Sunday, December 02, 2007

Yeah, you're in the right place.

NewFNP recently had a conversation with a good pal from grad school, BostonCNM (not to be confused with although currently and temporarily co-habitating with BostonFNP). BostonCNM has recently changed practice sites from a cushy suburban practice with an educated clientele committed to a midwife assisted birth to a ridiculously busy community health center in a wrong-side-of-the-tracks area of Boston.

There is something deeply validating about sharing the experience of working in a completely fucking disorganized setting, yet loving the work that you do -- and bitching about it with one of your BFFs.

It started newFNP thinking about how one might truly know that they are working in urban community health. What are the requisite community health bona fides? NewFNP will share them with you.

1) In general, your patients will not speak your primary language. Their language might have no written form or may consist of clicks, thus making them impenetrable to an otherwise educated and teachable person. You may perhaps speak the language, but that would mean that you or your parents had acumen which started you off on the Spanish language path at an early age. NewFNP's mom had that insight. Sadly, newFNP was both intransigent and snobby and insisted, at the age of eleven, that she would speak French. While this proved quite helpful during her Tahitian vacation at the age of seventeen, it has proven itself much less so in the years since.

2) You will run out of crucial supplies. These may include but are by absolutely no means limited to: specula; lead testing strips; table paper; otic thermometer probe covers; patient drapes/gowns; charts; and medications. Furthermore, you will discover that these supplies are missing at inopportune moments, such as when your patient is in the lithotomy position, covered with paper towels and with two serving spoons fashioned into a speculum by the ingenious placement of folded cardboard and a rubber band in lieu of the real deal.

3) You will care for patients who have absolutely no idea how to care for their health. You will feel astounded at this. This feeling will not go away.

4) Your patient no-show rate will be in the 50-70th percentile. Therefore, your front desk staff will bring in tons of walk-ins. And then, one day, your no-show rate will be 10% but they will still let in the walk-ins. On those days, you will be fucked.

5) You will work with people who frustrate you and who could, at times when one is feeling less than generous, be considered incompetent. NewFNP has noted this before, but believes that because it is so intrinsically linked to community health practice, it is worth noting anew. See Office Staff Rant for a more thorough investigation of this phenomenon.

6) You and your co-workers will have more than one job. Medical assistants double as referral coordinators. Admin assistants place the orders. Providers do everything. NewFNP makes copies, fills out a trillion forms, writes letters and fields phone calls from senior management asking about this or that. This does not lead to efficiency, nor does it lead to satisfactorily completed tasks. Moreover, it may contribute to job dissatisfaction.

7) You will have crazy stories to share with your pals who work in law or fashion or business. You will frequently hear phrases such as "No fucking way" or "What the fuck?!" or "Jesus, how long do you have to stay there?" when you recount these stories.

8) In the end, goddammit, the goods will outweigh the bads and you will feel good about your work at the end of the day. But not so much in the morning when you see the line snaked around the block as you walk into another day of 10-15 minute appointments.


Karern said...

I have enjoyed reading this blog since I came upon it a few weeks ago just as I was about to begin my practice. I LOL as the situations are familiar. I have expereince as an RN in a community clinic, NP practicum in health care for homeless, worked in a prison, and my current practice, although private clinic, is a new endeavor to serve Spanish-speaking patients. We are all bilingual here. I collaborate with one MD. We have plenty of English-speaking as well as a few other languages represented in our patient population. A large number are MA or Medicaid and some self-pay.

npsusan said...

You are hysterical and often voice my unspoken thoughts! I work in a high school based health center as a PNP. I loved the "covered with paper towels" thing. I had a fellow NP who told the patient to slide down to the end of the table, and upon doing that the NP opened the drawer to get a speculum but was encountered with two live mice in the drawer! How about the boy who walks in for a sports physical with his football uniform on and the rest of the team is waiting for him in the bus to go to the game!!!

npsusan said...
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BostonFNP said...
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