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Doc's Progress Notes

Week of February 5, 2001

Last updated: 2/11/2001 at 9:14 PM PST

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Monday February 5, 2001

Back to work again today and the first thing I encounter at work is computer problems. Specifically, the domain server for our Windows NT network at work is down which meant I had no access to e-mail or our electronic medical records software for some time this morning. It was like the old days having to call the lab for lab results rather than looking them up on the computer. Finally, the network came back up but before that it was coming up for a little while then going down again. During one of those transition periods, unbeknownst to me, I changed my password to get into the electronic medical records software and a little while later I was unable to sign on using either the old password or the new password. I ended up having to call the Help Desk at work to have them reset my password explaining that I had not forgotten my new password, the system simply would not accept it. We did finally figure out that I had changed it during the intermittent down times for the network and the new password probably did not get to the server but the old password was deleted as it was supposed to.

Later, the network comes up fine and all my e-mail is there. I was becoming a little paranoid after what happened at home this weekend. By the way, my new hard drive is running fine, it is quick and now I do not have to worry about running out of hard disk space for quite some time. Now, if I could just get that data back that is permanently lost.

I am the inpatient physician this week so I spent all day in the hospital. We have around twenty on the service right now so I was admitting and discharging all day. The total number remains what it was this morning when I took over which means I did not do enough discharging throughout the day. Hopefully, I can remedy that situation somewhat tomorrow.

Tomorrow I am scheduled to have some training for another few modules which are being added to out electronic medical record software package. These modules will be used mostly by the nurses and medical assistants but the clinicians still need to know how to use them. We will be adding joint injection medications to the medical record for instance and we will need to know how to do that. Presently it is dictated into the note but the last of this month that information will start to be entered into the electronic medical record.

That's about it for tonight. Maybe tomorrow night I will have more time and can do a longer post. See you tomorrow.

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Tuesday February 6, 2001

Very busy day at the hospital. I wore my new running shoes to break them in and it was a good thing. I was walking around all day admitting and discharging patients, talking to families, and doing consults for the psychiatrists on their patients who had medical problems. Our hospital has seven floors and I do not take elevators so I was going up and down the stairs all day long. As I was getting ready to leave tonight at six I was paged for one last admission so I did not get out of the hospital until 7 PM. I left paperwork on my desk to do tomorrow morning but tomorrow will probably be as bad.

We seem to be in the midst of RSV and rotavirus season for the kids. My last two admissions this afternoon were kids, one with probable RSV and the other with a gastroenteritis which I am guessing is caused by rotavirus. Earlier in the day it had been elderly people with bad hearts or cancer or both. In family medicine we do see a variety of patients.

The software training went OK today. I got to stay for about half of it before I had to leave to admit a patient. It never fails to amaze me how primitive the graphical user interface on the software package looks as compared to the Windows software I use every day and don't think about. The next update is supposed to give us a better GUI which will allow some cascading menus and other basic Windows conventions which it is frustrating not to have now.

It is now official that we will have a new physician coming in the summer to numerically replace the one retiring in April. She is trained in both internal medicine and pediatrics so will help cover our other med-peds person. They do much more critical care pediatrics than we family physicians have been trained to do and feel comfortable doing so it will help that they can cover each other rather than depending on us to cover one of them. There will still be a crunch in our team though as she will attract new pediatric patients from the pediatric groups in town and we still have to absorb all the patients that our retiring partner has. He has been here for more than thirty years so has a huge number of patients, all of who will have to have a new physician. He is encouraging them all to stay with our group which means the remaining partners have to make room for them on their panels. Patients have to wait a month now to schedule a physical with me so I am afraid of what it will be like after April.

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Wednesday February 7, 2001

Today was busy again. The hospital is really getting full. It is getting difficult to find a bed for a patient who needs to be admitted, especially for children. The pediatric ward has already overflowed into the adult medicine part of the hospital and kids keep being admitted. RSV is very prevalent right now in the kids younger than one year. As I was leaving tonight my partner who was starting on call was admitting a 15 day old infant who probably has an upper respiratory infection caused by RSV. The emergency department doctors were telling me today that they ahd sent three children home already this afternoon with positive tests for RSV. They were just not sick enough to be in the hospital. They are all sent home with the same advice, there is no specific treatment and most children recover from the viral infection without problems. The younger the child is the more likely it is to have problems requiring hospital admission.

If that weren't bad enough, there is still rotavirus around causing diarrhea and vomiting. The child I admitted yesterday evening turned out to be positive for rotavirus and is doing much better today and will probably go home tomorrow. During the day today, there were two other children admitted by my partners with either pneumonia or dehydration.

Our community is not the only one getting hit hard right now. The Veterans Administration Medical Center in Portland is currently closed to admissions and ambulances. One of their patients ending up being admitted to me last night by the emergency department doctor because they would not accept him there. He has never been seen here before as he gets all his care there. That makes it much more difficult for me and us as we do not know anything about him. He does have a complicated past medical history that I think we have pieced together now and he will probably be able to go to a nursing home tomorrow for a short rehabilitation stay until he regains his independence in ambulation.

Tomorrow is my last day as inpatient physician for another few weeks. By this time I am always ready for it to be over so I can get back to my regular routine busy as it is. Being IPP does mean I get a chance to talk to the other physicians on the medical staff of the hospital more as we are not both rushing to get back to the office on time. That is a good thing as well as a chance to continue learning new things. When I ever stop enjoying learning then I will know it is time to quit.

That's it for tonight. Tomorrow promises to be another busy day so I must get to bed now so I can get up bright and early tomorrow. There is the possibility of snow in our forecast for tomorrow so we will see if we get any. I am hoping not.

