How often do we have the opportunity to actually engage in doing something that we love and be able to see the fruits of that work to the harvest?
In a previous career, I taught middle school. I had the honor and privilege of teaching Writing and Grammar and Social Studies to sixth, seventh and eighth grade students. It was a complete joy to watch students begin the course of work in September and see their progress through until the end of the school year. I always had a special fondness for the end of term reflections that students were required to submit.
This "reflection project" was not mandated by the school or the school district, the state or the US Department of Education to meet some subjective outcome-based agenda. I required it as a way for students to see what I had been able to observe during those months of school and finally the end of the year: their growth not only for the "grade" they may have earned, but for their growth as thinkers and writers. Students were required to look at and reread their writing assignments at the end of each quarter, then at the semester, then the end of the year. They then selected those pieces which they considered their "best" work and kept them in their portfolio. At the end of the year, they opened that portfolio of their self-described "best" work, reread each assignment and selected what they believed was their overall best effort.
As a way to engage them in this process, -- and to be completely objective -- each student had a questionnaire to guide their reflection. Many students chose work they remembered as being fun (like the poetry or other creative writing projects they did); others chose work that was a "writing across the curriculum" project where they could combine writing (which they did not like) and another subject like science (which they did like).
Funny though, I read reflections where the student could not believe that they "actually wrote that essay in September" and "thought it was my best work" because, compared to their "best work" in May, the September work was "terrible." They reflected on the process of writing, be it an essay of some form, a poem or a story -- the process was the same. From the initial brainstorming to the rough outline, first draft, revisions and final product, each step was part of the process and this paper trail was part of the work to be turned in for a grade.
Of course there were those students who were more engaged in this process than others; that is to be expected. What was amazing to me, however, was that by the end of the year, all of them felt that they were better writers and better thinkers. As they looked back on the year some expressed amazement that they groused and complained at the writing process as the assignments were given (sometimes four completed writing projects each quarter) when they saw how successful they had been by the end of the year.
As a teacher I experienced the wonder of sowing the seeds of learning to (sometimes) reluctant minds, cultivating and then seeing the harvest, but it wasn't what I expected. The greatest satisfaction for me came not by successfully completing the curriculum by the end of the year; the greatest joy was watching the students realize their own success as writers and being able to share in that success through their reflections...a wonderful life experience.
Tuesday, June 28, 2016
Thursday, June 23, 2016
In the Clinic with Groupies
Being part of a small practice allows us to build strong relationships with people....a good thing by and large. We have a happy working relationship with our staff which has on occasion spilled over into personal things.
In the office, the relationship between Danika and Andrew is that of lead medical assistant and medical assistant. They are also mother and son, which provides some great interactions.
Now Andrew is an exemplary employee as well as outstanding medical assistant. His skills are second only to Danika, who also had the honor of teaching him as he went through medical assistant training. His work ethic is beyond reproach and he takes very seriously each patient encounter. He has a pleasant, friendly, caring personality and has a way of connecting with patients to make them feel at ease.
There is one patient, for example, Fred, who loves Hawaiian shirts. He has never come to the office for a check up or urgent complaint that he is not wearing one of those bold colored, big floral pattern button-down shirts. This is a source of conversation between him and Andrew, especially as Andrew is getting Fred ready for his appointment...checking vital signs, height, weight...as well as performing any lab work necessary. The chit-chat goes back and forth and Andrew invariably will make a comment about the shirt. It was not surprising, then, when one morning Fred showed up, without an appointment, asking to speak with Andrew.
It so happened that Andrew was busy with another patient, so Fred had to wait. I noticed that in addition to his hallmark Hawaiian shirt, he was carrying a small parcel. Once Andrew was free, he met Fred across the front office window where Fred presented him with the parcel which contained a Hawaiian shirt. The details surrounding this gift I do not know; Andrew and Fred obviously shared an affinity for them, and Fred's generous nature moved him to do something kind for someone who had shown him kindness. Danika finds this mildly amusing and, I think, feels some maternal pride at how much patients respect and appreciate what we do for them.
There are other patients, however, whose attentions to Andrew provoke that maternal defense mechanism akin to a lioness protecting a cub from some dangerous predator.
Our physician assistant, Maureen, is a tremendously hard-working and skilled practitioner. She is thorough in her examinations and proactive in patient care. She also has a large number of middle-aged and elderly female patients (MAEFP). As Andrew is Maureen's primary medical assistant, it falls to him to take care of things like prescription refills, reporting lab results and the like, as well the usual tasks for patients here for appointments. The "desktop work" typically done by phone and many times he needs to leave a message to call back.
If one of these MAEFPs calls back, they quite reasonably ask to speak with Andrew; however, of this large number of patients, roughly half will speak to no one but Andrew. When they come to the office they can become openly hostile if Danika or another medical assistant have charge over supporting Maureen in the course of their appointment. On top of this, if they call back in response to a voice message some of them will speak "only to Andrew."
Danika, being not only Andrew's mother but also a stiff-upper-lip, proper British lady, is fun to watch and listen to as she "takes on" these "predatory patients."
"Cleary Medical Associates, this is Danika, how may I help you?" she will say as she answers the phone. "I'm sorry, Andrew is not available now, Irene, how may I help you?"
"I'm sorry, Irene, what is it you need? Andrew is with another patient; what can I do for you? Yes, I know that he does a great job with blood draws; many patients have also commented that his skills are very good. Yes, I know that he pleasant and has a good sense of humor. How may I help you today?"
