Sunday, December 18, 2011

Of Two Minds

These days, I seem unable to think about much other than the challenges of Kayenta and my lack of comfort and confidence while taking them on. Thus, as I looked back at my tracks in the snow, coming and going, “of two minds” seemed an obvious title for the image.

At another time, or maybe as another person, a solitary stroll to the highest point in Mesa Verde National Park would not give rise to thoughts of struggles at work, but to paraphrase Rumsfeld, apparently you live with the brain you’ve got, not the one you might want.

For the weekend, I took a short road trip up to Cortez, CO and nearby Mesa Verde. Getting out of Kayenta has a funny effect, but I like it. The balance between determination to succeed and anxiety, which leans to the latter in Kayenta, shifts to the former when I hit the road. Perhaps this isn’t desirable or healthy, but it’s welcome. I spend much time in Kayenta wondering what the heck I’m doing, and it’s reassuring to every now and then feel more fully the value of the effort, and to see the big picture.

The next week should be an important one. Due to the difficulty of recruiting permanent employees to Kayenta, the physician staffing (other than me) in the emergency department (ED) is contracted out to a staffing company which provides the physicians. Needless to say, neither the contract bidding process nor our site attracts the crème de la crème of emergency physicians. This week I meet with the contracting company to try and convince them to send some upgrades.

We also officially start the acquisition attempt to implement the electronic health record in the ED. We have worked hard to get the necessary blessings to go forward, but it is a big ticket item (for those of you who remember the old Disneyland, it’s an E ticket, for sure), and there are many spots where it could get derailed. As a solidly 20th century physician, why would this 21st century item matter to me, you wonder? In my view, typically the electronic record process is geared toward the goals of the administration: billing, data tabulation, compliance with various regulations, etc. The real power of the electronic record to directly improve patient care and provider satisfaction ends up a secondary concern. We need, badly, to reverse those priorities here, and have selected a system which we believe will actually help the providers make good and prompt decisions, thus improving care.

We are attempting to be the first ED in the IHS to implement a system of this sort. Other IHS EDs either have no electronic record, or have gone with one that is difficult to use and impossible to implement in a place like ours. It will be quite a coup if we succeed. Stay tuned, miles to go before we sleep..

Success in either of these major efforts would go a long way toward making me feel like I'm actually doing something here, and that would be nice.

At the end of the week, home to Portland, the chance to hug family, then in mid January off to Mali for two weeks to hug more family. A good end to 2011 and a great start to 2012.