Brass Makes it Better

I had a rough day today. I am not sure many people (outside of my medical and residency friends!) know/appreciate how stressful and exhausting it can be to be a family doctor, especially in a new system and where more than 50% of patients are "new patients to establish care." It is not a big deal to see and treat a new healthy person in 30 minutes (and enter all of their information to our medical record), but when you have someone (or back-to-back people) with not only a mile-long list of meds to enter to the EMR and then their own laundry list of complaints to address in one visit, along with our documentation requirements (which sometimes takes more time than the actual patient visit itself!) and their 50 pages of outside records to review, it all adds up. It can be totally exhausting and it is on days like these that I envy people who have "normal" jobs.

For just one post, I'd like to vent a little and to speak some words of advice to all of you who may be patients at some point-- some dos and don'ts, if you will, of how we (or I) feel patients should act.

1. DO arrive on time.
We ask patients to arrive 15 min before their scheduled appointment time. I really feel strongly that this is one of the most important rules to adhere to in terms of patient etiquette. Your time with the doctor starts at the time your appointment is, so if you arrive 2 minutes before that and don't get into a room until 7 or more minutes later, you will (well, should) be limited in your time spent discussing your concerns. Of course, most of us providers feel bad/rude about cutting patients off, so basically late patients throw off the rest of our day, making other patients (who may have been on time) suffer, and requiring us to use our lunch hour to finish charting or stay late at work when we also have other things to do. I know that doctors sometimes run late. But most doctors run late because late patients make them late.

2. Don't bring a laundry list
We have "annual/new patient" 30 min time slots, and we have 15-min "acute" time slots (which should be quick visits like blood pressure follow-ups, colds, UTIs, etc.). When patients in a 15-min slot (or even a 30-min one) bring a "list" of concerns to discuss, I really, really cringe. Just make a longer appointment, please. Patients may feel that doctors prefer them to space out the intervals between visits and just cover more at the more infrequent visits. No, no, NO. I would rather see you daily or weekly for one concern each time than have you "bolus" me with multiple complaints in a short visit. Do you honestly think I can do a good job of treating your asthma/diabetes/foot pain/skin lesions/ vaginal discharge all in one appointment?!?! And please avoid the "by the ways" (which include adding on a work note, etc.) at the end of your appointment when your doctor has physically and mentally moved on-- bring it all to our attention up front, and you will make our lives 100% easier.

3. Know what medications you're on
Do you think I will have a good understanding of how to treat your blood pressure if you don't know the medication OR dose that you're on? It boggles my mind how rarely patients will think to bring a medication list, or the medications themselves (which is what I'd recommend if you're on more than about 3 meds) to the doctor's office. Please do. You will be better treated.

4. Take your doctors' advice
It frustrates me when patients (and parents of children) decide against recommended vaccines and then are frustrated by the frequency of (largely) winter infections. The flu shot will NOT give you the flu. The TDAP shot IS strongly recommended (I had a case of pertussis last week) regardless of how much you hate shots. For a humorous take on vaccine-refusal, read this article here. I spent a good part of my Tuesday (my day off) coordinating an outpatient infusion for a patient who then refused to go get it. Please know that medical school does teach us something, and that there are good reasons for what we recommend.

5. Be accurate with your allergies
Please don't tell me you're "allergic" to penicillin because you have a family history of it. Most "penicillin-allergic" patients are not, and, until you have severe hives, swelling, or anaphylaxis, I'm likely to offer you amoxicillin or keflex. Please also don't tell me that you're "allergic" to poison oak (which you can actually list as a bona fide allergy in our EMR). Really, who isn't allergic to poison oak? I certainly haven't been prescribing a lot of poison oak lately. There are also big differences in "allergies" and "side effects."

Okay, I think I'm done. Deep breath.

After today's clinic day, I really needed the relaxation and joy that was brought to me with tonight's concert at Humboldt State, which featured the Canadian Brass.

I LOVE brass music. I love holiday music. And to have them both in the same evening was such a gift! Seeing the quintet up on the stage really made me wistful for and miss the time of my life devoted to music and music performance, but it is still great to be able to appreciate the music from the audience. This show was a fantastic way to spend an evening-- the group demonstrated superb musicianship, and was additionally extremely entertaining, with real singing and dancing (they did a "Ballet Tribute" at the end) amidst/during the musical numbers. The program included various Bach highlights including the "Little Fugue," as well as some less traditional arrangements (i.e. Brahms) for Brass and even a Tango.

If you have time, listen to this You Tube clip [with group members of yesteryear] of their finale, "Saints' Hallelujah" (a mash-up of "Oh When the Saints Go Marchin' In" and Handel's "Hallelujah Chorus" from "Messiah."



Ah. Brass does make it all better.