Archive for February, 2018

Speechless during a speech

February 20, 2018

I stood up to give a talk

And then a Canadian doc

Said “You may want to switch

To a province less rich.

It might be a bit of a shock.”

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. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. I’m taking some time off after a month of part-time (48 hours per week) work in northern Iowa. Any identifiable patient information has been included with permission.

I originally went to work in Canada to learn about the medical system first hand. Of course I want to share the knowledge, and I put together a half-hour lecture for the County Medical Society.

I managed to arrive at this late date without learning Power Point. But having adapted to 15 electronic medical record systems in the course of 3 years, I figured that putting together a PP presentation couldn’t be very difficult. And, indeed, in less than an hour I found myself creating slides and downloading images from the Internet.  My brother, an accomplished graphic artist, provided me with two illustrations.

American physicians do not want to hear that the current Canadian system is better for the doctors than the American system, especially not the ones who came from Canada. I hasten to say that the systems now are not what they were 20 years ago or even 10 years ago.

Still, a Canadian ex-pat pointed out that I had chosen Canada’s most prosperous province (which I hadn’t realized), and that least-prosperous Nova Scotia might have given me a different view-point.

Over the next 3 days, I talked to 3 American doctors far from burnout. Two of them, both in their 60s, have refused to acquire electronic medical record systems.  One refuses to take insurance.

A week and a half later, I gave a slightly different version of the same talk to first- and second-year medical students in Des Moines. The audience’s palpable idealism impressed me, and I pitched my presentation to those struggling with the basic sciences.  I advised them that burnout is a very real problem.

The early warnings about burnout happened early in my medical school career. The dean of the med school, in the first week, told us that if we didn’t take care of ourselves eventually we’d be of no use at all in the medical system.  I don’t think he could have foreseen the escalation of burnout now threatening the system, nor that it would come not from emotional exhaustion, but from frustration with electronic medical record systems and overreach by management and government.

Twenty minutes into my talk, my phone gave me a text chirp. I ignored it and kept talking.

At the end, I took questions. One of which, almost word for word, got asked at the County Medical Society meeting:  What one single, practical thing can be done to improve our system?

Go to a single level of service, I said, instead of the 5 that we have now.

I got four questions from the audience, three others on 3×5 cards, and five more as the students exited on their way to the next class, snagging leftover pizza.

Then I looked at my phone. My physician daughter had given birth to her second child, a daughter.

And then, for about five minutes, I was speechless.

It doesn’t happen often.

 

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I got a call from the state

February 13, 2018

Amanda, she works for the state.

She called one morning at eight

“You haven’t reported!”

“I’m a locums!” I snorted

Things resolved when she gave me the date.

 

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. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. I’m taking some time off after a month of part-time (48 hours per week) work in northern Iowa. Any identifiable patient information has been included with permission.

A week after I finished up my most recent assignment the phone rang. Most of the calls I get these days come from robots, so I stopped answering with my name and title.  The voice at the other end said, “Excuse me, I was trying to reach the hospital.”

Thirty seconds later the phone rang again, the same caller, trying to reach the hospital. So I identified myself.

Amanda, calling on behalf of the Iowa State Health Department, wanted to know why I hadn’t reported a reportable illness.

The law says that physicians, on making certain specific diagnoses, have to notify the Department of Public Health. I approve of the law in its concept and reasonable enforcement and application.  But I hadn’t seen any patients for a week.

Amanda named the patient but not until she gave the date could I place the case as having happened the last day of that assignment. She wanted to know if I worked in that hospital.

Well, yes I had, but that locum tenens assignment had finished.

Then I had to explain locum tenens: temporary doctoring. (Nomad with a stethoscope, perhaps more poetic, carries less accuracy.)

On another locum tenens job in Pennsylvania, I’d learned a good deal about the disease: infectious but not contagious, treatable and curable, but with a very narrow window to start medication and avoid lifelong consequences. And it pleased me to no end that I’d made the diagnosis, just by being thorough and remembering lessons from past assignments.  I told Amanda she’d made my day, but she’d have to call the facility to get details about the patient’s symptoms. At the end of the call I asked for and received permission to recount the conversation and use her name.

So I walked around for the rest of the day with a big grin.

I don’t want to do straight ER or Urgent Care and miss out on moments like those.

But there followed emotional ups and downs. My college friend, Bob died of consequences of the medical problems I wrote about in October 2010, see https://walkaboutdoc.wordpress.com/2010/10/13/of-long-awaited-punch-lines-rolling-stones-and-fresh-faced-volunteers/

With the miracles of modern connectedness, I located other college friends who knew and loved Bob. One, also a physician, continues to love his work while most American doctors hit burnout.  He doesn’t have an electronic medical record, and he doesn’t care that the government will penalize him for mouse click deficiency.

In the midst of our grief, we talked about how much joy we get from patient care. We both want to continue as long as we can.