Doc's Progress Notes
Week of November 13, 2000
Last Updated: 11/19/2000 at 9:36 PM PDT
It's amazing what a little sleep will do. I feel like writing again. I came home last night and went to bed about 9:30. After reading a few pages (ok, more than a few) in PC Hardware In A Nutshell, I fell asleep and slept until after 8 AM this morning. I could do that since today is my day off and I have no patients in the hospital and the kids had late arrival at school today. I now feel much more refreshed than I have in at least a week. One thing also helped today, I got to run for the first time in about a week. I forget from time to time how much better running makes me feel, even if I am tired and wondering if I am coming down with something. I even had a headache before beginning, afterward it was gone.
I do have people to see in the hospital tomorrow. One of my own patients was admitted during the day today and I have two of my partner's to see also. Also tomorrow I have an afternoon meeting to plan the further introduction of more of our electronic medical record package in February. I'd like to see it all introduced at that time but there are still problems with the interface between it and the system being used by the dictation service that does our transcription from dictation. IDX is supposed to be working on an interface for their product that will import the transcription into the correct record but it will not be ready for February. We are still at least a year away from a paperless chart. One clinic that our company owns in another region is paperless but they do their transcription in house. Our group is too big and we are unable to hire enough in house transcriptionists.
I do have a quandary that I need help with. I have been using a Palm IIIe for almost a year now and I depend on it for many different things. It's memory is almost full now and coincidentally I need to spend some of my CME allowance for this year before the end of the year, otherwise I lose it. I don't need any more textbooks in the next two months and I am not going to any meetings during that time either. I can use the money on another handheld with more memory since I have outgrown the 2MB in the Palm. So, now my quandary; do I buy a Palm V (or IIIcx or Handspring) with simply a lot more memory and continue running the software I run now or do I purchase a Windows CE (Pocket PC) device? I do not need wireless Internet access but I do need to be able to synchronize Outlook calendars and contacts between home and work. The Palm (and Handspring) are smaller and more easily carried but the Pocket PC can do a lot more. I have asked the Daynotes Gang for their opinions and invite anyone else who wants to comment to contact me. Now I have another excuse to go to computer stores and surf the net, as if I needed another one.
Thursdays continue to be busy. Some time ago I said that Thursday is my most hectic day of the week. Today did not change that trend. I saw three patients in the hospital this morning then my first patient in the office did not show. That was my only open slot all day plus all the usual paperwork for a Thursday. I end up refilling a lot of medication for my partners who are off on Thursday which makes the stacks of charts on my desk taller. I am seeing a lot of upper respiratory infections at the present with a few pneumonias among the smokers thrown into the mix.
This afternoon my medical assistant and I went to a meeting to discuss the next phase of implementation of our electronic medical record software. We decided on what to phase in next and when to do the next phase in after that. I feel we are moving too slowly but that is my personality coming through. I would like to take everything on at once and learn it quickly because I can see the eventual value and time saving with it. Thankfully, cooler heads prevailed and we are moving more slowly than that. We did get a plan in place however for the future.
After the meeting, I had to go back and find another stack of charts on my desk that had to be answered before I left tonight. I went through them hurriedly and left the ones I could for tomorrow morning since I had to pick up my daughter from her orchestra practice at 6:30 PM after picking up dinner for the family before that. I did make it on time both places.
My hospital patients this morning averaged in their early eighties. Actually, only one was mine and the other two were patients of my partner who was off today. Both of them have cancer, one of them colon and the other one stomach. The one with colon cancer has been through all therapy known for it and it has continued to grow so he has now run out of options and is being admitted to hospice for comfort care only. This means we will do everything to keep him out of pain for the last days or weeks of his life. He is accepting of this and so is his family. The other patient has recently been diagnosed with stomach cancer and feels she is old enough that she does not want anything done. Her family, however, has a different idea. They want everything possible done and are pushing us to do that against her will. Thankfully, she was transferred down to Oregon Health Sciences University Hospital today where they can sort out all the ethical issues involved.
My own patient was admitted yesterday with a possible heart attack, pneumonia, and a bladder infection. She turned out to have had a small heart attack and has had no problems with it. She is 89 years old so we will be very conservative with her. We will not recommend any invasive procedures to document her coronary artery blockage since she is at high risk for complications from the procedures. She is not a healthy 89 year old which is entering into what we recommend for her. I have made a few changes in her medications which should help prevent another heart attack and she can return to her assisted living center when her pneumonia will allow.
Finally, my question from last night about Palm vs Pocket PC has generated several responses. I am amazed by the number of responses and the information I have already received. Most of these issues I had thought about a little but not to the depth that I reading about. Thanks for all the responses so far and I will keep you updated about what I decide. I am not going to make any decision until I read How to Do Everything with Your Pocket PC and Handheld PC which was written by a fellow Daynoter Frank McPherson to whom I owe an apology for not remembering he had written this book. I am ordering it tomorrow.
