Medicine

Selling Alaska

/ Sheila / Leave a comment

I wear many hats in my day job. Working in healthcare has stretched me in ways I didn’t expect. Some of my tasks are straightforward…arranging meetings, trainings, working with electronic records, learning the work flow of clinic front office processes. Others allow for more creativity, more flexibility, require attention to details of individual need and style.

Recruiting for open provider positions falls into this second category. Selling a vision of professional satisfaction, personal choices, family stability in a new environment, all while keeping yourself and your message honest about the pros and cons of the opportunity you offer…it’s a challenge from the start.

You find yourself trying to read the people you talk with, imagining them in the setting you know well, wondering if they’ll be successful, weathering the difficulties of life in rural Alaska, and celebrating the triumphs.

Rob calls practicing in the small clinics of remote fishing villages “earning the stethoscope.”

I call it brave, sometimes foolhardy, not a choice for the faint of heart.

When you have to ferry out to the nearest hospital, or on a good weather day, take a float plane, advanced care options are not easy to come by. Actual medevacs cost a fortune, most of which we pay for via tax dollars.

I’m always amazed at the folks who live in the middle of nowhere, on tiny islands, and who regularly appear in the local clinic for any and every need under the sun. They travel out of town, going to regional hospitals for specialty consults, surgeries, treatments. They come back home to recover, to live out their days….some to overcome and thrive, others to give up and resign themselves to dying at home, in their own space.

The people who come to work in these clinics are often wide-eyed idealists, imagining they’ll have an Alaskan adventure, experience a frontier with all the romance and excitement the travel brochures promise. The folks who are transplants to Alaska mix with the local staff, people who understand the land, the life, and the limitations of practice here.

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The beauty is here, for sure, and the adventure too. But you have to really want it to get much of it…too often the hiking, fishing, exploring, and traveling charms that lure people to work here are elusive…too much of life is consumed with work, and traveling out to visit family, to tend to other life needs…it can be surprisingly difficult to work in Alaska and have much time to really enjoy leisure here, in my experience.

A lot of people come to pay off school debt, to put aside some nest egg money, work in under-served communities to fulfill a service obligation of some sort.

The health care shortage the whole country experiences seems amplified here, where people can’t easily drive to the next community over, likely have one clinic and maybe one or two providers to choose from for their primary care.

Every clinic in this region is recruiting, looking for a few good men and women who’ll be clinical super-heroes, serving patients and trying to keep from burn-out.

If I sound dramatic, I don’t mean to. It’s just the reality of doing a hard job in a beautiful but challenging environment. You never know what you’ll have to deal with, and you may have to deal quite a while before you can send your emergency patient on to a hospital.

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We’re interviewing a candidate this week, hoping to connect with a person who’s up to the challenge…someone who will be able to weather the weather, the annual 13 feet of rain that falls in this rainforest, and the small town setting that feels like a fishbowl at times.

The bait…the beauty of the land, the ocean, the trees…it’s amazing when you see it, green and blue and so big you can’t believe it. But it takes a special sort to take the relative isolation, the limited options of restaurants and stores and amenities. The other major resource is the people that live here: resilient, often self-reliant, taking life as it comes.

To be honest…and I am honest with these people…it’s a mistake to be anything but honest…I can only take it so long myself. Working part-time here works because it’s part-time. I love the beauty, but I’m more into eating salmon than catching it. And while I don’t need mega malls or big cities, I’ll admit I miss the road system I so took for granted when it was always just outside my door in the lower 48. And a few other conveniences that can be hard to come by in fishing villages.

But some people wear it like a glove, snuggling into the small town settings, finding joy in the community and the fishing and the boats and the water. That’s the person we hope to find. Helps to find a couple…this is a hard place to look for a significant other. And great medical skills are a must.

Here’s hoping for a good fit! The only thing worse than not persuading a candidate to take your open position is persuading the wrong candidate to take your open position. Trust me, a bad fit is never a good thing.

So we’re honest, but we’re also selling…selling a lifestyle, a place, professional opportunity, financial security.

Know anyone who would be a good fit? Send them my way! I have an adventure to share!

Three little words…

/ Sheila / 4 Comments

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!

Empathy

/ Sheila / 7 Comments

This video makes me think as I go about my hustle-bustle life, working in the health care arena every day…easy to see patients as data points and staff as names filling in the call calendar. This is a reminder that they are each individuals with hopes, joys, sorrows and fears; weary, excited, disillusioned or naïve. Patients and staff bring their whole selves into each encounter. As much as medical professionals try to be professional…they are human beings first. And patients may be easy or difficult to address. But they are people, not numbers.

May we remember to give grace to the person across from us, walking beside us…even to the one who is unreasonable or demanding or simply not comprehending. You never know what is going on underneath the surface…what their life story is at this very moment.

