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Doc's Progress Notes

Week of March 26, 2001

Last Updated: 4/1/2001 at 8:20 PM PDT

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Monday March 26, 2001

I only have thirty minutes to write this update so I had better get started. I have homework tonight, actually I need to review some material for a meeting very early Wednesday morning so I need to get started on it tonight so it is not all left for tomorrow night. There is too much material for it to all be done tomorrow night. Actually, there is not too much but I do want to get a head start on it.

Today was fairly frustrating at the office. I had a lot of no-shows this morning then I had twice as many patients show up this afternoon as this morning. Our schedulers had double booked them in the wrong slots as far as I am concerned but after it was done it was done. Neither I nor my medical assistant has the time to continually monitor where the schedulers are double booking patients and it seems that they have a different philosophy than I do. Or, at least, whom ever trained them has a different philosophy. I would double book patients where I know the other patient is not very likely to take much time; for instance, with a patient who has a cold. Not with a patient who needs their medication adjusted or started. I can see there is more talking to do with our clinic manager.

Tonight I went with Delanae as she sold a showcase. She did great. The couple just needed a little more information to go ahead and purchase the showcase from her (see here if you are confused). Now, they just have to name their business and figure out some more details about it. Actually, it is the husband who has the business and he makes incredible wooden bowls and furniture. He wants to start selling more of them so needs an internet presence and advertising. fits the bill for both just fine. Hats off to Delanae for a job well done. I feel honored to have been allowed to watch her work tonight. It is the first time in a long time.

My time is almost up so I must go and do some reviewing for Wednesday. See you tomorrow.

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Tuesday March 27, 2001

Today I refused to get irritated by some things out of my control. There was a mixup with how a patient was scheduled and there were two people scheduled at the same time. I just gave the problem to the office manager and told her to solve it, I was not going to get involved. As a result I did not get irritated and the problem got solved to everyone's satisfaction, I think. I may just delegate more problems to other people in the future.

I got a report on a patient today that I did not want to hear. I had done a chest x-ray on a lady yesterday who had back pain which she thought was due to her cough. I had seen something on it but was unsure about it so I waited for the radiologist to read it too and call me. He called today and agreed that it looked like a pathological fracture of a rib. A pathological fracture is one that is not caused by trauma but by cancer or another destructive process in the bone. This means we have to start looking for a cancer somewhere that could have spread to the bone (metastasized we call it). The most common cancers to do this in women are breast and lung as I recall but I will check this with an oncologist. The social problems associated with this new diagnosis will be tremendous for this couple. Now, I have to tell her.

I did get to give some good news today. Another patient, in her 70's, recently had a coronary angiogram because of an abnormal treadmill stress test. She did not have any blockage on the angiogram however which is great news for her. She now has no excuses not to exercise which her daughter-in-law and I have been trying to get her to do. The bad news is that she appears to be suffering from some significant dementia which may turn out to be from Alzheimer's Disease so I will be doing a more indepth dementia workup on her within the next month.

Tomorrow I have a meeting at 7 AM in Vancouver again. That means I will need to leave here at 6 AM which means I need to get to bed earlier tonight. That means I need to cut this update off about here and get ready for bed. See you tomorrow.

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Wednesday March 28, 2001

Just doing some internet rounds before running. I am now almost caught up on my usual sites including Delanae's that I do not always get to on a daily basis. It really depends on how busy I am but I try to hit each one daily. There have been weeks when I have only read all the other Daynoters sites once that week but used that day to catch up on the entire week's worth of posts. Unfortunately, a couple of times I have been two weeks behind but that has been rare.

Let me extend my condolences to Sjon Svenson on the untimely death of his father Monday. I went through this with my father two years ago and it is never easy. No matter how prepared we think we are we are never completely prepared when that time comes. My prayers are with Sjon and his family.

Based upon some feedback I received from the director of nursing and the administrator at one of the local nursing homes, one of our new clinicians is going to need some coaching. That person has been doing some things that are probably overkill as far as treatment and diagnosis goes. Unfortunately, because of some lack of documentation this will leave the nursing home open to questions from state inspectors on some topics and some of the labs are clearly excessive. Excessive labs cost the patient, the facility, and the taxpayers more money than is clearly necessary for proper patient care. I hate to get into this subject because all this is open to interpretation but in this case we have an excellent role model that could do some coaching for this new clinician. This clinician just needs to document better and ask for help more often. All new clinicians have to learn this; I did and those who don't will be going from job to job and wondering why they are never asked to stay.

The bottom line is that I need to meet with our medical director and discuss this situation with him and also get a mentor for this clinician. I know who I think would be best and I will see if the medical director agrees. Education and mentoring is all that is needed at this point.

As of right now I have no one in the hospital. I still have a 7:30 meeting in the morning at which the above topic needs to be brought up. It is supposed to be about something else but will dovetail nicely with the main topic since our healthcare improvement director will be meeting with myself and our medical director. After that it will be my usual busy Thursday I'm sure. My partner, who is off on Thursday and his absence generates a lot of work for me, only has five more days to work before his retirement is official. His public reception, to which patients are invited, is tomorrow evening then we will have a group dinner for him later in April. The office is going to seem empty without him.

