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Tuesday, April 1, 2008 12:54 p.m. Ah. I haven't blogged in such a long time. Life is going on as per usual. I'm not so glum today as I was the last entry, mostly because I'm on vacation in Korea. With coanteen... who seems to be diligently blogging on regular basis. But then, I could argue that her life is much more interesting than mine. I can't believe it was December the last time I blogged. And whining about working five days a week, albeit with stressful patients. The situation devolved into working seven days a week, some of which were with inpatients at the hospital. Empyema and end stage COPD! Here I come!! Every year, the patients seems to get older and sicker and more complicated. I suppose it's the aging baby boomers. Sometimes, I wonder how one person can accumulate quite so many illnesses. To accumulate bad COPD. And survive the first heart attack. And then the second one. And then he first stroke. And then the second one. And survive the first cancer. And then also have other ongoing chronic things like glaucoma, peripheralvacular disease, moderate renal failre, high bloo pressure, high cholesterol, anxiety, depression, obesity, arthritis, sleep apnea, constipation, etc. They're what we sometimes call the "internal med deluxe" patients. They're the 65 year old morbidly obese and sedentary smokers who want a quick fix magic cure and still eat their medium pizza for lunch and go out for a smoke and never have to exercise (for their arthritic knees hurt). They're on twenty different medications and their medical history reads like a novel. They're resentful that they're on these meds...but unfortunately, stopping a blood pressure puts their SBP's into 200's and stopping cholesterol meds puts their lipids sky high. One time, I worked in a clinic that did drawing/spinning of blood samples themselves... and we spun a blood sample of one of these patients and there was a thick layer of what looked like whipped butter at the top of the vial at the end of spinning. -_-;;; About 5 times as thick as it would have been for most people. Guh. I guess the problem is that these people used to be fewer and further in between... mixed with mostly really old people who were sick because they were really old and frail but not necessarily complicated. But now the patients are more and more complicated..and... Sigh... I don't really know how long I can keep doing these hospital services. They're really really stressful. But enough about stressful work. Now it's all finished for the time being and I'm on vacation. Yay~~!!!! Eating lots of yummy foods. ^_____^ Refer to coanteen's blog for more details on the foods. But today's soup of coagulated blood was quite interesting. And quite yummy. ^^;;;;;;; Currently at an internet cafe, blogging and checking email. Worrying a little bit about the income tax I have to pay at the end of this month. This would be my first full year with full income. It's a bit stressful as I haven't paid any of it along the way.... Wanna go drinking. but it's only 1 in the afternoon. Is that too early? I feel like I've been up walking around forever.... which I guess is true considering we were up at 6 am. =_= Must get over this horrendous jetlag... I always ramble on too much with these blogs. And whine too much about work.... There was a time when I tried to write regular, nice, concise journals. Oh, well... I suppose it just reflects that my mind is more cluttered and whiny nowadays.. Wednesday, December 12, 2007 11:35 p.m. Um.. Coanteen's not deploying to Afghanistan yet. That is good. We get another Christmas together...and hopefully partying in Asian in the spring. ^^;;;; If she survives the winter in Nunuvut, that is...-_-;;; Have been working almost 5 days a week. What the hell was I thinking? And do people just go..more...mental during the holidays? Do I have a sign on my forehead saying, "Yes! I'm nice! Tell me all your worldly woes for the past 10 years!"???????? Did drop in today. About 60% of patients were about depression, both new and old and ongoing... I try to be sympathetic..but when patient starts talking about his girlfriend's long dead parents' psych issues...as a reason why he's depressed... I really didn't want to hear all that. I can diagnose and treat depression without hearing all that. I don't need details of 20 reasons that may remotely be a cause of your depression.. Usually, I treat my depressed/anxious patients pretty well. There's a number at the clinic that I think I've treated well with meds/encouragements/counselling, etc.. enough that they came back and said that I made a big difference.. And usually, people are depressed because of legit reasons or accept that it's a chemical imbalance..and that it often runs in the family. But today, it just felt like everyone just wanted to whine~~. I think it's the holiday season. Everyone feels that they're somehow ENTITLED to happiness ALL THE FUCKING TIME during the holiday season. Why, oh