Last Week



Doc's Progress Notes

Week of April 2, 2001

Last Updated: 4/7/2001 at 12:08 PM PDT

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Monday April 2, 2001

Having some problems with internet connectivity tonight, hope this gets posted tonight and that I will be able to do a little surfing also. I did not have time to do any surfing at work today, too busy. I can usually catch about 15 minutes some time throughout the day but not today. Even though I did not have anyone in the hospital I had the Leadership Council meeting from 7 to 9 then patients and/or phone calls and refills all day long. I did make it home in time to catch most of the NCAA national championship game which was a pretty entertaining game. Now, no more excitement until the NBA playoffs begin and we see if the Blazers can win it all this year.

Tomorrow is my day off for this week rather than Wednesday. One of my partners needed Wednesday off so we traded. Like most of my days off I have several things to do connected with my practice. I need to go to a nursing home and talk to a family whose relative is nearing the end of his life and wants to die in peace. They are not sure they are ready for that so I need to go talk to them and answer their questions. Then, I need to check the labs on the patient I mentioned above as well as a couple of other patients, one of whom is the husband of my medical assistant. I need to see if he has diabetes or not and tell him tomorrow. Also tomorrow I need to get Stephen started mowing the lawn again as it is time here to start cutting the grass again. Interestingly, it rained, hailed, and a few snowflakes also came down here today according to patients who had driven through all of the above, including one who lives close to us. The For Sale sign is now up in front of our house so if anyone wants to offer us the amount of money we want for this house then they can buy it. Any offers?

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Tuesday April 3, 2001

The yard did get mowed today but Stephen did not do it. He was gone to a friend's house when I got home this afternoon so I did it myself. It will need to be mowed again by this weekend however so I will let him do it again then. It looks like it will be raining until then so the grass should be plenty high enough to be mowed again. I actually spent less time doing it then I thought I would have to spend.

I called my mother late this afternoon for our weekly chat. She brought up that she was having problems with her blood pressure being up and also some problem with her thyroid gland. She has been going to a local clinic rather than her usual doctor whose office is 25 miles away. This puts me in a little of a dilemma as I think she would be better served going to her regular physician who knows her better (and who I also know and trust). I finally told her this during our conversation but she is already scheduled for some testing by the clinician in the local clinic and feels that she will go ahead with it. It is very difficult to not try and manage her healthcare myself but that is the wrong thing to do. I should only advise her and be certain she is getting the best care.

Delanae had her first local meeting here in Longview tonight. It was held in an E-Cafe where they have DSL connection which I did not know was even available anywhere in Longview yet. The owner says they have had it since January after being promised it beginning last September. I know it is not available where we live. Anyway, I know she had fewer people show than she was hoping for but even the largest meetings started small. It will build because it is a great opportunity both for businesses and for people looking for a way to earn money. It is also an opportunity for someone to get in on the ground floor of a company that is about to really explode over the next two years despite what is happening with the U.S. economy right now. This is an internet company that has a real concrete idea and an idea that will appeal to more and more businesses as more and more households get connected to the Web and wireless internet connectivity becomes affordable for everyone.

Tomorrow I will be back at work. It will seem funny working on a Wednesday again but it is only for this week. As far as I know right now, I have no one in the hospital so maybe I can get some work done in the office before I start seeing patients in the morning. I just realized that starting next week I will not have to share my office with another clinician, I will have two desks to spread out on. I am sure I can fill up both desktops without any problem. We will see how long it takes me.

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Wednesday April 4, 2001

I am not accustomed to seeing patients on Wednesdays. Seeing patients today really messed up my schedule. Of course I was very busy today and did not get finished with my last patient until about 5:40 this afternoon. I was supposed to be at the church at 6 to eat dinner then get the sound system ready for the worship service at 7. I ended up having to leave four charts undictated in order to get to the church in time to accomplish the above. I will go in very early in the morning to finish them and see the one patient I have in the hospital now. I also owe some people some return telephone calls that I did not get to make before I left. I do not like doing this but today it has been necessary.

