The End of a Long Day…

I’m feeling sorry for myself today…48 hours until vacation, and today seemed uniquely designed to get me good and stressed out prior to that.  I must take my board exams tomorrow – an 8 hour test given by computer.  I have not prepared as much as I’d like to have.  So, I’m worried about that.  Add to that a day of alternating vague and complex complaints, several EKGs and pelvic exams, a colposcopy, and, to top it off, an ER trip for my last patient.

There are times in family medicine when I feel really good about being able to handle all these complex and diverse complaints in rapid succession, and there are times when I feel worn out and stressed out by it.  Today it was both.  I felt like I gave each patient the time they needed (though I made a few late for their other appointments).  I also felt that I took enough time this morning for medical student teaching – I try to give that close-to-equal weight as patient care – even when I’m rushed.  But here I sit – ready to go to sleep in my chair.  I can’t, of course…still have to do some practice exam questions to prepare a little more for tomorrow…

My patient went to the ER because of a heart condition that required it.  For some reason, despite having very low blood pressures this morning (below that normally considered requisite for consciousness), she wanted to wait until early evening to see me, and everyone in my office was fine to let that happen also…She wasn’t in horrible shape when she arrived, but she did require some time and effort here in the office before getting her to the ER.  She sees several specialists – any one of which would have been appropriate to consult for these symptoms before me – but she wanted to see me first.  On one hand, I rejoice in that – my patients SHOULD all want to see me first – I’m their family doctor.  The person they should see first about everything!  However, I knew, in this case, that her workup would cause a lot of fuss in our office and would likely result in me trying to convince her to go to the ER and then getting her there.  I feel lazy when I have feelings like this – but ultimately it WOULD have been more efficient for the patient to go to the ER first – continuity be damned.  It’s at these times that I worry about primary care’s future in the US.  If YOURS TRULY – a primary care evangelist – has these feelings, what hope is there?