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I’m Baaack

This week I returned to work after needed to stay off and isolated for the last week. While I didn’t come to work, I wouldn’t consider it a vacation. My days were filled with taking care of the toddler (3 year old) while my wife worked from home. In one word, it was exhausting.

As far as recovering goes, I noticed improvement almost each day in terms of the severity of my cough. I was coughing less frequently each day. I never developed a fever. I also never developed any shortness of breath or difficulty breathing.

And so, here I am, back at work.

Stay safe and healthy, everyone.

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Paid Leave

I have seen that a few companies are offering paid leave if their workers test positive for COVID19. In theory this is great. In reality, this is bogus. 

Policies are worded very specifically. Most of the statements I have seen that list paid leave are for patients that TEST positive for COVID19.

The problem is we do not have enough tests!

At my practice (a large, tertiary, University-based clinic in Southern California), we are operating under the assumption that most people who contract COVID19 will have a mild form of the disease that will not require a hospital admission. However, they will need to be off work for the duration to limit the spread and prevent a high-risk patient from contracting it and needing a hospital stay. 

So the majority of my patients who develop fever and cough (in cold/flu season) are told to stay off work and to act/behave as if they have COVID19 but they do not have a confirmed positive test to support the diagnosis. 

Are these people going to be able to claim benefits? I don’t know the answer to this. But if not, it will be a huge disincentive for people to follow recommendations and stay home when sick. 

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Banned From Work

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.

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July – It’s That Time of Year Again

It’s July.

It’s that time of year again.

Those involved in medical education — or just those that work at academic medical centers — know that this is the time of the year when brand new interns step into their roles as doctors.

Cue all the jokes about July being the worst time to be sick in a hospital.

During my chief resident year I was in charge of the first Journal Club session of the academic year. I assigned the residents an article about the July effect. You can find that article by here: Annals of Internal Medicine.

Jokes aside, I think the month of July is an exciting month to be involved in medical education. It’s a time of very new beginnings. As an attending physician supervising learners it is a time of heightened stress. However, I think it’s also a time of when you get to see new baby doc spread their wings for the very first time. This is the first time they are addressed as “Doctor.” These are the first orders they will write as a physician. This is the beginning of the rest of their professional careers.

The transition is defintely not always smooth-sailing. But it is definitely worth the trip.

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Doctor, Please Explain…

Recently I have been thinking about communication.

In my short career so far, I have realized that there is often a huge chasm between what we (physicians) think we have explained and what patients understand.

As a general rule, I try to take the time needed to talk to patients and answer all their questions. Sometimes I think I do an adequate job. And patients have voice appreciation for it before. I have been thanked for actually taking the time to explain my thought process and my plan. But I’m sure there are other times when I my question-answering leaves something to be desired.

Unfortunately, time is a luxury. Sometimes things get rushed. Sometimes there are patients who need more attention because of their condition so we spend a shorter amount of time talking to the more stable patient.

I’ve also had nurses tell me that they care for patients who ask them all sorts of questions about their medical care but when the physician comes in to see them, the patient either forgets or chooses not to pose the question to the physician. Sometimes they get overwhelmed. Sometimes they are intimidated. Nurses tell me that sometimes after the doctor leaves the room, the patients will ask their questions to the nurses.
Most of my work caring for patients involves residents/interns and medical students. I try to emphasize the need for clear and accurate information each time I work with a new group. Nevertheless, miscommunication happens. We aren’t perfect. We operate in a flawed and broken system that expects perfection and efficiency from medical providers.

If you’re reading this post, I’d love to hear about your experience as a patient. Are there still things that confuse you about that experience? Are there things that you wish your doctor had taken more time to explain? Are their topics or diseases that they sped through while talking to you? Do you wish they’d have slowed down and spoken in plain English? I want to know what the confusing topics are! I want to know where we, as a profession, fall short!

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Parenthood Thus Far

It’s now December. I went back to work in mid October after approximately 6 weeks without a shift. During those six weeks I had the occasional meeting to attend and other administrative responsibilities. But I had no 12 hour shift to fulfill. After feeling like I’ve been going non-stop throughout medical school and residency, it felt weird not to have any clinical duties for so long. At the same time, however, it wasn’t a vacation.

Prior to my 6 weeks off, I thought I would be able to stay at home, take care of the baby, and take time to read. I had hoped to have this time to catch up on much-needed reading. I soon learned that a newborn takes a lot of time. Despite both me and the wife being off work, we frequently found ourselves getting behind on things we had to do because, well, we were trying to keep this new creature alive.

During residency I had my share of on-call shifts that lasted over 24 hours. The newborn period soon came to feel like a prolonged call shift lasting days. Our nights were split into shifts where we would take turns taking the baby and making sure she was clean, dry, and fed.

We were lucky that Faith, our baby, was quick to take the breast or bottle. She wasn’t fussy and she didn’t need much coaxing to eat. But let me tell you, this little one can go from 0 to ‘hangry’ in no time at all. It’s as if she finally has the realization that, “Oh, I actually AM hungry.” This is usually followed by immediate wailing and crying.

They say that parenthood changes you. They say that having a child shifts your own priorities. I wonder how she shifts mine. I suppose only time will tell.

Oh well. It’s December. It’s baby’s first Christmas. And I will try to enjoy it while it lasts. In a few days the baby turns 4 months. I can’t believe it’s been 4 months already. It’s been crazy watching her grow so much in such a short period of time.

 

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Back To Work

I go back to work this week. It’s the first time I have been on a shift since mid August. My wife and I recently celebrated the birth of our first child, a baby girl. I was fortunate to be able to arrange my schedule in order to accomodate this time off.

It’s odd going back to work after a long time. Part of me welcomes going back. Part of me wants to hang out with this brand new, little human being.

They say that having children changes your priorities and perspectives.

Personally, I think its’ too early for me to say what, if anything, has changed.

Sure, I wish I could spend a ton of time with the little one. But I also have gotten antsy and wanted to get out of the house.

If it were an option or possiblity, I wonder how I would do being a stay-at-home dad/husband. I would probably have to be intentional about being active and doing things out in the community with the baby. Needless to say, I’ve got tons of respect for men and women who are full-time caregivers with their children at home.

We’ll see how it goes.