Last Week



Doc's Progress Notes

Week of August 7, 2000

Last Updated: 8/13/2000 at 8:35 PM PDT

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Monday August 7, 2000

Short post tonight. Long day today beginning before 7 AM and just now finding a little time to do this. I am on call so may have to leave at a moment's notice. The office was a little slow today reflecting the fact that a lot of people are taking last minute vacation before school starts again. We always slow down this time of the year and get back busy again right after school starts when the strep throat and viral illnesses begin to be spread around again by kids being together all the time.

The hospital is real slow, again reflecting just the time of the year. I only have one person to see tomorrow as of right now. We have several physicians gone right now on vacation and really don't miss them. This would not be true if it were winter time.

No really interesting patients today, or at least none that really stick in my mind. Well, there was one with a different story that what I usually hear. He had been operated on for a ruptured disk by a physician in Vancouver, WA in 1996 and had had a primary care physician here locally for several years. He lost both of them to the effect of drug addiction. The neurosurgeon committed suicide and the primary care physician ended up leaving town. He is understandably wary about coming to a new physician and spent most of his appointment with me interviewing me to ascertain my character. It was an interesting experience for me but in the end he decided he would continue coming in to see me. Luckily, he is healthy and will only need yearly physicals for a few years. Maybe he can learn to really trust me during these years before he really needs any acute medical care.

End of post for tonight. Wish me luck on getting some sleep tonight.

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Tuesday August 8, 2000

I did get some sleep last night. Actually, I got no calls after about 1 AM which was the only admission I had all night also. It remained slow in the hospital today as I discharged one this morning so our census ended up even after that. I did not admit anyone through the day today so I will not be going in tomorrow morning to round on anybody on my day off. I will go in for a little while to check my e-mail and messages.

There is a summertime virus going around here and it is trying to get me. I have a dry cough and a mild sore throat and a little fatigue. I don't plan on it getting me however, as if I had a real choice in the matter. This virus did increase my number of patients today so it looks like yesterday's slow day was only a one day thing. I am really getting a lot of new patients right now as some companies' insurance carriers are changing. We are getting several who are transferring over from Kaiser Permanente since their rates are going up and their benefits down. When that happens, patients get tired of a true HMO quickly, or at least in this area they do. Since we are a multi-specialty group we contract with health insurance carriers and are not part of an HMO nor do we have an insurance product which we must micromanage (translation: deny needed care for the sake of making a profit for stockholders). Our intention is to remain independent of HMO's as long as possible and, given what is happening elsewhere, we may never be pressured into joining a dying industry.

Stephen's football practice schedule came today. His two-a-day schedule will allow me to pick him up after practice each evening and probably catch some of the evening practices, for sure the Wednesday practices. Unfortunately, his jamboree, which is a practice game against another school, will be on a Saturday when I am on call and have to be at the hospital. Hopefully I can make it out for a little while to watch him. I don't have a game schedule yet so I can work on being off early enough to get to out of town games. My ambition is to make it to all of his games this year. I know this will be physically impossible but I will try.

I am going to bed a little early tonight so I can get some needed rest. Tomorrow will be a busy day even though I will not be in the hospital. See you tomorrow.

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Wednesday August 9, 2000

I have spent today running from appointment to appointment. First, a haircut for me then a meeting with our pastor and youth pastor then an appointment for Stephen. Now, I am going to fix burgers on the grill then take the kids to youth services then on to the grocery store. In between, phone calls trying to work out some referrals for various reasons. I actually got a very helpful customer service representative with an insurance company rather than someone who seemed impatient. This woman actually seemed concerned about getting the proper medical care for the patient. She was quick to say that she was sorry that she could not have been more help which I appreciated. I thought she was very helpful.

