Palpable Purpura

After turning in fellowship applications last night, I can finally focus on my CPC. One of the things that my patient has is palpable purpura so that's what I'm reading about today. Unfortunatly, my patient also had thrombocytopenia which can cause purpura itself (although it really should be nonpalpable). One interesting fact: the elderly often have purpura called senile purpura. It's also called solar purpura or actinic purpura. I think I may want to look into the origin of these names because I am thinking: senile because they are old? solar from the sun? I will go with actinic - sounds more medical.

So last night I looked up the GERD and achalasia thing, and it turns out I was right. Someone can have longstanding GERD and if they suddenly stop having reflux and start complaining of dysphagia it can be achalasia. Unfortunately, it could also be a cancer as well.

Today one of my patients had a mass in her gallbladder which was sludge v. cancer. I hope it's just sludge. We did the liver ultrasound after a sudden transaminitis in the 100s-200s, but I don't think the mass has anything to do with it. Just an incidental finding. And not a good one, either.

The noon conference today was about our clinic. I've been reading a lot of articles lately about how to run a good practice (I have a hard time deciding whether I want to do endocrinology or outpatient medicine ... or maybe even hospitalist.) It's sad that healthcare today expects us to see patients in 15 minutes and document everything as well. It made me think about how much time I spend doing things in our clinic that are inefficient or don't require an MD. I spend an inordinate amount of time sending faxes, mailing letter, calling other hospitals or practices for records, and calling pharmacies to refill prescriptions. Not to mention that I handwrite all my notes in addition to dicatating them so that we can bill for the handwritten note and others can view my notes easily in the dictation. It's no wonder that all the residents complained when they increased our clinic requirements from 105 to 150 sessions in our three years.

The other news I have is that it takes me a long time to read 7 pages in Harrisons. That stuff is dense, dude! I think tonight will be some light reading...from the beginning of the book. Heh.