Patient Satisfaction Score

The latest issue of Family Practice Medicine has an article on patient satisfaction scores.

I remember my first patient satisfaction score VIVIDLY.

I am in my first family medicine job in Alamosa, Colorado. I receive a 21 page handout with multiple graphs about my patient satisfaction scores. I am horrified because I score 30% overall. I am more horrified by the score than the information that I will not receive the bonus.

I go to my PA (physician’s assistant). He too has scored 30%. We are clearly complete failures as medical providers.

Then I go to my partner who has been there for over 20 years.

She snorts. “Look at the number of patients.”

“What?” I say. I look.

My score is based on interviews with three patients. Yes, you read that correctly. THREE PEOPLE.

And I have 21 pages of graphs in color based on three people.

I am annoyed and creative. I talk to the Physicians Assistant and we plan. I call the CFO.

“My PA and I think we should resign.”

“What? Why?”

“We scored 30% on the patient satisfaction. We have never scored that low on anything in our lives before. We are failures as medical people. We are going to go work for the post office.”

“NO! It’s not that important! It is only three patients! You are not failures!”

“Three patients?” I ask.

“Yes, just three.”

“And you based a bonus on three patients? And sent me 21 pages of colored graphs based on three patients?”

“Um…”

“I think we should discuss the bonus further….”

I did not get the bonus. It was a total set up and I am not sure that ANYONE got that bonus. Much of the maximum “earning potential” advertised was impossible for any one person to get. You would have to work around the clock. They got out of paying us by having multiple bonuses that each required a lot of extra work…. They were experts in cheating the employed physicians. That became pretty clear and I was 5th senior physician out of 15 in two years, because ten physicians got right out of there. I lasted three years, barely. I knew I would not last when an excellent partner refused her second year of $50,000 in federal rural underserved loan repayment to quit AND stayed in the Valley working in the emergency room. I called the CEO: “Doesn’t this get your attention?”

“She just didn’t fit in.”

“Yes, well, I don’t think anyone will.” I asked my senior partner how she stayed. “You pick your turf and you guard it!” said my partner. I thought, you know, I hope that medicine is not that grim everywhere.

Unfortunately I think that it IS that grim and getting grimmer. Remember that in the end, it is we the people who vote who control the US medical system. If we vote to privatize Medicare, we will destroy it. Right now 1 in 5 doctors and 1 in 4 nurses want to leave medicine. Covid-19 has accelerated the destruction of the US medical non-system, as my fellow Mad as Hell Doctor calls it. We need Medicare for all, a shut down of US health insurance companies, and to have money going to healthcare rather than to paying employees $100,000 or more per year to try to get prior authorizations from over 500 different insurance companies all with different rules, multiple insurance plans and different computer websites. Right now I have specialists in four different local systems. The only person who has read everyone’s clinic notes is ME because it is nearly impossible to get them to communicate with each other. Two of them use the EPIC electronic medical record but consider the patient information “proprietary” and I have to call to get them to release the notes to each other. Is this something that we think helps people’s health? I don’t think so. I have trouble with the system in spite of being a physician and I HATE going to my local healthcare organization. Vote the system down and tell your congresspeople that you too want Medicare For All and single payer.

Physicians for a National Healthcare Program: https://pnhp.org/

Healthcare Now: https://www.healthcare-now.org/

I have had people say, but think of all the people out of work when we shut down insurance companies. Yes AND think of the freedom to start small businesses if we no longer have to fear the huge cost of insurance: Medicare for all!

G is for greenish blue

G for greenish blue. I am blogging A to Z about artists, particularly women artists and mostly about my mother, Helen Burling Ottaway.

Greenish blue is a stretch, but this is a blue crab. They are greenish blue. I wrote the poem and my mother did the etching. I was thinking of a cooked crab, but H. Ottaway did a live crab. I went with her to the crab restaurant, where she explained that we wanted one live crab. “One live crab?” said the restaurateur. “Yes, one live crab.” The owner shook her head, but sold us one live crab.

At home, my mother got the crab out and put it on the floor. The cat was intrigued. The crab was NOT happy. I took photographs of her drawing the crab and making the etching. Apologies for the reflections but I am not at home, so I can’t retake these!

Three photographs: Helen Ottaway drawing a blue crab on the floor, the crab and Helen running an etching on the press.

You can see the crab and her drawing it, as well as the etching press. I took the photographs in the mid 1980s.

Our poem/etching collaboration was a delight! She said that she would illustrate poems as long as they rhymed. “No free verse,” she said. “I don’t like it.” So, the poems had to rhyme. We did ten different ones. I am so glad that we did, since we didn’t have nearly enough time together!

ATOZBLOGGINGCHALLENGE2022 #art #Women artists #Helen Burling Ottaway #ATOZCHALLENGE

If

This is one of the ten poems that my mother made etchings for, the year I was just done with college. 1983-4. I wanted to write, but had no idea what to do with the poems that I was writing. My mother Helen Burling Ottaway had done a series of etchings with a family friend’s poems, so I asked if she would do the same with me. She said, “Yes, on one condition.” “What is that?” “They have to rhyme.” She did not like the free verse. Almost all of the poems were about animals, except for one about my sister. Another friend printed the poems on a lead type press and then my mother worked on editions numbered 1-50 of each, inking the plate separately for each one. This one is number 5/50. You can see the imprint of the plate on the paper in the photograph.

