Wednesday, December 31, 2008
In the year 2009, I will have been graduated from high school for 16 years, graduated from college for 12 years, graduated from medical school for 8 years, married for 8 years, and a mother for 5 years, and graduated from residency for 4 years. I can't believe it. I turned around, I blinked, and the time was gone. I read once that as we get older, one year of life statistically becomes shorter. For example, at 2 years old, 1 year is half of your life, at 50, I year is 1/50 of your life. I do know that the coming year holds a big move, hopefully a sale of a house, the start of a new job (and with it a new lifestyle), kindergarten for CindyLou, and a multitude of other wonderful things that I couldn't even imagine. And it will feel like just a minute ago, but 2009 will be over, as well. My father always says that "These days *are* the good old days." I know one day I will look back at myself at 33 and laugh at how "young" I sounded. So my resolution for 2009 is to take each moment, the stressful and the relaxing, the harried and the hopeful, the highs and the lows, and remember that it is but the most fleeting moment in time, and from that, may I, may we all, find peace in truly living each moment in the coming new year. Happy New Year, Mothers in Medicine!
Saturday, December 27, 2008
Thursday, December 25, 2008
The wintertime, especially around the holidays, is a really depressing time for residents. Especially interns. There's nothing like being on call during the holidays, driving to work while it's still dark and knowing you'll be up all night and won't be going home till the next day. That you'll be away from your family, your spouse, your child on a holiday that's all about togetherness. It's a time when a lot of sleep-deprived interns are pushed to their breaking point.
So if you're someone who works in a hospital as a doctor, nurse, or professional patient, do something nice for one of those depressed residents stuck in the hospital through the holidays. A few kind words, a cookie, a much-needed hug, etc... it's all good!
Wednesday, December 24, 2008
One of the patients I met that week was a woman I'll call Sara, a nonsmoker in her 40s with lung cancer and carcinomatous meningitis. She was getting intrathecal chemotherapy instilled into the Ommaya reservoir in her brain three times a week...and this week, while her attending was skiing in Colorado, it was my turn to do it.
As you can imagine, putting chemo into someone's brain is a tad unnerving. The sterile field is no joke. Enough said.
Sara was a delightful young woman but very scared of needles. Sara's husband was an extraordinarily hairy, extraordinarily affectionate guy. Though I had never met them before, it was obvious they were MADLY in love. They had been married for 7 years, as they told me in a giddy voice at some point, but they looked like honeymooners--nuzzling noses, rubbing each other's shoulders. It bordered on inappropriate for a clinic waiting area, but I figured: hey, she's got metastatic cancer; they can do whatever they want. I certainly wasn't going to say anything about all the physicality....
except that it was almost impossible to administer her intrathecal chemotherapy. Over and over, I would sit her up and prep and drape her upper half. At the moment of truth, dose measured, name and history number of the sticker double-checked against her hospital bracelet, syringe full of chemotherapy approaching, his big hairy hands would grip her cheeks through the drape, and he would plant a big kiss on her forehead and say, "It's just one more small needle, hon, and it'll be over in a few seconds" or "I love you so much. You are the strongest woman I know." On more than one occasion, he actually lifted the drape with those big furry hands and said, "Baby, how do you manage to look so beautiful without a single hair on your head?" He looked lovestruck every single time I saw him, as though he would die if she had to be draped and therefore out of his sight for another minute. Over and over, I explained that this was the brain we were dealing with. Over and over, I explained the sterile field and how you really couldn't get in it, seriously. Over and over, he couldn't resist--or, more precisely, couldn't resist her. Every single time I saw her that week--three visits in all--it took at least 3 tries to seal the deal and instill the chemotherapy into her brain. Though I will admit that it drove me crazy at the time, particularly on the busiest days, I always walked away from those visits kind of smiling to myself.
I learned 2 or 3 weeks later from Sara's attending that she had passed away. She was sitting on the toilet one morning and just fell over dead. Her husband was so grief-stricken by the realization that she was gone that he just held her on the bathroom floor until she was cold and it was dark outside, and then called 911. By the time the ambulance came, she was clearly long-deceased, and they did nothing more than give her (and him...in the back, lying on the stretcher with her) a ride to the hospital. Apparently it violated their policies, but apparently they couldn't say no to him. Huh.
Though I didn't know either Sara or her husband well, I was absolutely overwhelmed by their love. I have cared for a lot of cancer patients and their families at the end of life and witnessed love under the magnifying glass of impending death more times than I can remember. But Sara and her husband were different somehow. Their love was truly unconditional, timeless...raw and unstoppable.
