Doc's Progress Notes
Week of January 29, 2001
Last Updated: 2/4/2001 at 8:44 PM PST
I made it through last night without having to go back to the hospital and admit anyone. In fact, I did not admit anyone after 6 PM last evening. That is unusual for a Sunday night and especially unusual since there were sixteen patients admitted to the medical floor last night as I found out this morning. Somehow, none of those got admitted to my group. I'm not complaining, just feeling lucky. I was tired last night after seeing kids all weekend in the office.
I still got several calls after I went to bed last night so it was not like I got a lot of sleep. Then, I had a meeting of the Leadership Council this morning at 7 which meant I had to be there before 7 to see my patient in the hospital. The patient is doing better although she has an unexplained hyponatremia (low serum sodium level) which I am trying to find the cause for.
I got a bit of bad news today. It seems that now that we are a one income family again, at least for some amount of time, now my income is going to be cut a little. My production figures for the past three months are much less than what I thought they would be which means that my income will go down for the next three months. Great timing for us and I wonder about the data although I get to see the data that the compensation formula depends on. Our compensation is based solely on the number of work units we produce called RVU's. Each visit or procedure generates a certain number of RVU's which are totaled at the end of each month. That number is then plugged into a formula and our compensation for the next three months is calculated. With adjustments, that means that I will be making 30% less than I made in Arkansas prior to us moving here. The Pacific Northwest is certainly not the area of the country to live in and practice in if you want to make near the median compensation for all family physicians in the US. I knew that before we moved here but believed and still believe that I can get close to that amount but do not know how I can really work harder than I do now and spend any time at home.
Not much more to say about today. Hopefully, tomorrow will bring some more optimistic news. I know I have two patients to see in the hospital tomorrow, both of whom have emphysema. I am sure I will also see more patients in the office with upper respiratory infections including influenza. More details tomorrow night.
I am in a much better mood tonight. Not that my income has suddenly gone up but I am over my one night of feeling sorry for myself. I realize that what happens to me is in God's hands and he does not wish for me to feel depressed or sorry for myself. I have never been afraid of work and am not now. I will rebound and attain the goal I have set for myself which is the same one I had when we moved here. I will replace the income I gave up when we moved here and do it by continuing to learn how to work smarter.
Today was kind of a strange day at the office. On the one hand, I did a couple of procedures that I enjoy which is removing moles and other lesions from skin. On the other, I had several no shows but ended up seeing enough patients to qualify as a full day. The upper respiratory infections continue in both adults and children. Some of these people are having very high fevers which scare their spouses or parents. I am spending a lot of time explaining how to bring fever down using aspirin, ibuprofen, and acetaminophen and why you may not want to if the patient is not too uncomfortable. Simply, an elevated body temperature slows the reproduction of the virus which is causing the infection. This is turn allows your immunity to gain an advantage over the virus more rapidly. Tacked onto that is the explanation about how antibiotics do not work on viruses and how bacteria have become resistant to multiple antibiotics due to overuse of those antibiotics to treat infections which were not bacterial in origin. I really need to tape this lecture so I can just play it several times a day.
My two patients are still in the hospital. One should be able to go home tomorrow as her low sodium level is correcting itself nicely now that she is on a fluid restriction. My pulmonary specialist partner made some changes in her medications and she is breathing better. The other patient, I think, is finally convinced that she has to quit smoking and lose weight so she can breathe better. Hopefully, I can get her home in the next couple of days.
Tomorrow will be another busy day off. I have a total of three meetings tomorrow besides needing to see the two patients in the hospital. Stephen has an appointment in the morning which I need to take him to also. I also need to go to one nursing home tomorrow to see my patients there. Also, I got a call from another nursing home today asking if I would accept a couple of new patients coming there who do not have local doctors. If one of them comes in tomorrow then I will need to go and see them. I would like to find time to run tomorrow but do not know yet when that might be.
Shelley Bowman wrote to ask me if I really meant that today was my day off or if I had made mistakes in my post last night. I wrote back to say that yes I had really meant that it was my day off. For me, my day off is simply a weekday when I have no patients scheduled in the office. There are many other things which I have to catch up on during that day. If I tried to accomplish everything I need to the other four days of the week then I would be at the office, hospital, and nursing homes sixteen or seventeen hours a day. I am home precious little time now and have to scramble for my exercise time as it is. I would rather trade some hours on my day off than work that schedule full time.
