Working day 9 out of 11.
On "phone calls" from Sat am to Mon am, 48 hours, considered "easy" call. Really it isn't because sleep gets disturbed, but obstetrics heated up too. Had one in house in labor Friday (Friday was working day 4) and admitted another to rule out preeclampsia. Bedrest and labs and started the 24 hour urine, called perinatology. Ran back and forth between clinic and labor patient and finally cancelled last clinic patient. Got to go eat with kids and went to a dance thing for an hour, then called in. Baby out around 1 am. After baby ok I sat down in OR to wait until C/S done and kept falling asleep, sliding down wall. Got to bed at 3. Woke 8 when phone calls started. Rounded in early afternoon, made plan on the other lady, not preeclamptic, gestational hypertension, discussed amniocentesis since her dates were not so good (24 week ultrasound, presented at 23 weeks) verses in or out patient bed rest. She went home with amniocentesis coordinated for Monday with Dr. H, ultrasound and lab.
I was not driving well by late Sat, so called for help and checked out phones to PA and obstetrics to Dr. H (She'd seen me falling asleep) and slept Sat night. Played music at the two church services on Sunday, exciting, and then beeper back on at 1 pm. Somewhat disturbed sleep on Sunday with phone calls. Another of my patients had a scheduled c/s at 8 am so I was there at 7:30. Baby a rose, fine. Then we tried to do the amnio, not enough fluid. IV hydration started and I checked out again at 10 am to actually start my day "off". Did some shopping therapy and got some sun, lunch outside. Amnio still wouldn't go later that day. She went home again.
Rounded on moms and babies Tues and then busy clinic. Didn't run horribly late. Had some lunch meeting, don't remember what, set pager for 20 min into it so alarmed and I could leave and eat in blessed peace. Didn't get many charts caught up on over the weekend what with phone calls and ob, so sent email to Partners-That-Are-Attempting-To-Be-Supportive explaining why I hadn't gotten caught up much and saying if they wanted to go to admin to get me a day off to do charts, was now fine with me. Also that I thought it was a catch-22 that we have the stone-ax EMR (electronic medical records) so that we can get the charts done in the room, but with the visit time lowered, I can't actually do it or if I do we run really late. Accumulate 3-5 min per patient and then see a zebra. Dang. Only one of the 3 partners replied, the one who will actually stand up. He sent reply to admin. They seem to have been taught in admin school never to answer ANY question that I've asked on email or voice mail for the last 9 years and 3 months. Think I'll take a voice recorder to next meeting and see what they do. COO had asked for suggestions on how they could "help me catch up" besides letting me see less patients or have a paid day where I did charts, had emailed 7 suggestions including could we please have a call room as we are not supposed to sleep on the patient beds, but reply? Nada.
Tuesday started with 7:30 meeting with coding auditors. Resent coming in at 7:30 when they will dock me leave if I leave 20 min before the end of the day. Also call does not count, ever. Auditors actually helpful. No one is coding enough level 5s. They think we're doing them. To my great joy they said that the bad part about EMRs is that without a typed narrative, the charting sucks. Hooray! I've been saying that for three and a half years! Met with them one on one at 4 and was told my charts are excellent because I avoid the templates as much as possible and type a narrative and they can follow the logic. Yee-ha. I have bent the damn EMR to my fierce will. Only took me three years. Billed one obstetrics patient wrong and they said one was undercoded. Next day coded a level 5.
Busy Wednesday and at very end of day, note from COO about agenda for tomorrow. Apparently they don't like me telling patients that I don't think congress should require us to see 18 patients a day. Apparently upsets staff and colleagues. I need to cease and desist and they want my plan for how I will build to 18 patients a day if indeed I accept the organizations rules. Seems like an implied threat to me. However, since the other obstetrics docs really need me since the call is killing them, don't think they'll fire me. Called Dr. P who is coming to meeting as my handler. Promised to look like Medical Borg, will wear easter egg yellow suit. Demure and 1940s, skirt below knees. Will bat eyelashes and say how I understand the hospital's position and I will stop making the suggestions by email that they asked for and will discuss all of the many things I have done to try to achieve compliance with 18 a day. (Hope to see 18 a day the day before I retire and not until then). Plan to ask for some family medical leave since that seems to be what people want. Ok, fine. COO says I need to treat partners and admin with respect, I will point out that the provider meeting two weeks ago where I was the only one among six people who did not know that I was on the agenda and it wasn't written down felt rude, crude and disrespectful, thank you very much. Resembled alcoholic intervention. Gosh, I drink an ounce or two of wine at least two nights a week. Jerks.
So have 15 on the schedule today, with three openings on the schedule this afternoon. If they fill them I'll be late for the meeting. Would not bother me very much, I have to say. Me, my family and the patients come first, damn it.