prison break

Well, i am about to complete my second week working in a prison. I really never thought i would be able to type those words. And unlike my two roommates, i have acclimated well, and even - shudder- started to enjoy myself. The work is interesting, challenging and starting to be rewarding. The two men, or boys, i live with seem to approach ever task with a negative attitude and horrible outlook. Besides being irritating to me, they have started to rub the nurses and staff at the hospital wrong too, so people are not willing to help them out, causing them to get more frustrated, and thus the cycle continues. Today in particular i thought about two proverbs that seem to fit the situation quite nice,

1. you catch more flies with honeythan with vinegar
2. when life hands you a bag of lemons make lemonade

i have started to ignore the horrible comments my roomates make, the constand disregard for those that work and live in the area on a more permanent basis - instead, i decided to just make the most of the two months i have here to learn something. Holy crap! it works :) I walk in smile, say good morning, made an effort to learn the security guards names, the nurses and the other key players (scheduling secretary, radiology techs, transcriptionist and the outpatient clinic nurses) - all this takes very little effort, but the payoff is amazing and already showing results.

For instance, i work in a government institution - the department of corrections, which is currently running with a 13 million dollar deficit (sound familar, like a microcosm of CMS???) basically all this means, is paperwork and lots of it. you want something done, you need to fill out a specific form, have it approved, signed by the correct people and placed in the hands of the correct people to have done, whatever it is you want done. On top of that, certain tests or doctors are only in the prison on certain days. If you want an MRI better have it mon or fri. If you want it read by the radiologist check the schedule to see who is working that can read that MRI. You want your inmate (patient) to see a cardiologist, fill out a form, include all justifying documents, have it approved, signed and give it to the floor secretary who will send it to the scheduling secretary who then faxes it to the medical center to hopefully get scheduled....yep it sounds complicated, and there is a LOT of paperwork.


The same thing happens for medications that are not formulary, or if you want a patient on certain antibiotics or pain medications. Forms, approvals and multiple people before it happens. If you are reading this i think you can figure out where understanding where and how to grease the wheels can benefit your patient.....and being a jerk to everyone is NOT the way to get anything done quickly, esp because most things that are quick, are still not quick by the standards we are used to in the private hospital settings....but here is how i managed to get around this....

for instance today, i have an inmate with a large list of problems, some urgent and others more chronic. But overall he is not doing well, and there have been moments where i wish Dr House would show up and help me diagnosis this patient. But i am trying to do the next best thing, i am advocating for him and his health. He needed to see a neurologist, it is taking too long to get an appointment....so i walked down to scheduling and asked who is the person to talk to re scheduling. I then asked what i need to fill out to have my patient moved to the appointments for tomorrow....she told me, i did it. He was seen. The MRI i had shot last week still had not been read. I waited in radiology for the radiologist to show up, had the film in my hand, and asked him to go over it with me. Had him dictate, asked the transcritionist to transcribe it - then walked it over the appointment with the neurologist. He then recommended that he see an ENT ASAP. I started to fill out the paperwork, went back to scheduling to find out when the next day the ENT is here...its tomorrow, ok. What do i need to do to get him on the list. I got her copies of the consult, the MRI report and my phsyical exam from that day. DONE. he is seeing the ENT tomorrow.

Later in the day i was dealing with another patient, and it turns out one of my forms had not been signed by the correct physician to have the approval. The scheduling secretary came up to the floor (almost unheard of) found me, and told me she is going to track down the medical director for me to have him sign it. Amazing. She really could have simply said the request was denied and than i would have to start all over again and the next week, my patient would have gotten worse....as she has done for the other people who are not nice to her.

the boys constantly want to know how my patients labs, consults and radiology is scheduled, completed and read - while they are still sitting around with their thumbs in their butts. I try to tell them to just be nice to people. Instead, one of my roomates, tries to tell me, "the way things get done is by talking to people like they are stupid, and pointing out their mistakes." Sometimes i wonder if people can hear themselves speak....

i have found that my days go back quickly, there is always something to be done, something to follow up with - or someone to chat with for a few minutes today who will be able to help me out tomorrow. Truly amazing and simple lessons to be learned. I have learned and seen a lot of amazing medicine, but the life lessons of dealing with people is by far the greatest acheivement so far.

i will upload pics when i have some faster internet...if you have facebook you can check them out - they are already posted!