Friday, September 02, 2005

A case and more

After 4 days of work, newFNP is flat out exhausted. Is it 4 days of waking up at 6AM? It is 4 days of thinking in Spanish? Perhaps 4 days of a pace to which newFNP is utterly unaccustomed? Let's chalk it up to a combination of the three. To say that newFNP spent her first day off energized and ready to take on more would be a big fat lie. To say that it is a miracle that she went to the gym, cleaned her bathroom and have started to conquer her laundry is not hyperbole. She's ready for another nap.

So newFNP saw a woman yesterday with a history of mild RUQ tenderness and slight AST/ALT elevation. She is obese and the provider before newFNP was unable to palpate her liver. Ditto for me. The previous provider ordered an acute hepatitis profile - negative for A,B, & C. No statins, tylenol or alcohol. No history of gallbladder ("vesicula") disease in the family. What does one so when your differentials are exhausted (to speak nothing of your own energy level)? Well, if you are new FNP, you ask the MD and she says, "Is she fat?"


"Hypertriglyceridemia. Tell her that this is as serious as hepatitis and she must change her diet. Check her lipids."

OK! Done.

But this brings newFNP to another point. Every fat patient she sees - and these patients are unfortunately not infrequent - reports a very healthful diet, rich in fruits and vegetables with rare intake of fatty, high-calorie foods. Do they eat ice cream? They say no. Sure, they have uncontrolled Type 2 diabetes, but according to their diet recall, they should all be lollipops. Now, newFNP is not one to throw stones, but come on. What is in these vegetables that makes all of her patients fat? Are they fat-enriched vegetables? That is a genetically modified food newFNP has not yet heard of. Are they cooking their foods in lard, oil, butter? They say no. NewFNP calls bullshit, but that is not a therapeutic tool she wants to bring into the clinical encounter.

NewFNP knows what she should do. Have them write down everything they are eating for three days and bring that back to me. Give them a list of culturally competent healthful choices. She has done neither. Shame on newFNP. It's on her to do list to remember every frigging thing she should do, but you have to crawl before you can walk. She's scooting.

If you are in school and will be working in a clinic in which you see pediatrics, learn the vaccination schedule. NewFNP bitched so much about learning it when there is a chart in every clinic listing them. It's true, her clinic has a chart, but you need to have a working knowledge of it. NewFNP almost let a kid leave yesterday without his 11-year old Td. Ugh! She's not an idiot, but she is an overwhelmed new provider. And he was my last patient of the day.

OK, she's an idiot. But she won't be the next time.

1 comment:

autoninja said...

Hey -- I knew you would be busy but I had no idea the job would be nearly overwhelming. But you're one of the brightest and most dedicated people I know, so you and I both know that you're going to get on top of this and soon be the veteran that everyone else is coming to for answers. It's the truth.