If you believe in that sort of thing

The phrase I hear out of the mouth of so many people after they say the word 'fibromyalgia' is, "if you believe in that sort of thing." Not without justification, fibromyalgia has transcended simple diagnostic criteria and entered the realm of myth. People will walk into the office and tell me that their fibromyalgia is acting up, or that they know someone else who has fibromyalgia and that they benefited from     insert narcotic drug here    .

I really want to find the doctor who first started telling people they have fibromyalgia and beat him. While I agree, there are chronic pain syndromes, but to simply write it all off as fibromyalgia and call it a day, that's practically criminal. And even worse, to give out narcotics and call that treatment, that should be a capital offense.

If you ask me which camp I'm in, I ascribe to the 'there is no such thing as fibromyalgia' philosophy. There is a root cause always, whether it's osteoarthritis, hepatitis C, or any number of diseases that fuck one up. Half the time, I am willing to say that rather than having fibromyalgia, the patient has narcotic withdrawl symptoms. The best successes I've had with chronic pain patients are to introduce changes in living. I have yet to meet someone who is happy and well-adjusted and in chronic pain.

Part and parcel with my disbelief of fibromyalgia, I don't believe in OxyContin either. It has no therapeutic value. There is never a situation, except terminal cancer patients, where I would say go ahead, here's some oxycontin. I've written scripts for oxycontin 5 times.

Maybe I'm just not sympathetic, but from this side of the examining table, it's hard to figure out if someone has pain from some random disease or pain from being alive. Even worse, how can I tell if their pain is from too little pain medication or from being on too much pain medication? And only seldomly do I have a patient that has the insight to realize that they've traded one demon for another.

Dooced

Yet another blogger got dooced. I find this most amusing, not because of the fact that firing someone for expressing their opinions in a public forum is sheer evil, but because the person doing the firing is a writer for the NY Times and decided to write an article about it that borders on libel (not slander, as the Spider Man movie so accurately related).

I am obsessed with neologisms. I think they're intriguing, and being dooced is certainly one of those new fascinating words that seems so weird, but finds its use so aptly, now that blogging is so very common, and that blogging about work is even more so. Am I concerned? Certainly. I certainly don't want to be fired from my residency, since it's kind of hard to start a new residency after being fired from one. But really, it's not like I've done anything here that is out of bounds. I've resisted the urge to bitch about other residents and my program and other stuff like that, and I haven't divulged patient information.

I'm confident that even if people from my program found this, I wouldn't get fired for it. Of course, famous last words. This site ain't anonymous for nothing.

Overbooked

I have actively been turning patients away from my clinic. This is a crime. I've met fantastic people that I would love to see in my clinic, but I have to tell them the truth: I'm booked solid for the next 3 months. In fact, I'm double booked through most of my continuity clinics.

The true crime of this is that a lot of those bookings are patients that aggravate me. They don't listen to what I say and just rampantly ignore what I try to do to help them, but they show up and drone on interminably about how their lives suck and how I should prescribe more vicodin.

I feel like I should just tell them that it's because of them that I've been turning people away. It's because of them that I've had to refuse to take some wonderful people, and that, if they're so dissatisfied with me, they should find someone else. I just want to say to them: there are people who would love to have that double booked appointment that you can't stop complaining about, so if you wanna find some other doctor, go find one, because I've got other people waiting.

King of the idiots

As I'm fond of saying, I am no longer one of the idiots. Now that I'm a senior resident, I'm king of the idiots. My particular group of idiots are a nice group of folks, but wow, I have a hard time believing that I was that green when I started residency. Contrary to that, I hit the ground running as best as I could.

It's taken me a little while, but I actually feel like a senior resident now, and that's pretty funny. I mean, the difference a couple of days makes. Now the patients are sicker and I'm doing a whole lot more worrying. Still, I'm happy to say that my 'terns haven't killed anyone yet (not for lack of trying).

But the one thing I've realized as I've taken on my new role of senior idiot is that I really enjoy the teaching involved. I mean, it never occurred to me before, but I really do enjoy passing on knowledge, even if it's simple stuff. You know, doctor comes from docere which is Latin for teaching. Strange to say, it's the teaching and not the patient care that I really enjoy.

Oh, there's some stuff I like about patient care, but it's silly stuff. It's seeing my 49 year old hypertensive and managing his cholesterol and blood pressure medications. It's improving the exercise regimen of my 60 yr old diabetic. The thrill of seeing my name on a piece of paper has long since worn off. Now, what I really enjoy is seeing my patients and just talking to them and getting to know them.

I feel like I'm doing a pretty poor job as senior, but I'm trying my best. I hope that my interns are learning something.