Wednesday, May 23, 2018

No Respect for the Generalist

One of the parts of my job is holding the triage phone. This is not something I enjoy. It feels like folks call me for a way to reach other folks and finagle transfers to our teaching hospital. I am not at my best on the phone and phone tag is irritating.

My first conversation with the outside hospital doctor started with bare bones introductions before she asked me if I was a nephrologist because she wanted an expert opinion on whether her patient needed hemodialysis. Now, this was a woman with lots of comorbidities who had heart failure which was responding well to diuretics but her creatinine has creeped  up. We discussed her care and decided that there was no indication for urgent hemodialysis.

My very next call from another outside hospital was for another person with newly diagnosed congestive heart failure with a prior history of chronic lymphocytic leukemia. Now, here even before our introductions, the doctor blurted out, asking me if I was an oncologist. I told him that I was a primary care doctor working in the hospital. We reviewed the details of the patient's history and concluded that he needed management of his shortness of breath before looking at further oncologic management.

It is shocking to me that generalists don't seem to trust their own clinical judgement. Care for a patient often degenerates into a consult-a-palooza where a lot of specialists opine about diagnosis and therapy without a leader of care so that therapy may not always be in the best interest of the patient. This is a common scenario which plays out daily in our hospitals and reflects poorly on our internists.

Monday, October 2, 2017

Something Isn't Right


Woke up anxious and looked at my phone
Wrong thing I know-- but there it was again
Violence unbridled-- lots of folks dead, done
I made sure not to look at the news again.

Friday, September 29, 2017

A Wasted Day



There have been so many of them
Morning -- Noon-- Afternoon--
Work And Work And Work again
The first shift,
The second shift,
Remember the milk
And the after school stuff.

That is just the way the cookie crumbles.
Time passes,
Trees change.
From the noisy, freezing air conditioning,
to over the top heating,
to the children's new tees.

Facebook reminds me-
A year ago you posted this picture and
you see this shiny eyed
Little boy
Who loved you
Once Upon A Time.


Wednesday, May 27, 2015

Heat Wave In India And Hot Yoga

Every evening, I watch the news- and everyday this week, I learn of the heat wave in India. About the people that have died. How poor folks can't be indoors, can't afford air conditioning or maybe even a house. Or how there is such a great water shortage that one has to pay for water and even so there is no guarantee that the water is safe for drinking. 97 million people in India don't have access to clean water.

I thought about all this during savasana (corpse pose) at a hot yoga class. The class - intermediate vinyasa- advertised the temperature in the studio being 99 degrees. In India, temperatures have soared to nearly 120 degrees. I have free access to clean tap water which I drink throughout the class. I feel strong, rejuvenated after my class. What exactly have I done to deserve it? I have worked hard but the laborer in the fields around Delhi has also worked hard, if not harder than I have.

Is Geography Destiny?

Saturday, July 13, 2013

Weekends

The American Way, or at least what I think of as the American Way, is to work hard and live large over the weekend. So, what does one do when one has been a lotus eater through the whole work week? Can one justify living large over the weekend, then? That is my big question for myself especially as a mother and hard working full-time doctor. Anyway, I cooked breakfast, exercised and now I am ready to hit the beach for some quality Socal living. I'll justify my existence later. Ciao!

Monday, February 27, 2012

Cold,rainy and hailing in San Diego

It is simply amazing how quickly we humans become soft-we moved from Philadelphia about four years ago and now we are so used to the great So Cal sunshine that even a day of cold,damp weather can make us miserable. The interesting thing is that we refuse to believe that the weather can change.I told my husband today that the weather guys predicted 100% chance of rain and his reply was it is not going to rain simply because of that prediction. Of course,I had to pick hi. Up as it was raining so hard in the evening.

Thursday, October 27, 2011

Beets, Beets, Beets

Purple or golden
All sorts- with greens on top
every time I see a bunch
want to take them home for lunch
unfortunately,
the family
doesn't agree
with this homily.