Ship mast in black and white. 
“So, I am the manager at that other clinic right by you.” The woman regarded me haughtily.

“Oh, right… Nice to meet you…” I turned and scribbled my name on the sign in sheet.

“We are sort of in competition… in a way.” She half smiled. “It is nice to be able to put a face to a name, doc. I hear a lot about you from patients that come over.”

I stared at her. 

I had had a terrible, super crazy day. She was The Competition? Hell. Some days are so emotionally depleting that it leaves me numb and incapable of dealing with snarky small talk.

“We are overrun with patients. There is just no way we can take care of all of them. You are welcome to anyone you can steal.” 


“Oh. Well, we have the same problem. We are waaaaay too busy.”


I walked away so I would not say something I would regret.

Then I located my own office manager. We had been summoned see how much money the new EHR was going to cost us. 

It is “optimized” for a 24 inch screen. They “strongly” recommend a computer on a retractable arm in each room. That will cost close to $3000/exam room. Plus each staff member will need a new computer/monitor. Plus the physicians will all need laptops to take home and a docking station with the 24 inch screen in their offices.


The tiny, poorly designed exam rooms in this godforsaken clinic I inherited are so cramped that I fail to see how this is going to work. Bolting it the wall? 

Where exactly?

And why?

Why can’t they optimize it for equipment they know everyone is going to have anyway?!?!?!! I still welcome the change. It is long overdue. 


Don’t pay attention to cost, they said. Just pay attention to work flow, what will work best for you. The cost will be capitalized….

How can I not pay attention to cost?!??!?


81 thoughts on “Clouded

  1. Bless you – I agree with FF above… dbag for sure! What’s she playing at, anyway? Chin up, doc! What you can’t control will happen anyway. It’s a shame, as money can clearly be spent more efficiently, but still… can’t change it? Gotta live with it. At least you GET equipment… here in the land of socialized medicine, they are constantly, CONSTANTLY cutting back somewhere. Not that I’m complaining. At least my taxes pay for it…

    Liked by 1 person

  2. I say this because I am a nerd and read way too much computer technology than is necessary yet I still enjoy it. I will keep it short.

    Consider the recent Windows Surface Pro for enterprise usage, strike a deal with Microsoft and source the large screens from a reliable third party when necessary and practical.

    I would almost recommend the iPad but the Surface Pro has more “computing power”, better workplace integration and is more compatible for office usage and working on the go. The Lenovo Yoga tablets and hybrids can also be used.

    You can do so much with 10 to 12 inch HD screens these days. Add interactive touch interfaces and you have tablet, touch device and PC in one package. Saves in space, installation costs and weight in the workplace.

    All the best (and bring in a proper nerd without managerial bias!)

    Liked by 1 person

  3. “Optimized for a 24 inch screen” sounds like something out of the ’70s. It would be either a) an excuse to sell lots of hardware; or b) a reason to ignore complaints about how it looks. Take your pick. Either way you are being had by hype.

    Liked by 1 person

  4. the people who make those decisions about cost who say just pay attention to workflow are willfully ignorant of basic economic principle. While they’re telling you to pay attention to only workflow they want to conveniently leave out the obvious that you and I intuitively comprehend and that is, the cost of the new equipment isn’t going to be subsidized by the people making that recommendation to you in the first place. The cost is going to be passed on in other areas like overbilling insurance companies, charging more for procedural activities, auditors coming in and making sure you charge for every little thing like you mentioned in a previous post and the like. Meanwhile the executives and management will still get their huge bonuses and profit sharing and this “workflow without attention to economic implication” concept won’t touch their bottom line in the least and once again, the people at the top will be insulated from the realities of their decisions. Meanwhile, who will be under more pressure to see more patients in less time, fill out more forms and so on?

    Liked by 3 people

  5. Dana is right on – COST. When the internet was new, many said that it was a magical beast that broke all the old rules about how to do business. Billions were poured into it by those who believed that they would become exceedingly rich by getting in on the ground floor – expecting their money back many times over – even though no one had exactly explained how that was going to happen. It turned out that there was magic but it played by the same old business rules as before – COST. Anyone who says – never mind the cost – is losing their grip on reality. No matter the endeavor, cost is critical factor. But, as you said Victo – that’s not yours to determine.

    As far as squeezing the wall mounted screens into your exam rooms – it sounds unrealistic to me. You know one of the biggest mistakes made by those who are purchasing tech is their lack of consultation with the users. I used to be a business analyst in IT and I’ve seen that done over and over. It is such a waste of money. In B-school we studied exactly that issue and in the process we did many case studies of real situations that happened and the outcomes. We used to laugh our heads off at some of the idiotic decisions made without consulting end users. Even in the dialysis that I now attend, they recently replaced all the machines with updated equipment and they included laptops attached to each machine with an “ergonomic” mounting arm. The purpose was so that nurses could do their charting at the bedside. Well, it is very cramped in the unit and the patients were hitting their heads on the laptops and the nurses had to keep moving while they were standing. So, the expensive laptops on their ergonomic arms are now all folded back behind the 33 dialysis machines and the nurses do their charting by talking turns at the 4 desk tops in the nurses’ station that are hooked to the same network.

    As one of your readers suggested, the doctors all have ipads that are similarly hooked and they take them everywhere- including home. That eliminates the necessity of computers sitting around waiting for a user and it also eliminates space issues and personal use issues as well (the ipads are assigned and remain with the doctor as long as they are practicing in the hospital). Anyway, I know you have little say in your company’s decisions, so I wish you the best of luck with your new IT.

    As far as the competition is concerned = that is funny and I can guarantee you that she was sent to scope out your operation because they are not doing as well. Your response of not even seeing them as competition is the key – you are doing your best for the patients and are not competing with anyone. Which is perfect – keep up the good work Victo…You rock!

    Liked by 1 person

  6. Snarky on one side and cost-crazies on the other. It sounds sort of like my week, Doc. Similar but different. They won’t buy us office supplies (not so much as a pen), but they have millions of dollars that each director is required to spend. Wishing you a fabulous Friday. Hugs.

    Liked by 2 people

  7. I don’t like to think of doctors as participating in a competition for services rendered. Nor teachers, police, lotsa jobs…Uh, yeah, no.
    How can you not think of cost? Everyone has a budget, except salesmen, apparently πŸ˜‰

    Liked by 2 people

  8. When I was in the rat race, I occasionally met snarky folks like your “competition”. It never failed that I came to pity them after I learned the real truth. Their performance and success was always sub-par. Sometimes they even crashed and burned. I suspect when you learn the real truth about your so-called competition, you’ll find she’s a pathetic creature.

    Liked by 1 person

  9. Well, MeOw to the manager next door. Well, of course you want the 24″ optimized gamahedron enhanced viewing experience! The boosted quadrangularized hypoteluronic phase synthesizers of the main operating system would be worthless without it. You are being much too myopic in thinking about things like room size and budgets. Sheez. I worry about you.

    Liked by 1 person

  10. Victo, not liking the memories of working in a similar system with the same problems. Add the quota on patient case loads for NPs to cover their salaries. Pushing us to work faster, smarter, and cut corners. So much for good patient care in a big business model! Chryssa (aka Christine)

    Liked by 1 person

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