Tuesday, April 28, 2009

Saying Sorry

So, I blew it.

It wasn't the first time, and it certainly won't be the last.

I was in clinic last week, and I greeted my patient who had been waiting about an hour. I could tell he was upset. I would certainly be upset if I waited an hour. Sadly, I can only move as quickly as there are attendings available to hear the case. No attending = I wait to present the case = I get backed up = my patients wait. It's the nature of the beast that is a training program.

Turns out he was a bit peeved at the wait. However, he was mostly upset that I had forgotten to order his labs to be drawn 2 weeks prior to the visit. With HIV patients, you bring them in every 3-6 months to look at their CD4 counts and viral loads. No labs? Nothing to talk about and nothing to do. A waste of a visit.

I could've gotten defensive: why didn't he call in and tell me when he went to the lab 2 weeks ago, so I could've ordered them on the spot? Why didn't he just call that day and change his appointment so we could get his labs done? There were a few ways we could've salvaged things if he had been proactive.

However, the blame was mine: I forgot to order them. I took a deep breath and just said sorry. I told him that he was right, that I had forgotten, that I had wasted his time, and that I was sorry. Contrary to the Movie-of-the-Week, this did not end in hugs and rainbows. He was pissed and left unhappy. But, I heard him and acknowledged the hardship I had caused. He looked a little relieved, which is nice, but ultimately he was going to be upset with me. And that's ok.

Not everything turns out peachy, and I am not a perfect doctor (or person for that matter!). I can only show my patients the respect they deserve by confessing my mistakes and apologizing for them. Hopefully, when he comes back in 3 months, we can have a better doctor-patient relationship because of it. But, if he never wants to see me again, at least I was honest with him. That's the best I could do.

Wednesday, April 15, 2009

Back to Work

So, I've had a light clinic month for the last 2 weeks. No complaints from me! I needed a break after a hellish 2 weeks on the consult service at the VA. I can't talk about, I'll get too angry.

So, in clinic today, I had a patient with PTSD -- Post Traumatic Stress Disorder. He came in to the ID clinic for fungus on his toe nails. What he really wanted to talk about was the horrors of Vietnam. I wish I had more time to dedicate to that for him. As it stood, I did the best I could with my limited amount of time.

He kept coming back to one main theme. He said he was born a Mormon. He studied and went on his mission trip. He then went into the Marines (enlisted or drafted, I'm not sure) and went to Vietnam. He went TWICE. Two tours in the violence and horror that was the Vietnam jungle. He looked at me and said, "I killed 6 people in my first 2 days there. 'Thou shall not kill.' How do you deal with that??" Of course, I had no answer.

He proceeded to tell me that when he came home after his first tour [aside: why do they call it tour, like it's a fun romp around the world?], he was talking with his family. "They were all 'Peace' and 'Love' and 'Jane Fonda.' They didn't want to hear about it. They wouldn't let me talk about it." He was so conflicted about his religious upbringing and the acts he witnessed and committed. He was crying out for help, for someone in his family or community to listen to him and let him purge his nightmares. He got nothing.

No matter how you feel about the Vietnam War, our involvement in it, etc, you can't punish those men that were sent to fight. They were doing a job and often just trying to save their own skins in the ordeal. America really treated those vets poorly when they returned. Thankfully, my patient has a group for therapy that he enjoys. Sadly, he says he lost his first two wives because of Vietnam -- they couldn't take his emotional lability, his voluntary admissions to the psych ward, or his leaving for hours / days at a time. He gets these flashback and then wakes up under some tree, not knowing where he was or how he got there.

I can't say he'd be different if someone would've let him unload back in 1970-something when he returned the first time. I can't say that his PTSD wouldn't be as bad if someone would've given him a shoulder 30+ years ago. I can say that he turned his back on his religion and his God for many years because of that moment. Fortunately, he has found his way back, and he said that getting back to church was one of the best things for him. It's just sad that he was pushed out in the first place.

Monday, April 6, 2009

Where do we go from here?

Ever hear that song by David Essex - "Rock On"? You can see a YouTube video here. There's a line where he says, "Where do we go from here..."

That's how I'm feeling these days.

I'm near the point in my fellowship where I have to decide what I want to do when I'm done. This doesn't sound hard -- I've been training to be an Infectious Diseases specialist...so, duh, go and be an ID doc! It's not that easy.

There's outpatient HIV work. There's hospital consulting. There's any combination of those two. There's joining a group, starting your own group or (for those who love risk) starting your own solo practice. There's research - many, many different types. There's staying LA (which is a pretty saturated market) or looking out in the 'burbs.

Here's the kicker: I don't know what I want.

I know what I don't want. I don't want to be bored. I don't want to work 28 days a month. I don't want the pressure of starting my own group. I enjoy research and teaching. I am fascinated by HIV and Hep C. I love international HIV work.

Ideally, I want a job where I can do frequent over-seas trips to either do research or direct patient care, possibly some teaching of residents or med students there. I want to do HIV work with some HCV work here. Teach and supervise residents/fellows here. So, I think I need to stay in academics. In order to try and get a job in that competitive world, I think I'm going to need to do a 3rd year of fellowship. This pains me mostly because of the salary. I'll have to moonlight still to make enough to pay off the house and such. But, it's just one more year in the grand scheme of life.

So, I've got some meetings coming up to see where that 3rd year will be and how it will be structured. So many questions still.