Occasional headaches

I like most of my patients. Especially when they simply tell me thank you. I feel like I run around all day, sweating profusely, and a simple thanks every once in a while makes everything I do worth while. Then there are the days when I wonder, “what am I doing here?” Those are the days my patients give me massive headaches. This may be more of a venting session than a blog but here I go:

#1. When my patients go to the local hospital for various reasons and forget to take their list of medications. Sounds harmless right? Well here’s what happens: my patient gets discharged with a completely new medication regimen because the doctors have no idea what they are taking. Then my patient gets confused about how to take their new medications. I don’t find out about the hospital visit and medication changes until weeks later because they didn’t call. When I arrive to their house for a routine home visit follow up, I find out they have no idea what exactly they were in the hospital for.  I’ve been told vague things like, “It had something to do with my heart.” Best part is, they have no discharge paperwork. I then have to act like a detective and go to the local hospital and figure out what exactly happened. Sometimes I'm lucky enough to get the discharge diagnoses.

Hillside has been trying to build a solid relationship with the local hospital for many years. Getting information from the doctors or nurses is tough. You get the vibe that they think you’re prying or questioning whether or not they are doing their job well. It’s an awkward and very difficult situation to be in.  The new doctors here at Hillside are thinking of volunteering in the emergency room on Sundays so we can get to know the hospital staff a bit better. They hope to strengthen our relationship with the hospital staff and hopefully they’ll feel more comfortable working with us. 

#2. Patients who lie about taking their medications daily. I know when you’re lying!  I give patients only a certain amount of pills every visit so I can keep track of their compliance. Many patients still love to tell me that they take their pills everyday exactly as prescribed. False. I can count the pills in their bottles and see that they have only taken a few days worth. If a patient is completely non-compliant, I’ve learned to sit down and have a serious conversation about it. There are many other people who would benefit from having the wasted pills (I’ve found pills don’t last long in the humidity and heat down here). I also let them have a choice whether or not they want medications brought to them. I encourage my patients to communicate with me, especially if they feel uncomfortable about a certain medication- I just need to be told. I do like to take the time and explain what each medication is for and why it would be helpful for their body. This seems to help many people feel more comfortable taking their pills as prescribed and many times they see great results such as decreasing extremely high blood pressures and blood sugars.

#3. Receiving labs after a blood draw can be challenging. Many labs cannot be processed at the local hospital. Patients' blood has to be sent up north to Belize City (by bus) to be tested. This can take weeks. Many of the times we don’t get the results for unknown reasons.

Examples of tests sent to Belize City:

-HgbA1C (test which reflects an average blood sugar level for the past 2 to three months)

-LDL (bad cholesterol)

-HDL (good cholesterol)

-Acid PHOS (enzyme)

-Potassium

-Magnesium

-Chloride

-Calcium

-Ferritin (iron)

-Chagas (disease)

-PSA (prostate specific antigen)

Patients are required to pay for:

-TSH, T3, T4 (thyroid panel) $50 U.S.

-CEA $60 U.S.

-PSA $30 U.S.

-HDL/LDL $5 U.S

-HgbA1c  $50 U.S.

*****If the patient has a social security number and we get the tests approved by the physicians at the local hospital- PSA, HDL/LDL, and HgbA1c can be paid for by the government.

Receiving the exact labs we ordered is difficult. Sometimes blood gets lost or tests weren’t done or data wasn’t entered into the computer ect.  There are times certain labs would be extremely helpful to have when figuring out what is going on with the patient.  We have to rely heavily on our clinical skills and work with the limited resources we have to do the best we can.