Jan 1999 Table of Contents

Practice Diary



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Fam Pract Manag. 1999 Jan;6(1):54.

E-mail

Wanting to be in the wave of modern medical practice, I put my e-mail address on my most recent batch of business cards. My patients are actually starting to respond. Jackie sends me jokes: blond jokes, bad-day jokes, Viagra jokes and, of course, doctor and lawyer jokes. Monte forwards words of wisdom and unbelievable stories, like the guy who jumped off a bridge using a cable for a bungee cord and tore his foot off, or the 41-year-old man who got stuck and drowned in two feet of water after squeezing headfirst through an 18- inch-wide sewer grate to retrieve his car keys. Rick sends me attachments that cannot be opened, and Wendy sends me musical electronic greeting cards.

Today a patient actually asked me for something medical: a stress test that he needs to be cleared for diving. I replied tonight and asked if he wouldn't mind calling tomorrow to set up an appointment. Then I forwarded him some Bill and Hillary jokes.

Old charts

I hadn't seen Anne for years when she appeared in my office today with her 16-year-old daughter. Back then, Anne was a primigravida, and Crystal had been breech. We had been unable to turn her, so protocol dictated a cesarean. I recalled that there was something unusual about Anne: She had von Willebrand's disease, a rare blood dyscrasia. She reminded me that, in 1982, we had given her 40 units of cryoprecipitate to prevent hemorrhaging. Several years ago, she added, a routine blood screen showed that she was HIV positive.

I couldn't speak for several minutes. Anne broke the silence by saying that, in 1982, no one knew that blood products were unsafe, she needed the cryo to save her life and she didn't blame anyone. But her husband had died the preceding year, and there was a class-action suit for persons who had contracted AIDS through blood transfusions. If I still had her chart and she could prove she had been given a tainted product, it was worth $100,000 to her. For the rest of the day, I couldn't stop thinking about Anne, hoping I still had her chart. When I came home tonight, I immediately headed to my barn. I dusted off the spider webs, dug through the boxes of old medical records and actually found it! Her chart contained a long, dictated note from the obstetrician and a hematology consult as well. Delivering it to her tomorrow will be a pleasure.

Hands on

I was manning my phone this morning while Isabel, my office manager, was doing an EKG. A patient called with a “complicated” question about her bill and asked if she should call back later, when Isabel was available. “No, let me take a stab at it,” I said, and I actually took care of it. When I got off the phone, I felt as though I'd just cured her medical problem. I also felt a sense of empowerment. Perhaps I'm not hostage after all to my software or whomever handles my billing.

My friend Doug, who runs his own backhoe, tells me he couldn't stay in business without fixing his own equipment when it breaks down. I think there's a lesson in that for us physicians.

Staff appreciation

The difference between Isabel and my last office manager is, to paraphrase Mark Twain, the difference between lightning and a lightning bug. She's a real people person, and my patients love her. She's loyal besides. A few months back, when she had done an especially good job going through our aging report and bringing it up to date, I wrote, “Great job, Isabel” on a sticky note and put it on her desk. Today I notice the note is still there, peeking out from under her collection of CDs. I guess praise — even in the form of a Post-it Note — isn't something you throw away.

Office aesthetics

A patient remarked today that our office feels homey. I regard that as a great compliment. Twice a year I grovel before my wife, a world-class gardener, to come weed and plant the garden in front of our office. Several years ago we added a wooden ramp to the entrance and found that not only did our patients in wheelchairs appreciate it, but others did too. My big find last year was a 35-gallon fish tank, which I bought at a yard sale. We've set it up in the waiting room with a small recirculating fountain. Patients say the sound of the water is soothing and watching the fish is relaxing. I've put my antique medicine bottle collection on the window sill, with treasures like Dr. Nunn's Black Oil Healing Compound, Hamlin's Wizard Oil, and Dr. J. Hostletter's Stomach Bitters (interspersed among them is Dr. Brown's Cream Soda and Downtown Brown's Light Brown Ale), and I just recently added a water cooler. With the paint touched up and the carpets steam-cleaned — a minor makeover — the office feels somehow newer.

Dr. Brown is a family physician in solo practice in Mendocino, Calif.

Copyright © 1999 by the American Academy of Family Physicians.
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