Doc's Progress Notes
Week of February 7, 2000
Last Updated: 2/13/2000 at 6:46 PM PST
Long Monday as predicted in yesterday's post. It began with our monthly 7:30 AM group meeting which included a good discussion about how close the members of our group need to live to the hospital and a very good clinical presentation. The meat of the discussion centered around should people who do not have to take call be required to live within a certain distance of the hospital and even should those who take call have to live within a certain distance or should they be allowed to make their own arrangements about being close enough the nights they are on call. At this time there is a residence requirement within a certain distance, I think the Leadership Council will now be reexamining that requirement and modifying it to make it less restrictive and more friendly so we can potentially attract even better clinicians.
The morning was fairly slow and I was able to spend all the time I felt I needed with the patients and did not make anyone wait very long. This afternoon, however, everything fell apart. I saw more than twice as many people as I saw this morning so I was seeing everyone later than their scheduled time. Some times were double booked as two people had been mistakenly dropped from the schedule on Friday without them having cancelled so they showed up for their appointment time which had now already been taken by someone else. Since it was our front desk's mistake, I had to see them which put me even further behind. On days like this you want to take that front office person and ring their neck but you smile and say "no problem, I had nothing better to do than correct your mistake".
Then, the last patient of the day was taken back at 5:20 and I had finished seeing him at 5:40. He then went out front to make a return appointment in two weeks and ALL the front office people had gone home so he could not make a return appointment today. That's what happens when the corporation that owns the group I work for puts the front office people under control of the admitting department of the hospital so they are cross trained and can fill in in the hospital rather than being under the control of our own team leader. I don't like this particular setup and this is a major reason. The medical assistant who works with me cannot go home until I am finished seeing patients and I believe at least one front desk person should also stay, they do in the private world believe me. If they were more responsible to the team, maybe we could cut down on some of the scheduling mistakes.
Enough rant for one night. I did get finished in time to get to worship team practice on time at 7 PM and now am home finishing this update. Then I will get things ready for tomorrow and get a little sleep tonight before I have to be back at the hospital in the morning by 7 so I can round on my hospitalized patient then go to my 7:30 meeting. I'm getting tired of hearing myself whine about my long day so I will stop now and write something about computers.
Brian Bilbrey sent me a message tonight saying that he was unable to link to my CV from last night's posting. He thought it was because my hosting service was having problems with the space I had used in my directory name i.e. Other Documents. I had put the space in by mistake but Internet Explorer 5.1 had no problems resolving it last night when I tested the link as I usually try to do right after posting to this web site. So it seems that the problem was not my hosting service but the browser he was using. I have changed the directory name by eliminating the space, changed the link, and reposted the page so all browsers should work fine now, if there is still a problem with the link, please let me know. On that note I will call it a night.
Exciting day today! 7:30 meeting went well, we have some new opinions to think about regarding recruiting or not recruiting another clinician. Unfortunately, the meeting was not well attended by the clinicians who would be most affected by these decisions. In the morning the Leadership Council is meeting again to talk about some new ideas about recruiting and compensation. Once again, my day off will start at the same time as my regular days. Oh well, at least I never get out of the routine of getting up at oh dark 30.
The office was hopping this morning with one patient having an acute asthma attack while at the same time another had a kidney stone. I had to try and be in two places at once so my split personality was useful <g>. Both ended up doing well, the person with the asthma attack went home breathing normally and the person with the kidney stone went home with pain meds to try and pass the stone in the privacy of his own home. I told him I would admit him if the oral pain medication wasn't enough or if he changed his mind and did not want to try and pass it at home. He should be able to pass it within the next couple of days and will bring it in to us for analysis.
This afternoon was not quite as hectic but was busy. We made some patients feel better, some were disappointed because I could not cure them today. One man came in hoping I could cure him from his back pain which he had once every 3-5 years, I had to tell him that I could not guarantee that he would never have the pain again but to be thankful it only happens every 3-5 years. Another man was convinced that penicillin which he had gotten from a dentist years ago would cure his mouth ulcer which are normally caused by viruses or trauma. I had to inform him that penicillin was no better than placebo for curing it, his dentist had probably used it as placebo knowing it would not hurt him unless he was allergic to it. Another eight year old boy had jumped off a slide yesterday and his foot was still hurting today. X-rays showed he had three fractures in the bones of the foot. Luckily, this can be treated with crutches for a couple of weeks then careful weight bearing without jumping for another two weeks, then he should be fine, kids his age heal so quickly. He will now have to watch recess and karate practice for a month, tough on someone his age.
