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A doctor's busy day
By Damian Boudreau, Staff Writer
Saturday, September 22, 2007 | No comments posted.
Internist Peter Lund limped down a hallway at the Bay Clinic in Coos Bay. He turned corner after corner, speeding down hallways and corridors.
He turned another corner and entered yet another hallway. A row of doors stretched out before him, ending at a corner where his medical assistants, Jodi, Sarah and Tami worked. He hobbled down to the end of the hallway, turned left, and entered his office. Piles of paperwork, patient charts and faxes battled for space on the top of the massive wooden desk in the center of the office.
The wall behind Lund’s desk read like his resume: a graduate of the University of the Pacific in Stockton, Calif.; a degree from a University of Mexico medical school; a graduate of the University of California, Irvine.
Lund sat down before his computer and began flipping through screen after screen of patient charts — lab evaluations, prescription orders and messages from other doctors. Light from a large window behind the computer poured into the room. As he worked, he rubbed his gray beard.
“Today wasn’t too bad,” he said.
It was 5:30 p.m. In the past nine hours, the 52-year-old had examined 18 patients, including a former nurse, a retired Marine, a teacher and a housewife. He ate one meal — a lunch that lasted 10 minutes — most of which he spent listening to a representative from a pharmaceutical company push the virtues of a new drug.
Today he’s been more than just a doctor. He’s been a friend, a confidant, a therapist and — to some patients — the harbinger of bad news.
Early interest
Growing up in Stockton, Calif., Lund knew by age 16 he wanted to be a doctor.
“I couldn’t think of anything else to do,” he said. “It truly is the noblest profession.”
After his residency, he began practicing at a 40-doctor facility in Manteca, Calif. When the company was purchased by a large HMO, he decided to look elsewhere for work.
Lund learned about Coos Bay from his patients who spent time in the area. After a visit to the Bay Area, he decided to leave California to practice at Bay Clinic.
“I wanted to live in a place where I could retire and sail,” Lund said.
About four years ago, Lund, his wife of 22 years, Jane Lund, and his two teenage sons made the move to the Bay Area. Both of his sons attend Southwestern Oregon Community College and are adamant in one aspect of their future careers.
“They both told me they don’t want to be doctors,” he said. “They think I work too much.”
Before the storm
Lund’s Monday began at the Bay Area Hospital. He arrived before 6 a.m. to check on a couple of patients: an elderly woman in ICU who has a nasty intestinal infection, and a patient who suffered a stroke and was brought in by his wife. Then he headed to the Bay Clinic, just across the street.
Lund sat at his computer reading through patient charts. He currently shares a pool of 2,400 patients with family nurse practitioner Brian Barger.
His assistants, Jodi Lockhart, Sarah Cornelison and Tami Carroll arrived shortly after Lund.
As Lund walked out to greet them, his halting walk did not go unnoticed by Lockhart.
“Why are you limping?” she asked.
Lund explained that while working on a car over the weekend, he slipped on a socket wrench and fell, spraining his ankle. Common medical advice stresses that patients with a sprained ankle should not walk on the injury, but should keep it elevated and iced.
Lund does neither.
Shortly after 8 a.m., Lund met informally with clinic Administrator Daniel Walsh in a room near the lobby. They discussed a couple of resumes Walsh had received over the weekend from “J-1” doctors from South Korea and India. The
J-1 program allows clinics and hospitals in qualified rural areas to hire physicians from foreign countries to practice medicine while they continue their studies. J-1 doctors at the clinic are sponsored for three years, Walsh said.
First in
Lund’s first patient of the day was George Vaughn. He’s been a patient of the clinic for 15 years.
Vaughn, 86, had a rash under his left arm that had spread significantly since his last visit a few months ago, despite the use of an antibacterial cream.
As they talked, Lund typed into a computer sitting on a counter in the room, updating Vaughn’s medical record. Lund told Vaughn he’d like to take a picture of the rash to show to clinic dermatologist Dr. Karen Brown.
Vaughn raised his arm.
“Do you want me to smile?” he asked.
They both laughed.
Lund explained to him that as people age, many body systems, including the skin, become less reliable and more susceptible to disease.
“Old age is like running around with blinders on and wearing cotton gloves,” Lund said later. “The best way to live a long life is to choose your parents wisely.”
Like Vaughn, many of the patients that Lund saw during the day were elderly. While those over 65 make up more than 13 percent of the U.S. population, they account for nearly 40 percent of visits to internists, according to a 2002 report from the International Longevity Center. And the Coos Bay area has a larger proportion of people over the age of 65 than the average for Oregon, according to 2007 data from the Oregon Office of Rural Health. Nearly 19 percent of the Bay Area’s population is over the age of 65, compared to the average of 13 percent for the state.
