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Doc's Progress Notes

Week of May 29, 2000

Last Updated: 6/4/2000 at 9:53 PM PDT

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Monday May 29, 2000

What a concept, starting out the week with a holiday. I think I like it but I will tell you for sure tomorrow. I realized that tomorrow is the only day this week that I will be seeing patients in the office. Wednesday through Friday I am involved in a Rapid Process Improvement project that I will tell you about when I actually am involved in it since I have never been involved in one up to this time. All I know is, it takes all day all three days and Friday we have a meeting late in the afternoon to institute changes in the way some processes in our offices are done. This should be an interesting week to say the least. I have interviews to participate in Wednesday and Fridays also as well as a special Leadership Council meeting on Thursday. At that meeting, we will be confronting the physician we are seriously considering not renewing their contract. This will be a prove to us why we should renew your contract type meeting. I don't look forward to it.

Today, it rained almost all day. It was a great day for staying in and doing some reading and paperwork to get ready for tomorrow. Delanae went to the grocery store and we are now stocked up for the week and the family moving in with us tomorrow is also bringing food. I don't know where we will put it all.

Tomorrow night, Stacey has her final orchestra concert of the year. She is presently renting a violin until she decides for sure if she really wants to continue playing the violin for the rest of her years in junior and senior high so of course she needed this violin repaired today before tomorrow's concert. The music store was open today but their repair person was not there with it being a holiday. So, she has a different violin now which she will use tomorrow night and then return at the end of this week. I am going to tape her performance using our new JVC Compact VHS Camcorder since Delanae has a banquet to go to that is given by her radio station to honor the graduating seniors in the local high schools with the highest honors. It is only fair that I should be able to go this time and she not since I have had to miss a lot of the kids' events due to being on call. This will be my first time to use the camcorder so wish me luck. I did read the instruction manual today which is a great place to start.

See you tomorrow.

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Tuesday May 30, 2000

The concert tonight went off without a hitch, at least after Stacey's music got there. I got her to the school a little early and she then remembered that she had left her music at home. So, I dropped her off and came back here, got her music, and took it back to her. I then taped her part of the concert and she has now watched it and critiqued her playing. From what I could tell, she did fine but she thinks her technique was all wrong. Tomorrow she is trying out for a youth orchestra for this summer.

At work today, Kathy and I were trying to cram a whole week's worth of refills and other phone calls into one day. We made it but it was busy. Tomorrow I begin the Rapid Process Improvement project at 9 AM and we will see how that goes. While I am doing the project, Kathy will be filling in in the office and generally creating havoc wherever she can <Grin>.

Sorry for the short post tonight, but it is late already and I have to get up in the morning. I will try and write more tomorrow night since I will be home earlier. Good night.

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Wednesday May 31, 2000

It was just a dream that I would be home earlier tonight. After church and returning some videos, I was home at about the same time as last night. Tomorrow night should be different but don't hold your breath.

The first day of Rapid Process Improvement was tiring. This is more because of the mental fatigue from sitting and listening and trying to come up with ways to change processes. We learned about changing processes in a very short time and now will spend the next two days trying out these changes in real time in the clinics and see which ones work and which ones don't. Interspersed with this will be two special meetings which have nothing to do with this project but which will cause some more mental stress. One is the meeting with the physician whom we are considering not renewing their contract. There is bound to be some conflict especially if the physician should threaten legal action. We hope to be able to iron out any conflict and actually keep the physician but they will have to make some radical changes in their relationships with staff and other physicians.

The other meeting is simply a meeting of the physicians in our team. This is our regular monthly meeting and should not be too emotionally draining. I also need to go through my inbox again tomorrow so it does not get too overflowing while I am "out of the office".

Delanae says Stacey did very well today during her tryout and Delanae was told that she was just what they were looking for. Stacey says she was not told any of this and does not know if she will be selected for the orchestra or not. She always tends to downplay how well she did so we will see what the real story is. The orchestra does not start until after school starts back in the fall.

Another short post tonight. Maybe more tomorrow but no promises.

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Thursday June 1, 2000

The second day of Rapid Process Improvement was also tiring. It is tiring because we sit and discuss ways to change processes that will save time and reduce wasted motion and produce the desired effect more efficiently. Inherent in this process is thinking what are the possible unwanted side effects of each change in the flow of a process. Ours is complicated by the fact that we are reviewing a lot of the forms and other paperwork that is used or comes across a physician's desk each day and trying to decide what is critical and what can be discarded. Then, we look at the critical ones and say how can we make it better so my time is used more efficiently for delivering patient care. Now, we have discussed each one, eliminated some, and changed some more. Tomorrow we try them in real life using some selected physicians and monitor how well they do using them. That is the ultimate test and the reason it is called rapid process improvement, they are trying new flows within 72 hours of starting to look at a process. This was originally called continuous quality improvement but that process took longer.

Our special Leadership Council meeting with the physician in question this morning went about as expected, I guess. This physician basically has the wrong perception about everything and we believe is, at best, not telling the whole truth about some interactions and events. We have documentation from several sources that is different from what that physician told us today. The physician is a disruptive influence and refuses to change and will find out that unless a major change is forthcoming that there will not be a contract renewal. Prior to that, a chance to resign will be given. All of us on the Council had hoped that the overwhelming evidence was somehow wrong but it was not to be. The meeting was cordial but there was an underlying confrontational feeling between the physician and our medical director who had done all he could to change the physician's behavior prior to bringing it to our attention.

