First day working in Clarinda

My plans sure had a great bump

With an executive order from Trump

Now I’ve got me a scribe,

Which is close to a bribe

And gave my orientation a jump.

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, traveled 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 went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

A facility has a doc out temporarily for unplanned health reasons. They do not expect the planned replacement to recover from injuries sustained in an accident in time to help out.

The Executive Order freezing federal hiring used such vague wording that a VA facility couldn’t give me a start date. Thus, at the end of 2 weeks planned vacation, I started looking for work.  One of my favorite agencies found me a spot in southwest Iowa, hard by the Missouri border.

This placement represents a success of the concept of locum tenens, temporary doctor placement.

Yesterday the clinic manager gave us a tour of town. We learned that all the patient lifts in the country come from Lyle manufacturing.  The other big plant here makes ball bearings.  Glenn Miller grew up here, the town sports a museum in his honor and has well-attended band competitions every year.  Clarinda Academy, a last-chance facility for troubled youth, sits close to a minimum security prison and a mothballed state mental health hospital.

At orientation today I toured the hospital, got my ID badge, met dozens of friendly people whose names I promptly forgot, and got trained on the Electronic Medical Record, CPSI.

Perhaps I’ve learned so many (14 in 27 months) that they all look the same, but in less than an hour, it started to make sense.

The patients love the internist I’m filling in for, and don’t particularly want to see a stranger. After a 4 hour orientation and a 1 hour lunch, I saw 3 patients.

None of them smoked, none sought prescription drugs for recreational uses. All employed, all motivated to get better.   Each got at least one prescription, all got advice on lifestyle changes, mostly about the caloric content of beverages: at 140 calories each, one serving of milk, juice, soda, or beer per day comes to 14 pounds per year.

A hundred years ago a junior doctor working under a more experienced physician kept the medical records and in return received teaching. To this day, a medical student or resident rotating through a specialty service refers to the experience as a clerkship.

With legal and financial pressures pushing doctors’ notes longer and longer, many physicians have turned to scribes: people who make notes during the face-to-face visit. The doctor gets out on time, sees more patients, and pays more attention to the patient.  Today, I had my first taste of working with a scribe, and I liked it.



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