Today is my PE shift (I really wish they would use another term...it makes me think of phys ed in school and that gives me a stomach ache, along with all sorts of other automatic anxiety reactions!)....which just means I go in at noon. Actually, I start seeing patients at noon. Here they schedule you per the times you have patients. For example, when I work days I work 8-4:30 which is an 8 hour day with a 30 minute lunch break....but my last patient is scheduled at 4:30 and an unlimited number of patients can be scheduled into that slot. On Friday I had no one in my 4:30 spot but one of the other travelers had 9-I went over and helped so he saw 7 and I saw 2 (we finished at 6:30). I am paid by the hour so I don't much care but the regular providers are salary-I'd hate that! And the pay isn't too good so they end up signing up for the Public Health Core (or something like that-they are the Attorney General's uniformed, noncombatant force) which pays much better.

Somehow there is a lack of understanding that if you have a patient at 4:30 and they arrive on time (they are allowed to be 15 minutes late and we still must see them), they have to be checked in up front and then the nurse must pull them back and do her part ...so by the time the provider sees the patient it will be at least 10 minutes past the 4:30 appointment time (and that is only if all goes well). Then after I see the patient I have to complete the chart (they must be completed same day as there are bar codes on the forms that all have to be checked in before the day can close-I know providers that this would KILL). So in reality, all things working on perfect and the patient only having one problem, able to easily are readily express the problem and requires no diagnostics and is an established patient, the best one can do is get out by 5 or 5:30. But, it seems that the easiest patients never wait until the end of the day to come in....it seems to always be the sickest or the most complex in that time slot! Ideal seems to happen only on some management planning sheet.

Another interesting scheduling issue here is that the patient can reschedule repeatedly throughout the day-I have had patients in my 10 am appointment slot who misses that appointment, reschedules for 1, calls and reschedules for 3, no shows that appointment and is see as at 4:30. That is just an example but, talking to other providers, we all experience patients who appear on our schedule two, three or four times in a day before we actually see them at least two to three times weely...or sometime we don't see them at all. Of course, if you have a busy schedule that blocks numerous appointment times during the day for other patients so they get pushed closer and closer to the end of the day (all patients must be seen on the day they want to be seeen).

Oh, and did I mention that we are expected to run our clinics on time....even though the patient can be 15 minutes late and we only have 2 exam rooms?

This is a very patient oriented system and I am all for that-but, I think there has to be a balance. If I were a full time employee with a family working on salary I wouldn't like this very much....even if you don't have the overbooks you never know when you will so there is not a feeling of control over your life....you never know when you will be home in the evenings. I don't even think it is the number of overbooks or how often they occur-I think it is the potential for it everyday giving one a feeling of lack of control. I read once when I was in management that an employee can handle incredible amounts of stress on the job if they have control over their workload whereas the employee who does not have control over the workload can handle very little. I think this is very true!!

Having said all of that-I would love to be a patient in this system. This is amazing-especially considering it is an IHS facility and they have a reputation for poor service. This is cutting edge health care....health care at it's best!!!

It's too bad other health care systems can't be set up like this. The patient gets great service at no charge for visits, procedures, diagnostics or meds...or anything. OPPPPS.....I guess that would be socialized medicine wouldn't it??? Very patient oriented but not very profitable for the provider-well, we will never see that with the powerful AMA lobby.

I'm glad I will be opening my own practice!!! I hope I can provide compassionate care, that is individulized, and gives the client a feeling that they have been heard and empowered in their own healing journey while providing a comfortable income and a good quality of life for me.

OK...on to another subject.......the Nakai concert. I have reflected on the concert. I have decided that the music was good-probably great. It' s just that I am a Carlos Nakai fan and wanted to hear more of him and less of the orchestra. My issue-not one of the composer or conductor (same person). I think the dancers, both modern and native, were really good (the male modern dancer was not as strong as the female but who am I to comment on a grad from the Julliard school who dances all over the world?). It was a good, probably great, symphony-well worth the money I spent! It was R. Carlos Nakai with the Alaska Symphony Orchestra-which means he was a guest muscian. That is exactly what it was!

Guess what? It is snowing today. Most of the snow had blown off the trees and they were once again just evergreen trees but today they are dressing up in a wonderful coat of white again!!! I really do love the snow!

This is a wonderful house from which to watch this funky, eclectic neighborhood! Even with huge flakes of snow falling the streets are alive with people walking back and forth, going about their business. To and from the bus stop, to and from the grocery store, to and from the corner liquor store, to and from the corner drug salesman, to and from the homeless shelter.

Just in writing the above paragraph a man in a dark coat and cap walked by, kind of slumped in this posture and carrying a backpack....and a 30something woman with the posture of a dancer and a bright red coat with her waist length hair exposed to the wet snow. Wouldn't you love to know their stories?

Last Friday on the corner across from the house was a working girl with a barely there top and a less than miro mini (about 12 inches of clothing from the top of the shirt to the bottom of the skirt) coat open to expose it all...working the street. I feel so for her and wonder what dire circumstances landed her in the streets selling her favors for food or booze or drugs.

This is a unforgiving environment for the homeless....it is not unusual for someone to be found dead. For some reason they didn't make it to a homeless shelter...or passed out from the drugs or booze and froze. The homeless shelters try but there isn't enough room-each person is limited to a certain number of days per month in each shelter so they roam from shelter to shelter and try to stay with someone or find someplace in between to make their nights last the full month. One of the shelters has an inner courtyard and when the temp is below 0 they let people sleep in there. Also I think the neighborhood vans that roam around checking on the homeless call the police if they find someone who is passed out or incapable of getting to a shelter and they are hauled to jail for the night. And then there is Beans soup kitchen-they feed all that they can. But, the alcholism nd drug addiction has created a huge population of homeless souls roaming the streets of Anchorage and it is a sad and pitiful situation. I don't know if it is worse than any other big city-probably not. And I am impressed with the services that are put in place to try to help....it's just such a big problem! When I go to water aerobics in the morning at 5:30 or 5:45 there are more people walking on the streets then there are cars....always, day and night, there are people on the streets. In reflection, looking back to the beginning of this blog it is easier to understand why you would need to allow so much flexibility in scheduling when some of your customers come from this population that is just struggling to survive-to make it to the clinic they have to be sure they can get a bus and that they are back at Beans when the meals are served, and at the shelter so they won't loose their spot-thank goodness they can receive free health care if they are lucky enough to be Native.

Oh, well, I better get ready for work! Hope you have a good day with a warm roof over your head, plenty to eat and people who love you!