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Doc's Progress Notes

Week of January 15, 2001

Last Updated: 1/21/2001 at 10:21 PM PST

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Monday January 15, 2000

Let's try a quick update tonight between phone calls. It has been pretty much the usual Monday in the group. It began with a Leadership Council meeting at which we welcomed two new members to the Council, recently elected. One of them has a Compaq iPaq which he got for Christmas. Of course, I am instantly very envious as mine has not come yet. I plan to call him tomorrow to ask him where he got his and when. I am getting a CD-ROM drive put in my desktop at work so I can install the software for the iPaq when it does come. We have to order the CD-ROM installation through the IT department and they will come get the computer on my day off and install the drive. I can probably expect that to be done within about a week. Then I will be ready for the iPaq, whenever it comes.

We spent most of the meeting discussing the difficulties our group has had with the billing department. Our pay is based on our productivity so we are concerned that we have accurate capture and posting of our charges. We have not been confident that that is being done accurately. The heads of the department came to the meeting today to walk us through their process and outline the error checking involved. I think the Council feels more confident that this department is headed in the right direction after years of complaining from the physicians and continued frustration on the part of our physician leaders in dealing with this department. At least now they are opening up and showing us what they are doing rather than just tried to overwhelm us with reports.

The kids were out of school today for the Martin Luther King birthday holiday. Stephen had his second day of driving in his drivers education course. His first day was last Wednesday and they had just done normal driving around town. Today was the day to learn to back up and parallel park. He said this was a very frustrating day for him and he will need to practice more. I told him that those were two of the most difficult things to do in a car for most people. He will have to demonstrate some proficiency doing them to pass his drivers test for his license. He will complete his drivers education course at the end of this month and then can do the drivers test for his license. He has already passed the written test. Once he does that, our auto insurance will probably double. I will have to find out what it will do with our present policy, probably on Wednesday. He is currently trying to get his grandfather back in Missouri to sell him his little pickup and drive it out here for Stephen. It is about fifteen years old and has less than 45,000 miles on it as it has only been driven to work and back, a distance of no more than five miles.

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Tuesday January 16, 2001

No update.

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Wednesday January 17, 2001

One of those exercise versus update evenings last night. I got home a lot later than I had planned, more on why in a moment, and chose to exercise on the NordicTrack rather than update. After exercising, I spent time talking to Delanae which is something I am trying to do more of. I tend to be very quiet at home and do not give her the verbal feedback that she needs. I am trying to change that and one way is to be sure I spend time with her every evening during the week just talking. Sorry, but this page is not more important than her who is my number one priority and not as important as keeping myself in reasonable physical shape. I preach to my patients that they need to exercise and if I do not myself then that makes me the worst kind of hypocrite (IMO). That exercise needs to include talking to my family more rather than just writing it here.

One of the things that kept me late last evening was a confrontation with a patient. She decided to change to me as her primary physician and came to see me about her chronic headaches. She had agreed to a contract with one of my partners for narcotics to treat her chronic, daily headaches but we found out that she was seeing other physicians in the community and receiving other narcotic pain medications during this time which is a clear violation of her contract. When she came in yesterday afternoon we had her social worker/case manager from the local mental health agency and a social worker from our group there along with me and she was confronted about this breach of her contract. I told her that if she wanted to remain as my patient then she would have to be taken off narcotics and go to a pain management center for consultation regarding further treatment options. She would have to be detoxed off the narcotics, either inpatient or outpatient, and would have to prove with urine drug testing randomly that she was not taking any narcotic pain medication from anyone in the community (or outside the community). We have given her thirty days to make that decision, otherwise she will be sent a formal termination letter saying she will no longer be accepted as a patient by our group. She is a drug abuser who has a real problem and needs help. Why do I say she is an abuser? She has stolen other people's pain medication and forged at least one prescription. We are offering her help if she will accept it rather than just summarily dismissing her from the practice.

Other than that, it was just a busy day. I had a lot of messages to answer and several patients who were sick and needed extra time to discuss their illnesses. The spending extra time talking to the patients is generally what gets me behind during the day. Sometimes it is because a patient will arrive late and we had a couple of those yesterday too. Everything worked out in the end.

I also did not check my e-mail at home yesterday so I was unaware of all that had happened to Landon Syroid until this morning. I have now sent an encouraging word or two to Tom and will continue to pray for the speedy recovery of Landon. Tom and Leah will simply be amazed at how quickly he does recover at his age.

We got some good news today. No, the iPaq PocketPC did not come. I called the auto insurance company about adding Stephen onto our policy so he could drive one of our vehicles and it will only raise our premium 50% rather than a higher amount as we had thought. Don't get me wrong, 50% is high enough; I was just afraid it would be more. We had thought about just getting him another vehicle now and insuring it only but it turns out it would cost more to insure it for him than it would cost to add him onto our policy for one of the existing vehicles. We will still be getting him his own vehicle but now will not be in as much of a rush to do so which will give us more time to look and discuss various options. He will not be eligible to take the driving portion of his test to get his license until the first of February.

