Melissa Young, MD

One of the great things about medicine is that you interact with all kinds of people every day. Male, female, young, old, people of different ethnic backgrounds and economic status. These interactions can be moving, challenging or funny, but some can be frustrating. Here are examples of some of my patient encounters which serve as reminders of how essential patient education is in clinical practice.

Please take your shoes and socks off (even though there are signs that say, “If you have diabetes, please remove your shoes and socks so we may examine your feet.”)

  Just the ones you don’t want amputated.

Many patients are unaware that diabetes is the leading cause of non-traumatic amputations in the U.S., as well as the leading cause of blindness and dialysis.  It is important for them (and us) to look for early signs of damage so that we can prevent progression.

"Have you been taking your pills every day?"

  So, have you been taking your pills every day?

 There wasn’t a time when you ran out? You didn’t skip any?

 Oh, OK. Because your Hba1c went from 6.9 to 8.3.

  Oh yeah, I stopped pill number four months ago.

Patients are on many medications-several for diabetes itself, then more for hypertension and hyperlipidemia. Medications can be discontinued for a number of reasons:  Cost, side effects or even pill burden. Before we decide we need to add more drugs to the patient’s regimen, we need to make sure they are taking the medications listed on their chart.

-Next page:  "How often are you checking your blood sugar?"

"How often are you checking your blood sugar?"

 How often are you checking your blood sugar?

(looking at meter download):  There’s one blood sugar in the last two weeks, and that’s from today.

Self-monitoring of glucose is important. It gives patients immediate feedback on the effect of food, exercise, medication and illness on their glucose control. For physicians, it is necessary data so that we can better fine-tune their medication regimen. Patients sometimes say want they think we want to here, not the truth. We need accurate data in order to come up with sound treatment recommendations.

-Next page:  "I can eat all the blueberries I want, right?"

"I can eat all the blueberries I want, right?"

So, I can eat all the blueberries I want, right?

 No, you can have blueberries, but not “all you want.”

They do have vitamins, but they are sweet because they contain sugar. 

Too much of a good thing is bad. Very often patients eat foods they think are healthy and eat them in excess. Fruits provide fiber and vitamins but contain natural sugars. Whole-grain bread, for example, may have fiber and is better than overly refined white bread, but they are still carbs.

-Next page: "I can't lose weight no matter what I do."

"I can't lose weight no matter what I do."

  I’m tired and I can’t lose weight no matter what I do.

 I don’t know what that means. Are you dieting? Counting calories? Measuring portions?

 Well, it’s not like I’m sitting around all day.

So, when you say “no matter what I do” you mean not dieting or exercising.

Lifestyle modification is essential for both weight loss and diabetes management. It requires conscientious decisions about food choicesand physical activity. Many patients point to factors outside of their control instead of adopting lifestyle modification.

-Next page: "I don't understand why my blood sugars are so high."

"I don't understand why my blood sugars are so high."

 don’t understand why my blood sugars are so high at lunch time.

  That’s just it, I don’t even eat a real breakfast.

  So, you don’t eat anything all morning?

Patents often underestimate the carbohydrate or calorie content of the foods they eat. They think a bagel isn’t breakfast, a couple of sliders isn’t lunch and a flavored sweetened latte is “just a cup of coffee.” But nothing can be discounted, even a standard white bagel which at 51.1 grams of carbohydrates consumes 19 percent of a day’s daily carb intake.

Articles

“Please take your shoes and socks off”

I wasn’t completely forth-coming in last month’s

. While I said I had been mulling over whether or not to hire a new associate, there is actually an imminent reason I have to consider hiring a new associate. Two months ago, my current associate came to me, tears welling in her eyes. I knew it before she even said it.

She found a better opportunity in another town. Her family believes this will be better for them. I sat quietly and asked a couple of questions. Where exactly is she going? When is she leaving? She said I was taking it surprisingly well. I said I had to be objective and make plans; I didn't have the luxury to be emotional right then. She asked me not to be angry. Why should I be angry?  Would that make her stay?  And not to hate her. How can I hate her? 

Nine years ago, I was exactly where she is now. After working for a faculty practice for 8 years, I walked into my senior partner’s office and told him that I had to talk to him. Then I broke down and cried. I think it freaked him out. He was sure something horrible had happened. I told him that I had given it a lot of thought and I had decided that I wanted to leave and go into private practice. I can’t quite say what exactly was the deciding factor, probably a change in the work environment and culture coupled with a growing desire for autonomy. I had done my research. I had a business plan. I was (mostly) certain it was the right thing to do for me, my sanity, my family. So why did I cry?  As I explained to him, it’s like you’re breaking up with someone. You know it’s what you have to do, but you are leaving behind part of your life, part of your past, and you worry about who is getting hurt by your decision.

So, off I went into the uncertain waters of solo practice. But I was only solo for a year. I hired a new associate. Someone I knew, someone I had helped train. She has been with me for 8 years. Eight years, how ironic.

I had been hoping to start cutting back on my hours, just a little, so I wasn’t so frazzled and stressed. Just enough to prevent impending burn-out. Now I have to decide, do I stay solo or do I look for a new associate?  For now, I am going to absorb some of her patient population. Then I have to decide, can I keep seeing new patients? Do I limit my scope of patients? To keep my sanity, do I cut back on how many patients I see a day? Do I have a mental health day periodically?  Do I keep buying Mega-millions tickets so I can retire early?

I have a huge transition period coming up. She leaves the end of December (I have a trip that I had planned over a year ago and she was gracious enough to delay her departure until I get back). Right now, it almost doesn’t seem real. Everything is still business as usual. So no, I don’t hate her.

But I told her to ask me again in January.

My partner is leaving in December. She asked me not to be angry; not to hate her. I said I couldn't and wouldn't -- but to ask me again in January.

Parting with a Partner is Hard to Do

Because I'm not really sure I acutally want one... 

I started my career as an employed physician. I was the second endocrinologist in a faculty practice in a community hospital. After 8 years, I decided it was times to leave. I started my own practice. I was solo for about a year. Then I hired an associate. It was easy then. I knew her already as she had been a resident and then a fellow at my former practice. I knew her both as a person and as an endocrinologist and I was confident things would work out.

I was right. And those who know us would agree. Several people have stated that it is remarkable how well we work together and how well we get along and that the same isn’t true in many other practices.

Over the years, I have casually looked for another associate. I’ve interviewed a handful of people. There were a couple who I thought might be a good fit. But for one reason or another, nothing really came of those interviews. I didn’t worry about it before. We were doing alright just the two of us. We had our routines down and we made things work, although we both knew that one more person would lighten our load.

I am contemplating again whether it is worth it to look for someone else to join us. Whether it is worth it financially. You know the first year or two, until the schedule is full, the practice loses money on a new associate. I’m also not sure if I can either a) get used to having someone do things differently than I do, or b) teach someone to do things my way, or c) find someone who already does things the way I like it. I feel like I’ve been doing this too long to start doing things differently. I don’t mean to sound inflexible, but I’m comfortable with things now and I was really hoping to just start easing back a little.

I’ve started casually asking around again, seeing if anyone knows anyone who might be interested.  I guess I’ll see how the next few months go, and I’ll decide if I need to get more serious about looking.

Do you have any thoughts/experience you'd like to share? Drop a line to the 

Even though my practice partner and I are perfectly fine together and have been for years, I wonder now and then if we should hire. Still wondering.

Author | Melissa Young, MD

Articles

“Please take your shoes and socks off”

Parting with a Partner is Hard to Do

Wanted: New Associate (Maybe)