Finishing up in San Diego

I am writing this towards the end of my assignment in San Diego. I’ve had a really good experience. San Diego itself is still a majestic place. The work side has been pretty straightforward and “easy” considering the complex geriatric patients I typically work with.  

The other PCPs here told me how impressed they are with me. That I surprisingly just jumped into the new role and rarely have any questions for them. They said typically new providers have tons of questions. I reassured them that it was likely because I already worked here before, albeit 5 years ago.

Some of the physicians are within a year out of residency, so they come to me with medical questions or to see if I agree with their plan of care. This has been quite flattering.

I have enjoyed getting experience in things I don’t see often in geriatrics such as sexually transmitted diseases, identifying developmental delays in children, and reassuring young adults that their abdominal pain of 3 months is not appendicitis.

Interestingly in California I noticed a lot of patients try to get short-term disability through their PCP for medical reasons. It must be a California thing because I am filling out disability forms on a weekly basis. This is in contrast to working in other states. Some reasons for short term disability include status post stroke, fracture, or cancer. I believe the state provides them with financial benefits.

It’s gotten to the point though that no one wants to work. For instance, I had a patient with diabetes ask for short term disability. He said it’s because sometimes he doesn’t take his insulin properly and his sugar drops. I told him there are millions of people with diabetes in the country, so if every one of them was on disability we wouldn’t have a work force. And of course, he needs to start taking his insulin properly.

One of the other PCPs told me she had a patient request short term disability for a low back cyst they had removed over a year ago… The short-term disability request has become the new narcotic refill request. Where patients start crying and put on a show if you decline authorizing them for short term disability.

I had a patient that I gave one week off for abdominal pain, who showed up one month later saying her job fired her because she never went back to work, and now I had to fill out HR paperwork stating she was out for medical reasons. I told her I felt like I was being taken advantage of because I only gave her 1 week off, and if she was in so much abdominal pain as she claimed, she would have completed the imaging and lab tests I had ordered by now. So, she started crying and saying she was so depressed etc. which of course she never mentioned previously. That’s probably been the only part of my job I haven’t enjoyed.

I usually see 20-22 patients per day, a mixture of them being phone visits. I often finish early and in between patients, I even read a book which I am able to finish in about one week.

They asked me to extend here for another 3 months. That would have been great except I already committed to working in Virginia in the spring. I wouldn’t want to back out of the Virginia job because I’ve had a good relationship with that company for the past 5 years. However, I wouldn’t mind returning to this specific clinic if the need arises again in the future. 

On my last day, the clinic staff spoiled me with breakfast – bagels and donuts for everyone. My medical assistants gave me some going away gifts. And my fellow Doctors and Nurse Practitioners treated me out for lunch. I thought that was so sweet and started to feel a bit sad about leaving. It’s amazing how you can develop relationships with people in such a short time. They are crossing their fingers that I come back!