Category Archives: people

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Balancing act

I am working at a site in the greater Seattle area, but I am not going to say where. Why? Two reasons. One is that the patient diversity is huge: the organization is organized to take care of low income, uninsured and immigrant patients. The second is that I am still trying to decide if the balance of the organization is working. It may be working but it might not be working for me.

I am at a large clinic, with primary care, dental, behavioral health, a nutritionist, a pharmacy and three in person translators. In any one day I will probably use translators for at least six languages. English, Spanish, Dari, Hindi, Punjabi, Arabic, French, Somali and sometimes languages that I have to look up the country because I don’t know where that language is spoken. The work is fast and furious.

The overall no show rate is 20%. This makes the day very unpredictable. It can be very very fast and busy with everyone showing up and then later there are three no shows in a row. I think that the no show rate has been less than 20% but on Tuesday it was more. However, everyone showed up in the morning and there was a hospital follow up that should have had 40 minutes and only had 20 and of course then we ran later. My lunch theoretically starts at 12 but I went to lunch at 12:50 and came back 6 minutes late, at 1:06. Then people no showed while I worked to finish off everything from the morning. It did feel a bit nuts.

We are using the electronic medical record EPIC. I find EPIC epically frustrating. It is “feature rich” which means it has too many ways to do things. If I ask someone how to record a phone call to a patient, it takes eight steps. A week later I have to do it again, I ask again, and the next person shows me a DIFFERENT set of eight steps. And there have to be at least eight ways to do anything, so it is very confusing. Also, the “home” page can be personalized to the extent that people look at my version (I have not personalized it much) and say, “Mine looks different. I don’t know how to do that on yours.”

Whew. So, how to cope with the fast furious unpredictable schedule? I am “precharting”. For this Tuesday, I spent 70 minutes going through the patient charts on Saturday. Then I may know why they are coming in, if they had a heart attack two weeks ago and are following up, if it is a well child check and the last one was two years ago, if there are outstanding issues like a elevated liver tests or they have not been in for their out of control diabetes for a year. Then, of course, some of them do not show up. It is so busy that all I feel when someone no shows is some relief, like a ray of sunlight in a dark forest. Ok, the person who was horribly sick and in the hospital for a week and had surgery, they really do need to follow up. But I cannot make them, no one can.

We have live translators, outside translators who come with the patient, family sometimes translates and two phone translation systems. Our live translators cover the following. One Spanish only, one Dari, Arabic and ?maybe Russian. A third language. The third does Hindi, Punjabi and something else. I can’t tell by language who is a recent immigrant or refugee or who is a citizen of the United States for thirty years.

The clinic system has high standards for care of an often vulnerable population. However, I have not decided if it falls into a statement by my grandfather: “The higher the ideals of an organization, the worse its’ human relations.” My job in Alamosa had very high ideals, but I was fifth senior doctor out of 15 in a mere two years. A burnout job. This one has three new doctors coming in soon. My training and assistance to learn EPIC has been sparse and not up to my standards. If the new doctors are treated the same way then this is a burnout job as well. This is a place that I could work in intermittently alternating with other places in the country, but only if it is balanced for both the patients and the physicians. The jury is still out, but there are many red flags. It is a six month job and I am two months in, so we shall see.

Hugs to everyone.

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For the Ragtag Daily Prompt: nuts.

The photograph is from Larrabee State Park this weekend. My daughter came out and saw many of her friends, stayed with me, and we camped for one night at Larrabee.

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Cracked

If all of the murderers were locked up
we would be safer.
We all can agree on that.
No, war is not murder.
Except when they are murderers.

If the immigrants were sent back,
we would be safer.
Only people who have been here for forty generations
should be allowed.

If we all followed the book
the right way
there would be no more pandemics.
God would smile upon us.
Which book? The right one, of course!
The right way!
Out of 45,000 different versions
of the right way.

Don’t step on a crack
Or you’ll break your mother’s back

Codified and punishable
But some punish the mother
Others will punish you

They are murderers
and wrong.

