Wednesday, August 22, 2007

Welcome back, my ass!

The rough thing about attending a posh CME in a serene location is that one tends to forget the reality of everyday work life in the ghetto. In case you had forgotten, allow newFNP to refresh your memory: it sucks.

NewFNP is right back in the thick of it: leaving an hour late, attempting to correct the fact that she had seven patients scheduled in the three o'clock hour today and dodging bullets fired by the ever-critical and sorely lacking in introspection OB-GYN. Hey sister, when you point one finger at newFNP, there are four pointing at yourself, you ho-bag.

NewFNP returned from her conference ready to take on the world. Well, the world has dealt newFNP a real shit-storm. So much so that newFNP has begun to question whether she really is doing well for her patients.

The OB/GYN is quick to point out the cazillions of flaws she sees in the care that newFNP and the other prenatal providers have delivered, yet this provider sees an average of 10 patients per clinical day. She is not at all hesitant to allow other providers to see the remaining patients on her schedule as she delves into every detail of her patients' care. NewFNP truly makes every effort to address all pertinent aspects of medical care as well as engaging the patient about social issues, but newFNP has a 30-patient schedule and, therefore, misses things sometimes. Does this make newFNP a bad, incompetent or inadequate provider? Is the OB/GYN right in just giving a big "F-you" to the rest of us while she assesses for every fucking hangnail that may trigger preterm labor, birth anomalies and the omnipresent threat of legal action?

Another new physician pointed out that newFNP's clinic is "killing" our patients because we cannot start diabetic patients on insulin if their A1C's are over 8.5 or 9. The reason newFNP is unable to do so is that a very small number of patients can afford blood glucose monitoring supplies. The new provider didn't mean it as a judgment, but rather as a statement of fact. However, newFNP feels acutely aware that she is between the proverbial rock and hard place. NewFNP can either slowly kill them with the ravages of hyperglycemia or quickly kill them with the rapid action of hypoglycemia. Talk about choosing between the bat and the belt! What a fucked up world we live in. Perhaps there is a program that would supply all of newFNP's DM patients with testing supplies and syringes, but newFNP doesn't have even five minutes in her day to research this.

NewFNP is uncertain what to do. She is at her two-year anniversary at her clinic. NewFNP is community health and had planned on staying at this clinic indefinitely. But how in the fuck can newFNP put up with all of this?

On the positive side, everyone loves newFNP's new hair-do - even the fashionable gay guy so newFNP knows that she is looking hot! Watch out!


Anonymous said...

If it is any consolation, the patients at my clinic have PPO insurance, have monitors, have samples of the latest and greatest medications: Januvia, Exubria inhaled insulin and STILL won't take a mother fucking finger stick BS! Oh I'm sorry, they all say they take FSBS, 4 times a day even, they just fail to write it down to provide any actual proof to help me give them medication. You know what? Their Aic are 8,9, 10. So it's not just the ghetto...

Loving Pecola said...

I absolutely think that if you are really unhappy you should go elsewhere! We need providers in the "ghetto" but we don't want them if they they dont want to be there or if their work environment is too bad for them. I bet you're doing a great job with your patients, especially given limited resources, but you also have to do what's best for your sanity.

Laurie Anderson, RNP said...

Hi, my (fedrally qualified health care equivalent) clinic has little $ either. We got Bayer to donate meters and we got some grant $ to pay for strips. We don't get blood sugars 4 times a day either; no one does. On a good day I "negotiate" for 2 finger stick glucoses a day, starting with fasting and 2 hours after lunch or dinner (I get them to chose one or the other). After a week or two, I get them to switch fasting and 1 hour before their evening meal. This is followed by fasting and HS. I always get fastings because the rule is "fix the fasting first."

You should give a little more thought to this. You are not, not going to kill someone with a little insulin, especially once a day Lantus in the background.

I would be glad to talk to you some more about this off the blog if you'd like. Diabetes is an area of speciality practice for me. Just email me at

Laurie Anderson, Director of Wellness Serivces,

BostonFNP said...

Everyone has an opinion... and your rotton OB/GYN is allowed to have hers. It does not make it feel better, however, when she is railing all over you. BostonFNP has the joy of knowing NewFNP well enough to know that the thought of not doing everything possible for your patients is what keeps you up at night. Rest assured that on the other side of the country, in a neighborhood both strikingly similiar and dissimiliar to yours, I am also struggling with cranky collegues, time limits, "non-adherant" patients and money restraints. The real question is, if not us, who? Lord knows, the good ole' MDs aren't pitching in many internal med specialists these days. Keep up the good work, sister, and hang in there.

Anonymous said...

I miss you and your witty posts. hope everything is okay after your vacation.

Anonymous said...

work environment is too bad for them. cialis nz I bet you're doing a great job with your patients, especially given limited resources, but you also have to do what's best for your sanity.