Sometimes you just have to yell!

Just another day in primary care, trying to get patients to actually care about their health. I have finally found an aspect of primary care that I enjoy, in essence its something i have enjoyed for a long time, arguing. In the office today (and pretty much everyday) are patients that are not following the guidelines and suggestions given by the doctor, they inevitable feel bad and come back, and when asked why they didnt do what they were supposed to in order to feel better come up with ridiculous excuses.
"I just didnt feel like taking a pill in the morning"
"I am single, and do a lot of heavy lifting, so i cant diet"
" I started feeling better so i stopped taking my blood pressure medication"
" exercise is too time consuming, cant you just give me a pill?"
" both of my parents died of heart attacks, but i dont want to take medication"

So today, i tried to educate patients about the importance of their health with a little bit of yelling. When someone has triglycerides in the 800's and tells me he cant diet because he is single, i get to explain what will happen to him if he continues to let this go unchecked. For males the consequences of poor cardiovascular health is evident by the inability to maintain an erection or even have one at all. Sometimes a little scare tactic is what it takes to get through. He decided to try and stop eating fried foods, start taking fish oil supplements in addition to medication.

Another man comes in, with a diastolic blood pressure over 100. He has chosen to stop taking his blood pressure medication 3 weeks ago, because he said it may him pee too often, and he had been feeling better. Now he has constant headaches, his vision is getting blurry and he has sever neck pain. When i tried to explain how not treating his BP and allowing it to continue at the current state, he could have a stroke at any moment. He didnt really seem phased by any of this, but did mention how both parents died of massive heart attacks. We tried to explain that if he didnt start taking care of his BP then he would end up the same way, and his kids would be without a father. Still not fully understanding the gravity of the situation, instead his main concern is the pain in the neck and head, so he demanded to be placed on percocet and valium since it helps with the pain and relaxes him (ie lowers his BP in his mind). I am nearly shocked to see a man be more concerned with scoring some drugs to treat the symptom instead of treating the cause of the pain by lowering his medication. Once we made some calls, we realized he has been filling pain medication prescriptions all over town from 12 different doctors in the last month. He ended up walking out of the clinic with no meds, not even for his BP. He became agitated and irate with us for accusing him of doctor shopping and drug seeking. Seriously....drug seekers come in all forms.

But at least today went a little better, i am starting to think my doctor doesnt hate me, and instead is just harsh by nature. My mantra, "i can do anything for a month" is working really well, and so is blanking out when she yells and talks to me in a degrading manner in front of patients. I just sit there quietly with a smile, suck it up, write some notes down and go home and look up the info, so the next day she cant yell at me for the same reason. Unfortunately, i feel she looks for minor details to pick out and tell me where i am wrong....i wonder if she had a bad experience as a medical student?? hopefully i will not treat my medical students this way.

on a side note, i got to drain an abscess on a breast today and it was AWESOME!!! hope i see more pus tomorrow....

number of strep throat cases seen so far in 3 days at a family med office = 12 and counting