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree

These frogs can jump, they have no laps
They are not birds with wings
the have parachutes between their toes
And I am sure that they can sing

They spread their toes and jump so high
To float like snowflakes in the air
Frogs fall like rain from clear blue skies
It must be nice up there

Why they jump I do not know
Maybe escaping hungry eyes
Perhaps to catch a tender bug
Or they just like to fly

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree.

What I learned from my first doctor job

When I started my first job, I had a nurse and a receptionist within a bigger clinic, all primary care. Fresh out of residency. One month in I asked to meet with my nurse and the receptionist.

The receptionist brought the office manager. I was surprised, but ok.

I started the meeting. “I am having trouble keeping up with 18-20 patients with fat charts that I have never seen before, but I think I am getting a little better at it. What sort of complaints are you hearing and how can we make it smoother?”

The office manager and the receptionist exchanged a look. Then the office manager excused herself.

Weird, I thought.

The three of us talked about the patients and the flow and me trying to keep up. About one third were Spanish speaking only and I needed my nurse to translate. That tended to gum things up a bit, because she could not be rooming another patient or giving a child vaccinations.

I thanked them both and the meeting broke up.

Later I found that the office manager had been brought in because another doctor tended to manage by yelling and throwing things. And another doctor had tantrums. So the receptionist was afraid of me and had asked the office manager to stay. The moment they realized that it was collaborative and I was asking for feedback and help, the receptionist was fine without the office manager.

That was an interesting lesson on working with people. I had been very collaborative with the nurses and unit secretaries in residency. As a chief resident, I told my Family Practice residents to treat the nurses and unit secretaries and in fact everyone, like gold. “They know more than you do and if you take care of them, they will save your ass!” The unit secretaries would go out of their way to call me in residency. “Mr. Smith is not getting that ultrasound today.”

“Shit. Why not? What the hell?” I would go roaring off to radiology to see what the hold up was.

The unit secretaries did not help the arrogant residents who treated them like dirt.

I thought it takes a team. I can’t do my work without the nurse, the pharmacist, the unit secretary, the laundry, the cafeteria workers, the administration. It takes the whole team. I value all of them.

many flags

For the Ragtag Daily Prompt: language.

I spent three days with the Rotary President Elect Training this past weekend. I am part of District 5020, which stretches from the end of Vancouver Island, BC, Canada down the Olympic Peninsula, WA, United States. There were people from ten districts.

The Rotary’s Polio Plus program is working hard to eradicate polio. This year the match from the Gates Foundation will be 2 dollars for every dollar the Rotary brings to end polio.

The flags from all the different countries and people working together: that speaks the language of peace and hope to me.

gridiron

For the Ragtag Daily Prompt: gridiron.

This is my son in 2010, grilling.

Cooking off the gridiron.
Trey and friend Otto.

By 2012 the high school team is the Redhawks. My son played football, though he knew I didn’t approve. Too much brain trauma. He was fast or lucky or both and no concussion or broken bones there.

teamwork

For the Ragtag Daily Prompt: orchestrate.

Photographs of my father’s boat, Sun Tui, returning to the water after a lot of repair work. I was looking for photos of my children playing violin or viola, but came across these. We had a team to repair the boat and a team to put her back in the water and raise the mast again. All the players play their parts and play together.

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Dang motor.

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And out and about:

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At the fair!

I had fair duty yesterday at the Jefferson County Fair. Two hours in the Port Townsend Sunrise Rotary booth. We’re in the new Commercial Building. The day started out with a fabulous band parade. I got a few photographs, next post. The fair booth is to tell about our Sunrise Rotary and what we do in the community and the world! The list is the banner on the right, everything from picture dictionaries for every 3rd grader in the county, to exchange students learning about the world, to Polio Plus and Shelterbox and big and small projects in our county and other countries. Hooray for teamwork and for all the people who donate their time and energy and fellowship and money.

The booth is still up today. We are already selling tickets for our “Running of the Balls” fundraiser. We roll numbered golf balls down Monroe Street before the Rhody Parade and the winner and 2nd and 3rd get cash! $2000.00 to the winning golf ball!

If you buy five tickets for $20.00 at the fair, you go into a drawing to get 50 more numbered golf balls in the race. Stop by!

And for the golfers, we need more golf balls. We don’t have enough for next year. Some get away, darn it. Contact me or another Sunrise Rotarian to get rid of the old golf balls.

 

 

incubate

For yesterday’s Daily Prompt: incubate.

Taken in February 2011. One thing I loved about synchronized swimming is that our older girls worked and played with the younger ones.

And here is my daughter and another teammate posing for one of the younger girls to take a picture: their smiles are much bigger and more spontaneous than when they pose for us!

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