Doc's Progress Notes
Week of May 22, 2000
Last Updated: 5/28/2000 at 8:10 PM PDT
Today is almost over. It began early at 7 AM with a leadership council meeting that lasted longer than it was supposed to because of all we had to cover. Included in that was a discussion of a physician in our group who is having problems fitting into the group. That physician would function better as head of their own clinic but is a member of our group. We will be meeting with that physician later to discuss the issues involved which will be a tough meeting for everyone concerned.
Just before I got to the office prior to the meeting I realized I had forgotten my stethoscope and that it was still sitting at home. I could turn around and go home and be late for the meeting, try to go after the meeting, or try and borrow one from someone else in the office. I chose the latter since I still had three patients to see. Luckily, one of my partners had a spare one and allowed me to borrow it. It felt strange in my ears all day but I made it through.
By the time the meeting was over, it was time to start my office hours so I did not get to see my three patients until noon. I wolfed down a sandwich and then saw them. One was ready to go home so I took care of that discharge and the other two are still hospitalized. One will go home tomorrow if she is able to eat tonight and get up and around pretty much by herself. She is in her early eighties and lives alone so she needs to be able to do most everything for herself. The other patient is a lady with Alzheimer's Disease who is very demented and hallucinating. We have had her in the hospital to start her on medication to reduce her hallucinations and aggressive behavior to her caregivers. We finally have her very near her baseline function I think so will be discharging her on Friday to go to a nursing home near Seattle where she lived most of her adult life. She actually lived on Whidby Island there and the nursing home is on the island. Her husband still lives there but she no longer knows him.
Finally, after I finished at the office, I went home and picked up Delanae and she and I went to worship team practice. There, I got to play bass with the full group for the first time in a long time since the regular bass player is gone this weekend. This was the first time I had played with a drummer in a long time and it was very different. The drummer for the group is a LOUD drummer and really sets the tone and rhythm forcing me to follow him. That is the way it should be but I have gotten accustomed to playing without a drummer so it took some adjusting. I still feel kind of lost but it will work out for Sunday and is a good learning experience.
I must wrap this up so I can get to bed at a decent hour tonight. Tomorrow promises to be just as busy. I have a rapidly growing mountain of journals on and by my desk at the office that I need to either read or throw out. Maybe I can do some of that Wednesday morning since I need to go in and make nursing home rounds anyway.
I remembered the stethoscope today. Yes, I got to the office with everything I was supposed to have this morning. I sent one of my patients home from the hospital today and the other one will be discharged Friday. She is the lady with Alzheimer's Disease that I mentioned yesterday. The patient I discharged today had been admitted unable to keep her antibiotic for a bladder infection down. She was ready to go home this morning as she was eating and drinking without problems. I did find out that I had a new patient in a nursing home today who had been admitted over the weekend and I had not been informed of the admission. It is a man who recently had radical throat and neck surgery for a cancer at the base of his tongue. He is being fed through a tube into his stomach and is breathing through a tracheostomy while the swelling from the surgery goes down. He will also need radiation therapy for the cancer which will further hamper his ability to swallow for a few weeks. He had been sent home from the university hospital but his wife was unable to care for him by herself. Any way, one of my partners who was on call this weekend had admitted but neglected to tell me so I find out today when the nursing home calls me needing an order for something. That is very embarrassing for me and hard to explain to a family. You can bet my partner will hear about this especially since she whines all the time about how she doesn't find out things at the right time.
I met some interesting people today. They were new patients either transferring from the group member who left a couple of months ago or ones who had had no local physician previously. One lady, who was only 39, had seven children, the youngest 12, and six grandchildren, all under the age of six. She said all her children called her daily so I asked how she had time to do anything else other than talk on the telephone. She laughed and said she had a very long cord for the telephone so she could do her household work while she talked. The other one was a man, who with his live-in girl friend, had five children living in the house. They had just moved into a bigger house so the oldest could finally have room for his own bed rather than sleep with his younger brother all the time. The best part of being a family doctor is that you get to meet these families and interact with them.
Tomorrow morning looks busy. I need to go by medical records and sign a bunch of charts and dictate one chart that I know of. Then I need to make nursing home rounds and try to clean off my desk at work a little. I also have to go by the post office, get a haircut, and meet my pastor for lunch at noon. All in all, it looks like a busy day off tomorrow since I need to spend the afternoon in the garden again weeding it before the rain comes back this weekend.