"I see that he called to give you some lab results. I can do this; the results are on your chart. No, Irene, I am capable of giving you these results; Andrew is not available," she continues, an edge to her accent becoming more pronounced; her eyes narrowing as she fights back the impulse to hammer the telephone receiver against the desktop.
By this time, Andrew is free and says he can take the call. As Irene is now on hold, Danika, addressing Andrew says, "NO! She is not going to manipulate us! She thinks that she can only talk with you, and she needs to understand that anyone in the back office is able to address her questions or take a message."
Danika gets back on the phone call, now a little more composed, and very professionally lets Irene know that we work as a team, and the most important thing is that patients receive their testing results in a timely fashion. Obviously Irene agrees and allows Danika to give her the test results, which will necessitate her scheduling a follow up appointment. Danika sets the appointment and ends the call saying, "So we will see you next week, Irene..... Oh, Andrew works everyday and he should be here on Wednesday, but I can't guarantee it. If he isn't, there will be a medical assistant here helping Maureen. Have a nice day. See you next week."
So for what it is worth, it is a blessing to have back office staff who possess outstanding clinical skills. We have struggled for many years to bring together people with a strong work ethic, diligent, caring and personable. It is also a blessing to work with staff who provide not only great medical support, but who are hugely entertaining.
In the office, the relationship between Danika and Andrew is that of lead medical assistant and medical assistant. They are also mother and son, which provides some great interactions.
Now Andrew is an exemplary employee as well as outstanding medical assistant. His skills are second only to Danika, who also had the honor of teaching him as he went through medical assistant training. His work ethic is beyond reproach and he takes very seriously each patient encounter. He has a pleasant, friendly, caring personality and has a way of connecting with patients to make them feel at ease.
There is one patient, for example, Fred, who loves Hawaiian shirts. He has never come to the office for a check up or urgent complaint that he is not wearing one of those bold colored, big floral pattern button-down shirts. This is a source of conversation between him and Andrew, especially as Andrew is getting Fred ready for his appointment...checking vital signs, height, weight...as well as performing any lab work necessary. The chit-chat goes back and forth and Andrew invariably will make a comment about the shirt. It was not surprising, then, when one morning Fred showed up, without an appointment, asking to speak with Andrew.
It so happened that Andrew was busy with another patient, so Fred had to wait. I noticed that in addition to his hallmark Hawaiian shirt, he was carrying a small parcel. Once Andrew was free, he met Fred across the front office window where Fred presented him with the parcel which contained a Hawaiian shirt. The details surrounding this gift I do not know; Andrew and Fred obviously shared an affinity for them, and Fred's generous nature moved him to do something kind for someone who had shown him kindness. Danika finds this mildly amusing and, I think, feels some maternal pride at how much patients respect and appreciate what we do for them.
There are other patients, however, whose attentions to Andrew provoke that maternal defense mechanism akin to a lioness protecting a cub from some dangerous predator.
Our physician assistant, Maureen, is a tremendously hard-working and skilled practitioner. She is thorough in her examinations and proactive in patient care. She also has a large number of middle-aged and elderly female patients (MAEFP). As Andrew is Maureen's primary medical assistant, it falls to him to take care of things like prescription refills, reporting lab results and the like, as well the usual tasks for patients here for appointments. The "desktop work" typically done by phone and many times he needs to leave a message to call back.
If one of these MAEFPs calls back, they quite reasonably ask to speak with Andrew; however, of this large number of patients, roughly half will speak to no one but Andrew. When they come to the office they can become openly hostile if Danika or another medical assistant have charge over supporting Maureen in the course of their appointment. On top of this, if they call back in response to a voice message some of them will speak "only to Andrew."
Danika, being not only Andrew's mother but also a stiff-upper-lip, proper British lady, is fun to watch and listen to as she "takes on" these "predatory patients."
"Cleary Medical Associates, this is Danika, how may I help you?" she will say as she answers the phone. "I'm sorry, Andrew is not available now, Irene, how may I help you?"
"I'm sorry, Irene, what is it you need? Andrew is with another patient; what can I do for you? Yes, I know that he does a great job with blood draws; many patients have also commented that his skills are very good. Yes, I know that he pleasant and has a good sense of humor. How may I help you today?"
"I see that he called to give you some lab results. I can do this; the results are on your chart. No, Irene, I am capable of giving you these results; Andrew is not available," she continues, an edge to her accent becoming more pronounced; her eyes narrowing as she fights back the impulse to hammer the telephone receiver against the desktop.
By this time, Andrew is free and says he can take the call. As Irene is now on hold, Danika, addressing Andrew says, "NO! She is not going to manipulate us! She thinks that she can only talk with you, and she needs to understand that anyone in the back office is able to address her questions or take a message."
Danika gets back on the phone call, now a little more composed, and very professionally lets Irene know that we work as a team, and the most important thing is that patients receive their testing results in a timely fashion. Obviously Irene agrees and allows Danika to give her the test results, which will necessitate her scheduling a follow up appointment. Danika sets the appointment and ends the call saying, "So we will see you next week, Irene..... Oh, Andrew works everyday and he should be here on Wednesday, but I can't guarantee it. If he isn't, there will be a medical assistant here helping Maureen. Have a nice day. See you next week."
