those days?

..

Eight patients today:

1) New patient. 23 years old, 300lbs, irregular periods, has a beard. Scheduled for “headache”. Says no doctor has ever asked her about any of the above…

2) Mother who witnessed her 13 year old son’s sudden cardiac death 6 weeks ago from what turned out to be long QT syndrome. He survived ACLS and now has an AICD. She is having panic attacks. Duh..

3) Adult ADD on boatloads of Adderall and Wellbutrin. “OBTW do you think this is broken? Showing radius/ulna with new 30 degree angle …about 2cm proximal to her “other wrist”

4) 82 year old lady whose husband just came home from 2 months in the unit and 3 open heart surgeries. She “had chest pain all last night so I want an EKG, and I had a TIA last Thursday so I want ultrasound of my arteries, and you have to do one of those swabs of my vagina because I feel a little funny there again and I peed in a cup already because you need to make sure there is nothing wrong with it and I need you to help me find someone who will clean my house because the Home Health nurses are so messy and they won’t help at all……..”

5) 70 year old lady with extreme paranoia associated with her Alzheimer’s is acting out and tried to throw a chair at her husband, probably gave herself a lumbar compression fracture in the process….She couldn’t hit me this time because she is moving pretty slow, but she refuses any imaging test….

6) Diabetic smoker already s/p left AKA now with dusky foot all around her non-healing foot ulcer despite all maximal revascularization efforts by the vascular surgeon, and refusing further treatment by anybody but me because she just got a $14,000 bill from her last catheter based cryoplasty and stenting intervention…Like I can work miracles..

7) Thank God! A simple sinusitis!

8) New patient: “My doctor is nice and all, but she doesn’t try to find out why: I am tired all the time, I hurt all over, I can’t sleep, I have a headache the time, my arms are numb, I’m constipated, I have irritable bowel and reflux, I can’t breathe, my white blood cell count is always high, my mother dropped dead of a heart attack last summer, nobody has ever checked my cholesterol, I need albuterol 4 or 5 times every day, but all it does is make me shake and I want to know what causes all this.” All this from a 36 yo lady with a BMI of 23 who didn’t want me to do a fundascopic exam because it would mess up her mascara.

9) And this one wasn’t even on the schedule: Owner of a local shooting range who carries concealed weapons, dropped by to express her anger that I sent her a reminder about the colonoscopy she never went after I referred her in the fall because of rectal bleeding and a family history of colon cancer. She is angry that I “bothered” her about that when she was just found to have metastatic melanoma. I had just gotten a note from the surgeon last Friday (a couple weeks after the reminder went out), and she hadn’t called me when she developed inguinal nodes on the side from which her primary was excised 3 years ago

I would say “just shoot me”, but that last lady probably would.

I think I will just crawl under a rock.. As an IMP, I can do this stuff and feel at the end of the day as if I have been beaten up, but at least (I think anyway) that I have met the extraordinary needs of these “high maintenance” people. I don’t know how anybody who sees 25 or 30 patients a day can deal with a panel like this….I sure couldn’t

Anybody got a cigarette?

Annie

_,___

[Guest guest]

Amen and Amen! I don’t recall how many

times today I was one breath away from launching into my “master plan”,

but then remembered to lean back and ask the patients what THEY thought was the

most important thing to do first. Saves

me every time!

And you’re right. This crowd is enough. Three level 5 visits and the rest 4s

except the simple sinusitis.

Thanks for letting me vent!

Annie

Re:

Do you ever have those days?

RE complex pts.

Ah-- point is with organization

(preferrably point of care EMR), you don't NEED more than these pts to make

your practice work.

Biggest effort will be to agree with

each pt which things you feel are the most important compared with what PT

feels is most important.

If you don't address what the pt

feels is most important, then you won't succeed, no matter how

" right " you are medically.

Otherwise -- don't forget the power

of the pt to say " no " and as long as you feel noone else could do

better, you can " agree to disagree. " In writing, and pt to sign

it.

Thankfully, I usually don't get as

many complex pts all at a time, but there are days...

Be smart, communicate, bill for your

services!! And, be careful what you wish for, looks like you've got it

(enough pts and complex ones to keep you busy for quite a while).

Dr Matt Levin

FP, solo since Dec 2004

Residency completed 1988

Do you ever have those days?

..

Eight patients today:

1) New patient. 23 years old, 300lbs,

irregular periods, has a beard. Scheduled for “headache”.

Says no doctor has ever asked her about any of the above…

2) Mother who witnessed her 13 year old

son’s sudden cardiac death 6 weeks ago from what turned out to be long QT

syndrome. He survived ACLS and now has an AICD. She is

having panic attacks. Duh..

3) Adult ADD on boatloads of Adderall and Wellbutrin.

