I have now spent four days clinical time at the health department. I like my new preceptor, she is patient and receptive to questions. I tend to ask a lot of questions…
I have seen a lot of patients and am finding that they seem to belong to three groups in general.
1. Those who have no insurance or are on Medicaid, and find that the health department primary care clinic is a reasonable option for basic health care needs. The amount billed is based on financial need on a scale ranging from full pay to free care. It is a pleasure to help them meet their health care needs, I know what it is like not to have insurance, so I can relate. These people are happy to get the care and tend to follow the treatment plan set up for them.
2. The walking train wrecks. These are people who wait until the latest possible moment to seek health care for a problem they have, or they wait until they have several problems, and try to pile them all into one visit. For example it might go something like this: I have had a runny nose and cough for three weeks and now it hurts to breathe, and I have this really big pimple on my butt that just keeps getting bigger, and I ran out of blood pressure medications 2 weeks ago and my back hurts really bad.
3. The yes, buts. These are people who come in very regularly claiming to feel lousy (and they most probably do feel lousy) and want you to fix them up, or maybe really not. This is what I mean…
Okay Mrs. Smith, I see you are here for your diabetes and blood pressure check. Did you bring your sugar readings log?
“I would’ve, but I forgot. They have been much better, in the low 100’s.
Mrs. Smith, that can’t be quite right, your A1c reading is 11.3 which is higher than last time. This reading indicates that your average blood sugar is in the high 200’s, not the 100’s.
Yes, but that was because of the holidays, it really has been lower most of the time.
I really need you to bring in your log next time, okay. Have you been following your diet?
Yes, but it is too hard to follow and I really like to eat, so I don’t always.
Are you walking 30 minutes at least three or four times a week? Remember how important it is to exercise?
Yes, but a lot of days I forget, or it is too hot out.
You know it is very important to take your blood pressure medication every day as prescribed, are you taking your meds? Your blood pressure is quite high today.
Yes, but I don’t like the water pill. It makes me go to the bathroom too much, and I didn’t get my refills yet, so I ran out yesterday. Do you have any free samples? I just forget to take them sometimes.
Did you get the medication box we discussed that you can fill each week so you can remember to take your meds?
Yes, but I forget to fill it up. Oh, and my feet are swelling up really bad, can you do something about that? I am feeling so tired lately, and I gained 6 pounds last week. Is there a pill I can take to lose weight?
I swear, some people just like to complain, and if I hear “yes, but” one more time, I may scream. Well, maybe not, but I’ll roll my eyes when they aren’t looking.
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