Smoker
Lund met with his fifth patient, 61-year-old Linda King, at 10:20 a.m.
King was worried about a TV news report which called into question the safety of a medication she takes for the control of her diabetes.
Lund assured her the medication is probably safe. He seemed more concerned with her smoking habit.
“There are 3,000 chemicals in cigarettes,” Lund told her.
In addition to any number of cancers, Lund explained, smokers can develop Buerger’s disease, which causes inflammation in the extremities and sometimes ulceration and gangrene. Eventually, portions of a person’s hands and feet may be amputated. While the disease was long thought to mainly affect young men, a growing number of women smokers over 50 are getting the disease, according to research at John Hopkins University.
Some people who get the disease even keep on smoking despite the lack of limbs, Lund said.
As the doctor spoke, King shook her head, her gray ponytail swinging back and forth from shoulder to shoulder. Despite his plea for her to stop, she seemed unmoved.
“I tried to quit smoking seven times,” she said after the appointment. “I just enjoy it.”
Lunch
Lund raced down the winding hallways and through a room full of hundreds of orange and pink tagged manila folders. It was a few minutes after noon. His destination was a conference room near the back of the clinic.
“This is where we sell our souls,” he said as he entered, laughing.
Inside the room, a man with a navy blue suit and a broad, gleaming smile sat among the nurses and medical assistants.
He was a representative from a pharmaceutical company, and he was buying lunch.
A row of tables along one wall of the room held trays of food, most with a Mexican flair: black beans, Spanish rice, salad, a gloppy, cheese-encrusted concoction and a huge bowl of tortilla chips. For dessert? Cheesecake with strawberry sauce.
Paperwork
After lunch and a quick meeting with electronic medical records system administrator Debbie Wright, Lund returned to his office. He called Bay Area Hospital to check up on a patient. While doing that, he continued his paperwork. From insurance, prescription, Medicare and Medicaid forms to written confirmation of his verbal orders, it seems just about everything requires his signature.
“Jodi, how many hours a week would you say I spend on paperwork?” Lund asked while weeding through a pile of forms.
“About a third of your time,” Lockhart shouted back from her desk.
More paperwork means less time for patient care. If Lund works 60 hours a week, that means nearly 20 are spent doing paperwork. And while many of his patient records are going online, Lund still receives a steady amount of paper records.
While he worked at the computer, Lockhart entered and handed him an updated patient schedule. Without hesitation, he signed it. He didn’t need to.
“It’s just a habit,” he said.
More tests
Lund met with Morrene Kamph, a former cow milker, at 1:46 p.m. Kamph, 73, traveled from Langlois to see the doctor. Lab tests revealed her cholesterol had increased since her last visit.
Lund peppered her with questions to try and find the source of the increase. Kamph, dressed in a bright blue shirt and black pants, was adamant that she’d stopped eating eggs and was getting exercise.
After a few seconds of silence, while Lund clicked through screen after screen of Kamph’s chart, he finally spoke.
“Well, you must be doing something bad,” he said, chuckling.
After a breathless pause, she countered: “I’m too old to do anything bad.”
Lund didn’t give up. He prodded her for more information and badgered her for details about her daily activities. He eventually decided to have her come back for another round of tests to make sure it wasn’t just an anomaly.
Suffering
Later that afternoon, Lund walked down the hall toward a waiting room and removed a paper chart and entered. Penny West, 53, sat in a corner of the room, holding a cane in front of her. Her gray hair contrasted her bright yellow shirt. Her daughter, Bettye, stood next to her. Penny didn’t smile at Lund as he entered. A black and red bag containing medication sat on the examination table in front of her.
Lund spoke, his voice cutting through the tension in the room. He asked Penny why she was visiting today.
With labored breath, Penny complained of increased water retention and chest pains. Her eyes reddened as she spoke. She had a number of white spots on her hands, arms and legs which she said frequently turned into red sores.
As Penny talked, Lund listened intently. He reached out and gingerly picked up her right foot. He pressed her ankle with his thumb and left a deep mark — a sure sign of water retention, he said.
He asked Penny whether she’d been following a low-salt diet. Both mother and daughter looked at each other. Bettye said she’s been trying to get her mom to eat more vegetables, but she doesn’t like them.
“For you, salt is poison,” Lund said, explaining the importance of a healthy diet.
After the appointment, Bettye wheeled her mother out of the clinic in a wheelchair.
In reflection
After a day of talking, listening, badgering, coaxing and coddling, Lund said it is particularly difficult when patients don’t listen to his advice. While Lund may understand the reasons behind that mentality, he doesn’t share it.
“You hate to see people that don’t realize the obvious,” he said. “It feels like you’re beating your head against the wall.”
However, for all the patients that don’t listen, it’s worth it when he can help people take control of their health, he said.
“I complain constantly about being a doctor, but I don’t think I would want to do anything else,” he said.
