Doc's Progress Notes
Week of January 22, 2001
Last Updated: 1/23/2001 at 10:21 PM PST
And this week is off to a start. Sorry, could not think of a proper descriptive for start. I started to say rolling but that would make no sense. Nothing else came to mind so I will leave the first sentence alone, at least for now.
I went to the office this morning thinking I had no one in the hospital. I find out after getting there that indeed I do. I had never seen her before and she is transferring to me from my partner who is retiring. My partner on call had called last night sometime and left a message which I was not given until I got home tonight and pointed it out to the guilty party. No big problem however, I had plenty of time to see her before office hours started.
I had no shows again today. That always throws Mondays off for some reason. The schedule is full so people are turned away and then people do not show for their appointments. They don't even bother to call. I don't understand people who are not considerate enough to at least call. Sure, someone occasionally forgets they had an appointment but I bet the majority of people we get hold of the next day or so say they just decided not to come. It is hard to be nice to them the next time they do show because they really need something.
I now have my first HIV positive patient here. Unfortunately, he has a history of noncompliance with his appointments at other physicians offices. For that reason, he will have to show a record of compliance with appointments in my office before he can be considered for the standard treatment of people who are HIV positive. The reason is that there is emerging resistance by the virus to the antiviral treatments being used in HIV positive patients and one of the main risks for this resistance is noncompliant patients who are not being monitored closely. Therefore, if a patient is not coming in for his regular checkups and blood work then they are taken off the medications. I will have to have a long talk with him the next time he is in the office.
Tomorrow looks like a long day. After I finish up at the office, Delanae and I are meeting a couple for dinner at one of our local restaurants. She works for us as a nurse practitioner in the nursing homes and he owns a local pet grooming place. They moved here from New Jersey about a year ago now and love it here. We are getting together to talk a little business and eat some good food. See you tomorrow.
I was right about it being a long day, but was wrong about how it would end. We did not go to dinner tonight as planned, possible career changing decisions are being discussed in this family so we decided it would be better to postpone the business dinner. No, I'm not going to stop writing progress notes either in medical charts or here, at least for the foreseeable future. Delanae's current business is definitely changing and is very sensitive to any economic downturn which is what is happening in this area at the present time. I think we are going to have a recession in this country and in our area we are seeing the definite signs of it coming.
In my business, we are seeing medical insurance companies pulling out of this area leaving patients without any local doctor to see since the insurance companies have not renewed contracts with local doctors. Their contract with the employer runs six months longer than their contract with local doctors so they tell the patients they can go to doctors they have under contract still in Portland, which is 45 miles away, until the six months is up. Meanwhile, the employer is left trying to find a new insurance company to continue the medical insurance coverage he is under contract to provide to his employees. A new insurance company means the local doctors have to once again sign new contracts so there is negotiation once again as the clock is ticking. With this happening every year there is no stability either for the patients or the physicians. In particular, one company just found out two weeks ago that their employees, which number somewhere around 500, will not have any local physician to go to at the end of this month but their contract with the insurance company will be enforced until it ends at the end of June. Those patients will now have to find a new physician in Portland for six months and then find out what their options are at the end of the six months or pay out of their pockets to see the physician locally that they have been seeing, in some cases, for years.
For us, if we don't have a pretty good idea from year to year about how many patients will be coming to us for medical care, how do we plan how many physicians we need in the group. If the demand outstrips the supply then we will alienate patients with long waits to see their physician and take the chance of overworking the physicians. If, on the other hand, the supply exceeds the demand then our group can go broke and/or splinter apart before it has a chance to go broke. At the end of January 2001 we honestly do not know how many patients we will have needing medical care by our group three months from now. It looks like it could be a wild ride for our family and my group.
Today was busy at the office. I have three patients to see at the hospital tomorrow, two of who came in before this morning and one who came in during the day today.
Tomorrow also looks like a full day. I will need to see those three patients tomorrow even though it is technically my day off. Then, I have meetings until 2 PM. After that, Delanae and I are leaving to drive to Tacoma to see Elton John and Billy Joel in concert there. That means we probably won't be back until midnight or so which will make for a very long day. Wish me luck.
