Week of April 23, 2001
Monday
Tuesday Wednesday
Thursday Friday
Saturday Sunday
Most Recent Update
Back again for another week of writing this journal. Sometimes it seems like more work than it is worth, especially when I run out of things to say or at least I have writers block. Then, there are days when it releases some tension to say these things here. Today I do not have any writers block so here goes.
Today began with rounds on three hospitalized patients. The most interesting one is a relatively young man, for heart disease anyway, who came in Sunday with chest pain and many risk factors for heart disease including smoking, high cholesterol, bad diet, and a strong family history of heart disease. His pain was really not typical of angina or pain caused by a blockage in an artery to the muscle of the heart itself. But, he has elevated enzymes in his blood released from the heart muscle when the muscle is damaged in a heart attack. So, what this man may have is a pericarditis or inflammation of the tissue around the heart muscle as well as a small heart attack. He will undergo a cardiac catheterization on Wednesday to determine if he indeed has blockage in a heart artery or arteries. If not, or if the blockage can easily be dilated open or bypassed, then he has a chance to change his lifestyle and prevent further heart artery blockage.
Today, in the office, I was plagued by no-shows. These were not patients with short appointments but patients with long physical appointments. If they don't show then we have a lot of time that I can catch up on paperwork but that time could have been spent seeing people who really needed to be seen today and had to be put off for 24 hours. We are looking very hard at open access scheduling which will allow us to see most people on the day they want or need to be seen. I can't wait as I have heard that everyone who has every tried it has really come to like it. As has been true in other places, we have to change years of thinking to incorporate this type of scheduling.
During the day, I did get some good news on a patient. I had seen a man last week with jaundice which is caused by a high bilirubin level in his blood. This had happened because of something wrong with his liver but he had no hepatitis or gallstones in his gallbladder which could have gotten out into the common bile duct and temporarily blocked it causing the jaundice. So, I ordered a magnetic resonance cholangiogram to evaluate the bile duct especially near the head of the pancreas gland thinking he could have a tumor in that area which would explain why he was having painless jaundice. Thankfully, this cholangiogram was normal meaning there is no evidence of any tumor or other problem blocking his common bile duct. So, what is the problem that caused his jaundice which has just about cleared by now? Well, he may have passed a gall stone without pain and his others are too small to pick up with the ultrasound or he may have had a very mild viral hepatitis which did not show up on the usual panel we run. This panel only picks up Hepatitis A, B, and C. I will continue to follow his lab work until his bilirubin is completely normal and if it goes up again then we will repeat the ultrasound of his gallbladder.
Tomorrow will be a long day again. I have a meeting, sponsored by our malpractice insurance company, on how to prevent physician burnout and manage time better. I need to learn how to say no better which I hope to learn during the meeting. This meeting is tomorrow night after my day in the office so tomorrow night's update may be a little late or a little short or both. Thanks for dropping by for a visit.
Pretty good meeting tonight. Physician burnout was the topic and the problem is very big. The suicide rate for physicians is three times the rate of the general population and up to one third of the physicians practicing are not performing up to their potential because of burnout. This burnout can lead to depression and social withdrawal. It happens because we are conditioned to be people pleasers and to suppress our own needs and not discuss them because that would mean we were weak. More and more is being asked of us and we have a hard time saying no. I know I must become better at saying no and not feeling guilty about it.
I now have three patients in the hospital but one should go home tomorrow and one is having a cardiac catheterization tomorrow. One was just admitted tonight and one of my partners will see her tomorrow as I have to be at a meeting in Vancouver tomorrow at 7 AM. I then have to be back here in time to see patients starting at 8:30 so it will be a quick trip down there and back. I should be able to make it as it only takes about thirty minutes to drive from the hospital in Vancouver to the hospital here. I won't have time to see the patients tomorrow morning so I have someone else seeing them and I will check on them at noon. It should be busy tomorrow, especially since tomorrow night is church night for all of us.
So I forgot something, OK. I have been told that my redirect page still points to last week. I know I updated it Monday night but forgot to FTP it to this site to complete the update. I am in the process of fixing that problem now. I also forgot to check on who my daughter was riding home from church with before I left after the service tonight. No excuses, I guess just a lot on my mind.
My patient who had the cardiac catheterization today had an almost complete blockage of one of his arteries to his heart. He was taken to Portland later in the day and the blockage was dilated open and a stent placed in the artery to keep it open. He is a very lucky man that he did not have a much larger heart attack and much more heart muscle damage. He must now change his lifestyle; quit smoking, get his cholesterol down, get his diabetes under control, and lose weight or else he may have a big heart attack in another 5-10 years. As I told the cardiologist who called me about him today, he had the easy job now I have the hard job of helping him change his lifestyle.
