Some people are interested in knowing what kind of days we as physicians have so they can have more of an insider view. I can only speak for myself of course! But I have observed other MDs during residency and can assure you their days are extremely busy as well. I will also try to interject some of my thoughts as I go through the day.
It just so happened I was dreaming about taking care of one of my patients last night when I woke up at about 4am. I don’t usually wake up this early but for some reason I did last night. I often talk in my sleep as per Tim’s report and I am most often in my clinic talking to someone as I am going down the hall. He says I seem to be in a hurry to get to the patients room or something along those lines. He has heard me talk many nights over the past several years and on a couple of occasions it has been so much and so loud that he almost had to go find another place to sleep! So I will try to tell myself before going to sleep,when he is with me, if I remember, not to talk, not to talk, not to talk and it often keeps me from talking.
I could not go back to sleep this morning so I opened my iPad and began to go through my email and delete the irrelevant and read the important. It was too dark to go out and walk or feed the chickens yet. I did get sleepy again and doze back off before finally waking up at about 6:15. Most mornings I try to take in a very small amount of news so that I know a little about what is going on in the world. One or more of my kids will call me many mornings and I will walk and do chores while we are talking.
Some of my chores include letting out the birds from their house, watering my plants if they need it, fertilizing plants if they need it, feeding other animals such as dogs and cats, feeding myself, visiting with Tim while he drinks coffee, and scanning Facebook or other email that includes medical information to keep up to date. Some days I have to leave earlier than others. Due to having rheumatoid arthritis I have attempted to go into work a little later such as 9 – 10 am so I can be less stiff and more alert and awake. If I have time I also try to meditate, journal and walk around my fields for some exercise. We finally got a tub in so some days I get to soak in epsom salts!! Some weeks are better than others on getting all of these things done.
Even if I feel really badly, I will go to work and walk into the clinic and almost always my body and mind will feel so much better. I am not sure what it is but I love being at my clinic every day. As soon as I walk in the door my day starts with someone coming to me with a paper to sign, a script to print out, a question about a patient, or a drug reps tablet to sign. Then the day goes in a busy walk/run!! Not really run, just a busy walk! We attempt to spend at least 30 minutes with every patient unless they just have a cold or something small.
Our office uses a business model called Scrum that we started last summer. This is a business model that was developed to resemble methods used by the Japanese when building Toyotas in Japan many years ago. We have three teams, the front office, the medical assistants in the back and the three practitioners. Each team has a short meeting daily to review the day before and plan ways to improve on the current day. We have just brought Brandi Ware on board as a CRNP in May and we had our first Scrum party with her last Friday to teach her our methods. So we are hopefully back on track to scrum daily and weekly as we had in the past before she came to work for us.
We are constantly working to make our jobs more efficient by wasting less time, working more productively, and teaching each other tricks that make our jobs easier. I am happy to say that we have had all of our current staff except Brandi for a complete year now without any turnover!! That has made life much easier. It has made patient care better and patient satisfaction go up greatly!
There are many signatures required throughout the day, letters to write so patients can have their animals in their apartment, home health orders, hospice orders, FMLA papers, prior authorizations for medications that insurance does not want to pay for, codes to be corrected so an insurance will pay the lab bill, nursing home calls to answer, patients to respond to on the patient portal, medications to approve to be sent through the internet now, labs to review, outside studies to review, occasional consulting physicians to talk to along with just seeing patients all day long!
I do go home for lunch every day!! It is my quick relief from the hard work and I eat a very healthy meal. I do this almost every single day no matter what unless we have a company, drug rep, hospice or other representative bring us lunch and even then I often go home to eat!! Once a month we have a scrum/staff meeting and I will stay at the clinic for lunch. But even then, Tim will bring me a very healthy lunch. These lunches really seem to help keep me going. When I go home and I have gardening chores I will sometimes do these during lunch. Otherwise I just sit and relax for a bit. I never do notes during lunch!!
Most of those jobs mentioned above are manageable. The hardest job I have seen almost every MD go through is keeping up with notes. We now have to document all aspects of the patient’s visit. I can remember a time when I was pregnant with my oldest daughter and my OB had an index card with my name on it and nothing else unless he prescribed a medicine. That was the extent of his note and she is now 36. Now our notes are about 3-4 pages long or more! I am always behind on my notes. I am often very far behind on my notes!! When I was a medical student I did a month long rotation with a family doctor down in Monroeville, Alabama. I stayed at her house the whole month and I watch her charts in the corner of her office pile half way to the ceiling. I saw her stay up until midnight many nights I was there so she could get notes done and she still was not caught up. That was before her office decided to get an electronic health record. When I went back for another rotation as a resident she was on the computer until midnight trying to get her notes done as well again!!
My children will attest to the fact that so many times when they have called me over the last 9 years (my ninth anniversary of opening my clinic is October 1st!!) that I am often working on notes. I hate to tell them what I am doing when they call!! I have worked on notes after getting up early in the morning until going to work, worked on notes throughout the day, then worked on notes many nights until 9-10 pm. I have worked on notes up to three weekends straight and not taken a day off I don’t know how many times to try to get caught up. I have worked on notes when we had to change to ICD-10 last fall for two weeks straight almost all night many nights to get them done before the change. I had to do the same this spring when we changed over our system to Athena, a new electronic medical record. Our new system promised that notes would be less of an issue and patient care would be our focus! It seems to be somewhat better but I am still many notes behind!! That is why I am saying our system is not sustainable. Many MDs are getting burned out trying to keep up with the paper/computer work. Solo practitioners and even smaller group practices are struggling to stay on top of all that has to be done. Fortunately for me I love all that I do, even notes. I just don’t want to do so many notes on days I would like to be with my family and friends or go to a party, camping, etc. I know most other MDs have this issue because it is often hard to get their consult notes as they are behind also. WE have to find a better way!!
After the last patient leaves I have messages, scripts to print for the next day, patient portal messages to answer, calls to patients who request a call and notes to finish for the day. Some days I have a meeting to go to but I try to limit those as I have a lot of work until about 7 or later depending on the day. Some days I have a nursing home patient to see or a group hone Alzheimer’s patient to see. We also do home visits but I don’t do those as often as I used to. Judith will do most of those now. I often try to eat a bite around 5 after the last patient leaves so I don’t break down and eat something quick and unhealthy. I often have brought left overs from lunch. Finally, after I am finished or at least too tired to continue I go home and get on Facebook, read emails, study new medical advances again and go to bed. (Tonight I am blogging on my new blog!!) Maybe this will work as a release!! Do not talk, do not talk, do not talk!!!!
That is a quick over view of a country doctors day, at least my day!! I am absolutely not complaining about any of my activities. I have chosen this life and do not regret it one bit. Seeing my patients in the clinic or the nursing home or at home is such a great privilege!! But I do need to do less and I want to work to find a way to help other MDs do less and still be able to give quality care to our patients. Our own health can break down and then we are no good to anyone!! My next blogs will cover many things I have tried to cut back!! I have some new ideas and will work on those in the near future!