Doctor’s Day

Cute butterfly on a blossom

Doctor’s Day was yesterday. Did you know that?

Caught me completely by surprise.

It used to be a big thing ten years ago. The hospital hung banners up and handed out logo emblazoned umbrellas, bags, pens, and whatnot. My staff signed a big card the office manager picked up and a new potted plant would now sit on my desk. Drug reps dropped off cards and swag. There would be emails celebrating doctors sent from the suits. Well not really from the suits. From their secretaries. The point was, though, you just could not escape what day it was. 

To be honest, all of the hoopla back then made me feel very uncomfortable. 

This is not why I am doing this. I am not here for the accolades or the potted plants and I resent the insinuation that these things matter to me. Please leave me alone.

Each year it is less and less of a big deal. This year? Silence. Not a single frickin word from anyone. In fact, my only clue was a post from someone else on WordPress. 

Yesterday I told a woman she has metastatic ovarian cancer. I told a man that he now has diabetes and we developed a treatment plan together. I did a newborn visit on a precious two week old baby. I cried with a woman over her divorce and saw a man whose mother just died from the same disease he now has. Then I watched the last few minutes of my son’s karate class and picked up cupcakes for my daughter’s class party. 

This is life. My life. Every day. 

And you know what? Despite any bitching and complaining that I do here, I really, really love my job. It is such an honor and a privilege to care for people, to be there when they need help. THAT is what keeps us going… keeps me going.

In truth, I’d do this job for free. Just don’t tell the suits that I said that. šŸ˜‰

Salvation is Near!

There is nothing like prying your kids off of each other for the fifteenth time before 10AM to make you question your parenting skills. 

And your sanity.

We are on day five of me at home with my kids. I don’t have anyone reliable to watch them when they are out of school for the holidays (there is entirely too much time off of school nowadays if you ask me šŸ˜‰) so their father and I split the time. Currently, it is my turn. Tomorrow I get to go back to work for a few days.

Yippie! (You didn’t hear me say that…)

Stay at home moms, I don’t know how you do it day after day, week after week, month after month. Honestly, I am not as strong as you are. I am beginning to think I look pretty sexy in sweats. That’s right. Not to mention the fact that all of the cookies I have baked have snuck off to hide somewhere… I couldn’t possibly have eaten all of them. AND I am talking to rising bread dough as an equal. 

All of this has convinced me that I am a much better parent in smaller doses. I had suspected this, but in the past my kids still napped. 

Now they don’t. 

So. 

I say all of this to say that if you hang with your kids all day every day and still like them and yourself, you have my respect. I send you a virtual fist bump of solidarity. 

Meanwhile, I am going to quietly sneak off to pack my work bag for tomorrow morning so as not to draw the attention of the angry hoards demanding that I fold yet another origami frog.

Woohoo! (You didn’t hear me say that…)

Fecundity

“Mommy, when I have a little sister, I want to name her Leia.”

“Leia?” I swelled with pride at my young padawan’s name choice.

“No! Not Star Wars. Lee-yah!”

Oh.

“Hey, Mom, I want a little brother…”

Every evening, my daughter says a prayer asking God for a baby sister. Then she punches her brother when he prays for a baby brother.

The kids are ganging up on my poor uterus. What’s left of it, anyway. Between us, I think the hot flashes are its retaliation. The kids just don’t understand, no matter how many ways I try to explain it, that the physiology is impossible and I am not ever adopting another baby. 

No way. 

No how. 

I was asked by DearLilyJune, “In what ways does being a doctor help you in being a mother? Vice versa?” And HotplateKate asked, “As far as questions, mine would be about the struggles you (or others) face combining medicine and motherhood.”

There definitely pluses and minuses. 

For instance, I now understand the funny looks moms gave me when I asked if they were brushing their toddler’s teeth twice a day. Yeah. Twice a day. Hell, once a day is generally all you can manage when you work full time. And you know what? That is just fine. 

Also, I now understand the whole first time mom pathology. I have felt that craziness myself and I am so much more forgiving and patient than I used to be.

When I have a sucky day, I can get some good hugs and kisses that make it 95% better. The kids make enduring the crap so much more worthwhile.

