Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, November 10, 2006

I Done Good

I did a good thing yesterday.

It was one of those busy, crazy days when you think you're never going to get caught up; where there are always two people waiting to be seen (I run my office like a Russian railroad; it kills me to keep people waiting) and the pile of charts on my desk for callbacks just keeps growing (because I don't have time to go back and whittle away at it as I go.)

A lady had left a message on the machine: she thought she had a UTI, and she had just found out she was pregnant (and so was worried about what she could take.) My standard answer to a message about a UTI is that it needs an office visit. I like to have a urine culture cooking even after starting empiric therapy. I've picked up some weird bugs and some STDs, and sometimes it isn't really a UTI at all. So I try very hard not to treat these by phone. It's a quickie visit: pee, dip, pound on your back so I can document no CVA tenderness, prescription and off you go.

So this one wasn't supposed to take much time.

We went into an exam room and -- as I always do -- I took a history. My opening question to someone whose chief complaint is "I have a urinary tract infection" is "Tell me what's going on without using the words 'urinary tract infection'." Her complaints were mainly urgency and some frequency. It didn't really sound like much in the way of dysuria.

Then I added, "And I understand you're pregnant."

A strange expression came over her face as she told me about the two pregnancy tests she'd taken over the weekend. Her last period was October 1st. She took a second test because she couldn't believe the first one. She didn't look happy. I asked if it was a planned pregnancy.

It wasn't. Not exactly. Not *right* now. They had been planning to start trying in another couple of months. Her husband was thrilled; she was "still getting used to it." She still didn't look happy. She said she was in shock. She wasn't sure she was ready for it. But she also felt terribly guilty for not being completely happy. She couldn't think about anything else, but didn't want to talk about it at work. She was having a tough time, but, as she said, she was definitely "getting there."

I thought about it as I listened to her. I thought about the fact that things happen for a reason. I shared Flea's story about the "good" fortune of his colleague's wife's misdiagnosis in infancy. And then I added this:

"I don't know how or when or if you'll ever find out why this happened, but I really believe this is a soul that just couldn't wait another couple of months to come and be with you." We both teared up, so we helped ourselves to tissues.

"Does it help to think about it like that?" I asked.

"Yes it does," she replied.

I told her I wasn't at all certain she really had a UTI, as urinary frequency is a common symptom in early pregnancy and the urine dipstick was completely negative for white cells, nitrites and red cells. I sent the culture and told her I thought it would be best to hold off on antibiotics for the time being; she was ok with that. I offered her a hug, which she accepted.

Even though I was still running way behind, I felt good.


At Sat Nov 11, 01:48:00 AM, Anonymous Anonymous said...

Yeah, you done good . . .

At Sat Nov 11, 07:13:00 AM, Blogger Big Lebowski Store said...

Thank you so much for sharing that story. I wondered if anyone was as struck with it as I was. It's an approach that I hope to take with me in my professional life (and perhaps other lives as well). But I hadn't thought of applying it to patient encounters.

So yeah, you did good.



p.s., YOU BASTARD! You got to use this story in public before I did!!!!

At Sat Nov 11, 07:24:00 AM, Blogger #1 Dinosaur said...


You did use it in public. You posted it on your blog. Doesn't that count as "public"?

(Ever see a dinosaur whimper?)

At Sat Nov 11, 09:11:00 PM, Blogger MedStudentGod (MSG) said...

Fantastic job. It is truly incredible how some people demonstrate a knack for the spoken (and written) word. I don't have that certain trait (currently), but hope that in a few years I'm able to assuage patient fears and concerns the way you do.

Also, I would really like a chance to read a copy of your first book and, when it's done, your second.


At Sun Nov 12, 02:58:00 AM, Anonymous Anonymous said...

You sure did do good!

At Sun Nov 12, 03:44:00 PM, Blogger The Tundra PA said...

I love it when you open your mouth and the thing a patient most needs to hear is what comes out. Good job!

Dinosaur's androgeny seems to be leaning a little left of center...

At Sun Nov 12, 11:00:00 PM, Blogger Richard A Schoor MD FACS said...

Your a hell of a doc! From a urologist's perspective, perfectly handled.
My heart is warmed.

At Mon Nov 13, 05:00:00 PM, Blogger Sid Schwab said...

Nicely put, and obviously well-received.

And I too was fanatical about running on time, nearly always managing to. Patients love it.

At Fri Nov 17, 09:49:00 AM, Blogger apgaRN said...

Very heartwarming, Doc.

From my end of things (labor & delivery world), it's difficult to imagine that my patients ever experienced those first few months of shock and disbelief... usually by the time they make it to L&D they've come to accept the situation. However, I helped with some of the care in a very sad case a couple of weeks ago... an older woman with several kids at home, thought she was going through menopause but found out she was pregnant instead. She was not at all pleased with the idea as she thought she was long done having babies. She was almost in denial and hadn't told anyone except her husband about the pregnancy. When she went in for her routine ultrasound, the baby had died. She came to us for induction, and was emotionally broken with feelings of guilt and grief. The induction went smoothly, and she delivered her tiny baby... her first boy.

So hard.

Huh, somehow that started out being related to your post... now it just sounds like a sad, sad story.

We just can't know how our expectations will be fulfilled. We often think that we have it all planned out and know all the answers. Yet it's the small things that alter the course of our lives.

Wishing your patient all the best... it sounds like you've given her a new and brighter perspective.



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