Relocation – It's Not for the Weak
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by Jarrod Shapiro, DPM
Joined Mountain View Medical & Surgical Associates of Madras, Oregon July 2008
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The worst part of relocation is the actual moving. As physicians most of us have been forced to relocate several times during college, our training, and early careers. I’ve managed to move 10 times in the past 10 years! Few things seem to test our patience, preparedness, and perseverance better than moving. Additionally, moving is almost always more expensive than we budget for. To this end I wanted to provide a realistic view of the expenses incurred while relocating. This will apply not only to those in my situation (relocation after a short time in practice) but also for residents completing their programs, students, and even practitioners who are moving to new opportunities. Before I dig into the nitty-gritty of moving, I wanted to answer a question I received a short while back. |
Are You an Ostrich or a Snake?
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by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K Throckmorton, DPM
Lansing, Michigan |
I don’t like to get too heavy handed with the metaphors, but over my short career, especially in wound care circles, I’ve found there are two basic types of patients: ostriches and snakes.
What do I mean by this? LET'S FIRST TALK ABOUT OSTRICHES:
When an ostrich senses the presence of a predator, it will lay down with its head and neck flat on the ground —
making the appearance of a mound of nondescript earth from a distance. When directly threatened, an ostrich will run away. This is most likely the origin for the idea of burying one's head in the sand (although ostriches have never been seen actually performing this activity). |
WHAT ABOUT SNAKES? What does a snake do when it’s threatened? It strikes.
Simple. “Mess with me, and I’ll bite you!”
My patients seem to fall into one of these two categories, with small variations in between. When confronted with a potentially disturbing problem they’ll either bury their heads in the sand or attack the problem head on.
A couple of weeks ago I saw one of my established patients with stage 2 PTTD. Its been very painful for her and she has been recalcitrant to all treatments (cam walker immobilization, Ritchie brace, Arizona brace, anti-inflammatories, shoegear changes, and two full courses of physical therapy). She's in pain, limping, and having difficulties with daily activities, so I recommended surgery (for the second time). What was her response? “Doctor, do you think another few weeks in a boot will get rid of it? How about another round of physical therapy?” She’s very actively the ostrich. Would it be a good idea to convince her that she needs surgery? Would the hard sell work? I’m sure I could convince her to have surgery, but what if
there’s a complication? This ostrich will all of sudden become a tiger! I’m letting her tell me when she wants surgery. In the mean time—we’ll try a few more weeks of a cam walker and another round of physical therapy—which probably won’t work.
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On the other hand, I love treating snakes. I want a patient who’s ready to attack their problem directly and with vehemence. These are the types of proactive people who take responsibility for their own actions and actually listen to their doctor. Last week I had one of my wound patients in the hospital with a streptococcus abscess that I had drained a few days previously. Unfortunately, he had significant compromise distally and required a TMA. My first reaction to seeing his foot after his I&D was, “#$@%”, this guy needs more surgery.” I sat down with my patient and his wife, discussed the issue, and waited for the questions. The patient’s response? “Let’s get it done, doc.” That’s the snake in action – confronting the problem, not running away, bravely ready to do what needs to be done. He was out of the hospital on postop day 2 after his TMA, TAL and is doing great.
Of course, our patients are only mirrors of our own lives and personalities. We’re no better than our patients. How many doctors have you seen smoking? Don’t they know better than anyone the potential damage smoking can do? Ostriches. How many of us stop at the conveniently located 24 hour fast food restaurant late at night after finishing that diabetic amputation case? Ostriches. In many ways we can call type 2 diabetes the ostrich disease. Keep eating that high carb, processed food diet and you too will be the lucky recipient of a life-expectancy-shortening, amputation-prone, body-destroying disease. Enjoy that Big Mac!
Most people are a combination of these types – sometimes we’re the ostrich, sometimes the snake. In fact, medicine and surgery requires a somewhat proactive attitude for success. You had to be pretty proactive and hard-working to make through school and residency. We’re all snakes to some degree.
For myself, I try to take the snake’s approach to life. Sometimes I’m the ostrich, but I try to limit it as much as possible. The problem is, it takes a conscious choice to attack an uncomfortable situation head on, while we often unconsciously avoid that which makes us distressed. When I’m confronted with a problem, I try to handle it as quickly and expeditiously as possible. I don’t pass the buck. I don’t bury my head in the sand and wait for the problem to go away by itself because it never does.
You might think the snake, slithering on the ground, often the picture of evil, isn’t the best animal to pick for this metaphor, but I’d disagree. What more clear image is there than the snake decisively striking down life’s problems? Are you an ostrich or a snake? You decide.
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Until next time,
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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GRAND SPONSOR
This program is supported by
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STRATA DIAGNOSTICS
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