Ten Thoughts Tuesday.

It must be really hard to make an on-call schedule for thirty-five physicians.

It must be even harder to admit you made a mistake on said call schedule, then attempt to rectify the mistake, only to make another one while fixing the first one.

Sometimes I wonder how some people can be so utterly incompetent. It really makes my head hurt.

I’ve had a sore neck and shoulders for the past month, on and off. I’m convinced it’s because I don’t have a supportive pillow but I cannot, for the life of me, find time to go find a new one.

All I can think about right now is a run.

And the cherry pie and vanilla frozen yogurt I’m going to have for dessert.

I think I might start training for 15 km.

And no, I’m not going to sign up for a race!

Humidity in October sucks.

My head hurts.

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?

No-Show Thursday

So, I’ve had a total of 6 patients no-show for appointments today.  2 of them were booked as new patient “meet and greets”.

Oh wait … is that patient for me?

Nope, they’re here to see the other doctor.

Back to surfing I go…

No, seriously, WTF?  It’s not raining, snowing, or hailing. Why can’t people honor their appointments?

And I can I just add how incredibly frustrating it is when new patients book appointments and then no-show?  Way to instill confidence that you’re a reliable patient.  You can bet those folks will not be rebooked.

Thus, I have spent the afternoon drinking copious amounts of tea to stay awake, nibbling away on trail mix, reviewing lab reports and calling patients, twittering and surfing the net.  Nice afternoon, huh?

Afternoons like this draaaaaaag.  I’d much rather be 30 minutes behind and busy than sitting on my ass in my office.  I did manage to get an extra few minutes at lunch to go out to a few local merchants and found me some fabulous fall running gear, so that made me happy.

And now.. it’s 5pm and I’m officially done for the day.  Home awaits.



A Difficult Week.

The office has been in some turmoil these past few weeks.  Just when I thought it couldn’t get worse, I walk in today to find that one of my secretaries decided to take the day off  with no notice. Just a message on voice mail that she was sick with a “stomach thing.”  Oh, and did I mention it’s the Friday before a long weekend and I’m working alone in the office today, covering 3 practices?

I’m tired.

I’m grumpy.

I’m pissed off with my staff.

I hate being a boss. I don’t want to deal with delinquent staff who think it’s okay to just call in “sick”, especially on a long weekend, when it’s so bloody obvious that she was fine yesterday and suddenly got a “stomach thing”!  Not to mention the fact that she had a 3 day weekend last week!  I have enough to deal with and don’t really want to be doing her job as well as mine today!

I’m also pissed off with myself.  Something came to light regarding a patient that has me completely freaked out that I might be named in a lawsuit and though I did everything I could to rectify the situation, in the end, after a series of miscommunications and communication breakdown between myself, the patient, the specialist and the hospital, I may just end up losing a lovely family to another physician.  I feel sick inside.

Us doctors, we’re not perfect. I know, shocking right?  Sometimes things get missed.  Mistakes happen.  And though I haven’t done anything horrible like leaving a surgical instrument in someone’s chest,     how I am feeling right now, I might as well have.  I am being pretty hard on myself, I know, it’s just who I am.

I am mad.  I want to be a perfect doctor.  I don’t ever want to make a mistake or miss a diagnosis.  I’m supposed to be the expert.  But try as I might to be perfect in this job, I have been reminded just how much I’m not.  It stings like a sonofabitch. I am managing over 900 patients with their test results, consult letters, referrals and office visits.  To say it’s challenging is an understatement.  Ugh, it sounds like I’m trying to make excuses.

Truth is,  I have no excuse.

This is my job.  I should be more vigilant. More cautious. More attentive.

Lesson learned. But at what cost?

What they don’t teach you in medical school.

There’s a few things that medical schools fail to teach medical students.  Some things you just learn by experience, ie. from your own life or from just seeing the same things over and over and over again.  And there are things that you are either good at or not.

1. How to counsel a first-time mother who’s completely stressed out that her 1 month old infant sleeps all day and is up all night.

2. How to show said first-time mother how to get her infant to latch.  Breastfeeding is fucking hard!

3. How not to keep your patients waiting.

4. How to run a business.  A business?  Say again?

5. How to hire a good secretary.

6. How to manage an efficient office.

It’s the last three that are really what this post is about.  I share an office with two other physicians.  Actually, I joined their practice 5 years ago.  Since then, we’ve hired one additional secretary, who is, for all intents and purposes, totally useless.  Let’s call her Rosemary.  Okay, so that’s not really fair.  Rosemary knows how to scan documents and doing the e-filing.  But that’s about it.  She isn’t very good with the phones, can only do one task at a time, and when trying to talk to her it’s like talking to a brick wall.  So, you might ask, why did we hire her?  For the life of me, I can honestly say, I have no fucking idea.  I think, back then, we were looking for someone to do filing, work on referrals and hoped that the person would grow into the job and eventually take over as primary receptionist as our current gem is nearing retirement age and would like to start cutting back her hours.  But this is not the person we got.  So, the hunt began  and we put an ad in the local papers, did a few interviews and met a lovely woman who we decided to hire.  How the hard work starts.  We need to cut back Rosemary’s hours so that our new secretary takes over the roles of answering phones, working on referrals etc.  The kicker?  We haven’t exactly told Rosemary that this is happening.  Oh, she knows that the new girl was hired, but she doesn’t really know we are cutting her hours.  Ugh! Where was this class in medical school?  Seriously!

I got into medicine to be a DOCTOR, not a boss, not a manager, not a small business owner.  But this is exactly what I’ve become and I can honestly say, it’s the part I hate most.  I’m not good at it.  I’d like to be, but it’s just not in my nature.