I'm not sure why, since I really didn't know him, but I decided to write him a quick condolence card. It was a completely nondescript card from a box of generic condolence cards--a sad reality of life as a medical oncologist that we buy the bulk condolence cards in packs of 10 or 25 the way others buy their generic thank you cards--but it's the thought that counts, right? As I wrote and reflected on why I had been driven to write to this near-stranger, the words just kept coming. It ended up having 2 or 3 extra pages (all on basic white paper from a Staples 500 pack) added, folded up inside the card. Unleashed, the letter morphed out of my control--as I recall, there was talk of great loves and young life inexplicably cut short and spirituality. I never got any reply. I hadn't really expected to, but I nonetheless wondered if I had overwhelmed him (did he even remember who I was?). Eventually I let it go and kind of forgot about the letter and Sara and him in the deluge of loss we face in oncology.
Years passed. On a random busy December day, I was in clinic and one of the front office staff came to get me, saying I had a visitor. It was Sara's husband. I didn't recognize him at all at first. He had cut his previously longish hair very short and shaved off his full mustache and beard since I last saw him. He looked tired and old for his apparently middle-aged age. As I approached him, I searched his face for clues of who he might be, not wanting to deal with the awkwardness of confessing I had no idea who he was. Then he stuck out his hand--the hairiest hand I have ever felt--and it all came rushing back. "You're Sara's husband. How are you doing? I hope you're not here as a patient..." (it is a Cancer Center after all).
He proceeded to ramble, standing right there in the lobby, how much he had loved Sara, how much he treasured that letter, how much it had quieted his mind that a stranger could see how much he loved Sara, reasoning that if a stranger could be so moved by his love for her, then surely Sara must have known how much he loved her, and how that was all he could ever ask for on earth. Then he said, "We always had a bunch of photographs and knick-knacks on our hearth. After Sara died, I cleared them all off. The only thing up there now is the urn with her ashes...and your letter. Anyway, I just came to tell you that." Then he turned and walked right out the front door.
I was too dumbfounded to say anything or walk after him, but in mind, I said to him: You just got in the sterile field all over again.
Tuesday, December 23, 2008
1. Cookies: My mother made dozens of cookies when I grew up: pecan sandies coated in powdered sugar, gingerbread cutouts, spritz, bourbon balls, fruitcake cookies, “painted cookies” (sugar cookies with glossy egg wash in corresponding colors) just to name a few. What we did with all of these cookies, I really don’t remember. Maybe we gave some away. We ate some for dessert nightly. We left a few for Santa. While I enjoy cooking, and cooking with my sons can be a lot of fun, I just don’t do it much. My mom gave me an appreciation for homemade baked goods, and I love that holiday tradition. But the boys & I don’t need the temptation of baked butter and sugar close by – Pillsbury, Duncan Hines, or my own.
2. Carrying a pager on 12/25/08: I’m on call for my partners and myself this year. The upside is that only the sickest of the sick children’s parents call that day. I’ll make rounds in the morning, and my kids are understanding about my leaving for an hour or two.
3. Stuffing things in bags at the last minute: I believe I have perfected the wrap in tissue and shove in snowman bag much as a quarterback throws a perfect spiral. It’s all in the wrist. My mom’s method is to wrap and then add beautiful ribbons and bows and embellishments. It also requires sitting. My method can be done as I am striding to the car on the way to a recital or party.
4. Looking forward to mother-in-law’s Christmas day because I don’t have to cook (much): My mom is an amazing cook. My family tradition is an English Christmas dinner with roast beef, Yorkshire pudding, parsnips and potatoes, and gravy. It makes my mouth water just to type those words. We lived overseas when I was in grade school, and adopted this tradition. I’ve alluded to my ability to juggle cooking and call – just not able to do it. I’m very grateful to my in-laws that they host the family for a covered dish get together. My husband makes his popular meatballs (another Crockpot winner!)
5. The internet: I shop (thank you, Amazon). I keep up with life, and blog: Where would I be without the ability to find and ship gifts to multiple places? My mother spent hours going from store to store searching for the perfect gift, packing them, and hauling the box to the post office. I do some of that, but the internet has streamlined the process so that I can continue to work full-time (a Pediatrician’s busy season) through the months of November & December.
A year ago, I didn’t know what a blog was let alone had an idea I would be writing on one with such an amazing group of women. Thank you. Mothers in Medicine! Thanks, KC, for giving me a chance to voice my opinion. Happy Holidays to you and your families & I look forward to the New Year!
