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USA: being a family doctor is not cool

Everywhere they boil beans, the primary care crisis is national heritage, and is that even the mighty U.S. in the same thing happens to us every day there are fewer medical students who want be family doctors, or at least that is what is concluded in the article: Changes in Medical Students' Views of Internal Medicine Careers From 1990 to 2007 , published in Archives of Internal Medicine . The causes of this decline is the fact that family doctors see many more patients than other specialties and instead charge less pasta. The students surveyed felt that general practice workload was more and more stress than other specialties. Thus, during a career spanning forty years, the total difference between a cardiologist and a generalist is close to $ 3.5 million (the technology-focused specialties pay much better attention to the management of diagnosis). Over the years, the attractiveness of primary care medicine, as a reason to study medicine, has fallen from 57 to 33 percent. Given these data, the thing is clear, it is necessary to change the image of the Primary Health Care compared to other specialties, so that students not only respect and admire the family medicine but want to do it.

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"photo or film? An emergency

seems to have opened Pandora's box of worms, depending how you look, with the announcement of the creation of the specialty of emergency medicine. I sincerely believe that most current residents are adequately trained and qualified for emergency medicine, but is this the philosophy of your training? We are family doctors to work in health centers or doctors we are potentially useful in all areas?. Possibly a surgeon is able to pass a primary care clinic, but is this role? Has this been the target your training?. I am one of those who still believe that that family medicine had its specific place of work: the health center, also believe it that the family physician performs and organizes its work within a team primary care sharing goals and working for the same and given population. I also believe in the integral and integrated, or those of its main pillars: Global and longitudinal, that of serving the whole person as a whole, and serve in their context and in their environment throughout his life. I am among those who believe that after the various attentions must establish a monitoring plan in order to assess adherence and evaluation of results achieved. I also believe in the need to meet the family as a system, how the disease affects them some of their members and how to use it as a health resource. It is true that we have forgotten his last name, as of COMMUNITY, that of identifying risk groups in our society, to make an active recruitment of vulnerable subjects, that of cooperating actively involved with community organizations in our environment. This is what I have learned over the years that is family medicine, and my limited understanding of emergency medicine is something else, possibly more exciting, more resolute, but for me it's like the difference between seeing a photograph and a movie.

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normal in a patient with difficulty

Today I have come to the guard at the Health Center a 62 years old, attached to a companion of EAP, with malaise, generalized aching expressive, sweating, pallor and intense nervousness. Nothing strange in an emergency with one caveat: it is deaf. After trying to calm her

(seizing his hands, looking into his eyes, taking a picture of calm), I had to step up my resources of persuasion to convey that I will do everything possible to understand it (active listening, empathy).

She tried to express all their symptoms through gestures and sounds and cries issuing high-sounding (remember you do not hear and you can not modular) that produce to those who are close to her obvious discomfort.

noticed that I did not read lips, so I took the gesture as a form of communication. I issued no sounds or raise my voice to hear me (something impossible that would have produced more alarm in the waiting room)

His HC was pretty bland, hiatal hernia, depression and other old episodes of no great importance except " Postmenopausal Osteoporosis "the 51 years with a T-score of -2.2 (?) and" Scoliosis Malignant learned "from 52 years without a radiological test (¿?). I have no clear neither the beginning nor diagnosis nor complementary examinations. The first is foreign to this age without a premature menopause (which is not included in the story), why he was given a DEXA at \u200b\u200b51? Why diagnostic T-score \u0026lt;-2.5?, And the second home is usually in childhood or tumor (no symptoms). Know if you have been treated (brace or surgery) at the time, if it has not been effective or if she has rejected. None of this is reflected in its history

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symptoms showed clinical signs of lower respiratory infection and a severe back pain. And would take about 10 minutes of consultation when I taught a report of emergency 6 days before, came on the same box, and after blood count, urinalysis and chest X-ray (reporting of fused vertebrae but not in cardiac and lung disease) was discharged with a diagnosis of musculoskeletal pain vs . Colic renouretera l. I can not find plain abdominal radiography and abdominal Eco. The patient was upset with the service and expressed his contempt for the information contained in the report.

Once I got to communicate and understand problem, I relaxed a little. I thought, "now comes easier exploration" ...

Lo and behold, after exploring oral cavity and neck (without problems) I'm back with a severe scoliosis and left with a huge hump floor. On auscultation there was a decrease of buzz in the hump and the rest normal. The renal percussion was positive on the left side abdominal tenderness and pain showed a tour of the ureter. Throughout this phase, the patient was very helpful and informed me of their pain adequately. However, through my head was about the idea of \u200b\u200b how can I explain what colic?

A strip of urine confirmed the microhematuria, proteinuria and pyuria. It was clear to the diagnosis and treatment, my problems were again the media until I found out who could read (" course!, How will not know if their main form of communication") I explained everything asked and I mentioned the desirability of outside normal consultation with your doctor. We parted with a handshake.

Communication problems are always present in health emergencies, but in patients with neurosensory disabilities, much more. Imagine

the patient came to our usual consultation being of our quota, "what else should we do?

