Pie, ice cream, and click-and-wait


Oh no, please.  Not again

The problems with ICD-10

It makes us all late,

The darned click-and-wait

Why can’t we go back to the pen?

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, followed by assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, a bicycle tour of northern Michigan, and cherry picking in Sioux City, I’m travelling back and forth between home and Pennsylvania. Any patient information has been included with permission.

I have just finished a 14 hour day.

I haven’t worked many Labor Days, so I have little basis for comparison.  But the day started slow, I didn’t see any patients till almost 9:00AM.

The crew brought food to share.  Light-hearted banter echoed through the clinic.  I read my email, went to a doctors’ social media site, and read Wikipedia about things medical and literary.

I introduced the PA to the wonders of Zanfel, an over-the-counter agent that can take the poison ivy resin out of the skin.

Bethany brought ice cream, pie, and a rotisserie chicken over at 11:00AM.  I didn’t want to jump the gun on lunch.  But a few patients trickled in and about 1:00 I ate.  I texted Bethany to come over in the early afternoon.  The PA left at 2:00PM.

The pace picked up to reasonable and stayed there till about 5:30, when the patients started signing in at the rate of 6 per hour, and it got really hectic.  Twelve patients signed in during the last hour.

A distressing number of x-rays in Urgent Care show fractures, certainly a better yield than when I worked in private practice.  We see more abnormal chest x-rays as well,  but most of the problems related to asthma or acute infection.

The poison ivy patients made a resurgence, probably because overall high numbers.  Skin and soft tissue infections remain important.

Lyme disease stays a concern.  Twenty percent of the ticks carry the disease.  Any tick on long enough to become engorged, or  present for at 24 hours demands presumptive treatment with a very short course of antibiotics (200 mg single dose of doxycycline).  I have seen an inordinate number of the “bull’s-eye rash” (erythema chronica migrans) of early Lyme.

I also see too many people, convinced they have chronic Lyme, on long courses of dangerous antibiotics.  And anyone with any heart problem at all gets a test for Lyme.

At the end, with incomplete documentation stacking well into the double digits, despite fatigue. I did OK with the challenging patients.  I kept my cool saying “no” to inappropriate medication requests, I maintained patience with difficult children.  All in all, I did well with the people.

But last week’s shift from ICD-9 to ICD-10, intended to bring more specificity to the diagnostic process, has not settled well.  So, for example, for a foreign body I can easily specify which side and whether it’s the first or subsequent visit, but it took me 10 minutes to specify the correct organ afflicted.

I did not do well with the click-and-wait problems.

I finished with the last patient just before 9:00PM, and started on my 14 unfinished records.  The staff left.  While the cleaning crew went about their duties I sat in the quiet and relived the experiences.  I put down accurate descriptions of wounds, x-rays, and histories.  But I didn’t comment on the human cost of the disease, or what the injury meant to the patient.  Somewhere during the day, the headache and gut discomfort that followed me since Saturday, faded into the business.

When Bethany came to pick me up, in the warm late-summer darkness, I was pretty wired.

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