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Doc's Progress Notes
Week of June 5, 2000
Last Updated: 6/11/2000 at 6:29 PM PDT
Monday Tuesday
Wednesday Thursday Friday Saturday Sunday
Most Recent Update
Short update again tonight. I am on call tonight and am feeling very stressed. It is not a good way to close out a Monday, being on call. I just got through admitting a multi drug user who needs a place to stay so decided for the third time in less than two weeks that he would come in for detox. Detox to him means have a warm place to sleep and three square meals until the lure of the drug life is too strong and then leave and resume his habit. He will repeat this over and over and has in the past. I cannot refuse to admit him since he has a "plan" for drug rehab worked out with an accommodating social worker at one of the local mental health clinics. He can then come to the Emergency Department and ask for admission for detox. Our medical group then has to admit him according to the plans worked out with the mental health clinic. His last time in the hospital, which was May 29, he stayed less than twenty-four hours before leaving. That time he swore he was depressed and suicidal until the psychiatrist confronted him at which time he told the psychiatrist that he just needed a place to stay for a little while as he was out of money and drugs. He heard that our hospital was a nice place and had tried others in the Portland metropolitan area before. This is what yours and my tax dollars are being used for. I do not mind spending time and energy helping people who really want to be helped but I do not like being used by someone who does not want help.
There is some good news. We received an offer on our house in Arkansas today that we have accepted. Closing should be around the 17th of July with possession in thirty days. The house has been on the market three years now waiting for the real estate market in that area to recover. The couple buying it is moving back there from California and have relatives in the area. It has certainly been a long three years waiting for it to sell. We have had it rented most of the time but have lost money on it every month for those three years. The only thing helpful was the losses were deducted on our income tax statement.
Hope you are having or will have a better night than me. Good night.
I am still alive. I survived last night but was stressed. I was short with my family and friends last night due to being on call. That's what stress will do to you sometimes. I have been apologizing today and have been back more to myself. Well, I did send a nasty birthday greeting to Bob today but he deserves it. You should see the stuff he writes to us on the back channel.
Today at the office was a good day. Kathy and I really started using the new documentation forms that we came up with last week and they are going to work. There are some minor tweaks that we are seeing to do but our goal to reduce the clinicians' workload while accomplishing more documentation is possible it appears. The clinicians and their medical assistants piloting the changes are happy with the result after two days. We will be getting our group back together in two weeks to discuss rolling this out to the entire group.
There was a meeting of the family physicians in our group today to discuss some possible reorganization. We have several clinicians who are or are going to less than full time so there needs to be some reorganization to be sure all the patients in each team are covered and our patient access does not suffer too much. The initial step will mean that one physician who has been in our team since I came will be moving to another team within the next month. There will be other changes in the fall as one of our group goes on maternity leave then comes back to only work two days a week. We are recruiting for one more physician to take up the slack.
In other local news, our hospital and Kaiser Permanente have failed to reach an agreement on hospital rates so they will have to pay full rates for their patients hospitalized here. Kaiser had wanted to renegotiate the rates lower so had cancelled their contract almost three years ago. Both sides had finally come to agreement in principle on the rates but Kaiser refused to sign the contract due to some language in it. So now there is no contract after three years negotiating. No one knows what the full effect will be. Kaiser will want to take more of their patients out of town to their hospital in North Portland but that is 40 miles away and we think a lot of patients and employers here will balk at doing that. They can always hospitalize them here but that will cost Kaiser more in hospital rates than their old contract which they cancelled. The next six months or so should be interesting, our group may pick up a lot more patients since open enrollment in health plans will be approaching rather quickly. We will see if this development steers some of the largest employers locally away from Kaiser and to health plans which we accept. Our specialists had contracts with Kaiser which will continue, just not for hospital care.
Outlook in a Nutshell just came. Actually, the copy from Amazon just came today. There is another copy coming from Varsity Books within the next two days because the one from Amazon got ordered accidentally. I meant to order the one from Varsity Books and thought I had cancelled the one from Amazon but received an e-mail yesterday saying the one from Amazon had shipped. Now, I will have to decide which one to send back. In the meantime, I will be looking through the copy I have tonight which means I won't get caught up on the sleep I missed last night. Oh well, such is life.
As predicted yesterday, I now have two copies of Outlook in a Nutshell since the one from VarsityBooks.com came today. I will send one back, probably the one from Amazon.com since it was more expensive unless Delanae decides she will use one at work. She has Outlook 2000 there on their network and has been showing some of the others there what one can do with it. Yesterday, she amazed her boss by showing him how she could calculate the date that a commercial would stop if she knew how many times a week it was going to run and the total number of commercials. I haven't looked to see if that tip was documented by Tom and Bo in OIAN.
Today, being my day off and rainy, was spent reading and running errands. I finished a novel today that I had started yesterday and read through a couple of magazines. I have no one in the hospital right now so I did not have to see anyone there. While out running the errands, I did stop by and check e-mail at the office but there was nothing there of great importance. Well, of lesser importance is that our group is finally going to offer to buy us white lab coats with our names and group logo on them. I have been pushing for that since I came as I think it lends a look of professionalism to us if we have the logo on the coats. Now, everyone who wants one supplies their own and none match or have the group logo on them. Worse, some have logos from previous hospitals or groups where the clinician used to work.
