Learning from Restaurants, Part 2

Courtesy, Office Style

Refer to this post for the beginning of the series:  http://dr-lasermed.blogspot.com/2012/01/what-we-can-learn-from-restaurant.html

I have always tried to run my office with as much care and kindness as possible.  I treat my patients the way I would want to be treated.  Over the years, my staff and I have worked at finding ways to make things as comfortable and patient friendly as possible. 

We start when people schedule their visit.  My front office person (Princess) is always polite.  She goes out of her way to make sure our patients get an appointment time that is convenient.  She tries to remember if they have children that need to get on or off the bus, they work nights, etc.  New patients get asked what time is convenient, and she does everything she can to work around their schedule.  She also makes sure they know how to find the office.  Princess calls people the day before their appointment, reminds them of the time and checks to see if they need those directions again. 

If the patient is coming after having been seen in another office, we ask her to bring her records if possible.  This avoids a second visit with another fee.  This is something that most people don’t think about.  We try to be aware of cost to the patient of everything we do.  This includes the time away from work or other regular daily activities. 

We have also tried to find the best and least expensive places to have lab work and diagnostic testing.  Sometimes this is dictated by insurance.  If our patients are paying cash, price is important.  I believe this will be more common in the future.  Patients don’t think of these things, so we try to be helpful this way.

Remember, this is a gynecology office, so there are certain things that we do that are just not going to be pleasant.  I can’t help that.  But I can explain up front what is going to happen, wait for the discomfort to pass, let women lie on the table or sit in the exam room until they feel better, etc.  I also tell patients that I hate pain as much as they do.  I use anesthetics or have them take medications before procedures if possible to minimize pain.  I also talk to them while something is going on.  Many of my patients don’t realize that I have even started doing some nasty test, and it’s already done.  Over the years I have been problem solving both in and out of the exam room this way. 

I try to take a practical approach to treatments, too.  I know most of my patients are busy women.  If it’s too complicated, too expensive, or she doesn’t believe in that particular treatment she often isn’t going to finish it.  I try to pay attention to how my patients feel about different treatments, medications etc. 

We also make sure patients have follow up appointments scheduled before they leave the office, whether it is here at our office or with another doctor.  I also let them know what to expect from their medications or after a treatment.  If any testing was done, one of us calls the patient with the results, even if they are negative.  It’s important to follow through. 

There are some issues with these policies.  That will be part three in the series!

Stereotypes and diseases – only guidelines

Gout is that disease that old men who drink lots of wine get, right?  Their big toe gets sore and they get cranky.  It’s not supposed to run in families. 

I just love stereotypes.  My first gout attack happened in my early 40s.  I had switched some medications around and developed pain in one of my ankles.  I had no idea what this pain was.  I went to see my orthopedist about my knee.  I asked him about my ankle and, voila! A diagnosis of gout. 

Female

 Just barely in the age range (40-60)

Positive family history

Ankle

I get .25 out of 4.  But I still have the disease.

I learned about gout, which is controlled by diet mostly.  I behaved myself, and didn’t have another attack until I had an “indiscretion” around my 50^th birthday.  Everyone asked what I wanted for my birthday, and I answered “lobster”.  Not a good thing in my situation.

I have been really good since then.  The pain is so nasty that I’ll do anything to avoid it.  I have no idea why my MIDDLE toe turned red and got really sore a couple of weeks ago.  I thought I had an infection.  Gout never hit that joint before.  And I have been behaving myself.  Really.

Walking has been “exquisite pain”.  That’s a lovely doctor’s phrase.  I’ll let you all contemplate what that means.  I understand why the pictures have the old guy with his foot up.

Just remember, stereotypes don’t always fit the disease.  Remember that the disease doesn’t always manifest itself the same way every time. 

I’ll go heat my foot and take my new medicine.  Just contemplating going upstairs (ouch!)

What We Can Learn From Restaurant Service

And How I Figure My Tips Based on Service

Tall Guy and Mr. Impatient went out to lunch yesterday.  They went by themselves.  Afterwards, Tall Guy and I discussed it.  He had some interesting insights on the service he received today.  He calculates his tip the way I do – based on how good the service is.  Here’s why.

