 Hey guys if you're new here, my name is Boris. I'm a board certified physician assistant working in primary care and today I wanted to tell you about The worst kind of day you can have as a primary care provider Also, I apologize for the audio quality. I forgot my AirPods at home. That's usually how I record it sounds good with that I'm also just kind of like Like just straight up like emotionally beaten down by today. So I am talking quietly. I'm not yelling Not like bouncing off the walls, you know happy like I normally am making these videos at the end of a long day So bear with me with the sound quality, but those of you interested in medicine, especially interested in primary care I think you're gonna be interested in this video. So Yeah, bear with the the poor sound quality but Anyway, so today The reason today is the worst kind of day as a primary care provider is I had to start not one But two people on insulin that is my least favorite thing to do in my life in my career Here's why because it's not just a medication that you know, you skip a day and it's whatever It's fine or this is a medication. We're taking temporarily You know to make you better to help you do whatever it may be to just like solve something And then you're gonna be off of it. No Putting somebody on insulin usually not always but usually is More or less a life long Commitment to having to painfully inject yourself with insulin. You can get an insulin pump. Those are extremely expensive You can get a continuous glucose monitor Those are also extremely expensive. So most people can't afford them. They usually can't have them So basically when it comes to this and I'm forced to do this I know That it's not just me clicking a few buttons on the screen and saying, you know, your a1c is this It has not come down with these medications. Therefore, we have to do this. That's it, you know, see you next time It's not that I understand the gravity of what I'm doing to these people and with the gravity of what I'm doing to These people is that I have to make them Inject themselves at least once a day sometimes twice a day and sometimes even more depending on how out of control Their diabetes is Per day with it, you know a needle. It's doesn't feel good. It's painful every single day for the rest of their life And also unless they can afford a continuous glucose monitoring system, which I just told you is expensive They I'm also making them prick their fingers with a landsat once Preferably twice sometimes more per day every single day for the rest of their freaking life To control their sugar because as we all know diabetes is a horrible disease It totally destroys your blood vessels. It goes after the blood vessels in your feet your kidneys your heart and your eyes first That's why a lot of diabetics, you know lose toes You know abutations all kinds of wounds that don't want to heal kidney problems their GFR goes down They have kidney disease eyes They have to have diabetic retinal retinal exams because their eyes get worse Of course, it puts them at a huge risk of heart disease heart attacks. It's just it is a horrible disease and You know, unfortunately when you fail medication management Insulin is the next thing that you have to do and you know, most people do stay on insulin for life So that is the gravity of the situation That is why I hate starting insulin more than anything else as a primary care provider because I just know What I'm making these frickin poor people do every single day for the rest of their life, you know So that's that's why it's the worst day of your life Also another thing I wanted to just discuss Since today I had to start two people on insulin because their a1c is like 10 and it just will not come down No matter what we do and these two people the reason I want to tell you about them is because they are polar opposites They are totally different one guy is about 300 pounds Totally uncontrolled diet is way out of control eating totally crappy food every day of his life, you know bread pasta sweets ice cream You name it. He's eating it. He doesn't care. Well, I mean he cares, but he's just not doing his part He's you know got the full metabolic syndrome cholesterol diabetes Obesity eating just eating himself into a grave That's one guy the other guy Skinny totally not obese Asian-American I forget where he's from exactly but you know Asian-American if you've been practicing medicine for a while You know that Asians, especially East Asians are very prone to diabetes even when they're not, you know obese when they're not I have every other thing of metabolic syndrome. They just the theory is based on you know years and generations of famine They are much more susceptible to becoming diabetic from the American diet So unfortunately, you know, he comes to this country for you know a better chance for him and his family and you know It's the crappy food here and without even really over eating becomes diabetic and that I don't know which one's better Which one's worse, you know, you'd be the judge of that They're two totally different people so subjectively. They're just it's terrible for both of them And I feel horrible for both of them and their families But just my point is this terrible disease strikes without mercy at some people who you know Objectively are doing all the wrong things and also some people who objectively are not doing anything wrong and just you know Look at the draw That's how their body is and that's how it responds to the American diet and you know the point is today both of them Got this, you know crappy diagnosis and had to be started on insulin. So Yeah, not really a whole lot to say about This kind of a thing just wanted to share the reality of working in primary care as a primary care provider the things that sometimes you have to do to people In order to try to keep them as healthy as possible, you know, and yeah, so kind of a rough day Just whatever value you might get from that. Just thought that I would yeah Thought that I'd share that so you know what you're getting into if you ever decide to work in primary care Yeah, I'll see you guys in the next video. Hope you have a good day. Bye