this is a personal experience blog. my daughter is special needs, and has a very complex social situation. unfortunately, she was just discharged from her pediatrician, and now i am trying to fnd her a new pediatrician. many of my choices are not accepting new patients, and some of the pediatricians who are accepting new patients are declining to accept her. for me, working in a community health center, we have no choice regarding accepting patients. but private physicians can choose not to see certain patients. although of course i am biased, it would seem to me that children like my daughter are exactly the patients that need a good pediatrician the most, not just the children of intact, fully functional families.

a pehea

more for my not-read blog.  it doesn't really matter, since i think that many blogs are only sort of narcassistic extensions into cyberspace, but it's all good.  i am thinking more and more about fellowship, and struggling between the knowledge of a huge and growing need for primary care and the financial realities of practicing medicine in hawai'i.

even though i've been through 4 years of medical school now, 4 years of residency, and have been practicing for 6 months, there's still that anticipation every time i see a patient. even if it's simple, i don't doubt that i know the evidence-based diagnosis and/or treatments (at least most of the time) and will apply them (at least most of the time), but there's still that wonderment. i guess that that's a good thing. sometimes, though, practice can be just the worst kind of work, particularly when seeing patients for chronic pain, usually low back pain. for me, this is the worst part of medicine, having to prescribe opioids (most of the time), and convince people that other modalities are much more effective, and less habituating. for every client, i try to explain that all pain is processed by the brain, and as a result, the conscious and subconscious programming in how we approach pain is essential to treating the pain. i try to lay out the different options, from traditional healing of different cultures (hawaiian massage, chinese accupuncture), physical therapy, exercise, weight loss, but sometimes it's like hitting my head against the wall.

this is only vaguely relevant to health, in terms of viewing violence, but i washed alpha dog tonight, and was not very impressed. a bunch of rich (mostly) white (mostly) kids, with no clue and too many resources. i know that i sound sort of old writing this, but i could think of so many other things to do than what was depicted/idolized in the movie. not too busy at work today, just a lot of the fish and poi sort of stuff, i guess.

hmm, i never knew that there were so many medical blogs. so i think that i will start writing one, but sort of lazy at first. i work in a semi-rural clinic in hawai'i, practicing internal medicine and pediatrics. but at various times, i end up doing infectious disease, ob/gyn, psychiatry, or a myriad of other things. it's part of being in a health center.

aloha. eia ka 'ao'ao e a'e. ua ho'omaka wau ma http://www.xanga.com/home.aspx?user=kaolelo. 'a'ole maopopo pono ia'u na mea a'u e waiho'ai ma ane'i, aka mahalo no ka nana ana