Doc's Progress Notes

Week of November 1, 1999

Last Updated: 11/09/99 01:06:13 AM

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Monday November 1, 1999

This journal is finally live today. It has been in the planning stages for too many weeks. I had to finally set myself a deadline and publicize that deadline to sit down and start it. As mentioned on my home page this will be a journal about my daily experiences as a physician and will by necessity include a lot about computers.

Let me start by saying that I am not a professional writer (which is obvious). I have been influenced by the Daynotes Gang and particularly by the style of Tom Syroid who was kind enough to mention this page in his Insights journal yesterday. Initially I had planned to construct this with Microsoft Word 97 and Front Page Express because that is what I had on hand and I wanted to see what could be done with very simple tools. I ended up getting so frustrated with the formatting introduced by both programs that I resorted to learning straight HTML(also known as copying ideas off other pages) and used NoteTab Pro as my HTML editor and CuteFTP to FTP the files to this page. I know that as this page gets larger I will have to find a program that will manage this page and update the files without so much effort from me. I follow the debate about different webpage software packages with interest. Meanwhile, I am trying to find a copy of FrontPage 98 so I can try and learn to use it.

I should probably mention that I am doing this work on a Gateway P5-200 MMX computer using a dial-up connection that I can never get to work faster than 28.8K. Just last week I finally installed Windows 98 Second Edition as an upgrade over my previous Windows 95 OS. I did this mainly to have the home networking capabilities offered in Win98 SE as I need to network my computer and my wife's so we can share printers and our internet connection. I want to use Category 5 cable, a hub, and NIC's but need to run the cable some distance. Does anyone know how far apart two computers can be using that cable alone? My wife's computer is downstairs so I would need to run the cable at least 75-80 feet.

That's enough computerese(sp?) for now. My Monday is going to start with a 7AM meeting of my medical group. These meetings are monthly and are designed to keep 50+ doctors, physician assistants, and nurse practitioners informed about what is happening or about to happen with our group. Unfortunately, they tend to be too structured to allow much time for real questions and with so many people we usually have to appoint a committee to formulate a recommendation so we can get things done. Our annual Retreat is also coming up this coming weekend so this monthly meeting should be fairly short. I'll try and let you know later how it went (I'm assuming more than just myself will be reading this). Then on the office to kick off another week seeing patients. See you later.


Today's morning meeting actually was better than expected. It began with an update about Hepatitis C. This is a very important disease since it is the leading cause of liver failure and therefore liver transplantation in the US. We need to do a better job of identifying those people with chronic Hepatitis C to try and prevent cirrhosis and liver failure. Part of the problem is that a lot of people with Hepatitis C have no symptoms and therefore do not know they have the disease and have never been screened for it. Anyone who has ever used IV drugs recreationally or had multiple sexual partners need to be screened.

The rest of the meeting was pretty routine but included recognition of the clinic managers who helped us move into our new office building this year. More on that later (a topic for a day when I can think of nothing better to write about).

While reading other journal pages I saw they had an automatic update feature installed that told the day and time their page was last updated and thought this was real cool. So I installed one when I tried constructing this with FrontPage Express. Unfortunately, it does not update automatically when I simply FTP the files here from my local copy without using FP Express. Anyone have any ideas how I can get this feature to work until I begin using FP 98 or 2000 or another program that supports this feature natively?

This afternoon's highlight was the very stubborn lady in her late 60's who didn't think she needed to go into the hospital. She felt she could get more sleep at home in her own bed (which is probably true) but she was in significant congestive heart failure and needed monitoring which she could not get at home. She also lives alone since her husband died also of congestive heart failure and her daughters are not really helping her out much. Finally, with their help we got her to agree to be admitted but she wanted me to guarantee how long she would be in the hospital. Despite what people think, doctors don't know exactly how long it will take someone to respond to medication. We wish we did, then everyone would always do just as we expect them to. But people are people and continually amaze us. All in all a good Monday at the office for which I am thankful.

Tonight I went to a meeting of our worship team from church (I am the sound guy, not a musician or singer, my wife is the singer in the family). We are a real team and when we get together it is always something special as we really care for each other as people. Now we are waiting for our son to return from his junior varsity football game and then to bed. Good night all.

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Tuesday November 2, 1999

Today's entry will be shorter probably and there will only be one posting. This will be the usual routine on weekdays since most times I won't have time to do more than one posting. My plans are to work on this during the day when I have time, E-mail it to my home, paste it into NoteTab, add what I need to, then post it here once a night. Maybe weekends will be different.

First, thanks to the people who wrote to answer my question about Cat 5 cable. The general agreement is that it can run 300 feet without problems. It is very humbling to realize that what you are writing is actually being read. When I started this (yesterday) I wasn't sure if anyone including my family would be reading it. I will try to personally answer all who wrote yesterday later today or tomorrow.

My son got home ok last night. His team lost and he has only three more days of football practice left then he wants to try wrestling. He has never wrestled before and I know very little about the sport except the stories about meeting a certain weight. I guess our family will learn a lot about it if he goes through with his plans. Where I grew up and lived until two years ago there is no wrestling except that TV "sport". I will, of course, be monitoring his weight closely.

