Here’s what it sounds like on the dictation. This is a drama played out over and over in America’s hospitals. It’s exhausting for patients and daunting for the ER and hospitalists, who try to keep things going smoothly and appropriately.
(Patient is 82 year old female who passed out. She has a severely bruised hip but no broken bones. However, she does have some frequent premature ventricular contractions…a minor arrhythmia which may be related to something more serious.)
“I spoke with the patient’s family doctor, Dr. Owens. Dr. Owens said that he sees no reason to admit her, as she has no hip fracture and has experienced similar episodes in the past. He states ‘all I can do is treat her pain, and that’s not enough to keep her.’ I explained that she could not ambulate due to the pain and he suggests her family stay with her. He asks that I consult Dr. Randall, her cardiologist. Dr. Randall states: ‘I tried to get her to let me do a cardiac cath last year. If she doesn’t want the treatment, I have nothing to offer her.’ Dr. Owens further suggests I talk to orthopedics, Dr. Ramey. Dr. Ramey explains that if nothing is broken, he has nothing to offer. However, he asks that I consult pain management, Dr. Fagioli. Dr. Fagioli states, ‘I can see her in the office next week, but it doesn’t sound like there’s a reason to see her right now. Give her my number.’ I pointed out that she could not walk due to the pain and he asked that I speak to Dr. Randall, her family physician. Dr. Randall stated ‘I’m going off call now, so just call the hospitalist and see what he says.’ Dr. Marcus, hospitalist on call, was consulted. I explained the situation, and that the family wished for the patient to be admitted.
Dr. Marcus stated: ‘I hate my life.’
Patient admitted to Dr. Marcus for pain control and evaluation of syncope.
I think we do such a good job that we shield our patients from even being aware that this goes on — the public really needs to know the obstacles they face in just gaining admission to the hospital — and more insidiously, the “not me” attitude of many among us…
How to do that? I don’t have a good answer. At the point of care, it would be too frustrating to the patient and family to know that in their time of need, no one “needs” them…
AKERdoc
9 years ago
Yes, we deal with this a lot all over the country. But in reality, while I myself try to get admission just like you did, we are giving in to the family’s wishes not necessarily doing what is medically needed. Why does she need admission? Because she can’t ambulate? Why can’t she be at home and not ambulate with the family caring for her? What is a hospital bill going to add? Easy for the family to make wishes as they or the patient isn’t paying for it. We want mom admitted because we can’t put our life on hold… Read more »
Nicole
9 years ago
I think why Dr Leap truly wanted to admit her is because she had multiple PVC with arrthymia with a syncopal episode and needed to be monitored by cardiology. She was obviously a non compliant pateint so who knows what could be going on so the only way to find that out is to stick her in the hospital at put her on a cardiac monitor and consult cardiology to run there test. Just saying. It was the right thing to do with or without the family’s imput. Even if it just observation. I am just a little ole ER… Read more »
Nicole
9 years ago
And I just wanted to thank you Dr. Leap. Your site is so refreshing to all of us healthcare providers who feel like we get push around and struggle for our sanity sometimes, especially in the ER.
Your stories are like therapy at the end of a Long shift lol. Some humor in there that only someone that lives it day to day can understand. You keep people like us going. Keep up the great work!
Nicole, RN
Nicole, thank you so much for your note. I really want to be the voice for those of us who do the hard work in the hard settings of modern medicine. If I can give you a laugh or a boost, then I feel thankful and blessed. Incidentally, I really want to reach out to the nursing and EMS world more as well, so if you have friends, please direct them to the blog! And feel free to friend me on Facebook and/or follow me on Twitter. Merry Christmas my friend! And keep the faith!
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Every day. Every day. Thanks for commiserating.
Thanks, Dr Leap!
I think we do such a good job that we shield our patients from even being aware that this goes on — the public really needs to know the obstacles they face in just gaining admission to the hospital — and more insidiously, the “not me” attitude of many among us…
How to do that? I don’t have a good answer. At the point of care, it would be too frustrating to the patient and family to know that in their time of need, no one “needs” them…
Yes, we deal with this a lot all over the country. But in reality, while I myself try to get admission just like you did, we are giving in to the family’s wishes not necessarily doing what is medically needed. Why does she need admission? Because she can’t ambulate? Why can’t she be at home and not ambulate with the family caring for her? What is a hospital bill going to add? Easy for the family to make wishes as they or the patient isn’t paying for it. We want mom admitted because we can’t put our life on hold… Read more »
I think why Dr Leap truly wanted to admit her is because she had multiple PVC with arrthymia with a syncopal episode and needed to be monitored by cardiology. She was obviously a non compliant pateint so who knows what could be going on so the only way to find that out is to stick her in the hospital at put her on a cardiac monitor and consult cardiology to run there test. Just saying. It was the right thing to do with or without the family’s imput. Even if it just observation. I am just a little ole ER… Read more »
And I just wanted to thank you Dr. Leap. Your site is so refreshing to all of us healthcare providers who feel like we get push around and struggle for our sanity sometimes, especially in the ER.
Your stories are like therapy at the end of a Long shift lol. Some humor in there that only someone that lives it day to day can understand. You keep people like us going. Keep up the great work!
Nicole, RN
Nicole, thank you so much for your note. I really want to be the voice for those of us who do the hard work in the hard settings of modern medicine. If I can give you a laugh or a boost, then I feel thankful and blessed. Incidentally, I really want to reach out to the nursing and EMS world more as well, so if you have friends, please direct them to the blog! And feel free to friend me on Facebook and/or follow me on Twitter. Merry Christmas my friend! And keep the faith!