Tips are “gratuities”.  Most servers earn most of their salaries based on their tips.  The understanding is that the tip is at least partially based on service.  I know that restaurant servers are paid very little by the management.   I have also known women who make a living working in restaurants.  Remember, I’m a gynecologist.  They all know that their tips depend on their service.

So, most servers know that they need to be polite.  There are subtle tricks to increase the total on the bill.  (“Do you want fries with that?”  “And to drink?” 
“Do you want desert?”)   I don’t mind.  Sometimes those suggestions are helpful.  They are more familiar with the menu and the kitchen, so they can tell me what substitutions are and are not allowed. 

When the children were smaller, it was great if they would locate us out of the main traffic area.  We also needed booster seats or high chairs.  Solving problems like these makes patrons much more grateful.  I always made our tip bigger.

We often have “special orders”.  Mr. Impatient doesn’t like pickles, parsley, lettuce or any other “stuff” on his plate.  I make sure to be very plain about this when we order.  Paying attention is important.  If the plate comes out wrong, the tip will be much smaller.  I don’t want to deal with drama when I’m paying for my meal. 

There’s an art to knowing how often to check back on the customer.  In food service, seeing if the coffee or drinks need refilling is the usual excuse.  Following through is what I would call this at my office.  Having the check ready is part of this, too.  I hate having to wait to pay my bill. 

Mr. Impatient took me out to lunch today after he had some blood work.  Our waitress was wonderful.  She brought us menus and our drinks right away, suggested a way to switch the omelet without charge so that it was the way I wanted it, checked back just enough times to fill our drinks, and was ready with the check when we were ready to go….  It was quite busy, but she kept track of how we were doing.  She even gave us “go cups” of our drinks.  Her tip was well over 20%.  Of course, Mom figures out the tips.  Mr. Impatient hasn’t quite figured out this process yet. 

This is the article that inspired this post:

http://etereman.com/remanu/when_things_dont_go_as_planned/

Another time I will explain how I can and do apply this to my medical practice. 

Around the Web – Medical Blogs Early January 2012

I actually read all those blogs that you see on the side panel.  They are my favorites.  I read a bunch of others, too.  Here are a few articles that I found interesting this week. 

I. Wonderful article about why we are heading towards a major physician shortage:

http://www.kevinmd.com/blog/2012/01/physician-shortage-perfect-storm.html

“Predictable? Yes. This is an expected consequence of American demographics. Since it takes more than ten years to properly train a doctor of medicine, we should be aware of this and brace for the impact.

Have we prepared for the doctor shortage? Of course not. We are talking about your government here. Instead, the Federal Government has interjected itself in between you and your doctor. In spite of ubiquitous protests from virtually every physician group, the Federal Government passed the socialistic and unconstitutional “Affordable Care Act”.”

II. CPR has changed.  We now only do compressions.  I love this short video about how it is done.  Obviously done in Great Britain where they dial “999”

http://torontoemerg.wordpress.com/2012/01/07/making-cpr-fun-and-funny/

It’s worth a watch.

III.  “In traditional Western medical ethics, a doctor’s fundamental responsibility is to practice to the best of his ability for his patient’s benefit. But lately, doctors are being taught a radical new collectivist medical ethics where the “social good” trumps the individual patient’s welfare.”  Interesting concept.

http://finance.townhall.com/columnists/paulhsieh/2011/12/30/who_will_your_doctor_work_for_under_obamacare

Newegg promotional codes are always available for the latest computer.

She Wants What? Volume II

Outrageous requests from patients continue to amaze me.  On the doctor’s web site I hang out on called “Sermo” we call this entitlement-iasis.  We physicians consider requests not related to the medical care that is currently being rendered to be patient’s entitlementiasis.

Here’s a recent example:

I have a young patient (for me, this is someone still attending the public school system) who I haven’t seen for more than 6 months.  Evidently, Lazy Mom has let Cramp Girl stay home from school more than the school system allows.  Lazy Mom is now in trouble.  She is being charged with truancy.  This may actually require a civil penalty through the court. 