why... Why do you have to come in with depression that you've ignored for the past 2 years to whine to a drop in doctor, when you could have made an appointment with your OWN doctor if you'd been willing to book 1-2 weeks ahead of time? Frustrated. Today was a bad day. And then I had some rude patients.. Was so close to just firing them. And then I had one that didn't want to pay no show fees..and pretty much came out and said that she thinks it shouldn't matter if she no shows because I still have other patients to see that day... so I'm still making money. Of course, she no showed for a physical.. wasting my time.. and using up opportunities for other people who really need the care. So annoyed!!!!! Eh.. There are mice in the house. We've caught 5 so far. And have lost 2 in transfer. We're dumb.. Usually, we put them in cardboard boxes with plastic bag insulations and chocolate covered almonds and cereal..and put them in big dumpster and wish them luck. Tired... Thursday, October 11, 2007 06:18 p.m. =_= Truly only working 3 days a week for these next few weeks. Can I get any lazier? I am such a pushover. I hate my pushover-ness. I don't think I can get anyyyy worse.... Helped resident study for her practical exam. This is the same resident that stood me up the last time. I go on my day off to help her and she didn't show... So naturally, I should have never helped her ever again. But I did. And... she is quite bad at the practicals. I dunno how she'll do. The exam's only 2 weeks away. In addition, the wife of a resident that I had taken on as a patient.. just because she's had some rough time with her health and he practically begged... has missed 2 appointments. One of which was a full physical. Do these resident not respect me or something? I'm still staff. I don't think they're allowed to walk all over me like this... I was reluctant to take her on..but made a lot of leeway for her so she can be seen before her investigations and stuff... and this was when I wasn't accepting any patients formally either. Ah.. Really. I should just fire her. Really. Missing 2 out of 3 appointments booked is really not good. Not good for her health either too. Can't provide proper care like this... Anyway, the world seems a big ball of annoyance. But still getting by. Hubby is still cute. He wore this oversized raincoat today. So cute!! ^^ And planning to go to Korea in the spring. Yay~!!!! Sunday, September 16, 2007 06:58 p.m. Mmmm... have been reminded by Nahmool that I don't blog often enough. And truthfully, I've been quite neglectful. It was good to hear from her again... I think it's been years since we kept in touch. Lots of things happened. Like the "fucking hell" entry a few months ago where a unit director assumed I didn't know what I was doing just because I'm a young female doctor...and was completely inappropriate in caring for a patient which my resident had to scramble to set up support services for... And then he had the gall to lecture the whole team of residents/nurses/social worker..and me, I guess (although I wasn't there when he did this) that we were ethically inferior. The gall of him. Have put in a formal complaint on him. And then the hospital also "mistakenly" did not update my contract with the new policy, didn't tell me that there was a new policy..and thus underpaid me by about 20 000... and wasn't going to tell me anything about it until I found out from my co-worker that I had been horribly underpaid. x_x Work annoys me to no end. But at least, I complain and hopefully, eventually, it gets sorted out. Honestly, not really all that stressed. Although annoyance runs abound. My renal failure patient is doing much better. Cr down to 200. My cancer patients not doing quite so well. I gues it's to be expected that if you're a primary physician for at least 500 patients, that a few will die of cancer every year. One's already died.. Bowel perforation from cancer turned into abcess which perfed massivly into the abdo. Non surgical candidate. Another's not doing well.. Another's probably got cancer but doesn't want anything done to confirm as he's 90 and don't want treatment. Another's got cancer, diagnosed quite late because she kept telling me "I don't want a scope no matter what" and cancelling her appointments. In the end, she did see a specialist, even if to just discuss a scope..and decided she'll do the scope after all.. and lo and behold, did have cancer, almost completely blocking her trachea. Will likely require tracheotomy. I wonder how many of those patients who I send to specialists or say "you may have cancer but it's still low likelyhood.. please comeback if this treatment doesn't work in two weeks" actually never go to their appointments and never show for follow up. Free health care has the drawback of everyone thinking that they have absolutely no responsibility in following up with their own health. Which is still not true. They still need to come back for follow up when they were told...to get optimal care. Enough about work though. Mmm... reading comicbooks by Kangfull. Watching One Piece anime. Watching "Coffee Prince" korean soap operas... Have ordered "super rookie" dvd's too. Listening to Eru songs right now... Why is it I can't seem to enjoy American pop culture/TV even though I've lived in Canada for 19 years? Wow. 19 years. Ah. I feel old. Coanteen's in the middle of nowhere again. I wonder if I can send her anything... Wednesday, July 18, 2007 08:22 p.m. Ugh. It's stressful again. Patient suddenly going into renal failure, creatinine shooting from 130 to 279 in a couple of months. Why???