Mr. T., an 81 year old, comes to our office, unannounced, approximately 1-3 times a week.
He navigates the public bus system to get here.
He ambulates with the assist of a cane only.
He has all our contact numbers to call for triage advice but always chooses to just come in.
He does have very mild cognitive impairment and is followed by a memory disorder specialist and a psychologist as well.
He's completely compliant with his medications and lives with his two sons.
He'll come in for colds, transient-fleeting headaches, skin tears, a splinter in his finger, an isolated, slightly elevated home blood pressure reading, etc., etc..
Most recently he came in due to a disturbing dream.
I was able to obtain his records from his previous health care facility and this has been his modus operandi for many years.
He usually just needs a brief physical exam and reassurance and heads home satisfied and thankful.
When my nurse noticed he was in again she said, "Mr. T. hadn't been in for awhile. Where has he been?"
My only reply was, "you missed his last three visits because you were on vacation last week for your son's wedding."
She smiled and so did I.
Friday, October 7, 2011
Thursday, October 6, 2011
Mine for 6 months
Mr R., a 74 year old, comes to Florida, from up north, every October (and stays for about 6 months).
He is a wonderful man (I'm not kidding...once you get to know him).
He's a wonderful man that's also cantankerous (I'm sure he would agree).
I'm his primary care physician while he's here.
He recently called (he'd been back in Florida for three days).
I was out of practice, in terms of how to deal with him, since I hadn't seen him for the previous 6 months.
My Nurse: Mr. R. is on the phone and demands to be seen. He says it's an emergency. He also wants you to know he had a bad summer due to the earthquake and hurricane Irene. He says he should have never left Florida this year.
Me: OK, tell him to come right in. I'll be happy to see him.
A little while later...
My Nurse: He doesn't want to come in now, he wants to come tomorrow.
It obviously wasn't an emergency (now I'm starting to remember).
Me: OK, tell him to get here as early as possible so I can see him before other scheduled patients arrive.
A little later...
My Nurse: He doesn't want to come early in the morning. He says he's not an early morning person and he told you that last year.
He's right, I do remember him telling me that last year.
Me: OK, tell him to come sometime during the day and I'll see him between patients with scheduled appointments.
A little later...
My Nurse: He says he won't come and just wait. He's afraid he'll catch something and get sick from all the other folks in the waiting room.
I'm now at full recall...he wants to be seen only when he wants to be seen...how could I have forgotten?
Me: OK, tell him to come at "lunch" when no other patients are scheduled.
That's what I did last year and it seemed to work.
A little later...
My Nurse: He says OK but feels bad you never get to eat lunch.
Me: Yeah, I'm sure he does.
Let's see, only about 5 and 1/2 more months to go (I'm sure you all know what I'm talking about).
He is a wonderful man (I'm not kidding...once you get to know him).
He's a wonderful man that's also cantankerous (I'm sure he would agree).
I'm his primary care physician while he's here.
He recently called (he'd been back in Florida for three days).
I was out of practice, in terms of how to deal with him, since I hadn't seen him for the previous 6 months.
My Nurse: Mr. R. is on the phone and demands to be seen. He says it's an emergency. He also wants you to know he had a bad summer due to the earthquake and hurricane Irene. He says he should have never left Florida this year.
Me: OK, tell him to come right in. I'll be happy to see him.
A little while later...
My Nurse: He doesn't want to come in now, he wants to come tomorrow.
It obviously wasn't an emergency (now I'm starting to remember).
Me: OK, tell him to get here as early as possible so I can see him before other scheduled patients arrive.
A little later...
My Nurse: He doesn't want to come early in the morning. He says he's not an early morning person and he told you that last year.
He's right, I do remember him telling me that last year.
Me: OK, tell him to come sometime during the day and I'll see him between patients with scheduled appointments.
A little later...
My Nurse: He says he won't come and just wait. He's afraid he'll catch something and get sick from all the other folks in the waiting room.
I'm now at full recall...he wants to be seen only when he wants to be seen...how could I have forgotten?
Me: OK, tell him to come at "lunch" when no other patients are scheduled.
That's what I did last year and it seemed to work.
A little later...
My Nurse: He says OK but feels bad you never get to eat lunch.
Me: Yeah, I'm sure he does.
Let's see, only about 5 and 1/2 more months to go (I'm sure you all know what I'm talking about).
Wednesday, October 5, 2011
Accidental flatulence (at that time of the day)
I get to the YMCA on most weekdays and exercise from about 5:30 until 6:15 AM.
It's usually an older crowd (at that time of the day).
I wake up to my alarm at 5:15 AM.
I already have a bag packed (from the night before) and the "Y" is only about a mile from our home.
Most of the really elderly folks, who exercise (at that time of the day), report having been up since about 3 to 4 AM.
