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Banned From Work

March 30, 2020 by Leave a Comment

This week has started off oddly. I am at home. I am not on vacation. I wish I were. Instead, I am at home in a sort of self-quarantine.

Last week, as I was getting ready to go to work I noticed that I was coughing. Initially I thought that I was had a tickle in my throat and that I just needed to clear it. But the cough persisted.

At our institution our outpatient faculty clinics had already instituted a strict screening policy. All visitors to the building were funneled to the main entrance. There, two people screen any person entering regardless of whether they are visitor or employee.

The questions each day were the same. Have you had a new fever? Have you had a new cough? Any shortness of breath? Any contact with known COVID19 patient? If all questions were answered with a negative, they would hand you a sticker that said “Cleared” and a face mask.

I knew that I would fail the screening. I also knew we had a shortage of tests. I would not be eligible for testing. And, the institutional policy for returning to work with new symptoms would require me to wait a minimum of 7 days.

So here I am. At home. Avoiding contact not only with patients but with my co-workers. I understand the reason for the policy. With the pandemic we must do everything we can to minimize spread of this COVID-19 disease.

Each day I have checked my temperature. Each day I have not had a fever. My cough has improved each day. And on National Doctor’s Day, while this pandemic rages, and my healthcare colleagues continue the fight, I sit and I wait.

Filed Under: After Residency, My Life Tagged With: , , , , ,
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Rationing Tests?

March 25, 2020 by Leave a Comment

Rationing tests? In the U.S.A.? It may sound strange to hear that in the land of plenty we are rationing tests. But here we are, ill prepared for a global pandemic.

One of the most difficult things to say to patients who are having symptoms of cough and/or fever during this pandemic is that they need to stay home and act as if they had COVID-19. Testing, for the most part, is being reserved for the patients sick enough to require a hospital admission. I don’t think it helps that many people keep seeing things in the news touting how people can get tested without fully explaining the limitations we have. Or maybe my region of the country is the abnormality?

Ideally we could swab anyone who had symptoms. But since we cannot, maybe this will help:

  • With a limited supply of testing supplies, we should only test those in which testing will change the management or treatment.
  • It is accepted that there is a spectrum of presentation of COVID-19. Some patients may have zero symptoms. Some patients may have mild symptoms. Some patients will need extra support that requires treatment in a hospital (like supplemental oxygen, mechanical ventilation, etc.)
  • If patients are stable enough that they are breathing comfortably, they should stay home and act like they have COVID-19. They should treat symptoms and self quarantine to avoid spreading it others who might develop more severe disease.
  • Patients who have symptoms that include shortness of breath or trouble breathing should go to the Emergency Department to be evaluated. They may be hypoxic (have low oxygen saturation) and need additional support. These patients who are sick enough that they require care in a hospital should be tested.

Again, it isn’t a perfect system. We don’t have an infinite number of testing kits/supplies. We don’t even have enough test everyone we suspect of having COVID-19. But this is why testing is being limited.

Needless to say, this post is not intended to be medical advice. If you have questions about your particular case, please contact your primary care physician.

Filed Under: After Residency, My Life Tagged With: , , , ,
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Pandemic!

March 25, 2020 by Leave a Comment

It is painful to watch the amount of distrust or disbelief amongst the public – even among those who are in healthcare. Last week I saw an article about young people still going on about their usual life, not willing to put things on hold. One of the people interviewed was a nurse.

I saw another article from this week that beaches remain open in Florida for spring break. Parties were just told that they must keep their groups to 10 or less. However, the article also showed a picture taken on a Florida beach in Clearwater that showed pretty crowded situations (the picture was taken on 3/27/2020).

Sometimes I just want to face palm.

Filed Under: After Residency, My Life, News, Opinion Tagged With: , , ,
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Obesity Week 2019

December 6, 2019 by Leave a Comment

I had the chance to attend Obesity Week 2019 in Las Vegas from November 3-7. Obesity is not really a topic or area that I had much exposure to during training. But in the past few years I have wished that I knew more about it. After residency I worked exclusively in the inpatient setting as a hospitalist. For those of you unfamiliar with this term, it means that I only worked in the hospital treating patients who were sick enough to be admitted in the hospital. During this time I would frequently encounter patients with chronic medical conditions, many of which would improve with significant weight loss. But the extent of my intervention was to advise the patient about the importance of lifestyle changes and to follow up with their primary care physician. Because for the hospitalist, the physician-patient relationship ends when the patient is discharged from the hospital.

A few years ago I asked around our division why our outpatient Internal Medicine clinics did not have an obesity clinic. After all, I thought, this should be well within the scope of practice for an internist. This is not to say that no one at my institution was treating obesity. In fact, we had a medical weight loss program as well as a bariatric surgery program. But Internal Medicine did not have a dedicated clinic for obesity. Instead, internists had to address obesity along with any other medical conditions during a patient visit.

Fortunately, while I was asking around and looking into obesity treatment, I discovered that one could become board certified in obesity medicine by the American Board of Obesity Medicine. And, through asking around, I learned about the annual Obesity Week meetings held by The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).

Over the last year I have transitioned out of inpatient medicine. Currently I see patients in the Internal Medicine clinic at my institution as a primary care physician. But I am also starting a new learning/educational journey with the obesity medicine. I am not sure where this journey will take me. But as with the journey thus far, I’ll continue to try and write and reflect on it here.

Filed Under: After Residency, My Life Tagged With: , , ,
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Back To Writing

November 6, 2019 by Leave a Comment

Over the last few years my activity on this blog has definitely decreased. I suspect that it is a combination of a lack of time and a sense of not having an audience. The blogosphere has changed over the last few years. This is the age of the social media influencer. I see a lot of activity on Twitter and Instagram now. When I started my blog I was an undergraduate student trying to apply to medical school. That seems like a lifetime ago. And in a digital/technology world, that is several lifetimes ago.

But I have to remind myself that when I started blogging, it wasn’t for the audience. It was for me. At the root of it all, writing was cathartic. And I need to get back to writing for me. And if there are friends who want to follow the journey, then that is a bonus.

Filed Under: After Residency, My Life Tagged With: , ,
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Aging

May 1, 2019 by Leave a Comment

I’m not talking about the aging of my patients.

I’m talking about my own aging.

I looked at the medical students rounding with me last week and realized that these “kids” have only ever known an Electronic Medical Record.

I recalled to them my experience as a medical student when I would handwrite orders for the team on triplicate forms and then turn the orders in to the unit secretary to be faxed off to the pharmacy and/or distributed to the nurses.

Their faces clearly showed their shock and disbelief.

The idea was totally foreign.

I think I felt an ache in my back at that moment.

Filed Under: After Residency, Education, Medical School, My Life Tagged With: , , , , ,
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Good job, Senators

July 26, 2017 by Leave a Comment

After all the waiting and political posturing, today the U.S. senated voted no on a straight repeal of the Affordable Care Act (commonly known as Obamacare).

In the days leading up to this you heard many, including POTUS, urged the senators who had campaigned on repeal of the ACA to step up and deliver on their promise.

Today, the U.S. Senate voted not to repeal.

For those who had campaigned on the promise of repeal but decided to vote No because it hurt your constituents, I respect you.

Campaigning for something and then trying to follow through blindly despite learning how it hurts those you represent is — well to me, it isn’t doing your job at all.

The ACA isn’t perfect.

But a full repeal that would result in coverage loss for millions of Americans with no answer in sight is downright wreckless.

Filed Under: News, Opinion Tagged With: , , , ,