Disappointment and Resignation

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. 

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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. 

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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