So for what it is worth, it is a blessing to have back office staff who possess outstanding clinical skills. We have struggled for many years to bring together people with a strong work ethic, diligent, caring and personable. It is also a blessing to work with staff who provide not only great medical support, but who are hugely entertaining.
Monday, June 20, 2016
Whatever Happened to Flag Waving?
We are in one of my favorite times of the year: those weeks between Memorial Day and Independence Day. Spring moves into summer, days are longer and with Flag Day falling between these national holidays, we have three opportunities to recall those things unique to our American heritage.
What we have and what we are able celebrate in the 21st century is the direct result of generations of Americans, many of whom, in spite of the disparate cultures and beliefs, came to these shores in optimistic hopes for something better. What they did, and what so many immigrants who come here today are unwilling to do, is set aside their native heritage to become part of and pursue a dream of health, life, happiness and freedom only possible here. Immigrants of the past made the active choice to leave one culture for the hope of creating something greater in a country that valued and rewarded ideals like honesty, integrity, hard work and giving back.
The best example to illustrate this point is Frank Capra. The renowned movie producer and director immigrated from Italy to the United States with his family (parents and six brothers and sisters) in the last decade of the 19th century. As a youngster he sold newspapers, fruit, played the banjo in saloons and worked other odd jobs in order to save money for college.
While studying chemical engineering at Cal Tech, he worked as a waiter, ran the school laundry, worked in a power plant. He also edited the school newspaper and served as a captain in the Cal Tech ROTC unit. The rest of this biographical background can be read at click here
His journey took him into the film industry and most people will remember Capra for his "screwball comedies" of the 1930s and 1940s. What I appreciate about his body of work, though, is how he melded a sometimes crazy storyline with the ideas of social consciousness -- entertaining audiences and at the same time bringing home points of optimism and really, the innate goodness of people. He made movies at a time when people needed to see and feel good about the circumstances in their world, particularly the Great Depression. During World War II, and like other movies made in this time, the undercurrent theme was unabashedly American. With battles and warfare scattered across the globe, Americans still suffering the economic ravages of the Depression, the stresses families felt as loved ones were sent overseas to fight, Capra's movies provided an escape from the harsh realities of life.
Many of the stories Capra brought to the screen portrayed the idea of the struggle of the "little guy" when confronted with those corrupt powerbrokers of business, finance or even government. Besides that now standard Christmas favorite It's a Wonderful Life, those interested should check out You Can't Take it with You, Mr. Deeds Goes to Town, and one of my new favorites, Mr. Smith Goes to Washington. The theme of American individualism, American honesty, the ideals of hard work, being a good neighbor -- those things that are now considered "so much sentimentality" and not so much "reality" are lost on at least two generations of Americans who have little knowledge of our American heritage and what it truly means to be an American.
Francois Truffaut, the iconic French filmmaker, (director, screenwriter, actor and film critic), had this to say about Frank Capra:
In recognizing the facts of human suffering, uncertainty, anxiety, the everyday struggles of life, Capra, with his unquenchable optimism, was a healing force. This good doctor, who was also a great director, became a restorer of men's spirits.
In these very uncertain times with the threats of war and global terrorism, American cities suffering the ravages of unemployment, increased crime, widespread corporate and government corruption, wouldn't it be great if another Frank Capra -- immigrant-turned-American -- emerged to remind us of the optimism and hope that really is what America is all about? Everyday struggles are the plight of all humans, but what America offered was an ability to build a brighter life in spite of the obstacles, simply because American culture fostered the idea that hard work, honesty, ingenuity and the value of the individual are the things that the human spirit needs to thrive in this life.
So we fly our American flag from Memorial Day through Independence Day. It is a simple thing to do and a wonderful reminder of what it is to be American.
What we have and what we are able celebrate in the 21st century is the direct result of generations of Americans, many of whom, in spite of the disparate cultures and beliefs, came to these shores in optimistic hopes for something better. What they did, and what so many immigrants who come here today are unwilling to do, is set aside their native heritage to become part of and pursue a dream of health, life, happiness and freedom only possible here. Immigrants of the past made the active choice to leave one culture for the hope of creating something greater in a country that valued and rewarded ideals like honesty, integrity, hard work and giving back.
The best example to illustrate this point is Frank Capra. The renowned movie producer and director immigrated from Italy to the United States with his family (parents and six brothers and sisters) in the last decade of the 19th century. As a youngster he sold newspapers, fruit, played the banjo in saloons and worked other odd jobs in order to save money for college.
While studying chemical engineering at Cal Tech, he worked as a waiter, ran the school laundry, worked in a power plant. He also edited the school newspaper and served as a captain in the Cal Tech ROTC unit. The rest of this biographical background can be read at click here
His journey took him into the film industry and most people will remember Capra for his "screwball comedies" of the 1930s and 1940s. What I appreciate about his body of work, though, is how he melded a sometimes crazy storyline with the ideas of social consciousness -- entertaining audiences and at the same time bringing home points of optimism and really, the innate goodness of people. He made movies at a time when people needed to see and feel good about the circumstances in their world, particularly the Great Depression. During World War II, and like other movies made in this time, the undercurrent theme was unabashedly American. With battles and warfare scattered across the globe, Americans still suffering the economic ravages of the Depression, the stresses families felt as loved ones were sent overseas to fight, Capra's movies provided an escape from the harsh realities of life.