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Thursday January 18, 2001

Something is infecting both Stephen and myself. Actually I know what it is, a virus that is making the rounds here. He came down with muscle aches and a sore throat yesterday and did not go to school today. I am now feeling achey all over and probably have a low grade fever. It is not so simple for me just to miss as it is for Stephen. I will most likely feel well enough to go to work tomorrow but tonight will be spent curled up in a chair or on the couch as soon as I finish with this update, which will be short.

Nothing really out of the ordinary today that I can recall. One patient of mine had a cardiac catheterization today and will not be a candidate for bypass surgery although he has significant blockage. He had bypass surgery ten years ago but has not taken care of himself since then and is blocking his arteries again. Couple that with the fact that his heart is not able to pump but 50% of the blood that it should be pumping and he is at high risk for surgery. Consequently, we will treat him medically and hope he does not have recurrent chest pain or another heart attack which would be devastating to him. He will get several lectures about controlling his diabetes and keeping his serum cholesterol level down over the next few months.

Another patient today reminded me about why I went into family practice. This was the five year old daughter of someone who is a sister to one of my other patients. She was there with her mother and later her brother came in with his daughter. In one day I got to see and talk to three generations of the same family who are all coming to me now. That's what makes my specialty great, we get to interact with entire families who, when they trust us, welcome us into those families and we build relationships that way. I don't think any other specialty can say that. I always am humbled when I realize that an entire family puts their trust in me.

And now it is rest time. Good night all!

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Friday January 19, 2001

I'm better today but, unfortunately, Delanae seems to have come down with this viral illness. Stephen went back to school today and has a friend over tonight to spend the night and he seems back to normal. I should be able to go back to exercising tomorrow, based on how I feel tonight. Delanae stayed home today and slept a lot. Hopefully, she will improve as much in 24 hours as Stephen and I did.

Today was pretty uneventful in the office. I saw patients who ranged in age from two weeks old to 82 years old. Most were somewhere in between. Some had colds, two had chronic pain, some were depressed, one had diabetes, a couple e-mailed me, and one just wanted to meet me and see if we could get along as doctor and patient. Oh, I almost forgot, one was having to leave the practice because of an insurance change and was not happy about it. I don't remember all the others but that is a typical day for a family physician, at least this family physician.

Tonight, Delanae and I laid on the couch and watched "28 Days" on DVD. Definitely a hard movie to characterize, sometimes funny and sometimes sad. If you watch it on DVD check out the extras included on the DVD. The soap opera within the movie is really weird. If you don't watch it on DVD then you won't know what I am talking about.

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Saturday January 20, 2001

I sat down to write something but am coming up empty. I got up and went to a sound technician's training session this morning. Learned some new things to use when I begin doing that again in the new church we are attending. It is larger and the sound system is larger and has more cool bells and whistles with which to play and learn about. I may stay up and observe the current sound technician tomorrow during services. I am the only new guy, the others have been doing it at this church for some time.

Delanae got up early to watch the inauguration. She also recorded it in case she fell asleep while watching it which did happen. I saw part of it before I departed to the church. George Bush's speech seemed short and to the point. No revolutionary ideas advanced but then none were expected. Let's get the new government in place and get on with the daily business of government.

Not much computer work today. I am still waiting for my new hard drive and, of course, my iPaq PocketPC. I am ready for both; this hard drive has been pruned down to make moving applications easier. I have the newest Partition Magic installed and my data backed up. I am ready to go and ready to install the Belkin card to give me USB ports also. I have stored URL's for some programs I want for the PocketPC once it comes. I have resigned myself to just waiting for it to arrive. Maybe next week........

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Sunday January 21, 2001

I spent a lot of time at church today. I went to both morning services this morning to begin learning this mixing board. The only way to really learn it is stand behind or beside the person running the board and try to think what you would do before he does it. That is the first step, the next step is to do it yourself under supervision. That comes next, sometime in the future. It is a large enough board with enough inputs that two people could comfortable work it at one time with one being the chief and has final decision power. Another couple or three services and I will be ready to start running it some with help.

Tonight we were back at church where Stacey played in the orchestra. She did well, the only other violinist was an adult who was old enough to be her grandmother. I think she enjoyed it. They are trying to get a youth choir going but are finding it hard to schedule a time to practice without taking another night away from families.

This afternoon was spent helping Delanae learn how to burn a CD. Since her computer has the only CD burner in the house on it then we used it. She is copying all her digital pictures from floppies to a CD both for storage and to copy the CD to send to her parents. Her sister has brought her computer to her parents' house so now they could look at a CD with all the family pictures from here on it. After several false starts, I think the procedure has been worked out now. It certainly is not completely intuitive but then what is in the PC world.

Tomorrow morning is coming bright and early. I have gotten no call tonight from my partners so I may not have anyone in the hospital to see tomorrow morning. I will find out early tomorrow however. See you tomorrow night.

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