Personal Space.

This has been bugging me for a while now.

In my exam room, there’s a good 4-5 feet distance between where I sit and where the patient sits.  I think it’s a comfortable distance for a conversation. It gives both the patient and myself adequate space. Often patients are bringing in their work bags, suitcases, briefcases, sometimes their groceries even! I’m okay with all of that because there is plenty of room.  But there are a few patients who insist on pulling up their chair right to my desk.  I mean, we are now sitting face to face with a small desk between us. If I crossed my legs, my foot would hit the patient’s shin.   During these encounters I just want to yell out, “Personal space, people!!!!  Personal space!!”

Would you get right up and personal with your  doctor?  It’s a professional encounter – I am not their best friend, but sometimes, I suppose I am their confidante, so I can see how getting close to me physically might be comforting to some.  But it really, really, really bothers me when certain patients do it.  Are they trying to see what I write in their chart?  Are they thinking that the closer they get to me, the more I’ll believe their story?  Frankly, it’s kind of creepy.  And of course, it’s always the patient that rubs me the wrong way to begin with – the patient who comes in monthly for the pain pills, or the one that has fibromyalgia and needs constant hand-holding and reassurance that he doesn’t have some rare degenerative neuromuscular disorder that three neurologists haven’t been able to diagnose.

I need to figure out a way to politely ask these patients to move away from my desk.  I suppose I could use the “patient confidentiality” angle, as I do use electronic record and when I am going from screen to screen, the appointment schedule is visible.

Any advice?

Back On Duty.

Final weekend of maternity leave.

Last night I had a lovely dinner meeting with the doctor who’s been taking care of my patients.  We had a “handover” of sorts.

Handover – A handover is the transfer of responsibility and accountability for some or all aspects of care for a patient or group of patients, on a temporary or permanent basis. It entails appropriately transferring information to help deliver safe care. (CMPA)

I had been keeping up-to-date on a few patients since I was off, but not many.  Our three-hour meeting was informative and extremely useful.  This physician has done an excellent job and a quick peek at some of her clinical notes on the EMR confirmed it. I am officially back on duty as of, well, now.

I have to admit, I feel a little apprehensive.  I am used to this feeling – I’ve had it every single time I returned to work after an extended leave like this.  Am I going to remember how to write a clinical note?  Will I remember how to take an appropriate, concise but detailed history?  Thankfully in the past, after the first few hours back, it generally feels like I never left.  I certainly hope this is the case next week.

Another variable thrown into the mix is my 6 month old son. When I returned to work after the previous two maternity leaves, the kids had been sleeping through the night for at least a month.  (How did I get so lucky?  Third time’s the charm, right?  Right?!) Sadly, no.  He’s not quite sleeping through the night yet.  He still wakes at least once, usually between 11pm – 2 am.  Husband has been wonderful and doing these feeds more often, but I still wake up.  I am still tired during the day.  I worry how I’m going to function now that I have to actually use my brain again.

Despite the fatigue and the apprehension, I am ready to get back to my work.

I love my job.

I love medicine.

Twenty Days.

Twenty days left of maternity leave.

Wow.

Hard to believe.  Time has gone by exceedingly fast this time around.  I’m excited to return to work and a little sad.  I really have enjoyed every minute that I’ve been home with everyone.  But it’s time to start earning some real money again. It’s time to be a doctor again. Life has to get back to the new normal.

The baby is going to be six months old on the weekend.  He’s finally starting to take some cereal (okay, so it’s only been two days), but he’s still getting up at least once, if not twice a night.  I am really hoping for a miracle over the next few weeks – I need this baby to sleep through the night.  Sure, husband will be doing the night feedings once I start back to work, but let’s be honest, baby wakes up so I wake up.  Fuzzy brain does not a good doctor make.

In the meantime, I am going to take advantage of the next few weeks I have left.  I’ve already done a huge purge of my closet – clothes I haven’t worn in years, since before my first pregnancy, have gone to Goodwill. I am starting to go online to the electronic medical record more often to read up on patients.  I am reading more medical related stuff.  I am mentally preparing for work.

Twenty days.

 

EMR Transition Pains

So, this EMR transition has been a little bit harder than I thought it would be.  Okay, that’s a lie.  It’s a lot harder!!