Today is election day and here in Washington State we are voting on an initiative to eliminate the vehicle excise tax and set the vehicle registration fee at $30 per year. It also would require that all measures to raise taxes be referred to the voters. Presently, since we have no state income tax, each vehicle is taxed based on its current value and age. That tax may range from $60 to more that $700 depending again on the vehicle's age and current value. It has been an interesting debate since even the people who oppose the initiative are in agreement that the current system needs to be changed. They, of course, think this initiative goes too far. We will see how the 30-40% of registered voters who bother to vote feel. I have already voted by absentee since we can elect to have the ballot sent to our homes each election. This is very convenient for me since I do not have to go to a polling place. This doesn't guarantee that people will vote but it sure removes one excuse why people don't vote.

Today was the day for no-shows at the office. These are people who call in for an appointment but don't come in and don't bother to call and tell us they are not coming. These are a chronic problem for any doctor's office since we always have people wanting to come in that we don't have time to see. No one has ever been able to figure a way to completely stop no-shows and I guess we never will. I was taught by my parents to be polite and if you can't show for something at least call and tell the person you had an appointment with. After a person has had three no-shows we send them a letter asking them to find another physician; the first two times we call them and see what the problem was and offer them another time.

My lady from yesterday with congestive heart failure is doing much better. I'm hoping she can go home to live by herself again but knowing the natural history of congestive heart failure and her age she will be unable to take of herself independently in the very near future (less than a year). This will mean her daughters will have to get more involved in her life which will cause friction of its own. On the other hand, I hope I am being too pessimistic and she will be able to live independently for another 10 years or so but experience tells me otherwise.

Today was capped off by the mens group meeting we have every Tuesday night. This mens group is made up of obviously of men from the church we attend. We are accountable to each other and have built relationships with each other that don't end with church. We have been doing this for 18 months now and if we miss a week the general feeling is that that week was not complete. So ends today, must answer some e-mail and get ready for tomorrow.

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Wednesday November 3, 1999

Today started out like most other weekdays: run (in the dark which I hate) at 5:30, then eat breakfast and shower, take one, two, or no kids to school (depending on if I have a 7AM meeting or not or if Delanae is sick), do a quick scan of the Daynoters sites and see my first patient at 8:30. This morning Delanae was sick so I took both kids to school but still got here on time. First patient, however, was late. It never fails, but on the positive side I did get the morning updates read using the T-1 connection here at the office. I could get spoiled using a really fast internet connection. Maybe someday we'll have a cable modem or DSL connection at home. Right now neither are offered in our area.

Amazingly the initiative to rollback the motor vehicle license to a flat $30 a year passed yesterday. I was afraid it was doomed to defeat what with all the newspapers in this state against it. Predictably, there have already been state government department heads on the news wringing their hands and saying what will we do without all our money. Based on the experience of California after all their propositions passed in the 80's, state government here will learn to become more efficient in the use of the money they have. Ominously, I saw one state representative on the news saying that the legislature will find money to replace the money that will be lost. I smell a new comprehensive tax program to replace that money. The passage of the initiative will save us about $1200 next year but since my son is turning 16 also next year and will be able to drive I'm afraid the extra auto insurance costs to add him to our policy will eat up all that.

I had a few minutes at noon today so went out to put gas in my car. I stopped by a little computer store downtown and they told me they had a full retail copy of FrontPage 98 which they will sell me for about the same price I have seen it on auctions. I have decided to go ahead and buy it and use it to experiment with on this site and see if I want to use FrontPage full time. I also downloaded a copy of 1stPage 2000 and have just started playing with it. It certainly looks full featured especially for a freeware program. I looked on the site to see if they sold anything and could not find anything for sale.

Two seventeen year old kids came in today, planning to be married soon and currently living together. She has had abdominal pain and nausea for several months and a negative pregnancy test. Her pain may very well be due to gallstones and if it is she will need surgery. The point of this story though is that these kids had no idea how to go to a pharmacy for medication, had no money to pay for it, and basically wanted us to be their parents and walk them through what they needed to do. It is obvious they are not mature enough to make decisions that will affect them the rest of their lives but how do you impress this upon them and where are their real parents. We got the idea that they could not go back to their parents for help.

Today was capped off by Wednesday night services at our church. It is the night I get to play the bass for our worship team. I really enjoy playing although I just started about six months ago. The others on the team have all played their instruments for 20 years or more so I am the real rookie. Sometimes I just get lost but the only way to get better is to play and learn from your mistakes. The other members are gracious enough to teach me and patient enough to allow me to make the mistakes and learn from them. See you tomorrow

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Thursday November 4, 1999

I'm still holding up under the pressure of trying to write something every day. Delanae says she loves the journal which is enough praise for me to keep it going. Delanae, by the way, is my wife, that beautiful woman I mentioned on my home page. She wants to have a home page and already has a URL reserved and parked but is waiting for me to make designing one easier. I do all the work so she doesn't have to . One of these days, when I have more time , I will put up some more information and links about my family.