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The end of life.

few weeks ago I'm in the month of free rotation of the tutor with palliative care units located in the CS Zarandona, this quiet period in which we leave to our residents at the forefront of the consultation and we move into be spectators and apprentices in the various facets of our profession. Well, for me is proving a breath of fresh air to see how these partners working despite the situations that continually serve. Some you may think that what a cool treat patients and families who are living final situation, farewell, with many feelings on the environment, ... but hey, it's my feeling. I've gone to rediscover who was my mentor and teacher, with whom they regard as mentors when I was a resident and a group of people working toward a common goal: to help all those involved in the final stages of being human. The work environment from the outside is calm, quiet, everything slows down, I think that's what I want to pass them as the end of life (of course, as I see it, the personal situation that each of these professionals must live can be very different). Are other rhythms to which we in primary care, is imbued this climate, the days I have been to pass the query when my dorm this outgoing call, I caught it and see "was otherwise" yes lie a tremendous backlog.

I also noticed the amount of people we help: on the one hand we have professionals (like me) who need support when faced with the end of the patients, we ask whether we are doing well, doubts in cancer treatments, etc .... Then the patient, a central figure throughout the process, and last key figures, all that surrounds it: family, caregivers, .... In fact recently we went to a 95 year old patient who was undergoing last days / hours as they say (very malic and I would say) and while there were serving about 12 people at a time (the patient, the 5 sons, 2 daughters, 3 grandchildren and 1 neighbor), and out of an area of \u200b\u200bthe house to another, in the days before there had been a job with most of them concerning how could the end all, and come this time I could see the end of the cycle, the patient died within 2 hours of leave home. The next day we went to the funeral to offer his condolences to the family and nearly complete the process (was a last visit to the family a week later to collect the material and see how we were and the feelings of "those who have been"). Noting the daily work of all of them have seen how important it is to identify (as we try to make us in the office) who are in need of all those listed above: sometimes we are professionals, patients and family are calm but it is we we do not condone the final standings. Sometimes the family or patient, or both. Generally everyone is going to require help and support, each in a certain degree, but if we locate the most needy are more effective interventions.

Finally say that I have rarely seen so sincere appreciation and emotional as here of patients and families / carers throughout the process and when it ends the work done. So, on behalf of all of them and myself learned so thanks to all: Eduardo, Rosa, Pepe, Isabel, Censi, Toni, Michael, Head, Ana, Mercedes, Maria and Pilar.

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National Day of Primary Care

In this day, the Forum for Primary Care Physicians, which represents professional organizations of primary care medical nationwide, has called the National Day of Primary Care, (here in Murcia should be the day of the "Area of \u200b\u200bcontinuity of care" and that is how we are represented in the flowchart of Management and Single as you see we have lost by losing to the name). In this blog we subscribe to the publication of the text:

Call the door! We will no longer regularly called

Written by Robert Sanchez. Medical fourth-year resident of Family and Community Medicine. Prosperity Health Center. Madrid

If you had a health problem he had to make an appointment with your doctor and felt that he waited several days to be seen, waited a long time in the waiting room, he passed to the query will not let you speak enough to tell their problem, we explored above, you dispatched quickly, he requested a blood test or a test or take long to make an appointment with the specialist never came ... should you read these lines that follow.

Although people do not realize when he says that "medicine is a vocational profession" refers to the doctor, which is the basis of the health system. One is not born with a vocation to watch films or deal with a kidney.

Now the doctor Family Medicine is studying exceeds the MIR and four years of specialty. It is a versatile professional, approachable, common diseases specialist, highly qualified to make difficult decisions in difficult cases, knowing the limits of their knowledge in some areas and a professional above all, human and close to their patients. The doctor knows them well and that allows you to make more appropriate to the case that if he did not. Everyone likes it when the doctor will always be the same because it is the known.

Well, it so happens that those who command and doctors who know little of family, health centers and public health because they use are destroying this system is so well appreciated by people.

If things continue at this rate GPs soon disappear as it is or your figure will be reduced to symbolic.

Do you know why they say that doctors are needed in Spain? Doctors there, if any, would let more people studying the race and ready. The problem is that many people who want to study medicine, but nobody wants to be a doctor. There is more to take a look these days to the election of graduates who choose a specialty after making the MIR.

Why? The Departments of Health of all the autonomous communities, irrespective of their political, abuse greatly to their family doctors.

They get 5 minutes per patient (as the patient walks in, greets him, it shakes hands, sits down and consider what happens to you, and have been 4, and remains to be explored, decide on the diagnosis, to treatment, give the recipes, maybe lower, maybe ask some evidence, review their past problems, review the medicines you take ...), lists of up to 50 and 60 patients a day, they are subject to multiple red tape have to do home visits and emergencies that arise ...

So it is impossible to take good care of your people, so it's easy to pass you something big, something happens to any patient for lack of adequate conditions for work. When things happen, come the cries. Not only is that one day a disaster occurs in this sense, but family doctors want to give quality care, under the conditions that people deserve to pay their taxes.

more Physicians have older who have always identified themselves with their work, but now there is an unbridgeable gap between them and their bosses who are not sensitive to improvement proposals that seem to live on another planet.