Tomorrow, I start my day by helping do sports physicals for high school students at one of the local schools. We physicians donate two mornings in the spring to do physicals at the school for free for any high school athlete. They can also get them through our offices but many get them this way. It begins at 7 AM tomorrow so I must get to bed and get some sleep. I am still behind from call Monday night. Good night.
The sports physicals went well this morning. Twenty four physicians showed up to help so we were able to move the kids through rapidly. We actually finished early so I got an earlier start at the office than I had expected. That kept me closer to being on schedule all day. Thursday continues to be my busiest day of the week since I have to help cover for three physicians who are off on Thursday which means I am doing their refills, messages, as well as seeing patients and doing my own telephone work. I'm not whining, just commenting. I don't mind doing the work, I just have to remember to keep adjusting my schedule so I do not have to be anywhere early on Thursday evening. I still left the office today with two charts undone since I could not get hold of the patients on the telephone by 6:30 tonight. This continues to be a problem, playing telephone tag with patients and most of these do not have e-mail addresses so I can correspond with them that way.
This is Stephen's last weekend with his friends here for a few weeks so he is making plans to spend part of it with some of his friends. He and Stacey leave Saturday June 17 to fly back to Arkansas to spend a month there with grandparents and friends. Stephen is also being allowed to take his written test for his driver's permit Saturday. He is now old enough to get a permit providing, of course, he can pass the test. He will be going back to a state where kids his age have been driving for a year so he is understandably jealous of them. We need to get him into a driving school when he gets back from his trip since he has not been able to schedule it through the school.
Delanae is working on her first big annual contract. Two restaurants owned by one man are buying a year's worth of advertising and want to get the contract done ASAP. It is her first twelve month contract so it is a big step for her. Her commission on this sale alone will be more than she used to earn in other jobs a few years ago. It is close to what I earned as a resident seventeen years ago now. Has it really been that long? She is very nervous about getting it absolutely right as she meets with the owner tomorrow to finalize the deal.
I still have no one in the hospital so tomorrow will be a relatively late arrival for me. I don't have a meeting until 8 AM but will be there by 7:30 anyway. See you tomorrow.
No update today.
Short post today before I go to bed. I just never got around to posting anything yesterday and I have already forgotten what happened yesterday. I know we watched a really bad movie again Being John Malkovich. We picked it up because of the Academy Award nominations but it is terrible. I did not watch the ending and I don't really care how it ended. I ended up going to pick up Stephen from the theater where he had gone with some friends of his so I did not catch the ending. Then tonight we watched End of Days which turned out to be another pretty bad movie unless you like gratuitous violence and devil worship. Skip it if you don't. Delanae picked both of these winners and now refuses to pick any more movies to bring home.
It rained here all day so we didn't get to do anything outside all day. I did get to run between showers and we took a walk this evening around a different neighborhood here in town. We are looking at a house there which, if negotiations go well, we may be able to trade for. It is nicer and larger than what we live in now and, hopefully, we would not have to keep putting money into to fix things. The neighborhood is one that some of the other physicians live in. We met two walking their dogs there tonight.
This is Rose Festival weekend in Portland and today was the coldest it has ever been for this date in recorded history. The high was only 59(F) there so they had their Rose Parade in the rain and cold. In contrast, by Wednesday of the coming week it is supposed to be 80(F).
Tomorrow comes early so I will end this now. Maybe I will have more tomorrow.
We have had rain all day so I spent most of the day, after church, working on Outlook. I have been reconfiguring Outlook using Tom Syroid's book Outlook 2000 In A Nutshell. By the way, it works for Outlook 98 also which is what I have. The book has been a tremendous help in learning more about Outlook and especially how to use it more efficiently and take advantage of more of its features. As a bonus, I have once again found how to make the PST's smaller and more manageable, information Tom had shared with me before but which I had failed to do until now. It is done now and I am feeling better about my file management.
Yesterday was a gray day in more than one way. I forgot to mention that Stephen failed to pass his knowledge test for his driver's permit. He got only fifteen questions right and he was required to answer twenty correctly. He gets more chances to pass the test but he was really unhappy yesterday. It was his own fault, he thought he could just look at the book once and pass the test without doing much studying. He has now learned his lesson, I think.
Even though it was raining all day, I did manage to run during a lighter shower. I have set myself a goal of running/biking 45 miles on or the day before my 45th birthday this year. That will be August 21st and I will keep you updated on my progress. I am sharing this with everyone so I will be more motivated to train for this. When I decided to do my one and only, so far, marathon I let all my friends know so I would be more motivated to train for it rather than find excuses not to train. I will probably have to do the running/biking the day before my birthday as I don't think I can get out of working on my birthday due to the need to have the clinic completely covered that day. When I looked at the schedule Friday it looked like too many people have already asked for that day off.
Tomorrow I have meetings both at 7 AM and at 12:30 so it will be a busy day and begin very early. The weather is supposed to improve as the week goes by and my day off is supposed to be very beautiful with clear skies and temperatures of around 80 (F). I am looking forward to that. Don't know when this will be posted since I am having connectivity problems with my ISP. See you tomorrow night.