One of my meetings today was to take a test. Actually, it was to take the Myers-Briggs Personality Type Inventory which is supposed to tell you how you best process information and react to things. Our medical director wanted all of us on the Leadership Council to take it to find out what our personality types are and how we would feel most comfortable reacting with other people. I think mine turned out to be pretty accurate although not completely so. By the way, I turned out to be an ISFJ.
I did find time to run today. I got home in time to run, take a shower, then go to the church for dinner and services. I have been doing the Nordic Track daily since Friday so it was good to get back out on the road and run. I am a little sore now but that will work out quickly. Actually, it won't work out as quickly as it used to when I was fifteen years younger.
Speaking of younger, our neighbor and I were standing outside the youth room at church waiting for our kids tonight as the youth service was ending and the music was still playing. I turned to her and remarked that I was enjoying their music more than the music that was played during the adult worship service. She agreed, saying we needed more rock in the worship music. I also noticed the upcoming concerts the youth were going to and a couple of them I would like to go to. I guess I am not over the hill yet although Stephen just stuck his head into my office and mentioned that I was playing "church music" on the computer while I am writing this. That is his way of saying that the music I am playing is a little soft for his tastes. I thought the same thing of my parents when I was his age but the difference is that they truly did not like any of the music I liked, preferring Lawrence Welk to anything I listened to. And, they would not have even considered going to any rock concert I was planning to go to.
My new hard drive came today so I plan to install it this weekend. I will also install the PCI card to give me USB ports. Maybe all this preparation will encourage PC Connection to ship me my Compaq iPaq that I am anxiously waiting for. Delanae called me today to tell me that FedEx had delivered a package for me knowing that I am very impatiently waiting for the iPaq. No such luck yet.
This week is almost over. Today was busy as usual for a Thursday. Kathy was helping train a new medical assistant today while we say patients. She actually did a good job for not having any experience. Of course, she had the best MA in the group training her. She really got her baptism today with all the refills we did and the huge number of messages we handled. My desk was piled high with charts several times during the day. She didn't run out of the office screaming so she will be OK.
I helped out one of my partners today. He had seven people in the hospital so myself and another partner with whom he shares an office each saw two patients for him. That allowed him to spend some time with the other patients.
The other patient is a lady who used to work as a front desk clerk with us. She suffers from recurrent bouts of vomiting for which the cause has never been found. She was admitted earlier in the week with another bout of vomiting. She is better but still having nausea. We tried to convert her to oral medication and liquids today so she could go home this afternoon. I will find out tomorrow if that worked out.
After office hours today I had to go to one of the nursing homes and admit two new patients who came in late yesterday afternoon. I got there and discovered that one of their charts was missing. The charge nurse called the director of nursing who had to admit that she had accidentally locked it in her office. She was very embarrassed, saying she had never done that before. I was able to do what I needed to do without all the chart since the patient was so newly admitted.
Tonight we got a call from the family who stayed with us for a month last June. It was nice to talk to them again and hear that they missed us and we them. The youngest daughter, who is four, wanted to talk to me on the phone and told me she missed me. I had previously told her that anytime she sees me she has to come and give me a hug. She told me that she was going to start T-ball this coming summer and make a "hoop". T-ball is, of course, baseball or softball with the ball being hit off a stand or tee and there is no hoop involved(that was for all of you who did not grow up in the US or have children or grandchildren who grew up here).
Tomorrow morning promises to be even busier. Then, tomorrow night, we have "Gladiator" to watch on DVD. It promises to be an interesting day.
Major problems over the weekend. That is why no update until now. I installed the new hard disk and USB controller card without problems. Partitioning and moving data to the new hard disk proved to be a problem. First, I had all my data and applications backed up on a Jaz disk which I verified as able to restore them without problems. Then I began the process of partitioning the new hard drive using PartitionMagic 6.0 after I had formatted it with the Maxtor software which came with it. No problems so far.
