To make me be productive.
It always seems that when I'm trying to avoid a task, that I've deemed "unpleasant", I manage to get an awful lot of other tasks done that are suddenly "less unpleasant". Right now that would be filling out a re-credentialing packet for one of the locums companies. Honestly, it's a paperwork PITA. Nothing's changed in two years, but I still have to fill out 15 pages of application, and then fax another 30+ pages of supporting documents to prove that nothing has changed, that I'm still who I say I am, and that I don't eat small children, extra-crispy, for lunch...<sigh>....
I've been working on this in bits & pieces for a week now & still can't seem to get done, and today was the deadline. Ooops. I guess now I have to do the "full" packet....
So help me God -- I will eventually drown in the paperwork associated with being a doctor. And this is so not what I signed up for. Seriously. All I want to do is take care of patients [specifically kids], help'em feel better, maybe teach a parent or two something that helps them help their kids, and call it a good day. But in today's day & age, doctoring isn't so simple anymore. And sadly, it's probably just going to get worse.
I worry about what the upcoming future holds for medicine. Right there along with thousands of other doctors. I've had to stop reading the threads in my doctor-only networks because it's too depressing. We all know that change is coming & we're all afraid of what that means. But mostly no one seems to be able to figure out a way that medicine will become more about doctors spending time taking care of patients. Most of the changes I read about all seem to do the opposite: take time away from the patients & spend time on paperwork/electronic medical records to justify the time that we're with the patients.
There's a lot of build up in the media that would make the average person think that switching to an electronic medical record will be the godsend of medicine. But from my time in the trenches, I'm not hopeful. For starters, there's no one consistent standard from office to hospital to medical center, etc. And trying to create one EMR that will work for all specialties so that we can all be interconnected -- well have you ever tried to herd cats before? The fundamental problem is that the medical language that I need to document & communicate about my Pediatric patients is completely different than what my colleagues in Orthopedics or Internal Medicine need, and no one specialty is going to want to be second fiddle in the software selection.
And there's so much variety within any specialty in regards to software. I've subbed in enough offices now, that I know which programs I can tolerate, and which ones I refuse to ever touch again. I hate being in the exam room & not being able to smile & giggle & interact with the kiddo because I'm typing away at the computer. Now if you put me in a practice with an EMR and gave me a nurse/MA/assistant whose sole purpose was to type everything I said & did into the computer so that the documentation was done & I didn't have to touch the keyboard -- Well sign me up for that choice! In a paper chart office I can see 45-50 kids in a day. With an EMR, 35 is about my maximum before my brain is fried. And it's not that entering data is that hard, it's that I've yet to work with a computer fast enough to keep up with me........
I so blatantly prefer working in offices that are still primarily paper-based, that my recruiters know that when they tell me about a new job site, I'm going to ask if there's an EMR. And odds are, I'm not going to be interested. And here's the truly tragic point: I am a computer-philic. I aDoRe technology. I was the geeky resident who had the palm pilot & all the cool software & reference books at pen point on rounds. Heck - I was the one who "consulted" for the rest of the residents & would guide purchase decisions & then spend the weekend tutoring them on how to use their new gadget to make their life easier. I still have custody of my patient databases that I created to track all the procedures I did in training on my palm, because I could do so, faster, more thoroughly, in more detail than the routine way of collecting patient stickers on sheets of paper. So it pains me to actually not like the reality of EMRs.
There's also cost. Sure there's starting to be "initiatives" to help encourage us to make the switch from paper to EMR. But really? It's a token drop-in-the-bucket. When I first started looking around for a Pediatric EMR for my concierge practice the quotes I got 2 years ago averaged around $25,000. Uhmmmm, yeah. I mentioned that I'm in Pediatrics, right? You know. Down here at the very bottom of the medical pay-scale. Uhmmmmm, so for me, an EMR falls into the category of unattainable business expense. I literally started my practice on a shoestring of about $500. And even now, I still work primarily locum tenems to support my family & pay my malpractice insurance. If I even had a spare $25,000 believe me, I have a number of other ways to spend it before getting an EMR.
