:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Tuesday, January 24, 2006  

Clinic Vignettes:

Yesterday i saw a patient for the second time. a 35 yo male who complains of severe abdominal pain. He had already been seen by GI and received a CT scan of his abdomin, a Colonoscopy, an EGD (where they look into your stomach with a camera internally) and numerous blood tests. all normal. you guessed it, he's insured. the first time i saw him i identified that he carried alot of stress around eating, he ate really fast and often would eat while working, to avoid having to take a break, so i was suspicious about a possible connection since he clearly didn't have gastritis or colon cancer from the very thorough GI tests. i had recommended that he slow down his meals, add fiber to his diet (flax seeds) and drink some aloe juice. over the few weeks he had improved some symptoms since he was no longer having epigastric burning sensations but the pain in his belly was actually worse.

mulling this over together, after about 20 minutes, we figured out that he has GAS. i feel a little embarrased that it took me a second visit to figure it out, but the GI docs actually took this man thru an entire GI workup costing thousands of dollars for GAS. turns out he was eating so fast, he was swallowing air... this case supports my experience that sometimes having insurance is detrimental to your health. those studies are not always benign.

i took care of a man yesterday, about 45yo, with anxiety/depression. he is in a custody battle with his wife right now over their 5yo son. very sweet man but clearly distressed. a few weeks ago he saw a psychiatrist because he was feeling very angry. the psych started him on seraquel, a newer antipsychotic agent. this man took the medicine for a few days but had to stop it secondary to a very curious side effect. he started feeling LOVE for everyone. note, i'm not talking about sexual attraction, i'm talking about LOVE. he's a cab driver and he found himself telling his clents that he loved them. his comment to me was, "doc, it's a beautiful thing to love people, but this was too much, right?" :>

a young pregnant woman came to the clinic with her partner a few weeks ago. she hadn't yet received prenatal care because her insurance hadn't kicked in yet and she didn't want to have a "pre-existing" condition! in the interests of decreasing her concerns about the pregnancy and ensuring that she have good quality care, we decided together that i would see her until her insurance kicked in under an assumed name... wow. it wasn't like i could do anything else and still sleep well that night. it's almost like it's criminal to be pregnant and poor.

saw a patient today with cataracts on both eyes. she's 35yo and undocumented. after being rejected by Lion's Club for a free surgery, i steered her to the local public hospital. my assistant helped her make a financial aid appointment so that she could get registered and set up for a surgery. the staff person on the phone told us that the patient didn't qualify for any financial assistance, and couldn't be seen at the hospital. this is interesting since the hospital now has two new policies for folks who are undocumented. the first policy has been there for over a year - any poor person, no matter what their documentation status, can qualify for a fair price discount of 40%. secondly, they just instituted a new policy stating that noone would be turned away even if they cannot pay.

either this staff person is misinformed, doesn't care or is purposefully lying. we hung up the phone, called back a few minutes later and spoke with a different staff person who gave us the correct information and scheduled the patient for an appointment with financial aid.

maybe that's the way around racism or bigotry - hang up the phone when someone is rude and call back until you get someone who isn't ignorant or rude.

posted by andru | 1/24/2006 04:52:00 PM | |


You know, they always tell you not to look for zebras in med school. It's really hard, though, when you know too much. I often stay up at night thinking about kids I see in my clinic and send home with common diagnoses...it's just an otitis or heartburn...but what if it's really mastoiditis or a bleeding ulcer?
Well, I'm glad this man just had flatus. Just too bad that it took so much time, energy and resources to figure it out.

# posted by Blogger girl MD : 1/25/2006 3:12 PM  

there are deep ironies and real fears we have to contend with as doctors.

my sadness is that there is such an emphasis on fear and technology, and systems that are so hard to access that we lose the ability to follow the clinical course of an illness over time, which would reveal the zebras and severe illnesses to a reasonably large degree.


# posted by Blogger andru : 1/27/2006 8:06 AM  

Post a Comment
cure this!
what's "to the teeth"?
hot links
dope orgs/sites
to the teeth archives
poem: history
Willing to Fight
the revolution will not be televised