Many of the stories Capra brought to the screen portrayed the idea of the struggle of the "little guy" when confronted with those corrupt powerbrokers of business, finance or even government. Besides that now standard Christmas favorite It's a Wonderful Life, those interested should check out You Can't Take it with You, Mr. Deeds Goes to Town, and one of my new favorites, Mr. Smith Goes to Washington. The theme of American individualism, American honesty, the ideals of hard work, being a good neighbor -- those things that are now considered "so much sentimentality" and not so much "reality" are lost on at least two generations of Americans who have little knowledge of our American heritage and what it truly means to be an American.
Francois Truffaut, the iconic French filmmaker, (director, screenwriter, actor and film critic), had this to say about Frank Capra:
In recognizing the facts of human suffering, uncertainty, anxiety, the everyday struggles of life, Capra, with his unquenchable optimism, was a healing force. This good doctor, who was also a great director, became a restorer of men's spirits.
In these very uncertain times with the threats of war and global terrorism, American cities suffering the ravages of unemployment, increased crime, widespread corporate and government corruption, wouldn't it be great if another Frank Capra -- immigrant-turned-American -- emerged to remind us of the optimism and hope that really is what America is all about? Everyday struggles are the plight of all humans, but what America offered was an ability to build a brighter life in spite of the obstacles, simply because American culture fostered the idea that hard work, honesty, ingenuity and the value of the individual are the things that the human spirit needs to thrive in this life.
So we fly our American flag from Memorial Day through Independence Day. It is a simple thing to do and a wonderful reminder of what it is to be American.
Thursday, June 16, 2016
In the Clinic the Struggle for Understanding Can Be Humorous
One of the nicest benefits to being part of a small medical practice is that patients come to know each of the staff, and the interactions can be pleasant and, at times, amusing.
A few years ago, when the only "associates" to Cleary Medical Associates were our medical assistant, Jeannine and me, Dr. Cleary had a middle-aged gay patient who unfortunately had a host of chronic care diseases. When Barry came to the office it was typically an extended appointment. Barry did not drive and really came a long distance to see Tim.
One afternoon, Barry came for his appointment and with him was his partner, Jess. As Jess was not a patient and Barry declined having him come back to be part of the office visit, he remained in the waiting room. Jess was a gruff sort, apparently not interested in any of the magazines or other reading material we had available. He just sat there staring at me as I worked at the front desk. I decided I would try to talk with him, but all my attempts to engage him is some light conversation fell flat. His reticence may also have been increased when another patient, an elderly gentleman named John, came in for his appointment.
At this point Jeannine emerged from her after school spot in a little room we set up for her complete with books, games and a DVD player so she could watch her favorite movies. She had grown tired of being at the office, so she came out to see if there was anything of interest to do. She saw John, and having seen and talked with him before, immediately went to the waiting room to say hi. After chatting with him for a few minutes, she turned her attention to Jess.
"Great," I thought to myself, "she is going to try to talk with him, and he will rebuff her." Jeannine doesn't take being put-off very well, and I was not at all sure how he would react to our little soul or how she would respond to his gruffness. Braced for the worst, I watched as Jeannine went across the room and sat in the chair next to Jess.
"Hi," she said, "My name is Jeannine. Are you here to see my dad?"
"No," Jess replied, "I am waiting for Barry."
"Oh, so you are not a patient."
"No," came the brief response.
"What is your name?" she asked.
"Jess."
"Oh, so are you married?" she inquired.
"No, I have a partner," he said.
"So you are married."
"No, I have a partner, Barry."
"So what is your wife's name?"
"I don't have a wife; I have a partner."
"OK, so what is your wife's name?" she asked again.
"I don't have a wife. I have a partner."
"Oh, so what's your wife's name?"
At this point I am trying not to lose it as this question and answer session carried on for about three minutes. It was amusing to me to watch Jess struggle to get Jeannine to understand the very different relationship he and Barry shared with an audience intent on following this conversation. He was clearly at a loss to find the words she might understand, but was surprisingly very patient with her.
John, for his part, sat quietly trying to concentrate on the book he brought to read. Every now and then, though, Jess would glance his way, then mine, not in an attempt to plead for help -- perhaps it was just to see how we were reacting to it all. At length the medical assistant came to call John back and Jeannine knew that Jess would be leaving soon.
As she moved from her perch next to Jess, she turned back to him to thank him, and would he please tell his wife "Hello."
"Sure," he said, finally giving up any hope of having her understand.
So for what it is worth, I am glad that I did not interfere with Jeannine's interaction with Jess. As much as I would have liked to divert Jeannine to something else, I knew any efforts would only lead to her becoming upset with me, with an uncomfortable scene likely to ensue. Besides, it was far too funny to watch these two go back and forth in what might have been an unending conversation. In the end, Jess became a patient in the practice and without fail, when he would come to his appointments, if Jeannine was not immediately present, he would always ask where she was...."the real manager in the office." And, without fail, she would pop out from wherever she was and go out to talk with him.
A few years ago, when the only "associates" to Cleary Medical Associates were our medical assistant, Jeannine and me, Dr. Cleary had a middle-aged gay patient who unfortunately had a host of chronic care diseases. When Barry came to the office it was typically an extended appointment. Barry did not drive and really came a long distance to see Tim.
