Into the Medical Blogosphere

Do we really need another medical blogger, you may ask? I have been reading other excellent and quite experienced medical bloggers for a while now, contemplating the thought of starting one myself. I often come home from work with a flight of ideas and experiences to share, and search for an outlet for my thoughts. So I hope that this blog will not only be a therapeutic diary of my trials and tribulations as a physician, but also something useful for my readers as well.

I am a family medicine physician practicing in the department of public health in southern california. I often feel like the "Jill of All Trades" in my practice, seeing everything from pediatrics to geriatrics. I am lucky enough to still be practicing everything i learned in residency: low-risk prenatal care, minor surgeries/procedures, lots of women's health, and have a large chronic disease population with diabetes, heart disease, COPD, and everything in between.

I have seen up to 19 patients in a half day -- yes, half day. On average, however, I see between 12-15 a half day, which is still no easy task. But it is amazing how efficient I have learned to become, at the same time, still able to deliver quality care while keeping my patients happy. But this didn't happen overnight -- which can perhaps be a topic for a future post.

Forget the number of patients I am pressured to see on a daily basis for a moment -- that is the "easy" part. But the acuity of the illnesses is what makes my job in public health so demanding. My patient population is one without great access to care -- they are the ones with Medicaid, Medicare, and often no insurance. Many of them come in only when they absolutely have to, because they are unable to afford medical care and maybe haven't seen a physician in years. So I am often all they have and all they can afford.

I have prescribed and managed diseases that i never thought would be in my scope of practice. I am often the PCP and their specialist. For instance, I have patients with severe rheumatoid arthritis whom I have had no choice but to initiate Methotrexate on, and continue to take care of alone without a specialist input. I am their rheumatologist. I have young men with new-onset seizures that I have placed on anti-epileptics, and am acting as their neurologist. I have hyperthyroid patients taking PTU whom I monitor by myself, and act as their endocrinologist. I have seen patients with Bipolar Disorder & Schizophrenia whom i've prescribed antipsychotics for, practicing as their psychiatrist.  I am the Jill of All Trades, MD.

Now, I am not encouraging other primary care physicians to do what I do -- I don't think it's right for primary care to act as the specialist in any way. But what can i do? I have nowhere to send these people. It is either watching these patients suffer, or treating them by myself. They cannot afford the $285 dollar visit to the county hospital specialist. Their visit to see me is $35 out of pocket. Some are not be even legal residents, and they do not qualify for Medicaid or Medicare. For those that are legal, many have been denied repeatedly by Medicaid/Medicare, or don't qualify because they don't have children or are not above age 65.

In this age of great health care reform discussions, I can try to give you my personal perspective in my blog. I am deep in the trenches, seeing these people without health insurance or with poor access to care suffer first-hand. I can describe my personal experiences and challenges of treating these patients on a daily basis. My ideas are my own, and I have absolutely no affiliations.