Tag Archives: teamwork

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Honey

Work is being a bit of a difficult place. I think that if a clinic is has two new providers with one new medical assistant, there should be some formal support in place. Not the manager of multiple offices sticking their head in the room with the three of us at computers and saying, “Everyone happy?” Um, no. This came to a head two days ago. Then yesterday I am asked to write up what I said to the manager.

No. I don’t think that is appropriate. If they have formal evaluation forms, fine. If they want a biweekly formal meeting, fine. If I ran the zoo, I would be sitting down biweekly with the job description to say, “This area is going well, this part needs some more attention. What is going well from your perspective and how can we communicate better to help each other and the patients?”

In fact, in my very first practice in 1996, I asked for a meeting with my receptionist. They had one for each pod of 2-3 providers. She was so freaked out by it that she brought the office manager, much to my surprise. I didn’t care and just said, “What is going well, what isn’t, where are the communication gaps, how do we fix them?” The receptionist looked at the office manager, said she had been scared that I was going to yell at her, but since I wasn’t, she let the office manager leave. We were fine after that. I just want a well functioning team and I am happy to help build it.

So, after thought, I am going to refuse this write up and ask what their HR process is and say that I am not satisfied with the office support and that it is quite unreasonable to leave two providers new to the clinic to guide and train a new medical assistant.

The Ragtag Daily Prompt is honey pot. That bring up this delicious and quite naughty Taj Mahal song, ooooooo. As my mother would say, you catch more flies with honey than vinegar.

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Conserving energy

I was out of clinic for two years and then very part time for a year and now not quite full time as a temp. I bargained to not quite be full time.

The electronic medical record is having a consequence, along with the pressure to see more people faster. The primary care doctors, at least the younger ones, do not seem to call their peer specialists any more. (Family Medicine is a specialty, just as Internal Medicine and Obstetrics/Gynecology are.) I called a gastroenterologist and left a message last week about a difficult and complex patient. The patient had cried three times during our visit. The gastroenterologist was very pleased I had called, was helpful, agreed with my plan of using the side effects of an antidepressant to try to help our patient, and thanked me three times for calling her. Wow. I am used to calling because during my first decade in Washington State, our rural hospital had Family Practice, General Surgery, a Urologist, Orthopedics and a Neurologist. For anything else, we called. I knew specialists on the phone for a one hundred mile radius and some knew me well enough that they’d say a cheery hi.

Now communication is by electronic medical record and email on the medical record and by (HORRORS) TEXT. Ugh. I think that there is quite a lot of handing the patient off by referring them to the Rheumatologist or Cardiologist or whatever, but the local Rheumatologist is booked out until February for new patients. That leaves the patient in a sort of despair if we don’t keep checking in on the problem. If I am worried, I call the Rheumatologist and say, “What can I do now?” I’ve had two people dropping into kidney failure and both times a call to the Nephrologist was very very helpful. I ordered the next tests that they wanted and got things rolling. One patient just got the renal ultrasound about three months after it was ordered. Sigh.

I have one patient who is booked in February for a specialist. I called that specialist too, they did not want any further tests. I told the patient, “You aren’t that sick so you won’t be seen for a while. It isn’t first come first serve: it is sickest first. We all have to save room for the emergencies and sometimes those are overwhelming.” The specialist agreed and the patient is fine with that and I think pleased to know that we do not think she’s that sick. She feels better. If things get worse, she is to come see me and might get moved up. Neither I nor the specialist think that will happen.

Is this conservation of energy, to communicate by email and text? I don’t think so. I think sometimes a phone call is much more helpful, because the other physician knows exactly what I am worrying about and they can tell me their thoughts swiftly. Sometimes they want me to start or change a medicine. Things can get lost in the overwhelming piles of data and the emails and labs and xrays and specialist notes all flowing in.

My Uncle Jim (known as AHU for Ancient Honorable Uncle Jim) used to sing part of this:

Yeah, that’s just how I call my fellow specialists.

For the Ragtag Daily Prompt: conservation. Don’t cats win at conservation of energy?

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Devil’s Kitchen and No Thoroughfare Canyon

Sunday a friend and I hike in the Colorado National Monument again. I have not run out of trails at all! Two trails. Up the Devil’s Kitchen shorter trail, which requires some clambering. Fabulous rocks and fabulous views!

Next the No Thoroughfare Canyon Trail. It has falls and a pool: here is the pool.

It is a bit dry at this time of year. We did not do the entire canyon: we’re both traveling this coming weekend, so we needed time to get ready. Packing and cleaning.

