The word is out among my patients that I'm good at cutting things off of people.

[Aristus]

The number of lesion excisions, sebaceous cyst drainage, and skin-tag removals I've been doing has increased exponentially lately.

There's an amusing 'I-heard-from-a-friend-who-heard-from-a-friend' quality to some of my clinic visits.

I'll get a patient fixed up on an unrelated issue (Diabetes, acute URI, anything...) and then he'll pull up his shirt and ask: "Hey, can you get rid of these?" It's kind of fun.

I like procedures. Unlike a lot of treatment plans that require repeated follow-ups, monitoring, tweaking, and re-trying, a procedure allows for visible, same-day results. That's satisfying.

[Ino]

1. Where are you?

I'd like to see a doctor who'd do "extras" without making me schedule another appt.

[Aristus]

2. I didn't mean to give you the wrong impression.

I only do 'same-day' procedures on rare occasions when clinic is slow and there are no other patients waiting. Usually, I have them schedule a specific appointment for the procedure, and most often for the last slot of the morning or of the day. That way I can work uninterrupted, or without having to worry about other patients who may be waiting. Sometimes I defer a procedure for medical reasons. The patient's blood pressure is too high, or something like that that is a contraindication for an invasive procedure.

Patients often complain, with justification, about long waits to see the provider. And many of them are the result of other patients asking, usually after I've wrapped up the reason for their visit: "Oh, one more thing..." On rare occasions, it's something that can't wait, and has to be addressed immediately. but usually, with the clock ticking and other patients waiting to be seen, I'll say: "This looks like it can wait for another visit. I'll have time for a more comprehensive evaluation next time."

[The Second Stone]

3. Mazeltov?

I can think of a moonlight job attending a lot of parties called "bris".

[Aristus]

4. I haven't been trained to do circumcisions.

And I don't have any pedes patients, anyway. Adult medicine only.

[The Second Stone]

8. Oy vey, such a stickler for rules all of a sudden

transgendered operations it is then! Is someone obsessed with his willy? Why yes, yes I am.

[TrogL]

6. I've got a liver spot on the back of my hand that went to seborrheic keratosis

Is there any way of removing them?

One doctor froze it with liquid nitrogen but it's starting to grow back.

[Aristus]

7. I just do a shave excision for that.

Never tried cryo therapy. Either way, there's no guarantee it won't recur.

[mrmpa]

9. With thanks to californiapeggy for the phrase, "My dear Aristus"

I read your posts quite often. I want to thank you for what you do. I visit a free clinic here, I don't mind the wait to see the Doctor or the Pharmacists. After being without my diabetic medication for 6 months, I was able to get it from the clinic. The Doctors and staff are very compassionate.

Last month I was able to get into the eye care clinic. I knew my cataract had gotten worse and it has. I am waiting for the phone call from the hospital & doctor who will do the surgery pro bono as I have no insurance or job.

I thank the Doctor and the rest of the staff every time I go and again thank you.

[Aristus]

10. Aww, thanks...

That was a nice note.

I love what I do, and really feel like I'm helping to make a difference. Life on the streets is hard enough without having to defer medical care. And although many of my patients work on a regular basis, (giving lie to the right-wing notion that the homeless are lazy freeloaders) the jobs they are most likely to land don't include health insurance. It feels great to be able to give homeless patients the care they need, in a setting where they know they will be treated with respect.

It has the added value of keeping patients out of the emergency room for primary care, saving the taxpayers a great deal of money in hospital care write-offs of uncompensated care.

[AnneD]

11. As a Nurse...

I am partial to wound care. It is very satisfying to see results quickly. In fact, I am even thinking about getting certified in it after I retire from School Nursing this year.

[Aristus]

12. Go for it!

I admire Wound Care Specialists. It's not something I could do all the time...

[AnneD]

13. Yeah....

I started out as an aide in the Head and Neck clinic at MD Anderson. I remember the Head Nurse asked me if the site of people that were post facial reconstruction surgery would upset me. I told her that I really didn't know, but if it did, I would let her know. She appreciated my honesty and they hired me anyway.

It was really funny but it never phased me, and I saw things that would churn most folks stomachs. Now I could not sit through a sinus irrigation, despite my best attempts but that was it. In fact, I became the best translator they had. I even amazed myself at what I could understand as people using flaps, partial tongues, etc. and it could sometimes be difficult and they would feel self conscious.

The best one was when a woman came in only speaking Arabic. She had her son translating. I was asking her routine questions and was writing down the answers before he son finished translating. Then she asked me a question. Before the son even translated, I told her I had one daughter. Amazed, he asked me if I spoke Arabic. I told him no but that all mothers spoke the same language. He translated and we all laughed. She ask again and before he translated I told her my daughter's name was Leila. The son said he knew I spoke Arabic because Leila is Arabic. I told him it was a pretty name (they wouldn't understand Eric Clapton) and that it was popular in the 1800's. Until they came in I had never met anyone from SA, but they thought I was holding out. They were my favorite patients and were always kind to me.

[petronius]

14. Meh, I'm sure I'd be good at cutting things off of people, too

As long as we weren't being finicky about pain, scarring, and excess bleeding that is...

Seriously, congratulations on that skill! I've always appreciated a good clean excision - much better than when some fumblefingers goes at you with the semi-sharpened melon-baller (or at least that's what it felt like).