Despite working in a private practice family medicine clinic, today I managed to land all of my neighborhood’s psychotic patients who came in seeking primary care.
1. Lady with borderline personality disorder came in asking for a steroid injection into her knee. Her regular doctor was out of town and she demanded that we perform the procedure. As I tried to take her vitals, take a history, and even find out what medications she was on, she kept angrily replying, “All that information should be in my chart! Just give me the shot.” On physical exam, I noticed that she had multiple linear scars on her arms pointing in different directions, a sign that she had been cutting herself for a very long time. She tried to explain the scars by saying, “I have a lot of cats.” We sent her home with a prescription for tramadol and told her she would not be getting a steroid injection from us.
2. Schizophrenic diabetic man came in with peripheral neuropathy of his lower legs. Essentially, that means that his blood sugar has been uncontrolled for such a long time that now the nerves in his legs are severely damaged. The man can barely feel his feet, and what sensation he does have left he describes as constant burning and tingling. He even lost the hair on his legs because his diabetes had gone on for so long. When I asked him how he checks his sugar at home, he replied, “That machine is just too damn complicated to work. I’m so fucking frustrated with how hard it is because I’m a genius. No seriously, I’m a genius.” He then went on to tell me how he had witnessed UFOs and how aliens had been healing his friends of their illnesses. He was wondering when the little men would be paying his home a visit to take care of his illness. We gave him a prescription to Lyrica, which he then forgot on his way out. He never did come back.
3. A couple in their 70s presented for a routine checkup. The man had been diagnosed with OCD previously and had minor anxiety attacks with everything I told him. Since he was about 24 years overdue on getting a colonoscopy, I told him that he would need the procedure to look for any signs of colon cancer. He just about had a heart attack. The wife—who is now on husband number 3—consistently yelled at him to shut up while the doctor was talking. They’re a solid example of marriage as a failed institution.
I surely have lots of respect for you primary care doctors. With the awful payment structure that is bestowed upon generalists, I just don’t see how you guys do this day-in and day-out. Outpatient medicine really is the seventh layer of hell for me. (Layer number six is general surgery.)