Please please please, one or two little things that I keep forgetting to email each week that I have been clinic chief. Nothing terribly earth-shattering, most of it is common sense. Now my tenure comes to a close, and it passes on to Yakov and Jade. So to help them out, please try to follow the following:
1) WRITE FRIKKIN' NEATLY!! It's bad enough trying to get to know a patient whose chart is as high as an elephant's eye but to wade thru heiroglyphics in which you cannot make out whether the patient had an EMG or was recommended to have an EMG, or the MRI showed "mild C7-C8 extrusion" or "bad C7-C8 compression" or even if the patient had a neuro exam just adds insult to injury.
2) Along the lines of the first topic, please make sure to SIGN clearly - presumably YOU are the best person to decipher your OWN writing, and if the clinic chief cannot figure out who you are, this won't be streamlined. To say nothing of patient continuity. (patient what?)
2a) To aid and assist, abet and adjunct the point in #2, please also include your pager number. If you have a stamper-thingydo, feel free to use that. Sign in blood! Inscribe your personal genetic makeup - anything to ease the identification process.
2b) You can also take a white label/sticker and affix it to the front of the chart near the top and write your last name. That's what we sort of used to do. It takes no time at all to do and it's really helpful.
3) Come on time. Hey, come early! Don't say "clinic starts at 9:30 so I will come at 9:37" but rather "clinic starts at 9:30 but I will start at 9:24 b/c pts are already here and this way we speed things up so I see the attending first and get out first and this way patients don't try to break down the door whining and yellling that they have been waiting since the Truman administration to be seen and their ride is coming to pick them up RIGHT NOW and it is all the clinic chief's fault."
3a) In addition, Guy is trying to set up lectures and breakfasts. I don't know how or when these are going to be, but it should be good. Food for body and mind is a reason to come at 9 or 9:10.
New Thing, Pain Clinic specific: 4) We need a policy for kicking ppl out of the clinic and keeping them out. Often there is a note in the chart about a Utox that warrants discontinuing narcotics and then the patient is seen and prescribed narcs as if nothing happened. For all pain patients, please look at the previous neuro note or two AND at the intervening "chart review" type notes. Perhaps also a letter needs to be sent to ppl getting kicked out. Dr. Duarte is sort of working on this, but be aware, if one of your patients falls into this category, or you do a lab review and bingo - please deal with it appropriately. Similarly, we are trying to stop getting prior authorizations. So when there is a note in the chart "no more prior auths, discussed with patient" and then a subsequent note about obtaining prior auth's with no explanation, it looks bad in a number of ways. So let's stop. Generic morphine is just as good as MS Contin, right?
The LIJ clinic has problems. In fact, one might even say there are problems that have the LIJ clinic. (Computers, the lab system, the running out of consult forms, the fact that 10% of the charts are never there - especially Jen's patients' - the intimate relationship the waiting room has with the sanctum sanctorum, the attending stampers, the space, the pain patients, the clearance forms, the insurance holdups, the pain patients, the commuting back and forth to North Shore, the attending wait times, and oh yes, the pain patients...) But these few things are little things that we can do to make it easier on ourselves.
Thanks for listening to my little rant.
I await the next huge cataclysm - when the LIJ consult chief has home clinic at North Shore and Someone Else gets pulled to run LIJ clinic...
-Joseph
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