Post Mortems

RECEIVED THE FOLLOWING NOTE from the Department of Health Services: "Dear Dr Meyer: Medi-Cal's Medical Case Management Program has been coordinating the medical services needed by your patient, XXXX, since August 6. Effective October 28, Medi-Cal will no longer provide case management for the following reason:

Two patients discussing their last appointment: "How long does an office call take these days? Well before I could say, 'health main-te-nance org-an-i-za-tion,' my check up was over."

Reminds me of a doctor some decades ago who designed his office with two doors and no chairs. He claimed he could often gladhand the patient at one door, put on the smaltz, listen to the heart and lungs while walking, write the Rx at the standing desk and usher the patient out. He bragged that only about one in ten required the use of the examining table-presumably for the occasional abdominal exam. This efficiency was only superceded by the one-line on the 4 x 6 inch medical record card that he entered without breaking stride...Wonder if today he has a desk outside the second door for the required lengthy medical record to cover the E & M guidelines?

A fellow member asked me at Mercy San Juan Hospital recently why we let the society close its library. With MSJH reducing its library staff by half and decreasing the number of journals, he felt that eventually all hospitals would essentially eliminate this function. He felt a medical library primarily benefits doctors, and they should control their own repository of medical information.

Just received the latest California Physician. Nice looking journal with lots of pages. So many it goes on the stack for later, more-serious reading. California Physician has been a quarterly for over a year, and six unread issues have piled up on my credenza.

I asked doctors in the staff room about the new format. The majority response was similar-more than can be quickly read. In the past they could spend 5 or even 10 minutes with it every month. No one I spoke with had spent an hour on the new format during the past year. Another case where our administrative leadership comes up with a more beautiful, cost-effective, but less useful product.

Will the same fate await our Sacramento, El Dorado and now Yolo readers? Will we get out of the monthly habit and lose touch even more? Feel free to email your comments.

delmeyer@healthcarecom.net