Posts Tagged ‘Mickey Mouse’

Permit, license, insurance, and a contract with the Queen

October 7, 2018

I ended up feeling so keen

For three things, together they mean

I no longer lurk,

But I can come out to work

After my contract I sign with the Queen.

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. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, a British Columbia reprise, my 50th High School reunion, and a 4-month assignment in northwest Iowa, I have returned to Canada.  Any identifiable patient information has been included with permission.

Monday morning I strolled over to the clinic, marveling at my first snowfall of the year.

I had submitted my work permit electronically to the College of Physicians and Surgeons of British Columbia (CPSBC), which they required before reactivating my license.

I got my new passwords arranged. I’ve done 18 new electronic medical record (EMR) systems in the last 4 years, and, having been away from this one for the summer, I spent the morning practicing.  Mickey Mouse’s name turns up as an imaginary patient in a surprising number of EMRs, including this one.  I entered the diagnosis of felinophobia (fear of cats), and practiced ordering prescriptions, lab, and x-rays. I strolled around the hospital and greeted staffers.

I checked my email every 15 minutes for a reply from the College.

I walked back to the hotel for lunch and a nap. Still unlicensed, I returned to the facility.

By the end of clinic hours boredom set in. One of my colleagues called the College on my behalf.

Tuesday came as a replay. Clicking the REFRESH button every 15 minutes doesn’t count as exercise, and by noon I had started to ache from inactivity.

And I didn’t have cases to talk to my colleagues about. I missed being one of the cool kids who has stuff to talk about.

In the late afternoon my email lit up with notification of license reactivation, but I also had the chance to talk with the College about the possibility getting full licensure, making it return more flexible and shorter assignments possible.

I get my professional liability insurance through the Canadian Medical Protective Association (CMPA), based in Ottawa, 2 time zones to the East. So I called them at 6:30 Wednesday morning (8:30 their time), and by 6:35AM I had insurance.

At 8:00AM I strode into the clinic, grinning. In front of witnesses I signed my contract with Her Majesty, the Queen of England, and started into work.

I took care of my first patient of my return before the official start of clinic hours. I got permission to write about the problem, Eustachian tube dysfunction: the pressure in the ears which follows a cold or allergies and for which no effective medication exists. (Insurance rarely covers the only effective treatment, the EarPopper, a device that “pops” the ear, and costs over $300).

PTSD, chronic med refills, adult immunizations, and discussion of complicated endocrine investigations should not come to walk-in clinic. But they did.  At about 10:00AM I had a patient with a true urologic emergency, when I was running and hour late.

The day didn’t get less frantic after that, and I missed lunch.

I vastly preferred the action of the jam-packed day to the boredom that preceded it. And, at the end, I had cases to talk about, just like the cool kids.

 

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Thursday last week I started to work

June 4, 2017

I took care of the patients I got

I gave a couple a shot

But for one of the rest

I’ll need quite the test.

The work just hit the spot.

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 traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I started the day early, and lingered over breakfast while I watched a YouTube video about the underlying geology of northern British Columbia. The clash of tectonic plates has resulted in a coastal mountain range separated from the west edge of the Canadian Rockies by a central valley, everywhere scarred by the violence of glaciers.  All in all, I’m experiencing lovely scenery in an orderly, safe community where the children can walk unaccompanied to school.

Now 4 days into my Canadian adventure, I came to work this morning prepared for orientation in MOIS, the Electronic Medical Record (EMR) system (and my 15th in 30 months), but, alas, still lacking password sign on.

I took care of the latest, and hopefully last, couple of glitches in my bona fides. I did some email.  At the very last part of the morning, I started EMR training, which I followed by playing with the test patient named Mickey Mouse.  I knew immediately his birthdate was off, but finding citalopram (an antidepressant) on his med list came as no surprise.

When I came back from lunch, I had my first patient on my schedule.

I immediately fell back into my 3 question rhythm: Tell me about your problem.  Tell me more.  What else?

Though just starting on the learning curve for the EMR, and though I needed EMR coaching 5 times for 6 patients, this system seems easier to learn than most. Or maybe I have learned how to learn.

Two patients needed injections, three patients’ problems centered on their right leg. The last patient of the day turned out to be more complicated than anyone could have imagined, and will need follow-up and work-up.

To my surprise, the doctors here do their own injections, a job in the States uniformly delegated to RNs, LPNs, and, sometimes, Certified Medical Assistants. I have had to learn injection techniques on myself, as I take vitamin B12 shots into the muscle monthly, and Enbrel injections into the fat just under the skin every 5 days.

I took care of a total of 6 patients in the afternoon. Still clumsy with the EMR, I didn’t finish until 5:00PM, an hour after the clinic closed, but still a good deal earlier than what I’ve been doing for most of the last 40 years.

I thoroughly enjoyed myself.

 

 

Bear season: the people can fight back

May 30, 2017

Out here we’ve plenty of bear.

But we go out whenever we dare.

We won’t bring to ruin

An innocent bruin.

So we lock up our dumpsters with care. 

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 traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, about to get a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Right now this part of British Columbia finds itself in the middle of bear season, meaning that for a few short weeks the people get to fight back. All the dumpsters in town have bear-resistant closures and signs that urge the lock up, because “A fed bear is a dead bear.”  I find no open trash barrels anywhere; those containers have a very clever opening system too small for a bear to get a paw into.

With as many of the bruins as inhabit the area, I would expect more conflicts with the people. Such, however, occur rarely.  The ecosystem also supports mountain lions, wolves, coyotes, moose, elk, and deer.  Though few people talk about hunting elk, many talk about moose and caribou and deer.  Surprisingly few talk about bear hunts.

I still don’t have everything I need to start seeing patients. I must obtain professional liability insurance, and to do that I must have a bank account for automatic withdrawal.  And none of the banks were opened today.  I got the form filled out, with the exception of that one number.

So tomorrow I’ll come in after 930AM, when the banks open.

I started learning the Electronic Medical Record (EMR) system, my 15th in the last 30 months.  I enjoyed seeing Mickey Mouse appear as the test patient; he has played that role in a lot of EMRs that I’ve learned.  Some places have his correct birthdate, May 15 1928.  They list his spouse, Minnie, and some include his felinophobia (fear of cats) on the problem list.  His medication list has included citalopram (an anti-depressant) more consistently than any other medication.

I heard that a doctor put together this EMR, but I don’t know how to verify that assertion. If so, I can hope that it functions.

It will have to be very good to beat New Zealand’s MedTech32.