One afternoon, Barry came for his appointment and with him was his partner, Jess. As Jess was not a patient and Barry declined having him come back to be part of the office visit, he remained in the waiting room. Jess was a gruff sort, apparently not interested in any of the magazines or other reading material we had available. He just sat there staring at me as I worked at the front desk. I decided I would try to talk with him, but all my attempts to engage him is some light conversation fell flat. His reticence may also have been increased when another patient, an elderly gentleman named John, came in for his appointment.
At this point Jeannine emerged from her after school spot in a little room we set up for her complete with books, games and a DVD player so she could watch her favorite movies. She had grown tired of being at the office, so she came out to see if there was anything of interest to do. She saw John, and having seen and talked with him before, immediately went to the waiting room to say hi. After chatting with him for a few minutes, she turned her attention to Jess.
"Great," I thought to myself, "she is going to try to talk with him, and he will rebuff her." Jeannine doesn't take being put-off very well, and I was not at all sure how he would react to our little soul or how she would respond to his gruffness. Braced for the worst, I watched as Jeannine went across the room and sat in the chair next to Jess.
"Hi," she said, "My name is Jeannine. Are you here to see my dad?"
"No," Jess replied, "I am waiting for Barry."
"Oh, so you are not a patient."
"No," came the brief response.
"What is your name?" she asked.
"Jess."
"Oh, so are you married?" she inquired.
"No, I have a partner," he said.
"So you are married."
"No, I have a partner, Barry."
"So what is your wife's name?"
"I don't have a wife; I have a partner."
"OK, so what is your wife's name?" she asked again.
"I don't have a wife. I have a partner."
"Oh, so what's your wife's name?"
At this point I am trying not to lose it as this question and answer session carried on for about three minutes. It was amusing to me to watch Jess struggle to get Jeannine to understand the very different relationship he and Barry shared with an audience intent on following this conversation. He was clearly at a loss to find the words she might understand, but was surprisingly very patient with her.
John, for his part, sat quietly trying to concentrate on the book he brought to read. Every now and then, though, Jess would glance his way, then mine, not in an attempt to plead for help -- perhaps it was just to see how we were reacting to it all. At length the medical assistant came to call John back and Jeannine knew that Jess would be leaving soon.
As she moved from her perch next to Jess, she turned back to him to thank him, and would he please tell his wife "Hello."
"Sure," he said, finally giving up any hope of having her understand.
So for what it is worth, I am glad that I did not interfere with Jeannine's interaction with Jess. As much as I would have liked to divert Jeannine to something else, I knew any efforts would only lead to her becoming upset with me, with an uncomfortable scene likely to ensue. Besides, it was far too funny to watch these two go back and forth in what might have been an unending conversation. In the end, Jess became a patient in the practice and without fail, when he would come to his appointments, if Jeannine was not immediately present, he would always ask where she was...."the real manager in the office." And, without fail, she would pop out from wherever she was and go out to talk with him.
Thursday, June 9, 2016
In the Clinic: Let the Saga Begin
Tim and I are so deeply blessed to be able to work together. For about 20 years our daily work occurred in two places: his at his outpatient clinic location and mine in the endeavor of herding children on their daily adventures. A dozen years ago, though, he made the decision to chuck corporate, large clinic medicine with its myriad of physician administrators, pharmacists, clinic administrators and referral committees to go back to a solo practice. The caveat was that I would be called on to manage the day-to-day business so he could do what he does best -- build relationships with his patients to serve them when his skill was needed and partner with them to keep them healthy.
It was at this point that I could see first-hand what it means to be a physician, and it was a huge education for me trying to manage Tim's schedule with no fund of knowledge. I mean, I could manage my schedule and keep the children on task with theirs, but I had never thought it was rocket science to put a patient on his schedule and it not create a major problem. How difficult could that be? More challenging than it appears.
The number of times I scheduled a patient to be seen, and only allowed 10 minutes for Tim to diagnose and treat "just a sore throat," or "right-sided back pain" is epic. It never occurred to me that a pain in someone's back, or side, or head could be anything more complex than what it is, so it should be a "no-brainer" to be able to quickly come to the conclusion that the patient may only need something simple, say, some over the counter remedy or possibly just rest.
Little did I then understand that each patient who comes to be helped brings a unique blend of health and wellness, the strength of which can, in most cases, be related to lifestyle. From Tim, I have learned that treating a sore throat in an otherwise healthy person is not at all like treating a patient who comes to the clinic with diabetes, hypertension, anxiety, depression or some combination thereof, complaining of the same sore throat. He needs to listen, question, examine and consider treatment options based on the patient's overall health, medications (including supplements) they may be taking, drug allergies and the like -- all of which cannot be done in the span of 10 minutes. Indeed, the major reason he left large group practice was directly related to administratiion's pressure for providers to "push through" as many patients as possible in the course of a day, with the requisite patient paperwork to be completed before leaving the clinic.....and here I was doing the same thing to him.
We clipped along for a year or so, just Tim, Jeannine, me and a medical assistant in one form or another. As the years passed, though, Tim's reputation as a caring, compassionate physician grew and we found ourselves with a many, many patients to help. The push for implementing more technology into the practice, what is now called "health information technology," required additional staff and we soon found ourselves with not only a medical assistant supporting Tim, but another full-time administrator to support me. God is certainly good, because after trial and error we were able to secure an outstanding medical assistant, Danika, as well as bring into the practice our eldest daughter, Mary, to support me.