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Thursday February 8, 2001

Short update tonight. Time has gotten away from me somehow. Another busy day in the hospital with lots of upper and lower respiratory problems. One in particular is an infant who has pneumonia and Influenza A. The pneumonia may be caused by the influenza or it may be a complication of the influenza. Either way she was beginning to have some respiratory distress before I left tonight. My partner, who is a pediatrician, was seeing her and determining what could be done to keep her off a ventilator. She was breathing very rapidly and her breathing muscles were going to tire quickly if she kept that rate up for a significant length of time. Then she would be unable to breathe for herself. I will see in the morning what happened with her.

A motor vehicle accident today put a real chill on everyone who works at the hospital. There was an accident involving a car and a truck on a highway in Oregon just across the Columbia River from us. There were two adults and two children in the car that turned in front of the truck. The adults were pronounced dead on the scene and the two children were brought to our emergency department where they both died. Evidently, all were wearing seat belts but the impact of the crash was too great. I do not know if this was an entire family or any more details at this point but I know it is difficult for all the emergency department personnel to experience something like this and then go on and take care of everyone else the rest of the day. I was not directly involved in any of this but it does definitely cast a pall over the rest of your day. It again reminds me that we do not know what is going to happen one minute from right now. Everyone needs to get right with God NOW by accepting Jesus Christ into your heart before it is too late. None of us know the day and time of our death.

Tomorrow I go back to being in the office all day. Of course, I have a meeting at 7:30 in the morning and I have two people to see before that. I also have one person to see in the hospice care center as well as an overcrowded schedule in the office. Did I mention also that there is supposed to be snow on the ground in the morning so I may be sliding down the hill into the hospital. Stay tuned tomorrow night to find out how the day went.

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Friday February 9, 2001

No update.

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Saturday February 10, 2001

Yesterday was so busy that I did not find time to update this page. I had two patients to see in the hospital before a 7:30 meeting in the morning. I made it but only after getting up a half hour later than I had intended. It seems that I forgot to turn on the alarm Thursday night and woke up at 6 AM yesterday morning thinking something wasn't right. What wasn't right was the time, of course. Anyway, I did make it and get the patients seen in time to make my meeting. During this meeting I was offered a position on a medical advisory committee for a physician owned PPO which contracts with insurance companies to provide care for patients. In this case, they have the contract with the state of Washington to provide and manage care for some of their Medicaid population. The PPO is based in Vancouver, WA and their medical advisory committee makes decisions about medical appropriateness for some procedures and policies. Members do get compensated for serving on it which is good since the meetings are twice a month on Wednesday morning at 7 AM which, again, is my supposed day off. I will not have to drive to Vancouver for every meeting, most can be by conference call the medical director tells me. However, the ones I drive to I will also be compensated for my mileage driven. The first meeting will be held next Wednesday and I will need to be in Vancouver for it.

The rest of the day in the office was spent seeing patients. We had zero no shows yesterday and a couple of work ins who really needed to be seen. We also had a lot of charts to catch up on which I had been unable to get to while being the inpatient physician the previous four days. Kathy mentioned a couple of times during the day how many patients are we going to see today? She did manage to get out of the office on time although I wasn't quite done with my dictation when she left. After finishing that, I had to go by the Hospice Care Center to see a patient who was admitted on Thursday for terminal care.

I also had to run down to the car dealer yesterday to sign the papers for Delanae's new car. Luckily, the dealer is less than half a mile from the hospital and office so it did not take long to get there. Of course, after I get there we discover the papers are not ready since the car is not there yet. It is coming from a dealer in Auburn, WA and had not arrived at that time. So, she is getting the car but it is not here yet but will be here by Monday at the latest. That means I will have to find time Monday to go by and sign the papers. That also means that I will be getting the Jeep to drive again and we will park my car somewhere where more people can see that it is for sale. If you are interested in a BMW, the listing is ,here.

Today, Delanae is in Portland for an all day business meeting and Stephen has a friend here who spent the night. Later, I need to go in and get a new box of contacts at the eye clinic I use. Tomorrow afternoon after church, when it is supposed to be dry, I need to wash the BMW so it will look better now that it is not supposed to rain for a few days next week. We did not get any of the snow that was predicted for Thursday night so I had no problems getting down the hill and the kids had to go to school. Later today I may try and reinstall Windows 98 on this computer and see how much performance increase that gives me. I may or may not have a later update today.

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Sunday February 11, 2001

Today did turn out to be very nice. It was sunny this afternoon with the temperature around fifty so I did wash the BMW so it now looks better. Tomorrow, Delanae's new car should be in so we won't be driving the BMW much after that. I can park it around the hospital during the day so it will be seen by a lot of people. I may also let one of the local dealers sell it on consignment since then it will be very visible and they will keep it clean. I could also reduce the insurance on it to the minimal coverage required by law as we would not be driving it.

Delanae spent her day today listing Creative Memories items on ebay. You can check them out, if you are interested, here. I know nothing about them but I understand that they are all very valuable to consultants and some are no longer available. If you know any Creative Memories consultants looking for things then steer them to her auctions.

Tomorrow looks busy as always. I have two patients to see in the morning at the present time but that could change by morning. I think I have a Leadership Council meeting in the morning at 7 but our medical director is on vacation this week so we will see. It is the correct week to have one, I think. I have so many meetings that I get confused about what schedule they come on. I keep them in Outlook but it does not allow me to put down the first and third or second and fourth Tuesday or Wednesday of the month so I sometimes lose track of which week will have what meeting. I do know that the hospital family practice department does have meeting scheduled for 12:30 tomorrow and I really need to attend it. Hope everyone has a great week!

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