~!!!!!! He's like "but I feel fine." He might be feeling fine, but I feel like I'm having a heart attack watching his labworks. Tuesday, March 27, 2007 05:36 p.m. fucking hell. Wednesday, February 21, 2007 05:49 p.m. The sarcastic email worked and now I have the hospital service back. Also found out that I was supposed to be paid fee for service for all inpatient work.... which means that they have not paid me for some stuff from previous calls that I could have been paid for.. -_-;; Trying to get money back. All in all, this will probably mean that I'll make about 17000 dollars for those two weeks. It's a lot of call and weekend work and a lot of responsibilities to the extent I don't think I'd be able to do this kind of thing more than a couple of times a year... but it's still good. And no overhead. My god, the overhead kills me. Doing evening clinic right now. Some people haven't shown up which is annoying as hell. But it means I did all my paperwork and I'll be out of here when my shift ends without having to stay longer... Working much too much... and other than the hospital work, the pay is actually quite crappy. -_- Monday, January 29, 2007 06:55 p.m. Sent a slightly nasty and slightly sarcastic letter to the scheduling people and the unit director and the program director. Don't know how professional that was...but was kinda frustrated. Monday, January 29, 2007 06:18 p.m. Hospital Politics... Am ready to hit my unit director over the head. The scheduling lady asked if I can do hospital service in March. Since I only see urgent care and don't have appointments booked more than a week ahead of time, I assumed it was fine.. especially since I only need morning off to do hospital service. So I said Ok.. And I talked to the department director.. and the department secretary.. and the doctor who deals with hospital privileges at our clinic. The unit director emailed out today saying they can't let me do clinic because a lot of people are on vacation.. and the scheduler's like, "oh, i thought it was *her* responsibility to clear with you!" Now.. this is the first hospital service that they asked me to do. Did anyone tell me I was supposed to get his permission? NO!!!! They told me to talk to this person and that person..and I talked to like four or five people as they told me!!! But nobody told me to talk to the unit director! And *why* do I need to talk to the unit director to take the morning off for two weeks? I don't talk to him for permission for vacations! Or CME days! And why is the scheduling lady telling me to do hospital service when I'm not supposed to do it? Urgh. This unit director's weird. He never does any work. Whenever he's around and I'm around, he'll try to give all his patients to me or the resident so that he could goof off in his office. He drives me crazy. Urgh. Tuesday, January 16, 2007 12:12 p.m. New lesson learned! Not that I didn't know this previously...but confirmed again! A doc at my office does a tv show where he takes phone calls from the viewers, etc. This lady came in saying she doesn't like her own family doctor but admires my colleague in my office very much because he's the most compassionate person ever!!! Apparantly, her own GP hasn't helped her enough with her arthritis pain and she had called in to my colleague's program and he's told her that she shouldn't have to live with so much pain. Of course, patients are not always completely honest. And such was the case. She is in her 80's, has bipolar disorder, is on numerous psychiatric medication... and her won GP has tried different NSAIDS as well as full dose of Tylenol.. and even offered tiny doses of morphine which is probably one of the cleaner narcotics...and the patient didn't take them. Now, did she disclose that she's on multiple psych meds that can interact when she phoned in? NO!!!! Did she say her family doc already tried all the meds that were likely to help without giving her problems? NO!!!! Frankly, I don't think there's much more that can be done.... I think her own GP did all that could be done...and if my colleague thought there was more that could be done, it's only because she wasn't honest when she talked to him about her own history. Frustrates me to hell. So I nice and politely told her that I think her own GP did all that was within reasonable risks... and I probably won't be able to help all that much