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.