It’s hard to see the scale in photographs. The rocks on the ground are as tall as I am. And that is the trail, winding through those rocks. Did the rocks wash down from further up? They do not look like the surrounding hills. Those are some serious boulders for a seasonal stream to carry.

For the Ragtag Daily Prompt: clamber.

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10 rounds

Got sick in clinic yesterday, about 20 minutes after eating lunch. Abdominal cramping and lost lunch and lay down until I could drive home. Went to sleep for another four hours. I got up to hydrate slowly, some water with a little sugar, every 15 minutes. Taking it slowly is gentler on the stomach. I went back to sleep.

I got up at 11 pm and had a few crackers. This morning I am tolerating tea, but my body feels rather like it’s been beaten up. No clinic today, but I think tomorrow would be ok. We shall see.

I am not sure of the cause. I was given some gluten free donuts and wonder if one had gluten. Food poisoning is not very common in the places I have lived. We are seeing some people with Covid who have abdominal symptoms rather than upper respiratory, so I am debating whether I should home test.

It’s been a strenuous twenty four hours!

The photograph is from the Fruita Fair a few weekends ago. I really wanted to do this with the kids. Today even looking at the picture makes me slightly nauseated! Whew! They were in climbing harnesses and then attached to giant rubber bands and bouncing. Some were able to do flips, too. Not me, not today!

For the Ragtag Daily Prompt: strenuous.

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Food, food, food

When I get pneumonia, I drop ten pounds the first week. Since I had influenza viral pneumonia in 2003, I don’t run a fever. I just have a fast heart rate resting and get short of breath walking across the room. With Covid, I needed oxygen.

Each time, it takes longer to gain the weight back. Then I go over my normal weight and eventually have to rebuild muscle. This time I did not gain any weight back for over a year. But now it’s been three years and I am in the muscle rebuilding and weight loss section.

It does get harder as I get more mature. Older and wiser, right? Well, maybe. At any rate, I am trying to lose weight without any drugs or injectables or herbs. I am trying to eat the way the diabetic educators tell us to: half the meal should be vegetables. Every meal. A small grain and a small protein and not too much fat and vegetables. Corn really falls into the grains.

In clinic I often do a diet history of the day before. What did the person eat? I think about half of the histories come back with almost no vegetables. Pizza is NOT a vegetable, it’s mostly in the grain department. Grains are plants, I agree, but they send blood sugar up a lot more than celery and kale and collards.

Meanwhile, where is CHOCOLATE on that plate half covered with vegetables? Darn. My dessert could be a small piece of chocolate with a carrot on the side? Chocolate dipped carrots? I honestly do not like celery. Celeriac yes, celery no, though I have it in the curried chicken salad I made yesterday. That chicken salad is not half vegetables. It has some celery for crunch but it also has grapes. So, I ate it last night with an equal amount of mixed lettuce and sugar snap peas from the Farmer’s Market.

I do not have diabetes, but if I am recommending a dietary change, I think I should be able to do it too. We shall see. I think right now my diet is about 1/3 vegetables. Fruit does not count as a vegetable for this.

The other thing about vegetables is you have to cut them up. Ok, wash them too. And it’s not like one doesn’t have to cook beans or rice or meat, but vegetables do take time. If I have a person with low blood sugar or who is feeling awful, saying make half the meal vegetables may not be realistic. When someone is really frail or ill, it may be that getting out of bed, washed and dressed and to the table is overwhelming. Cut up vegetables? Cook from scratch? Maybe not.

For the Ragtag Daily Prompt: lunch.

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Hi ho, hi ho

This is zoomed in to the Colorado National Monument in the early morning. The light and shadows are wonderfully dramatic and change by the minute.

I won’t trudge to work today. I was mildly sick the last two days and am better today, so I am happy to go. Hoorah for feeling better.

For the Ragtag Daily Prompt: trudge.

And two songs from The Yes Yes Boys, 2004, here.

I do just what I please:

Make it easy:

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Useful

I admire this orange sculpture outside the local library and then realize that it’s useful. Bike tools and a pump, in a central location and orange too! Very nice! I like it up against the darker orange of the building.

I’ve been haunting the library about twice a week, taking out piles of books. A new friend has also lent me a kindle, to read all of Lois McMaster Bujold’s Penric and Desdemona series. And what else will I find in it? It is like exploring someone’s bookshelves!

I have managed to acquire a few books and I am now watching for Little Free Libraries to pass the ones that I have read on to someone else.

For the Ragtag Daily Prompt: sculpture.

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Cool

I am still wearing sweaters to work.