My mother called tonight to give me some bad news. She was involved in an auto accident about thirteen months ago now when she applied the brakes of her car on a wet highway and the car slid striking another vehicle crossing the intersection and who had the right-of-way. She was trying to stop at a stop sign and was not cited by the police. The man got out and walked around after the accident and checked on my mother who was also OK. His wife called a couple of days later to check on my mother and be sure she was OK. Now, my mother is served with a lawsuit alleging huge medical bills, mental strain, loss of earnings and future loss of earnings due to the accident, etc. all of which can be resolved with X amount of money. That amount is not specified in the letter advising her of the lawsuit but I am sure the low life scum of a reptile called an attorney would be happy to name a figure and will at some point. Although a couple of my best friends, over the years, are attorneys I detest what has happened in this country due to their brothers and sisters being willing to try and assess blame for every accident that occurs and demanding compensation for every real or imagined injury. The only way this accident could have been prevented is if it had not been raining and my mother had not been driving that day. To try and extort money for something that was not her fault simply reinforces my above description of attorneys as low life scum somewhere in the reptile family. Perhaps I falsely insult reptiles, though.

End of rant for tonight. It is time to go to bed as tomorrow starts very early.

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Friday June 2, 2000

The RPI is over. We finished it this afternoon with a presentation of our recommendations. All were well received and a plan to implement them is in place. Over the next two weeks one of the other physicians and I will be presenting our results to the other physicians in our group to get them to incorporate our recommendations. The administration has given us the go ahead to implement them all which will involve creating a new chart order and reprinting some forms. We have also thrown out some forms and made the ones we use much simpler and more user friendly. The recommendations are rather simple but it took getting a group of people together for a relatively short time and allowing them to look at everything we do in documenting and see what the most efficient way is to obtain the critical data needed. Now, Monday I get to return to seeing patients and putting these recommendations into use in the real world.

Tonight, the Blazers forced a seventh game by beating LA again. Too bad it is in LA in one way but good in another as the Blazers have played well there all season. Scottie Pippen has really stepped up to lead the Blazers which should put a stop to all the doubts people have had about his ability to lead a team. Tonight, he harassed LA all over the court and did not lead to score many points for the Blazers to win. My prediction is that he will need a big offensive night Sunday night for the Blazers to win. I believe they can and will since they have shown tremendous mental toughness to come back and even the series after being outplayed so much in those two games at home.

This weekend looks to be warm and dry here which means I will have to water the garden. I still need to plant some tomato plants if I hope to have any tomatoes out of it this summer. None of the tomato seeds came up and not much else is other than peas. The weather here just doesn't get warm enough early enough. Next year if I want a garden I will have to start it inside then move it outside after everything has germinated. We'll see next year.

Now, I am going to read some and then to bed. See you tomorrow.

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Saturday June 3, 2000

Today felt like summer here. The temperature got up to the mid 80's with clear skies and low humidity. I discovered that more corn was coming up in the garden than I thought and there were a few more bean stalks also. Hopefully, the warmer weather will make more come up. I did have to water the garden today and probably tomorrow but the rain is supposed to return Monday.

Tomorrow is the big seventh game between the Blazers and the Lakers. It will begin at 4:30 PM here so you can guess where I will be at that time. Delanae will be watching it with me as she has developed into quite the Blazers fan. During game six Friday night I heard her grunting about bad calls and cheering for Arvydas Sabonis. She's also trying to get me to give up my following the Arkansas Razorbacks but I have already told her there is no way I will ever give up following them closely. I became an Arkansas Razorback fan at a very young age and will stay that way.

I caught some of the French Open today on TV. I used to play a lot of tennis but gave it up about four years ago because I was spending all my time playing and none at home. I played on clay only once but it was fun. That was a doubles match which me and my partner won. It was played at a state championship tournament and I think that was the year that my team won the state championship but it could have been the year before.

See you tomorrow and don't forget to cheer for the Blazers!

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Sunday June 4, 2000

What a tough way to lose. For those of you who did not watch the Portland-LA game this afternoon, Portland was up by 16 in the fourth quarter and ended up losing by five. Portland came back from being down three games to one in the best of seven series to tie the series at three all. I guess they spent all their emotion doing that and had nothing left for the fourth quarter today. It was a great game however between two very closely matched teams and I now hope that LA wins the NBA Finals which they should easily but it probably won't be easy. Either them or Portland were the best team in the NBA this year. If Portland can keep their team together over the summer and perhaps add a bigger backup center they should be back in the same Western Finals again next year.

I did not do much today other than watch the game. We did go to church this morning and had a great service as usual with very good worship. Worship just keeps getting better and better even though I think it can't get better. Tomorrow night our worship team practices and our regular bass player is back so I will be back to being sound person again. However, I am on call tomorrow night so I do not know how much time I will actually get to be at practice. I also do not know if I will have an update tomorrow night or not but I will try. Good night.

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