A primary care practice of around 3500 patients, of which roughly 2000-2500 are actively seeking routine medical care, still requires additional support, so it wasn't long before we were looking for another medical assistant to work with Danika and our physician assistant Maureen.
We advertised, sought recommendations from the technical training schools, used externs, but we were just not able to bring another medical assistant into the fold and have it work out longer than six months. Then we found Andrew, who happens to be Danika's son.
So for what it is worth, our merry little band at Cleary Medical Associates solidified about three years ago. Tim and Maureen of course manage the very clinical direct patient care while Danika and Andrew admirably support them in the back office. Mary's administrative duties cover any and all aspects of front office work, helping me in too many ways to mention here. At the heart of it all, though, is Jeannine. Her value is beyond measure as she manages all of us, patients included. God is certainly good. More later.
It was at this point that I could see first-hand what it means to be a physician, and it was a huge education for me trying to manage Tim's schedule with no fund of knowledge. I mean, I could manage my schedule and keep the children on task with theirs, but I had never thought it was rocket science to put a patient on his schedule and it not create a major problem. How difficult could that be? More challenging than it appears.
The number of times I scheduled a patient to be seen, and only allowed 10 minutes for Tim to diagnose and treat "just a sore throat," or "right-sided back pain" is epic. It never occurred to me that a pain in someone's back, or side, or head could be anything more complex than what it is, so it should be a "no-brainer" to be able to quickly come to the conclusion that the patient may only need something simple, say, some over the counter remedy or possibly just rest.
Little did I then understand that each patient who comes to be helped brings a unique blend of health and wellness, the strength of which can, in most cases, be related to lifestyle. From Tim, I have learned that treating a sore throat in an otherwise healthy person is not at all like treating a patient who comes to the clinic with diabetes, hypertension, anxiety, depression or some combination thereof, complaining of the same sore throat. He needs to listen, question, examine and consider treatment options based on the patient's overall health, medications (including supplements) they may be taking, drug allergies and the like -- all of which cannot be done in the span of 10 minutes. Indeed, the major reason he left large group practice was directly related to administratiion's pressure for providers to "push through" as many patients as possible in the course of a day, with the requisite patient paperwork to be completed before leaving the clinic.....and here I was doing the same thing to him.
We clipped along for a year or so, just Tim, Jeannine, me and a medical assistant in one form or another. As the years passed, though, Tim's reputation as a caring, compassionate physician grew and we found ourselves with a many, many patients to help. The push for implementing more technology into the practice, what is now called "health information technology," required additional staff and we soon found ourselves with not only a medical assistant supporting Tim, but another full-time administrator to support me. God is certainly good, because after trial and error we were able to secure an outstanding medical assistant, Danika, as well as bring into the practice our eldest daughter, Mary, to support me.
A primary care practice of around 3500 patients, of which roughly 2000-2500 are actively seeking routine medical care, still requires additional support, so it wasn't long before we were looking for another medical assistant to work with Danika and our physician assistant Maureen.
We advertised, sought recommendations from the technical training schools, used externs, but we were just not able to bring another medical assistant into the fold and have it work out longer than six months. Then we found Andrew, who happens to be Danika's son.
So for what it is worth, our merry little band at Cleary Medical Associates solidified about three years ago. Tim and Maureen of course manage the very clinical direct patient care while Danika and Andrew admirably support them in the back office. Mary's administrative duties cover any and all aspects of front office work, helping me in too many ways to mention here. At the heart of it all, though, is Jeannine. Her value is beyond measure as she manages all of us, patients included. God is certainly good. More later.
Making Each Day Count
Our days and our nights come and go pretty quickly. In between the sunrises and sunsets there are countless diversions and interruptions in our work or play -- the noise surrounds us and our brains are continually filtering and refiltering the static and activities in a effort to make sense of it all. This can be both mentally and physically exhausting.
The ability to pull away from time to time in the course of the day is a wonderful habit of health and many people will meditate, chant, take deep breaths or other things to move their minds ever so briefly away from the activities and concerns of the day. For me, I like to pray.
The best regimen I have adopted surrounds intentional prayer. Waking early, my thoughts will focus on those century-old prayers which remind me that the day is "not all about me," -- that my "prayers, works, joys and sufferings" will be offered as I serve others throughout the day. I will call on the Guardian Angels and others of my favorite heavenly intercessors to guide me through the day as the seconds tick into minutes, then minutes into hours.
The problem is that I then get going on the day and inevitably Tim will start his totally annoying morning yammering of nonsense or break out in song, followed by his comment, "I could have been an opera star." Yeah, he could have been something, but quiet doesn't seem to be among the choices.
If not him, then there is Jeannine. I never know exactly what awaits me as I make my way down the hall toward her room each morning. Sometimes she is wide awake and energized for the day -- up and getting the morning ablutions completed without me nagging. Most mornings, though, her reply to my cheery "Good Morning, Fuzzy!" is a groan or some unhappy mutterings I don't understand and she declines to repeat. All of a sudden those great intentions that started my day are forgotten as the noise begins to creep into my brain.
Life really intervenes and I find myself putting out brush fires and reacting to the activities of the day; furthermore, I find that I have lost that mindfulness of purpose I set as the day began to serve those around me with an open heart (you know, forgetting the it's not all about me attitude). This has really bothered me as I truly wanted to be able to live each day as positively and lovingly as possible. That infernal static just keeps getting in the way of my good intentions.