Has Lazy Mom notified me at any time that Cramp Girl, who is in high school, has stayed home from school?  No, she has not.  She called the other day wanting notes for multiple dates over the last 4 months.  These dates were for the condition I was treating Cramp Girl for.  She did not tell me at any point that Cramp Girl was not well enough to go to school.  I would have seen her in the office and adjusted her medication.

Lazy Mom is also saying that Cramp Girl was out for a school trip, a day her sister couldn’t drive her to school, a day the electricity was off at her house, a day she had a stomach virus…..

I personally send my kids to school too much.  They tell me so frequently.  I figure that they don’t know they are sick at 6:30 in the morning.  If the school sends them home, then they are sick.  It works for me.  But education is a priority for me.  My kids are in the honor society, on the honor roll, etc. 

No note for Lazy Mom.  Cramp Girl needs to go to school.  How else is she going to get an education?  How else is she going to get a work ethic?  Oh, I forgot, Lazy Mom is on disability.  I guess that’s what she’s trying to teach Cramp Girl.

A New Year’s Wish – Medication Lists

This is something I have done for myself.  As a physician, I would wish that every person who has any medical problems would do this for themselves, too.

Please make a list of every medication you take.  Copy the name of the medication off the bottle.  If you get them from different doctors, write down the doctor’s name.  Write down the dose of the medication.  How often do you take it?  What do you take it for? 

Here’s a chart that you can copy or use notebook paper to set up:

Medicine Name	Dose	Directions	Reason	Doctor’s Name

Add as many lines as you need.  Mine is over half a page.  It wouldn’t hurt to write your allergies on the bottom or the other side.  Also put down a contact number in case you are in an accident and are unable to talk.  Your primary doctor’s name and phone number would be nice on there, too.

If you put this paper in your wallet behind your driver’s license, it will be available for any emergency personnel.  It will also be available any time you go to a new doctor or hospital. 

I tend to forget at least one of my medications when I’m stressed.  I know I’m not the only one.  I’m especially bad with the newest ones.  I actually told my medical doctor I was on the dose that was purple.  I was sure it was 20 mg; he thought it was 10 mg. We had to open up sample bottles to figure out which one it was.  I was right. 

It would save medical people lots of time if everyone would take a few minutes and write down their medicines.  I keep my list in my computer in a table like the one above.  If you don’t know how, get your kids or your local computer geek to show you how.  We will all be glad you did.

Overhearing medical advice

I will sometimes hear people talking about medical problems.  This can be at the grocery store, waiting at the DMV or any number of other places.  They may be discussing their own problems or those of a friend or relative.  It may also be an issue that was on a talk show or in a magazine.

Here’s my dilemma: Lots of the information that is passed around is not exactly right.  It’s easy to ignore the pronunciation issues.  I just wince and keep on reading my book or crocheting my baby blanket. 

What’s harder is to not comment on the medical advice.  The people that are talking are strangers to me.  I have never met them before.  They don’t know what I do.  I have no idea what they do.  I will never see them again.  Is the advice harmful?  Generally it isn’t.  

I had a professor when I was a resident who asked me: “Why do Obstetricians have wide, flat hands and smoke cigars?”  I answered, “I don’t know Dr. X, why?” “They have wide, flat hands from sittin’ on ‘em so they don’t do somethin’ that they’re not supposed to do.  And they smoke cigars to have somethin’ to do when they can’t sit on their hands anymore.” (He was from Texas and talked that-a-way)

I remember his advice when I am in this sort of dilemma.  I figuratively stick my hands under my bottom.  I literally bite my cheek.   I hum to myself.  I crochet faster.  It’s not my business.   I’d rather deliver a baby.  Hmmmmm.

Grandchildren and other little ones who don’t go home with you

Family gatherings are fun, especially when there are little ones there.  They are sooo cute.  The best part, at my age, is that the little ones do NOT belong to me, and I do NOT have to take them home.

My niece has a daughter who is not quite a year old.  She is great to watch.  She reminds me of all the things my kids did at that age.  Lots of falling on her (well padded) bottom.  She cruises the furniture but doesn’t walk quite yet.  She discovers new things and gets that wonderful grin on her face.  Her giggle makes everyone in the room light up, too.  I said I understand why there are so many laughing baby videos on YouTube. 

