I saved my brain today.

The last 3 days my nose has hurt. Not like rubbing my nose too much and it's raw, more like I got smacked in the nose super hard. Sometimes I think I might be borderline hypochondriac - although I don't usually complain until it's really bad and then I start to read. Reading can be good, but I have tried really hard while in PA school not to over-read or to hold other clinicians to the same level that I treat patients - thoroughly and with up-to-date knowledge. The nose thing started abruptly, no digital trauma or any type of trauma except for maybe a week ago one of our dogs accidentally bumped me in the nose - but it never got sore. Then my nose started to bleed a little, then last night I ran a little fever and was a little pukey. Today, my cervical LN are sore and it hurts my neck to lift my chin. I've already done the research and my primary concern: facial cellulitis. i then notice a slightly erythematous area on the bridge of my very sore nose that's a little warm. I had to give in and go to the doc. Shawn was super proud of me - I hate going to the doc and pretty much never go unless it's life or limb. To make the appointment I have to try and explain these symptoms as concisely as possible and words get lost in translation and when I arrive to my appointment the MA says "so you have a cold huh?" Um, NO. My heart rate was 125, temp 99 and BP 110/70. The MA was sure the pulse was wrong but I could feel my heart racing in my chest as it done in the last 24hrs. Once again I tried to explain things to her. I don't think she was even listening - you can't listen if you are interrupting. (LaBoy's golden rule right? - Just give me 90seconds for goodness sake). Provider comes in (NP) - so I hear you have a little cold. Strike #2. I really hope I do a better job listening to my patients than this - how annoying. After I proceed to tell her how my nose hurts too bad to even touch it lightly she wants me to lay down to jam the speculum in my nose. Seriously? C'mon. She feels my cervical LN which are grapefruit size (ok not more like shelled walnuts or ping pong balls) and gets one more peak into my nose. Result: major septal infection, RTC 3 days to see if my septum perforated. High dose of Keflex and a little pseudophedrine. Not one mention of any cautions about using atbx - especially in a female of child bearing age from her or the pharmacist or mention about the risk for colitis as with all the cephalosporins. She didn't check a system above and below (inside my throat, ears), she didn't even listen to my heart for good measure. So what does all this mean - besides the fact I saved my brain from having an infection spread to it by going to the doctor... it means that providers lose something along the way. As a student we are extra careful in our exams, even as a beginning clinician I suspect we will give a little extra documentation and diligently ask questions and do a stellar physical exam. But when does this honeymoon period of exercising all those great skills we learned from the Great Gietzen or LaBoy end? I hope never. I hope my patients never feel cheated in my time with them or my thoroughness. I know there is a time and place to be quick and a time and place (like in prison) where you can't meet every whim of each patient - but I sincerely hope that my skills that I have learned in both communication and exam and decision making will never falter and compromise my patient care. The 50 y/o pharmacy tech showed more compassion and care and overall customer service in our short meeting than the provider or the MA. What's wrong with health care? So many things have to change and so many of these things won't change depending on who we elect in Nov to reform our failing health care system. I realize how very opinionated I have become regarding health care even more now as a PA student than even as a paramedic (although I have many sentiments about the flaws in that system too). Some of my gripes about health care may seem insignificant, and others may seem biased or crude or even discriminatory, but I haven't come to these conclusions all on my own. I listen to the patients and their complaints (like why are there grossly overweight providers preaching about the need to lose weight or how one patient refused to be treated by anyone on the floor that appeared to be obese.), I am a consumer of health care and I see first hand how I can be a change in the health care system and it drives me to hope that one day I can make more change (like insurance companies not punishing consumers for well checkups - how ridiculous!). I may not be able to change the world, the system or health care as a whole. But I can rest assured knowing that I can provide the best damn health care I can - the kind I would want to be given to me and in knowing I saved my brain today so that I will be around to implement this change.