Once it was formatted as one partition, my first mistake as I am now aware, I then went in with PartitionMagic and divided the one large partition into smaller partitions. I then moved the data and applications, using MagicMover, to their new partitions on the new disk, deleted the old partitions on the old disk and rebooted. All the new partitions came up with the correct drive letter and everything looked fine. However, I could access the applications but not the data partition. No problem, I thought, I will just reformat the partition and recopy the data from my backup disk. No dice, the restore software thought that partition was full and had no room on it. Scratch my head awhile, this is late last night you see, then decide to recreate the partition back on the original drive and restore the data there. This went fine and then I tried to copy that partition back to the new disk again using Partition Magic which said everything went fine but no data could be seen by any program. Not good, but I still had the data partition on the Jaz disk so I could try something else.
I then reasoned that this space was labeled a primary partition so maybe it would work if I relabeled it as a logical partition using PartitionMagic. This worked but when I tried to restore the data from the backup disk it still would not copy onto the partition and PartitionMagic now showed that I had three disks rather than the two physical disks I knew I had. Not good and now I knew I was not doing the primary/logical thing right. So, I go back and resize one of the the two partitions after the data partition which worked fine to cover the data partition and added another partition after those two. I rebooted and the partition letters came up just the way I had expected them to again but Drive E, my data partition, was still not accessible. It is now Sunday afternoon after church and lunch. I had stayed up until 1 AM this morning trying all this and realized that I was just frustrated and sleepy. Also, I had run out of time to do an update.
So, now the situation is that I do not know how to make the E: partition accessible without reformatting the new disk and starting all over again. I have my data only on the backup Jaz disk now but still have good partitions for D;, F;, and G: on the new disk. I realize that all I can do at this point is start all over again by reformatting the Maxtor disk with the included software and set up the partitions at that time rather than waiting and using PartitionMagic after it has been formatted into one primary partition. I believe that is the mistake I made in the beginning, not dividing it into partitions at the time it was first formatted. Anyway, before reformatting it I move my restore software to my C: partition on the old disk and then test that it works properly by trying to restore from my Jaz disk. I get an error message saying that the disk was not formatted. HUH?! This is where my only copy of my data partition is and had worked fine earlier in the afternoon. I tried Norton Utilities to no avail. Backtracking through what I had done earlier, I believe the problem is that I left the disk in the Jaz drive one time when I rebooted and PartitionMagic was deleting and creating new partitions and its drive letter may have been used once when I had more partitions than I needed on the hard disks. Therefore, it was deleted by PartitionMagic since it is a SCSI drive which Windows sees as just another drive letter. Moral of the story, always be certain that your backup disk is ejected before messing with drive letters.
Now, I have lost all the data that was on that partition which included all my Word documents except for about 10 on a Zip Disk, most of my saved e-mails from Outlook which means there are several passwords that are gone, and these webpage files. The web page files were easy to recreate, I just downloaded them from my server here using ftp. The e-mails are gone forever as are most of the documents. Also, all the original downloaded programs were on that data partition so if I want to reinstall any of them I will have to go back and download them again. Some of them were purchased and their serial numbers or passwords were in those e-mails which are gone. AARGH!!!!!!
Back to the story. I reformat the Jaz disk then backup all the applications from the D: partition onto it then verify that they indeed are there. I eject it from the drive and reformat the new hard disk specifying all the partitions at the time of formatting D:-G:. PartitionMagic says they are all there, I restore the applications to D: without any problem, I then open Drag and File to look at them and find that the partition I had labeled as DATA is showing as K: rather than E: which is still not accessible. In other words, the partition labeled E by PartitionMagic has been labeled K by the operating system and E shows as an inaccessible drive. I give up at this point and use DriveMapper to change all the references on the system to K. I do not understand why the drive letter E is still labeled as inaccessible by the operating system but I can live with that until I reinstall the operating system which I hope to do next weekend. Then I will have to remap all the applications to point to E for their data instead of K.
So, what did I learn? It was easy to install the new hard drive physically but partitioning it was another matter even with books to help me. I also learned to NEVER leave your backup disk in the drive which is something I do not do routinely. I will be recovering from this weekend's adventures for some time. Luckily, my Quicken data was not on this partition and was backed up differently so I did not lose any Quicken data, including archived data from previous years.
Yes, I did get the USB card installed without any hassle. It was a true Plug and Play installation so it is ready whenever the Compaq Pocket iPaq gets here. More on other subjects tomorrow night, right now I need to write up an ad to sell the BMW and I need to get ready for tomorrow.
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