She is in that “Mommy adhesive” phase right now.  That’s too bad, because I would have loved a cuddle.  Oh, well.  Maybe when she gets a little bigger and gets to know me better, I’ll get a few hugs.  I did get some wonderful smiles today, though. 

Just don’t call me great-auntie, ‘kay?

Techno – Dino 7 – I’m learning

My friend the Computer Geek was impressed with my Christmas post.  Not as much as I was, but he was impressed.  He did ask why he didn’t have a nickname or a place on the sidebar. 

Sooooo, today I decided to put Computer Geek and Yearbook Gal on my sidebar.  Unfortunately, they refused to appear in bold print.  Don’t ask me why. 

I, however, figured out (all by myself, mind you) how to go in and modify the html to make it bold.

If you don’t speak computer, I modified the language behind the program to get the print to be heavier like this because the little button that’s supposed to do that wouldn’t work properly. 

How cool.  Who knows what I’ll do next.

It’s all because Computer Geek showed me how to add those Amazon banners so you can order from Amazon right from my blog.  It took me forever to figure them out.  Just click on them, and you’re there!  Neat-o?

Maybe I’ll learn to do attachments to my e-mail next?

Laser

Oh, those college kids!

Found on facebook:

http://www.carlsonschool.umn.edu/holiday11/#.TvXB4VXvuMQ.facebook

Enjoy!

Remember our troops

As I am reminded by another blogger

 (http://emergency-room-nurse.blogspot.com/), not everyone is home for Christmas. 

Photo from emergency nurse's blog.  I don't know where she got it.  It just seems appropriate.

Don’t forget them.

Merry Christmas.

Techno-Dinosaur 6 – Christmas Post

I worked really hard on my Christmas post.  I figured out how to get my word processing program to translate “Merry Christmas” into a bunch of languages.  I was so proud of myself.

Then the column thingie wouldn’t work and I had to redo the entire page.  I wanted all of it on one page.

Then I found out that clip-art won’t post on the blog.  At least I can’t get it to (yet – oh, Adam……)

So I had to find my old Photobucket account, get a new password, remember how to download and upload pictures…. Did you notice the ones with motion?  I’m particularly proud of them.

I accidently put the same picture under two different languages.  I can’t have that.  I guess I have a little OCD.  So I inserted the one I intended to have there.  The old one didn’t come off.  OMG!!!!  Don’t panic!  Which button do I push now?

This one post has taken me the better part of a week, off and on.   I’m sure there are 6 or 8 hours of work in it.  I learned stuff, thank goodness.  I’m glad it has been a little slow in the office, or I would still be working on it. 

Merry Christmas

Merry Christmas

Joyeaux Noël!  (France)

 Wesołych świąt!  (Poland)

Καλά Χριστούγεννα!  (Greece)

Buon Natale!  (Italy)

God Jul!  (Norway) 

Glædelig Jul!  (Denmark)

สุขสันต์วันคริสต์มาส  Thailand

Веселое рождество (Russia)

Glad Jul!  (Sweden)

Iloista Joulua!  (Finland)

Christmas Alegre! Portugese (Brazil)

Mutlu Noeller! (Turkey)

¡Feliz Navidad! (Spain)

Rituals and Musical Memories

There are certain things we learn in childhood that carry over to adulthood.  I was raised in a household where regular church attendance was expected.  The church service and the hymns are impressed in my memory. 

I remember practicing for the Christmas Pageant every year.  At the time, all the girls were angels.  One got to be Mary.  The boys were shepherds or wise men.  One got to be Joseph (but nobody really wanted that job).  I used to really like wearing the white outfits with wings.  There was a trick to sitting in those pews with the stiff wings we wore every year.

The Christmas story was the same every year… “It came to pass in those days that there went out a decree from Caesar Augustus that all the world should be enrolled….”  I could and can recite it word for word.  Of course, we don’t use the King James Version of the Bible any more. 

All those old churches have wonderful pipe organs.  They are built so that the music surrounds you when the organist plays.  If you sing in the choir, you usually are positioned near the organ, so you get to feel the vibrations through the floor.  The music is not just something you hear, but something you feel. 

