I am at the half-way point of my Adult Practicum term. The midterm exam is due this week, I’ll take it on Wednesday. Friday will be my first day of clinicals at my doctor’s practice for the second half of Adult Practicum. It should interesting. My greatest complaint about my previous two preceptors is that they didn’t tell me enough.W hen I saw my doctor last week, he said he has been accused of telling people how to build the watch when asked what time it was. That works for me!
Seeing the patients that came to the health department for their primary care was definitely “interesting”. Coming from a background with high work ethic and a belief in the value of your health and the need to do everything to maintain it, mostly to be able to keep the ability to work and be productive, it was a shock to see what was considered important by some of the patients I saw. Their values differed from mine in several major respects.
- For them: 1) if Medicaid pays for it, I want it. If it isn’t paid for, I don’t. 2) If it doesn’t make me uncomfortable, it isn’t important. 3) Whatever I can use to go on disability is good, even if I am a big, strong, young man and my only disability is a bum knee from basketball. 4) Why bother with prevention if you can just fix things afterwards.
- In my world it goes 1) I will find a way to pay for it as healthcare is important 2) What ever it takes to prevent future problems or treat current ones gets done, I need to keep healthy and active so I can work and do what needs done. 3) Disability is the last thing I would ever want, I will find a way to work and stay independent until the last possible second (so bad that I can’t get out of bed, well, even then you can use a phone or computer) 4) An ounce of prevention is worth a pound of cure.
A woman came in whose main complaint was a sore in her armpit. When the nurse took her blood pressure, it was 210/102, approaching stroke city…then the patient admitted to having some pain in her chest. “But that is not why I came in, I want you to deal with the sore under my arm!” All through the ECG she complained about the armpit thing. Thank goodness there wasn’t an ischemic event going on (heart attack), though the ECG showed LVH (enlarged heart, probably related to the ridiculously high BP).
We reviewed her BP meds, changed the doses a bit to better address the BP issue, tried to educate her a bit on the risks of heart attack and stroke, etc. Not interested, “Just take care of that thing in my armpit!”. Okay, we drained the small abscess that had formed from a folliculitis related to shaving her armpits. Then she was happy.
I have to wonder if a large part of the higher rates of stroke, heart disease, diabetes, uncontrolled hypertension, etc. in the “underprivileged” is a result of noncompliance with treatment plans, or simply not caring enough to take care of their own health. The care is there and available, but if you don’t use the care available or follow the treatment plan, you will not be healthy or get better.
I have seen several patients with genital warts, lots of genital warts and big ones. Personally, one teensy little bump would send me straight to the doctor’s office in a screaming panic (not that I would put myself in the position of it being possible to get such a disease if I had anything to do with it). I can not conceive of letting things go the way some of these patients did. When the treatment is finished (which is painful, as it basically consists of burning them off with acid) I sit and chat with them a bit, educating them on prevention, etc. Not a single one of them used condoms. They knew about condoms, they knew about safe sex, but it didn’t seem important to them. I asked some of them “So, you want to be a daddy?” The answer of course was usually “no”, or “not now”. I asked if the girl they were having sex with was the one they wanted to be the mother of their children. The answer to that was always “no”. They know that sex=possibility of babies, but when it comes to their own personal selves, “I wasn’t thinking about that.” The universal attitude seems to be: fix it if it happens when it comes to diseases, and for some of the girls Plan B or abortion as contraception. Thank goodness, there are a lot of girls that take advantage of the free contraception offered by the health department.
The concept of being responsible for the results of your own actions doesn’t seem to be a big value these days. Or as the young people say: “Whatever.”