Too Hard or Too Easy

Several weeks ago I made the decision to move from working in the hospital to the clinic. For five months I was a "hospitalist". I only did inpatient care of our hospitalized patients. It was a great experience in many ways, one that I will never forget. But, there are no days off in the hospital here. I was going nuts. 157 days in a row of seeing blown up people has a tendency to do that! One of the family doctors working in the clinic wanted to get some hospital experience. There was a small window of opportunity to make a change, and we took it.

For the past several weeks I have been spending my days in the comfortable confines of the The Outpatient Clinic. They actually made me the boss as well. The hours are set. There are few surprises in the workload. The pace is very reasonable. And, I actually had a day off as well which was amazing. Nevertheless, there are still plenty of challenges even away from all the trauma patients. To be a good clinician in the outpatient world you must be efficient. Nobody likes a doctor who runs behind schedule constantly. It makes everyone irritable including the staff and the patients. Do you ever remember waiting a long time at a doctor's office? It is not the most pleasant of experiences. The bottom line is that as a doctor you have to do the best you can to get people in and out of there. It can make for a real grind especially in a high pressure clinic.

Our clinic here is far from high pressure. But, we do get patients referred to us from all over Afghanistan. It can be interesting at times. Recently, there was a patient I thought had a rare condition called occipital neuralgia. I injected some medication over a nerve on his scalp. It relieved the headaches he had been having for 3 weeks within a few hours. Several days later he is still headache free. Now the patient thinks I am REALLY smart which obviously is not the case. For every good case that we have like this, there are at least 3 bad cases. What I mean by this is that other doctors and physician assistants "dump" patients on us. When the patient becomes too difficult to figure out, they send them to us. When the patient has an alterior motive, they send them to us. When the patient is drug seeking (they want morphine), they send them to us. When it becomes TOO HARD to do the right thing, they send them to us!

It is easy to give someone a hundred morphine tablets when their back hurts. It is easy to make up a diagnosis when the patient demands an answer. It is easy to order a test instead of telling the patient that you do not think anything is wrong. It is easy to prescribe antidepressants instead of taking time to find out more about why the patient is crying. And... it is TOO EASY to send the patient to another doctor when they are too sick or too broken to serve in a war zone and their commander wants "boots on the ground". After all, the pentagon is very concerned about how many troops are here. Thus, commanders do not necessarily care if a soldier is healthy enough to do a job because the mission comes first.

This is what we deal with every day in the clinic. It is not glamorous. It is not exciting. Actually, it is frustrating as heck. But, it is a job that has to be done. Nobody will ever give me a medal for filing the most paperwork to send sick and broken troops home. The exact opposite of that is true. Nevertheless, I was taught in my training to be an advocate for the patient no matter what. In the end it is very difficult to do what is the right thing instead of avoiding what is TOO HARD or doing what is TOO EASY.