Maelstrom

Obviously, I haven't posted in a while (whatever happened to May?). A course of events ensued, the outcome of which was that I rather suddenly (over the period of a few weeks) became the only neurologist seeing patients at my primary hospital. This is a 400-bed hospital, so my workload suddenly and rather dramatically shifted.

Actually, shifted is not the right word, since I didn't stop doing the other things I have been doing, like office work, doing some EMGs, and so on, so this was all just added on.

I'm not sure we ever had "enough" neurologists here, but in the last several years, some have left, but also there has been this redistribution, with various ones of us restricting our work to fewer places, some neurologists only seeing office patients, and a few only seeing hospital patients. It's most likely a combination of lifestyle issues, having a more dependable workday, but to some extent realizing that it's not efficient economically to be running around from one place to another, better to stay in one or a few places.

Now I've gone from a variable handful of patients at a time to having 6-8 new consults on any given day (sometimes more), and I may have a running list of 30+ patients to follow. It used to be I could keep what was going on with various patients in my head pretty well, but this is breaking down. After I see 5, 6, 7 new consults, then go to the office to submit the charges I can have a time remembering who each patient was, especially the earlier ones. I figure it out, but there goes some wasted time in the process.

Handing off patients to see for the weekend coverage also becomes a chore, but I had already set up a system where I make out a list with annotations and print it out. I just can't imagine going down a list verbally and the guy on the receiving end keeping things straight.

The worst time for me is at the end of a weekend, or this coming Sunday at the end of my vacation, getting some 20-30 patient list of people I don't have a clue about. Every followup becomes a chore as you have to review each chart to get the gist of what's been going on, even with the heads up info I will get from this or that person in the group.

Solutions?

I've ordered a netbook, something I can carry with me on rounds to keep track of things better. Sometimes it's a big help just to prioritize patients, like who needs to be seen first, who definitely needs to be seen today, and so on. The model I've ordered, a Dell 2100N, has a rubberized case and with the extra batteries will last for several hours on a charge, so I am hoping I can just have it running as I go on rounds and carry it along with my "black bag" -- I'm getting an optional carrying handle, so I won't need a case.

Like any hardware solution, it's not automatic or magical, so I've been trying to find software that can help. I think I've found it; it's something called basket, or I guess more formally BasKet Note Pads. It's a free-form note-taking app that works very fast. You work with a blank page, and simply by clicking on an open area you create a small text box that you can enter info into. You don't bother to save anything, it's all automatic in the background. If you shut down the computer with it running, it pops up right where you were when you start up again. Each page is called a basket, so I figure one basket per patient, then I just click from one to the next as I go.

So once I get it, I'll post about it after I've seen how this goes. Should be interesting.