16 April 2007

12th Q Hang-Up

Hello Blog,

It's been awhile. Mostly because I either haven't had anything to say or what I've had to say shouldn't be said for all the world to see. Let's see if I can sum up the past few weeks.

First week of 12th Q clinic was going fairly smoothly. I was working long hours both taking care of patients and as a clinic training assistant (CTAs sport the long blue smurf coats). So far, our class was highly annoyed that applications for cases of high complexity changed from a listing of diagnostic codes for qualification to an 8-page document that requires tons of essays and lots of math to make the columns add up in our favor. Why on earth did the forms change on us mid-stream when we're in our last quarter before graduation? Also, the forms are so over the top compared to what's expected from the chiro college accredidation agency and in comparison to other colleges around the country. In the attempt to show-off to CCE, our clinic admin just created a ton more work for the already paperwork-burdened faculty AND us. Sometimes it takes 2 weeks to get an appointment with a clinician just to get signed-off on a file so we can continue to see a patient. . . now, that's messed up.

Anyway, other than the high complexity case thing, things were going until we had our "active learning session" or ALS class. The assoc. prof who runs that class informed us that we'd only get 6 more simulated cases of high complexity, yet they wouldn't be presented until week 3. Hmmm, let's do the math here. Since they were a few cases short for our class when we started clinic 6 months ago, we're already behind. In fact, if 60% of our class needs to check out by week 8 in order to preceptor, and we only have 7-9 out of 15 cases of high complexity already accomplished, we won't finish with 15 cases by week 8 if we don't START the cases until week 3. When we asked the ALS instructor about this. He just scoffed and told us to apply for more live cases, as in, it's not his problem, he doesn't give a rip, deal with it yourself. Right. Noted. Now, we don't like that answer and we made sure the clinic admin knew that if we didn't get our simulated cases of high complexity because they failed to present them in class, then we wouldn't be able to check out in time for preceptorship. Their response to us was that they'd do everything in their power to help us get our high complex cases done . . . and so, they've asked US to present cases of high complexity to the other interns.

Wow, I don't know about ALL of my classmates, but I know that for most of us trying to get done in a few weeks, we're already super swamped (why am I here blogging, because I'm taking a study break). Being in clinic from 8am to 8pm for 3 days a week, sitting through a board review course through the entire weekend, finishing up business projects for class in spare time, and still trying to see patients and get all other clinic paperwork squared away, sure . . . I'll just put together a powerpoint to teach an hour-long class on a high complex case. Wait a minute. . . isn't that what the lead ALS instructor gets PAID to do? Yeah, that's what I thought.

But, the straw REALLY broke the camel's back last week when they announced we had NEW clinic requirements. We're in 12th quarter, getting ready to LEAVE, and they spring new grad reqs on us. Grad reqs that are WAY above and beyond the reqs that are ALREADY above and beyond CCE requirements. What's funny is that when we sat through clinic orientation in 10th quarter, we were told (and this is on film) that we would be held to the clinic requirements that were in place for us from that day on . . . and that nothing new could change while we were in the pipeline. It could affect classes behind us, but not us. We signed forms for the current clinic handbook, and felt secure knowing it was a big feat, but we could accomplish the reqs that were laid out for us.

NOW, it's week 2 of 12th quarter, and 60% of us expected to meet the 8th week checkout deadline for preceptorship by having all of our clinic requirements DONE. Being done means you help the younger interns along and transfer your patients to them. I've even transferred patients who could stand to get x-rays taken on them . . . it wasn't a HUGE pressing ordeal, and since I was WELL over the Palmer radiology clinic reqs, I figured I'd help out the next guy. Well, now I regret making some of those transfers. Because the new reqs are that we accomplish 2 New patient exams (that's at least 3-4 different appointments with patients and a TON of paperwork headaches)--that also means those of us who were long off the new patient lottery list may now have to put our names back on in order to acquire new patients. The new reqs also require 2 x-ray series. Series is 2 regions of the body on 1 patient or same series on 2 patients. Well, if most of our patients have been transferred, or if we've already taken films on most of our patients, we can really only take films on new patients.

Why would we have to take even MORE films on patients if we'd already surpassed the clinic reqs on radiology? We asked this question, and clinic admin only replied with a tail-between-the-legs response of "the new reqs came down from Davenport". I don't care if it came down from CCE (which it won't, since they take years to implement new changes and tell you WELL in advance), they can't change things on us so late in the game. They're asking us to REALLY probe if our patients have any complaints warranting x-rays. Not only that, but there's a huge cost incurred for the patient for this procedure. Hey, I'm a very pro-x-ray intern, I like to see what's going on in the spine. But, none of my remaining patients need further films at this point in time. So, now I need to go find new patients, of which I can perform exams, hopefully justify taking films, and then just immediately hand them over to a new intern without every really providing care for them? WE asked the clinic about this, too. They don't care. Of course they don't care. If they DID care, they'd fight on our behalf, and not implement the changes to our class, but to the next incoming class. THAT would make sense, which is exactly why they won't do it.

Somehow, some way, I'll get out of this ridiculously frustrating joke of a place called an "educational clinic", and move on to a real clinic where I can intern and learn about running a practice with ethics and standards and consistency, something I have NOT seen emulated at Palmer. Some day, I'll graduate and never look back. Oh boy, I can't WAIT.

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