I started singing in the choir when I was seven.  I still do.  There’s nothing like the feeling of the organ music and a group of singers tuned together singing music that we all have worked hard to learn the harmonies for. 

Of course, in a big Lutheran church, there are many folks who have learned those harmonies.  You can sit in the congregation and hear the harmonies on the old familiar hymns.  None are more familiar than those we sing at Christmas.  We end our service Christmas Eve with the congregation singing Silent Night by candle light.  This year Tall Guy and Three Speed will be the ones who are putting out the candles.  Mr. Lasermed will be playing the organ.  Mr. Impatient and I will be sitting in the front row by the organ, singing. 

Sleep in Heavenly Peace.

  

Random Acts of Kindness

The holiday season is the time of year when we hear about people doing kind things.  Caring acts happen all year long, and are rarely recognized.  As a Mom trying to raise children, I am trying to teach them to be kind to others “just because”.  Some of the conversations we have about this can be funny.

We have an elderly woman in our neighborhood that uses wood for her heat as much as she can to save on her electric bill.  When we have a big storm, there are lots of branches that come down from the trees into our yard.  The children and I gather them up into boxes and take them to her.  It’s a lot of work.  At first they wanted to know who was going to pay us for this.  I explained that we were doing a “good deed”.  Since we didn’t live near our Grandma and Grandpa, we were doing it for someone else’s Grandma.  It took a long time for that one to sink in. 

My Mother had a neighbor who is an author.  When she and her husband were moving to assisted living, she had a lot of books that she couldn’t keep.  The local school wasn’t interested.  Our middle school had recently opened and had few books in its library.  I offered to come get the books and bring them back (two hour drive each way).  She had hundreds of books to donate.  My children carried them up and down the steps in her house and we packed my van full! 

We sorted the books on my dining room table.  Some titles had quite a few copies, some had only a few.  I had no idea how many books she had written over the years.  She had everything from children’s books to adult’s books, with the concentration on books for adolescents.  There are several series of books.  One of them had entertained my children during their elementary years.

The librarian was astonished when school started.   They distributed them throughout the school system here.  A few ended up at the local library.  My children got credit towards their community service in boy scouts.  The author got some nice letters from school children. 

What did I get out of all of this?  I got a feeling that I had improved my community and taught my kids how to volunteer.  We kept the rest of the books in the series that we hadn’t finished.  I also got a lovely note from the author about how she appreciated the work I had done.          

Medical Software Company SNAFU

This is the time of year that I bought my Electronic Medical Record Software.  Every year you have to pay for “support”.  This costs almost half as much as the software cost when purchased new.  I’m sure that it will increase in price annually.  The support people are available if I have any problems.  Like the cable company is available if you have a problem with your cable.  Enough said? 

I was thinking it was time to pay the support bill.  The other day I checked my online banking, and – SURPRISE!!!! – they had taken their money out of my checking account.  There was no warning.  No: “Dear Dr. Lasermed – next week we are going to take a huge chunk of money out of your checking account.”  Nothing.  I got an e-mail the day they took the money.

I generally don’t authorize anyone to take things out of my accounts without letting me know first.  I don’t have credit cards.  I only have debit cards.

I called the company.  They said “it’s in your contract”.  The contract is 8 pages of little tiny legal printing.  They didn’t say that they warned me a year ago.  They also said they assumed that the card was a credit card. 

I spoke with the nice people at my bank.  They have dealt with this problem before.  If I deposited cash before closing, there wouldn’t be a problem.  I could write a letter to the company so they didn’t do that again.  Check and check.  Blood pressure is beginning to come down. 

It’s amazing how the only times I ever have problems with my account are when some business takes something they are not authorized to do.  The woman at the software company said “THEIR SOFTWARE IS NOT SET UP TO SEND NOTIFICATION BEFORE THEY DO ANY BILLING”.  I want to know why they can’t fix their software, since that’s what they do, write software?  She really didn’t know. 

Playing with the box – not the gift

I have a niece who is almost a year old.  I have been reminded of my children’s second Christmas.  Since they were born in the summer, they were still infants the first year.  The second year they were walking, babbling human beings.  They really enjoyed watching orchestral Christmas music on TV.  Their favorite movie was Toy Story. (To Infiggity and beyond…..)