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Staying the course

Have you ever started talking to someone, only to find out that they throw amazing accusations and lies at you? I have had a patient say “You are FORCING me to use heroin.” It’s a bit disconcerting.

Imagine this in a debate. I can leave the room and end things in clinic. I can ignore family members that tell made up stories about me over and over. They want to believe what they want to believe. They don’t fact check. Aren’t you glad I don’t do that with people in clinic? Make stuff up? I don’t want a doctor who does that nor a president.

I don’t find it “presidential” to spend an hour and a half snarling lies, false blame and accusations. That is not leadership.

I am not voting for the biggest liar on the block.

For the Ragtag Daily Prompt: serenity.

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Polka dot yard

Many of the yards here have weed cloth and then rocks. Sometimes this surrounds a patch of grass and sometimes it doesn’t. There are lots of early morning automatic sprinklers.

This morning my cat Sol Duc encountered a toad in our yard. This is the first toad she has met. She was quite interested but was not sure what to do with it. It hopped when she sniffed it or when she poked it with a paw. I thought it was not going to turn out well for the toad but then the sprinklers came on. The toad had a reprieve.

The photograph is another yard. These people are creative with their rocks!

For the Ragtag Daily Prompt: polka dots.

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Peak

The pendulum swings far and back
Too many babies, what will we all eat?
Suddenly the switch, another panic attack
Now too few to support Wall Street
We wait in running cars in the drive-thru line
Wanting our turn to order fast food
It’s sunny through the smog and we feel just fine
The weather’s getting stranger, the world in a mood
Maybe we’ve peaked while driving around
Who will take care of us when we are old?
Peaked at the drive-thru, going down without a sound
An AI wonders at the price of gold
This might be as good as it gets
Maybe an AI will keep a few of us as pets

For the Ragtag Daily Prompt: drive-thru.

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Not blonde?

Ok, wait, green hair?

Also not blonde. This is the Great Port Townsend Bay Kinetic Sculpture Race. The fabulous parade and bribing of judges was Saturday morning, when I took these photographs. The costumes are wonderful. After the parade comes the brake test and the water portion of the race. The Kween was there and the Unexpected Brass Band. Then Sunday is the hilly portion and mud bog. The sculptures are all human powered.

Oh, look, blonde.

For the Ragtag Daily Prompt: blonde.

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Diversity

This is the Trevi Fountain. We can curate the photographs so that we can’t see the crowd. Here is the crowd.

There are lots of changes from 43 years ago, 1980, when I traveled there. More people. We were traveling in January and February 1980, so that’s not a fair comparison. But the crowd is more diverse. At that time we ran into Australian travelers, the same people in hostels as we traveled. We were mostly Caucasian. Now the crowd is much more diverse and I also do not know what language a person will speak. Race is a messy construct anyhow, very unscientific, but I really like the diversity and not knowing what language a person will be fluent in until I hear them speak.

Here is the Vatican Museum. Also crowded and diverse.

Here is a park near the train station in Rome with some “Olympics” for both kids and adults.

We were staying in hostels and only did one formal tour. I wonder if the expensive hotels have the same diversity.

Let’s end with the fountain again.

For the Ragtag Daily Prompt.

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Layers of history

We wandered Rome today, to the Pantheon first and the through layers of ruins to the Colosseum. It is so amazing to see and read about buildings from 2000 years ago or 1000 years ago. It appears it’s peculiarly difficult to dig the new metro line without unearthing more ruins.

For the Ragtag Daily Prompt: peculiar.

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Enemy

A friend and I are talking this morning and he is talking about praying daily. “Forgive us our trespasses as we forgive those who trespass against us”. That turns into a discussion of enemies and ourselves. It’s easier to have an external enemy identified than to deal with ourselves, isn’t it? Here is today’s poem.

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Enemy

Do you have an enemy?