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Thursday March 29, 2001

Today was not very busy compared to other Thursdays. I had several no-shows and no one in the hospital to see. I did have meetings before office hours and at noon today. The noon meeting was to discuss the situation with the new clinician that I mentioned yesterday. The unanimous result was to recommend coaching and mentoring and hope this person responds to this. None of us want to begin all over again and find a replacement.

Tonight, Delanae and I met with a realtor. We have decided to put this house on the market and see if someone will offer us what we need to get out of it. If that should happen then we would rent a house until we were in a position to purchase a house we really want. We would like to be closer to the center of town and where I work so I would not have to drive all the time. I would like to be able to ride my bicycle to work in nice weather and be close enough to the central telephone office where we could get DSL as some of the people who live closer to the center of town have been able to do. We would not look forward to moving but the reality of us having to do that anytime soon is very small, in my opinion.

We're sending coats back. We had ordered lab coats for all members of my group and they came this week. Unfortunately, they came without the logo of our group which was one of the main reasons to get them. Now, the first few that came had the logo on them but none of the ones that came this week did. How did that mistake happen? Anyway, they are going back to the company that was supposed to embroider them with our logo. No one knows how long it will be until they are returned to us.

Tomorrow I am supposed to be the moderator for a cancer conference. There is a cancer conference every Friday at our hospital where cases are presented to be discussed with all the specialists who treat cancer including an oncologist who comes up from the medical school in Portland. The moderator job is being rotated around among the people who attend and somehow I was nominated for tomorrow. The subject is lymphomas and leukemias and luckily one of our local oncologists is somewhat of an expert on the subject. I will let (make) her do all the talking so I do not show my ignorance. Details tomorrow night (maybe).

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Friday March 30, 2001

Somehow Thursday and Friday got reversed. Today was much busier than yesterday which is the opposite of the way it usually is. When I went to the cancer conference at 12:30 today I still had two charts from the morning to dictate. Of course, I got back late since I had to play moderator for the conference and keep things moving along. We were late getting started as some of the participants were late getting there. That made us late finishing.

So I get back and do not have time to dictate the two charts still left from the morning. The afternoon is even busier with no one being simple, everyone takes more time than was allowed. I finally finish up at almost six and still have SEVERAL charts to dictate. I finally leave the office at 7:10 and drive home. It seems like there is something I did not finish there but I cannot figure out what it is. I will probably find out Monday if there is something I left unfinished.

Tonight, Delanae and I take turns using the Nordic Track then settle down to watch "Remember the Titans". It was a great movie, especially the music. I was singing along with some of the songs and Delanae was singing along with the ones she knew (she was born 10 years too late). Of course, she has a much better voice than I do so she sounded better. Stacey has already seen the movie twice but maybe she will want to watch it again tomorrow night. She and Stephen are both spending the night at a friend's house tonight so we had the house to ourselves. Tomorrow night, two of Stacey's friends are spending the night here so we will have a house full of kids. We are enjoying the peace and quiet now while it lasts.

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Saturday March 31, 2001

Rainy morning this morning so we slept in until I had to go pick up Stephen and Stacey. Delanae had a meeting with the owners of a business buying a showcase from her this morning. This afternoon we watched the NCAA Tournament Final Four games after she faxed the information to This was our first time to use WinFax Pro from her computer and it worked fine. She just scanned in the forms and faxed them off. Very simple to use but the modem did not want to hang up forcing me to do a hard reset of the computer.

Tonight, the kids and I watched "Remember the Titans" again. Stacey and her friend are watching "The Replacements" right now. Only one friend came to spend the night which has kept things relatively quiet so far. They know they have to get up one hour earlier in the morning since Daylight Saving Time starts tonight which means the clocks here get set up one hour. It is always interesting to see how many people are late to church tomorrow because they forgot to set their clocks up. I must go now as it is getting close to bedtime for me, especially after I set the clock up one hour.

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Sunday April 1, 2001

Hope no one forgot to set their clocks forward last night. We did not forget but it was tougher getting up and out having lost an hour's sleep last night. My family does not like to go to bed on Saturday night so I stay up with them and watch "The Replacements" again because they are. We finally go to bed and all of a sudden it is an hour later by simply resetting the clock. We were not late this morning but no one was happy about having to get up.

I got to watch a special this afternoon about Pistol Pete Maravich. I remember him in college and how there had never been anyone like him before and I don't think there has been anyone since then or will be in college basketball. This was during my late high school years and I can remember following his exploits while he was playing for LSU. We lived in Arkansas but watched some SEC basketball on television there so we got to see him play some. I learned today why he was never as great a pro as he should have been. He had trouble adjusting to the pro game where he was not the only star and needed to share the shots more. I am not sure why he was not able to as he was a fantastic passer. Nice special and it was great to hear that he was a born again Christian and a great witness for his faith before he died.

Tomorrow I need to be up early again as I have a Leadership Council meeting at 7 AM. So far I have gotten no call from my partner on call telling me I have a patient in the hospital so I will not plan on having to make rounds in the morning unless I hear something later tonight. I am off Tuesday of this week rather than Wednesday so I will be able to sleep in some Tuesday morning, especially if I do not have anyone in the hospital. The kids are on spring break so I do not have to get up to take Stephen to his early morning weight lifting class. See you tomorrow.

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