This was the year that Christmas lasted and lasted.  Each gift was really two gifts.  If it had a box big enough, the box was a toy, also.  Boxes were for climbing in, building with, making trains out of, putting on their heads, using for shoes and any other activity they could think of.  Then they would play with what was in the box.        

One toy would make my boys happy for several days. 

There was no rush to open all the presents.  Nobody was greedy.  When it seemed like they had started to get a bit tired of any particular toy, we would get out the next set of packages that looked the same.  We would repeat the process. 

This year Christmas lasted two or three months.  Every time they got to open another “set” of presents, we went through the same process.  Peals of laughter rang through my house.  There was lots of crawling around on the floor chasing kids who were chasing toys. 

It was a glorious time.  They are only little once.  Enjoy it Moms and Dads. 

Around the Web – Medicare Patients Readmission Rates Unacceptably High

Doctors have noticed these trends for years.  Because of insurance company pressures, we are sending patients home earlier and sicker.  There is pressure not to keep a patient in the hospital very long.  Are they being sent home before they are completely recovered?  Possibly.  Do you rest better in your own bed without someone coming in to take your temperature and blood pressure at 2 AM?  Definitely!

Medicare is now keeping track of how often patients who are discharged from a hospital are readmitted, and how soon this happens.  They have figured out that this costs them a lot of money.  Within 30 days, one in five people are back in the hospital (20%).  Within 90 days, one in three patients are back (34%).  This is costing Medicare over $17 billion per year.

Some patients develop infections.  Some patients have bleeding.   Something happens to an incision.  Something absolutely unrelated to the original problem will happen.  (Since when is a broken leg related to pneumonia for example?)  There are readmissions for medication problems.  People end up in the ER, and back in the hospital. 

Patients are leaving without really understanding what they are supposed to do when they go home.  Medications may have been changed while they are in the hospital.  They are unclear about which medications they are supposed to take when they get home.  Here are suggestions about what you as a patient (or caregiver to the patient who is coming home) should know and do:

1.     Know your diagnosis and any procedures that you had.

2.     Know when you should have a follow up appointment, and who it should be with (surgeon, family doctor, physical therapy, etc.)

3.     Schedule your follow up appointments ASAP.

4.     Make sure your regular doctor gets copies of any and all paperwork from the hospital.  If the hospital doesn’t send them, call your doctor’s office to let them know you were in the hospital so they can tell you how to arrange for records to be sent.

5.     Make sure you know what medications you are supposed to be taking when you go home.  Are you supposed to resume any of your previous medications?  Are any of the medications you are given different names for the same medications you take at home?  DO NOT LEAVE THE HOSPITAL UNTIL YOU KNOW THIS!!!!!

6.     Find out what you should expect that is normal.  Bruising?  Aches?  Swelling?

7.     Find out what you should look out for that is not normal.  Fever?  Redness?  Pain getting worse?  Shortness of breath?   

8.     What are you allowed to do?  What are you not allowed to do?  Lifting?  Showering?  Childcare?  Do you need someone with you?

9.     Who should you call if there is a problem day or night?

10.                        If you have dressings, stitches, a cast, drains or other surgical “stuff”, ask for directions on care and cleaning.  Ask about when things should come out. 

11.                        If there are test results that you are waiting for, ask how you are supposed to find out the results.

12.                        Before you sign any papers, make sure you understand everything.  Ask someone to explain it until you are sure you know what you are supposed to do.  Don’t let anyone rush you through this process.

13.                         If you have questions or problems after you go home, call the hospital where you were or the emergency number you were given.  We like to “head off” problems before they get big.  Sometimes a simple office visit will avoid a hospital stay. 

14.                         Bring a copy of all your papers to your follow-up appointment.

Hopefully these tips will keep you from having to go back to the hospital.  As doctors, once we send you home, we want to see you well and in our clinics or offices, not back in the hospital.  We hate those hospital gowns as much as you do!

http://www.washingtonpost.com/national/health-science/medicare-may-penalize-hospitals-that-readmit-too-many-patients/2011/10/18/gIQAAMTopO_story.html