Clinic, or How I Became a Drug Dealer

I'm doing a required rotation this month at an internal medicine clinic, and boy, is it cush. This place fascinates me. We work from 9:30 till 12:30 or 1, then eat (drug-rep) lunch, then patients from 2 till around 4 or 4:30. Wednesdays are half days, so we leave after morning clinic is over. One of the attendings only works half-time in the mornings, and on days when my attending cancels his clinic I work with her, which is nice.

It does have its quirks, however.

1. I have never worked in a place with so many drug reps. There is a constant stream of young, very attractive, well-dressed men and women in fancy shoes wheeling suitcases in and out of the clinic delivering samples of all the newest, most expensive brand-name medication. They buy us lunch almost every day, and they have several happy hours scheduled for the month. I think a drug rep is even bringing a pre-Thanksgiving lunch. We load our patients up with little sackfuls of whatever they may need.
   
2. It is apparently possible to work in private practice, internal medicine, with very few procedures, and still make a very handsome living. I'm not really sure how this works.
3. I like my attending, but he is a leetle bit crazy. He will sit in his patients' rooms and discuss every aspect of his life, and theirs, and they love him for it. I've been told by the nursing staff that it is my job to try to "hurry him up" and to chart for him. His handwriting is unbelievably bad--we've all heard the jokes about doctors' writing, but this is so bad I can't decipher it at all. Also, he'll document a clinic visit with only a few scribbles, maybe even just one "word", so even though he remembers every detail of their previous visits, I have no idea what the hell I'm getting into unless I find a note from a previous med student. Fortunately, I'm a talker, too, so he likes me.
4. This is the first time in my life I've ever seen a script written to switch a patient FROM Klonopin (long-acting benzodiazepine) TO Xanax (short-acting, highly addictive benzo). As a future psychiatrist, this move offended my very soul; I made the nurse write the script, as I just couldn't do it. Seriously, when the patient comes in asking for Xanax "because it just makes me feel so wonderful, the Klonopin just doesn't do it", it's probably not so wise to actually switch them to Xanax. Especially when the same patient then walks through to the lab asking (loudly and publicly) "Are you going to do drug testing? Just don't test for THC, okay? I smoked some pot the other day." While yes, Xanax is good for treating a panic attack while it's happening, taking it CONSTANTLY, throughout the day, is not really indicated. It would be like being drunk all day, actually.
5. For that matter, today I wrote the wildest script, all on one piece of paper: "Xanax 0.5 mg TID PRN #20, Vicodin 5/500 1 tab q4 hours PRN #20, Lunesta 3 mg 1 tab qhs PRN, Buspar 15 mg daily." Oddly enough, the patient was in too big a hurry to actually get his labwork. He also was very reluctant to take ANY kind of anti-depressant, even for his anxiety or for smoking cessation.
6. Since I've been in this clinic, I've seen more scripts for Xanax, Soma, Flexeril, Vicodin, and antibiotics for viral URI than I've ever seen in my life. We also prescribe a lot of Cipro for prostatism (urinary frequency, nocturia, incomplete emptying), even though there is no evidence that most of the patients who present with symptoms of BPH have any form of infectious prostatitis.

However, an amazing thing happened today. I met a quiet, unassuming man, in for a simple check-up. When I went to present his case, my attending asked, "Did that guy tell you who he used to know?" Uh, no. Didn't get around to asking that in my ROS, sorry. We went in and the patient was pressed to tell me who he used to "run around with." It turns out that my patient marched with Dr. Martin Luther King, Jr. WOW! He talked about being hosed out of a sit-in, and how hard they had all fought, and how he hears racism coming from both sides even now. I was just totally in awe. Sure, all of us now say racism is bad, racial equality, no discrimination, etc., but it is entirely another thing to march when the forces of the state are aligned against you, people are going to jail, being beaten, humiliated, and even dying. Would I have the guts to be Rosa Parks? I doubt it--I'd probably have said "yes, sir" and gone to the back. It was such an honor to talk to this man, like hearing a piece of history, that I certainly did not "hurry up" the attending in that interview.