Next: Health insurance might be a helpful thing to have, but it certainly doesn’t guarantee health care.
He turned another corner and entered yet another hallway. A row of doors stretched out before him, ending at a corner where his medical assistants, Jodi, Sarah and Tami worked. He hobbled down to the end of the hallway, turned left, and entered his office. Piles of paperwork, patient charts and faxes battled for space on the top of the massive wooden desk in the center of the office.
The wall behind Lund’s desk read like his resume: a graduate of the University of the Pacific in Stockton, Calif.; a degree from a University of Mexico medical school; a graduate of the University of California, Irvine.
Lund sat down before his computer and began flipping through screen after screen of patient charts — lab evaluations, prescription orders and messages from other doctors. Light from a large window behind the computer poured into the room. As he worked, he rubbed his gray beard.
“Today wasn’t too bad,” he said.
It was 5:30 p.m. In the past nine hours, the 52-year-old had examined 18 patients, including a former nurse, a retired Marine, a teacher and a housewife. He ate one meal — a lunch that lasted 10 minutes — most of which he spent listening to a representative from a pharmaceutical company push the virtues of a new drug.
Today he’s been more than just a doctor. He’s been a friend, a confidant, a therapist and — to some patients — the harbinger of bad news.
Early interest
Growing up in Stockton, Calif., Lund knew by age 16 he wanted to be a doctor.
“I couldn’t think of anything else to do,” he said. “It truly is the noblest profession.”
After his residency, he began practicing at a 40-doctor facility in Manteca, Calif. When the company was purchased by a large HMO, he decided to look elsewhere for work.
Lund learned about Coos Bay from his patients who spent time in the area. After a visit to the Bay Area, he decided to leave California to practice at Bay Clinic.
“I wanted to live in a place where I could retire and sail,” Lund said.
About four years ago, Lund, his wife of 22 years, Jane Lund, and his two teenage sons made the move to the Bay Area. Both of his sons attend Southwestern Oregon Community College and are adamant in one aspect of their future careers.
“They both told me they don’t want to be doctors,” he said. “They think I work too much.”
Before the storm
Lund’s Monday began at the Bay Area Hospital. He arrived before 6 a.m. to check on a couple of patients: an elderly woman in ICU who has a nasty intestinal infection, and a patient who suffered a stroke and was brought in by his wife. Then he headed to the Bay Clinic, just across the street.
Lund sat at his computer reading through patient charts. He currently shares a pool of 2,400 patients with family nurse practitioner Brian Barger.
His assistants, Jodi Lockhart, Sarah Cornelison and Tami Carroll arrived shortly after Lund.
As Lund walked out to greet them, his halting walk did not go unnoticed by Lockhart.
“Why are you limping?” she asked.
Lund explained that while working on a car over the weekend, he slipped on a socket wrench and fell, spraining his ankle. Common medical advice stresses that patients with a sprained ankle should not walk on the injury, but should keep it elevated and iced.
Lund does neither.
Shortly after 8 a.m., Lund met informally with clinic Administrator Daniel Walsh in a room near the lobby. They discussed a couple of resumes Walsh had received over the weekend from “J-1” doctors from South Korea and India. The
J-1 program allows clinics and hospitals in qualified rural areas to hire physicians from foreign countries to practice medicine while they continue their studies. J-1 doctors at the clinic are sponsored for three years, Walsh said.
First in
Lund’s first patient of the day was George Vaughn. He’s been a patient of the clinic for 15 years.
Vaughn, 86, had a rash under his left arm that had spread significantly since his last visit a few months ago, despite the use of an antibacterial cream.
As they talked, Lund typed into a computer sitting on a counter in the room, updating Vaughn’s medical record. Lund told Vaughn he’d like to take a picture of the rash to show to clinic dermatologist Dr. Karen Brown.
Vaughn raised his arm.
“Do you want me to smile?” he asked.
They both laughed.
Lund explained to him that as people age, many body systems, including the skin, become less reliable and more susceptible to disease.
“Old age is like running around with blinders on and wearing cotton gloves,” Lund said later. “The best way to live a long life is to choose your parents wisely.”
Like Vaughn, many of the patients that Lund saw during the day were elderly. While those over 65 make up more than 13 percent of the U.S. population, they account for nearly 40 percent of visits to internists, according to a 2002 report from the International Longevity Center. And the Coos Bay area has a larger proportion of people over the age of 65 than the average for Oregon, according to 2007 data from the Oregon Office of Rural Health. Nearly 19 percent of the Bay Area’s population is over the age of 65, compared to the average of 13 percent for the state.
Smoker
Lund met with his fifth patient, 61-year-old Linda King, at 10:20 a.m.
King was worried about a TV news report which called into question the safety of a medication she takes for the control of her diabetes.