“OBTW do you think this is broken? Showing radius/ulna with new 30 degree

angle …about 2cm proximal to her “other wrist”

4) 82 year old lady whose husband just came

home from 2 months in the unit and 3 open heart surgeries. She “had

chest pain all last night so I want an EKG, and I had a TIA last Thursday so I

want ultrasound of my arteries, and you have to do one of those swabs of my

vagina because I feel a little funny there again and I peed in a cup already

because you need to make sure there is nothing wrong with it and I need you to

help me find someone who will clean my house because the Home Health nurses are

so messy and they won’t help at all……..”

5) 70 year old lady with extreme paranoia

associated with her Alzheimer’s is acting out and tried to throw a chair

at her husband, probably gave herself a lumbar compression fracture in the

process….She couldn’t hit me this time because she is moving pretty

slow, but she refuses any imaging test….

6) Diabetic smoker already s/p left AKA now

with dusky foot all around her non-healing foot ulcer despite all maximal

revascularization efforts by the vascular surgeon, and refusing further

treatment by anybody but me because she just got a $14,000 bill from her last

catheter based cryoplasty and stenting

intervention…Like I can work miracles..

7) Thank God! A simple sinusitis!

8) New patient: “My doctor is nice and

all, but she doesn’t try to find out why: I am tired all the time, I hurt

all over, I can’t sleep, I have a headache the time, my arms are numb,

I’m constipated, I have irritable bowel and reflux, I can’t

breathe, my white blood cell count is always high, my mother dropped dead of a

heart attack last summer, nobody has ever checked my cholesterol, I need albuterol 4 or 5 times every day, but all it does is make

me shake and I want to know what causes all this.” All this from a

36 yo lady with a BMI of 23 who

didn’t want me to do a fundascopic exam because

it would mess up her mascara.

9) And this one wasn’t even on the

schedule: Owner of a local shooting range who carries concealed weapons,

dropped by to express her anger that I sent her a reminder about the

colonoscopy she never went after I referred her in the fall because of rectal

bleeding and a family history of colon cancer. She is angry that I

“bothered” her about that when she was just found to have metastatic melanoma. I had just gotten a note from

the surgeon last Friday (a couple weeks after the reminder went out), and she

hadn’t called me when she developed inguinal nodes on the side from which

her primary was excised 3 years ago

I would say “just shoot me”,

but that last lady probably would.

I think I will just crawl under a

rock.. As an IMP, I can do this stuff

and feel at the end of the day as if I have been beaten up, but at least (I

think anyway) that I have met the extraordinary needs of these “high

maintenance” people. I don’t know how anybody who sees

25 or 30 patients a day can deal with a panel like this….I sure

couldn’t

Anybody got a cigarette?

Annie

_,___

[Guest guest]

Whew, Annie- I prescribe extra time with that gorgeous horse tomorrow, and

all the next week. I don't think I've ever seen a day like that! I wish

you were closer so we could share a post-work debriefing cream soda or beer.

We need a virtual pub on this listserv...

Lynn

>

>Reply-To:

>To: < >

>Subject: Do you ever have those days?

>Date: Thu, 28 Dec 2006 20:22:45 -0500

>

>.

>

><http://geo.yahoo.com/serv?s=97359714/grpId=9360914/grpspId=1705061327/m

>sgId=10682/stime=1167340261/nc1=3836825/nc2=3848490/nc3=3848627> Eight

>patients today:

>1) New patient. 23 years old, 300lbs, irregular periods, has a

>beard. Scheduled for " headache " . Says no doctor has ever asked her

>about any of the above.

>2) Mother who witnessed her 13 year old son's sudden cardiac death

>6 weeks ago from what turned out to be long QT syndrome. He survived

>ACLS and now has an AICD. She is having panic attacks. Duh..

>3) Adult ADD on boatloads of Adderall and Wellbutrin. " OBTW do

>you think this is broken? Showing radius/ulna with new 30 degree angle

>.about 2cm proximal to her " other wrist "

>4) 82 year old lady whose husband just came home from 2 months in

>the unit and 3 open heart surgeries. She " had chest pain all last night

>so I want an EKG, and I had a TIA last Thursday so I want ultrasound of

>my arteries, and you have to do one of those swabs of my vagina because

>I feel a little funny there again and I peed in a cup already because

>you need to make sure there is nothing wrong with it and I need you to

>help me find someone who will clean my house because the Home Health

>nurses are so messy and they won't help at all.... "

>5) 70 year old lady with extreme paranoia associated with her

>Alzheimer's is acting out and tried to throw a chair at her husband,

>probably gave herself a lumbar compression fracture in the process..She

>couldn't hit me this time because she is moving pretty slow, but she

>refuses any imaging test..

>6) Diabetic smoker already s/p left AKA now with dusky foot all

>around her non-healing foot ulcer despite all maximal revascularization

>efforts by the vascular surgeon, and refusing further treatment by

>anybody but me because she just got a $14,000 bill from her last

>catheter based cryoplasty and stenting intervention.Like I can work

>miracles..

