7:00 a.m. When they called me for this consult on this young female with known lupus presenting with pleuritic chest pain, they didn’t tell me that (a) she has a history of pleural effusions, and (b) her creatinine is 4.9 mg/dL.
8:00 a.m. Waiting for my patient to be roomed. We’re implementing a new electronic health record, so I have to wait for the medical assistant (MA) to finish her tasks: input the patient’s medications, take his vital signs, and ask for his chief complaint.
8:20 a.m. Patient is still not ready for me. Who thought it would be a good idea for the MA to take the patient’s medications? It’d be so much more efficient if I did it myself.
9:00 a.m. Finally finished with the first patient. It was a follow-up visit that was scheduled as 15 minutes. I am now 45 minutes behind schedule. Thankfully, the MA managed to use the 45 minutes to room the 8:15 patient.
12:30 p.m. Whew, I just finished my morning. I start again in 30 minutes. I am never going to finish these 12 charts in 30 minutes. Also, I am hungry. If I don’t eat now, I am going to have my MA for lunch.
12:45 p.m. Speaking to Dr. Winchester from Blue Cross to get approval for a contrast MRI of the right foot. (This call may be recorded. What did your x-rays show? Have you failed conservative treatment? Will it change management? Here’s your approval number.)
1:00 p.m. The new patient is here. She is the proud owner of a very long med list. It’ll probably take the MA 30 minutes to get through all that. Let me call dermatology in the meantime; I need a full-thickness skin biopsy on Mrs. Rodrigues. (One week later, biopsy shows polyarteritis nodosa.)
3:15 p.m. I just finished a visit with Silvi. Her rheumatoid arthritis is quiescent, but she is in tears. Not only did her mother die unexpectedly from a ruptured aneurysm 2 months ago, she has just received a new diagnosis of breast cancer, and her husband lost his job. I can’t make this stuff up. That was an emotionally draining visit. I need a drink. Oh wait, there are no drinks to be had at a doctor’s office. Maybe the drug rep brought some ice cream.
3:20 p.m. Some ice cream regret going on here.
4:40 p.m. Just got done with a new-patient consultation for a "positive" antinuclear antibody test of 1:40 and a positive systems review. I’m exhausted.
6:15 p.m. Returning phone calls. Mrs. Greggerson is regaling me with details of her ablutions.
6:35 p.m. Filling out prior authorization forms for a biologic. Among the questions: A1c, T score, growth velocity, Mini-Mental State Exam, free and total testosterone, hepatitis C viral load and genotype. I would like to officially nominate this form for Most Number of Irrelevant Questions Ever.
7:00 p.m. Finally, last prior-authorization form for the day. Wait ... it’s for methotrexate? Since when have I needed to get prior authorization for methotrexate? I didn’t think it was even possible for me to get any angrier after the Mini-Mental State question.
8:00 p.m. Finally home. I’m too beat to go to the gym. My good decision–making reserves are exhausted. I would rather have a glass of red. The resveratrol will do me more good than a workout.
Dr. Chan practices rheumatology in Pawtucket, R.I.