That being said, the kiddos also make things more stressful. I have to pick them up by 5:30 every evening, no matter what is going on at the clinic. I have to get them ready and drop them off every morning. I have no extended family that can help out at this point if the kids are sick or if they are off of school for a holiday. Their father steps in a bunch and is a huge help but there are times he simply can’t.

Why don’t you just get a nanny? I get asked that a lot. To be honest, that is a difficult proposition but even if I could arrange it easily, I want to be a parent. I want to be a mom. So I choose to engage in a precarious balancing act. So far, I am making it work. I love medicine and I love my kids. I am glad that I have enough flexibility that I can do both. 

In Another DimensionĀ 

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Joey of Joeyfully Stated asked what field of study I would have pursued if I had not become a doctor.

My undergraduate degree is in Genetics and I had intended when I started out that would get my Ph.D. After doing a few years of research on pea chloroplasts, I realized it was going to be a helluva lot of incredibly boring work for very little payoff. 99% of genetic research is very unsexy as it turns out.

So I decided to go to medical school. I really wanted to get a doctorate level degree because my family had told me I couldn’t. I was a girl, after all. I like sticking it to people who tell me I can’t do something because I am a girl.

In truth, my back up plan in case medical school did not work out (because there was no way in hell I was going back to pea chloroplasts) was to get an MBA somewhere. Something practical. Thank heavens that did not have to happen because I would have been absolutely miserable.

Here is a post I did last year on what would be my dream career: My Alternate Reality

ComparingĀ 

zinnia in black amd white

Life is made of joys and sadness. Ignoring the sad, painful times neutralizes the joyful ones.

One of my office managers keeps insisting that we not talk at all about the negatives of our job. He would prefer that the staff and physicians only project happiness, sunshine, and roses at all times. I am not sure that is entirely healthy.

This is the way of life lately. No one wants to hear or even acknowledge the negative. Sadness makes us uncomfortable. It is painful. It is a natural thing to want to avoid it.

Why can’t you just be happy?

The problem is that completely ignoring it promotes isolation. It keeps us from recognizing who is suffering, who is at risk, who needs help. This is a tough job for all involved. What is wrong with acknowledging that so we can all work through it together? 

Am I the only one who feels this way? What is wrong with me?

And it takes away the drive to get better. 

If everyone is happy, why do I have to do it right?

The worst part is that it takes away the celebration of the real triumphs. 

What? Can we BE more happy?

It is OK to feel fear, doubt, sadness, frustration. It is what we do with those emotions that is the key. How do we respond and use them constructively?

I see this in patients, too. So many believe they should not have to feel any negative feelings, that such feelings should be avoided at all costs. 

I know I should still be happy. I am going bankrupt, my wife left me, and my son is in jail, but I should be happy. Everyone tells me I should just be happy. Make me feel happy.

Doc, I am really, really trying to stay positive. I have metastatic cancer and I am in pain all the time and chemo is kicking my butt. Everyone tells me I should stay positive or I won’t beat this but I really just want to cry. I need to cry.

You know what? Being sick sucks. Having cancer sucks. Sometimes life just sucks.

And it should be OK to say it sucks. It should be OK to grieve and be sad and to cry if need be, even if it makes others uncomfortable. 

What we need is balance. Not a cult of happiness.

Down The Pipes

ventilation shaft on a boat

He had just been here last week. Why was he back so soon? 

The tag line on his visit said, “NOT BETTER.”

What do you mean you’re not better?!!?!!?

Somehow, I always feel a bit defensive when patients don’t get better, it is as if the illness has exposed my weaknesses. I have come up short. I know it isn’t logical, but this is the way I feel.

Do they think I did something wrong?

Sometimes they do.

I took a deep breath, burying that defensiveness so it would not show on my face, then knocked on the door and entered. 

“Hey, Doc.” He looked at me apologetically. “They told me I couldn’t work and would have to get paperwork from you.” 

He passed me a thick stack of FMLA forms.

“You couldn’t work? You had said your cough wasn’t that bad. Did it get worse?” 

