Monday, September 28, 2020

Pet peeves

Electronic medical records are great! They make billing so easy! All that information at your fingertips! But what if it's bad information?

Disorganized info in the EMR is a pet peeve of mine. One patient's Past Medical History was listed as the following:
Abdominal hernia
Esophageal Reflux
Hiatal Hernia
Irregular menstrual cycle
Migraine
Migraine
NO SIGNIFICANT MEDICAL HISTORY [all caps in original]
Unspecified disorder of skin and subcutaneous tissue
Varicose veins of lower extremities with complications

That's a lot of diagnoses to have "no significant medical history," even if "migraine" is listed twice. The varicose veins have complications, so the patient probably found those "significant." There is an old or external medical record that, when it interfaces with ours, generates diagnoses such as "unspecified disorder of the ...," and I honestly rather nothing were listed, as it conveys no useful information.


Thursday, September 17, 2020

My Middle Name Means "Grace"


You might be #blessed, if you have time between a Zoom meeting and your next patient for a snack, and your clinic has not only ice cream in the break room freezer but multiple toppings (featured here: peanut butter brittle and chocolate sprinkles; in the cupboard: 2.25 jars of caramel sauce). My clinical load is currently light, as I am still building up my panel. The few patients I see are a mix of new people establishing care with me and my colleagues' patients who need an ED or hospital followup, have an acute complaint, or want medications re-prescribed.


What with various hiccups in my on-boarding--from being allowed to bill in the electronic medical record to getting insurance for Dear Husband--it's been a somewhat anticlimactic start to my attendinghood. Thank goodness my colleagues have been kind and welcoming, and only one patient has wondered whether I'm a trainee so far.


I'm still spending significant time every day studying for my second, pediatric board exam in the middle of October. One of the question writers' favorite genres is "guess this child's age based on what she can/not do." I wrote a spoof:

A patient wakes up at 11am and spends an hour on her phone. She changes her pajamas before eating leftover potstickers and an ice cream sandwich at 2pm. She thinks about contacting the DMV to renew her license but does not. She watches 11.35 hours of Netflix before falling asleep on the couch. How old is this patient?

A. 16, not quite an adult
B. 36, adults well
C. 46, should know better
D. 76, doesn't care

The answer is, E. All of the above. We're in the middle of a pandemic, and most people are doing the best they can, so maybe change out of your judge-y pajamas and extend a little more grace to yourself and the people around you.

True story: I've mean meditating so much on this that if I were to get my first tattoo, I have been considering the word "grace" in script on the back of my right hand, so that I would literally be offering grace to everyone I meet. Except, I couldn't go to an ink parlor right now (see: COVID). And, who shakes hands now these days anyway? (See: COVID.)