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.

Thursday, July 26, 2007

Treatment Plans

"Treatment Plans" seem to be a nursing thing. I generally talk about "the plan" or just "here's what we're going to do." But other professionals have other ways of formulating and recording their thoughts.

That's cool.

Then again, there are times when patients come up with the best treatment plans all on their own.

I have a patient who had a baby about three weeks ago and the baby wasn't gaining weight fast enough. The nurses in the pediatrician's office [yes, she's taking the baby elsewhere; perhaps not for long, on] waggled their fingers at her and suggested she consult with a Lactation Consultant. The Lactation Consultant came and consulted, and generated a "Care Plan," of which the mother got the yellow carbonless copy. The Lactation Consultant also ordered some labs...sorry; the Lactation Consultant felt it would be wise to check the mom's hormone levels, so she suggested she come see me to have them drawn. (Never heard of that before but what the hell. I drew the suggested labs; her TSH was fine; her testosterone was <20; her prolactin was 78; all perfectly appropriate levels for a lactating mom.)

By the time I saw her, the baby was doing great with some supplemental bottles, though she had decided to stop pumping. Between nursing and pumping, she told me, there wasn't any time to do anything else all day. So she was just going to offer the baby the breast before the bottle and chill out about the whole thing.

Her words:
My treatment plan is to not make myself crazy.
I approve. (I also may be impressing her sufficiently with my laid-back approach to peds that she may decide to bring the baby to me after all, even though she'd have to drive farther.)


At Thu Jul 26, 10:49:00 PM, Blogger make mine trauma said...

How nice that there really is an old fashioned solo practice Family Doctor still out there. When I was a child I believe such things existed. Now it seems everyone feels the need to practice as a group. Doesn't this generally mean that you may end up being seen by any of the partners (or the PA, APN or even MA?),not necessarily your own doctor?
This entry jogged some long forgotten memory of stories about F.P.'s that used to be a patients doctor from childhood to adulthood and then treating subsequent generations from those adults. The FAMILY Doctor. Now I get it! You may be a dinosaur but thank goodness you are not extinct.

At Fri Jul 27, 01:05:00 AM, Anonymous Anonymous said...

Up here in Ontario, group practice is definitely the way things are going, for many reasons. The government offers many financial incentives -- bonuses to your pay, yes, but more importantly, government funding to have nurses, pharmacists, social workers, lactation consultants, and dieticians part of your group.

For patients, it means that yes, you *may* end up being seen by the partners or the nurses -- generally when the main physician is too busy or on holidays (i.e. in a solo practice you would be seeing noone or a walk-in clinic that doesn't have access to your medical records). You also have access to an MD 24 hours a day and allied health at your fingertips.

A pretty good deal all around, in my opinion...

At Fri Jul 27, 07:57:00 AM, Blogger CrankyProf said...

One of the downsides to being pregnant/having a newborn is the absolute avalanche of unsolicited advice and opinion that you're bombarded with every day.

Being able to politely deflect advice and not make yourself crazy is a rare thing.

At Fri Jul 27, 05:42:00 PM, Blogger knitalot3 said...

Who knew a lactation consultant could order labs?!?


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