Today I spent most of my afternoon tracking down the attending physician on call whose signature I needed to send one of my patients home with the home health care services he/she had been receiving before he/she came to the hospital. At one point it seemed very realistic that this patient would be held for one more night because of this one "incomplete" form, despite being medically stable and otherwise cleared for discharge. Do you argue, one night in the hospital isn't so bad? One night in the hospital, for this patient, meant very real exposure to risks of delirium, hospital-acquired infections (likely multi-drug resistant), increased risk of blood clots, and increased risk of falling. All at a price to taxpayers of somewhere in the ballpark of $5000/night (not accounting for any of the above complications).
Twice this week I've had similar situations with other patients who were clinically stable, but because of medical history and presenting symptoms (and medico-legal liability) needed an MRI (and interpretation) before we could confidently send them home. Both patients waited in the hospital over 24 hours before receiving this test that was essential to medical evaluation, gathering at least one "unnecessary" overnight stay with the same risks and costs as above.
Fortunately, in the first case, a few phone calls and a helpful social worker finally resolved the paperwork that was hindering the patient's final discharge. And in the other cases, the needed tests were eventually performed and the medical evaluation/treatment completed. But at what cost to the healthcare system? Fortunately none of these patients developed blood clots, bed sores, or secondary infections. But the hospitalized time alone--unnecessarily prolonged--is easily tens of thousands of dollars, just in my meager experience which may not be even a tenth of the patients in one hospital in one city, a blip in the supernova of healthcare expenditures which have been so popularly scrutinized... The embedded inefficiency is incredibly frustrating.
Wednesday, July 25, 2012
Friday, July 20, 2012
Series of firsts
First stroke actually requiring paperwork and orders
First day successfully narrowing antibiotic therapy on all my patients (goodbye, vancomycin!)
First conversation regarding a new diagnosis of cancer
First call from a pharmacy to clarify a prescription. Advair comes in multiple strengths, who knew?!
First time seeing a patient (or family member, with whom I had nearly equal contact) in a grocery store...
First time being introduced to a senior resident with the words "I've heard really good things about you."
First weekend overnight admitting shift tomorrow... I have no idea how to jack my sleep cycle in the next 24 hours that will keep me awake/functional for an entire night
It's funny what a microcosm the hospital is, so septated yet overlapping. It's a kaleidoscope constantly re-introducing the same colors in different sequences. A place of healing, but also of grief, pain, and outright mysteries. Of contrasts and irony: one patient hugs all the residents on the med team for giving her antibiotics and sending her back to the nursing home; another threatens to leave "against medical advice" for not receiving the graham crackers she had requested only a matter of days after chest compressions and 360 joules brought her back from the brink. Where I might carry an inflated title, but any practical knowledge I have comes from the nurses, aides, pharmacists, and hospital phone operator. And senior residents. Who are amazingly helpful and smart and patient. Someday maybe I'll have my act together enough to have some worth as an educator in my own sphere. Next month I outrotate, and that's a scary thing; I'm almost used to my hospital, and I like the niche I have in my own team. But first things first; tonight, I am sleeping.
First day successfully narrowing antibiotic therapy on all my patients (goodbye, vancomycin!)
First conversation regarding a new diagnosis of cancer
First call from a pharmacy to clarify a prescription. Advair comes in multiple strengths, who knew?!
First time seeing a patient (or family member, with whom I had nearly equal contact) in a grocery store...
First time being introduced to a senior resident with the words "I've heard really good things about you."
First weekend overnight admitting shift tomorrow... I have no idea how to jack my sleep cycle in the next 24 hours that will keep me awake/functional for an entire night
It's funny what a microcosm the hospital is, so septated yet overlapping. It's a kaleidoscope constantly re-introducing the same colors in different sequences. A place of healing, but also of grief, pain, and outright mysteries. Of contrasts and irony: one patient hugs all the residents on the med team for giving her antibiotics and sending her back to the nursing home; another threatens to leave "against medical advice" for not receiving the graham crackers she had requested only a matter of days after chest compressions and 360 joules brought her back from the brink. Where I might carry an inflated title, but any practical knowledge I have comes from the nurses, aides, pharmacists, and hospital phone operator. And senior residents. Who are amazingly helpful and smart and patient. Someday maybe I'll have my act together enough to have some worth as an educator in my own sphere. Next month I outrotate, and that's a scary thing; I'm almost used to my hospital, and I like the niche I have in my own team. But first things first; tonight, I am sleeping.
