Monday, September 25, 2006


I guess the spiritual Dramamine worked. The vertiginous feeling subsided and the working week began without dizzy spells, despite a poor night's sleep.

This is the second week which has begun gently, without the Monday morning explosion of need that can at times feel crippling. I even had spare time to offer a co-worker help with some debilitatingly tedious paperwork. That's one for the karma bank, I guess.

Each month, I try to at least make some effort towards contact of every patient on my caseload. Using the small spreadsheets that I've created to assist with this task, I keep track of who's been contacted, who's MIA, who hasn't returned my calls, who doesn't have a phone and was sent a letter. As the end of the month nears, I peruse my lists for a snapshot of the month's heavy hitters and frequent flyers, and it is blantantly clear who has not surfaced at all.

In care management, case management, and any situation in which many people are on a panel for one provider, it is always classically the squeaky wheel who gets the grease. The patient who calls incessantly, makes alot of noise and demands action---that's the person who consequently gets the attention. Most of those attention-getters are savvy and know how to capture me and focus my gaze in their direction, and their efforts are generally rewarded. For those who abuse it, they may be reprimanded gently and asked to consolidate their multitude of calls into just a handful, saving up problems and questions for a once-weekly check-in.

One patient of mine is very dear to my heart. She has multiple medical problems which are not necessary to this story, only to say that her pain and other symptoms cause her considerable distress and worry, leading her to schedule a plethora of appointments, often unnecessarily. Her children also have many medical and psychological problems themselves, and at times I wonder if she may display some symptoms of Munchausen Syndrome by Proxy, although I'm also aware of a movement of mothers who advocate against unnecssary and false allegations of Munchausens. That said, it's a very sickly family no matter how you look at it.

In terms of squeaky wheels, I guess she takes the prize, calling me with the most trivial news. To wit, "I'm just calling to tell you that the pharmacy only had ten of my pills and I'll have to pick up the rest tomorrow," or "I just called for my refills and they'll deliver them on Friday." Her sweetness and childlike innocence prevent me from getting too annoyed, and I occasionally ever-so-gently request that she not call with such trivial messages. I counter these comments with praise for her ability to keep track of a multitude of appointments and prescriptions needing constant attention and vigiliance. She may be a little mentally slow, but she is anything but disempowered. She may be a squeaky wheel, but she does it with such innocent guilessness. She really is a peach.

There are enough moments of sweetness and connection to keep me afloat, even amidst the onslaught of stress. I have to hold onto those moments like oases in the maelstrom, and try to let the stress simply flow by instead of drowning me in its tumult. Today was a success in that regard. May tomorrow be moreso.
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