Monday, May 15, 2017

Readers of this sporadic blog may recall a piece I did about reaping the spoils of the Exhibit Hall at the 2015 Scientific Assembly of the American College of Emergency Physicians. This week I was at the Annual Meeting of the Association of Clinical Documentation Improvement Specialists (ACDIS). For those who don't know, a few months ago I took a career turn to become a Physician Advisor for Clinical Documentation Improvement. It's been great. I'm leaning a new set of skills, doing research and data analysis, and helping to build systems to insure the financial security of a community hospital system. And as a night shift ER doc of over 20 years, it's also been an introduction to things like daylight, rush hour traffic, and lunch.

Allow me to elaborate on the latter, as this is truly a new and vital concept in my life. When you work in the ER, you eat on the run and generally in the ER, at your desk or in the break room (the latter when the JCAHO drops by). But it turns out that if you work in an office during the daytime at the semi-executive level, you can leave the office and eat. Anyplace you want, for as long as you want, until you have to attend your next meeting or you start to feel guilty about being gone. (Which is why all the Jews and Catholics tend to come back from lunch first. Two fine religious traditions united by guilt and shame.)

(By now you're wondering, "Dr. Rodenberg, Oracle of Northeast Clay County Florida, just what the heck is Clinical Documentation Improvement, anyway?" I'm so very glad you asked. Would you like the Official or the Unofficial Answer?

Official Answer: Clinical Documentation Improvement is about promoting the accurate reporting of clinical diagnoses for the purpose of fully reflecting the patient's severity of illness, risk of mortality, and needs for care.

Unofficial Answer: More words, more buckaroos.)

But I digress. I write today to tell you about the exhibit hall. It's another prime opportunity to scour the vendors to see what I can acquire in my adult daytime version of Halloween, complete with costumes like suits and ties that say "Important Professional" or "Clandestine Russian Operative."

As before, there are rules to the game.  You may take only one of each item from any one exhibitor.  As long as you don't have to talk, you can feign interest in anything.  If you are required to talk, you may not lie.  For instance, you cannot say you love a product, but just don't have the budget authority to buy.  You may, however, invoke fixed personal characteristics as a way to defer further conversation, which comes in handy when data systems have small type and you've lost your glasses because, by gosh, you'd love to learn more but you just can't see.

Let’s go shopping!  Excelsior!


One metal water bottle. Turns out that inside the bottle there was a small piece of paper with usage instructions in both French in English. I found this out after I had filled the bottle with water and inhaled the paper during a particularly enthusiastic swig. Once I had assessed myself for the possibility of aspiration pneumonitis (ICD-10-CM J69.0) and dried out the paper, I found it to be a most friendly greeting.

"Great choice!' Here are a few helpful tips to enhance your enjoyment of your new drink ware."

(You know how they tell you you're supposed to start with at least three positives before you introduce a negative into the conversation? Apparently that doesn't hold in the Promotional Metallic Beverage Container Industry. because immediately flowing that chipper introduction ware seven bad things that could happen to you, culminating in a note that the bottle could be an "entrapment hazard - don't stuff tongue down bottle neck. Injury can result. ICD-10-CM S09.93.)

Three tote bags, two white and one hot pink. The pink bag came form a vendor whose second trinket I did not acquire. They had do-it-yourself charm bracelets in silver, gold, and brass colors. You could select from any number of baubles to string along the wire, most of which were either letters or shapes from a box of Lucky Charms. The Dental Empress has fine taste, and clearly there was no way I could pass this off as David Yurman. So I deferred.

Elvis Presley. White suit on Day #1, black suit on Day #2. I did not get to take Elvis home, but did get my picture taken with him. I posted it on Facebook. According to the response, apparently I have better hair but he has better eyebrows. I also took a picture of Elvis with his "assistant," a pretty little thing who waits for the King down in the Jungle Room. I did not get to take home the assistant, either. Good hair only gets you so far.

Two stress balls, one white and one green. (Insert your own joke here.)

One small ringed binder of sticky notes of various sizes in Skittles colors. ("Post the rainbow.")

Some kind of two-part thing that has a bottom you stick (I think) to the top ledge of your computer and a top that kind of looks like a Troll doll with a brush for hair. I was told you take this to brush dust off your computer. No matter how hard you shake it, it does not sing like Justin Timberlake.

A "Las Vegas Trade Show Survival Kit" in a black knapsack. Inside is a notebook, an expandable button-like thing you stick on the back of your cellphone so you can grip in between your fingers when you take a selfie, an Elvis rubber duck holding flowers and a microphone under it's wings that says "Stress has left the Building," a flashlight, and deck of cards imprinted with "Deal Me Like They're Hot," five $250 foil-wrapped chocolate poker chips, and two extra strength Tylenol.

A photo booth montage of four poses of me holding a fake taco.

