backlash?

whip lash from a car accident, this one i'm familliar with, but when you live in earthquake territory.... then a patient might just have earthquake-lash. Ok.... imagine waking up, to the jolt of an earth quake, quickly sitting up in bed, and whipping your head back and forth. May lead to a nasty cervical spasm, as it did with one kind patient I treated today!

Just wanted to post because we both got a chuckle out of the reason for her neck pain..... ice, rest, and some muscle relaxants will have her back to good in no time (some arnica homeopathic remedies will help as well!).

Q and A

this in response to NP Odyssey's comment regarding ways we can update patient information and help with visit efficiency; Thought it was a "pearl" worth posting (why do I actually hate the "clinical pearls" term, somehow it rubs me the wrong way.. but it's universally used and therefore understood... it fills in the same category with me that "midlevel provider" does)....

Here it is;

one thing that can really help [with preparing for an efficient visit] is an agenda setting form that the MA has the patient fill out prior to the visit, it can have the patient list the three things they want to address in the vist, and also ask if they have been seen in the ED/specialist (so you can get the record), gotten any labs or studies done (so you can get the result ready), and if they need any forms filled out (so they/you can get a head start)... this helps to focus the visit from the start, and helps the provider enter the room prepared (by a handy MA who read the agenda form!).... it's an amazingly simple way to help with visit efficiency and also empower MAs to their highest licensure level (part of the patient centered medical home model). Tom Bodenheimer at UCSF is doing some great research regarding similar strategies to combat the ever increasing demands of primary care; http://www.annfammed.org/content/5/5/457.full

Over the counter and in the kitchen....

Remedios Caseros... Home remedies...

- in community clinics, our clientele is rich with remedies, many helpful, many not so helpful, and some a bit comical culturally speaking.

Today, my elderly client with impetigo came in for a re check, bactroban and septra are certainly clearing up the lesions well.. but his arm was covered in a thin layer of a dried red substance...

"Sir, what did you put on your arm here" I asked
"why, tomato juice, they tell me it's good for itching"
- apart from a theoretical use for dogs sprayed by skunks, can't say I've seen this one used as a remedy before.. asked him to d/c use for now so the bactroban can penetrate well without any interference.

- That being said, a quick google search showed multiple sites including "Dr Granny" that claim that tomato and it's acidic PH can help with pruritis.

Sometimes, remedios, and our Latino communities openness to using them can come in handy, for example;
- Te de Manzanilla (Chammomile tea); good for "calming nerves" and soothing/rehydration of the sorest viral pharyngitis patient

- liquado (smoothie) good for constipation especially during pregnancy;
- yoghurt (natural low fat) ; probiotics and calcium
- a few prunes or dates; fiber, laxative action
- papaya; natural digestive enzymes
- flax seed (grind fresh); fiber, laxative, omega three action
- Nopalitos (cactus leaves); research shows that they can be good for glucose control and may help with insulin resistance.. this being said, they often aren't a full substitute for other diabetes treatments, but are worth a shot!

any other favorite remedies out there? Would love to hear about them!

worried well

I have had a week of many worried well patients coming into the clinic... post holidays there is always a rush of panic attacks, anxiety and depression as many lonely patients seek help for ongoing stress related conditions, but I can't recall a week of such interesting and random worried well complaints. This being said.. I have had a huge influx of questions... ranging from "is it ok to take vitamin C with my antibiotic" to "can you just check my blood pressure, I feel fine, but just want to know what it is".. to my favorite, "do you know of a person that would come to read to me in my house while I recover from the flu?" (Uh... no, sir, I do not.. but ask your local library... librarian is probably cursing under his/her breath at me right now). In addition, I have seen an increase in the "phantom phone call" visits.. patients receive a phone message, aren't sure from whom, or what number, but are convinced their primary care clinic might be the origin of this call, or know of the details.. i have not had ONE case where I have been able to track down any clarification of said supposed call.. nor a patient that has saved a voicemail message for me to even listen to. Sometimes I suspect that it may be an automated message from our new clinic phone system... but then a re check of a non-up-to-date phone number quickly confirms that this could not be the case.

Take home message(s);

- your doctor or NP knows a lot, but not everything...
- we appreciate the respect that your assumption that we DO know everything communicates, and are glad you feel well cared for
- save phone messages, and write down names/phone numbers.. hell, when you call us, listen to our voicemail that asks you to do the same, an kindly comply
- when you change your phone number and/or address, update the clinic please.. we need to reach you sometimes, and make sure you know your phone number as well.. especially if it has changed (and we recognize the unique life scenerios that necesitate frequent contact info changes).

that is all. Happy Friday!

super vaccine?

Most creative question of the day;

will my flu shot prevent dengue fever?

- hmmm, wish we had a super vaccine, but this only includes three strains of influenza protection, kudos on the interesting question though :)

it's a digital world...

Saw a lovely twenty something new dad in the clinic today, walk-in visit for Tdap to protect his sweet new son against the woes of pertussis... asked for a photo of the baby, and was treated to a video of his scheduled repeat C-Section birth. Wow... in all detail. As a former labor and delivery nurse, I felt honored to share in the viewing, and also quite struck at the place that digital recordings have come to take in our lives and in medicine. I'm sure the Mother greatly appreciated Dad's recording so she could re-live the action on the other side of the OR drape later.. and I feel special to have been offered a peek at the special moment as well.

not what she said...

you may remember a prior post on selective English T-shirt wording which patients sport unbenounced to the actual meaning of the wording.

Today, I saw another choice example of why an English-Spanich Diccionary may come in handy at your average San Francisco thrift store;

Walking on the corner of 19th and valencia, a kind tiny older hispanic woman was seen sporting a shirt reading "expert cougar hunter".... hmmm, something tells me the meaning is lost on her, and i expect her cougar hunting skills are minimal if at all existant :)

Not clinically related, but thought it was worth posting before the weekend to put a smile on a few faces!