Tuesday, January 20, 2015

Work breaks, back logs and psychosomatics

I'm a week back from a couple of weeks in Istanbul and Turkey.  It was an incredible learning experience with daily touring and education in mosques, churches, museums, art galleries. I really felt like I was in an "immersion" program, far more intense that my medical study programs.  I had read extensively and taken multiple audio courses before going. Then while I was therein addition to have a guide I was reading and writing daily.
Returning home I was most afraid of the dreaded post overseas airplane 'flu'.  So often I've caught a cold travelling. Once I returned from the third world with dysentry but mostly I've just developped winter colds because of the stress of long flights and contact with so many different people in closed spaces.
Many doctors I know and many businessmen don't take time off from their work, simply because the back log is overwhelming when they return.  I've resisted the temptation to stay in the harness and cope with the excessive daily work.  Instead I take these study breaks and even go on vacation.  Extended weekends don't cause much back log but whenever I'm away from the office more than a week it's bedlam when I return.
When I return from Russia last spring my staff had left and returned to inform me they'd decided they didn't want to live in Vancouver.  The backlog combined with staff turn over was murderous. I worked weekends for weeks and late into the night each day.
There haven't been sufficient psychiatric resources in Vancouver in decades.  If people with physicial disease had to face what people with mental illness do on a daily basis they'd go insane themselves and add to the overwhelming backlog.
When I graduated I saw people weekly and had a waitlist of a month or two.  Now I'm more likely to see people at 1 to 3 month ,sometimes 6 month, intervals and had a 2 years waitlist till I limitted patients to my very specific subspeciality area and also more commonly accepted patients from family physicians I knew.  Increasingly general practitioners and especially walk in clinics want to cherry pick their patients and 'dump' more complex or complicated cases (see psychiatric cases) on the specialists.  All the 'cream' has long been taken from medicine by the midwives, psychologists, counsellors and health food stores.  The 'worried well' just aren't the issue they once were in the standard medical practice.  Probably because they want 'strokes' and only the 'alternative health care folk' have the resources of private funding to entertain the 'worried well' or 'walking wounded.'  Too often the public health care system is serving only the most desperate.  Everyone that pays taxes should have access but often government health services 'triage' resources for the most desperate meaning everyone else is waitlisted months to years.
When I began in psychiatry my patients rarely had more than one or two diagnosis.  Today it's more common for my patients to have multiple psychiatric and physical diagnosis and often major social and financial issues.
When I go away there's no one I can refer to.  It's been 20 years since I could have another specialist 'cover' my practice.  Last year I saw several patients from practices of my cohort clinicians who were simply 'orphaned' when their doctor retired.
In the British Columbia model every patient seeing a specialist must be referred so when the specialist is away the family physician is supposed to provide the care alone.
The irony of this is that only last month it was made public that Quebec doctors on average were seeing only 10 or 11 patients a day whereas the physicians in the rest of Canada were seeing at least 30 patients a day.  Most GP's I know are seeing more like 50 a day in Vancouver.
There's just not any 'fat' in the frontline systems.  Of course this doesn't speak to the Monday Morning Quarter backs.  The Canadian health Care system compared to the German Health Care system has 20 x the administration with no evidence that any of that administration is improving health care delivery or services.
I think I'm just belly aching because despite my best efforts I fear I may be getting a 'cold'.  A facebook cartoon went around about the "ManFlu" with the proverbial woman asking the sick guy in bed, 'can I get you anything, orange juice, soup, kleenex, your balls, maybe?"
I got back last week and all I could do was face the deluge of work that was waiting for me. I was in the office till 7 or 8 each night and missing lunches and hardly taking time to pee.  I had a series of other obligations but the emergencies and despiration demand just took precedence. All I could do was go to work, 'put one foot in front of the next', 'do the next right thing', then get home and sleep. Jetlag was a problem because I was waking at 3 am.  I'm thankfully back to a good nights sleep but now I've the dreaded post nasal drip.
People have cancer, bullet wounds, bankruptcies and alien abductions. Meanwhile I'm here swallowing to see if the throats any rawer.
The fact is it's all psychosomatic.  I'm a whimp. I have 'self pity' at having work, I should be grateful and thankful and glad to have a purpose and use. So normally when I 'overwork' I get sick because as a child being 'sick' was the only way I could miss school.  There were no 'mental health days'.

I have a resentment at the government services too. Alright I admit it I've a resentment at Billionaires. Inflation being what it is I want Bare Naked Lady to put out a new song, If I had a billion dollars, just to keep up with the times.  There's just so much waste and misuse in the system and no one asks me to be Sultan or Emperor. Instead we have millions being made on heroin and cannibis and I'm here like the proverbial dutch boy trying to get people off drugs when the real money is getting people addicted.  Self pity.  Poor me.

It's the January in BC blas and I've been on vacation. Imagine the poor sods who just have to live through January.  Worse is those Climate Change Deniers in Winnipeg and the prairies who have lost all faith in spring with the snow deeper and streets dirtier.

All I've got to complain about is post nasal drip. But I'll milk it.  I'll whine.  Tonight I'll go to bed early. I missed the first week back onslaught of disease but fear I've taken a shot on the second week.  Soon I'll be in medical student ichthitis, convinced I'm dying and certain I've a new Canadian ebola strain when all I have is at best the 'manflu'.  It's so embarrassing.
The other thing that gets me is lice and scabies.  I'd rather run from polar bears. Except I'm feeling lethargy.

Well I'm here, not contagious, not coughing, but sharing my evil thoughts rather than singing hallelujuahs and praising the Lord.  Maybe a trip to Japan for a little radiation would save me from that horror of horrors, the 'man flu'. A man flu can need a dose of Chernobyl.

Really I just think I should have a nap. Nap time should be mandated for all over 50.  A little nap would be good right now.  If I wasn't self employed I'd get the union to lobby for comfy cots and afternoon nap time.  Imagine as a kid I didn't like the kindergarden 'nap time'.  What a fool I was.

I think this blogpost started out as something meaningful and now has devolved into something pitiful. Patients have come and gone and between them I've added disconnected lines. Gilbert is groaning below the desk.  We've had a walk together.  I just "think" I may be getting a cold.  I can't remember how many times, this time of the year, I've been gargling vinegar, dousing myself in vitamin c, sometimes on antibiotics and always gargling and drinking endless soup.  Maybe I've got PTSD from living years in Winnipeg in January and just have flashbacks out here on the coast.
I got the flu shot.  I prayed. I'm a good man.  Why am I being punished? I can feel that tickle in the back of the throat like jalopeno snot just building there.  I remember when I would switch to smoking menthol cigarettes when I had these 'throat ailments'.  It's the big scnoz weakness. If I had a smaller nose maybe I could keep infection out better.

Can't I just go back to bed, pull the blankets over my head and come out when the crocuses and tulips come out.  Here that's only next week or the week after.  I'll shake this off somehow.  Typically, I'll think I can't afford to be sick.  Get thee behind me Satan.  I cast the demons out of the schnoz and pray for healing sleep tonight.  Maybe it was just the propane heater last evening.  Another source of self pity.  They're cleaning the mould in my winter home.

 Maybe I'll get some Vicks and wrap my psychological throat in socks and remember my mother caring for me when I was a kid.  Those were great days and I didn't fully appreciate them at the time.  I miss my parents and aunt as I get older. I think a good reason for death is to get together again with all the folks that have gone.  Grand dad and grandma were others I took for granted.  Now I'm older I wished I'd talked and listened more to them.

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