“The cough got better. Everything was better but I lost my voice. I went to work every day and each day they sent me home. Other people, they just take them off the phones and put them somewhere else. I don’t know why they wouldn’t let me do the same.” He looked ashamed. “I really needed the money. I got a family to take care of.”

For five days his employer told him he couldn’t work because his voice was raspy. Each day he was sent home. Now I had to complete pages of paperwork for FMLA* stating he had a serious medical condition that prevented him from working. 

A hoarse voice does not constitute a serious medical condition. 

And yet, if I did not complete his paperwork, he would lose his job…

I am constantly backed into the corner by employers in various ways. If you want to get rid of your employee, tell them. Do it for legit reasons. Don’t make me the bad guy. Really. But it is so much easier to pass the buck, to let someone else take the fall, to make them do your dirty work for you. 

Look, we like you, but you missed too many unauthorized days. Too bad your DOCTOR wouldn’t fill out your paperwork…

“Please, Doc?” His eyes pleaded with me. 

I completed his paperwork. 

“Hey, maybe you need to start looking for a new job. Just in case, you know?” 

He nodded. He understood.

At least he was being honest. I checked. 

There are plenty of patients abusing the system, too…

*FMLA (Family Medical Leave Act) allows certain employees to take up to 12 weeks off in a calendar year for a serious medical condition or to care for someone else with a serious medical condition. It is unpaid leave but it does make sure you have a job to come back to. For a physician it is about five pages of stupid questions to complete.

Cornered

IMG_2609

If you didn’t already know from previous blog posts, I became a mom in my late 30’s.

There are some benefits to being an older mom. Like, getting to watch everyone else raise their own kids the wrong way (nothing like having your own to teach you that you don’t know jack…. humility). Or having financial stability. Plus, you do have all those extra years to focus and get your career started off on a good track.

There are drawbacks, too, though. Such as realizing that everyone else will have graduated their kids from college when yours are hitting junior high. Freedom is a long ways off. Or, getting asked if you are your son’s grandmother. OR, having to wear reading glasses to apply dance make up to the moving target that is your daughter’s face. 

To be honest her make up looked really great… until I popped those readers on. Yikes. Another blow to the aging ego.

Seeing Through

IMG_3797

“Remember, that meeting is at noon today,” the IM from my office manager read. 

“Meeting?” I typed back. I flipped to my Outlook calendar. 

It wasn’t there.

Damn.

“Yes, THE meeting…,” the window popped up on my screen again.

The patient on the exam table was telling me a long story about the death of his childhood dog. I nodded and made a sympathetic sound as he got to the really sad part. I had heard it a few times before…

“The one where they don’t want us to be working on our computers, the one where we are supposed to provide our undivided attention?” There were fifty-two items on my EHR’s virtual desktop right now with a full schedule the rest of the morning and a lunch appointment with a friend.

A bright spot appeared suddenly in my field of vision. Like I had stared at the sun for far too long. But it was not going away, the sun was not visible, and I had not been around any flash bulbs or used the ophthalmoscope on the wall.

I blinked a few times.

Still there. I sighed. 

Not again.

“That’s the one. And have you RSVP’d for the Saturday meeting?” he responded.

“I’m not going.”

“You know that it is strongly encouraged and if you don’t go you have to email an adequate excuse to the system president.”

The scintillating pattern started to develop further and wind its way across my field of vision. It was a struggle to type without errors.

“I am not going.” I typed again and hit send.

“Are you serious?” he responded. I shifted my eyes around and moved my head a bit to see his words around the growing hole in my vision.

“Yes,” I typed back then realized the patient was quiet, waiting expectantly. 

Story over.

I thanked the gentleman for telling me the story and quickly entered orders on his chart in case the ocular migraine was going to get worse before it got better. 

An IM flashed from the front desk flashed up to say that my 9:30 patient was 20 minutes late for their physical exam appointment and could I still see them? The rule is 15 minutes late you reschedule unless there are extenuating circumstances. They shouldn’t even be asking.

“Please have them reschedule.” I was already running behind because my 8AM had arrived ten minutes late.

“I see you are needing a tetanus booster. Can I give that to you today?”

He nodded.