I love e-mail! I am managing my first diabetic by e-mail. He is the first diabetic on insulin with the capacity to e-mail me his blood sugars and the motivation to actually do it correctly. I was able to answer him in less than five minutes with what changes to make in his insulin dose. No tracking him down with the telephone and no tracking me down either. I know it is the wave of the future and will make for better patient care. I am also able to document very easily my patient care by simply printing out his e-mail with my reply and filing it in his chart. I find myself asking patients daily if they have e-mail capability and if they do giving them my office e-mail address as well as the telephone number.

That's about it for today. Have a great rest of the day wherever you are.

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Thursday August 10, 2000

Another Thursday down. Thursdays continue to be my busiest day of the week for some reason. I started today with a meeting that luckily I remembered at the last moment since the moderator had forgotten to send out reminder notices about this monthly meeting. As it was, only four of us showed but we ended up having a good discussion about what builds consensus in a group. With the tremendous growth of our group within the past two years, that is one of the things we struggle with, how to get everybody on the same page as far as goals. We will be discussing this again at our retreat in November.

My morning went fairly smoothly but the afternoon was a different story. Partly to blame was that a couple of patients were scheduled as short office visits when they should have been given long office visits. One in particular should have been scheduled as a new patient but had told the receptionist it would be a short visit to get an x-ray ordered. That was not the case as she was a new chronic pain patient to my practice and so needed quite an evaluation, part of which I did today and the rest I will do next week. Still, she took at least twice as long as she was scheduled for. That put me behind the rest of the afternoon. I did not get finished with patients until close to six as a result then had to make phone calls, dictate a few charts and visit one patient in the hospital before leaving.

I did get to run as I was supposed to pick up Stacey at her dance class tonight at 8:30. I finished in time to drive down to pick her up. We still have to go and pick Stephen up later tonight. Yes, we let him go out with his church youth group tonight as the youth minister asked us to let him go so he could have a little alone time with him there in a non threatening environment. This is the first very small step in trusting him again.

I must close for now. I have some bills to pay and lunch to make for tomorrow and a very early start on tomorrow waiting.

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Friday August 11, 2000

Another slow day today. I mean SLOW. For some reason no one was showing up so we ended up seeing only about one half of the number of patients I usually see on a regular day. I have no explanation for this anomaly other than it is August and that is usually a weird month in the office. The hospital is also really slow. No one wants to come in this month and miss their last chance at summer vacation before the kids are back in school. I did get my desk rearranged to try and make more room and make the flow of charts more efficient. I can't wait until we have electronic medical records and can do away with the paper charts for the most part. Point and click with a mouse is definitely the way to go rather than having to carry around charts and have them pile up everywhere.

Since we were slow today, the medical assistants and nurses spent some last minute time preparing for our survey next week. The Joint Commission on Accreditation of Healthcare Organizations is doing a survey of our hospital and medical group Monday through Wednesday of next week. We have to be accredited by this organization to qualify as providers for some of the health insurance organizations and various federal and state agencies use this accreditation as a benchmark for hospitals' quality. Basically, four or five people will walk around for three days and look at various departments of the hospital and clinics and score us based on how well we adhere to the standards developed by that organization to ensure quality care is being delivered. Ordinarily, medical groups aren't a part of this procedure except when they are part of an integrated health care organization like us since we are owned by the same corporation that owns the hospital. I have some question about the validity of some of the standards published by the organization but the fact is that we must be accredited in today's world. Literally months have been spent getting ready for this survey. Cleaning my desk and getting it better organized was my part in getting ready. It usually looks like the typical Daynoters desk which you have seen on other sites here before. Admittedly, I did find out I had more desktop room that I thought I did and I can get to things more efficiently than I could before but somehow it no longer gives the impression of the doctor too busy to clean off his desk.<g>

Today I got a call from a nursing home administrator and am meeting with her Monday about a problem that occurred in her facility some time back. One of my patients there fell and injured her leg. A mobile x-ray company came and took x-rays of the hip and called a report from their radiologist that there was no fracture. The next day she was still hurting a lot and so I had them bring her to our hospital and take more films. Sure enough there was an obvious fracture that should not have been missed on the first x-ray. I told the nursing home this so they now have that original film in their possession and will bring it Monday to compare with the hospital film so I can see why the fracture was missed on the first film. If there is a problem either with technique or interpretation, then I will advise the nursing home not to use that x-ray company again.