I have not been on vacation without telling anyone. I have not been able to find the few minutes a day to update this journal for the past five(!) days. Sorry about that and I will try to do better. Tonight I am writing this while I am on call so if I have to leave in the middle then you will understand. Now to try and recap the last five days.
First, Wednesday. I told you Tuesday about a possible career change for one of us, well it happened Wednesday. Delanae and I met with the manager of her station about changes in her job. They were basically not what we were looking for as far as immediate compensation and future compensation so the decision was made for her to leave that position. She is now working for herself beginning at zero which means an adjustment for all of us for the immediate future. The parting was cordial in every way with the manager wishing her luck but her business will be in direct competition with something he is planning to do with the radio station. Hers is destined to blow his out of the water however. For full details please read her page here.
I also had multiple meetings during the day and got caught up on my medical records at the hospital. I had missed doing that the week before but was not delinquent. Most of the charts just needed orders cosigned so it did not take very long.
Late in the afternoon, we headed to Tacoma for the Elton John-Billy Joel concert. It was more than what I had imagined. They played for four solid hours with one 15 minute break. They played together and separately with bands combined and separate. They covered some Beatles songs but all the rest of the music was songs written by one or the other. They were both awesome live and their bands were TIGHT. I thought Elton John's was a little tighter but they were both fantastic. I have not been a huge Elton John fan but he is great live. We did not get back home until 2:00 Thursday morning which made for a very early Thursday morning for me.
So, Thursday morning started out with me not having had enough sleep. It also turned out to be a very busy, very long day as usual. All the patients were complicated and most took longer than we had planned which kept me behind all day. By the time I got home that night I just had enough energy to eat and go to bed.
Friday was more of the same, busy that is. I again was late getting home after which Delanae and I watched "The Color Purple" on DVD. I should say she watched it as I went to bed about halfway through. For those who don't know, this movie came out in 1985, was directed by Stephen Spielberg, and starred Oprah Winfrey and Whoopi Goldberg. Oprah Winfrey is one of Delanae's heroes and she had never seen this movie and had always wanted to. If we had started it earlier in the evening I would have probably been able to sit through all of it but we did not start in until after 9.
Yesterday, I made rounds at the hospital with my partner and then saw patients in our urgent care clinic all afternoon. We were busy, especially with children with upper respiratory infections. It appears that RSV season is upon us now. I did not have to admit a child yesterday for treatment but I saw near twenty children throughout the day yesterday. I did admit one adult with severe constipation but that is a different story which I will not bore you with at the present. I ended up having to stay a little more than an hour later than I had planned. Somehow, I did not find time to post again last night as I spent the rest of the evening watching "The Talented Mister Ripley" with Delanae.
Today began with more rounds including sending home the patient with the constipation from yesterday. Then, I was able to go to church before having to be back for office hours this afternoon. It was a continuation of yesterday, only worse. All I saw were children and admitted one with probably RSV pneumonia and dehydration. I sent another one home with RSV pneumonia since he was still drinking but he will be checked again tomorrow in the office. If he gets worse then we will admit him. I was reminded again today why I did not want to become a pediatrician. I enjoy seeing a variety of patients, not just one age group. I enjoy seeing a few children during the day but not sixteen to twenty in one afternoon. Hopefully, the child I admitted this afternoon will be able to go home tomorrow, once he gets some fluids back in his body and begins drinking again.
Today I got an e-mail stating that my new hard drive had shipped so I should get it sometime this week. That is exciting news and means I should be able to get it installed this coming weekend. Now if my iPaq would just come. I am stockpiling links to software that I think I will want for it and one of the drug databases that I would like to use is supposed to be ported to the Windows CE system sometime soon.
Installing the new hard drive also means doing a fresh install of Windows 98SE so it will be an interesting weekend. I think I am ready for that with my action plan already mapped out. I will, of course, write details about it on these pages. Have a great week everyone and I will, hopefully, see you tomorrow night.
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