I’m pretty sure that for just about anyone who’s worked anywhere, ever, a favorite water cooler or dinner party topic is how busy everyone always is. “How’s work?” “Oh, you know…busy.” Followed by a deep sigh of exhaustion, as if to say “I DARE you to top my inhuman level of busy-ness. I mean, seriously. Most mortals would be crushed under the weight of my workload.”
So maybe take what I’m about to say with a grain of salt.
I work at a college health clinic. It’s October. It’s busy. Crazy busy. It’s pretty much nonstop busy from September through May, minus a couple of holiday-related slowdowns. And because we’re human beings and have a vested interest in preserving our own sanity, conversations among the clinicians at work frequently veer into the the realm of trying to find ways to decrease demand for clinical services. Meaning, get the students to stop coming to see us quite as often as they do now.
There are several ways to decrease demand:
1) Be really lousy at your job. Be unfriendly; give crappy advice; deliver unwarranted lectures on personal responsibility when your patient just wants Plan B. The more you suck, the more likely it is that word will spread about the poor quality of care available at the student health center, and the less likely it is that students will ask to be seen, leaving you more time to online-shop for the holidays. BAD IDEA NUMBER ONE.
2) Turn people away when your schedule is full. On the surface, sounds reasonable. This is how most of the non-ERs of the world match supply with demand. And speaking of them, there are several hospitals with high-quality ERs nearby. But take my word for it when I say that all it takes is one or two letters to the president from well-connected, pissed-off parents to make this BAD IDEA NUMBER TWO.
Now we start to veer into the realm of magical thinking…
3) Make it so that people get sick less. Aside from giving out free flu shots (done) there’s not a lot we can do here without a really fancy magic wand. The vaccines against colds, lacerations and pregnancy remain in development. Fantastic but impossible and therefore BAD IDEA NUMBER THREE.
4) Teach the students how to take care of minor complaints on their own, without coming to see us. In other words, ask them to be fully mature, self-sufficient adults, with the life experience that allows them to already know what to do when they get a runny nose, or get a little scraped up falling off their skateboard, or burn their hand on an over-microwaved slice of pizza last night.
“Can you believe the things these kids come in here with? I would never IMAGINE going to see my health care provider for something like that!”
OF COURSE YOU WOULDN’T. You’re a middle-aged adult. You have kids of your own. And you’re also a health care provider yourself, BTW, which gives you an unfair advantage.
I’ll be honest. I’m not immune. Last week a kid came in to see me because he was afraid he could have gotten rabies from eating a sandwich made with a slice of bread that shared a loaf that MAY have been nibbled on by a mouse. I’m not making this up.
But therein lies the dilemma. What is college health? Why do we exist? Are we an urgent care center, one step above advice from the CVS pharmacist (and/or Google) and one step below an ED? A quasi-Planned Parenthood, meeting all your contraception and STI-related needs? A primary care provider creating a medical home-away-from-home for young adults? Dispenser of free condoms and hand sanitizer? Host of awkward health promotion talks that nobody attends besides the health science students?
But we’re even more than that.
I had a minor epiphany a few weeks ago while I was dropping off my kid’s immunization record at the school nurse’s office. Two little girls, I’m guessing 3rd or 4th graders (which made them look like GIANTS next to my tiny kindergartener), ran into the office. One of them had fallen down on the playground. She’d scraped her hand. Classic palmar concrete burn. The nurse leans over the desk, glances at the hand, and sends her over to the sink to wash it off, then gives her a colorful band-aid and a baggie full of ice.
If that school nurse spends her days complaining about the kids coming into her office for minor abrasions, then she’s in the wrong line of work.
Your average college student may look like a fully formed grown-up, but in many ways, s/he’s not. Until now, if they’ve experienced physical discomfort, they’d go tell someone about it. That person takes care of it for them. Maybe that person is Mom or Dad. Maybe, if the discomfort happens at school, it’s the school nurse.
Our patients are really only one overly-long high school graduation ceremony removed from this earlier, easier stage of their lives. They’ve entered that awkward phase of life where technically, and according to the U.S. military and casinos everywhere, they’re adults. Yet they still have a pediatrician as their PCP. And they still need someone to help them figure out what to do when they fall down on the playground. (The playground is just a little larger now. AND FULL OF HERPES.) (Just kidding.) (Sort of.)
So the thing is, we need to be that, too. Whether we like it or not, we’re as much school nurse as we are urgent care or PCP. College health centers need clinicians with a higher level of training than your average school nurse, since our patients are also busy becoming professional insomniacs, and swimming in giardia-infested water holes in Nicaragua, and having lots of unprotected sex on spring break in Punta Cana, and spreading strep and norovirus around campus like wildfire. But at the same time, our patients still need someone to show them how to wash the gravel off their hand and cover the ouchie with a band-aid. Because next time, maybe they’ll find the sink themselves.
If we spend all our time complaining about it, we’re in the wrong line of work.