>7) Thank God! A simple sinusitis!

>8) New patient: " My doctor is nice and all, but she doesn't try to

>find out why: I am tired all the time, I hurt all over, I can't sleep, I

>have a headache the time, my arms are numb, I'm constipated, I have

>irritable bowel and reflux, I can't breathe, my white blood cell count

>is always high, my mother dropped dead of a heart attack last summer,

>nobody has ever checked my cholesterol, I need albuterol 4 or 5 times

>every day, but all it does is make me shake and I want to know what

>causes all this. " All this from a 36 yo lady with a BMI of 23 who

>didn't want me to do a fundascopic exam because it would mess up her

>mascara.

>9) And this one wasn't even on the schedule: Owner of a local

>shooting range who carries concealed weapons, dropped by to express her

>anger that I sent her a reminder about the colonoscopy she never went

>after I referred her in the fall because of rectal bleeding and a family

>history of colon cancer. She is angry that I " bothered " her about that

>when she was just found to have metastatic melanoma. I had just gotten

>a note from the surgeon last Friday (a couple weeks after the reminder

>went out), and she hadn't called me when she developed inguinal nodes on

>the side from which her primary was excised 3 years ago

>I would say " just shoot me " , but that last lady probably would.

>

>I think I will just crawl under a rock.. As an IMP, I can do this stuff

>and feel at the end of the day as if I have been beaten up, but at least

>(I think anyway) that I have met the extraordinary needs of these " high

>maintenance " people. I don't know how anybody who sees 25 or 30

>patients a day can deal with a panel like this..I sure couldn't

>

>Anybody got a cigarette?

>Annie

>

>_,___

_________________________________________________________________

Type your favorite song.  Get a customized station.  Try MSN Radio powered

by Pandora. http://radio.msn.com/?icid=T002MSN03A07001

[Guest guest]

I LOVE the idea of a virtual pub! One day we will all have webcams and

be able to share a beer and blow off some steam together.

And I did spend extra time with the horses this weekend. Considering

what Michele and anybody else in the path of all that snow has to deal

with I'm almost embarrassed to say it was 61 degrees here yesterday. I

have ridden every day and enjoyed it enough to not think about anything

else for those precious hours. So I'm ready to go back to work tomorrow

with a contented heart and a good attitude.

Happy new year!

Annie

Do you ever have those days?

>Date: Thu, 28 Dec 2006 20:22:45 -0500

>

>.

>

><http://geo.yahoo.com/serv?s=97359714/grpId=9360914/grpspId=1705061327/

m

>sgId=10682/stime=1167340261/nc1=3836825/nc2=3848490/nc3=3848627> Eight

>patients today:

>1) New patient. 23 years old, 300lbs, irregular periods, has a

>beard. Scheduled for " headache " . Says no doctor has ever asked her

>about any of the above.

>2) Mother who witnessed her 13 year old son's sudden cardiac death

>6 weeks ago from what turned out to be long QT syndrome. He survived

>ACLS and now has an AICD. She is having panic attacks. Duh..

>3) Adult ADD on boatloads of Adderall and Wellbutrin. " OBTW do

>you think this is broken? Showing radius/ulna with new 30 degree angle

>.about 2cm proximal to her " other wrist "

>4) 82 year old lady whose husband just came home from 2 months in

>the unit and 3 open heart surgeries. She " had chest pain all last

night

>so I want an EKG, and I had a TIA last Thursday so I want ultrasound of

>my arteries, and you have to do one of those swabs of my vagina because

>I feel a little funny there again and I peed in a cup already because

>you need to make sure there is nothing wrong with it and I need you to

>help me find someone who will clean my house because the Home Health

>nurses are so messy and they won't help at all.... "

>5) 70 year old lady with extreme paranoia associated with her

>Alzheimer's is acting out and tried to throw a chair at her husband,

>probably gave herself a lumbar compression fracture in the process..She

>couldn't hit me this time because she is moving pretty slow, but she

>refuses any imaging test..

>6) Diabetic smoker already s/p left AKA now with dusky foot all

>around her non-healing foot ulcer despite all maximal revascularization

>efforts by the vascular surgeon, and refusing further treatment by

>anybody but me because she just got a $14,000 bill from her last

>catheter based cryoplasty and stenting intervention.Like I can work

>miracles..

>7) Thank God! A simple sinusitis!

>8) New patient: " My doctor is nice and all, but she doesn't try to

>find out why: I am tired all the time, I hurt all over, I can't sleep,

I

>have a headache the time, my arms are numb, I'm constipated, I have

>irritable bowel and reflux, I can't breathe, my white blood cell count

>is always high, my mother dropped dead of a heart attack last summer,

>nobody has ever checked my cholesterol, I need albuterol 4 or 5 times

>every day, but all it does is make me shake and I want to know what

>causes all this. " All this from a 36 yo lady with a BMI of 23 who

>didn't want me to do a fundascopic exam because it would mess up her

>mascara.

