Primary Care

Two weeks. For two weeks this month I worked in the local primary care clinic, seeing the daily parade of patients and problems: the good, the bad, the ugly.

The clinic was short-handed with some staff out for spring break, and I was able to help out at the front desk. I went through training last year to be a super-user for the clinic’s electronic record, and it helps me to stay current to go in and work in the live setting when I have opportunity. And it’s good to catch up with staff I used to see on a daily basis when I worked full-time in the admin department. Plus, the clinic is in Ketchikan, so I got to be in my own home while I fulfilled this commitment. So all good.

I’ve blogged about this before. Most of my work in the world of healthcare has been on the administrative side. I came into healthcare through the back door of grant writing and office work. I’ve expanded to policy writing, recruiting, project coordination…all tasks that are familiar and comfortable. But patients…now that’s different.

Patients are the reality check to all the work I do.

I usually work in quiet offices, with much of my day consumed with writing, or researching, or interacting with other staff: problem solving, planning, coordinating efforts, meetings, interviews. All valuable, and part of the mechanism that keeps staff in house and programs operating.

But in that world I’m shielded from the nitty, and the gritty. Two weeks of primary care changes that focus.

The other staff I worked with are great: patient, helpful, appreciative of the support I offer, even when it’s imperfectly delivered. In a busy clinic, you need all hands to juggle clinic hours (the clinic offers extended hours; some days the schedule begins at 7:00 AM, and others it ends at 7:00 PM), patient demands, and keep up with the minute-to-minute of busy days. Navigating the electronic system for patient registration,  scheduling appointments, fielding a million questions a day…ok, maybe a thousand, but it seems like more…well, I’m reminded again: I’m grateful to be healthy; humbled to recognize that my complaints of life are “first world” in nature; and I alternate between admiration of people who are cheerful and upbeat in the face of difficulty, and amazement at patients who abuse the very staff who are trying to help them.

Patients are thoughtful, kind, appreciative, attentive. Some are dainty little old ladies, or stately elderly men, in for blood pressure checks and routine appointments that make them regulars. The staff know them by heart. They’re the ones that give you a sense of purpose and satisfaction.

Others are also known, but not for their good traits. They’re rude, demanding, careless, dysfunctional. They’re the ones with an attitude and a knack for saying the wrong thing. They no-show for appointments, then complain when they can’t be worked in; they “lose” prescriptions; they’re quick to criticize and expect more. You see one of those names on the schedule for the day and you hope you don’t have to encounter them. They make you glad with their absence. And yet, even as you put on the smile and ignore the attitude that’s so inappropriate, you wonder: what happened to this person to turn them into a (take your pick) bitter/manipulative/ungrateful/difficult human being?

Work in a clinic setting, and it’s inevitable: you begin to have better understanding of the issues. The headlines about healthcare and insurance and regulations have a real-life meaning that you see through forms, and requirements, and layers of bureaucracy created to manage patients, and the business of paying for care.

The patients make it real too. Some of them can barely walk. Some of them smell. Some of them are dying, slowly but surely. Some of them are living, but miserably. I see the way the staff work with the needs, the challenges, the drama. I’m impressed that these people make a life of touching, healing, processing, listening, advocating, arranging, soothing. The list could go on, and does: the work is never-ending, and the reward is more of the same.

Sometimes it’s funny. When people become patients, you can expect the unexpected, and just when you think you’ve seen it all, it’s another day, and you’ve haven’t seen anything yet.

Sometimes it’s heartbreaking. Patients die, and every week there are two or three sympathy cards laid out on a back shelf, ready to mail “to the family of…”

I say it often: working in healthcare is not a job for the faint of heart.

The job of professionals is to make hard work look easy, and the team I just worked with does that on a regular basis. They find the grace to rise to the challenge every day.

I never had any aspiration to become a nurse, or a physician, or a hands-on healer of any sort. And I’ll admit I’m more than a little relieved that now I’ll go back to my role as a sometimes-recruiter, sometimes-project coordinator, juggling many balls and enjoying the variety of my world. But I have to acknowledge, a little time in the hot seat, interacting with patients is a good thing. It reminds me that there are people at the heart of the work I do from my safe and sanitized desk.

Three little words…

And those would be…you guessed it! Electronic health record! Life has been busy this summer, working between two clinics, both in the midst of major technology changes. I’m learning and growing with the rest of the staff. In one setting I’ve been more a facilitator, in the other, I’m a super-user. I’d like to have a cape to go with the title. Then I would know I’ve really arrived!

If you don’t know this technology, you will. Coming soon (if not already) to a health care facility near you, and pretty much everyone in this country, electronic health records take medical charts from paper, print-outs, and dictated notes to digital documents that will securely hold lists of meds, diagnoses, treatment plans, test results, diagnostic images and demographic information, all neatly and legibly…no more scrawled physician’s notes to decipher, no more jumble of physical charts.

No matter how much advance planning is done, the transition from paper to digital, or in the case of the second clinic, from one digital system to a new and more robust one, is painful. Painful, painful, painful. Workflows are different, responsibilities shift, new terminology abounds, tasks change. People get upset. Some are excited and adjust beautifully, others see it as the end of the world as they’ve known it. I see it as inevitable, and know that like any new process, a few months from now no one will think about it anymore; it will just be the way work is done. No drama, and hopefully minimal frustration. But that moment of recognition is still somewhere on the far horizon.

So this is my world, for the moment. Or it has been. I’m on a break, warming up in sunny California, escaped to a few days of RVing and slow living. I go back next Monday, ready for the “go live” in one clinic and ramping up to welcome new provider staff to the other clinic. Part-time contracting is interesting, and it can be rewarding. But this summer it’s also been just a wee bit hectic.

So, I’m glad to be back in my own little corner of the digital world, excited to pick up the threads of the blogs I’ve missed reading, and checking in to see what everyone’s been doing while I’ve been largely pre-occupied. I’ve missed my friends, and hope I’ve been missed too. Funny how you can spend all your time in front of a computer and still feel like you’ve been away!