Wednesday, March 24, 2010

First time here?

In the shadow of historic health care reform's bill signing, newFNP gently knocked on a patient's door prior to doing her physical exam.

NewFNP does not room her own patients, but she has instructed her MAs to have the patient completely undress, don the paper gown open in front for ease of breast examination and place the paper drape over the lap for maximum modesty protection.

Rarely does the patient take this instruction, passed along by newFNP's MA, to heart.

Most often, the gown is open in the back. No big whoop - newFNP just opens the gown in the front for the breast exam. Sometimes, the patient will undress from the waist down only. Gentlemen will often keep their underpants on while otherwise undressed.

But for the first time, newFNP opened the door to see a 38-year old woman stark naked sitting on the exam table, folded gown and drape sitting untouched beside her. NewFNP reminded her as to how to utilize the paper goods and exited the room.

In what universe do we just hang out nude in the exam room? NewFNP knows that this woman has been introduced to Western medical practice because it was not her first time at newFNP's clinic. So what gives? Are there places in which patients are examined in the buff?

It's also shockingly common for newFNP to enter the exam room for a well woman exam and see the patient supine on the exam table, as though newFNP wasn't going to talk to her at all prior to assessing for cervical motion tenderness or discharge. It's not a stretch for newFNP to imagine that in other countries, where paternalism is a more welcome value in medicine or where there is a large uneducated, illiterate population, providers really do just do the exam and move on.

But newFNP really would like to have some type of therapeutic partnership with her patients and would hope that she could give them some health tools to take home. Therefore, it's pretty helpful for newFNP to chat them up while A) clothed, albeit in paper and B) in a seated position rather than in the relatively powerless supine or lithotomy positions!

Thursday, March 18, 2010

Honesty - the best policy?

NewFNP had a bullcrap day at clinic. Sometimes that happens - no big whoop.

But then sometimes a patient says something that just sends newFNP into a personal tailspin.

NewFNP has cared for this patient for years. She's anxious and depressed, but kind. She's very thin and forever trying to gain weight. NewFNP, on the other hand, has the metabolism of a stoned hypothyroid tree sloth. Thus, the only amount of exercise and diet that allows her to be truly thin is an amount unattainable when working full time, visiting her elderly grandma, walking her dog, shopping and doing all the other activities that make newFNP newFNP. And because newFNP is a thirty-something year old white girl who has been conscious of her weight since the days of Seventeen magazine and Forenza, her issue with her weight is both omnipresent and frustrating.

So when her well-meaning patient told newFNP that she was "mas gordita," newFNP wanted to cry in the room. She felt as though she had been punched in her doughy lady belly.

NewFNP supposes that perhaps it's good that her patients feel so comfy cozy with her as to comment on her habitus. But damn if it doesn't feel badly to have her major issue voiced in an exam room. It feels more than badly - it pretty much ruined her GD day. Maybe newFNP should go on Kirstie Alley's TV show with her, sans the Scientology of course.

For crap's sake, her own PMD didn't even call newFNP chubby.


Tuesday, March 02, 2010

Stirrup fail

It is preferable that when new patients come to the clinic, newFNP is (A) on time, (B) fashionable and (C) attentive. Thanks to her super cute new not-even-on-the-website-yet JCrew top, she was quite fashionable. Thanks to her caring nature, she was attentive. On time, however, remains an elusive trait for newFNP in her professional life -- ironic in that newFNP is pathologically early in every other aspect of her life.

So, all in all, two outta three. NewFNP will take it.

The appointment was moving along as smoothly as a newly threaded brow when newFNP attempted to extract the stirrup from its in the table hiding place. The stirrup gave newFNP a little resistance. Not to be deterred, newFNP gave it a little tug. Nothing. Determined to get the best of the stirrup, newFNP pulled at it with a little force.

And that is when the entire fucking stirrup came out of the table and into newFNP's hand. Imagine her surprise! She felt somewhat like the Statue of Liberty carrying her torch as she walked around the clinic, folded stirrup in hand, attempting to find her MA both to share with her the craziness of our clinic environment and to have her help newFNP replace the errant stirrup. Give newFNP your tired, your poor, huddled masses yearning to breathe free -- and to have their pap tests with intact examination tables.

NewFNP not so gently maneuvered the stirrup back into place and with the snap of broken plastic, shifted the stirrup, and subsequently the patient, into position and continued on with the exam.

Bienvenidos a nuestra clinica de la comunidad!, newFNP told her patient, who was kind enough to laugh.