Monday, December 22, 2008
But, reading the comments to my post where people shared the ways they give and show their children to give during the holidays was inspiring. I loved how Nurse Heidi holds a charity drive in her garage, how Laura and her mother bought gifts for kids on an Angel tree every year growing up, how Tempeh's extended family spreads kindness with every gift they exchange.
Saturday, we took my daughter to the mall (note: madhouse, avoid if possible) for the sole purpose of picking out a gift for a girl who wouldn't otherwise be getting toys this year. I loved watching her critically evaluating the toy aisles looking for a good gift. I have this! She would like this! She finally decided on a Little Mermaid doll, since Ariel is her favorite character. Note, she does not have one herself.
We went to the fire station yesterday and she dropped off the doll in the big box in the lobby.
As I walked back to the car, holding my daughter's hand, I felt such a connection to her. Such a tenderness. Such rich love. It was such a small act, this donating of a doll, but it felt like much more. It was, indeed, a beginning. A seed, I hope.
Happy Holidays, Mothers in Medicine.
Friday, December 19, 2008
Thursday, December 18, 2008
"These are attributes of physicians that serve them well professionally," said the presenter,* flashing a list onto the giant screen:
- perennial caretaker
- emotional remoteness
The family medicine conference attendees nodded and murmured in recognition, and he continued, "And these are the attributes of physicians that are liabilities in family life." He flipped to the next power-point slide:
- perennial caretaker
- emotional remoteness **
As the audience burst into appreciative, rueful laughter, I was struck by how neatly my domestic difficulties had just been explained.
I've often noticed that the very qualities that enable me to do a good job at the clinic frustrate my efforts at caring for my family and our home.
My days at work are organized exactly as I like them, from the length of patients' appointments to their medication lists to the position of the stapler on my desk. I interview patients, I examine them and I write prescriptions, requisitions and orders. I don't determine what walks in the door, but I manage every aspect of the problem once it's presented to me.
My life at home is an unpredictable, distracted mess. Much as I'd like to slot in a toddler bum wipe at 10:15 and keep the school backpacks stowed in the hallway closet, urgent requests and displaced things greet me at every turn. I may be the one guiding the day in a general sense, but the thousand details are determined by three messy, spontaneous children.
The satisfaction of measuring performance by objective standards at work cannot be achieved in the same way at home. I can pick up the faintest of heart murmurs, I can suture a laceration beautifully, I run my clinics on time, but how do you grade yourself on raising a daughter well?
At the clinic, I take on challenging work, complete it, and turn to the next diagnostic puzzle. But at home, I repeat menial tasks thousands of times, while others undo them.
Like most physicians, I thrive on competition. It's always motivated me, and winning is powerful affirmation. But motherhood is a different beast from the MCAT, pharmacology prizes and residency applications. No one's going to come out on top, and comparing yourself to other mothers is futile and dangerous ground. The competitive mother after gold stars is the one no one wants to be around.
The only item on the list to which I can't relate is emotional remoteness at home. My problem is the opposite. Because I am so emotionally controlled at work - probably because I hear the very moving stories of refugees every day - I tend to let any restraint slip away when I walk in the front door in the evening. I can be extremely irritable, though no one at work would ever believe it. Once, when I was being particularly foul, Pete gently suggested, "I think you should try to treat us like you would your patients."
I want to be a great doctor, and even more, a great mother. But if the qualities of one can be the undoing of the other, no wonder it feels such a struggle some days.
*Dr. Paul Farnan, St. Paul's Hospital CME, November 2008
Wednesday, December 17, 2008
One of the best things about having my son has been getting to relive my own childhood. What better time to do that than Christmas! The cookies! The stockings! The lights! As he’s gotten older we’ve started to watch the classic Christmas cartoons I loved as a child.
He has always loved Dr. Seuss, so last year we got him “The Grinch that stole Christmas” book. We read it for a couple of weeks, then we all sat down and watched the cartoon (not the Jim Carey version, the original). It was such a hoot. He loved it and it was as good as I remembered. We all had it memorized by the end of the season. Even though we packed it up with the Christmas decorations, throughout the year when anyone in our family said “I have an idea” my son would pipe up and ask, “Is it a wonderful, awful idea?”
This year I got him the “Charlie Brown Christmas” book and we had been waiting patiently for the special to come on TV.
But….. it was a little different than I remembered.
First of all, the whole premise of the show is a child who is battling depression. Not necessarily the feel good plot of the year. Seriously, any child psychiatrists out there want to give me a differential diagnosis on Charlie Brown?
