Thursday, May 27, 2004

No good deed goes unpunished

A few months ago I got an emergency call from a small local hospital I cover - A pregnant woman was in advanced labor in their emergency room and they don't have Obstetrical Services. I immediately started to arrange rapid transfer of this woman to an appropriate nearby facility, while I raced to the Emergency Room in case she was really about to deliver. I arrived roughly 12 minutes after they first called me (I checked my watch, can't be too careful about these things) to find the woman in labor, basically fine, but around ten people standing around not really doing anything to help the situation.

So I fixed that. Examined her, scanned her, took a history (why couldn't any one of the other personnel there, including several MDs and assorted other "medical care providers" do this?), and made sure neither of my two patients was in any danger. I refocused the "administrative" personnel on getting that transfer going, rather than having to deliver the baby in the Emergency Room or the ambulance or something. She was term, prenatal care in another state (!) and decided to visit her aunt, then went into labor.

During the course of my examination of this woman, she started screaming at me - I examined her "too roughly," and she was angry. (Then I was angry, but I choked it back; after all, she's in labor, she's scared, all that. Maybe I was too rough? I was a bit anxious myself, trying to make sure we didn't have an impending disaster on our hands, and faced with a dead baby nobody is going to take my side and say, 'well, he didn't want to be too rough with the examination, so he couldn't really figure out what was going on.')

After a TOTALLY UNACCEPTABLE delay, we got her transferred, and she went on to deliver safely; while I was happy about that I was still annoyed that I was the target of her anger, given all of the people around her who had done nothing to take care of her other than, well, call me to come take care of her.

The hospital where she was transferred notified me the next day that her blood and urine tested positive for cocaine and alcohol.


Monday, May 17, 2004

Cut out the cancer

While travelling this week, I happened to notice that the covers of both Time and Newsweek were dedicated to the Abu Ghraib prison story. Meanwhile, the enemy (ed: "whose enemy?") by which I mean the enemies of Western Civilization, those people who overtly and covertly are trying to exterminate Western values of freedom, equality, and diversity, videotaped themselves beheading a contractor. And they're proud of it. I assume we won't be seeing front cover stories about that, instead we have to flagellate ourselves because a bunch of prison guards took naked pictures of a group of people formerly known for torture, rape, murder, and the service of manaiacal dictator. So excuse me if I don't weep openly for their "suffering." (A friend of mine actually cried, cried(!!) for their humiliation. I find it hard to imagine how she reacted to 9/11 and I didn't ask.)

Was it wrong? Sure. Should it be punished? Yes. But let's move on, and remember the bad guys don't want us to capitulate in this war. They want us to DIE.

Friday, May 07, 2004

The Catch

As a pediatrician in practice, I am referred newborn patients at our local hospital. Once the infant is born, standing nursery admission orders (using my name, my license, my malpractice insurance, my hospital privileges) are initiated. Sometime within a reasonable interval, I arrive at the hospital and examine the patient. Then, I interview another patient, (the Mother, sometimes anesthesized) to obtain, and relate, information about my patient. A few days of hospital care usually follow, and may include some elective surgery (a circumcision). Then my patient is discharged, in tandem with the other patient (the Mother). And, if I'm lucky, I never see them again. My responsibility persists for 18 or 21 years, depending on which lawyer is talking.
My office then attempts to arrange to obtain some financial recompense for my highly specialized, insured, licensed and heavily regulated labor. Of course, the hospital paperwork contains only information needed for hospital billing, and although I have asked ( I am the President of the Medical Staff, for crying out loud) they refuse to obtain information relating to physician billing during any part of the registration process (like before the Mother is anesthesized) because the additional info would "confuse their billing process."
If I get any response from the Mother to our attempts to get paid, it usually consists of her informing me that I am not "in" her insurance, so I she refuses to pay me. She insists that I should have informed her about not being "in" her insurance before I proceeded to care for the infant.
So, the next time I approach an anesthesized, exhausted and worried new Mother, the first thing I have to say is "What kind of insurance do you have?" I can't give her any reassurance about her infant, because I haven't examined him yet. Most of them don't have a clue at that point which insurance plan (her's? Dad's? the one from the job she's on maternity leave from? or the job she was at when she conceived?) covers the infant.
Anyway, we're off on the wrong foot; because all I "care about" is insurance. Damned if I do, damned if I don't.

Anatomy Lesson and the USS Clueless

I read Stephen den Beste regularly (, and I almost emailed him about this comment, but then I decided it's just the kind of nitpicking he derides, so I'm posting it here instead, for myself.

He suggested that his inability to acquire foreign languages easily was due to his type of cognition, "holistic thinking," and that he was unable to memorize long lists of words (this is "Detail" thinking rather than "seeing the forest for the trees.")

I think it's just the opposite. I barely passed Gross Anatomy precisely because I couldn't (wouldn't) memorize laundry lists of ligaments and nerve branches across the whole body, and I think I'm more of an "holistic" rather than "detail" thinker, but I find foreign language acquisition relatively easy, and always have.

If you ignore "minor details" like spelling and pronunciation, English and Spanish are 75% the same, in my view. If you get hung up on the differences between the words "Ado-LES-cent," and "ado-le-CENT-AY" then you might find it difficult to speak a "new" language.

Professional Prognosis

In the doctors' lounge I overheard two old surgeons complaining to one another about an Editorial written in the professional journal of their subspecialty, which suggested that established doctors shouldn't tell medical students all of the bad things about practice, and that they should instead emphasize all of the positive things that can be found in the practice of medicine. They didn't see it that way.

I think most people have a pretty good basic idea of the positive things- that's why they're drawn to the practice of medicine. The question for young people considering the practice of medicine is, "How much are you willing to put up with in order to do this?"

I think we should travel to college campuses with large posters saying, "Want to be an obstetrician?Congratulations on your decision to spend the next four years acquiring a $120,000 tuition bill and then working four years for $35,000 a year. By the way, three out of four of you will be sued for malpractice (at least once)."

Monday, May 03, 2004

Nothing Works

That's another thing that has been weighing on me recently. Almost nothing works around here. My computer: broken (I have to do this from the library). Getting someone to fix it: nearly impossible. So, access to my email, to my patient records (on the computer) - nope. I like to type my patient histories - YES, MY COLLEAGUES ARE STILL HANDWRITING THEM - because it is faster, wasting less of everyone's time. But I haven't been able to PRINT them for over a month. I have to save them to disk and then find another station in the office to get them down to the printer. This is so frustrating. And the bottom line is it makes me wonder about the context in which I work - there isn't adequate support for me to maximize my working time - instead I'm dealing with the computer. Other things in the office (the telephones, the answering service) all grind along the same way. Believe me, I'm doing what I can to fix it, but it's frustrating that I have to put any energy into it at all - why do we have a medical office at all, if not to make it easier for the doctors to see the patients? Yet nothing seems to exist to make that easier. And the rot that underlies this problem is the real problem.

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