For all of you out there who use Netscape as your browser of choice you haven't had a chance to read these words. Bet you didn't know that. I just found out last night when I tried to read my own journal with Netscape; it will display my banner but nothing else. There are no problems with the index page. I only keep Netscape for funsies but thought I had better check to see if everything worked ok with it. Anyone have any ideas what I can do to make this page readable with Netscape?

We had a meeting of my particular team at noon today. The Family Practice part of my medical group is divided up into three teams which consist of 6-8 physicians and nurse-practitioners/physician assistants each. Each team functions a little autonomously and have a monthly team meeting. Today was ours; during it we discussed future planning and what we can do to make ourselves a better medical group as far as patient satisfaction and excellent patient care. NO big decisions of course yet but we did kick around some good ideas.

Coincidentally, this weekend is our group's yearly retreat. We will be meeting at The Resort at the Mountain which is at the base of Mount Hood. This year's focus is on wellness for physicians and their families. Of course, even though our families are invited there is very little time that we will have together, most of the time is spent in meetings. Ordinarily we would drive down tomorrow night but my son has a football game tomorrow night. It will be his first time to play with the varsity so I will go to it then drive down by myself after the game and my family will come down Saturday morning. I am supposed to be nominated for the Leadership Council during the retreat this weekend also. This is the group of physicians which actually makes policy for the entire medical group. We serve up to two four year terms then rotate off.

Today at the office had a little bit of everything. I had the no shows again like I talked about yesterday. I had the lady who was 30 minutes late just before lunch that turned out to be probably having significant chest pain and is going to see a cardiologist next week. This afternoon I was real busy, seemed everyone needed everything. I finally made it out of the office in time to pick up my copy of FrontPage 98 then had to go back to finish dictating charts and answering telephone messages. Then I went with my wife to pick out a new vacuum cleaner and finally home to fix spaghetti for my family. I do that about once a month anymore, I used to do it once a week but for some reason don't do it that much now.

I will wrap up this day by posting this update. Since I will be at the retreat starting tomorrow night there will be no new updates until sometime Sunday. I'm off to install FrontPage 98 and play with it a little. Good night all and God bless.

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Friday November 5, 1999


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Saturday November 6, 1999


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Sunday November 7, 1999

We made it back from the retreat. It was a day and a half of meetings to talk about Physician wellness. We discussed what Wellness means as it applies to ourselves and our marriages. Most of the time, physician wellness is low on our priority list because of the time we have to spend taking care of patients. However, when we are having problems we no longer can do a very good job of patient care. Our marriages suffer, our families suffer, and we suffer burnout and become impaired physicians. There are a tremendous number of physicians leaving the medical field because of burnout due to increased paperwork demands by insurance companies, increased stress due to the malpractice climate, and increased paperwork and demands by our expanding goverment regulations. This is a tremendous loss both because of the waste of money spent to train them and the loss of access by patients but also because a lot of them are outstanding physicians not borderline or impaired physicians.

Anyway, we brainstormed ways that both we and our group can prevent this burnout. This was done in small groups where we came up with specific ways to address remedies for the problems discussed. Now it will be up to our Leadership Council and administrators to put some of these ideas into practice. It looks like I am going to be on the Leadership Council so I guess I will be dealing with this for the foreseeable future.

My family and I ended up having to go in two vehicles, with my wife and son coming down yesterday morning. His football team played the other high school in town which is of course their biggest rival. The played in a driving rain and surprised the other team by beating them 24-20. I got to see about two quarters of the game before I had to leave. It was wild with about 16 fumbles between the two teams due to the wet ball. My daughter and I drove down Friday night; she was supposed to keep me company on the trip but ended up sleeping most of the way. Unfortunately, at the retreat there was not a lot for family members, especially children, to do. Delanae and I did have a nice dinner with the other retreat participants and their spouses (significant others) Saturday night. That is a good way to meet some new people that we don't see very often. My suggestions for next years retreat included some activities for children and the whole family as well as an organized hike or run/walk.

Thanks to Dan Bowman we have the Netscape loading problem with this page fixed. Netscape would actually load the page but not display it. Dan figured out that I had not closed my table with a /table tag. This did not bother IEx or Opera but Netscape could not figure what to do. Anyway, thanks again Dan for your work while I was gone retreating.

Tomorrow is Monday, already is in other time zones. I am redoing my application for hospital privileges again which involves a lot of work and paper. I have to find a picture of myself to send with it and get some numbers from my group's administrative office then it will be ready. Maybe after I finish with this application and do all the other things I do during my days (I will be expanding on them in coming days), I will have time to add some more to this web site and experiment with FrontPage 98 to use in maintaining this page. In the meantime, I am still using NoteTab Pro and CuteFTP. I'm off to eat some dinner and get ready for tomorrow.

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Copyright 1999 Jim Crider All Rights Reserved