Then, tonight I had to do more setting up of the sound system than I usually have to do on a Wednesday night. Normally, all the mikes are out and set up but none of them were out tonight. I had to get them out and set them up and move one to a different spot than normal which meant I had to find an extension cord for it. Then I had to redo the levels on the mixer board and by this time it was time for the service to start. Everything ran OK after that but I never did feel comfortable throughout the service. I felt like I was not doing something right. I finally figured out that I had set up to record the service on the wrong track of the mini disc. By then it was too late to change back to the correct track which was 1 rather that 2 on which I was recording. It shouldn't be a major problem especially since we use the MD as a backup in case the cassette tape doesn't record correctly. I did remember to label the MD which other sound people have been forgetting to do; witness the stack of unlabeled MD's next to the recorder. Hopefully, they are labeled on the track what service was recorded.

Tomorrow looks very busy and long. I am on call tomorrow night and am supposed to meet with the regional governing board to hear a presentation by a consulting firm about what they feel our priorities as a region should be. In other words, what the nonprofit corporation that I work for should be concentrating on in this area. Should we be looking to expand further to the south or west or should we be pulling back and building up our patient base here in this county only. Also, should our medical group remain a part of the overall system or be split off separate from the hospital so we could try and be more profitable on our own. Personally, I think they are going to say that we should continue to be aggressively reaching out for new business and patients outside of the county we are in but not expand so much to the west. We will see tomorrow night.

Since I am on call tomorrow night do not look for an update tomorrow.

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Thursday April 5, 2001


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Friday April 6, 2001

No update.

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Saturday April 7, 2001

I am back and updating again. Thursday night's regional governing board meeting presentation was interesting and I was mostly right about what the consulting group was going to say. The consulting group says we are doing a great job of keeping our patients here in Longview with 75% of the patients needing hospitalization staying right here. That is a goal that every hospital is reaching for. Our area is losing some patients who could be hospitalized here though since the Kaiser HMO here sends some of their patients to specialists in the Portland area rather than contracting with our local specialists. We have to develop a strategy to make inroads into that. Also, our emergency department continues to see more and more patients and will soon outgrow their recent expansion which is not good news if this trend continues. The emergency department is a money losing proposition since so much of the care there is uncompensated or only partially compensated. So, if we have to spend more to lose more then that is not good news. We have to find a better way to redirect those nonemergency patients who use the emergency department as an urgent care clinic to clinicians offices. That may require some nontraditional methods be developed.

We serve a healthcare professional shortage area but it is a low income shortage area meaning that a lot of the patients either have Medicaid or no coverage. To make up for the uncompensated care we give the hospital has to continue to attract more of the compensated care that Kaiser is sending to the Portland area. And, in order to continue our mission to care for those who most need care, we have to find new ways to attract compensation for that care. I don't think anyone at the meeting was really surprised by the conclusions but now what we had been feeling were the problems have the validation of a nationally known consulting group in the healthcare field. This should make our Leadership Council meetings and retreat this month even more interesting.

Call Thursday night after the meeting was fairly uneventful. I only admitted one patient that night but had several calls between midnight and 6 AM which kept me from getting much uninterrupted sleep. Thursday at the office was busy but not as frantic as a lot of Thursdays have been. Yesterday made up for it however. I had my busiest Friday up to this point even though we had only one clinician gone from the office. As a result, I did not get home until after 7:30 and was too tired to do anything other than sit on the couch with Delanae and watch "Rules of Engagement" on DVD. I did not even think about updating this page or checking e-mail down here.

I slept in this morning and feel much more rested. It is sunny here right now so I will say goodbye and go cut out some blackberry vines that are trying to re-establish themselves in the yard. Have a great day!

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Sunday April 8, 2001

No update.

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