My week started with three deliveries in less than 24 hours. The last one occurred a mere 40 minutes before my first patient visit Tuesday morning.
Monday morning began with the “hurry up and wait” chaos so common on labor and delivery, followed by three deliveries in just under 24 hours. The last one occurred a mere 40 minutes before my first patient was scheduled Tuesday morning. Fortunately, this week I had the forethought to bring office clothes with me to the hospital so that I did not have to grace the clinic in my ever-fashionable scrubs.
While downing my Starbucks, I plowed through my morning schedule. I placed an IUD, checked a C-section scar, pondered the implications of my patient calling out an ex-boyfriend’s name during sleep sex, reviewed diabetes medications and glucose control in light of new peripheral neuropathy, had a required “face-to-face” appointment to replace medical equipment that had already been approved twice before for a permanent condition, and then ended the session with a 21-year-old already plagued with chronic back pain who has exhausted two neurologists, one neurosurgeon, and a pain management specialist. Thank goodness my first two patients had to reschedule and one cancelled or I would have been running even later than usual.
As the last patient checked out I tried to keep my eyes open to review the ever-growing number of tasks in my box alerting me to prior authorizations that I had to complete for medications my patient has been on for many months, paperwork for a child that had not been seen in over two years, and stat refills for a patient who ran out of his medications four days before. I had not yet started my billing for that morning’s session.
Tuesday afternoons usually permit some administrative time, however, residents were streaming into my office with myriad questions, my prenatal coordinator had concerns about a new OB patient’s hepatitis C test results, and one of the rotating medical students asked for a letter of recommendation.
I meant to bring home the day’s notes and billing to do at home after the kids were tucked into bed, but once dinner was done I collapsed in bed, intermittently interrupted by the baby waking up at one and three and five.
Wednesday morning I did not see patients, instead I sat in the preceptor room and reviewed ambulatory patients with residents. I was hoping again to get to the billing before the office manager started complaining. However, the residents had challenging patients and I spent the morning explaining the need to correct for prematurity when looking at developmental milestones, reviewing Pap smear screening guidelines, and identifying who actually needed blood work that day. The last resident patient was scheduled for just before lunch and as I sat waiting for the residents to finish, one of my advisees popped her head in to ask if we were still meeting during lunch. I assured her that I would be in my office in about 15 minutes and made a mental note to remind myself to write those types of meetings down because I had completely forgotten.
This resident is in her last year of training and that day we discussed outstanding items for her to complete before graduation, tallied up how many office visits she needs to complete before July, and talked about her career goals. The conversation continued until I realized that the lunch had taken us 15 minutes into my afternoon patient session. Wrapping up, I stepped out of my office to huddle with my nurses, finding a fourth-year medical student waiting to work with me. I sent her in to see the first patient while I reviewed previsit planning with my team.
The afternoon patients were intermingled with residents coming to discuss prenatal patients, as well as my office staff looking for my signature on a variety of paperwork. Additionally, the school guidance counselor called to discuss my middle daughter’s schoolwork. The medical student helped immensely that day, as she gave extra attention to my patients. We had a two-month old needing immunizations coming in with her 16-year-old mother whom I had just placed a hormonal implant last week. This visit let me check on both mom and baby. When I finished with the last patient and reviewed with the student, I still had phone calls to make and results to verify.
Thursday started with a faculty meeting running 15 minutes into my morning patient session. Fortunately, the first patient didn't mind waiting. Again I seemed to whirl through patient rooms, reviewing a urinalysis here, ordering blood work there. I had a new prenatal patient that day. It was her first pregnancy after struggling with infertility for years and I spent more time than I should, or perhaps more correctly, more time than I was allotted with her, so again I fell behind.
Friday is looming for me. There is still charting and billing to complete. It has been a long week with seemingly endless paperwork and phone calls. But over the course of the week I helped three babies into the world, taught young doctors, and took the extra time my patients needed me to take.