I finally had an idea to reset myself and I used the alarm on my phone to sound at 3 pm each day in order to do some intentional prayer. Those in the office, particularly Jeannine, are now accustomed to hearing the etherial harp sounding from my phone as my reminder to exit the busy-ness of the day for some intentional prayer.
I like to do a short version of the Divine Mercy devotion and meditate on the sufferings and death of Our Lord. Those few minutes in contemplation will many times reorient me and in the meditation of what He endured for me...how He served me to the fullest measure of His life...I renew my sense of purpose and many times I am able to close out the day at the office much less negative and irritable.
Making my way home at the close of each work day, and knowing that our evening routine may not quite be routine, it is nice to be able to recite my daily Rosary. In the time it takes to arrive home, I find that I can almost complete five decades, and if Jeannine decides to join in, we can finish the few remaining prayers before taking on the "real" business at hand: dinner.
You would think that the evenings at home, those few remaining hours before sunset, would be happy and productive hours. Sadly this is not always the case. Without intending to throw Jeannine under the bus, the nights are often fraught with contention as I struggle to encourage her to get some exercise done (taking a walk, dancing to her dance DVD), or goodness knows, take a shower, wash her hair and brush her teeth. My frustration builds and it is only as I leave her room after night prayers that I recall what Someone did for me, without complaint, but with humility and meekness. I have often turned to go back to Jeannine's room just to give her a hug and let her know I am sorry for any injustices I inflicted throughout the day, only to be met with a distinct look of bewilderment and impatience that I was "back again" to cause her more grief. Oh well.
So what it is worth, there will always be noise and static filling my days. Striving to avoid it is not practical unless I want to live in a cave by myself. Avoiding people and situations that impede my progress isn't the answer as it does not move me out of any comfort zone, encourage me to be brave and above all make me a better person. The answer is to embrace the noise, the static and commotion that fill my days with the idea that everything I do is a "prayer, work, joy, and sometimes a suffering."
The ability to pull away from time to time in the course of the day is a wonderful habit of health and many people will meditate, chant, take deep breaths or other things to move their minds ever so briefly away from the activities and concerns of the day. For me, I like to pray.
The best regimen I have adopted surrounds intentional prayer. Waking early, my thoughts will focus on those century-old prayers which remind me that the day is "not all about me," -- that my "prayers, works, joys and sufferings" will be offered as I serve others throughout the day. I will call on the Guardian Angels and others of my favorite heavenly intercessors to guide me through the day as the seconds tick into minutes, then minutes into hours.
The problem is that I then get going on the day and inevitably Tim will start his totally annoying morning yammering of nonsense or break out in song, followed by his comment, "I could have been an opera star." Yeah, he could have been something, but quiet doesn't seem to be among the choices.
If not him, then there is Jeannine. I never know exactly what awaits me as I make my way down the hall toward her room each morning. Sometimes she is wide awake and energized for the day -- up and getting the morning ablutions completed without me nagging. Most mornings, though, her reply to my cheery "Good Morning, Fuzzy!" is a groan or some unhappy mutterings I don't understand and she declines to repeat. All of a sudden those great intentions that started my day are forgotten as the noise begins to creep into my brain.
Life really intervenes and I find myself putting out brush fires and reacting to the activities of the day; furthermore, I find that I have lost that mindfulness of purpose I set as the day began to serve those around me with an open heart (you know, forgetting the it's not all about me attitude). This has really bothered me as I truly wanted to be able to live each day as positively and lovingly as possible. That infernal static just keeps getting in the way of my good intentions.
I finally had an idea to reset myself and I used the alarm on my phone to sound at 3 pm each day in order to do some intentional prayer. Those in the office, particularly Jeannine, are now accustomed to hearing the etherial harp sounding from my phone as my reminder to exit the busy-ness of the day for some intentional prayer.
I like to do a short version of the Divine Mercy devotion and meditate on the sufferings and death of Our Lord. Those few minutes in contemplation will many times reorient me and in the meditation of what He endured for me...how He served me to the fullest measure of His life...I renew my sense of purpose and many times I am able to close out the day at the office much less negative and irritable.
Making my way home at the close of each work day, and knowing that our evening routine may not quite be routine, it is nice to be able to recite my daily Rosary. In the time it takes to arrive home, I find that I can almost complete five decades, and if Jeannine decides to join in, we can finish the few remaining prayers before taking on the "real" business at hand: dinner.
You would think that the evenings at home, those few remaining hours before sunset, would be happy and productive hours. Sadly this is not always the case. Without intending to throw Jeannine under the bus, the nights are often fraught with contention as I struggle to encourage her to get some exercise done (taking a walk, dancing to her dance DVD), or goodness knows, take a shower, wash her hair and brush her teeth. My frustration builds and it is only as I leave her room after night prayers that I recall what Someone did for me, without complaint, but with humility and meekness. I have often turned to go back to Jeannine's room just to give her a hug and let her know I am sorry for any injustices I inflicted throughout the day, only to be met with a distinct look of bewilderment and impatience that I was "back again" to cause her more grief. Oh well.
So what it is worth, there will always be noise and static filling my days. Striving to avoid it is not practical unless I want to live in a cave by myself. Avoiding people and situations that impede my progress isn't the answer as it does not move me out of any comfort zone, encourage me to be brave and above all make me a better person. The answer is to embrace the noise, the static and commotion that fill my days with the idea that everything I do is a "prayer, work, joy, and sometimes a suffering."
