Bells Ringing, Holly Growing, Pumpkins All Dried Up

well, we're closing in on the holidays and i can't believe how fast this month has gone. there's Christmas music 24 hrs/day on one of the local stations and i'm starting to see lights out and about. if we're true to form to how we've been in the past, it will be december 20th before they go up, but to make up for our procrastination, we'll leave them up until at least early june. i love this time of year- it puts me in a great mood. even the novelty of holiday mall shopping hasn't warn off yet. it won't be long.

this week was better at the clinic- i stopped feeling guilty for not knowing everything and decided to just soak it in and get as much out of it as i could. i love the patient interviewing and exam part of things, and i'm picking up more on what diagnostics to order and am at least sometimes in the ballpark on treatment plans now. that's still rough.

what's amazing to me is how subjective everything is. if i happened to notice something while doing my exam, a) it may look/seem totally different to another practitioner and b) the significance of it as a finding can be dependent on how it is assessed (or whether it was found at all in the first place). was that just a normal looking shadow on the xray, or was that a lung tumor? did i really feel a lump in her breast, or did i convince myself i had because the patient said someone else had felt one there before? was that a tumor or an ovary on pelvic exam? is that an enlarged thyroid, or does the patient just have a huge fat neck? (referred to, in PC medical speak, as "increased body habitus"). was that a click or pathological S3 or just a normal split S2 heart sound that i heard? as a student, i take a guess at what i think it is/is not and run it by someone much more experienced. but in just a matter of months, i can't turn to my peers to look over my shoulder at everything and i'll be making these judgment calls on my own. i know that many new practitioners tend to order testing up the wazoo to help reassure them that their findings are accurate. i definitely understand why.

the worker's comp and disability stuff is tricky, too. i know there are people out there abusing the system, but in turn the system is virtually impenetrable for people who really need it. there are a few manual laborers at this clinic with these acute on chronic back problems who have zero income right now and can hardly sit or stand, much less resume lugging their big cans of paint or boxes of whatever they lug for work. and it's really on the practitioner and their documentation to prove that this person is legitimately wounded and warrants some benefits while they heal, or for the rest of their days. that's a lot of responsibility. and a hell of a lot of paperwork. these docs are cool, though. i see them calling insurance companies, pharmacies, etc on their cell phones in the exam rooms with the patients trying to sort things out before the patient even leaves the office. so at least they're trying to be proactive. but then you as the practitioner always have to have in the back of your head- what if this person is out for pain meds? what if they're shopping around town for someone who will agree w/ their claims, but they're actually ok and i'm just reinforcing the problems with the system?

so it's good to watch old pro's handle these probs. i'm learning a lot. and this stuff may not be as exciting as surgery or delivering babies, but it effects people's lives every bit as much.