It is high desert here. One morning it was really pretty cold when I walked Sol Duc in her harness. Really she walks me. Cats are like that. But I wished for mittens. The temperature was 38. The last few days the low is in the high 40s or low 50s. Two days ago it was 90 driving home from work.

The consequence is air conditioning. I do not have air conditioning on the Olympic Peninsula. My house is from 1930 and well designed to stay cool in the summer and we rarely hit 90 anyhow. Two summers ago my heat pump switched to cooling when we had one hot week, startling me. We did hit 100 one day in Port Townsend, but it still dropped thirty degrees at night because of the cool Salish Sea surrounding us. My patients would complain of the awful heat when we got to 80 degrees. It’s all relative, right?

Here in Grand Junction, we are just starting to heat up. The hottest time appears to be around 4 or 5 pm.

I was cold at work all day two days ago. I wore a linen shirt over another shirt and it was not enough. I went outside at lunch and heated up nicely in the sun. Yesterday I took a wool jacket with me. Air conditioning is very strange.

This morning it is 51 now and projected to reach 85. The high desert temperature change of 30 to 40 degrees is not that different from home, but the air conditioning is different.

For the Ragtag Daily Prompt: ambivalent.

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Teamwork

The plaque for this pollinator, the yucca moth, says that it and the yucca plant have evolved to be dependent on each other. Dependent sounds a bit worrisome. If I reframe it as teamwork, all of a sudden it sounds much better! And this is intentional pollination, which the author says is rare.

This is from the Holiday Exhibit, complete with train, at the US Botanic Gardens.

Does dependent sound more worrisome than teamwork? If so, why?

For the Ragtag Daily Prompt: pollinator.

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Keyboard supervisor

Elwha supervising me at the keyboard.

In high school I took typing for dummies. I was terrible at it and slow. Many women were avoiding typing classes in the late 1970s because they did not want to be secretaries. I wanted to be a writer and knew that I was a terrible typist. I also could not spell my way out of a paper bag. My mother was quite dyslexic and did not care. Once I had to sound out a word at the store from her grocery list: “LETIS”. Oh. Got it. Her letters are wonderful, not only interesting and creative spelling, but also wandering tenses and subjects.

We got our first electronic medical record in the early 2000s. We went from looking up labs on a computer and using a computer for maybe an hour total per day to full on eight hours a day. My shoulders and the nurses’ shoulders all locked up and we all filed for Workman’s Comp. I had to work with physical therapy to get my shoulders to unlock. My nurse pointed out that all problems were treated as “User Problems”. That is, WE were the problem, not the program. I realized that having the doctors who love computers pick out the program, learn about it for a year, and then teach us in two days and go live was a massive mistake. None of us understood it nor did we understand any of the computer lovers’ terminology. We rapidly quit asking questions because we didn’t like being treated as morons. Every person who was not a computer lover figured out their own work arounds. Two years later, the computer lovers tried to get us to standardize what we were doing. It’s not very surprising that we resisted and hated them. We had had to figure it out on our own with no help and we were very cynical and disbelieving that they would now “Make it easier.” Nope, they didn’t.

If I were to do it over again, the team picking the electronic medical records would include a couple of older doctors who hate computers. One of the selling points to the computer lovers was “you can write your own templates”. Our response was “We would rather be boiled in oil.” Three years after we got the system I asked the head computer lover doctor to write me a template. It was generic. Patient is complaining of (a problem) (more than one problem). The (problem) has been present for (a day, two days, a week, a month, a year, too long). The problem is (getting worse, the same, getting better). And so forth. Because we had all sorts of problems that did not have a template. My computer lover doc rolled his eyes, but set it up for me.

I also asked the clinic CFO WHY they didn’t set up typing lessons for the doctors who couldn’t type. I watched one of our group hunt and peck with two fingers. “You want them faster, right? You’ve said we could do the whole note in the room. How can they if they can’t type?”

“We are not giving them typing lessons.”

“Well, I think that’s misguided.” Ok, what I meant was that I thought it was STUPID.

Another selling point was that we could finish the note in the room. It turned out that I could do the note in the room after I had fought with the program for two years. It consistently took me 25 minutes. Then they ramped up the schedule and set us all at 20 minute visits. I started running late all the time. I told the front desk, “I’ve been told I should get the note done so I am. And if it takes me 25 minutes, that is what it takes.” Once the hospital kicked me out, I started my own clinic and did 30 minute visits. This did not make me rich but it made me a heck of a lot happier.

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For the Ragtag Daily Prompt: keyboard.