A collapsible blue, round, flat, wire-rimmed fan that I originally thought was a Frisbee.  It flies well.

A geometric designs coloring book and colored pencils.

A stone drink coaster bearing a picture of a bridge in Austin, Texas in a cardboard case whose cover is embossed with the words "Especially for You."

(Do you remember Bob Eubanks and the old Newlywed Game? How the couple that won got a prize "chosen especially for you?" I always wondered how that worked. It's not like they could have had that many prizes just sitting around the back lot, waiting for the final question. No, they must have interviewed the couples and asked them what they wanted, and then the week the producers got a dining room set they called the couples who wrote down "dining room set" on their "What prize can we pick especially for you?" survey and asked if they could come on own to the studio for taping. Speaking of which, I've figured out a foolproof system to win the Newlywed Game but I can't tell you what it is until the Dental Empress and I win the large Tax-Free Trust Fund selected Especially for Us.)

A plastic water bottle. No instructions found inside. I can learn.

A daisy-shaped pen in a plastic pot. These were given away by a Captain America cosplayer. Because if I had an adamantium shield, this is the first thing I would do.

A mouse pad.

A nail file.

A set of ear buds. (When I was typing, I accidentally wrote “rear buds.”  LOL.)

Two stress balls, one white and one green. (Insert your own joke here.  Yep, it was worth mentioning twice.)

A three-inch-tall snowman stress reliever that kind of looks like a miniature version of the inflatable clown punching bags we used to have when we were kids. It wobbles when you flick it on the head. The head is also magnetized so you can dress it up with paper clips.

Three kinds of phone stand. One cradles your phone so it stands upright. One holds your phone horizontally. The third, which you paste the back of your phone, has a kind of folding loop that you bend in place to keep your phone upright. None of these will work with my Otter Box phone protector.

Three decks of cards. It's Vegas, baby!

A first aid kid with a single alcohol wipe and six small bandages just large enough to cover that meth injection site. It's Vegas, baby!

(Now that I think about it, maybe the duck is Liberace.)

One small, barrel-shaped flashlight on a caribener. You take it out of the wrapper, push the button to turn it on, and watch it do nothing. You do this about twelve times before you wonder if there's even a battery in it. Then you open it up and there's a pieces that says "remove before use." You realize you've just been a subject in one of those chimpanzee problem solving, tool-using experiments. You're pretty sure it only took the chimp eight.

A portable cellphone power stick.

Four unflavored chapsticks.

One bottle of hand sanitizer for keychain use.

Six coozies. I've got a great idea for a science fair project. Take cans of soda out the refrigerator. Place the first can in a single coozie, the second can in two, and so on. Open the cans and measure how fast the temperature drops in each. Since coozies really don't work, the temperature will drop at the same rate no matter how many coozies you use. Say something about a null hypothesis. Take home ribbon. Results are disseminated on the Internet.  American Coozie Industry fails.  Wreak untold economic damage. Raise tariffs on imported coozies to Bring Back Our Jobs and Make America Great Again. You're welcome.

A bottle opener and corkscrew. Finally, someone remembered we were in Vegas. Keeping that.

Eighteen pens and one highlighter. Yellow, if you must know.

Two cylindrical clear, fluid-filled plastic tubes. I thought they were glue sticks. Turns out was lens cleaner and the other hand sanitizer. Which explains why I couldn't fix my broken glasses after I sat on them, but they were certainly clear and germ-free.

I'm probably not invited back next year.


It should also be noted that CDI professionals are mostly female. I point this out because vendors were not only giving things away, but raffling them off as well. At ACEP, with a roughly equal mix of genders, the prizes were specifically neutral. Not so this week. Vendors had drawings for purses by Michael Kos and Fendi. While I'm not a purse guy, I did register. Over the years I've learned that it never hurts to have some designer product hidden in the closet for the next time I do something stupid and the Dental Empress rolls her eyes at me. Which may be as soon as she reads that Elvis joke a few paragraphs back.

"What's that? Coming, my dear!"


Ahem. Grammar Guy here. Now that the other guy is gone, may bring up one more item? I realize that one of the glories of language is that it's alive, not rigid, always in flux, always in change. But it drives me crazy when everything's a journey.  As in "Begin you CDI Journey with Us!"  Granted, the book definition of journey is simply the act of traveling form one place to another, but in use the term has some sort of spiritual or adventurous dimension to it.  Long Day's Journey into Night, Journey to the Center of the Earth, Steve Perry. But this week it seemed that every project and program was a journey, the end of which seemed not to be ritual enlightenment or remarkable discovery, but the same old recognition that change is hard, it's all about the money, and doctors are curmudgeons. (All of which are true.) So can't we say project, or progress, or something else? I'll be the first to embrace this change with Open Arms. Who's Crying Now?