Friday, May 13, 2005

Still Having a Life

I took today (Friday the 13th) off to drive north to San Francisco with my family because my middle daughter is taking part in a "bridging" ceremony for Girl Scouts. She and her troop, along with 4000 other girls, will be walking across the Golden Gate Bridge tomorrow to mark their transition from Juniors to Cadets. It was a chance to take a short vacation in a wonderful city.


I hoped there wouldn't be as much demand today for my services as there was yesterday, when I saw 6 patients in the office. Being a solo physician, I have basically been on call 24 hours a day since I started my practice about a year ago. Except for a one week vacation to Canada last summer, I haven't been away for longer than a weekend. If anyone needs to see a doctor when I am not available, I have an arrangement with a fellow solo family physician who has agreed to see my patients if I go out of town. But so far, no one ever has had to yet. And fortunately, either because my patients are healthier or I just don't have that many patients, I rarely get called in the evenings or on weekends.

This morning while stopping for breakfast along Interstate 5, I received a call from a mother who was hoping I could check her son, who has had a URI for the past 5 days, to see if he had strep throat. I explained that I was out of town but reassured her that strep throat was unlikely since he was coughing and to continue using Robitussin DM. She was satisfied with this and even admitted that she figured that I would just diagnose a cold anyways if I had been able to see her son today.

An hour later, while filling up the gas tank near Panoche Junction, I reassured a patient who was worried because she continued to have dizziness and headache from her sinus infection despite starting antibiotics yesterday. I reassured her that it would probably take a few days for the antibiotics to "kick in". She was grateful when I suggested she could take Tylenol or Advil in the meantime for relief.

Upon arriving into San Francisco, I checked my answering machine and listened to a message from a mother who said her toddler-aged son suddenly broke out in a red itchy rash after swimming today. I left a message advising that she give him some Benadryl. Hours later she called me back to tell me that she figured out that he was on the tail end of a course of Amoxicillin and that his sister had had the exact same kind of reaction to Amoxicillin, too. His rash cleared up instantly with Benadryl, and she was appreciative that I had called to find out how he was doing.

While I was leaving the Borders bookstore in Union Square, a patient called to let me know that she had spoken to her psychiatrist because her antidepressants wasn't working very well so far and that he adjusted her dose. I thanked her for keeping me informed and for being conscientious in taking her medicines daily, since up until now, she had never been willing to be compliant with her medications.

The one person I wasn't able to help was someone who would've been a new patient. In his staticky phone message, he said he had a bad sore throat, which may have explained why I wasn't able to hear his callback phone number clearly. After several attempts at a few different number combinations, I had to give up. Finally, I cleverly called the person who he said had referred me to him and managed to reach his father who told me that his son had gone to the local urgent care to get treatment, which was probably the best thing he could've done.

In between all this, I managed to drive a lot, enjoy 3 meals with my family, check into our hotel room, get a new Hello Kitty necktie and buy a lot of books.

Coincidentally, today another solo physican wrote about her current vacation on the Practice Improvement Listserve, so I thought I'd share another perspective on vacationing while living "la vida solo":

Greetings to all you hardworking Family Docs from the sunny waves of Key West:

I am just finishing up my first week of vacation in a little over a year, and I want to:
A) Thank all of you (especially Gordon for pointing out this path) for all the advice and suggestions that have added up to making this trip possible; and
B) Confirm that it *is* possible to practice solo and still have a life.

I am by no means making anywhere near the income that I expected when I went into medicine, but taking this week off is not going to break me, especially because I am not paying for staff to run an office that I am not in. By using the technology that I have been putting in place over the past 2 1/2 years, I am able to be here, enjoying myself 23 hours of the day, and have been able to respond to patient needs that can't wait the other hour each day (right before Happy Hour!)

I have been able to record a message on the office phone that says 'I'm away but if you need me I'll call you back'; it also gives the name of another solo doc in town who will see them if it really can't wait-but no one has used that option; I check the messages, and also the faxes, and return all the calls; I schedule appointments for after I get back, and I phone or fax short term refills for the folks who already ran out of their meds, or will before I get back.

I have prevented three ER visits by reassuring anxious people that the symptoms they describe do not sound life threatening (like the guy who had a radical prostatectomy last week, then got readmitted for pneumonia, but called me because he can't sleep and thought Levaquin was causing insomnia--he thought maybe he needed to go the ER to get the levaquin changed to something else. After talking a few minutes about the stess of a life threatening cancer diagnosis, a major surgery, a complication of hospital acquired wonder he's feeling scared and having trouble sleeping! He's going to try a few behavioral modifications and a little Tylenol pm and call me again if things worsen.)

I have fielded about 6 calls and 8 faxes each day, and have had to spend $8/hr for highspeed access. Of course the services I am providing will not generate any income, but that's the trade off. If I were home, I would require an office visit for refills or acute problems. Patients can't very well just run down here to see me, so I have provided "telecare" that I would not ordinarily do. Everyone has been extremely pleased that I called them from my vacation, and all have limited the length of calls and number of issues they wanted to address. It seems like a reasonable compromise for now, but someday I hope to make those services pay a little.

Anyway, I am here and grateful for the chance to relax. I wish the same for all of you! Thanks again.

Lexington, KY (but Key West at the moment)
Solo 2 1/2 years, Nurseless 18 months
emr = Healthmatics from A4

I, too, wish for a chance to relax for all physicians, both solo and non-solo. And Happy U.N. International Day of Families to everyone!