Do I have an enemy?

maybe I have no enemy
I have people I have forgiven
I have people who I have asked to forgive me
I have people I have forgiven
but keep distanced
no reconciliation
possible if they continue abuse
blind and deaf
saying “We are righteous!”
over and over to each other

A book teaches me
asks what are you most proud of
in yourself?
Three things:
strong, smart, tough.
The mirror is what you fear the most
weak, foolish, vulnerable
I shy back, hate the author
and he is correct
at least for me

Like the sutra
sometimes I am weak
sometimes I am foolish
sometimes I am vulnerable

When there is a person
or people
I want to hate
What aspect of myself
of my past
of my psyche
are they bringing up?
Are they stronger, smarter, tougher?
Are they weaker, foolish, more vulnerable?
Why do I want to hate them?

It’s easier, I see
to hate another person
and cast them out like a demon
then to look in the mirror
and see the aspect of myself
that I long so much
to hate

That demon
once cast out
will return with seven more

Mirror mirror
on the wall
tell my why
the angels fall

if an angel gets it’s wings
every time a bell rings
each time we hate another, as well
an angel falls heaven to hell

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Age-defying

I get lots of quasi and fringe medical emails. I subscribe to some so that I know what they are “pushing”. The current trend is online “classes” where you sign up and then they have hours of talk and interviews and stuff. The talks can be three hours or more for a week. I am offered a bargain daily to sign up to be able to access the talks over and over. Hmmm, not today, thanks. I have very low tolerance for videos and television.

Currently I’m getting notes from an “age-defying” one.

I am skeptical about “age-defying” as they are describing it. However, there is a study that I think is very convincing about how to stay healthy as you get older. It was done in England. They looked at five habits: excess alcohol (averaging more than two drinks a day), inactivity (couch potato), addictive drugs, obesity and tobacco.

They had people who had none of the five, people who had all of them and people who had one or two or more. The conclusion was that for each one added, the average lifespan dropped by about four years. That is, the people who did all five tended to die 20 years sooner on average than the ones with none of the bad habits.

Recently in the US, the news said “Gosh, it turns out that any alcohol is bad for us.” I thought, how silly, when various studies made that clear over a decade ago. There was a very nice study from Finland, with 79,000 people where they looked at alcohol and atrial fibrillation. Atrial fibrillation increases the risk of strokes. They concluded that lifetime dose of alcohol was directly related to atrial fibrillation. That is, the more you drink, the sooner your heart gets really grumpy and starts fibrillating. Alcohol is toxic to the heart, the liver, the brain. Tobacco is toxic to the lungs, the heart, the brain and everything else. The addictive drugs: well, you get the picture.

So the anti-aging prescription is pretty simple to recommend. It just is not always simple to do. That is why we still have doctors. For chronic bad habits I am part mom/cheerleader/bearleader/nag/kind helper. Here is the prescription. Feel free to send me money instead of buying that seven day set of twenty one hours of lectures:

  1. Minimal or no alcohol.
  2. No addictive drugs (that includes marijuana and THC and we have almost no studies indicating that CBD is not addictive.Remember that THC and CBD and the other 300+ cannabinoids produced by the marijuana plant were not studied because it is illegal at the federal level.)
  3. No tobacco.
  4. Exercise every day: a walk is fine.
  5. Maintain your weight, which means as you get older you either have to exercise more or eat less or both. Muscle mass decreases with age.

The last anti-aging piece is some luck. Born into a war zone? Caught in a disaster, flood, fire, tsunami? Born into a family with trauma and addiction and few resources? Huge stress in your life? Discrimination or abuse? If you have had none of these, help someone else, because you have the luck. Pass it on.

The header photograph is all family members: two are my aunts and one is a cousin of my father’s and they all play church organ! Music sustains that side of the family. I took that in 2017 in Baltimore, Maryland. We had the uncles along too!

This is my grandmother on my mother’s side. I took this in the early 1980s at Lake Matinenda.

I will try to dig up the links to the two studies.