Spining Chaos always has a Calm CenterTo make ends meet, outside the office I work at an Immediate Care Center. (Insurance reimbursement makes it impractical to spend more than 15 minutes of face to face time figuring out a personal strategy for lifestyle change - thus the reason everyone gets a scripted "one size fits all, this is what you have to do before next years annual visit"). No wonder the research this year says wellness check ups dont make a difference in life span! So here I am working at a cough, cold, sprain clinic with a very expensive EMR (computer based medical recording system) that decided to crash. So the staff at the front desk worked diligently to contact the IT guys on a sunday-yeah right! In the mean time, I was so elated inside waiting to turn on the speed. Why? Any patient who has been to a clinic with paperless EMR knows the feeling of the doc facing the computer screen and spending little time looking at the patient unless you have good typing skills or know where to intuitively click boxes and scroll. Any doc using EMR knows how frustrating it is to have to click off boxes in order to fulfill the criteria to get reimbursed for the evaluation and treatment planning and having the whole ritual take time away from patient care. So here I am, a great excuse has been laid in front of me to ditch the computer and just write down the history, physical and treatment plan on paper. I could usually finish with pen and prescription pad faster than it takes to click print and walk the patient to the printer. I pulled some blank paper out of the copy machine, got my script pad and started charging down the hall chewing up one visit after the next. It was so liberating to get people cared for, explain why they were sick and come up with a treatment plan on how to get better and not have to wait for the plan to print up at the nurses station. Usually on a sunday, there is an after lunch crowd of sick people (referred to as the "after church group" since as church lets out, every family that has a sick kid stops off at the immediate care for an evaluation hoping to get better by monday morning school bell) We actually didnt have much of a back up as I was really able to fly through the paperwork. Alas.....good things come to an end. The tech guy called and said things are fixed....and the system was up but some of the rooms where slow as molasses so.....back to pen/paper(yay!). I ended up reverting back to full EMR (boo!) toward early evening and the whole immediate care slowed down again. (one lady in the waiting room commented that is shouldnt be called immediate care since it was anything but immediate-I agreed but if we were 2 hours behind, the ER was 4 hours behind so I was still the lesser of two evils)
So why do I call this hatred when it seems that I was on cloud 9? Well, as the crowd in the waiting room started to gather with the reintroduction of the EMR system, the natives became restless. It was such a contrast to greet families with joy (paper) vs greeting people that start the conversation with "I thought you forgot about me" (EMR). As I opened more doors with a wave of heat, crying kids and adults falling asleep waiting, I had to do more explaining of why we were backed up, calming down, and patients at that point felt very entitled and were demanding things like personally calling the script in (calling in a script takes about 5-10minutes of waiting time on the phone to the pharmacy.....doesnt seem like much right? If I crank out 20-30patients a day, spend an additional 5-10minutes each with a phone call, for the unlucky patient at the end of the day-thats a potential 3 hours of waiting.) So if I am not "grounded from stress" before starting my shift, I could easily develop a pissed off attitude like "why the F are you coming here when you should have been to your doc last week" or "get over the pain and get back to work you wimp" (at Danada Family Medicine in the 90's, I remember working with a hug ice pack on my shoulder every hour from a full thickness rotator cuff tear for weeks dealing with the pain just to get through work) But I didnt let the hatred rule my day, I worked and did it fast. The EMR was inching its way back into my life over the course of several hours. Most patients I got cooled down and gave a plan for feeling better. I am pretty sure I still have some data entry I have to catch up on but the hell with the computer. The entire day was a testimonial that EMR may help insurance companies keep an eye on what is being charged but it only slows down the practice of medicine. Helps a little for the doc regarding making notes legible, does nothing for the patient except making the wait longer as the clicking and printing takes forever. It still comes down to whats between my ears that figures the right questions to ask, figures the right tests to help with the diagnosis, and the right solutions to the problem. If the patient is irritated, I become defensive, the relationship is strained before we start and that effects what is between my ears and how I use it to help suffering.
I always tell teens that emotion is contagious. If you hang out with a drunken mob, you will assimilate the irrational behavior of the mob. If you hang with an abusive significant other, you will imbibe the abusive tendancies of the other. If you watch the reporting of "yellow journalism" you will be swayed in your thinking to become entangled in the conspiracy theories of the reporter. If you are with a room full of meditators, regardless of your expertise, you will feel the wave of relaxation experienced by the group. If you are with a group of people looking to change the world, you will think outside the box and come up with answers. It takes alot of practice to not let emotions around you dictate your actions. One of the things Deepak Chopra teaches is you cannot control your environment, the only control you have is your reactions to it. Herb Benson taught me, Deepak taught me, Andy is teaching me....meditation and the relaxation response set the ground work for longevity, health and disease free living. Learning to be "bullet proof" to external stressors is difficult, usually need someone to teach. If you initially invest in a good teacher it will set up for effortless development of personal practice on your own at your pace. (one of my classmates from the Chopra Center)
