Weekend Call: transitional chaos, a colleague retires, and another teaches.

The hospital’s making a switch,

The electronics are finding a niche

I don’t think it’s strange

I was there for the change

Unexpected is always a glitch

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

I agreed to take call this weekend to help out a colleague and coworker.  Had I thought ahead I might not have.

One of our hospitals made the shift from paper to electronic medical records (EMR) at midnight between Saturday and Sunday.  Only the Wednesday before the switch, when I had already committed to taking call, did I realize I would be on board for the transition.

All change inherently involves chaos; nothing ever works out the way you planned.  The greater the change or the faster the change, the more that the Law of Unintended Consequences applies. 

One of my colleagues, an emergency physician with whom I have worked for the last two decades, chose this time to retire; he didn’t see a future on the far side of the learning curve.  At 5:30 in the morning he called me about a patient needing an admission.  I listened to his presentation, accepted the admission, and asked if it constituted the last admit of his career.  (It doesn’t make a difference, but the clinical problems included diabetes, dehydration, and diarrhea.)

It had.  A small silence passed between us, memories filled with drama and irony.  I recalled my year of walkabout and the last day I spent at the clinic.  Much was said and little spoken.  “Well, it’s been an honor,” I told him.

I could hear his smile in his pause.  “Thanks, Steve,” he said.

An hour later, with my unfamiliar-looking census in hand, I arrived at the 6th floor ICU to spend 15 minutes with the patient and the next 45 minutes doing the documentation.   To my regret I stooped to occasional truculence and sarcasm aimed at the nice lady who wore the fluorescent yellow vest of a super-user, someone educated enough in the system to help those just starting.  I pointed out that I had 15 patients on my list and at that speed I wouldn’t get home till ten in the evening.

The next floor down presented compound problems of two new admits and two other patients in the surrounding context of rampant chaos.  

I found Dr. Tan (who gave me permission to write this) in the position of super-user.  We have worked together for close to 20 years.  With a background of a great working relationship based on clinical respect and trust, she gently ushered me into esoteric information pathways.  My second patient took me 45 minutes and my third patient took me 30. 

Our practice has too many hospital patients for one doctor to round on through the weekend.  One doctor takes call and sees patients at one hospital; the other doctor rounds at the other hospital, then goes home.  I take pride in being able to finish at one place and help out the other doc across town, but noon today found me done with the 6th and 5th floors and the rest of the hospital to go.  Knowing I wouldn’t possibly finish in a reasonable time frame, I broke for lunch. 

No food today graced the doctors’ lounge, but the cheerful mood verged on hypomanic.  Contrast those smiles to the last time I saw a hospital go digital and grim faces drip frustration.

At home I relaxed my way through soup and a nap. 

I finished the 4th floor and arrived in the Newborn Nursery at 3:00 PM.  Immediately confronted by logistic problems involving ordering things for circumcision, I glowered.   In 30 years I had never had to do such a thing, only with the current new digital system.  I expressed a desire to be done with the procedure by 5:00.  Better to be happy than right. I finished half an hour later.

On the way out I reported a large number of computers on the second floor incompatible with the new system.  Or so the nurses thought.

All in all, I had had the best day to transition, not the worst.




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