Respect

Dear Employers and Managers-

Today, I came home from work "sick". As one colleague put it, "sick and tired" after my repeated requests for simple the simple courtesy of being notified when my schedule is changed so that I don't drive 45 minutes to the wrong clinic (again) because you forgot to tell me about the change in schedule ( again).   I am aware that this disrespect of the time and efforts of health care providers is becoming the norm.  It is not okay.

 Those of us who work in this field do it because we love what we do. We have all worked our butts off educating ourselves to  improve the health of our patients and the communities where we live. We are by nature compassionate people and maybe that is part of the reason you think you can be dismissive and disrespectful of us-physicians, nurse practitioners, physician assistants, and nurses. As caregivers by nature many of don't speak up when we are treated badly. We respond by working harder and longer.


The majority of us don't get reimbursed for the endless hours we spend documenting because you book a patient every 15 minutes and squeeze in a few add on patients on top of it all.  We do it. We just keep doing this crazy schedule, missing out on our family time and our own health suffers from the constant stress to see more patients in less time while we need to document more and more.  Many of us try to book complicated patients right before lunch or closing time so we can work through our lunch or after hours to give those patients the time and respect that they deserve.  

Many of us work countless hours of unpaid overtime trying to keep up with the ridiculous amount of documentation that is expected of us. We spend countless hours reading on our own, attending conferences and networking more informally to keep up on  the latest evidenced based practices because we care about our patients. 

We providers commiserate with each other. We all have the same concerns and complaints about our work schedules and demands. We all complain about the administrators that are out of touch with the demands of quality patient care. The advent of social media allows us to comfort each other and offer words of encouragement. We offer each other our words of wisdom and coping strategies. We share our concerns for patient safety and for our own health and safety. For right now, we post pictures of piles of charts and cups of coffee long after the office or clinic is closed. For now. 

We are, most of us, a standard deviation or two to the right of that bell curve. In this rapidly expanding social media communication, I imagine that it won't be long before we move our conversations and posts from the problem to looking for solutions. I don't think that I am asking for anything unreasonable. I want you to be more respectful. I want you to honor the time and commitment we all put into what most of us believe is a calling to be healers. 

Let's just start there for now. 

Respectfully,

Doe

Life is so interesting.  I have been busy going with the flow for nearly a year now.  Will start posting all the good things again soon

Some days this wonderful vision we share is gets a little blurry. Sometimes we each need to remember the mission.   Sometimes we need some down time to reflect and regroup.  We are all working so hard to make this dream of changing the way healthcare is done, but we still are still struggling under rules and ways of doing business that sometimes conflict with our goal of improving the health of our community. 

Top 7 ways to make your child's well child visit miserable for everyone.

 1. Schedule their appointments at nap time.  Tired children are whiny without adding the stressors of a visit to stranger that has been know to puncture them with needles. If your child needs a nap or usually takes one, schedule the appointment after nap time, when they are refreshed. They will be much better able to cope with stressful procedures in the office ( or bank or mall)


2.  Don't feed them before coming to the office.  Hungry children have less energy available for stressful events. Please give your child a healthy breakfast and lunch. Bring a healthy, non sticky snack and water in case of unexpected delays. Please do not load them up on caffeine. If you forgot this, please just let us know. We try to keep healthy snacks available.


3. Don't bring anything along to occupy them.  Delays are just part of healthcare. We try to avoid long waits, but urgent things come up.  Expecting a young child to sit quietly in a chair for a long time is unreasonable. My advise to parents of young children is to have a traveling bag with healthy snacks, water, and toys/books/art supplies that they have never seen. You can pick them up at yard sales, second hand stores, or the dollar store.  It should be something that they don't play with at home. Children enjoy novel things and are more easily entertained. Please read to your children, we have an area with books that you are welcome to use.