The cushioned floor mats are used by most for stretching and sit-ups.
Occasionally, someone has some accidental flatulence (farts).
Sometimes, there's only one other person on the mat so I know who it was.
Other times I don't know because there's a small group.
Without fail, no one laughs and no one takes ownership (of course many possibly have hearing loss in the flatulence frequency range).
I had never been a member of the floor mat flatulence club.
That's no longer the case.
The only other person, in the vicinity, on my memorable morning, had ear phones in place.
Maybe. just maybe, my membership is still a secret because I didn't laugh and I didn't take ownership.
It's usually an older crowd (at that time of the day).
I wake up to my alarm at 5:15 AM.
I already have a bag packed (from the night before) and the "Y" is only about a mile from our home.
Most of the really elderly folks, who exercise (at that time of the day), report having been up since about 3 to 4 AM.
The cushioned floor mats are used by most for stretching and sit-ups.
Occasionally, someone has some accidental flatulence (farts).
Sometimes, there's only one other person on the mat so I know who it was.
Other times I don't know because there's a small group.
Without fail, no one laughs and no one takes ownership (of course many possibly have hearing loss in the flatulence frequency range).
I had never been a member of the floor mat flatulence club.
That's no longer the case.
The only other person, in the vicinity, on my memorable morning, had ear phones in place.
Maybe. just maybe, my membership is still a secret because I didn't laugh and I didn't take ownership.
Tuesday, October 4, 2011
False advertising
My wife asked if I would take my daughter to get a flu shot on the way to her daily horseback ride.
We had received a flu shot ad for the "minute clinic (a Nurse Practitioner run clinic that advertises quick, inexpensive visits for common ailments and concerns)," in a local CVS, that opened at 10 AM on Sunday morning.
We got there at 10:01 AM.
We were the 4th in line.
We left at 11:15 AM (when we were third in line), without having received the flu shot (we got tired of waiting).
I doubt we'll return unless they change their name to the "hour and 15 minute" clinic.
We had received a flu shot ad for the "minute clinic (a Nurse Practitioner run clinic that advertises quick, inexpensive visits for common ailments and concerns)," in a local CVS, that opened at 10 AM on Sunday morning.
We got there at 10:01 AM.
We were the 4th in line.
We left at 11:15 AM (when we were third in line), without having received the flu shot (we got tired of waiting).
I doubt we'll return unless they change their name to the "hour and 15 minute" clinic.
Monday, October 3, 2011
Tr, not Thr
A 68 year old male was annoyed that his blood pressure and cholesterol were above goal.
Mr. M.: I don't understand, I've been exercising 5 to 6 days a week on the threadmill.
Me: It's great you're exercising on the TREADMILL. You should continue.
Mr. M.: I thought exercising on the threadmill would keep me off blood pressure and cholesterol lowering medications.
Me: Exercising on the TREADMILL is a great thing to do but many folks, like you, that do everything correctly, still need to be on medications to help control both.
Mr. M.: But I've really been pushing it on the threadmill.
Me: And you should continue to exercise on the TREADMILL.
Mr. M.: I was hoping to get better results from the threadmill.
I think you get the picture. We were able to finally move on to a new subject after a few more back and forth threads vs TREAD.
Come to think of it, maybe I should have told him that walking or jogging on a treadmill would give better results than exercising at the mill making thread.
Mr. M.: I don't understand, I've been exercising 5 to 6 days a week on the threadmill.
Me: It's great you're exercising on the TREADMILL. You should continue.
Mr. M.: I thought exercising on the threadmill would keep me off blood pressure and cholesterol lowering medications.
Me: Exercising on the TREADMILL is a great thing to do but many folks, like you, that do everything correctly, still need to be on medications to help control both.
Mr. M.: But I've really been pushing it on the threadmill.
Me: And you should continue to exercise on the TREADMILL.
Mr. M.: I was hoping to get better results from the threadmill.
I think you get the picture. We were able to finally move on to a new subject after a few more back and forth threads vs TREAD.
Come to think of it, maybe I should have told him that walking or jogging on a treadmill would give better results than exercising at the mill making thread.
Sunday, October 2, 2011
Now I understood
Mr. P., a 77 year old, had always been insistent on having an annual PSA, despite his age and despite previous discussions on PSA testing in the elderly.
The most recent result was slightly high and the biopsy performed (at his insistence) by the urologist showed a "minute focus of adenocarcinoma (not surprising)." The amount was so small that a Gleason score couldn't be determined.
He wanted to undergo radiation therapy.
He was going to see the radiation oncologist the next week for a consultation.
He came to see me prior.
Me: Have you just thought about watchful waiting (I did not think he needed to aggressively treat his microscopic prostate cancer)?
Mr. P.: No, I just want to get rid of it once and for all.
