March 29th, 2010 by DrWes in Better Health Network, Health Policy, Opinion, Quackery Exposed, True Stories
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When hospitals mandate where patients are treated, it can lead to conspiracy and racketeering charges. Here’s an excerpt from a letter from the Chairman of the Board of Citizens Medical Center to one of the cardiologists filing suit:
“While it is certainly your right to exercise your medical judgement as you see fit, likewise, it is the responsibility of the Board of Directors at Citizens Medical Center to exercise their judgement as to what is in the interest of the business of Citizens Medical Center and its patients and Medical Staff. It is the Board’s firm belief that it is in the best interest of Citizens Medical Center for patients who are capable of being treated at Citizens Medical Center to be treated at Citizens Medical Center and not be transferred elsewhere.”
Business interests before doctor-patient interests? Ouch.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
February 15th, 2010 by DrWes in Better Health Network, Health Policy, Opinion
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It’s an age-old problem, made more complicated by our new era of electronic medical records: optimizing collections in a time of unprecedented price pressures on our health care complex. With the economic downturn and declining government payments for services, everyone in health care is feeling the pinch.
It is no secret that work not billed will ultimately be work not paid. Hospitals and practice managers, adept at business principles, know this. Deep down inside, doctors know this, too. Historically, doctors dictated when they billed their patients, even if it meant waiting over a week to do so. If a doctor was to take a vacation, some of those billings could wait until his return.
Not so any longer. Read more »
*This blog post was originally published at Dr. Wes*
September 2nd, 2009 by Dr. Val Jones in True Stories
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This post is a “Dr. Val classic” – first published in early 2007.
***
Internship, for those of you who may not know, is the first year of residency training. It is the first time
that a doctor, fresh out of medical school, has responsibility for patient care. The intern prescribes medications, performs procedures, writes notes that are part of the medical record, and generally learns the art of medicine under the careful watch of more senior physicians.
Internship is a frightening time for all of us. We’ve studied medicine for 4 years, memorized ungodly amounts of largely irrelevant material, played “doctor” in third and fourth year clerkships, but never before have lives actually been put in our hands. We know the expression, “never get sick in July” because that’s when all the well-intentioned, but generally incompetent new interns start caring for patients. And so, we tremble as we begin the new stage in our careers – applying our medical knowledge to real life situations, and praying that we don’t kill anybody.
I’ll never forget my first day of internship. I must have drawn the short straw, because not only was I assigned to the busiest, sickest ward in my hospital (the HIV and infectious disease unit), but I was on call that day (so I’d be working for 24 hours straight) with the most hated resident in the program (he had a reputation for treating interns poorly and being arrogant to the nurses). As I reviewed my patient list, I noticed that the sign out sheet (the paper “baton” of information handed to you by the last intern who cared for the patients – meant to give you a synopsis of what they needed) was supremely unhelpful. Chicken scratch with diagnoses and little check boxes of “to do’s” for me. I was really nervous.
So I began to round on my patients – introducing myself to each of them, letting them know that I was their new doctor. I figured that even if I couldn’t completely understand the sign out notes, at least by eye-balling them I’d have an idea of whether or not they were in imminent danger of coding or some other awful thing that I figured they’d be trying to do.
My third patient (of 15) was a thin, elderly Hispanic man, Mr. Santos. He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to all women of child bearing age. I ignored it and introduced myself in a professional manner and began to check his vital signs. I was listening to his heart, and I honestly couldn’t hear much of anything. There was a weird, very distant beat – something I wouldn’t expect for such a thin chest. The man himself looked awful, but I really wasn’t sure why – he just seemed really, really ill.
My pager was going off mercilessly all night. I wondered if this was how the nurses got to know the characters of their new interns – to test them by paging them for anything under the sun, tempting us to tip our hand if we had tendencies to be impatient or disrespectful. But in the midst of all the “we need you to sign this Tylenol order” pages, there came a concerning one: “Hey, Mr. Santos doesn’t look good. Better get up here.”
My heart raced as I rushed to his bedside. Yup, he sure didn’t look too good. He was breathing heavily, and had some kind of fearful expression on his face. I didn’t really know what to do, so I decided to call the resident in charge (much as I was loathe to do so, since I knew he would humiliate me for bothering
him).
The resident appeared in a froth – “Why are you paging me? What’s wrong with the patient? Why do you need me here? This better be good!”
“Um… Mr. Santos doesn’t look too good.” I said, frightened to death.
“What do you mean ‘he doesn’t look too good?’ Can you be a little bit more specific” he said, sarcasm dripping from his tongue.
“Well, I can’t hear his heart and he’s breathing hard.”
“I see,” said the resident, rolling his eyes. He marched off towards the patient’s room, certain to make an example of me and this case.
I trotted along behind him, hoping I hadn’t been wrong in paging him – trying to remember the ACLS
protocol from 2 weeks prior.
The resident drew back the curtain around the man’s bed with one grand sweep of the arm. “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.