Not only am I trying to get back up to speed on what’s going on with my patients, I am also struggling to remember them! The paper chart, I realized, plays a huge role here.  When I look at their paper chart, I see it in the context of my notes. Looking back at a note, I can remember what the visit was like.  For example, once I looked back at a patient’s notes from 2 years ago, the visit popped into my head. I actually remembered the patient in my office, on the exam table.  Weird.  Anyway, so now that I’m using an EMR, I’m finding that my notes are far more abstract – I guess I am still not used to seeing my patients’ notes in the EMR like I was seeing the paper chart.  Does that make any sense?  I have had a few follow-up visits in the 6 weeks that I’ve been back and it’s been difficult to remember the visit.  I’m sure this will change over time but it’s pretty frustrating right now.  It’s really slowing me down.  Perhaps I should book less patients, that would be the smart thing to do, but inevitably that will make patients mad that they can’t be seen quickly and I have always prided myself on being the kind of family doctor that sees people the same week they call.  Sigh .. guess I just have to suck it up for a few more months.

And another think I thought would be so cool about EMR?  Checking labs and stuff from home!  Um.. not so much.  Now that I can, doesn’t mean that I should, right?  Where’s the line?  I never used to bring work home with me – now, it’s there whether I want it or not.  It’s so easy to open that web browser and log into the system.   Sure, I can get a lot done in the off hours, but I’m realizing it’s taking away from my “me time”.  For instance, I haven’t picked up my cross-stitching kits in over two months!  Must change that!

Everyone who has ever made the transition from paper chart to EMR says it takes up to 1-2 years before feeling completely comfortable.  I’m aiming for 6 months.  Do-able?  I’ll keep you posted.

Zzzzzz…..

First week is almost in the bag.  I am exhausted.  One more day, then a long weekend. Thank goodness!

The back-to-work transition has gone relatively smoothly.  I’ll admit I feel a bit rusty and a little scattered, but I think that’s to be expected and probably won’t last very long.  Not only am I trying to catch up with what’s been happening with my patients over the last 6 months, but I am now using the EMR and probably trying to do too much, too fast.  Not only am I charting every patient on the EMR, I am also trying to input their CPPs as well.  [CPP = cumulative patient profile; ie. medical history, social history, allergies, current meds, etc]  Inevitably, I am at least 15-30 min behind on the schedule and I hate it.  The patient’s don’t seem to mind, but I do. I like to run a tight ship.  I feel like such a slowpoke.  But I’m sure it’ll get better.

My family seems to have adjusted pretty quickly as well.  My almost-3 year old doesn’t even seem to notice me gone. The other day I got home at 6pm and she asked me if I got my nails done. Wha?!?  “No, sweety.  Mommy was at work”.   My son, the 6 month old, just smiles happily when he sees me.  It’s been really hard not seeing him all day.  I miss him a lot.  He’s in good hands with his daddy and my mom has been helping out a lot, but it’s been hard leaving him.

I’m pooped.

Countdown to Work

20 days left.  20 days of leisure mornings, 20 days of dual parenting, 20 days of summer. 20 days to fit back into my pre-pregnancy clothes.  Ha! As if!

October 3rd is the big day.  I am excited to get back to the office, but a little scared too.  What if I’ve forgotten everything? What if my brain, after 5+ months of shitty sleep, just can’t function in a “doctoring” way again?!  I’m so tired these days, I could just fall asleep as I write this.  I suppose it doesn’t help that I’ve had a migraine since last Thursday.  Ugh.

Before I left the office in April, we implemented a new electronic medical record (EMR, for short).  It was a big deal for my colleagues, but couldn’t have come sooner for me.  My partners have been in practice for 15-20 years so the idea of transitioning from paper to electronic charts was quite daunting for them.  Since I had trained on EMR in residency, it was a no-brainer for me, and we actually chose the system I trained on, so going “live” was relatively painless, and my locum has been using it for the past 5 months.  So, in a way, I haven’t totally been out of the loop. I can log in from home and see the daysheets, review the notes from the day, keep up with what’s going on with my patients. I’ve even spoken to a few of my patients over the course of my leave – one is dying of a neuroendocrine pancreatic tumor, and another is fighting breast cancer (she’s a year younger than me).  So all in all, I feel like I’ve been able to keep updated with what’s going on at the office and with my patients, even though I’m not there.

Will I miss the kids when I’m back at work?  Honestly, probably not very much.  Sounds horrible to say, but it’s the truth.  I am a much better mommy when I’m able to go to work, feel productive and useful.  Not that I don’t feel that way with my kids, it’s just different.  I don’t get the same kind of intellectual stimulation from my kids that I get from my job, my colleagues and patients. I mean, that’s obvious right?  Some women can be with their kids day in and day out. Some women are just natural stay at home parents.  I am not.  And I’m okay with that. And thank goodness, my husband is too!  His dream job is staying home and raising our kids.  I’m a very lucky woman.

So.. 20 days left. Yay!