PCP: Hard Lessons

This entry tells what happened yesterday. I forgot to update because it was the longest day ever. With only Dr. P and an NP named Angela (whom I've met previously) to care for about 35 patients, we didn't get out until after 6:00 pm. And although Angela had many years' experience as a nurse, she still had to run through her patients with Dr. P so he could sign off on prescriptions and approve her treatment plans. (One of her patients was the little boy with epididymitis that we saw the other day; he was placed on antibiotics and is doing much better. As for the man with the testicular masses, his sono came back suspicious for either lymphoma or metastasis. More workup must be done) Because of this, Angela took a very long time with her patients and was soon more than an hour behind schedule. The staff grumbled a bit about how she took too long, but they weren't the only ones. Most patients are allotted fifteen minutes' time with Dr. P, but the more complicated patients (the ones with multiple medical problems or counseling b/c they're depressed or newly diabetic) take way more time than that. Because of these lags, people get in later to see Dr. P. At one point we were nearly one hour behind schedule, and people in the waiting room were getting pissed. I asked one patient, a pediatric nurse, if the wait was that bad. She said no, but that non-medical people don't understand how it is. "It's like I tell my patients: if it were you with the doctor, wouldn't you want his undivided attention?" True that. Another time we could hear a patient in one of the waiting rooms loudly griping on the phone about how long he'd been waiting to see Dr. P, and Dr. P immediately went in to talk to him (and placate him)

One of the saddest cases I saw yesterday was a 74-year-old man named R with late-stage Alzheimer's disease. His MMSE (mini mental state exam) two years ago was 11/30 (pretty bad), so I knew when we saw him it would be much worse. He seemed friendly enough and said hello when Dr. P greeted him, but he didn't know Dr. P (or anyone else) by name. His wife (who came with him) told us that he was in Depends full-time and recognizes familiar faces but not names. Here's the result of Dr. P's version of his MMSE:

Dr. P: R, how many children do you have?
R:...I don't know
Dr. P: How many animals can you name off the top of your head?
R: Animals? I don't know.
Dr. P: How many colors can you name?
R: Colors? I...I can't think of any.
Dr. P: Where were you born, R?
R: ....
Dr. P: Did you grow up in a city or in the country?
R: I don't know.
Dr. P: Last year you told me you were born in Mississippi.
R: Yes! Yes, that's right!
Dr. P: And you grew up on a farm, is that correct?
R: Yes.

Later Dr. P told me that the last time he saw R, R kept repeating himself by telling where he was born and that he lived on a farm, but at least he could recall those long-term facts. Now he can't even remember those. This was my first time to see late-stage Alzheimer's up close and now I can really appreciate how hard Alzheimers' is on family members as well as patients. R's wife clearly loves him and is caring for him full-time, and he can't even remember who she is. I hope I never get Alzheimers. They say that if your mind is constantly active, you're less likely to get Alzheimers. So hopefully my love of Sudoku, my appreciation for the fine arts like dance and music, and my violin skills will save me from losing my mind.