Hello everyone, and welcome to my penultimate NUHS blog. Yes, I
know it's going to be very sad when I am longer writing about my
entertaining weekends and insightful blunders with patients, but I
am sure you will be able to press on.
FSU vs. UF Game (Click photo to see full version)
Speaking of pressing on, I had to walk into the clinic this
morning with my head a little lower than I would've liked. I, as
some of you may know, am a huge Florida State Seminole fan. I love
my alma mater and have stuck with them through thick and thin, and
after this weekend, it will be no different. After a fantastic
Thanksgiving Thursday, my old roommate and best pal, Rich, made the
drive up to Tallahassee for one of the largest and long standing
in-state football rivalry games--FSU vs. UF. It felt great being
back in my old stomping grounds and hopes were high that we would
best the Gators. Unfortunately, our hopes were deflated, as we lost
a disappointing 37-26. To add insult to injury, my Tampa Bucs also
lost a close match up against the now 10 and 1 Atlanta Falcons. I
was not a happy camper last night, but some left over turkey, ham,
and casserole did help a little.
Being disappointed in sports is one thing, but what happens when
you become disappointed when treating a patient with no results? At
what point do you have to step back and realize that you may not be
able to help a patient? Then once you have made that realization,
whom do you send them to?
I have been writing mock narrative reports for the past week and
came across one of my old cases in which this happened. I took over
this particular patient from a graduating intern, who had been
treating her for lower back, right hip and right lower leg pain. We
had established that the patient had lumbar spine disc derangement,
decreased core stability from two cesarean sections, and peripheral
nerve entrapment of the peroneal nerve in the right lateral
compartment of the lower limb as well as a pretty substantial
gluten allergy. This patient was treated 2-3 times per week
depending on her schedule, and would find mild relief after
treatments, but after two months at this frequency she was still
not experiencing any lasting relief.
At this point I reevaluated the patient and began another course
of treatment. Prior, the patient was being treated with Cox Flexion
and Distraction. I then switched to McKenzie end-range loading
techniques (more extension-type therapy), which seemed to offer
longer lasting relief. Still a month went by with very little
change. Now, I started to pull my hair out. At that point I had to
have "the talk" with my patient about possibly finding another
treatment option. She was very apprehensive to any kind of
injection or surgery, which is understandable and very common. The
challenge then became finding another alternative to her care that
would benefit her and she would be comfortable with. Together we
decided that seeking out an established McKenzie certified
practitioner might help, as I am not totally comfortable with some
of the more advanced stages of McKenzie protocol. A month or so
went by before the patient called the clinic, but when she did it
was with good news and she was extremely happy that we made the
switch.
I never looked at the situation as a failure on my part, or that
I was losing a patient, because in the end something I did made her
better. This should always be the goal as a doctor. Money will come
and go, as will patients, and as stressful as it might be to keep
your lights on in practice, you have to be able to sleep at night
also. This patient ended up continuing to be treated by the other
practitioner, but she did refer her husband, who is still an active
patient.
I hope everyone has a quick and productive week. Everyone should
be studying for finals already. Studying early always helps with
the crazy amount of exams stacked in a two-week period. Make the
final push of the trimester a good one.
Catch ya later,
Dex