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Can I just ask...

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...as a frequent long-time lurker, and infrequent poster, does anyone ever experience CDMF? That's Chronic Disease Management Fatigue-my crispy near burnout exhausted way of saying, I've been doing primary care/family practice for 11 years in a community health setting w/underserved patients-rural/and the inner city folks who migrate out this way, along w/ migrant-types who come passing through our area of the lower 48. 

Is it typical for the litany of disease burden for these chronic, multiple comorbidity types to actually decrease, or the polypharmacy to actually decrease as the years go on for some of these patients? Or, does this list grow as these patients add-on years?  They are the most challenging for addressing the diet/exercise/wt loss issue, for smoking cessation, etc, d/t to the nature of their "social determinants of healthcare." I try to counsel on these changes w/ sensitivity to the constraints of my patient population, in terms of small steps, or realistic alterations they could enact with food choices, or trying to get SOME kind of activity, etc, (and of course, treat w/ medication as indicated per underlying medical condition/consult/or further work-up, etc...), but overall, I feel so very ineffective with these patients-like they're multiple juggling balls in the air, and the moment one medical condition gets patched back together, you're scrambling to catch the other 3 about to bomb out the hatchet. 

Maybe it's been a long week, and I just needed to vent. I'm sorry-just wondering if this has been the experience of other providers over the years, the longer you work in these settings of community health care/FQHC style/medical practice with under-served? 

Edited by Brigid2010
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Only thing I've ever found that even slightly got these patients' attention: asking them how many packs they smoke a month and their cost per pack.  Then I ask them what their car payment is.  Often cigarettes > or >> car payment.  Sometimes that gets them thinking about what they could be doing with the money they spend on cigarettes.

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yup,   I tend to change jobs every 3-5 years and this helps - learning new systems and patients


I truly think we are only sprinkling water on the forest fire of bad health.  Until society realizes we can not work 40-50 hour weeks, have a family, and live healthy we are just spinning our wheels

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Thanks for the insights-it makes me feel not so disheartened.  Burnout is still pretty happening though.  I'm fortunate in that I've been able to work part-time, as part-time a I can be, and still keep my pension service credit-finally got vested in this last year.  Part-time has helped w/ the work-life balance issue, and I have that rare thing of longevity w/ my current clinic, w/ all its concurrent frustrations. There are still worse places to work. I'm just not sure, these days, that there are better ones I'd risk, at least in the world of primary care, unless I was real sure it really was a positive move, and just not exchanging one headache for another. If it's not the world of underserved/uninsured patients, then it's Press-Ganey (or whatever that called) scores, and the OverLords of Corporate Medicine. Sad, sad situation, is medical practice in this country...


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