Managing Expectations During Winter

At least part of my job includes managing people's expectations in terms of outcomes and how well treatments work.  This is especially important in the winter time when we get bombarded with people who mostly have colds that don't really have prescription treatments.  Over the counter symptom management medicines and time treat these illnesses.  Throw in a periodic influenza case and pneumonia and I'm left with deciding if I should treat people symptomatically, with antibiotics, or with antivirals.  From my perspective the decision usually isn't too difficult if I can get a set of vitals and perform an exam.  Where things get tricky is when people call the office and request antibiotics over the phone, which happens several times per week (as a side note, I have never even thought about calling a doctors office and requesting medicines over the phone).  There are so many things wrong with that scenario that I'm not even going to get into it here, but the answer is almost always no.  I'm upfront about it with my own patients so they know what to expect.  Where people are left disappointed at times is when I'm covering for other doctors who do call in medicines over the phone because then they are confused when I won't do it.  I sometimes get disappointment when people come in for an office visit and I don't prescribe antibiotics but usually if I explain the situation (i.e. only 0.5%-2% of sinusitis cases are caused by bacteria) they are OK with it.

Prior to the holidays we may have bad weather but at least there is something to look forward to. Now that the holidays are over there is nothing to look forward to for another 3 months or so until spring time arrives.  This isn't a big deal per se except that the weather sucks.  It took me an hour to get to work on Tuesday (usually takes 30 minutes) due to the snow the night before.  Every inch of skin that I possess is so dry there isn't enough lotion in the world to keep it moisturized.  And this afternoon I am trying to somehow fit a Christmas tree into a bag that is half as big as the tree.  If I didn't have family ties to the area there is a strong possibility I would move to the Carolinas or some place with a more temperate climate.

A New Year Means I'm Getting Older

Welcome to 2015!  I worked a half day yesterday so I decided to pick up some wings on my way home.  Generally after I get off work I proceed directly home to avoid fighting with all of the traffic.  I got 10 boneless wings and some fried pickles which were fantastic.  However I knew before I even started eating them that I would pay for it for the rest of the day.  Over the past 1-2 years anytime I eat wings or pizza or similar type foods I have a predictable and unpleasant response to the food.  It mostly involves feelings of being bloated, belching, and generally feeling disgusting, i.e. dyspepsia.  I used to be able to hammer down food like this and not think twice.  Not anymore, however.  The symptoms extended into the evening.  I tried to have a few beers to celebrate the New Year but I couldn't even stomach that.  I developed a headache around 10:30 and ended up in bed at 11.  What a pathetic performance on my part.  I talked to a few of my friends this morning.  Both of them made it past midnight, though one of them was already in bed when the ball dropped and promptly fell asleep he said.  Obviously everyone is aging every second of the day, but the fact that I am showing physical signs of aging can be somewhat depressing if I really think about it.  But honestly, who has time to dwell?  I woke up this morning feeling great, helped take care of my kids, and moved on with life.

Overall 2014 was a great year and I expect 2015 to be great as well.  I hope everyone enjoys their holiday weekend.

Two Months With A Mac

I've used Apple computers intermittently in the past but never as my daily computer.  That changed two months ago when my decade-old desktop crashed and burned.  I had purchased a MacBook Air earlier this year and since my Windows machine quit working in October I've been using my Mac (with an external monitor and keyboard/mouse setup).  I have found using the Mac OS to be interesting.  This is mostly meant to be a compliment, though I will admit some aspects of the operating system are pretty goofy.

The reason why I even bought a Mac is because I wanted a laptop.  We are way beyond the point where you need a 20 pound laptop if you want it to substitute as a desktop as well.  My MacBook Air weighs less than 2 pounds and it easily works as a solid desktop computer for my needs on a day to day basis.  I just wanted a simple, traditional laptop.  Just like how I don't want a cell phone that is the size of a notepad, I don't want a laptop with a screen that is touch and can be removed.  That basically eliminates all Windows laptops as the overwhelming majority of them have these bells and whistles to play to Windows 8's strengths.  Plus the MacBook Air gets great ratings for the price so I decided to go with it.  (P.S. every time I complain about touchscreens and large cell phones I feel like such an old foggy as I am obviously in the minority about this as the market is clearly already in this direction.)

The Mac OS is simple and sleek to view.  It is a UNIX-based OS which is pretty evident in its appearance.  It looks and behaves similarly to other UNIX-based Linux systems I've used (most recently Ubuntu).  It is quick and stable.  It integrates well with the iPhone.  You rarely have to navigate file trees to find your files because the spotlight search is amazing.  Sometimes when I search for a file it will pull up old emails that I sent years ago.  It is actually a little scary if you think about it.  Programs and peripherals seem to work immediately and the way you'd think they would - everything is very intuitive.

Most of the complaints that I have with the OS are somewhat petty.  The screensaver frequently defaults to the National Geographic screensaver that comes with the computer.  No matter how many times you change it, it goes right back.  This is a well documented issue on their forums.  One time my desktop background changed on its own.  The mouse I was using worked fine with the laptop monitor but once I got my external monitor (a 24" monitor I got for $115 on Newegg.  I have no idea why I didn't get a bigger monitor years ago) the mouse movement was at times quite jerky.  Interestingly, I started using a different mouse and so far it has worked fine.  The longer I use the OS the more nit-picky items get added to the list of cons with the OS.  So far they are minor, but it is confusing to me how such a polished and largely used OS could have such goofy problems.

One of the reasons why I was able to adapt to the Mac OS so quickly from Windows is that it really is very similar to Ubuntu.  The UNIX/Linux heritage seems pretty evident to me.  It is like a polished Ubuntu in many aspects.  However, Ubuntu never did the goofy things I mentioned above.  In some aspects I think Ubuntu might actually be a better OS.  The trouble is if you want to do anything outside of the most basic computing tasks it is a major hassle.  So here I am with the Mac OS.  Maybe the best of both Linux and Windows combined into one system.