Then there are the other kids who are just plain mean. Calling him “stupid” and “idiot” all over the place. My son’s eyes got huge. These words that aren’t allowed in our house.
Add to that, the complete lack of adult supervision. Where are the adults? Why can’t they talk?
The plot is a quite lacking in general. Although I did feel some nostalgic warm fuzzies when Linus recited from Luke Chapter 2 and they sang “Hark the Herald Angels” sing at the end.
At least Lucy has some good business sense for her practice. She collects her 5 cent co-pay upfront. I’m worried she might be violating HIPPA, though since she doesn’t seem to have any walls around her booth.
Tuesday, December 16, 2008
SLEEP: Do you go right to sleep? Are they actually sleeping right beside you?
FOOD: Perhaps you're eating your own dinner. Or is this the time to make their lunches for tomorrow? Or make your own lunch (or your partner's lunch) for tomorrow?
READ: Is it time to curl up with a magazine (The New Yorker? People? Time?), or read the web in its entirety, your academic journals, some fiction?
WRITE: catch up on emails, your blog, your list-making
CONVERSE: have at least one meaningful, or at least uninterrupted, conversation with your spouse/partner.
LAUNDRY: and all those other housekeeping chores, anyone shopping online?
EXERCISE: see next
SEX: in your dreams or in reality
What did I miss, is there anything else? Oh yes, some people probably go out. Is there life after the kids go to sleep (suddenly I feel like I am writing this in Carrie Bradshaw style, do forgive me, MIM pals)?
Monday, December 15, 2008
Truly, as I looked around the room the day of the exam, I felt as if I were in the inner sanctum of a (not so) secret society. The testing center was the house of the brotherhood. The examiners were the brothers/sisters, and I was the lowly pledge, so desperate to be on the other side of that imaginary line between junior fellow and fellow. It was all rather unsettling. I have been beating myself up since the test has concluded, and I'll have to wait a little longer until I discover whether I am "in" or whether I am "out." My family has been grounding me since my return home. To them, I *am* their inner circle, and, whether or not the brotherhood deems me worthy, I know that I can count on their radiant smiles and open arms to welcome me into our own little cozy inner sanctum. It puts everything in perspective, of which I am in great need. So, no more slacking, at home, work, or the blogosphere. The test is over, and life moves on.
Sunday, December 14, 2008
The argument is that if you're five minutes late a lot, how come you can't just leave five minutes earlier in the morning?? Good point.
I can't really use the baby excuse because other residents in the program have kids, so I mostly say something along the lines of "I'm a senior resident and I'm pretty much checked out." I'm embarrassed to admit the real truth, which is that it often is Melly that makes me late.
I have good intentions: I'm usually dressed and ready to go with plenty of time to get to work. But then sometimes as I'm walking out the door, I hear her crying... and I think to myself how rare it is that I get to see her in the morning. I almost never get to be the one to rescue her from her crib and give her a bottle while holding her. That's so much more important to me than any lecture could possibly be. I don't think my priorities are screwed up.
And of course, if I hear her cry "Mama!" there is no chance of me getting out the door on time. I'm not made of stone.
It's especially hard for me because there has never been a time in Melly's entire little life that I have NOT been a resident. Except for my 6 weeks of maternity leave, I've never gotten to have an extended period of time when I could wake up with her every morning and spend the day with her. Or even part of the day.
Those extra five minutes in the morning are all I've got and I just can't make myself walk out the door. It's well worth getting yelled at.
Friday, December 12, 2008
Then I saw KC’s pictures of her family. Sweet pictures to be regarded for years to come. Happy baby pictures. Sibling enchantment (however brief). Glowing parents. I want pictures like that!
So I’m on a quest for some visual memento of my seven and eleven year olds. How else can I freeze them in time? I want to capture Harry’s tossed salad blond hair, and Will’s prepubertal glow. Not only would pictures satisfy my mommy-lust for holding back the sands of time, I could use them as Christmas gifts for family and Husband.
One of my office staff showed me her Christmas pictures. They were urban and modern, and I loved them. Her website showed pictures of playful kids in old chairs outside. This photographer, like KC’s, had the gift of not only catching the image of the subjects but their spirit as well. Sign me up!
So we were all set Tuesday afternoon to meet this photographer after school. The rendezvous point was a field of wheat on the other side of town. Prior to this meeting, I had run all over town looking for the right wardrobe. I had settled on solid color sweaters and t-shirts, and had tried hard to pick items that the boys would wear anyways.
