Written 4/12/10
After clinic, we went to clinic to get to see some patients. the first patient is non-Indian. A bit of a let down. My first thought is why did he decide to live here? I don't ask though. He seems a bit quirky. I imagine that living in the arctic might make one a bit private. The subsequent patients are Eskimo. The conversations are different than in the lower 48. There is a pause before they answer. They don't raise their voices. The accent is almost a mumble at times. Initially there is eye contact but it is not sustained. In turn I look initially and then look away. At home, the lack of eye contact would instill distrust. Here it is respect. The diagnosis is mostly mundane. We do preoperative screenings before patients have their colonoscopies. We have three gastroenterologists doing scopes while we are here. There is an extremely high rate of colon and stomach cancer in the Eskimo population. In their first day, they have already diagnosed one colon cancer.
I only got to see one pediatric patient. Apparently there is not a lot of them to be seen on any given day. I handed out a couple of stickers. They were very popular. There weren't very many excited cases. The Rheumatologist with me is already injecting joints and getting appointment requests. I suspect that our numbers will continue to climb as word gets out. After all, they announced us on the radio.
I was given the sitrep packet at lunchtime. It stands for situational report. The OIC has to complete a report once a day. There weren't any instructions verbally. It seemed fairly straight forward. After all I have done something similar for the ANG. I ask the other providers to keep track of the number of patients they have seen. At the end of the day, the chief doctor came by to check on us. He asked if I had gotten the information. I told him I had the packet but no instruction. It is then that he informs me that he also needs the CPT codes and not just the numbers. For lay people, that means the code assigned in billing to represent the complexity of the visit and therefore the monetary value. The ARF unlike the ANG has to calculate the monetary value of the work done here. The interesting part is that we are to code each visit as a new patient. This adds substantially more value than if we coded them as an established patient in the clinic. While the patients are new to me they are not new to the clinic. In the private world, I would never do this because it could be construed as fraud. Since no insurance or patient is being charged there is nothing illegal. I do think it is an interesting way to pad your stats. It is not my first time to encounter this practice. The army utilizes this system as well when we are deployed to the VA to work with them.
Since I am done for the day, I had the medical records department called and asked to pull charts. In the morning, I and the others will go back and figure out our codes. Basically I will start behind for the day. The report has to be in by 1000. Good thing the clinic doesn't start until 1000. Did I mention that? Patients don't get up early in these parts. Maybe it has something to do with the fact that the sun doesn't set until 2300. Lunch is at 1200 and the day ends at 1700. Somehow we can't get finished until 1800.
A couple of village teams were able to helicopter out today. There are three teams remaining due to weather. One team, Point Hope, may be in jeopardy of going at all. They are the largest team. The wind is howling and the snow is coming down. Maybe being assigned to the main village isn't such a bad thing after all. Everyone here tells us how happy we are here. The staff even more than the patients. The patients specifically request the "Military docs". We are quite popular. It's funny how they assume we have all been to Iraq. That question is far more common here than at home.
Tomorrow is another day.
After clinic, we went to clinic to get to see some patients. the first patient is non-Indian. A bit of a let down. My first thought is why did he decide to live here? I don't ask though. He seems a bit quirky. I imagine that living in the arctic might make one a bit private. The subsequent patients are Eskimo. The conversations are different than in the lower 48. There is a pause before they answer. They don't raise their voices. The accent is almost a mumble at times. Initially there is eye contact but it is not sustained. In turn I look initially and then look away. At home, the lack of eye contact would instill distrust. Here it is respect. The diagnosis is mostly mundane. We do preoperative screenings before patients have their colonoscopies. We have three gastroenterologists doing scopes while we are here. There is an extremely high rate of colon and stomach cancer in the Eskimo population. In their first day, they have already diagnosed one colon cancer.
I only got to see one pediatric patient. Apparently there is not a lot of them to be seen on any given day. I handed out a couple of stickers. They were very popular. There weren't very many excited cases. The Rheumatologist with me is already injecting joints and getting appointment requests. I suspect that our numbers will continue to climb as word gets out. After all, they announced us on the radio.
I was given the sitrep packet at lunchtime. It stands for situational report. The OIC has to complete a report once a day. There weren't any instructions verbally. It seemed fairly straight forward. After all I have done something similar for the ANG. I ask the other providers to keep track of the number of patients they have seen. At the end of the day, the chief doctor came by to check on us. He asked if I had gotten the information. I told him I had the packet but no instruction. It is then that he informs me that he also needs the CPT codes and not just the numbers. For lay people, that means the code assigned in billing to represent the complexity of the visit and therefore the monetary value. The ARF unlike the ANG has to calculate the monetary value of the work done here. The interesting part is that we are to code each visit as a new patient. This adds substantially more value than if we coded them as an established patient in the clinic. While the patients are new to me they are not new to the clinic. In the private world, I would never do this because it could be construed as fraud. Since no insurance or patient is being charged there is nothing illegal. I do think it is an interesting way to pad your stats. It is not my first time to encounter this practice. The army utilizes this system as well when we are deployed to the VA to work with them.
Since I am done for the day, I had the medical records department called and asked to pull charts. In the morning, I and the others will go back and figure out our codes. Basically I will start behind for the day. The report has to be in by 1000. Good thing the clinic doesn't start until 1000. Did I mention that? Patients don't get up early in these parts. Maybe it has something to do with the fact that the sun doesn't set until 2300. Lunch is at 1200 and the day ends at 1700. Somehow we can't get finished until 1800.
A couple of village teams were able to helicopter out today. There are three teams remaining due to weather. One team, Point Hope, may be in jeopardy of going at all. They are the largest team. The wind is howling and the snow is coming down. Maybe being assigned to the main village isn't such a bad thing after all. Everyone here tells us how happy we are here. The staff even more than the patients. The patients specifically request the "Military docs". We are quite popular. It's funny how they assume we have all been to Iraq. That question is far more common here than at home.
Tomorrow is another day.
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