I hope that all my tasks for today are completed, I think they are. I completed my medical records at the hospital this morning and saw my one hospitalized patient who is probably going to be transferred tomorrow rather than Friday. Tomorrow I also need to see a patient for one of my partners who is off on Thursday. Then, I went to the nursing homes and saw my patients there. They are all either improving or remaining about the same. All but one has some Alzheimer's Disease so if they are remaining about the same then that is good.
After finishing up nursing home rounds, I went to get a hair cut. When I got there, I was told I was an hour late; sure enough on my Palm Pilot the hair cut was scheduled for 10:30 not 11:30. I had gotten in such a habit of going at 11:30 on Wednesdays that I did not look to see if the time was different. I apologized profusely and she was slow enough at the time that she was able to work me in. I made sure that it is scheduled for 11:30 the next time.
After that, I had lunch with our pastor then home to work in the garden for awhile. Not much more is coming up as the weather has not been warm enough for any extended length of time to allow everything to germinate. I am learning that here in the Pacific Northwest one has to start the warm weather plants indoors to get them to germinate then plant them outside once they have germinated. There's always next year I guess. I will have peas this year and maybe a little corn as well as some lettuce. I will put out some tomato plants around the first of June and hopefully we will have some tomatoes before the summer is over.
I also got to take a nap this afternoon which is an uncommon occurrence on a weekday. It was wonderful and I had a nice run afterward. Worship was very good tonight and the prayer time afterward was also very good. Now, I need to get ready for a busy day tomorrow and I will be looking forward to a long three day weekend coming up. Since it will be raining here we will probably use it to catch up on some work inside including straightening up my office and writing some letters that need to be written. See you tomorrow.
Thursdays just seem to get busier and busier at the office. Maybe it is because there are less clinicians in on that day than other days. Today began innocently enough with me seeing two patients in the hospital and discharging one. She is the lady with Alzheimer's Disease who is going to a home on Whidby Island and had been hospitalized on the psychiatric floor for twenty days to get her agitation and hallucinations under control enough that she would no longer be a physical threat to her caregivers. The other patient I saw for my associate and she should be able to go home tomorrow.
The morning then was steady but not crazy. I did find one note left over from late Tuesday that had not been addressed until this morning and the caller was not told I wasn't in yesterday. Our receptionists are supposed to tell patients who call if we are off on that day and ask if it can wait until we are back. We called the patient's father back and told him about the mistake and that if he felt he needed to be seen to bring him in during the afternoon. We even gave him a time. I then went off to lunch.
After lunch, I come back to find the patient and his father there along with the regularly scheduled patient and another work-in who felt she couldn't wait a couple of hours. So, I was behind before I started. I finally worked through them and hopefully soothed any hurt feelings in the process. I will bring this topic up to our clinic manager again since to not communicate with patients about when they can expect to hear back from us is simply not good patient care. It is something we must go over and over with people who answer the telephone.
Then, I look at the rest of my afternoon schedule and find there is a patient scheduled for cast placement as the last patient of the day and that patient had not been on the schedule this morning. I proceed to ask what is going on and am told by the nurse that the patient had been to the ED the night before with a swollen hand secondary to a fracture and they had put it in a splint. The patient was unhappy with the splint so had called to come in for a cast. Rather than come and ask if it was the proper thing to do, the nurse had simply scheduled him. I proceeded to explain to her that I could not cast the hand if it was still swollen and it was probably still swollen if it was swollen the night before. I then had her call the patient back and explain to him that I would not cast it as long as it was swollen and it would take up to five days for the swelling to go down so we would see him next week when it was the proper time for casting. I then again requested that if there was any question at all to come and ask me before scheduling someone it that you are not absolutely sure about. Was I irritated some by this time? You can bet I was.
Then, another patient showed up thirty minutes late for their appointment and wanted to be seen. She is someone who had never been seen in our office before and had scheduled a new patient appointment before, which is a long appointment, and then had simply not shown without calling us to tell us she could not come. Ordinarily I am very lenient about people being late if they let us know because I am late more times than I'd like to admit. I draw the line, however, with this type of behavior so I refuse to see her. I find out later that she is doctor shopping for someone to prescribe her pain medications and has repeated this behavior at other offices around town.
Finally, I finish up seeing patients and try and return some phone calls. No one is home and the few who are have busy signals on their lines. I don't complete a single call by talking to a live person, only answering machines so they will know that I did call back. So I left a large stack of charts to call back on tomorrow which will make the day before a long holiday weekend even longer. I can't wait to see what happens tomorrow at the office. Details tomorrow night.