My mother called tonight to tell me that the lawsuit against her for alleged injuries suffered in the automobile accident has been scheduled to go to trial the week she is supposed to be visiting here next month. Depositions are to be taken next week then the attorneys will meet to see if there will be a settlement before any trial. I told her that the date for the trial will be changed and pushed back as it gets closer. She is fully covered by the auto insurance company for the amount of money that the plaintiffs are asking for. He is alleging that the wreck caused him to have to have a disc removed from his back more than a year after the wreck. Never mind that he denied any injury at the time of the wreck and refused any medical treatment. To me it is obvious that his attorney is simply trying to get my mother's insurance company to settle out of court for some amount of money. Even knowing this, my mother is still understandably upset about the possibility of this suit going to court before a jury although to the attorneys this is all a big game that they play out every day.

Enough rant for tonight. Tomorrow looks like a cleanup day around here. I really need to cleanup the hard disk on this computer as it is getting slower and slower but that may have to wait until the rainy season comes again to the Northwest. That should not be until the end of September though. Have a nice weekend everyone.

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Saturday August 12, 2000

Cleanup accomplished today. The house is cleaned up and the laundry done, mostly. That means that tomorrow can be a very lazy day after church. We got all we planned on accomplishing today done.

Tonight, Wendi and her kids, who stayed with us for over a month back in June, came over and brought pizzas for dinner. She was feeling lonesome and said she really missed us. We have missed her and the kids too even though it was a bit crowded here with eight people in the house. Of course, most of the time Stephen and Stacey were gone so it was only six people. Still, it was a bit crowded but the house seems very quiet still without them.

Only one more week of relative freedom around here. Stephen starts football practice the 21st of this month and school starts on the 28th. The week of the 21st he will have two practices a day with the second one ending at 8 PM which means I will be getting home with him after 8 PM every day. Then, when school starts, Stacey is saying she is going to play volleyball. I don't know yet when volleyball practice will be but it looks like Delanae and I will be playing taxi drivers again very soon. Some day they will each be able to drive and get themselves around but not for a few years yet. At the rate Stephen is going it may be never for him.<Grin>

That's all I can think of interesting for today. See you tomorrow.

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Sunday August 13, 2000

We moved rocks today. Yes, we moved rocks from one area in our yard to another this afternoon. This is being done so ivy can be planted since Delanae really likes ivy as a ground cover. When I wake up tomorrow I am sure that my back will be very stiff and sore after doing all this lifting today. I don't have to think about lifting weights today now.

We need to find my dog a new home. I have talked about Dexter before on these pages. He is an Australian Shepherd who is a red merle. As do all dogs like him, he wants to herd as that is what his breed does. Unfortunately, he wants to herd small children in other yards and to do that he will nip at them. His latest escapade was to take off quickly into a yard down the street to herd their eight year old boy with nips, all this while Delanae simply had her back turned for no more than thirty seconds. Understandably, parents do not like this kind of behavior when their child is in his own yard; we don't either as we are afraid the nips could be more serious. He cannot be on his cable every moment he is outside with us. He needs a good home with acreage he can run on and no small children around. I have contacted an Australian Shepherd rescue organization based in Portland and they are going to put out the word about him. We advertised him in the local paper here but could not find the right home situation for him. People couldn't believe that we would not give him to them just for calling and asking for him.

Tomorrow is going to start off busy. I just got a call from one of my partners that I have four people in the hospital who will be there tomorrow. Actually, I will only have to see three of them, one is being managed by a psychiatrist and doesn't really need any medical care from me. The hospital must have gotten a little more busy over the weekend. I know my schedule for tomorrow in the office was pretty fully prior to leaving Friday afternoon. Friday was probably just an anomaly. See you later.

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