“We must learn to regard people less in the light of what they do or omit to do, and more in the light of what they suffer.” 
― Dietrich Bonhoeffer, Letters and Papers from Prison

Reality check

/ Sheila / 1 Comment

I went for a little ride yesterday. No, I wasn’t at Disneyland or driving some stretch of highway. I was lying on a table in the ultrasound room of the Women’s Imaging Center, waiting for the results of a breast exam. It was a long half hour.

I had a mammogram a few weeks ago, just a routine screening. I got a call on my cell from my gynecologist’s office while I was in Arizona for Riley’s birthday. I needed to come back for a follow up. The radiologist had requested “more views.”

“This happens all the time,” the woman on the phone said. “They just like to be sure they haven’t missed anything.” Well, I was in baby mode, birthday mode, and it was comforting to accept that opinion. I didn’t lose any sleep over it, but I did make an appointment to have the second screening when I got back to Ketchikan.

I went downstairs for the second mammogram yesterday morning. Fortunately for my peace of mind, the radiologist read the images right away. She was still not quite satisfied, and recommended the next step, a breast ultrasound. I agreed; better to be safe than sorry. Since I work in the hospital, I asked the person scheduling to work me in whenever she had an opening. It might be a few days, but she assured me she would do that.

Two hours later I got a call. Could I come down at 2:30? Yes, I was happy to get this done, get it out of the way. A little voice in my head wondered if this was really just a sudden opening, or if there was something the radiologist had seen that pushed me up in the urgent queue? I hadn’t picked up on any concern. But isn’t that the job of professionals? Don’t alarm the patient. Remain calm. And after all, they do this every day. I’m the novice. I can still count on one hand the number of mammograms I’ve had.

The staff in the imaging clinic is extremely nice. I am polite and calm as I check in. The gowns are warmed. The lighting is soft.  No one is excited here, we all know this is just routine. If they don’t seem alarmed, why should I? I could have taken a nap during the ultrasound, except that it’s a bit difficult to relax with gel on your breasts and questions going through your mind every time the tech lingers over a specific spot. What does she see? Why is she slowing down? I know it’s not appropriate to ask the technician to tell me what she thinks. Although I’m sure anyone in that role has enough knowledge to recognize an abnormal tissue mass, it is not the tech’s responsibility to discuss findings with the patient. So I resist the urge to pepper her with questions. I’m a model patient, shifting and adjusting as she completes the test.

Again, the radiologist will read the views right away. And again I wonder: is that normal, or do they seem something that requires urgency? The tech steps out of the room to confer with the doctor, and I’m left to stare at the ceiling and question.

I think the things that I assume most women think: this will be fine. Nothing to see here. I comfort myself. I don’t have a family history of breast cancer. I feel fine. I’m only 50! (Cliché alert: as they say, it looks younger every day!)

Then, for just a moment, I allow myself to imagine. This is how it starts sometimes. Just a routine exam, a little question, another test. And then, something definite. A diagnosis is made. Suddenly the lists are not about errands or chores, they are about appointments, tests, surgery, follow up, treatment. I watched my dad go down this path with colon cancer. I’ve seen others go through this. Why do I think I’m immune from this possibility? Why do any of us think the age old “it won’t happen to me?” I already know the end of the story. I know someday I’ll die of something. But I’m only 50! And that eventual reality is comfortably distant, isn’t it?

I think about the times in life that have focused me: the birth of my children, the loss of a loved one. Or on rare occasions, the poignant moments that stand out, that are frozen in my memory: the good stuff. Why, I ask myself, why can’t I keep the truly important things at the top of the list? Why do they always slip down below the urgent? Why is so much of life about keeping milk in the house?

Maybe we aren’t built to stand the intensity of the deepest emotion, the pinnacle experiences, on a 24/7 basis. They’re intense, these times of insight. They’re beautiful, magical. But intense. Who could live at that level all the time? And maybe, the very fact of routine in life is what keeps the magic in the other moments.

It seemed like a long time the tech was out of the room. Maybe it wasn’t. I was just rounding the corner of all of this in my mind when the door opened. “Ok, just keep up with your scheduled screenings. Looks good.” She smiled and opened the door for me. I went back to the dressing room to change, reassured and feeling vindicated that I had known I was fine all along. Nothing to see here.

Yes, it was all routine. Except for those few minutes on the exam table. They were a sharp reminder of what’s important in life. Funny how the extremes, good or bad, wonderful or frightening, can have the same effect. I left the clinic and walked back to my office, smiling, thankful that this wasn’t the day to switch out my lists. I have to remember to pick up milk on the way home, and the dry cleaning, not schedule a surgery.