Me: Are you aware that it might be such a small amount of cancer that it won't shorten your life...are you aware it still might come back after radiation...are you aware of the potential complications and adverse side effects of radiation therapy...are you aware that some folks develop colitis from the radiation, have incontinence and erectile dysfunction?
Mr. P.: Yeah, I just want to get rid of it once and for all.
Me: Do you know anyone who has had prostate cancer?
Mr. P.: My best friend, my buddy for over 50 years, died from it. He and I were retired Army and Civil service workers. We were also hunting and fishing partners. He got diagnosed with prostate cancer and decided not to do anything. He went and bought a casket and paid for his funeral. He died 6 weeks later.
Now I understood. I briefly discussed the fact that his friend most certainly had metastatic cancer at the time of diagnosis, not microscopic as was his prostate cancer, but I let him know I hoped everything would go well with the consultation for possible radiation therapy.
Mr. P.: And thanks for talking to me about this. You gave me some things to think about. At least I know some additional questions to ask before I make my final decision.
Cool, he really was listening.
The most recent result was slightly high and the biopsy performed (at his insistence) by the urologist showed a "minute focus of adenocarcinoma (not surprising)." The amount was so small that a Gleason score couldn't be determined.
He wanted to undergo radiation therapy.
He was going to see the radiation oncologist the next week for a consultation.
He came to see me prior.
Me: Have you just thought about watchful waiting (I did not think he needed to aggressively treat his microscopic prostate cancer)?
Mr. P.: No, I just want to get rid of it once and for all.
Me: Are you aware that it might be such a small amount of cancer that it won't shorten your life...are you aware it still might come back after radiation...are you aware of the potential complications and adverse side effects of radiation therapy...are you aware that some folks develop colitis from the radiation, have incontinence and erectile dysfunction?
Mr. P.: Yeah, I just want to get rid of it once and for all.
Me: Do you know anyone who has had prostate cancer?
Mr. P.: My best friend, my buddy for over 50 years, died from it. He and I were retired Army and Civil service workers. We were also hunting and fishing partners. He got diagnosed with prostate cancer and decided not to do anything. He went and bought a casket and paid for his funeral. He died 6 weeks later.
Now I understood. I briefly discussed the fact that his friend most certainly had metastatic cancer at the time of diagnosis, not microscopic as was his prostate cancer, but I let him know I hoped everything would go well with the consultation for possible radiation therapy.
Mr. P.: And thanks for talking to me about this. You gave me some things to think about. At least I know some additional questions to ask before I make my final decision.
Cool, he really was listening.
Saturday, October 1, 2011
No more fungus among us
I hadn't seen Mr. H., a 63 year old, for about 6 months.
He looked great.
He had lost over 50 pounds and mentioned he had a girlfriend for the first time in over 10 years ago.
Mr. H.: Thanks for helping to get my confidence back.
Me: (I actually had no idea what he was talking about) I'm real happy things are going well with you.
Mr. H.: I'm glad you asked me if I would like to treat the fungus in my fingernails when I saw you last year.
Now I remembered. About a year ago, he had come in for a follow-up on his blood pressure. For the first time, I noticed he was sitting with his fingers, of both hands, curled up in a fist. At first I thought he was just tense, but when I went to check his pulse I noticed most of his fingernails had significant onychomycosis. I asked him if he would like treatment for the fungus. He agreed. On follow-up, 6 weeks later, you could see the demarcation beginning between the normal and the abnormal nails growing out. I hadn't seen him since.
Mr. H.: I didn't want to socialize because of my fingernails. I didn't go the church. I felt embarrassed to shake hands. I didn't want to go on a date. I didn't think anything could be done. I've been exercising, eating better and met a great gal.
Now that sure made my day!
He looked great.
He had lost over 50 pounds and mentioned he had a girlfriend for the first time in over 10 years ago.
Mr. H.: Thanks for helping to get my confidence back.
Me: (I actually had no idea what he was talking about) I'm real happy things are going well with you.
Mr. H.: I'm glad you asked me if I would like to treat the fungus in my fingernails when I saw you last year.
Now I remembered. About a year ago, he had come in for a follow-up on his blood pressure. For the first time, I noticed he was sitting with his fingers, of both hands, curled up in a fist. At first I thought he was just tense, but when I went to check his pulse I noticed most of his fingernails had significant onychomycosis. I asked him if he would like treatment for the fungus. He agreed. On follow-up, 6 weeks later, you could see the demarcation beginning between the normal and the abnormal nails growing out. I hadn't seen him since.
Mr. H.: I didn't want to socialize because of my fingernails. I didn't go the church. I felt embarrassed to shake hands. I didn't want to go on a date. I didn't think anything could be done. I've been exercising, eating better and met a great gal.
Now that sure made my day!
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