Another Road Trip 5: EMR training continues


I don’t want the patients to wait

But here no one’s making a date

No need for appointment

If you’re wanting some ointment

And I end up running quite late.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. Right now I’m working in suburban Pennsylvania, combining work with a family visit.

Three days into a new EMR and I started to lose the desperation.  My trainer, a gifted teacher with much energy and expertise, stuck patiently with me.  He helped me through the morning, and at noon announced that he would hang back and watch and see if I’d sink or swim.

This Urgent Care facility operates from 8AM to 8PM, 7 days a week.  The first part of the morning brought a lot of occupational medicine traffic: physicals, testing, and injuries.

I averaged 3 or 4 patients per hour, with a peak of 5.  Demand slowed completely at lunch time.  We all got a break, and I fought the urge to nap.

In the mid-afternoon, the pace slowed.  I kept up with documentation.  We got to talk about the organization.

So far I’ve learned a lot about managing patient flow, and much learning remains.  Corporate efficiency springs from clinicians thinking things through.  The system runs with minimal friction, wasted motion, or informational noise.

A lot of patients came and went for TB and drug screens without actually needing to see a doctor.

When action slowed enough and I had no more data to enter, I observed the morale seemed pretty high.  In response, the nurses and the trainer talked about the 7:59 rush: the traffic picks up just before closing time.

Before WWII, most doctors did business on a walk-in basis; appointments came in as a way of attempting time management.  That attempt largely failed because most practices regard scheduling as an entry-level position.

True to form, business in Urgent Care started to accelerate at 6:30.  Five patients checked in after 7:30, one at, literally, 7:59, two of them bleeding and in need of minor surgery.  Two had less acute but very real illness.  One requested services outside our scope of practice, and required a lot of explaining.

The last of the patient care finished at 9:00, but, overwhelmed by crisis management, the remaining documentation lasted until almost ten.

I left exhausted, wondering what I’d gotten myself into.  I don’t mind working hard, and I don’t mind working late, but I don’t want to work so hard and so late 5 nights a week.  Three would be enough.

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