4. Lie to them. Tell them that vaccines aren't going to hurt. Tell them I not going to touch them. When you try to tell them that listening with a stethoscope won't hurt, they won't believe you.   If you make a habit of lying to your children, for what ever reasons, they learn very quickly not to believe you.   These are the children that scream from the moment they come in the door and I hear parents say "nothing is going to happen" and the child does not even pretend to hear the parent. The child is not in the least comforted by the parents because last time that they came for vaccines or sutures the parents said  "nothing is going to happen. It won't hurt."
The parent child relationship is sacred and the child depends on you to form their view of the world.  It is so sad, when a child cannot trust their parents to tell them truth about the world. If want this visit and the rest visits to go smoothly, always tell them the truth. You don't have to scare them. Tell them they will get vaccinations that will hurt for a very short time.

5. Tell them that if they don't behave, the nurse is going to give them a shot.  This may be one of my pet peeves. Firstly, this is lying to your child and I may address this in another blog in the future.  You are teaching your child to fear healthcare.and these fears can last a lifetime. Vaccines or sutures are not a punishment. They are to help them stay healthy, and like exercise, somethings those things hurt.  Secondly, it is not my role to discipline your child.  Guiding your child's behavior and preparation happens in the way that you interact with them daily. 

6 . Surprise them with the visit. Tell them you are going to the store or to McDonald's and then bring them to the office for a well child visit and vaccines.  It is so much better to talk about the visit, show them pictures of the office on our website.  There are children's books in the library to help. Be truthful and positive. Tell them we are going to listen to their heart and lungs, touch their tummies and legs.  Prepare them without instilling fear. They takes their cues from you. We plan to have some open house events for children, so they can come in, look around and be comfortable without any scary things happening.

7. Tell them not to cry.  I have seen parents put their hands over their child's mouth and yell at them not to cry when they get vaccines, IV's or other painful procedures. I try to imagine what would happen if I were to do that to them?  Tell the adult that the shot won't hurt and not to cry and then send in 3 or 4 huge bouncers to hold them down, put hands over their mouths while I stick needles in them that are in a similar proportion to those used on children- a foot long syringe with a 3 inch needle, stuck about 5 times in each thigh. Yeah, don't cry.   Please tell them it is okay to cry.  The important thing is not to move. Rehearse things as a game at home.

We will be glad to answer any questions that you or your child may have before coming to the office. Watch for our website notices of our opening day. 

Oh Baby, I'm so tired

Right now I am still working locum tenens and traveling most of the time. The past few months, I have been traveling four days a week about 3 hours from home. My hotel does not have a kitchenette, just a tiny fridge and microwave.  I have not yet mastered the art of eating healthy under these circumstances. I know that I need to plan, and feel guilty as I chide my patients for not planning meals better. I have so many excuses.

Firstly, I usually leave here Tuesday evening and get to hotel sometime between 10 pm and midnight.  I get settled by 1 am at the latest and have to get up at 530 to start whining about going to work. I arrive at my customary time-10 to 15 minutes late. I promise myself that I will stop at Costco on the way back to the hotel and get fruit and healthy snacks. Sometimes, I actually do this, but mostly I get off work 10 hours later, emotionally and physically exhausted and promise to order something healthy from a fast food place. But lack of sleep and being emotionally drained does not lead to healthy choices. I choose a burger and fries. I don't even like fries. Oh, and I diet Coke because we all know that the diet Coke cancels out all the fat, sodium and calories from the other food.

I feel guilty while eating and don't enjoy even one bite. I know I am hurting myself. I am not practicing what I preach. I have plenty of time to feel guilted out because the caffeine from the diet Coke will keep me awake until midnight again.  I fall asleep resolved to exercise in the morning in the hotel gym even if I am tired, but the fraking update on my phone has silenced my alarm and I wake up too late to eat the hotel breakfast, pick up a healthy lunch and head off to work arriving late again. Community clinics are always stressful and at least for me, emotionally draining.  Fast food for lunch, but subway this time...a little better, no?  I stop at Costco, pick up fruit, yummy spinach salad and Brita water bottles. 