Lund assured her the medication is probably safe. He seemed more concerned with her smoking habit.
“There are 3,000 chemicals in cigarettes,” Lund told her.
In addition to any number of cancers, Lund explained, smokers can develop Buerger’s disease, which causes inflammation in the extremities and sometimes ulceration and gangrene. Eventually, portions of a person’s hands and feet may be amputated. While the disease was long thought to mainly affect young men, a growing number of women smokers over 50 are getting the disease, according to research at John Hopkins University.
Some people who get the disease even keep on smoking despite the lack of limbs, Lund said.
As the doctor spoke, King shook her head, her gray ponytail swinging back and forth from shoulder to shoulder. Despite his plea for her to stop, she seemed unmoved.
“I tried to quit smoking seven times,” she said after the appointment. “I just enjoy it.”
Lunch
Lund raced down the winding hallways and through a room full of hundreds of orange and pink tagged manila folders. It was a few minutes after noon. His destination was a conference room near the back of the clinic.
“This is where we sell our souls,” he said as he entered, laughing.
Inside the room, a man with a navy blue suit and a broad, gleaming smile sat among the nurses and medical assistants.
He was a representative from a pharmaceutical company, and he was buying lunch.
A row of tables along one wall of the room held trays of food, most with a Mexican flair: black beans, Spanish rice, salad, a gloppy, cheese-encrusted concoction and a huge bowl of tortilla chips. For dessert? Cheesecake with strawberry sauce.
Paperwork
After lunch and a quick meeting with electronic medical records system administrator Debbie Wright, Lund returned to his office. He called Bay Area Hospital to check up on a patient. While doing that, he continued his paperwork. From insurance, prescription, Medicare and Medicaid forms to written confirmation of his verbal orders, it seems just about everything requires his signature.
“Jodi, how many hours a week would you say I spend on paperwork?” Lund asked while weeding through a pile of forms.
“About a third of your time,” Lockhart shouted back from her desk.
More paperwork means less time for patient care. If Lund works 60 hours a week, that means nearly 20 are spent doing paperwork. And while many of his patient records are going online, Lund still receives a steady amount of paper records.
While he worked at the computer, Lockhart entered and handed him an updated patient schedule. Without hesitation, he signed it. He didn’t need to.
“It’s just a habit,” he said.
More tests
Lund met with Morrene Kamph, a former cow milker, at 1:46 p.m. Kamph, 73, traveled from Langlois to see the doctor. Lab tests revealed her cholesterol had increased since her last visit.
Lund peppered her with questions to try and find the source of the increase. Kamph, dressed in a bright blue shirt and black pants, was adamant that she’d stopped eating eggs and was getting exercise.
After a few seconds of silence, while Lund clicked through screen after screen of Kamph’s chart, he finally spoke.
“Well, you must be doing something bad,” he said, chuckling.
After a breathless pause, she countered: “I’m too old to do anything bad.”
Lund didn’t give up. He prodded her for more information and badgered her for details about her daily activities. He eventually decided to have her come back for another round of tests to make sure it wasn’t just an anomaly.
Suffering
Later that afternoon, Lund walked down the hall toward a waiting room and removed a paper chart and entered. Penny West, 53, sat in a corner of the room, holding a cane in front of her. Her gray hair contrasted her bright yellow shirt. Her daughter, Bettye, stood next to her. Penny didn’t smile at Lund as he entered. A black and red bag containing medication sat on the examination table in front of her.
Lund spoke, his voice cutting through the tension in the room. He asked Penny why she was visiting today.
With labored breath, Penny complained of increased water retention and chest pains. Her eyes reddened as she spoke. She had a number of white spots on her hands, arms and legs which she said frequently turned into red sores.
As Penny talked, Lund listened intently. He reached out and gingerly picked up her right foot. He pressed her ankle with his thumb and left a deep mark — a sure sign of water retention, he said.
He asked Penny whether she’d been following a low-salt diet. Both mother and daughter looked at each other. Bettye said she’s been trying to get her mom to eat more vegetables, but she doesn’t like them.
“For you, salt is poison,” Lund said, explaining the importance of a healthy diet.
After the appointment, Bettye wheeled her mother out of the clinic in a wheelchair.
In reflection
After a day of talking, listening, badgering, coaxing and coddling, Lund said it is particularly difficult when patients don’t listen to his advice. While Lund may understand the reasons behind that mentality, he doesn’t share it.
“You hate to see people that don’t realize the obvious,” he said. “It feels like you’re beating your head against the wall.”
However, for all the patients that don’t listen, it’s worth it when he can help people take control of their health, he said.
“I complain constantly about being a doctor, but I don’t think I would want to do anything else,” he said.
Next: Health insurance might be a helpful thing to have, but it certainly doesn’t guarantee health care.
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