Now I am at home after mens meeting and worship team practice. Dan Bowman was kind enough to inform me that my redirector page was still pointing to last week's page, I know I changed it Sunday night on my local copy but forgot to FTP it up to the web site, obviously. Now you can see that I actually did post last night. Until tomorrow then....
I finally got to run again today. The weather turned out to be beautiful here today so this afternoon after I was through seeing nursing home patients, through with meetings, and had been to my eye appointment I managed to run for about 25 minutes. This was the first time in two weeks, due to illness mostly, that I had gotten the opportunity to run. I now feel much better as I knew I would. I believe that I have turned the corner and I am not going to get a relapse of the upper respiratory virus that I have been battling. Just in time too since I have to be on call tomorrow night, my first call night in over two years. Am I looking forward to it? You've got to be kidding, but it is a necessary part of what I do.
My ophthalmology appointment went well. I finally got to meet one of the local ophthalmologists in person after being here for two years. He and I were lamenting the lack of a local medical society here where new physicians could meet the other physicians in the area. It seems there was a strong local medical society years ago but when Kaiser Permanente came to town it fragmented the local medical community and the local medical society was a victim of that fragmentation. I moved here from an area with a strong local medical society and everyone knew everyone and supported each other. When an HMO, like Kaiser, moves into an area bringing in their own physicians to directly compete with the local physicians instead of trying to work with the local physicians then fragmentation occurs. Local physicians become upset with the HMO physicians and physicians stop working together and become strangers to each other. I don't know that years of this can be changed but it is worth a try if there are enough physicians here who are willing to try and mend some fences.
Now, back to what I was talking about before that rant. I now have new contacts as my vision had changed in the past two years, which I knew and expected. Things are a little clearer now although there was not a lot of blurriness with the old contacts. The ophthalmologist did warn me that I would probably need reading glasses within two years AT MY AGE. He thought I would need them now with the new contacts but I do not, small type is still not a problem since my arms are still long enough. Still there will come a day when I have to wear reading glasses with my contacts, I do not want to try bifocals or bifocal contacts, at least for the foreseeable future. I am happy with my extended wear contacts especially for running and other physical activities. I have thought some about laser reshaping of my corneas to eliminate the need for contacts but that will not fix the eventual problem with reading. I will still, one day, need lenses of some type for reading so I will not do the laser reshaping, at least for the foreseeable future.
At home, we are getting closer to being able to put in new carpet downstairs and get everything moved back to its proper place so the house has wider walkways again. We are not going to show the house again until things are back in their proper place, the realtor agrees with this plan also. For more details about this saga check out Delanae's page.
I kind of like being able to write this update and have it posted before 5 PM in the afternoon. Now I will have time after church to get better prepared for tomorrow and still get to bed earlier than I have been the last few nights. I still need to check out the other Daynoters' pages but have time to do that before church. I will probably not have an update tomorrow unless it is something real quick tomorrow night. I will have some interesting things to tell you about Friday after being on call tomorrow night so see you later...
On call tonight, probably no update.
Adoption day today. My kids officially became MY kids today. I have been their father for almost eight years and they had wanted me to officially become their father so we had been working on it for a couple of years. God finally cleared all the barriers and today in a small courtroom, before a judge, in a ceremony that took less than five minutes, I was able to adopt MY kids. They also changed their middle names to what their mother had originally wanted to name them at birth so we are one happy family tonight.
I am happy but tired. I was awake, on the telephone, every half hour to every hour all night last night. And to think I wanted to get back to that. I had three admissions last night, two at 4 AM this morning. Then I got up again at 5 AM to get ready to come in to hand over the patients to one of my associates and then go to a meeting beginning at 7 AM. After that, it was a busy morning at the office with the highlight being a less than five minute telephone consultation with an attorney about injuries suffered by his client in an auto accident. I have never been on the telephone less than five minutes with an attorney because they are trying to get me to say things more favorable to their client. This one did not.
