job search

As a combined I don't think its ever too early to start looking for a job.  With a unique skill set like ours jobs need to be tailored for what we do and what we want to do.  So far it has been an exciting journey.

I visited a clinic witha primary care doc to get a feel for what the outpatient is like.  And I think because my home clinic is so resource poor, and we don't have radiology, rapid flu, an ultrasound, and occasionally (ok a lot) the pipes are old and the smell of sewer permeates the halls ---- That this clinic looked AMAZING!  All new stuff, clean, fresh etc.  And this was a FQHC site.  The diveristy of patients was pretty cool, compared to my site.  In a half day we saw - filpino, indian, vietnamese, Latino, and White to name a few.

The funniest encounter was between a couple of Nicarguan descent.  He, a skinny middle aged man, and she a overweight, well dressed, domineering woman.  He hadn't been seen for three years.  He began to tell the Doc that he was having urinary incontinence, especially when he went for long drives.  And as if this was not hard enough his wife butt in and said - "Oh no, its not long drives its 15 minute drives and he's wetting his pants."  Then later the doc asked him how much he drinks, and he said, "oh maybe 12 beers on the weekend."  And right away the wife butt in and said, "Oh no, he drinks a 62 oz, so its more like 24 beers!"  She also went on to report that her husband was also having erectile dysfunction and memory problems.  The longer th visit went on the more the man sank sheepishly deeper into his thin plastic chair, and pushed himself further and further into the wall.  Ultimatly, all this poor man got was a shaming, and a two finger rectal exam  I can see why he waited so long to return to the doctor.  And clearly no one was safe, as the doc took the man behind the curtain to do the prostate exam the wife cornered me - asking my age, if i was married, kids?, how long is medica school and so forth.

At one of the homelses clinics I shadowed at I arrved at 830, before the appt window opened.  I approached the window and found it closed.  Several men and one woman were sitting in the lobby, clearly waiting for many hours at this point.  A man with a feather in his hat said," They don't open until 830."  And then informed me that he line was structured based on when you arrived at the clinic.  The man in front could not stop talking.  He ranted on and on to the point that the man he had initially started talking to was looking around the room as if it to say - please someone takeover this conversation.  and of course this was the patient who didnt believe he ws bipolar, didnt want to take meds, and who felt there was a conspiracy surrounding his home, of which hed been homeless for three years.  i think all in all i did a god job representing myself.   I remain optimistic abt my future job options and the endless possibilities and combinations of practice types.

ENT and psych

Got to shadow an ENT pediatric clinic today. It's amazing how psychiatry rears its head everywhere I go. Although I was shadowing the attending I also served as her translator for the many Spanish-speaking patients she saw her day. One particular Latino family stood out. There was a young man who came in with his mom to be evaluated for persistent throat pain and problems with swallowing.   The attending asked him some review of systems questions and it seems like everything she asked was positive.  "do you have any chest pain?" "Yes."  "do you get headaches?"  "Yes." And on and on.  After she had done a laryngoscopy and told him that everything was normal he finally piped up and says, "do you think it's okay to take a pill for stress?   I think I'm really stressed."  At the same time before the attending could answer mom says in Spanish do you think that trauma might have anything to do with this? With tears in her eyes she revealed that that prior April her husband this young man's father had died trying to cross the desert in Arizona back to United States.  When the police came initially to their home they handcuffed him and took him away to deport him back to Mexico and the young man never got a chance just talk to him or say anything to him.  The attending and I were speechless.  When we had first come out of the room the first time the attending said this guy is depressed.  We could never have guessed what trauma lyed below the surface of what this young man was able to communicate to us about how he felt.  It's unfortunate that this was revealed the ENT office where all she could do was reassure him that he was okay reiterate to him that potentially this stress and trauma was causing him harm by giving him stomachache and throat pain and headaches and possibly even chest pain.  The attending referred them to a counselor and make sure to send a letter to his primary care physician. I offered mom a Kleenex and we moved onto the next patient.

I am beginning to realize that primary care really is the intersection of psychiatry mental health and our physical well-being.  I'd like to think that for the most part most primary care physicians when they have a relationship with their patients are able to pick up on these cross sections intersections. But I also realize that as primary care physicians we have so little time with each patient and are not always able to pick up on these cues.   I worry that even with my dual training sometimes I won't be able to pick on up on these cues.  Because there's so little time.