when all else fails, go with the longest answer

off tomorrow to take my family medicine recertification exam. once every 7 years, need to prove to those who certify these things (and ultimately those who determine how much of your hard-earned insurance dollars i deserve to receive) that i can still make correct decisions on health matters when presented with multiple-choice questions. too bad patients don't read textbooks or give me a choice as to what i think they may have. not likely to see any questions like these tomorrow:

1) a 28 yo male presents as a new patient after leaving his other doctor because he was misunderstood. he is healthy other than his chronic low back pain, which has been refractory to all treatments except vicodin and soma. unfortunately, his pain is worsening because of his new job and he left the prescriptions he received from his last physician at his cousin's house in virginia. he is allergic to ibuprofen and tramadol. physical exam is unremarkable except for poor dentition and several large tattoos. at this point, you should:
a) rewrite his prescriptions for a 90 day supply with 3 refills, as he has requested
b) instruct him on proper lifting techniques and posture, refer to physical therapy
c) extol the benefits of chiropractic care and its effectiveness in similar situations
d) suggest he may want to find another less gullible physician
e) refer him to a pain management expert, since his pain is obviously far beyond your capacity to treat him

2) a 46 yo female complains of a 3 day history of sinus congestion, similar to all her previous "sinus infections". her symptoms include headache, mild rhinorrhea, and sore throat. she has no fever, though in the mornings she has a cough productive of "very dark green, thick stuff". she smokes 1 1/2 packs of cigarettes a day. proper treatment for this patient includes
a) an antibiotic
b) a cough syrup with codeine
c) a decongestant
d) a note for work for the rest of the week
e) a 20 minute discussion about the symptoms of the common cold, appropriate treaments for the common cold, advice on smoking cessation and the dangers of smoking, and then ultimately a prescription for an antibiotic, a cough syrup with codeine, a decongestant, and a note for work.


wish me luck.