Archive for June, 2013

A great day in the face of adversity

June 26, 2013

The computers slowed down to a crawl.

A hammer would have started a brawl.

But you can give us an A

We had the best day

In all the clinical hall.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In 2010, I danced back from the brink of burnout and traveled for a year doing temporary medical assignments from Barrow, Alaska to New Zealand’s South Island.  I’m now working at a Community Health Center part-time, which has come to mean 54 hours a week.

Usually, Monday morning opens with hospital rounds.  Today I started early and finished early.  I had time to get to the VA to have my TB skin test placed and have FedEx send off a packet of materials in preparation for a 2 week job in southeast Alaska in August.  When I arrived at the clinic at noon I found the atmosphere tense.

Our Electronic Medical Record (EMR )system has problems, and every few weeks brings us another crisis.  Frustration builds as the system slows down.  By 1:00PM it made a glacier look positively zippy.  Then it started to sputter, shutting down completely from time to time.

The mood of the clinical corridor darkened as the work flow slowed.  I went downstairs and stuck my head in the Information Services room.  “Are things going to run this slow for the rest of the day?” I asked.

“I’m afraid so,” came the answer.

A lightning strike in a distant city had melted links in out communication chain.

I walked down the hall and asked an administrator to come up to experience the problem.  When we got to my computer, I demonstrated the 6 minute sign on.  The PA at the next workstation volunteered that she’d been working on the same patient for the last 45 minutes.  I showed the administrator how it took 5 minutes to change patients, but the process shut down completely.  I watched facial expressions mirroring my own.  I answered a few reasonable questions, and watched the administrator stalk out.

I turned to my two nurses.  “We’re going to have a great day,” I said.

Then I thought for a minute.  “We’ll use paper.  Call everyone on the schedule who isn’t here yet and have them cancel their appointment.”

I talked to a couple of patients by phone, emphasized that we couldn’t do anything, and acceded to a request for a mood stabilizer, to be followed by a more thorough visit later.

I looked down the hallway at all the people ready to do physical violence to their computers; the frustration and the tension became palpable entities.  If hands could have found hammers easily, terrible cybercarnage would have followed.

I thought about bicycling into a tropical storm in 1972 and singing Bob Dylan songs in the rain.  I remembered playing my saxophone in the Fourth of July parade in Barrow, Alaska in 2010 under leaden skies with mixed rain and snow and numb fingers.  I turned to my team.

“Anybody can have a good time when conditions are perfect,” I said, “But things are not perfect and we’re still gonna have a good time.  Because we’ve practiced and we’re good at it.”

And we had a great afternoon and evening.

Taking lessons at a block party

June 23, 2013

I’ll tell you how full is my dish.

A job sounds oh, so delish,

I will not go sour

To be paid by the hour

If after my work I can fish.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In 2010, I danced back from the brink of burnout and traveled for a year doing temporary medical assignments from Barrow, Alaska to New Zealand’s South Island.  I’m now working at a Community Health Center part-time, which has come to mean 54 hours a week.

I talked to a colleague with cancer today.  He faces a good month of surgery and chemo, and uncertainty of eventual return to work. We discussed the price that call exacts from a doctor.

A couple weeks ago I ran into another doc who retired completely 5 years ago at age 55.  He looked energetic and rested.  He talked with relish of how he’d taken a hammer to his laptop as his last act as a doctor.

A lawyer at a social gathering recently asked me what I thought about the Affordable Care Act, and before I could get a complete sentence out had fallen to pontificating about how the problems with American medicine were the fault of the AMA.  I listened for a quarter of an hour, and asked if he wanted to hear my opinion, or just go on about his.  He responded, frankly, that he didn’t want to hear what I had to say.

I would have told him that the ACA, good for the doctors and bad for the country, just makes me more marketable.

A couple of neighbors got together and threw a block party yesterday.  Over burgers and potluck I talked with some retirees, to try to get a sense of what they did with their time.  The most senior of the group, a WWII vet, now in his 90’s, still drives and still works.  Those of his employers I’ve spoken to love him; he shows up and he does his work and carries a reputation for complete trustworthiness.  His job bring him fulfillment, and I suspect adds to his life expectancy.

After the block party I went home and did some more work on my application for a locum tenens assignment.  I put together documentation for the easiest 225 hours of Continuing Medical Education (CME) from the last two years.  I copied the recertification wallet cards for the life-saving courses of ACLS, ATLS, BLS, and NRP.  I updated my legal history to reflect my (wrongful) speeding ticket in New Zealand and my four new but deserved parking tickets here.

I said yes to this assignment even though I have plenty of work at home.   I love my work but I want it to stop at 40 hours, and if it doesn’t stop at 40 hours I want recompense for the extras.  And I can walk to great fishing from the clinic.

Even with a contract signed the job could fall through.  If it does, I’m still going to go on vacation.

And I’m scanning my documents in case I want to go back to the locums life.  I’m trying to take lessons from the veteran I talked to.