more. Ugh. You should never badmouth another doctor just from what patients say... (not that I was doing that anyway). Usually (and this happens a lot when I talk to friends who talk about their so-and-so relative who didn't get whatever treatment because of blah blah)... the full story doesn't come out... and often if you dig deeper, the doc has done the right things and followed guidelines. It can't be helped that some people are unlucky enough to have so much wrong with them that it can't all be treated optimally. Monday, December 25, 2006 12:55 a.m. Christmas parties. Obligate Christmas parties as oppose to the ones you go to because you really want to spend time with the people. There was a party with my hospital work which I had to go to... it was ok. And then the week after that, was the party with my other work. It was ok. Fortunately, everyone ate the finger foods and left nice and early...around 7-ish... good people. And then there was the one my frined/family doc had down the street. How do you politely not go to a party that's only several houses down the street? It was ok. we left pretty early. Although all the parties were ok, my party tolerance was wearing pretty thin at that point. Now it is Christmas eve and visiting my hubbie's cousin's family in LA. We were invited to the cousin's boyfriend's family for dinner... the boyfriend has two brothers and had uncles and aunts over and...well...they're all from ecuador and very festive and spanish speaking and it was all very interesting... until.... Until they started to bring out a stack of half a dozen dvd's of 'family movies'. -_-;; Usually, most ppl will not abuse their guests with family photos or movies unless explicitely asked. I thought that was like...the golden rule of having guests over, carved in stone, never to be broken. And if they do show family photos/movies, I thought it was polite to limit things to short time period...or entertain in groups so that only the people who were interested can join. We were all sitting in a circle after dinner in the living room (really, there was nowhere else to go...) and they put on the family movies. Hubbie's cousin who's dating the guy thought it was hilarious as did the guy's family...but we were all like...uhhh... save me. Last thing I want to do is watch an hour of a teenager version of a guy I hardly know trying to badly breakdance or flex his muscles with his friends while his mom thinks he's the greatest thing in the world and keeps laughing really loud and try to explain each of the scenes... like... "that's our old ford explorer", "he lost weight their and got more fit" etc, etc, ugh, ugh, ugh. Finally, after an hour, I was rescued by my hubbie who asked if I wanted to go home and got one of the other cousins to drive us home... Thank god we took two cars because we couldn't all fit into one! Monday, December 11, 2006 06:35 p.m. i am so sick. x____x *sniff sniff cough cough* urg. hate being sick. had to work today, of course, despite being sick. too bad i can't get a sick note and cancel all my appointments like my patients can with their work. -_- the late lady that i whined about two entries ago was again 15 minutes late for her appointment. did not see her since she was late. she was given warnings that if she is late again, she will be fired from the practice. have to work again tomorrow. working sucks. want fuzzy socks too... actually my sock situation is generally good (wear medium size ^_______^). have lots of cotton, well-fitting ones. also have some fuzzy socks. will go put them on..... Wednesday, December 6, 2006 10:45 p.m. God. I will never feel guilty about telling patients who are late to rebook, ever again. Never again~!!! My first patient of the morning had half an hour booked for a physical... and she was fifteen minutes late. -_-;; and of course, she was one of those pushy people who will come up with five issues she wants to discuss right after you tell her I will only take up a couple. So after the first patient, i ran 25 minutes behind. If she was on time, that would only have been 10 minutes of running beind...but of course, she was late...so 25 minutes behind *all* morning. None of my other patients made me run behind any further... but i wasn't able to catch up. so pretty much, she wasted 25 minutes each of 13 patients. -_-;;;; That's 325 minutes of patient time which is 5 hours and 25 minutes. I think if she inconveniences *that* many people, she should have re-booked. -_-;;;; If I feel guilty about telling a patient to re-book, it's nothing comapared to telling 13 patients that I am sorry to be running behind.... It's those selfish people who really bother me. She could have stuck to just the simple physical since she was late and rebooked for all her chronic issues...but of course, she's the type to interrupt you and *foist* new issues on you and talk until you can't get a word in... -_-;;; She's also a smoker with a past history of asthma..and she asked me why she was coughing...and