The man was staring at the wall, taking in deep, labored breaths of air. I saw that the resident immediately realized that this was serious, and he placed his stethoscope on the man’s chest.
I approached on the other side of the bed and held his hand. “Mr. Santos, I’m back, remember me?” He smiled and looked me straight in the eye.
He replied, “Angel.” (in Spanish) Then he let out a deep breath and all was silent.
The resident shook the man, “Mr. Santos? Mr. Santos?!” There was no response.
“Should I call a code?” I asked sheepishly.
“Nope, he’s DNR,” said the resident.
I was flabbergasted.
“Yep, you just killed your first patient. Welcome to intern year.”
As I thought about his cruel accusation, I was comforted by the fact that at least, as Mr. Santos released his final breath, he thought he had seen an angel. Maybe my presence with him that night did something good… even though I was only a lowly intern.
June 24th, 2009 by Emergiblog in Better Health Network, True Stories
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Well, somebody likes their job, I must say.
Although I can’t figure out why she is smiling.
Her cap looks like conjoined coffee filters!
Conjoined coffee filters that somebody sat on!
Maybe she doesn’t realize it’s squished, and would die of embarrassment if she knew!
********************
The emergency department “regular”.
Every emergency department has them.
A patient can become a “regular” for many reasons. Maybe they are a recurrent cardiac patient. Perhaps they suffer from chronic pain. Sometimes, they become a “regular” because they utilize the ER as a clinic and bring the whole family in over the course of a month. Some regulars are drug seekers. Others are homeless and know they can find respite in the department for at least a couple of hours and maybe get something to eat.
If you work in an emergency department long enough, you will know who they are.
And you will get to know them.
*****
Recently, it dawned on me just how well you get to know them.
I work in a community hospital. It’s one of those hospitals that patients actually request to go to from all over the county. We have our shifts from hell, but it is far from the county-trauma-eight-hour-wait-time environment of the huge medical centers. There is time to talk to the patients, find out more about them than what hurts, what is swollen or what prescription they have lost.
Over time, the conversation stops being scripted and “starts getting real”, as they say.
*****
This particular shift was steady, but not crazy. And almost all the patients I cared for were “regulars”. Easily 90%. For some, it was their usual health issue. For others, something different.
I found out a lot that night over the course of that shift
Someone’s youngest would be starting kindergarten in September; someone’s oldest had just graduated from high school. Someone had gotten into a recovery program and had been clean for a month. Someone had just welcomed their first grandchild, another was mourning the loss of their mom the week before. Someone had lost their job earlier in the week. Someone had gotten married since their last visit. A baby sister was on the way for one of my patients. Another patient had enrolled in the local junior college.
We saw them, treated them and sent them on their way with a wave and a prescription.
Hopefully they left in better shape then they arrived, even if all they needed was reassurance.
All I know is that I thoroughly enjoyed that shift.
*****
I had done all the usual things. Saline locks, blood draws. Medications and re-evaluations. IVs and education.
But I had also congratulated success, commiserated over frustrations and offered consolation over losses. We covered birth and death, struggles and successes, dropping old lifestyles and starting new beginnings.
That shift, I saw my patients in a different light.
*****
The best part of nursing has nothing to do with disease or diagnoses or procedures or prescriptions.
The best part of nursing is the patients themselves.
I thoroughly enjoyed catching up with my “regulars”.
I hope I was therapeutic for them.
They were most certainly therapeutic for me.
*This blog post was originally published at Emergiblog*
June 16th, 2009 by MotherJonesRN in Better Health Network, Opinion
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Do you remember this person? She is a bedside nurse. She walks up and down hospital hallways in her white nursing shoes all day long while caring for her patients. She is trained for active duty. I’m asking you this question because nursing researchers have had an epiphany. They believe that they have discovered something new in the field of bedside nursing.
Over the years I’ve observed that the more degrees and letters that a lot of academic nurses get behind their name, the more out of touch they become with bedside nursing. This came to light once again when I attended a mandatory inservice at work. I was told that we were going to talk about an innovative concept that was going to revolutionize patient care and the nursing profession. Imagine my surprise when the speaker talked about hourly rounds. Did you know that nursing researchers have discovered that patients are happiest when their nurses spend time with them at the bedside every hour, and anticipate their needs? Wow, what a concept. Academic nurses living in the ivory tower of higher learning have discovered through years of painstaking research that patients also want nurses to answer their call light promptly when they need help getting to the bathroom. Holy cow! Hourly rounds decreases the amount of time patients spend using their call lights, decreases injuries due to patient falls, and increases patient satisfaction while they are in the hospital.
Did I miss something? I remember learning all this stuff years ago when I was attending a lowly diploma nursing program. We were always walking up and down the halls in our nursing shoes. No one conducted studies on how to make patients happy back then. A little common sense goes a long ways. The formula to good patient care starts with clean bed sheets and a filled water pitcher, and ends with a connection to your patient. That’s not new. That’s nursing.
*This blog post was originally published at Nurse Ratched's Place*