I sent an IM to my medical assistant to alert her to give him the immunization.

Once that was addressed I did a quick exam. 

Luckily, you don’t have to see well to be able to listen to someone’s heart and lungs.

“We are going to change your blood pressure medication, increasing the dose. Schedule a follow up for one month but if you can call me with some home blood pressure readings in a week or two I can adjust the meds further if needed and get this controlled faster, saving you an extra visit down the road. Got it?”

“Sure thing, Doc!” He grinned.

I almost missed his hand when he reached out to shake mine, then I dashed out of the room.

My office manager was standing outside at the nurses’ station waiting for me, arms folded across his chest.

“They rescheduled the meeting to next week.”

“What?!?!??!”

“So mark your calendar right now…”

It isn’t enough that I touch an average of 110-170 documents in the electronic health record per day. Or that I get from 20-50 emails per day (half of those are about various EHR systems that are not working properly that day or about our numbers for this measure or that measure). Or that I address countless IMs from various staff members throughout the day. I have the attention span of a flea nowadays and THEY made me this way. Now I have sit through hours and hours of meetings “paying attention”to stuff I really don’t care about anyway? I am not sure I can do that without being medicated.

I really, really don’t want to do that.

If brains on video games are remodeled, what happens to brains on EHRs, I wonder?

Is all of this why my ocular migraines are back?

Scarfing Ā 

two birds painted on a pink scarf 

“Doc, I think this is the first time I have ever seen you without a scarf!” she exclaimed as I walked into the exam room.

I pondered this for a moment.

She comes in an awful lot. Is it possible that I wear scarves that often? 

It had not really occurred to me before….

I started wearing scarves in earnest after my first child was born. Baby drool and upchuck do not look good on a professional woman but especially not when that woman works in the medical profession. Appearing dirty in any way is an instant black mark against you. With a mere flip and a twist I could hide any stains in a matter of seconds. It saved me more times than I care to admit.

Further, I could conceivably wear the same shirt five days in a row with a different scarf each day and everyone would think it is a completely different outfit… Not that I ever *did* that, you understand. Maybe two days in a week when I could not get laundry done or three days when I was backpacking through Europe. Still, in the event of a collapse of modern society, I have my wardrobe wrapped up. 

Are YOU prepared?

Admittedly, I have a vast collection of scarves that spans decades. I hate to throw them out so they accumulate in my closet even if they are not being actively worn. I even have some ancient silk ones that once belonged to my grandmother…

Now that my kids are well past the spit up phase I think these scarves have become a security blanket I can wear around my neck. I used to hide behind a white coat. Before that, I hid behind a short, red London Fog type jacket with the sleeves pushed up that I wore in all weather, rain or shine, even in 100 degree weather. 

Time to dial back the scarf use, I guess.

Spectator

 old stadium stands 

“Hey, Doc, everyone here looks different again. What’d you do? Run ’em off?” He was laughing but I really just wanted to scream in frustration.

It is not funny.

One of the most upsetting things I have found blogging about the difficulties I have had with staff turnover is that invariably I get the insinuation or outright accusation that I am doing something wrong, that I must be the problem. 

The reality, as I have mentioned, is that I have very little control. Most days it feels that I am a mere observer, showing up to the clinic to see what new staffing drama unfolds.

Two weeks ago I was told by a VP that there is a 46% turnover for medical assistants and front office staff within the first 90 days of employment across our system. System wide? 

Those numbers make my own clinic problems look so much better.

Why is it so high for our system, though, I wonder? My theory is that corporate makes it very difficult to reward good employees and very difficult to get rid of the bad ones. That magnifies the stress experienced by every single member of the team. 

Here is a 2004 article that cites a 53% average staff turnover in 2 years for medical practices and it mentions that network affiliated practices experience higher turnover than independent physician offices. That was 12 years ago. I wonder what the numbers are like now?

I don’t have any published data as far as our specific organization is concerned. No proof. I just have to take this VP’s word for it. He quoted the same numbers again the other day so maybe it is real.

Sure made me feel a bit better, though, even if it does not really solve my problem. It isn’t really all my fault, after all. There is something wrong with the system….