Again, I stay awake too late trying to answer email, work on business plan research, facebookking.  I know that lack of sleep leads to poor food choices, but I have not figured it out yet. I know I need to exercise to have energy but the constant traveling leaves me always feeling tired and unsettled. I know it hard for my patients who have very little education regarding this health stuff. But I have no excuse. Really.  I know what to do and I know how to do it.  I just don't make the time to plan ahead. I don't have a reasonable bed time. I know that I need a long time to wind down after work.

So, this week? Same plans.  This week, I will shop BEFORE I travel and fill my cooler with good things and remember to ask for a ground floor room because the hotel does not have elevators. This week, I will exercise even when I am tired. Really.....It could happen.

Physican Burnout? Put down the matches, Doctor!

Today I was reading yet another article on physician burnout  keep wondering why they do this to themselves? They have been slowly making in roads in stopping the insane hours of residency  They are barely starting to figure out that NO one thinks clearly or learns well when sleep deprived. All those hours does not make for a better physician. They KNOW that.  But seem determined to continue with this sort of extended hazing process.

The physicians themselves limit the number of medical school spots available and then strangely complain about the shortage or primary care providers that they are purposefully creating. ( BTW, thank you for making it easier for me). Now, they are working themselves into the ground, burning out and creating a depersonalized health care system that we all agree is not working. But who is creating scheduling themselves for 30-40 patients a day? They are.

I sometimes wonder what came first the burn out and resulting depersonalization of healthcare or the 10 minute visit that led to the burnout? They have the power to change this. They do.  I wonder if they are depressed? You know how depressed folks just get "stuck"? They know it is crazy. They know it is scary as hell to go home hoping to whatever God you pray to that you didn't miss something important. But they do it.

They really do have the power to change it over night if they wanted to. They could all just linkedin, fb, tweat, or g+ each other to say NO. No, I won't see more than x patients today or any other day. It is dangerous. It is wrong.  It doesn't work.  They could do this. They write their own rules. There are laws against the corporate practice of medicine. No one can force them., except themselves.

I am honestly wondering about the secondary gain.  They say that they want to be with their families. Do they? They could be. They each have the power to hang out a shingle just Marcus Welby and make their own hours.  They could stop taking insurance and start practicing medicine and healing again.  I promise you that they are NOT forced into this situation.  This is the life that they are choosing for themselves. 

Isn't there a pill for that?

Isn't there a pill for that? This is one of the most common things that I am asked by my patients when I start talking about nutrition, exercise, weight loss, pain management and graceful aging.  They ask me for pills to sleep and are initially upset when they find out that I can but will not write a prescription for Ambien.  I tell them that I don't believe in Ambien ( or Vicodin) deficiency.  They are often frustrated when I begin talking about sleep hygiene because they have already tried "everything". 

Everything does not include cutting out coffee, soda, energy drinks, and other forms of caffeine. Notice I don't mention chocolate: I am not cruel.  Everything does not include any form of exercise or a regular bedtime. Everything does not include getting away from screens and lights a few hours before sleep. Everything does not include any of the many things we all need to do in order to have restful sleep.

When I talk about eating healthier foods,  they ask me for supplements. Can't I get a pill for that? I am not against supplements such as fish oil, but they miss the point. We need to eat real food.  I know that many folks don't like water, fish, vegetables or exercise.  Sometimes it is an aquired taste. But I remind them that coffee, cigarettes and alcohol were all nasty the first time we tried them, but we stuck with the gagging, choking and bitterness until we became convinced that we loved those things.  We can do the same with fish and other healthy foods. We can.

Trust me, it is easier for me to write a prescription for that pill. I can be in and out of that visit in five minutes. I could more easily see the 25-42 patients that some clinics want me to see in a day.  It takes time for me to get to know my patients. It takes time to understand what works for them and where they need support. There isn't a pill for that.