Relatively speaking, I'm still a "newbie" in this field of Pediatrics. I've been practicing Pediatrics since 2000 and just in that time I've seen huge changes in medical technology & informatics. So much so that it's impossible to keep up. In contrast to today was the primary care preceptor-ship I had to complete between my first year & second year of medical school. I wanted to stay local, and had trouble finding someone to take me on. In desperation, I called every D.O. listed in the local county medical registry starting in the "A's". I finally found someone in the "C's" who had a week free & didn't mind me shadowing them. And was that a learning experience....
When I met Dr. Catherine Carlton, she was 80 years old and had been a general practitioner for 57 years. She graduated from medical school in 1938. She wasn't just in the minority as a woman in medicine but as a D.O. in medicine. I wish in 1995, I had better appreciated how I was learning in the shadow of a true medical pioneer. Out of curiosity I just looked her up & discovered that she passed away in 2002. Ah well. She probably never realized how much I took away from that brief week, but I still remember her as quite a character.
Her office was the same building that she & her father and then she & her husband had practiced in for their entire practices. Eventually the other two passed away, and rather than retire, she continued on. Her office was something of a time capsule. The front room had an office desk up front and a few very old beat-up wooden chairs against the wall. On the desk sat a 1930's black telephone like this one:
and it still worked. There wasn't any hold either. If her patients called & got a busy signal, they knew to keep calling until they got through. The lady who answered her phones had been there for 30+ years.
There was the "laboratory" that looked more like a re-purposed kitchen. The first day she handed me an old glass jam jar & told me to give it to the waiting patient for him to collect a urine sample in. "Universal precautions" was a theory that whistled through that office, but Dr. C. was a firm believer in good old-fashioned hand washing.
I greatly appreciate now that her medical records were 3x5 index cards. She had two old metal library 'card-catalog" files that held all the cards. When a patient visited, that warranted a note in pencil that took one to two lines. When the visits numbered enough to fill the front & back of the card, then a new one was stapled to the front of the stack. And there were some "charts" that had 5 or more cards stapled together. There were lots of single cards too.
She was very plain spoken with her patients - "none of this medical jargon to keep them confused". She talked to nearly everyone as if they were a second grader and she were their strict, but kind teacher. The gentleman with the urine in the jam jar -- well he was a diabetic and he got quite the lecture that day about watching his diet and not eating any sugar at all because of the amount of sugar in his urine. Up until that time I'd never really witnessed a patient being educated & chastised at the same time. He had to come back twice more that week to give more urine and each time he did a bit better. I've gone on to do the same technique with some of my adolescent patients over the years. I hope I've been 1/10 as effective as she was.
One of the other quirks I loved about Dr. C was that every day she had on the same "uniform," a navy blue pleated skirt, mid-calf in length, with a long sleeve white button down shirt and sensible lace up black leather shoes. Her shirt cuffs were always rolled up twice because she had hands-on work to do in her no-nonsense way. And at the end of every day, she'd go to her office and change clothes into what seemed to be the same outfit, and the clothes she'd worn in the office stayed there on a hook on the back of her door. At the end of the week, I realized that it was literally the same outfit that she wore in the office everyday, and that her "going home clothes" changed, but not by a lot. She was a firm believer in leaving her office germs at the office & not taking them home. In residency, instinctively I tended to do the same thing with my lab coat. When I had to wear the darn thing, it never went into the house with me at night, it stayed in the car. Then when I was a senior resident & took the latitude to not wear the lab coat, I had a fleece jacket I used instead & it lived in the car as well. It still didn't keep me from bring home RSV and infecting all the cats -- but truly -- that's another post!
For this to be my first formal preceptor experience, it ended up being a huge exposure to the ways that medicine had been simpler & in some ways more rewarding. Over the course of my training, I probably went out of my way to find preceptors & role-models who were more old-fashioned and I suspect that having been around Dr. Carlton influnced me that way.
Ah well, the more things change -- well, the more they change.... Except that I have successfully managed to procrastinate yet another day of getting that blasted credentially paperwork done. I guess there's always tomorrow....
Oh, and I'll probably be "blog-lite" this week. I'm filling in all week in clinic & then covering phone calls for a second doc all week as well. I just got started reminiscing & couldn't stop. C'est la vie....
