Sunday, June 27, 2004

Catching Up

Sunday, a day of rest, a day to catch up.

I had 2 more patients on Friday, both kids. The first one I scheduled at 7:30 AM when his mother called. She probably thought she'd leave a message at the office, but instead I answered since I still had calls forwarded to my cellphone. Since I was giving a talk at the Senior Center at 10 AM, I thought it'd be better to schedule him a little later at 12 noon, just in case it ran long.

The second one was a walk-in. As I was driving back to my office at 11:30 AM, I got a call from the Ob-GYN doctor's office next door to mine, and they asked me if I was open today because a patient wanted to see me. I assumed they had referred one of their patients who walked next door, only to find nobody there. I told them that I would be there is 2 minutes, and to just ask the patient to wait. I only figured out later that they were not the Ob-Gyn doctor's patient. They had been referred by the "chemist" aka pharmacist up the street because they were looking for a doctor to check out the 4 year old's earache. (I must remember to thank Dr. Chan!) The mother and her 3 children were visiting for 7 months from England while her husband taught at a local college. I gave her the usual paperwork, which she found amusing/annoying since medical care is free in England through the National Health Service, which she loved. I quickly diagnosed a swimmer's ear and got them on their way, because my 12 o'clock patient had come early.

His mother had learned about me through my sister, who is a co-worker. He came with his father, who was worried that his son might have West Nile Virus, because he had spent time at his grandmother's who lives very close to where a lot of WNV cases were recently discovered. Fortunately, I had recently read about WNV though information provided on a CD-ROM provided by the CDC. (I don't know if every doctor is getting one, but I received two CD's in the mail. Anyone want an extra?) I reassured him that 80% of people infected with WNV are asymptomatic, that about 20% will get fever, headache, rash, and less than 1% actually needed hospitalization. Anyways, he had swollen tonsils with an exudate so I did a rapid strep test on him. Unfortunately (or maybe fortunately?) it came up negative, so I send off a throat culture and put him on Amox for 5 days pending the report.

As always with these new disease outbreaks, there is a lot of concern, but also some overconcern (hyperconcern?). About two weeks ago at Kaiser I saw a patient who works in the department of public health who developed fever and a rash. She told an epidemiologist there who told her to get tested for West Nile Virus. When I saw her she had a classic rash for shingles. But because an "expert" in WNV (who I suspect is not an M.D.) told her she should get tested for it, I could not reassure her that her symptoms were only due to shingles, and that testing for WNV would not change her management. I should try to find out what her WNV test showed.

Earlier last Friday morning I gave a talk at the Senior Center on Nutrition, Exercise and Supplements. And even earlier that morning/night, I was working on that talk. Being a chronic procrastinator, I always wait until the last minute to prepare these talks. It's hard for me to get motivated to write them any earlier. Anyways, I'm wondering if it's worth it for me to continue these talks. I've given 3 so far. This talk was attended by 9 people (but 2 left early). My last talk was attended by 4, so it's an improvement. I haven't gotten any patients from doing these so far, but one person said he is planning to see me sometime. I do enjoy giving them, plus I feel that I do learn a lot from researching the various topics. Because of the informality of the small group, there are frequent interruptions and questions, which always prolongs things. But some people ask very good questions.

I'm not signed up for any more talks so far, and I think I'll take a break for the summer. Besides my Board Recertification is coming up next month and I really should study. But, it's hard for me to get, you know – motivated.

My wife (hi honey!) and children are out of town this week visiting relatives back East. So I spent 2-3 hours yesterday scanning in papers from previous patients. For the longest time I couldn't get the scanning program to communicate with the scanner (an HP 6110 All-in-One), so I had to hold on to the papers. About a month ago, I figured out how to get it working but just didn't have time to scan papers in. Unfortunately, I had to manually scan each sheet by hand. Even though it has a automatic sheet feeder, it only works with faxing and copying, not scanning. Grrrrr! But it is satisfying to know that I can now shred all those papers (when I get around to it).

Doing the math, if I eventually see 12 patients a day, and each patient has 9 sheets of paper (2 registration, 1 financial responsibility, 1 email consent, 3 patient history, 1 insurance card, 1 statement of benefits) to scan, that works out to 108 papers to scan a day! Of course, that's the worst case scenario. Hopefully, I'll have some returning patients who won't need anything scanned. But I am beginning to see the benefits of a high-speed scanner (and high-speed shredder). At this point, I don't have the money or space so manual scanning it is for now.

After sending 5 claims through Medrium, I have gotten back 5 rejections. Hmmm. The reasons for rejection are all the same: "NETWORK ID:REQ: LCNSE # IN NETWK ID FOR PAYER". I think that means they are rejecting the claims because I did not give them a network ID#. That's because I don't have one. I clearly checked off that I was not a participating provider - yet. But I hope to be soon. I hope this doesn't mean that I have to wait until I'm approved as a participating provider before I can submit ANY claims. There has to be a way for non-participating providers to bill the insurance companies. I'll call Medrium on Monday to see if they can help me figure this one out. I knew it wouldn't necessarily be easy to get a claim paid, but why can't I ever be wrong about these things?

Finally, last week I received an email from Dr. Bob Nelson, a pediatrician stationed in Afghanistan, who is thinking of opening his own solo practice after he gets out of the army. I connected him with Gordon Moore's Practice Improvement Group, and told him about this blog, which he has found helpful. I hope he doesn't mind me posting his comments. He wrote: "On 14 FEB you wrote that if your blog helps one person start a solo practice, you'd be happy. You should be happy." Thanks, Bob. I hope we'll both be happy. Godspeed and good luck!