Will, Harry, and I piled into the car for the 20 minute drive to this field – my rough directions in hand. We dodged traffic lights. The boys muttered about interrupted play time, but understood that surprising Daddy was part of the adventure. I chatted them up about how much fun this would be – trying hard to keep the atmosphere light. We found the field on the side of a road, and pulled over to park and wait. We were a couple minutes late. No problem – we had 30 minutes of daylight left.
My first clue to impending failure should have been that the wheat was actually weeds – a disaster for my allergic seven year old. The second clue was waiting for 20 minutes with two antsy boys in the car. I’m not sure I would have wanted the pictures of that afternoon. Surly Will. Pouting Henry. To be honest, I was pouting like a toddler, too. The photographer left us in the field. No show. Nadda. Disappointment is an understatement because then I had to explain to Husband why the boys were so moody when we returned home. Surprise revealed. Ta dah!
Maybe a trip to Hawaii for pictures is not such a bad idea after all. Hmm….
Thursday, December 11, 2008
The potential is huge.
But, I've been recently having second thoughts about this Santa-biz. I don't want Christmas to be all about getting. Sometimes, the way she acts, I think: wow, you have no idea how lucky you are. Sometimes, she is a complete brat. How to make her understand how blessed she is? To appreciate the joy of giving gifts (in all senses of the word) to others? Can they get that at this age?
And then I think of my friend Jen and her daughter M and know that they can. Jen runs a homeless shelter in the Bay Area and M, very close to my daughter's age, helps out at the shelter from time to time. Hearing about M at the shelter is inspiring. Her daughter is sensitive, loving, empathic, and so utterly giving it takes my breath away. I want that.
It may be cliche to volunteer at a homeless shelter during the holidays but what better time to start a family tradition of giving? I want my daughter to really understand that people out there don't have homes, don't have food, and sometimes, the only difference between us and them is luck. I want her to know this intimately, more than the times she asked me why I rolled down the window at the stop light to give money to the man standing at the island. (Why doesn't that man have a house?)
So I'm looking for local shelters where our whole family can go and help. The experience probably won't overshadow the receiving of Christmas presents for my daughter this year, but I'm hoping it will be a seed of awareness, of goodness, that grows.
Wednesday, December 10, 2008
Thursday, December 4, 2008
I wish we videotaped or had transcripts of the discussion. We got great advice, from having a fire drill-like plan of what to do if we get groped by a patient or a fellow physician (which has happened to members of the panel), to how to answer (or not answer) illegal questions in interviews about how soon we were planning on getting pregnant, how to manage when our kids are sick, and other wonderful bits of information and experience.
The next morning, I was driving 4 year old Z to school. He was sitting next to the big contraption the catering company rented to me to keep the food warm for the event. He was confused, somehow thinking it was for me to bring food to the people at the hospital. I explained to him that I was still in school to learn to be a doctor, then I would go to the hospital to help people.
Z paused for a second and then asked, thoughtfully, “When you are a doctor and you go to the doctor place, will you still be my mommy?”
“Yes,” I said. “I will always be your mommy.”
“Will you still come home to me?”
Oh, kid, you’re killing me. “Yes, I will still come home to you.” In my head, I was thinking, sometimes, during residency, it may seem like I don’t. But I will always come home, eventually. When all the babies are born, all the sutures are closed, all the cases are presented, I will come home. And I will try to find out about your homework and listen to you and hug you and kiss you before I collapse into bed.
Mom TFH is one of the oldest people at her medical school. The other students learn from her various valuable life experieces: as a pizza delivery driver, a Denny's waitress, an art major, a health food store manager, a purple haired punk, a natural supplement researcher, a midwifery student, and a mother. She has two boys and is married to a public elementary school PE coach. Going to med school just didn't keep her away from them enough, so she is doing a dual degree (D.O./M.P.H.), is the president of the ob/gyn interest club, and applied for a research fellowship.
Wednesday, December 3, 2008
I had a stereotype in my head of male doctors as men who were constantly chased after by women, regardless of their looks or personality. I figured male doctors believed they could have any woman they wanted, and I didn't want anything to do with a man like that. Modesty is a quality I value highly in the opposite sex.
Over the course of my medical training, I've met a lot of men who fit that stereotype to a tee. It's been frustrating seeing the way (some) female nurses swoon over my male counterparts. I've been shocked at the attention some of my male colleagues have received from the opposite sex, when it was clear they would have had trouble even getting a date if they were in a lot of other professions. It's especially frustrating for a female physician to observe this, since a lot of men are intimidated by our profession; whereas a male physician is "a catch". Damn double standards.