Epically Awful

At the beginning of November we got a new computer system in our office called Epic.  This new system affects all aspects of our office, from patient check-in to communication with patients to office visits, as the front office, nurses, and doctors use the new system.  Everything that goes on in our office goes through the new system.  Needless to say most people were nervous about this change as it was undoubtedly going to change workflow and how people do their jobs.  I, on the other hand, was pretty laid back about the change because I use Epic in one of my other jobs and thus am used to the system.  I was wrong about being laid back.  I should have been nervous.  The month of November is almost finished and I haven't had one good day at work this entire month.

It's difficult to describe in words what this change does to an office.  You almost have to witness it in person.  Everything is delayed.  Checking patients in, getting them to the rooms, doing routine tasks are delayed.  Refilling medicines and placing orders for labs or images get dropped or lost and patients call back wondering what happened.  Even filtering messages from phone calls around the office is a challenge.  For the first time in my career I have began telling people that we don't have time to address all of their concerns and that they will need to come back.  For the first time in my career I have not looked forward to going to work.  Last week, we were running over an hour behind schedule and when someone told me they didn't think I was listening to them I snapped at them.  When you go to work for 3 straight weeks and everything you do is wrong or in question you can only take so much.  When you have to apologize again and again for delays it gets to be a bit much.

Things will get better as we all get used to the whole system.  In fact, things are already better now compared to when we first started.  But there is a larger issue here, one that is beyond the scope of this post.  I am concerned about the future of healthcare in this country.  It is increasingly complex to provide even the most simplest of care.  If the non-medical person saw what goes on behind the scenes (how much effort is needed) after the patient leaves the office to deliver their care I think most people would be shocked.  This coupled with increasing cost and higher demands to deliver top quality care in less amount of time I believe is an equation that can't be solved.  Time will tell I suppose.  In the meantime, I hope things with Epic improve sooner rather than later.  I can't handle too many more days of this.

So It Begins...

Autumn was way too short this year.  My favorite season has come and gone for the year.  We've had our first snowfall of the year with accumulation and it seems way too early for that.  Not only that but it is cold outside.  Like January cold.  It was in the teens this morning on my way to work.  The only saving grace at this point is that it is supposed to be in the 50s this weekend with rain.  Maybe one last fall hurrah?

I have a busy commute as it is.  There is plenty of opportunity for slow down from wrecks, cops pulling people over, etc.  Add snow and/or ice and it is significantly worse.  Here's to warmer weather.  Winter is just starting and I'm already ready for it to be over.

Keeping Calm and Carrying On

October ended with a trip to Seattle which I would classify as an interesting place and a place that I'm glad I visited once but also a place that I'm not planning on returning to anytime soon.  The surrounding area is beautiful, however.

Trick-or-treater's never came to see us in our apartments and unfortunately we weren't able to participate in Halloween last year so this was our first year as a home owner where we could hand out candy.  Sarah bought some but the weather was crummy, in the upper 30s/lower 40s with rain and sleet.  We had very few trick-or-treaters.  Sophie and Elle dressed up as the monsters from Monster's Inc. (see Sarah's facebook page) and they had fun crawling around in their outfits, probably confused about the situation.  We have a lot of leftover candy.  I've had more snickers bars in the past week than I've had in the past several years.  I forgot how good those things are.

I think I'm finally used to using a Mac over a PC.  That didn't take long, maybe a few days.  I'm pretty happy with the switch thus far.  I'm also switching computer systems at work, which is a major hassle.  Luckily I already use the new system at one of my other jobs, but the rest of my office staff isn't so fortunate - it is brand new to them.  Hiccups are expected in the upcoming weeks.

A Week To Forget

Last week was one of those weeks where everything seemed to go wrong.  It started out with mild annoyances at work.  On Tuesday I had to call an insurance company to do what's called a peer-to-peer review.  I ordered a sleep study on a patient who had excessive daytime sleepiness and their insurance wouldn't cover it without me talking to them first.  It got approved but the doctor I talked to was an absolute ass for no real apparent reason.  On Wednesday I saw a new patient who left mad because I wouldn't give them antibiotics for a 3 day illness with normal vitals and a normal exam.  They had a viral illness that would improve with time.  I explained to them that antibiotics were not helpful.  Even after 10 minutes of explaining they were still mad.  It frustrates me how I can spend over a decade learning medicine and then people with absolutely no medical training come in and think they know everything because they read it on Google.

Things massively got worse from there.  On Thursday my 9 year old computer died.  I was using it and it shut off.  I thought the power in the house went out but it didn't.  It was just the power to my computer.  I tried to trouble shoot the problem but there were too many variables and the computer was nearly a decade old so I gave up.  I thought I would be able to rip the hard drives out and access our data but I was wrong.  Apparently the hard drive was a dynamic drive, a more advanced type of drive that many Windows platforms can't read (even though it is a type of Windows drive).  I am in the process of still figuring that out but so far have been unsuccessful.  Oh yeah, I started to develop a cold on Thursday too.  I never really got sick, but didn't feel great, just bad enough for it to be annoying.

Then on Friday, I got a call from my dad saying my mom had a massive gallbladder attack.  They took her to the hospital and removed the gallbladder and all is well now, but she apparently was pretty sick over the weekend.

I was more than ready enough for last week to be over.  Oh, and to add insult to injury my new student loan payment terms kicked in this week.  My new payments are similar in amount to a house mortgage, which, you know, is fantastic.  I am using my MacBook now as my main computer and am still in the process of getting things set up and organized the way I want and had them on my old desktop.