Doc's Progress Notes
Week of February 21, 2000
Last Updated: 2/27/2000 at 7:49 PM PST
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Back to work day, today. For some people this was a holiday, but not for us. Some of the union employees at our clinic and the hospital got time and a half for working today. For the clinicians, it was just another day. Being my first day back, there was a large stack of paper work to be done which kept restoring itself all through the day as I would get it worked down to a very small size. I think I put out all the fires left over from last week and now all the paper work is caught up on and I can go back tomorrow to a clean(relatively) desk tomorrow.
While I was gone, my medical assistant was on a team participating in a Rapid Process Improvement project to improve the efficiency of the office to try and get clinicians and staff finished earlier in the evening. This RPI team looked at the ways the more efficient clinician and staff did things and compared it to the ways the less efficient clinician and staff did things. They then got together and presented their findings to each other and came up with recommendations for changing processes to make them more efficient. She says they found some horrendously inefficient things being done and some of the people doing them were resistant to change even when shown more efficient ways. This just goes to show you that, no matter how inefficient a way of doing things is, if it is familiar to you, you do not want to change.
She told me that some members of the RIP team would come up with a more efficient way of doing things and would ask her about doing it that way and she would reply that she and I were already doing that. She says she finally got tired of saying that and kept quiet, which is very difficult for her. At the end, one of the administrators asked how someone who had only been with the group for two years could have figured out these more efficient ways of doing things when some of the more senior members were still doing things more inefficient ways. She told them it was because I was willing to change and look at different ways of doing things rather than just doing them the same way every time just because it had always been done that way. I don't think she told them this, but it is also because we are BOTH capable of and do look at things and ask why should we do them this way. We then try to find a more efficient way and if we cannot then stick with the way we had been doing it. Physicians are notoriously bad about not changing the ways they do things because they have learned that way, it is comfortable, and therefore it must be the right way.
Because we are efficient and today did incorporate some things learned in the RIP, we were able to get done today on time even with the increased paperwork due to us both being off last week. I guess today was the real test of whether the changes were going to work. Hopefully, others have embraced the changes and will now become more efficient and therefore not have to spend as many hours in the office.
I found out today that the lady I had mentioned several weeks ago who had endstage chronic lung disease died late last week. You may remember that she had been ready to go as she was tired of being short of breath but when the time would come to decide if she was going to the hospital or not she would choose to go. This time we had made arrangements for her to go to the Hospice Care Center when she got really bad. There they were able to keep her sedated and pain free so her passing could be dignified and without pain. I'm sure she is looking down on us from heaven now saying thank you for what you did for me.
Today I also got the privilege of sending someone home from the nursing home after rehabilitation. She had been hospitalized with what turned out to be a urinary tract infection and a colon infection which, at age 91, had made her very weak and unable to care for herself. At the time she was ready for discharge from the hospital, she was still not able to care for herself full-time so she was admitted to the nursing home for further rehabilitation to regain her strength. Now, 16 days later, she is independent again and is going back to her own home. This is now the third time she has been through a nursing home rehabilitation and, each time, has been able to go home and live independently again.
Tomorrow looks busy again with us still catching up. I must go and help Delanae run the kids off to bed and get my stuff ready for tomorrow. Later...
Thank God for Hospice again. This time it is a 92 year old gentleman who is dying from pneumonia which antibiotics are not clearing. He does not want to go back to the hospital, he wants to only be kept comfortable and pain free which we can do at the Hospice Care Center. His family is in complete agreement so he was transferred there today. I expect that he will not last 24 hours and his death will again be dignified and without pain. I will check there in the morning but don't expect he will be there.
My medical assistant and I did get caught up today. We are now current on everything but will be behind again tomorrow which is my and therefore her day off. I do have to go to a team meeting at noon tomorrow and then have a high intensity weight training workout to do tomorrow afternoon. I also promised to fix dinner tomorrow night and have church tomorrow night. Tomorrow will be a full day but I am not scheduled in the office.
I am still trying to order memory from Crucial for Delanae's computer from my home computer. I can connect to their web site from the office but from home I cannot. Tomorrow, I will go ahead and order the memory from the office. I do not have trouble connecting to any other web site from home so don't understand this problem. I'm not going to spend any more time trying to figure it out until the weekend. Now I am going to bed and get some sleep.
As I predicted last night, my patient at the Hospice Care Center died during the night. His death was dignified and painless. The family is making an appointment for his wife to start coming and seeing me for her medical care. They say he had been neglecting her due to his deteriorating mental condition prior to going to the nursing home. He had originally been admitted to the hospital because of a stroke then was transferred to the nursing home after discharge from the hospital.
