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.

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