A Country Doctor Writes:

I posted this on my Substack in February 2023 and realized I never posted it here.

The trending post right now on Acountrydoctorwrites.Blog is about the unending stream of calls for medical advice we get in my office and, I’m sure, others like it. We get calls asking how to treat a cold. My suggestion is that we hire some grandmothers. Our own staff, even though most are wise grandmothers and mothers, are not allowed to give “medical” advice in the litigious climate we live in. And the medical providers don’t have a lot (read any) of wiggle room in their schedules to handle non-urgent calls in a timely fashion.

I also recently posted about what I recommend in treating the symptoms of a cold(note that there is no treatment for the cold itself; it’s going to run its course). I don’t know if that will make a difference in our call volume, but it’s worth a try.

All medical bloggers touch on or delve deeply into the pandemic of physician burnout. My 1/22 post, The Future of Doctoring is Already Here: Do More, Give Less or Burn Out,   is the most read in my blog’s almost 15 year history – well over 13,000 views and counting.  On 2/14, The New York Times picked up on broadly the same unsolvable equation (not to say they were inspired by my piece) in their article According to Medical Guidelines, Your Doctor Needs a 27-Hour Workday.

So, how do I, or any of us, stay sane in this crazy system?

I have found my curiosity to be my biggest defense against burnout. Asking why, looking for connections, not settling for I don’t know, but doing a quick google search instead, is my recipe.

This week, for example, I saw a new patient, 27 years old, with foot pain that had been diagnosed in the ER as plantar fasciitis, heel spur. But his pain wasn’t just under the heel, it went partway up toward his knee. And he couldn’t feel light touch there. I asked if he had back pain. “All my life”, he answered. So I tested the strength in his legs, definitely weaker than in a healthy 27 year old. Next I asked him to get off the exam table and sit in the chair with arm rests next to it. “Try to get up from the chair without using your arms”, I said. “I know I can’t”, he answered. He grunted and tilted to no avail.

I don’t have an answer yet to what ails him, but I ordered a bunch of tests. How could I not think my job is interesting and meaningful?

Another patient has low calcium from hypoparathyroidism. The only endocrinologist in northern Maine has been gone for a couple of years, so I am monitoring her lab values. She was running a little lower than the endo or I would want, but she said her calcitrol was so expensive that she skimped on the dose. The other day she told me that when she had Covid last month, she had two strange spells where her body seemed to stiffen up and get a little shaky. Seizure, critical hypocalcemia, I thought. A quick search revealed that the inflammatory response to Covid has triggered hypocalcemia in many cases. I told her she had been on the brink of a grand meal seizure, and she said, “I’ll take them the way I’m supposed to”.

And there were others, not as exotic, but in a handful of cases I was able to connect the dots.

A woman with low sodium was borderline  before and normal years ago. Her first drop happened when she started taking Prozac some time ago, and when her dose was increased recently, her sodium level tanked. That is a known side effect from the SSRI class of drugs. So we reduced her dose as a first step – some people don’t do well stopping medications like that cold turkey, although Prozac’s long half-life makes it less likely that she would have severe withdrawal symptoms.

To be honest, there are many such little pearls, or mental challenges, some of which I can’t even remember when the week is over. So far I’m still very happy to be a somewhat overworked primary care doctor in this underserved corner of our country.