Category Archives: Tribe

Health Care Culture



I usually find a way to fit in a new job pretty quickly. Years of working as a locum tenens makes fitting in a survival skill.  I am surprised that I am feeling a little more guarded than usual. A friend of mine would call it “well defended”.

So much of healthcare is cultural. In some places every one handles colds in one way ( everyone gets a ton of medications) and in some places, we recommend tea, honey and rest.  In the first weeks I am in a new place, there are always folks who misunderstand my “style”.   With some patients I have to WORK really hard to convince them that I am really on their side.

Then, there is the whole culture of handling urgent issues.  Some places have protocols- anyone has a blood pressure greater than 180/90 gets the 911 treatment, no matter what the provider thinks is right.  Some place rarely send anyone to the ER and try to handle everything possible in the clinic.  Today was one of those days of explaining that I know what I want to do with this young patient, but I need to know how this clinic handles things. Labs/imaging and then to ER, or just skip it all and send to ER. Direct admit? What goes with her? Do I print the note, or write a new one on a script?

Some clinics work as a team, while some are just people in the same building without much interaction. Some folks are much more serious, some laugh and goof off all day between patients.  I am trying to find out where I will fit in this new place.  I feel “stressed out” trying to adjust. I am trying so hard not to be too much of me. I am working this time on having unspoken thoughts.

But, somehow it ends up like this…


( I am also trying to let go of wanting things to be perfect- like blogging.  )

It’s Complicated

It’s Complicated

My family, my tribe is complicated. I once tried to draw a genogram and there just aren’t enough types of lines to describe how we are related. Once we welcome you into this tribe, you are always part of us. Divorce and separation never change that for us. That makes us very complicated, but speaks to how deeply we love.

Today, I hear that someone once very close to me is dying. My heart is breaking for him and his family.  Even though they will always be part of our tribe, we are not part of theirs in the same way. It would be awkward to sit vigil as he prepares to be welcomed into paradise. I have been holding him in my heart and in my prayers all day. In my mind he is still the young handsome man I knew as a cousin. He played a huge role in the life of my children

in the early years. We laughed so much. He acted as mediator when the father of my children and I were both acting irrationally. I pray that his journey home to God is a peaceful and painless as possible.