Now, I must go get on the Nordic Track and get some exercise in while watching ER. Tomorrow night may be a very short update.
Another week down and how many to go? Friday was hectic. I had to leave a couple of issues unresolved tonight. One was a man with a kidney stone which has not passed yet and we had no local urologist who could return my call today. He will be fine as he has pain medication but I would have liked to have a plan in place for him for early next week. The stone is too far down to be broken up by lithotripsy, I think. He may need his ureter (the tube between the kidney and the bladder) dilated to allow the stone to pass. That is a procedure done by a urologist. Hopefully he will be fine this weekend and I can set it up Monday.
My lady who had the small heart attack Wednesday, along with pneumonia and a bladder infection, is doing well and should be ready to go back to her assisted living center tomorrow. I changed her to an oral antibiotic today and she is getting up without chest pain. She is tolerating the increase in her medicine well. One of the other patients that I saw yesterday is not doing so well. He went to the hospice care center today and died about four hours after arrival. This was expected, just not quite so fast. At least his suffering is over.
Delanae was sick today so we stayed in tonight with Stacey while Stephen went to a concert then to a friend's house. We watched "Apollo 13" on DVD while waiting for him to come by and pick up some clothes so he can go stay overnight at another friend's house. He has a dance to go to tomorrow night. This dance is one that the girls invite the boys rather than vice versa. He says he has no romantic interest in the girl who invited him, she is just a good friend. We will see. Tomorrow, I need to get the gutters cleaned out and my garden spot tilled before winter really sets in. It looks like Stephen will be no help. See you tomorrow.
Another clear, dry day in the Pacific Northwest. Normally, November is a very wet month, last year it rained every day in November. This year, November has been very dry. We have a high pressure ridge parked over us which leads to cool, dry weather. It is supposed to break down by sometime Thanksgiving and give us some more seasonable weather ie wet. We will take advantage of the dry weather tomorrow after church and do some work outside. Stephen was gone most of the day today so he was of no help.
Stephen is gone to his first dance where the girls invite the boys. They pay for the pictures, dinner, and tickets to the dance. The girl he is going with he says he has no romantic interest in. We will see. He is due back a little after midnight, her parents are bringing him home.
Delanae and Stacey have spent the day moving Stacey's bedroom back downstairs into the room that used to be her bedroom before it was Delanae's office. Delanae has decided she does not need a home office any longer, just a desk for her computer. We will be moving that back upstairs over the next few days.
My Arkansas Razorbacks finally won another football game today. They somehow managed to beat Mississippi State at Starkville, Mississippi which is one of the toughest places for visiting teams to win. Mississippi State was ranked in the top twenty five and was in the hunt to play in the SEC Championship Game. I will have to wait and read the newspaper accounts to find out how they managed to pull off the victory. Their basketball team should be much better this year and are ranked in the top 15 already.
The gutters are cleaned out and the roof swept. It is now clear of leaves and other tree droppings and ready for the rain to come. Thanksgiving Day is supposed to be wet here, according to today's forecast. It will be cloudy to partly cloudy the next three days with the temperature warming up some as the week goes along. It has not been above the mid 40's for highs for a week. That is a long time for this part of the Pacific Northwest. Just in case, Stephen moved some firewood under shelter so it can stay dry.
Stacey is now once again living in her original bedroom. Delanae's computer is still in there but otherwise it is Stacey's room now again. She has her shelves lined with Beanie Babies again.
Tonight, Delanae and I went shopping for Thanksgiving dinner ingredients. We have been getting a smoked turkey for several years because we like it better than cooking our own. We have another one for this year. We have some traditional dishes for Thanksgiving dinner, traditional for our family at least. Delanae always fixes herself candied yams, no one else eats them. We have a green bean casserole which Stephen loves more than anything else and tries to eat a whole pan in one sitting. We always have to have mashed potatoes and stuffing. Dessert will vary but this year will include both apple and choclate cream pies. Needless to say, we usually eat only one meal on Thanksgiving. This year it will be in the afternoon since I am on call that night. This way, we should be able to have the meal as a family without me having to leave.
Forget what I said last night about the Arkansas football and basketball teams. It seems that their football team earned their victory at Starksville, Mississippi by completely stopping Mississippi State's offense by playing much more physical than they had played most of the year. In contrast, the basketball team lost to an unranked team in the finals of their own tournament in Fayetteville. I don't know what happened except they shot less than 40% in their home arena. They will not beat anyone shooting that poorly, especially at home. They have plenty of time to turn things around, however, as that was only their second game of the season.
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