Change of venue

After a few months with the GI group, I made the decision (not easy) that it was not the place for me for various reasons, including that a specialty is not as interesting as family practice. The multiple MDs and lack of support in my role of new grad and new employee made for a large amount of stress. I was offered a position in a small rural health clinic nearby which had only one doctor and a PA, and a very friendly staff . Moving jobs was a no-brainer, especially as there is a good possibility that my student loans will get paid off by HRSA.

It seems that sometimes things are not as advertised. The place which seems really great at first, may not be a good fit after all. I suppose in retrospect, that my biggest concerns (the large amount of MDs and the fact that a specialty would require a lot more studying to catch up) were legitimate. The support promised did not materialize, and on top of that I ended up feeling quite alone, as I was in this middle area, not allowed to “socialize” with the staff, and not considered part of the MD inner circle either. Turns out, I was never actually in the loop af

So, now I find myself in a totally different environment, where we all feel like a big family with joking around a bit accepted, and a group of people willing to help each other out and work as a true team. The physician and PA are completely supportive. What a difference! It is nice to hear someone tell you did a good job at the end of the day.

And, being back in a family practice environment is great. Well, I had almost forgotten the “Oh and by the way, I also wanted to talk about…..” after the visit was over and the chart done. I am getting better again at the “well, we can make another appointment for you to go over that.”

I feel so much less anxious and stressed, I might be able to get back into more regular blog posts!

I wish you all a happy new year, and hope that  all of you had a fantastic holiday.

A moment to reflect

I recently met an 88 year-old survivor of the holocaust. This person survived four different extermination camps as a teenager. The only surviving member of his family. And a cancer survivor as well.

It makes me realize that nothing that could happen to me could even remotely approach the suffering this person faced in their lifetime. And he still smiled and joked with me.

“Humor is what keeps me going.” he said. I shared my favorite joke. He had already heard it, but that was okay, we still laughed together. I didn’t cry until I got home.

Office Politics

One of the hardest things to do when starting a new job, is to get a handle on the office politics. The difficulty level is higher when there is a large group of physicians, other mid-levels and a large assortment of assistants and office personnel. Add some new services being set up and the mix gets a bit volatile.

I have never been a real political person, so I would have had a real problem with all of this only a few years ago. After the rigors of post-graduate education, and the “Project”, it seems that I have developed some new skills in dealing with the politics, and a higher level of personal confidence. So far, things are going relatively smoothly, and I am learning who the movers and shakers are, how to keep myself in the loop, who are my allies and which people I need to be careful around.

All in all, considering the amount of people in the practice and the sheer amount of patients seen and procedures done, this three-ring circus operates quite smoothly, and I am feeling more comfortable each day in my new role. We are settling into our new community, making new friends and enjoying the outdoor activities and beautiful surroundings we have here. There is a 43 mile long bicycle trail which runs past lakes, parks, and forest near by which we are enjoying each weekend. Life is good.

I need a new bicycle…

One month in

It has been a month since I started my new position. Some days I feel great and other days, I feel totally stupid. Cirrhosis and NASH and the inflammatory bowel diseases are still a bit daunting. The physicians seem to be accepting me now, an are very willing to teach me the nuances of gastroenterology. There was about a week of “let’s see what this chick can do”, where I felt very scrutinized and alone. Evidently, I passed that little test and now I even hear an occasional “good job”.

Yesterday, I walked into an exam room and asked the patient my usual “What brings you here today?” He kind of gave me the stink-eye and said “Oh great, another uninformed health care person”. To which I replied “Sir, I always ask that question so I get a good idea of the patient’s expectations for the visit”.

After looking over his EGD results which showed gastritis and the pathology report which was negative for H Pylori, he asked me what reasons other than H Pylori could cause the gastritis. Seeing aspirin on his med list, I asked how much he was taking. Turned out, it was 325 mg of regular aspirin, because, he said, he heard it was good for you. Further questioning revealed chronic headaches and regular use of ibuprofen, Aleve and aspirin powders.

We discussed all of this, and the plan was to reduce the aspirin to 81mg of enteric coated, and avoid the NSAIDs. Use Tylenol instead, and to follow up on the headaches with his primary care provider.

When the patient left, he thanked me. I guess I didn’t look so uninformed anymore.

It feels good…