I was able to order some memory from Crucial this morning on my computer at work. I am still not able to connect to their web site from here at home. I am also going to be getting a CD-ROM drive to replace the one in Delanae's computer that no longer works. I will probably replace it at the same time I add the memory I ordered today to her computer. I am looking at getting a 10-20 GB hard drive for my computer within the next month. I'm also pricing Celeron 433 processors at the present time, thinking about putting a motherboard with dual Celerons in my present computer to replace the original motherboard from Gateway. That is more in the future and after I set up my home network in the next two months.
Tomorrow, I will be seeing one of my associate's patient in the hospital for him as he is off tomorrow. This unfortunate man had a stroke a couple of days after a routine nasal surgery. It turns out that he has known coronary artery disease and a past angioplasty as well as a high cholesterol. His stroke was probably unavoidable given his underlying vascular disease and not caused by some complication from the surgery. Unrelated to this, my associate came down with an outbreak of shingles this week. I put him on Famvir which is an antiviral used to treat shingles, genital herpes, and fever blisters. He has had a very good response to the Famvir with resolution of his itching and pain within a couple of days. By the way, all the above conditions are caused by a virus in the Herpes family of viruses. Shingles is just the re-eruption of the chicken pox virus along the course of one nerve.
Delanae is very busy getting merchandise for the upcoming auction being done by her radio station (the one she works for as a salesperson). She is so busy that she is forgetting things. Today, she was driving home and realized that she had not picked up Stephen from school yet and had to turn around and go back and get him. She was worried that there was something really wrong with her. I told her no, she is just very busy right now and it is easier to forget things when your mind is occupied, I've forgotten some very important things when I am especially busy and seem to do that more often as I get older. Besides, every parent would like to forget their teenager(s) from time to time <big grin>. She doesn't like the reminder that she too is getting older. On that note, I will call it a night. See you tomorrow....
Well, I am still alive. I wasn't sure after posting the remark about Delanae getting older last night. She is taking it well, at least for now. Stephen is home so he was not forgotten today.
Some work is being done downstairs finally. The walls were primed today and the concrete floor sealed before the carpet goes down in a couple of weeks. The walls should be painted in a day or two. I am getting anxious to get the offices set up again and get the computers networked so we can share an Internet connection rather than tying up two phone lines a lot. One of my associates tried to call me last night and again this morning to tell me about a patient admitted last night but couldn't get through to us. I told her it was because we had two teenagers but really it was because both lines were connected to the Internet both times.
My nurse was out sick today but the replacement nurse turned out to be very good and experienced. I called Kathy, my regular nurse, early this afternoon to see how she was doing and she told me she was much better and would be back tomorrow. I told her no hurry as her replacement was being nice to me. Kathy replied that she would have to talk to Paula and set her straight about how to treat me. Kathy has an Australian Shepherd, as do I, and her dog was keeping her company on the couch when I called. My dog would like to be a lap dog but we do not allow that in our house. Her husband gets mad at her for allowing the dog up on the furniture but that doesn't bother Kathy one bit. Their home is reportedly an animal haven and stray animals seem to be attracted to it, even more so than ours. Over the years, we have taken in a lot of stray animals, and either adopted them or found homes for them.
Because of Paula's experience, today went very smoothly. We got done on time and nothing was left undone waiting for Kathy to come back tomorrow. Having a nurse who knows how you like to do things and is experienced, keeps a doctor's office running smoothly. A cardiologist, who is currently in solo practice here, is joining our group and one of the main things he insisted on in his contract is that he be allowed to bring his own nurse of some 20 years to work with him here. I can understand that demand, even if some of the administrators did not. Some think that we should be able to work with any of the nurses who work in the clinic, but the really savvy ones understand how important having one nurse who works with one physician all the time is to a smoothly running practice.
Tomorrow is the last day for one of my associates. He is moving to a practice in Bellingham so he can be closer to his parents' home in British Columbia. He will be missed as he was a good physician and a really nice guy. I have heard nothing but compliments about him since I have been here. He stopped me in the hall today to apologize for sending me so many complicated patients after he leaves and also for referring a couple of his nursing home patients to me. I told him that was no problem as I was accustomed to dealing with complicated patients and nursing home patients. Paula, my replacement nurse today, has worked a lot with him in the past and confirms that he is always a nice guy no matter how hectic things got in the office. Good luck to you Rick and may God bless you in the future.
Kathy was back today. She was feeling much better but not yet quite well. She did make it through the day but was very tired by the end of the day. Today started out very strangely, none of our appointments for the first ninety minutes showed. None of them called to say they weren't coming or to reschedule. While it is not unusual for people to just not show and not call and tell us they are not coming, it is unusual for that many people in a row to no-show. The rest of the day we were busy though, which made up for the beginning of the day. I finally got finished with the last phone call about 6:30 tonight.
