Oh outpatient

I've just made it through my first 2 weeks of outpatient medicine and it's been quite an interesting ride thus far! I'm working at a community clinic in MD that serves the uninsured, low-income population. The patients have to pay a copay for each visit, then get a discounted rate for bloodwork and other testing. I would say almost all of the patients I have seen thus far were born outside of the US and English is not their first language. I've treated people from Iran, Sierra Leone, Mexico, Guyana, Nigeria, Cameroon, India, Pakistan, and many many more. (I try to make it a point to ask each patient where they are originally from) I've seen things I probably would not have seen in a family practice/internal medicine practice seeing all insured patients. For instance we had a patient walk in with a blood pressure in the range of 200/120 who had not been on high blood pressure meds for several months. I've had more than one patient who had an initial hemoglobin A1C of >12% (normal being less than 6%). It's also great because my preceptor LOVES to teach and he tries to give me at least one lecture a day on something ranging from reading EKGs (and what abnormal findings indicate) to the workup of a thyroid nodule. Despite all this interesting stuff, there are downsides - like the fact that most of my patients don't speak the best English making getting a reliable history out of them difficult. Also many have little medical knowledge (or what medical knowledge they have is more of a cultural belief regarding certain diseases such as diabetes and high blood pressure) making their compliance to medications and diet/exercise recommendations less than ideal. I can't tell you how many times I've sat with patients for an extra 10 minutes explaining what medications are their BP medicines vs their "sugar" medicines vs their cholesterol meds. But, despite the negatives, at the end of the encounter - no matter how frustrating or time-consuming, the patients are sooo grateful to be seen and treated. I've had many patients thank me profusely for doing something that many of us with easy access to medical care can take for granted. They appreciate the time spent explaining things and truly listening to them.

I've made some observations through these two weeks and have some tips to share. The next time you go see your friendly physician or, better yet, PA please remember the following:

1. If you are going to the Dr to complain of a sore throat or cough, please brush your teeth! There's nothing worse than getting a noseful of stinky breath

2. Please shower within 24 hours prior to your Dr's visit - stinky patients are no fun for anyone. And on the same note - try to clean your feet - we do have to look at those too

3. If you must have your young children with you in the exam room, please don't ignore them while the scream blood murder - it makes it very difficult to hear your heart and breath sounds with a screeching toddler in the background

4. Please please please - know your medicines and what they are for - and if you don't know - ask! Telling me you take that "little green pill for cholesterol I think" does nothing to tell me what medication you are actually taking

5. If you are told at your previous visit to bring something with you (whether meds or blood sugar logs) bring it with you...we don't just tell you that you need to bring it for fun - it really is important information

6. If you have diabetes - check your blood sugars regularly...we don't tell you to do this in order to torture you - it's important that you monitor them and it is important that we know this information to keep your blood sugars controlled

7. When you are told to get labwork before returning for your next visit - get the labs done...they really are good for something, I promise!

8.. Please don't quote Dr. Oz or Oprah or Dr. Phil for that matter...I realize that all these people are probably quite knowledgeable but they don't know your case, your medical problems and are getting paid lots of money to say what they say. If you really want to treat your medical problem with their advice try to get an appointment with them, not me.

9. And finally - we like treating you and we really like it when you thank us. There is not much better than seeing a patient smile and thank you as they leave when they came into the exam room looking rather wary

*[Note - the above tips were meant to be somewhat tongue-in-cheek...no offense was meant by any of it]*