Monday, June 6, 2016
Walking Jeannine
Walking Jeannine
Barbara Cleary
Walking is considered one of the easiest and most affordable habits of health a person can embrace. In fact, Dan Buettner, author of The Blue Zones, identifies "moving naturally" as one of the Power9 Strategies of those living to be 100 or more -- and what is more natural than walking and walking with a purpose?
I have always loved walking as exercise. In those years when Jeannine was in preschool, I would often take part of that three hour block of free time to go to the local mall and walk with the senior citizens before the stores opened. At first the challenge was to be able to keep up with them as they walked their laps. All too often, though, a new window display would catch my eye and before I knew it, a dozen people had passed me. How could I lose my imaginary Indy 500 walking race around the mall to a group of seniors? Ever the competitive spirit, I disciplined myself to avoid such distractions and before I knew it, I was lapping even the most dedicated of those walkers.
I then turned my sights on timing. With a basic pedometer, I calculated that walking the mall -- including all the "cul de sacs" -- I could get a little more than three miles completed in about 40 minutes. I could log almost 8000 steps all before 10 am as well!
Those were the golden days. Life has moved on more than intervened, and my daily travels around Portland no longer take me near that mall. My daily schedule prohibits me from walking with the seniors. It has been difficult to get back to committing myself to a walking schedule, and I have tried many creative ways to once again bring this habit of health back into my life.
I tried walking the neighborhood, which would really be ideal because we live in a very hilly place and the interval training this naturally brings would be perfect for me. The problem is that I am at heart a "fair weather" athlete: I will do any outdoor activity if the weather is optimal. It doesn't help that I live in Portland, Oregon because many days here do not inspire that motivation to get out and click off those steps. Then I went to Plan B. I could "Walk On-Demand" from the comfort and security of my own home.
Plan B did not last very long, either. The wonders of cable TV could have been the catalyst for my return to a walking regimen, but sadly I discovered that as much as I was a "fair weather" outdoor walker, I was even more of a "fair weather" riser. I was great at popping out of bed at 5:30 or 6 am if my husband had decided to go to the gym to get his workout completed before going to the office. I found, though, that I was much less inclined to move if he decided to postpone his exercise until later in the day. It wasn't so much that it was too comfortable to move, as much as it was that I didn't want Tim to catch me looking pretty silly at 6 am gyrating around our bonus room as I followed the lead of the "instructor" in a pathetic attempt to get a "2 Mile Walk" completed in 22 minutes. On to Plan C: enlist the help of our young adult daughter, Jeannine.
Jeannine has Down syndrome, and like me, sees walking as one of those things she can take or leave (mostly leave). There have been mornings when she will be inspired to walk the neighborhood, headset and music in tow, no matter the weather. The problem is that she wants to exert her muscle of independence on her own and really balks at the idea of a walking partner. In the end, I allow her to win "The War of Jeannine Independence" and I still don't get my walking done.
In a rare mood about two weeks ago, Jeannine happily agreed to walk with me to the grocery -- a journey of about a mile and a half. My purpose was just to get a cup of coffee from the in-store Starbucks. As it was a bright, warm and sunny early fall day, and, when Bales Thriftway is the incentive, Jeannine is up for the task.
One does not walk "with" Jeannine as much as "walk" Jeannine. Other walking companions will keep a flow of conversation going about any number of topics, or otherwise engage in some social interaction...not so Miss Jeannine. When she is really up for the walk, though, she dons her headset and iPhone and bops along ahead of me employing any and all dance moves she can create as well as singing at the top of her lungs. Sometimes I wish I was in one of the oncoming cars just to be able to see what she looks like from the front. Her Down syndrome characteristic small ears and ear canals prohibit her from using the earbuds most people now wear, and it has to be quite comical watching her from the front, because every now and then she has to readjust the bright blue headset as it begins to slip off her head. This, combined with her need to pull up her pants as they fall down makes for a very interesting sight.
We managed to make it to the grocery in about 40 minutes, where she promptly sat down at one of the outdoor tables and chairs. As I explored the flower baskets and plants in the garden area, I lost track of her. Thinking that I would find her in line at Starbucks, I made my way into the store where, not seeing her in line, prompted me to head to gluten-free aisle or the candy section....where she was not to be found.
There is not one person working in the store who does not know Jeannine and pretty soon I saw her holding court to three or four employees at a check out stand. After receiving my usual, "Not now, Mom," from her as she continued plying her captive audience with questions, I asked if she wanted any water before we headed home. She was not interested in hydrating be it water or anything else, so I firmly prodded her to end her interviews and we made our way back home.
The trek home was a night and day difference. No happy dancing. No bouncing ahead of me. No singing to her music. As a matter of fact, she carried the headset home, walked behind me and grumbled about how her "feets hurt." Amazingly, though, when we reached the entrance to our neighborhood (some 60 minutes later), ready for the 6-degree climb to the top of hill where home is situated, she gained new energy and chattered her way up the sidewalk, anticipating a large glass of water, tossing off her shoes and resting on the couch.
What have learned? Well, while walking and walking with a purpose may be a terrific habit of health, I may have to consider a "Plan D" -- as in "deep-sixing" it for something else. Ideally this would be something that would involve Jeannine because we would dearly love to instill this habit of healthy movement in her. Perhaps my Plan D should involve dancing; then we both could look comical, but we would definitely have some fun!
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