>9) And this one wasn't even on the schedule: Owner of a local

>shooting range who carries concealed weapons, dropped by to express her

>anger that I sent her a reminder about the colonoscopy she never went

>after I referred her in the fall because of rectal bleeding and a

family

>history of colon cancer. She is angry that I " bothered " her about that

>when she was just found to have metastatic melanoma. I had just gotten

>a note from the surgeon last Friday (a couple weeks after the reminder

>went out), and she hadn't called me when she developed inguinal nodes

on

>the side from which her primary was excised 3 years ago

>I would say " just shoot me " , but that last lady probably would.

>

>I think I will just crawl under a rock.. As an IMP, I can do this

stuff

>and feel at the end of the day as if I have been beaten up, but at

least

>(I think anyway) that I have met the extraordinary needs of these " high

>maintenance " people. I don't know how anybody who sees 25 or 30

>patients a day can deal with a panel like this..I sure couldn't

>

>Anybody got a cigarette?

>Annie

>

>_,___

_________________________________________________________________

Type your favorite song.  Get a customized station.  Try MSN Radio

powered

by Pandora. http://radio.msn.com/?icid=T002MSN03A07001

[Guest guest]

Dear Anne, I busted a gut on "2cm proximal to her other wrist.." Yes, I too have these days, but think of this -- mine are CAPITATED! Thankfully, 98% of my patients are delights, but when the albatrosses all land on the same day, it can be tough. Hang in there! Bob ForesterAnnie Skaggs wrote: . Eight patients today: 1) New patient. 23 years old, 300lbs, irregular periods, has a beard. Scheduled for “headache”. Says no doctor has ever asked her about any of the above… 2) Mother who witnessed her 13 year old son’s sudden cardiac death 6 weeks ago from what turned out to be long QT syndrome. He survived ACLS and now has an AICD. She is having panic attacks. Duh.. 3)

Adult ADD on boatloads of Adderall and Wellbutrin. “OBTW do you think this is broken? Showing radius/ulna with new 30 degree angle …about 2cm proximal to her “other wrist” 4) 82 year old lady whose husband just came home from 2 months in the unit and 3 open heart surgeries. She “had chest pain all last night so I want an EKG, and I had a TIA last Thursday so I want ultrasound of my arteries, and you have to do one of those swabs of my vagina because I feel a little funny there

again and I peed in a cup already because you need to make sure there is nothing wrong with it and I need you to help me find someone who will clean my house because the Home Health nurses are so messy and they won’t help at all……..” 5) 70 year old lady with extreme paranoia associated with her Alzheimer’s is acting out and tried to throw a chair at her husband, probably gave herself a lumbar compression fracture in the process….She couldn’t hit me this time because she is moving pretty slow, but she refuses any imaging test…. 6) Diabetic smoker already s/p left AKA now with dusky foot all around her non-healing foot ulcer despite all maximal revascularization efforts by the vascular surgeon, and refusing further treatment by anybody but me because she just got a $14,000 bill from her last catheter based cryoplasty and stenting intervention…Like I can work miracles.. 7) Thank God! A simple

sinusitis! 8) New patient: “My doctor is nice and all, but she doesn’t try to find out why: I am tired all the time, I hurt all over, I can’t sleep, I have a headache the time, my arms are numb, I’m constipated, I have irritable bowel and reflux, I can’t breathe, my white blood cell count is always high, my mother dropped dead of a heart attack last summer, nobody has ever checked my cholesterol, I need albuterol 4 or 5 times every day, but all it does is make me shake and I want to know what causes all this.” All this from a 36 yo lady with a BMI of 23 who didn’t want me to do a fundascopic exam because it would mess up her mascara. 9) And this one wasn’t even on the schedule: Owner of a local shooting range who carries concealed weapons, dropped by to express her anger that I sent her a reminder about the colonoscopy she never went after I referred her in the fall because of rectal bleeding and a family history of colon cancer. She is angry that I “bothered” her about that when she was just found to have metastatic melanoma. I had just gotten a note from the surgeon last Friday (a couple weeks after the reminder went out), and she hadn’t called me when she developed inguinal nodes on the side from which her primary was excised 3 years ago I would say “just shoot me”, but that last lady probably would. I think I will just crawl under a rock.. As an IMP, I can

do this stuff and feel at the end of the day as if I have been beaten up, but at least (I think anyway) that I have met the extraordinary needs of these “high maintenance” people. I don’t know how anybody who sees 25 or 30 patients a day can deal with a panel like this….I sure couldn’t Anybody got a cigarette? Annie _,___

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