The situation of young doctors is even more worrisome. Required, during the first ten years of practice to go back and forth. Contracts of days in various health centers, some weeks when you try to catch you up on Friday to not pay you the weekend. Instability, insecurity. Most of them choose to leave and re-submit the MIR for another specialty, or go to work in emergencies hospitals, or other units, such as home care or emergency, or abroad ...

That's the real reason why there are no doctors in Spain.

Family medicine cracks, gentlemen.

On April 12 is World Day of Primary Care and shift the union bosses will be the photo with the politicians of the day, but the reality is not built from top to bottom, but below upwards.

Professionals are motivated, want to change things for you, because they care, as in the slogan, people. But is that alone can not. Management as an Autonomous Community Counseling or Ministry of Health is not sensitive, it never was, to their requests.

why they need your help. This time the doctors tell you helps to draw the attention of the rulers.

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Adolescence and risks

few days ago, our resident Vanessa Ayala, published an entry about a clinic session on adolescent care which he expressed that "Physically, the adolescent may be considered a healthy individual, they sick on rare occasions" , a few lines below we read "... because of the sense of invulnerability and omnipotence of the adolescent, it must be remembered that this can lead to maintain risk behaviors (snuff, alcohol, drugs, etc). " This hypothesis seems to have come true, because for the first time kills more teenagers than children in the world. I was struck by the study, published in The Lancet , analyzing mortality data in the last five decades in 50 countries with high, medium and low income. The study finds that although overall mortality rates have declined, the numbers of premature deaths are far higher in people aged between 15 and 24. The causes are mainly violence, suicide and traffic accidents.

When a teen comes first to my query from the query of Pediatrics, I have the habit of scheduling a visit with him, which he titled " Welcome to the world of adults" , I know that this consultation should continue minimum technical standards of the service portfolio to weigh, height, power sockets, vision inspection, exploration mouth ... but sincerely I miss. In this consultation, which usually lasts about 20 minutes talking about adolescent sexuality ("awakening") , snuff, alcohol and other drugs ("forbidden") and traffic accidents ("the pleasure of risk ") . I know it's little time for such broad topics, but it's not a lecture, and strokes are just a way to open the door of my office in case I need. For me, frankly, is one of the most rewarding queries I do, and in view of the public believes that I have not changed my clinical practice, time will have to weigh, sizes ....

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The Fleet Landing GROWS

The Fleet Landing has grown and matured. As a "mother ship" starts throwing their units at random sea of \u200b\u200bthe blogosphere, without them falling off completely, keeping the umbilical cord.

Let every sensitivity undertake its own path in line with their perceptions of life and health but maintains the link to the blog to become a vocation for teaching.

I have the honor of being the first and I created my own blog to which I invite all readers: Health Notes for reflection.

I must admit that sometimes I felt uncomfortable expressing my personal views within a collective blog, among other things because, as you might expect, our EAP is very broad, with different conceptions of things and far to keep a single thought or politically or professionally.

I have long believed that if they expressed all these sensitivities, the blog of the health center could work and readers would understand as a melting pot of perceptions and different proposals, subject to varied and not more than philosophy or ideology that each one of its members.

But the reality has been different, apparently, productivity in publications of any of us has withdrawn the other and, ultimately, the latter no longer identify with our blog.

been two years of effort and learning that have not been in vain. The blog is well positioned and has its supporters and subscribers. Is present and future.

I hope this new blog as teaching tool, with which I agree from now, meet the interests of its supporters and subscribers.

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I messed

Normally I try to have a cheerful attitude in the query. Sometimes some patients reproach me " you laugh but I hurts." Of course I laughed at them, but try to get to my patients so happy, not frivolous, and perhaps smile over the account. I think sometimes necessary on especially in those patients in whom therapeutic exhausted all our resources and yet the pain persists or insistently deprimido.Quizá encouragement I have no other thing to offer a smile intended to relativize your state, you may think that the situation living is not as dramatic.

Today I think I messed up with Maria. Is 45 years old, blind and drag for 2 years of depressive symptoms that do not take the multiple combinations of antidepressants, benzodiazepines and neuroleptics used at doses "horse" as they say our patients. Perhaps the sadness is to live in a much more intense and bitter if you can not see, when you do not have any image that you can brighten the day.

Today I have come to the consultation, as often done, to tell a new symptom that has for a week, " I lie down and do not know where I stand " How? If I lay on my bed and I get up in the living room, kitchen or in bed with my son and not how or when I got there . It's spring and caught me most jovial of the account. next time Take care lest you wake up you in neighbor's bed .

finish the sentence before I realized the error, Maria's face was transformed , Did not bother him but the tears began to fall on his face. Rather than cheer, the joke was hurt more than I had ever imagined. I apologized waste, and subsequently tried to have the most professional attitude to finally admit that was not meant to be able to attribute their symptoms We have agreed to a new query for next week, which I hope will not save me resentment and where you can averirguar if it may be a side effect of taking multiple medications that I had symptoms. Must see, you screwed us in the profession we never know when we mess up