My patient with pneumonia and emphysema went home today which leaves me with only one patient still hospitalized. She is a lady with very bad blockage in a lot of blood vessels who, apparently, has had another small heart attack. She will stay a couple or three days, we will change her medications a little, then she will go home and maybe make some changes in her lifestyle also to prevent this from happening again.
The rest of my day was not too demanding. I had a few no-shows again today since it was beautiful here, sunny with the temperatures in the mid 70's. That is all due change within the next 24 hours however when the rain and cooler temperatures return just in time for the weekend. That will put me in a good mood to be inside for all the meetings of the Leadership Council retreat Friday and Saturday. We have some controversial proposals to consider regarding our current compensation plan and the overall direction the corporation is taking in our region. There should be some fireworks during the discussions but we will hopefully come out of it with a firm sense of where the group should be going over the next year and how we can continue to deliver the highest quality of care in a changing economic market. Wish us luck!
Short update tonight as I am trying to keep up with the Portland-LA NBA playoff game as I am writing this. Right now it does not look good for the Blazers but there is plenty of time left. I don't think they have the team this year to beat the Lakers but hope springs eternal.
Today was another day for no-shows. I did manage to get all my paperwork caught up so everything is done and nothing will be left for when I get back to the office Monday. It is still frustrating as I know there are a lot of people out there who are waiting a long time for an appointment because I am booked up a month in advance. I know this because they tell me this when they do come in. Hopefully, our move to open access scheduling will help limit this problem.
My one patient is still in the hospital. I had planned on perhaps sending her home late this afternoon but this morning she began having several second pauses in her heart rhythm and with those her blood pressure would drop. So, she is now in the intensive care unit under the watchful eye of one of our cardiologists. I am not sure what happened, some of it is medication induced perhaps but I worry that there is some underlying rhythm conduction disturbance in her heart muscle. This can be sorted out while I am gone tomorrow and the next day.
Now, I must go back to the basketball game. I will be gone tomorrow night but will be back Saturday. See you then.
No update as I will be at a Leadership Council retreat.
We accomplished all that was on the agenda this weekend and still managed to get finished earlier than planned this afternoon. Those of us on the Leadership Council for our group drove down to the retreat, which was held near Mount Hood, Friday morning and spent all that day and six hours today looking at data and discussing changes in our compensation plan, benefits, and group expectations. Significantly, our medical director says we got more accomplished at this retreat than he has seen a Leadership Council accomplish at a retreat before and there was no specialty to specialty disagreements, we looked at things to determine what was in the best interests of the group as a whole. He did not expect us to finish all that was on the agenda in the time allotted. Yet, we did that and finished early today.
Now, the next step is to present what we decided to the entire group. This process will begin with our next group meeting May 8 and will require some explanation as there are some fairly major changes especially in the area of benefits.
The weather Friday morning was beautiful. The hotel is in the foothills of Mount Hood and has a beautiful golf course. By Friday afternoon it was raining and rained the rest of the time we were there, however. I still ran Friday afternoon in the rain with one of the other attendees. He and I had a long talk about raising adolescents, his two are now in their late twenties and completely different than when they were adolescents. After talking to him, I feel there is hope for our son and I am fearful what will happen with our daughter as she gets older. After running and showering we adjourned to dinner then it was early to bed as we were all tired.
Today has been showery and cool. After I got home, while Delanae was taking a nap, I ran then we watched "Billy Elliott". Now, we are going to bed as we have to be up early tomorrow to make it to church on time for the first service so Delanae can sing in the choir. Hope everyone has a great Sunday.
Today was cold, windy, and rainy. A good day for staying inside which is what we did. Delanae sang in the choir at church this morning which meant we had to go to both morning services and the evening service as well, which we usually do. In between, she, Stacey, and Stephen had youth choir practice while I watched the Blazers lose to the Lakers and be eliminated from the playoffs. Also, I spent an hour on the Nordic Track during this time. Now, Stephen and Stacey are at a local pizza place with some of the other youth from the church.
I just got finished talking to my mother on the telephone. She told me that she had to go to the emergency department of the local hospital back in Arkansas where she lives because her nose would not stop bleeding. They packed it there and want her to be seen by an ear, nose, and throat specialist (an otolaryngologist) tomorrow or Tuesday and are arranging that. I asked her to ask the specialist to fax me what he finds. Hopefully, she does not have a posterior nosebleed which could require an operation to tie off a branch of an artery to the nose. I am powerless to do anything about it out here.
This week I will be busy at both day and night. Tomorrow night I am on call. Tuesday night is Delanae's biweekly business meeting here in Longview. Wednesday morning I need to leave for the Seattle area at 5:30 AM to make the meeting there which starts at 8:30. It will not be over until 4 which means I will get to fight rush hour traffic leaving the Seattle area also which may mean that I do not get back until after 7 that night. Wednesday will be a long day so, hopefully, I can get some rest Tuesday night. The rest of the week is just the usual medical practice busy work.