Monday, June 25, 2012
Beginnings
"And I ended up getting a job here..."
What simple words to embody the dark angst that was the whole audition season, interview season, second look weekends, the trepidation of match day... Months living out of suitcases, weekends spent in airports, mornings sitting carefully ironed and be-pearled, emitting first impressions and asking carefully rehearsed questions. Belated thank-you cards and fateful emails... then a flurry of graduation, a summer of roadtrips, and here we are at the real thing.
Passport found. Immunizations recorded. Epocrates downloaded. Benefits package skimmed over, and a ream of HR paperwork already submitted. Dress clothes picked out--in my mind--and here I go to set the alarm clock. Surely a morning of computer training and house staff photographs can't go too wrongly, but it is all a matter of stepping stones. Rule #1, show up. Preferably at the right building at the right time... without cat hair trailing down a pant leg... At least there are still a few days before everything is really on the line.
"In all your ways, acknowledge Him, and He shall direct your paths."
Baby steps.
What simple words to embody the dark angst that was the whole audition season, interview season, second look weekends, the trepidation of match day... Months living out of suitcases, weekends spent in airports, mornings sitting carefully ironed and be-pearled, emitting first impressions and asking carefully rehearsed questions. Belated thank-you cards and fateful emails... then a flurry of graduation, a summer of roadtrips, and here we are at the real thing.
Passport found. Immunizations recorded. Epocrates downloaded. Benefits package skimmed over, and a ream of HR paperwork already submitted. Dress clothes picked out--in my mind--and here I go to set the alarm clock. Surely a morning of computer training and house staff photographs can't go too wrongly, but it is all a matter of stepping stones. Rule #1, show up. Preferably at the right building at the right time... without cat hair trailing down a pant leg... At least there are still a few days before everything is really on the line.
"In all your ways, acknowledge Him, and He shall direct your paths."
Baby steps.
Saturday, June 23, 2012
Starting over
Out with the old, in with the new. Blog address remains the same but it's time for a clean slate. It would seem that in the seven years since I started blogging I've lost the art of putting words on the backlit screen with any regularity, but I do miss the interactions that have occurred through this medium.
At the moment I'm facebookless, partly as a backlash against society and partly as a force to gather my own thoughts before I jump into the deep end of the most difficult real-life experience I've grappled with to date: a real job, with real responsibility and real consequences. Today, all I want to do is hide in bed with the pillows over my head pretending like Monday is still far away.
But I know I'm here for a reason. He who began a good work in [me] will be faithful to complete it... and haven't I already seen so clearly the signs that I have been placed in this particular place in my life with none other than divine intention? Lord, help my unbelief.
I haven't decided yet whether to continue my habit of writing protected posts and cross-linking them here. While I enjoy the privacy of that method, I can also argue for the transparency and increased interaction of this open forum. Decisions, all my friends will attest to, are not one of my strong points, which is why I am not going into trauma surgery... but I suppose the outcome of this issue will make itself obvious in time.
And so, we meet again!
At the moment I'm facebookless, partly as a backlash against society and partly as a force to gather my own thoughts before I jump into the deep end of the most difficult real-life experience I've grappled with to date: a real job, with real responsibility and real consequences. Today, all I want to do is hide in bed with the pillows over my head pretending like Monday is still far away.
But I know I'm here for a reason. He who began a good work in [me] will be faithful to complete it... and haven't I already seen so clearly the signs that I have been placed in this particular place in my life with none other than divine intention? Lord, help my unbelief.
I haven't decided yet whether to continue my habit of writing protected posts and cross-linking them here. While I enjoy the privacy of that method, I can also argue for the transparency and increased interaction of this open forum. Decisions, all my friends will attest to, are not one of my strong points, which is why I am not going into trauma surgery... but I suppose the outcome of this issue will make itself obvious in time.
And so, we meet again!
Subscribe to:
Posts (Atom)