I said it's likely because of the combination of the asthma and the smoking...and she was like "is that all you can tell me?" -_-;;; what does she expect? -_-;;;; some kinda miracle? Quit smoking, lady! Ugh. So annoying. On the other hand, the staff is wonderful. Sometimes, I charge too little money for forms and the secretary automatically charges more for me. -_-;; She goes by what everyone else is charging. She wants to make sure I don't end up bankrupt...which considering the overhead of 40%, sometimes I wonder if it's worth it to even keep working. It bugs me that after 150 000 dollars of debt and nine years of post secondary education, nurse practitioners (whom i've worked with before and do probably less than 1/3 of the work of family docs because they're slower) still make more money than me after I pay overhead. -_-;;;; should have been a nurse practitioner.... On a brighter note, I too have my own personalized prescription pads. Truly something to rejoice about. It also has carbon backing so that you can put in on the chart and just write and it will automatically copy onto the chart. I also have my own business cards...and consult forms and requistions with name on it... very exciting. Friday, December 1, 2006 12:04 p.m. How can five months of not blogging go by...and still feel like nothing has happened worth writing about? -_-;;; Life seems to revolve around work as usual. Five days a week, my God, what the hell was I thinking? Probably my enormous school debt... At least I'm not in some -40 degrees location with no heat and frozen urine around urinals like someone I know... but that gives me little consolation... My recent pet-peeve is not being paid on time. -_- I have not yet been paid for November...and of course, my loan interest and other bills get deducted on the first of the month. What the hell is the finance department thinking? I'm so mad.... Ah. And of course, that's only for the regular pay. I still have not been paid for the overtime from *September*. Gah. It pisses me off that I have to use my credit line to pay bills. My new work was going quite well.... until two days ago. Mmmm.. One of the patients had a 15 mintue appointment and she came 20 minutes late....so the receptionist was like..."your appointment is already over so you should reschedule, the doctor will not see you at this point." I've never had that happen before...because when I was a resident, the nurses don't care about you as much. They don't want to deal with upset patients by telling them to reschedule so they just put them in rooms and tell you to see them...and then it makes you run 20 minutes late so that all your patients for the rest of the day are upset at you for being late. So it was a real first that the receptionists actually tried to protect me. But the patient was so angry and she was yelling and stuff. And being timid girl that I am, I felt so guilty. I still didn't see her, especially because she came in to have a mantoux test read 9 days after having it done so it was pointless... and she had the gall to blame that it's because *I* don't speak French and she couldn't understand me. But I usually make sure patients understand what I say even if I have to take a few more minutes to talk slowly and in easy terms. My nurse who actually did the mantoux injection knew French and she gave instructions too....and it's not my fault if I don't speak French. I have no intention of learning it in the future, so if she doesn't like that, she should find herself another doctor. It's not like it excuses her for being late anyway.... I have a lot of Vietnamese and Arabic patients who speak minimal English and we do fine. We just talk slowly and make sure things are understood. They don't get angry at me for not knowing their language. -_-;;; The thing that annoyed me most was probably that I had been working so hard not to be late. I think the most I've ever run late in that clinic was ten minutes.... and even that was rare. And I keep on time by booking fewer patients and sacrifising how much money I can make (and it's not like we make much money to begin with as family docs)... so that I don't end up wasting my patients' time by being late. And if I occasionally have to run late because of a patient going through crisis, that would be justified. But it makes me so upset if I have to run late because a patient is too careless to make it to the appointment on time and then rudly yell at my staff for being refused to be seen. So work is still somewhat stressful, but in a different way. I'm sure I'll get used to this. I just feel guilty anytime someone yells at me, even when it's not really my fault. But I'm just starting at this clinic and the last thing I want is to have patients make a habit of being late or rude. Technically I can fire this patient but I'll see what she does. Maybe she'll be better. Or maybe she'll leave on her own. If she's rude to my staff again, I will fire her and she can fine someone else to be rude to.