After finishing up at the office, I went by and rented "Entrapment" which Delanae and I watched and I enjoyed. She just wanted to see something with action which did not require her to think. The kids are both staying at other people's houses tonight so we were all alone. She got us a "Roastin' Toastin' Garlic Chicken" pizza tonight and we watched the movie while eating the pizza. She has to work tomorrow to get ready for the auction next weekend so I will be the one to sleep in a little late tomorrow. After that, I will have to pick up the kids and help Delanae move some heavy stuff later in the afternoon. It is supposed to rain all weekend so we couldn't do anything outside anyway.
I must go and get the dogs in now then it is early to bed for us. Talk to you tomorrow....
As it turned out, I only had to pick up one kid, Stacey, from the house where she was spending the night. It was a birthday present for her friend and the parents were worn out from trying to keep up with several 11-12 year old girls. I can only imagine, having tried to keep up with 5 one night myself. Stephen is spending another night at his friend Greg's and we'll pick him up in the morning on the way to church. Delanae is still at the radio station finishing up some work. She didn't make it in as early as she thought she would which is why she is still there. At least I didn't have to go move anything heavy this afternoon, that will be saved for tomorrow afternoon unless it is still raining. It has rained here all day and is supposed to rain all through next week. Typical Washington winter weather.
Driving out to pick up Stacey, I drove along the Cowlitz River and saw the smelt fishermen out again. I have not mentioned this before and it may be unique to the Pacific Northwest for all I know. During smelt season, actually only a few designated days this time of the year, these fishermen park along the banks of the Cowlitz and use large dipping nets to scoop up smelt as they swim in the river. Some actually wade out into the river to "catch" their smelt. It is quite a sight when driving over one of the bridges over the Cowlitz; cars lined up along the road paralleling the river for as far as you can see and all these people either on the bank of the river or wading in the river, all with these dipping nets. Smelt is used for bait by a lot of people, but some cook it in various ways and eat it. It is a very oily, salty fish and a lot of people don't like the taste. I tried some fried a couple of years ago and you can count me among the ones who don't like the taste. This "season" has supposedly been one of the best ones in several years.
Other than picking up Stacey and watching the smelt "fishermen", this has been a rather lazy day for me. I did do my weight workout today and ran but otherwise watched a lot of college basketball and took a nap this afternoon. I was going to do some work on the computer but just never made it back in here until now. I am going to get started on my tax records so I can get them to my accountant by the middle of March which will be a record for me. Usually, he is filing extensions for me and we actually file sometimes in the middle of the summer. I use Quicken to keep all my financial records so it is not that the records are hard to find, it is just laziness usually. We'll see if this year is different. See you tomorrow....
The tax records have been printed from Quicken and now I have to get Delanae's mileage from her, enter the figures in the appropriate blanks of the tax organizer from my accountant, then mail it back to him, he still lives in Arkansas remember. This has got to be a record for me, to be this close to being finished this early. This is why I use Quicken, to be able to be organized like this but I don't always get it done this early.
Tomorrow morning I start my first week of IPP duty. IPP stands for InPatient Physician. The IPP is responsible for admitting and taking care of all the unassigned patients admitted from the Emergency Department to our group as well as patients of physicians who are on vacation this week. This physician is also available for any urgent nursing questions during the day, rather than having to call a physician at his office. During our IPP rotation, we have no office hours and our hospital hours are 7 AM to 6 PM daily during that four day week (M-Th). It will be an excellent chance to meet a lot of the staff in the hospital and in turn for them to meet me. It's almost like being a resident again when we had hospital rotations where one worked in the hospital daily for 1-3 months at a time. We also do a Friday to Sunday rotation so on the weekends there is always two physicians in the hospital during the day which cuts down on the call load.
We're having problems with our septic tank again. That means that tomorrow the crew will be here to attempt to pump the tank this time. When we had the problem back in December, they thought that perhaps they could get by without pumping the tank but now it looks like it is inevitable. Hopefully they can find it easily this time and solve our problem. Stacey and I washed dishes twice today to keep from using more water in the dishwasher and causing the toilet to overflow again. So far, there have been no overflows this time or any water appearing downstairs again. I'm still trying to find out if our home warranty will cover the septic tank problems.
Now, I must get ready for tomorrow. I need to get some things done before 7 AM tomorrow since I have a Leadership Council meeting then. I will need to check out with the on call physician earlier so I know if anyone was admitted during the night. Talk to you tomorrow....
