No, Doctors are not perfect
But we try.
I am a family physician.
Since I cannot sleep and because I just wanted to try DKOS4 out, let me tell you about what my day will be like tomorrow.
Please follow me after the jump....
My alarm will sound around 5:30AM (in just 4 hours!). I do have an hour drive (55.3 miles) to work. It is a relatively new job. I moved to a somewhat rural community from New York City where I trained about 5 years ago. Although it was 'love at first sight' my first position did not work out. After resigning, I could not work within 25 miles for 2 years due to a restrictive covenant agreement in place from that contract. I decided I did not want to move (right away) because I really loved my house - hence the commute.
I digress. I drive and get in around 730AM. My first task is to log onto our system and review many-a-dozen lab or test results. This has to be done relatively quickly with an eye toward looking for 'action items': Is this result going to harm my patient? Do I need to act on it now or later? Should I call the patient or can my Nurse handle the communication? I need to get it done quickly so I do not start out behind. Luckily and happily we have an Electronic Medical Record (EMR) = thus I do not have to flip through reams and reams of paper. Of course, I do not get paid directly for doing this task. The less I order for my patients the less I have to do - the more time I have to "be productive".
My first patient will be at 815AM. At first inspection - I will have about 15 patients on my schedule starting the day- leaving about 10-12 slots open for sick visits and walk-ins. I am relatively new so my schedule is comparatively light. Most providers in my office will have very few slots open at the beginning of their day. The will have to choose between over-booking, double-booking or have their patients be seen by someone else at our office (usually me) or by someone across town at one of our a satellite offices. I will start out with 15 but will end up seeing about 25 patients tomorrow. My colleagues may start out with 25 but may end up seeing upwards of 35 patients.
A side note on physician compensation/economics. Docs get paid in our office based on a complex formula measuring their "productivity". Basically - the more patients you see the better you do. Some Doctors have decided that they would like to see fewer patients so as to not "burn out" or simply maximize their take home pay. They cleverly have devised a way to increase billable services for any particular visit. For example, did you know that each and every mole that is removed from your skin has a huge $ sign next to it? Billable and some times un-necessary procedures can we a windfall for some. Not for me - I tell my patients that they pay me for my medical knowledge and ability to balance this information with their personal agendas to stay well, feel better or heal quickly so they can get onto other more important things in their life. I am not a proceduralist. But alas again I digress...
My first patient will probably be a follow up doing well with relatively few concerns and I can see that patient in 15 minutes or less. It is always a goal to dispense with the healthy as quickly and as politely as possible, knowing that the sick and possibly life-threatenedly sick are just a phone call or walk-in away. Now that I am warmed up - I will glance at the rest of my day. Mostly follow-ups, but I do see some adult physicals and some well child visits, a couple of kids probably getting vaccinations. These are good "high-ticket" visits with little stress for me. These visits will be more complex of course in the sense that we cover alot and require 30 minutes each, but from a business point of view they are worth the time.
The calls start coming in. Mrs. Robbinson called and she is feeling really well (finally) "Can she stop her Coumadin?"...Ummm No! But we can discuss at our next visit.
"John's Dad called and wants a note for his son to start GYM again after a knee injury on Friday". Ummm is his knee feeling any better? Wasn't he supposed to come in for follow-up yesterday so we can decide together? "yes, but they dont want to come in..just a note please..thank you for understanding..he really wants to make it to VARSITY Lacrosse..needs to start practicing again.." Ok yes whatever..
"Emergency Room Doc wants to speak with you regarding a suicidal patient who can not get a bed in the Psych Unit. He wants to see you for New Depression Medications. Yeah, he decided that your medications were not working so he stopped them, broke up with his girlfriend and then drank heavily on Saturday. Oh yeah..and there is Meth in his urine and Marijuana, but he is sober now and he doesnt want to kill himself anymore and the Social Worker thinks he can just follow up with you. Do you have an opening today?" Ayy Oy vey...
I do worry as I see a SELF PAY (danger Will Robinson!) 50-something man on my schedule "who just doesnt feel well, pain numbness right side of body". I notice he has not been in to see anyone in over 3 years. Geez- maybe that HYPERTENSION went away and that DIABETES was magically cured. Or maybe he lost 50 POUNDS and is no longer SMOKING and thus has found a new path to healthy living??. I doubt it. He probably gave up on medicines because he could not afford them. I sense a train wreck coming in right before Lunch. Will I be ready?
After sending my "train wreck" to the Emergency Room for a possible stroke, I find my lunch. Luckily I prepared something to eat this morning since I will not have time to sit for a real lunch across the street. Looking at my schedule again I see that my afternoon is packed. "Rashes and colds!" I am happy to be so much in demand, but sometimes I ask myself shouldn't these folks just stay home? I mean really..If you come to the Doctor's office you will be around other people sneezing at you. And, most likely than not you will get a prescription for an antibiotic you probably do not need for a cold that will get better. And that rash? If it has been only one day-- it pprobably is not serious. Besides I am sure I will find a skin tag that absolutely needs to be removed! Not!. My bosses say "it is good for business". I ask "but is it good for the patient? Is it good for healthcare?" I should not bite the hand that feeds my family. So we have an open door policy. I will not get home until 7pm.
The truth is that it is really hard to convince patients over the phone that they will be OK. It is just easier to have them come in if they want to be seen - same day even. They will call and call and call until you give in with an office visit or a prescription or both. AND IT IS really hard to diagnose PNEUMONIA over the phone. This means full schedules for everyone all around of mostly NOT gravely ill patients. Besides most people when they call WANT something - a note for work, a note for school, a prescription for their overdue birth control..You get the picture. In their eyes, more care is Good care. I am just happy to have a secure job.
But I digress...
Moral of this diary: Save a life today so you can have a quiet lunch tomorrow and get home at a reasonable hour the next day.
Wash. rinse. repeat.
Every. single. day.
I'm sleepy now ..thanks for listening...
(To be continued..)