My Turn to Present

To keep retirement from becoming too unstructured, I've enrolled in the Osher Lifelong Learning Institute, acronym OLLI, where I take classes two mornings a week and learn to play Mah Jongg late Wednesday afternoons.  One class, which I also took last semester, has the title Of Minds and Men.  At one time it was for men, but not wanting to jeopardize any access to funding, it has been co-ed for a while.  The enrollment is restricted to as many people as there are weeks in a semester so that each person leads the discussion one time.  I wanted to learn about Echo Chambers, but the sign up sheet got to me last.  Procrastinators being what they are, people captured their date from latest to earliest, leaving me with date at the beginning, which means picking a topic that already has familiarity.  Last time I chose exorbitant drug pricing.  This semester it's Electronic Medical Records.

It's one of those subjects that divides emotion and intellect.  It is hard to overlook the potential of maintaining data in an organized retrievable way.  With little effort I can see lab trends over years, know exactly which xrays are on file and review the reports easily and the images with a little more effort.  Calling up the notes, I know who saw each patient when, though the reputation of the note writer often screams Ignore this One.  Handwriting problems disappear.  Spelling is left incorrect so that future readers can figure out what I typed myself and what falsehoods were generated by the computer which performed better in spelling bee than I did.  Since most people have most of the elements of their exams normal and I pretty much examine everyone the same way, I can create a generic exam, leave what's normal, change what's not, and delete those things I did not examine on that individual.  I should be a great enthusiast, but like most clinicians, I am not.

It's tedious.  And since work is generally task based, the time distribution of the individual tasks that comprises with work day has redistributed in a less satisfying way.  I generally do not like telephone sessions for going over lab work or revising medicines.  The computer requires use of a template to document the call, expanding a one minute telephone encounter to a four minute telephone encounter, most of it filling out the template.  That means call time has to be more scheduled than previously, where a 1-2 minute span on the telephone could be squeezed into an odd moment, to say nothing of expanding the time that I like doing the least.  My records are not adequately maintained, particularly among shared users.  It is common to have a medicine list with three different doses of the same medicine.  The medicine list works on the Roach Motel principal, the pills check in but they don't check out.  Huge amounts of data to tease out successful from unsuccessful processes should capture my professional imagination, but that task and the design to do it goes to somebody else.

I do not know how much credibility I will have among the class, when the other doctor will not be there.  But I will convey the good, bad and ugly in its the most objective way that a person who sees himself as victim can overcome.

They're Mostly Gone

It had been a while since visiting the medical center from which I retired, maybe about six months when I attended a Grand Rounds there.  This time I dropped off school supplies purchased a little at a time at Back to School Sales over maybe twenty years.  As I organized My Space, loose leaf paper and binders at that volume would be classified as clutter.  The Sisters, though, collect stuff like this for the school children of the neighborhood so I transported a few boxes of this stuff to her.  The environment looked the same, not especially active but with enough people inside the building to require me to park on the garage's roof.  My old office had nothing going on other than a new neurologist joining in the previous month and one of the Medical Assistants nearing the completion of her pregnancy.  I learned that the hospital's CEO would be retiring soon and sent her a mixed congratulatory and thanks note when I returned home.

Recently the administrative alignment of the network subsidiaries had changed, an initiative of headquarters a few hundred miles away.  My guess is that it would make no difference to operations, as it is not the first shuffling, none of which have dripped down to the level of patient care.  However, among Physicians Network, the two head honchos had been figuratively beheaded.  Looking back, we've had several CEO's, Exec VP's, Chief Medical Officers for the network.  They seem to arrive as a group and mostly depart as a group, often suddenly enough to suggest the exit was not a voluntary one.  I suppose the salaries they pay are rather good but the duration of the salary not very long.  Moreover, nearly all who depart suddenly are at mid-career, or at least well short of customary retirement age.  I have no idea what type of Golden Parachutes are in their contracts but it would seem prudent to ask for one given the predictably short tenure.

The clinicians seem much more secure.  Since my exit, one hospitalist moved on, one orthopedist concluded his contract, and two more clinicians came aboard.  Perhaps we protest about the management more than we need to.  Time is on the side of the clinicians.