Of course, I've met a lot of male physicians who have proved me wrong. (Mostly, those men didn't become surgeons.)
So in the end, I didn't end up marrying a physician. He's in the sciences as well, but not medicine. Although it might be nice if he could understand some of the more medically complicated stories from my day, I'm usually pretty glad I veered away from marrying a doctor. I wouldn't want to come home to a doctor any more than I want to come home and turn on House, MD. He's my much-needed escape from the medical world.
Another unexpected added benefit of not being married to a doctor is that now that we have a child, we don't have to concern ourselves with working out our call schedules so that at least one of us is always home. He's home every night. Lucky bastard.
But I'm sure lots of women out there will assure me that being married to a male doc is all that and more, as long as you find the right one.
Tuesday, December 2, 2008
So we have a girl now. And they are different than boys. With Son, I'd just lift up the penis and wipe up any poop on it.
With Daughter, poop gets mashed in between the labia, and I'm entirely freaked out using the wipes on such a sensitive area. And what if I inadvertently shove some fecal matter into her urethra? The state may not allow me to complete this adoption if I were to cause UTIs.
Husband laughs because I've had all this fancy training and I can't change a diaper.
To tell the truth, I've never been much into newborns, but this kid is special. She's mine.
We are having a stellar holiday season thus far. I hope your families are enjoying this season, too.
Monday, December 1, 2008
It is popular everywhere, evidently, to employ physician extenders to help get it all done. PAs triage patients in the ER and treat the more straightforward problems. Nurse practitioners make rounds on the critical care patients and the cancer patients, writing the detailed progress notes before the doctors arrive. They do casting for the orthopedists and see routine followups at the family practitioner's office. There's even a push for them to write prescriptions, although that's not happened yet in our state.
One of my partners has a PA. He sees 90% of his post-op patients at followup in the office, sees new hospital consults, does all his medical records, and screens all his incoming pages on call. He also often is the only person to see my hospital inpatients on the weekends when they're on call. This frees my partner up to be more productive and to have more time at home with his family.
So what's the matter with me? I admit, it's been very tempting to engage a PA myself. I'd love to have someone else dictate all those discharge summaries. I might even be able to see my family 5 nights a week instead of 3. How can that be a bad thing? Why don't I just hire somebody to help? *Everybody else is doing it!*
I just can't do it. Maybe it's a little OCD, but I keep hearing my mom saying to me years ago, "If you want a job done right, do it yourself." It's the mantra of my Type A surgical personality. I know you can't really do *everything* yourself, which is why we have an office staff. But when it comes to patient care, it's a different story.
My patients come to me because they trust me to help them. Most are in pain or critically ill, and they're vulnerable in so many ways. They are *my* responsibility. No one else can evaluate them initially, because I have to make the decisions about what patients need surgery. No one without surgical training can or should do that. In the hospital postop, there are so many subtle things that can go wrong, I don't feel comfortable letting anyone else other than my partners make rounds. (I dislike my partner's PA seeing my patients when they're on call, and my patients have told me they don't like it, either.)
In the office postop, patients want to see their surgeon, not somebody else. I want to see them, because it's rewarding seeing how they've (usually) improved as a result of what I've done. I hear patients complain frequently that "when I go to my family doctor, I never see him, just the nurse practitioner." (That attitude may be unfair to a very good nurse practitioner, but it's that patient's real response.) To me, it's important to nurture my rapport with each patient. I can't do that if I don't see them and talk to them.
There are real legal issues, too. If my PA misses something resulting in a bad outcome, that's my responsibility, and I take the heat. If my PA doesn't document something adequately, that can mushroom into a huge problem under the right circumstances. And if I check everything a PA does, it's not worth having them, because I might as well just do the work myself.
This is not to insult physicians who employ physician extenders or to insult the physician extenders themselves. It may be that with the growing population and the physician shortage, my approach may not be workable or realistic, just like house calls are a thing of the past. I may one day eat these words.
But for now, I'll keep treading water, doing my own thing.
gcs 15 is a 39 year old full-time neurosurgeon in private practice in a beautiful Southern state. She has a 10 year old son who plays travel soccer and ice hockey. Her wonderful, Type B husband is a primary care MD who quit medicine to be a college professor and loves teaching premed students. She adores her job but hates the politics involved in the practice of medicine. She's always struggling to find ways to get more hours in the day.