doctoring,why do they

DOCTORING
whats a week like in the office
work now only in the clinic seeing patients
our group keeps hospitalists in the hospitals to admit patients
they assume their care in the hospital
patients come back to us after they are discharged
our pediatric patients are admitted to a local childrens hospital
by a pediatric hospitalist group

see newborns children adolescents adults and their parents
have some 4 generations to care for

as family physician see everything
realized dont have to know everything about medicine
just need to reocognize when something aint right with a patient
with computers and specialists that will help out it is easy to
diagnose and care for patients than in the past

looked back at a week in the past
here is example of patients seen in the office
1 week olds mom called for appointment for infant
she ran fever of 100.7    in the office she had no fever
 she was eating ok    she was fussy
she had unremarkable stay in nursery
she looked ok on exam but was maybe a little irritable

concerned for the fever in newborn so she was sent to the
childrens hospital for evaluation   she had kidney infection and had
bacteria in her blood   she received 1 week of iv antibiotics
she was fine on office visit after discharge

instinct and following the no fever in newborn rule  helped to
recognize there was a problem

last year saw a child with vomiting and diarrhea  x 2 days  
he was not taking his fluids well and had just started to have diarrhea
he had high fevers    take care of all of the family so know this child
and his siblings and parents well  
so was easy to recognize the degree of illness he had
checked labs on him that showed he was dehydrated
since knew mom well and knew she would keep him hydrated
sent him  home with nausea meds and instructions on rehydration

he developed severe diarrhea over night    he was taken to
emergency room where he received iv fluids over several hours
he was discharged home     within few days he was able to return
to school    
he had a salmonella infection like what was seen recently from
contaminated eggs

last may saw teacher with 2 months of coughing
he saw someone else in an urgent clinic  was given antibiotics
initially was better but then became worse again
he probably had pertussis or whooping cough as we had
a lot of students and adults with it at they time

he had not had his Tdap update which has pertussis in it

he was placed on a second round of antibiotics
was given bronchodilators and cough meds
he gradually improved

adults should have Tdap every 10 years-protects against
tetanus and whooping cough

saw patient who is 75 and is a long distance runner
she is in great health  only medication is a low dose statin
drug for her cholesterol and takes aspirin
she still works 20 hours a week

she developed low back pain this summer and had to
stop running     then  she developed right hip pain-probably has
arthritis in the hip
now she has developed bronchitis and asthma like problems
she has not been able to run for several months now

she has that dwindle look to her

see patients as they get older to gradually start developing
health problems that prevent them from doing those activities
they normally like to do
will need to watch her closer for depression and changing health problems

some days will see a newborn their sibling  their parent or grandparent in the
office      is one reason chose family medicine

WHY DO THEY
why do they charge more for gas in california than in texas
why do they put lights on riding lawn mowers

the organicgreen doctor