February 24th, 2010 by Happy Hospitalist in Better Health Network, Opinion, True Stories
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As a hospitalist I sometimes come across patients who, for what ever reason, refuse to take the medications prescribed by their in-patient doctors. Some patients refuse out of fear. Some doctor told them years ago that taking medication X would make them worse. Some patients refuse out of ignorance of their disease process. Most of the time however, they just don’t understand why the medication is necessary. Some patients just refuse out of stubbornness. And some patients refuse because they have a really good reason.
However, when you’re dealing with critical illness and the only thing that’s going to save your patient’s life is a treatment plan they are refusing, sometimes you have to be in their face with reality. So how do I handle situations with patients who have the capacity to make poor medical decisions but refuse life saving medications? How do I convince my hospitalized patients to take their medications I’ve prescribed? Read more »
*This blog post was originally published at Happy Hospitalist*
February 21st, 2010 by Happy Hospitalist in Better Health Network, Humor, True Stories
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It’s 2:00 am in the emergency room. That’s when the real doctor humor stories comes out to play. By now I’ve sent two patients home from the ER, one of which I spent 90 minutes discussing why chronic abdominal pain management needed to involve an outpatient supratentorial component and why coming into the hospital would be a highly disappointing experience. By now I’ve also admitted two patients to observation status, one of which is a guy with uncontrolled diabetes who remembered me from a year prior and thanked me for telling him nobody else was going to live his life for him and he needed to take responsibility for his poor actions in life. By now I’ve also brought two patients in for full hospital admission, one of which was placed immediately on end of life cares for end stage COPD, the other of which who’s son got the wrath of my smoking lecture.
Once the work was done, the doctor humor came out to play. Read more »
*This blog post was originally published at Happy Hospitalist*
February 12th, 2010 by Happy Hospitalist in Better Health Network, Humor
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So I’m working on my history and physical examination and I ask my 87 year old retired vet what types of surgeries he’s had done.
“I’ve had every surgery in the book”, he says
So I asked him, “Have you had a sex change operation?”
“Well, no. I guess I haven’t had everything done.”
After a good group laugh, I went off to eat lunch.
*This blog post was originally published at The Happy Hospitalist Blog*
February 10th, 2010 by Happy Hospitalist in Better Health Network, Opinion
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So know I hear that Medicaid preauthorization is required to administer vitamins in an outpatient setting. One of the greatest things about hospitalist medicine is I can give just about any medication I think is clinically justified to my patients in the hospital. I don’t have any doctor, Dr Nurse, or other third party insurance bureaucrat telling me I have to get preauthorization before my patient can receive care. I have at my disposal a 24 hour all you can eat pharmacy. Sometimes they don’t know what I’m ordering, and my Green Goddess doesn’t get filled. But generally speaking, I get what I ask for.
That’s not the way it works in the frustrating outpatient world of clinical medicine. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
January 27th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, Opinion
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Have you ever stopped bothering to care about a patient? A doctor sent me his own personal account of the smoking Mr Jones:
Dear Happy. I read your article on bounce backs with great interest, and was astonished by some of the vitriol it elicited. I remember having one COPDer bounce back to me three times within a month at the VA when I was a medicine resident. He would leave, smoke and drink, and then come back and be readmitted to my service with exactly the same course each time. It was like Groundhog Day.
Finally I had a little talk with him and said: “Mr. Jones, each time you come in, you’re on death’s door. So I come down to the ER, stay up with you all night and save your life. But you know, I’m really getting tired of having you come in after drinking and smoking and then working like a dog to save your life. So let me tell you, if you don’t quit smoking, the next time you do this there’s a good chance that I’m not going to bother. Why should I? It doesn’t seem to be doing either of us any good.”
To my complete astonishment, he actually quit smoking and stayed quit for about a year. Then he fell off the wagon, deteriorated too far before getting to the hospital and died. I was frankly proud of him for the effort, but somehow suspect that I’d be shot in a drive-by if I ever told that story in public. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
