Christmas Eve, finishing at noon.

I don’t mind that the other docs leave
A balance I hope to achieve
And they’re closing at noon
The time off is a boon,
I’m happy to work Christmas Eve

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 (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Right now I’m in western Nebraska. Any patient information has been included with permission.

I work the holiday weekend because I don’t celebrate the holiday and I want those who do to have the time with their families. With two exceptions, I’ve done so every Christmas since 1975. Our facility made the decision to close at noon on 12/24/15. One of the permanent docs has already left for vacation.
I came in a bit early to care for a patient admitted yesterday through the ER.
Then I went back to my office to find no one on the schedule until 10:00.
I waded through a backlog of documentation that preceded my entry into the EMR here, NextGen. After two weeks in the system, I got full access this week.
I took the delay with equanimity. If I can’t get a piece of information or do a particular task, then I can’t. Management treats me very, very well here, and hasn’t overloaded me. If I eventually need to stay late to play with the semi-conductors, I get paid.
NextGen has a particular button to push, called PAQ. Because no one seems to know what that stands for, I’ve started calling it Pheasants and Quail, and until Tuesday, every time I clicked it a message appeared saying the provider was disabled, good for a few jokes. Yesterday the button started to function for me, giving me 118 of my own documents, plus x-rays, lab tests, letters, and consultations to approve.
As with most EMRs, NextGen has its share of irrational quirks. I don’t know another system that makes the doctor approve his or her own document twice.
With exactly one patient on my schedule, I cheerfully took another provider’s patient who showed up 45 minutes late. I had a good time talking with the patient and the family; we developed a plan and I completed the electronic paperword about the time the next patient, in the pediatric age range, got through screening.
I carry a yoyo because I take care of children; a really spiffy one because I can. I did a few tricks, involving a couple of mistakes, but impressed the family and the patient. At the end I said, as I usually do, “If you don’t smoke, drink, or use drugs, you can afford any yoyo you want.” I see it as a way to guide concrete-thinking children towards good lifestyle decisions.
A family member held up a thick envelope, expressed frustration that nationally recognized experts hadn’t helped, and requested I take the case.
I said I’d be happy to, but the more doctors that failed before me, the smaller the chance that I would succeed. “Make an appointment,” I said.
That documentation finished at noon, I went back down the hallway to the hospital and conferred with the patient and family. Terms like the 2 midnight rule and the 3 day stay rule flew back and forth. Eventually I said, “I understand the synthesis of porphyrins, but I haven’t been able to grasp the insurance company’s rules. Because they don’t want their rules to be understood. There is no transparency.” And I left the question up to the nurse who would talk to experts working Somewhere Else.
Bethany waited for me in my office when I returned. We sweated in the gym for an hour and went out to lunch.


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One Response to “Christmas Eve, finishing at noon.”

  1. Terry Says:

    I’m surprised and not surprised – the bane of the electronic programs….at least it’s everywhere 😛

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