I know exactly what he is talking about...

I was just browsing websites today when I came across this article and it really nails the problems with pain mangement. I think, pain management is very challenging and sometimes, I do not get things right- between expectations of patients, limits of the pharmacy coverage and my own biases/ thoughts regarding diagnoses. This gave me permission to say that I am not always going to achieve great pain control for every body that I see with chronic pain. I feel ready to manage therapeutic expectations of both my patients and myself.

Early Monday morning...

I really should be getting to bed- Labor day tomorrow, the kids are at home, I have to be at work, try to keep the apples in the air...but whatever, I am so glad, and greatful that I have a job where I can, and do make a difference, where I am forever learning. Later on today, I will be pleased to be at the hospital and "laboring" on Labor day.
Power to all the working people- the world depends on us!

How to be a part of a community

I recently went to the summer session of ACP at SFO. I have not been to a medical meeting in the past three years, so I really wanted to find out if there is any benefit to going to one of these meetings and as of now, it seems there is a benefit at least to me. I thought medicine through out the two days. For every one of the sessions, even the one on pneumonia ( surprise, surprise) I learnt something. For each of the sessions, I could relate the information to one of my patients.
The other benefit was meeting folks who practice all over, one of my new friends was a lady who is the only internist in her town in Minnesota, her scope of practice is much broader than mine but her problems are similar to mine. It was good to know that I am not alone.
I am so pumped to learn more, practice better and be more enthusiastic in my career choice. As an additional benefit, I met up with an old high school friend that I have not met in over two decades.

My cure for the Healthcare problem

Take profit away from the practice of medicine- it is absolutely unethical to make money off of sick people, I can understand making a living out of caring for people but profit- that is the real crux of the problem.
For a more balanced approach check this out.

My CD, my remote.....

My two year old has taken to carrying broken Cd's along with him- all the time. Sometimes it falls from the case and we have to rush to get it back- otherwise its the end of the line for the kid and an end to our ear drums. Some weird fixation, when will it end and what is it supposed to mean?

Hospital Rounds

Taking a page from DB's med rants this is a list of conditions I saw during rounds and need to think about carefully-
1.Hyponatremia
2.Pericardial effusion
3.Aspiration Pneumonia
4.Pleural effusion
5.MRSA cellulitis and abscess formation
6.Hypercalcemia
7.Renal cell carcinoma
8. Acute myeloid leukemia chemotherapy complication
9. Renal failure with multiple myeloma
10. Palliative care- patient with metastatic cancer, unknown primary who did not want any investigation.
What a rich source of learning.

Changes, changes, changes...

I will be doing more hospital medicine soon- two weeks out of every eight weeks. I am going to enjoy the contact and hopefully, the intellectual satisfaction of working with housestaff and medical students; but I wonder what it will do for my access. I am sure I will find out soon enough, but the opportunity to work close to home, at least for a fortnight was too good to pass up.
And talking about acess, all my patients can probably see me the day they would like to see me and that is not the case for my son's pediatrician; I had to wait a month for a well child appointment and it took him about two hours to see my kid and I was more than happy to see the nurse practitioner that was offerred. I cannot believe how much I dislike going to the pediatrician- not very good for my kids.