Doc's Progress Notes
Week of December 4, 2000
Last Updated: 12/7/2000 at 9:41 PM PST
Today began slowly. Actually, it began early with a meeting at 7 AM. This was a meeting of our group's Leadership Council and we spent most of the time discussing how we maintain quality while growing our group quickly. We also voted to accept the local neurologist into our group. We had interviewed him last week and now will officially offer him a position.
After the meeting, I saw my one hospital patient who is the gentleman with the colon cancer whose cancer had blocked his colon. He has recovered sufficiently from the surgery to go home where he will continue to be feed intravenously as well as eating regular food so we can build up his nutrition as fast as possible. We are doing this so he can get back to treating his cancer as soon as possible. We are not pushing him to do this as he has very long odds that the cancer can be even slowed but he wants to do everything, even knowing the facts. He needs to have his nutritional status built a lot more before he can tolerate the treatment.
My morning then slowed down as I had three no shows before my first patient actually kept his appointment. That turned out to be a nine year old boy who has mononucleosis. He will probably miss the rest of school this year because of the mononucleosis so he will have an early Christmas break. His mononucleosis is fairly classic in presentation with very swollen tonsils, fever, and feeling tired. He will do well and recover fully at home.
This afternoon was much more hectic. I, unfortunately, uncovered another probable lung cancer and a possible lymphoma. The lung cancer is an elderly lady who is a smoker and will probably turn out to have lung cancer that is not curable. She and her family are all very nice and the diagnosis will not be certain until we get a biopsy of what I see on the chest x-ray but it is classic in appearance for cancer. The person with the possible lymphoma is only twenty but has a growing lump on his leg which is very worrisome to me. It is in the soft tissue and not bone and the fact that it is fairly rapidly growing is worrisome. It does not appear to be an infected lymph node which would be much better news for him. Anyway, I will send him to a surgeon for removal of this mass so we can get a firm diagnosis on it.
Delanae needed me at home tonight. She had accidentally, while learning a new program to handle her digital photos on her computer, deleted all the photos on her hard disk. She has most also stored on floppies but a few new ones she had just uploaded from her camera and had not yet saved them to a floppy or Zip disk. Once I got home, she and I learned to use the Unerase function of Norton Utilities to recover these image files and I think we have recovered all the ones that she did not have on another disk. She was, understandably, very upset when I got home but is feeling much better now. It is always nice to be able to rescue your spouse and make her feel happier. That is my bit of wisdom for the night.
Today was more steady. I do not have anyone in the hospital so I was able to catch up on some paper work before my clinic started this morning. I did make arrangements for the young man from yesterday with the growing lump on his leg to see a surgeon later this week. As I said yesterday, I am concerned about what this is. It has the possibility of being malignant but we will see.
At noon today our team had a meeting with all the staff there. We needed to clear the air as there had been some griping going on behind people's backs. Our team's staff is the best in the Family Practice section but some things needed to be said and everyone's focus needed to be put back where it should be. We want to provide the BEST medical care in this area and be the BEST medical group in the Northwest. I recognize that I need to give positive feedback more and not just negative feedback.
Tonight, Delanae took me to a party at one of the local hotels. These are hosted by the local Chamber of Commerce as a way for local business leaders to meet informally and "network". Some of the people there I know as patients and a few we know socially. It was an enjoyable couple of hours.
My day off tomorrow again involves commitments. I agreed to serve on a rapid process improvement team as the sole clinician. It involves the process of generating referrals and insurance company preauthorizations for those referrals. The goal is to streamline and simplify the process as much as possible so things go more smoothly and it is quicker so the patient gets their needed referrals done as rapidly as possible. Doing referrals takes a tremendous amount of staff time so anything we can do to streamline that will help a lot. I was supposed to be involved for three days but Friday I will have to the the inpatient physician again.
Tomorrow night, Delanae and I have tickets for the Blazer game against the Raptors. This will be her first time to see an NBA game and she is really looking forward to it. We hope to get there about an hour early so she can soak up the whole atmosphere. I will need to leave early from the RPI in order to do that but I have already warned them about this. Tomorrow night's update may be very short or missing entirely, we shall see.
Last night's game was rather slow. The Toronto Raptors, who were without their star Vince Carter due to injury, slowed the game down knowing that was their only chance to stay close to the Blazers. They were successful in slowing the game down and staying close but they did not win. It made for a rather dull game to watch, for the most part. It was not the type of game that I wanted Delanae to see as her first NBA game. She did enjoy it despite it being devoid of a lot of excitement.
We arrived back home sometime after 11 PM last night so I did not try and do an update last night. The first day of the RPI was spent mostly discussing the goals and what the problems are. We identified a lot of problems then spent today trying to change processes to eliminate problems and waste. There has been some interesting changes suggested and will be put in place for trial tomorrow. Unfortunately, I will also have to be the inpatient physician tomorrow so will not get to spend as much time on the RPI as I would like. This weekend got added just about three weeks ago before the RPI was finally scheduled. I could not change the weekend on such short notice so I am stuck. Hopefully, I will have a little time tomorrow to participate in the RPI.
Tonight was Stacey's school orchestra concert. We are not through with concerts that she is in until next spring. Her basketball season ends next week and her next sport does not start again until spring. Maybe we won't have to do so much hauling kids around for awhile. Actually, Delanae is going to Portland tomorrow with Stacey's orchestra group. They are playing in a mall there but she will ride the bus down and not have to take a vehicle. We'll see how she does after chaperoning a bunch of kids in their early adolescent years. I'm just glad it is not me.
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