Friday is finally over. I worked with a different medical assistant today as Kathy took a day of vacation. This medical assistant did not know how I liked to do things which slowed me down some. You don't realize how dependent you are on an assistant until she is gone. Kathy knows what I am going to do almost before I do and so she saves some time by anticipating what I will need or what I am going to do. We did make it through the day however.
Unfortunately I had to leave some phone calls unanswered again this evening as there was no one home when I called back. I will try and call a couple of people back tomorrow but the others will have to wait until Tuesday since Monday is a holiday. None of them had emergencies just questions.
Sorry for the short post but I am getting very sleepy. We had several teenagers in our home tonight to watch a movie with Stephen so I was unable to get to the computer until now. I will try and make up for this short post tomorrow. It looks like rain here so it will be an inside day. Hope you have a great holiday weekend wherever you are.
Another short post today. Pretty lazy day for us. I did get up this morning and pay some bills and write a letter which had to go out by snail mail rather than e-mail. Yes, there are still some letters that have to go that way. I did experience ordering new printed checks online for the first time Thursday (or was that Wednesday?). It was remarkably painless and cheaper than ordering them from the bank. I use Quicken to keep records but write those checks which I cannot send electronically. I used to print checks but most of the time I did not have three (or a multiple of three) checks to print and trying to print one check on a laser printer is very difficult.
I did run this morning after mailing the bills and letter. It was a good time for running as it was the right temperature (low 60's) and the wind was blowing hard enough to prevent any sweat from forming. After I got home, Delanae and I put up the rest of the wallpaper in the bathroom and then the border. The bathroom is now officially done, except for a towel rack that we still need to get and put up.
After dinner, which I fixed, we watched Galaxy Quest then I came down to update this journal and practice on my bass. Tomorrow morning I will be playing for our main worship team for the first time. Our regular bass player is out of town this weekend so our leader asked me to fill in. This means that someone else is running the sound board for me also. I have been practicing more this week to get ready and I need to continue practicing this much even after tomorrow.
Tomorrow, after church, we will be coming home to watch the Blazers even their series with the Lakers at two all. It is a must game for the Blazers as they cannot afford to lose two games to the Lakers in Portland and expect to beat the Lakers for the series. I was disappointed in the outcome of the game Friday night but I have great confidence that the Blazers will prevail in the series then go on to win the NBA Championship. Be sure and watch the game tomorrow and cheer on the Blazers!
Another relaxing day. Well, almost. Worship went well this morning although I felt like I made ten thousand mistakes during the worship set. That is just me, driven to be perfect, hard to accept anything less from myself. It was fun and I am ready to do it again. Delanae was able to be onstage again and sing although she was sitting while she was doing it. Sitting and singing is very hard for her but she managed it.
We also invited a member of our worship team who is a single mother with three children from preschool to age eight to stay in our house with us while she is between apartments. This could be for anywhere from a couple of days to a couple of weeks. The new apartment is finished but the road to it is not in yet so they can't let anyone into the new apartments until the road is completely finished. This should be a different experience, having five children in the house along with three adults.
After lunch, well during lunch, we watched the Blazers lose to the Lakers. It was a very disappointing game to any Blazers' fan since they failed to win at home in a pivotal game. LA just outplayed them and looks like the best team in the NBA at this time. The Blazers could still come back and beat them but it would take them playing better than they have all season.
Our border job from yesterday tried to come down. Actually, only one strip of border which is under the lights of the bathroom so we are thinking it dried out too quickly. So, we put it back up this afternoon and have left the lights turned out until late tonight. Hopefully, we won't have to redo it again since neither of us really enjoys doing that type of work.
After putting up the border again, I tried to childproof my office and then remounted some of my plaques on the wall. They were there before but when Delanae and I changed offices last year then they were taken down and moved upstairs. Now they are back up on the original wall. Here's a picture of what the wall looks like with my computer on the desk below.
Out of view to the right are my bass guitars, amp, and bookshelves with books, CD's, and other things crammed into them. Maybe one day I will take a picture of the rest of the office. Anyway, it is relatively small child proof now, I hope.
Tomorrow, I am off again but I will have to work the weekend before the next two holidays. That is ok since I am used to working more holidays than this. Hope all of you have a safe Memorial Day tomorrow wherever you are.
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