When I finished the morning, Delanae and the kids came by to pick me up and go to the courthouse where we sat and waited for thirty minutes for our five minute "hearing". Then, it was back to the office where I was double booked for the afternoon. This means that there were two patients scheduled in every slot, rather than the usual one. By the time I finished this afternoon, I had seen in almost two less hours the usual number of patients I would have seen in a full day. Luckily, there were no hospital admissions since I will be at a review course all next week and would have had to transfer their care to one of my associates. The review course is in Portland and runs from 8 AM to 5:30 PM Monday through Friday. I will drive down every day and back every night. I checked today, and I will be able to park in a large lot north of Portland and ride to downtown Portland where the course is being held and return on the public transportation system for less than three dollars a day. I will be able to miss all the rush hour congestion this way and the cost for one day's round trip ticket will be less than half of what the parking downtown would be. This will be my first chance to experience an urban mass transit system several days in a row.
Tomorrow, I will be going to Seattle for the committee meeting I had told you about Sunday. After that, I will drive right back since Delanae is not going with me. She has a remote at a local cellular telephone store to help with tomorrow morning so she and the kids will stay here. Hopefully, through her contacts at the store, I will be able to get a new cellular phone there one day in the not so distant future. Her radio station is buying her a new one since her first one is no longer holding a charge or charging up correctly. Installing a new battery did not solve the problem so they will simply replace the telephone.
So now, I'm going to end this post and go to bed so I can get up and drive tomorrow morning. I'm looking forward to sleep uninterrupted by the telephone or the beeper tonight. See you tomorrow......
I made it to Seattle and back today. The meeting was fairly interesting, I was asked to write an article for the next edition of our Washington Academy of Family Physicians Journal. The article will be about using the MD Consult web site and will be slanted toward those physicians who haven't tried the site. I had recommended it to the members of the Information Services Committee at our last meeting and the chairman of the committee started using it and likes it as much as I do now. This article will be for the general membership of the Academy and introduce them to using it. My deadline is March 17 and I will be e-mailed the word limit and format next week. I will put up a link to it when it is published. I haven't written anything for publication, other than this journal, in years.
Finally, I have a picture at the top of this page, in case you didn't notice. It is my official picture for the medical group publications and handouts and is on our web site here. Until I get a better picture of me WITH facial hair, you will have to make do with it. Speaking of pictures, Delanae has one from yesterday's adoption "ceremony" on her web page here.
For those of you who have not seen it yet, Dan Bowman is trying to impress everyone with a couple of big words in his update today. I know what they mean and his students now also probably know what they mean. They have to do with the nervous system but you can e-mail him here for the exact definitions or a request to post those definitions on his page. The other big Daynoters news today is that Bob Thompson lost a game of FreeCell finally. He has posted the evidence in his daily update here. Let's everyone send him a letter of condolence. Just send it to this address.
Delanae is still working on her page so I will take advantage of this time and do some more work on my site. Good night everyone and God bless.
Rather slow day after worship this morning. Of course, everything is anti climactic after worship. I spent the afternoon reading a little, running, going to the office and writing an autoresponder message for Outlook on my office computer there as well as leaving a gone for the week message on my voice mail, and watching the last quarter of the NBA All-Star Game. I only saw the last quarter because I was confused what time it started here on the West Coast. Obviously I did not become unconfused in time to catch more of the game. The part I caught was very entertaining, however.
I also spent some time on the Web finding the schedule for the buses in Portland as well as where the routes run. I now have my route and schedule figured out for tomorrow morning and the rest of the week. I will be leaving here at 6 AM every day to get to the hotel in time for the start of the course every morning. Wednesday night I won't be home until 9 or so because there is a dinner that night that I am going to. My updates may be very short or absent most of this upcoming week.
In other news, Bob Thompson says he got a lot of messages about his FreeCell playing. Hopefully some of them were triggered by some of you who read my page yesterday. Thanks to everyone who took time to write Bob about his FreeCell record.
I hope everyone is ready for tomorrow, by now. For those of you who have forgotten, tomorrow is Valentine's Day. In the spirit of that day, I am cooking dinner for my family tonight so I must go and get started. Delanae and Stacey will be home soon from their trip to the local cinema to see "The Tigger Movie" which was Stacey's choice, obviously. Let me leave you with fan mail(I think) regarding the picture which is now at the top of my weekly pages. That really is me and was taken only two years ago. Bye now....
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