Oh what a day ... again

You know what its like ... you can smell these days coming and you just want to find a pillow and fast...

Update from yesterday .... My patient finally was discharged from the hospital after 1:00 pm but she had to sign out AMA (against medical advice) she did manage to get a CD with all her imaging studies. She is pain free and home now 72 hours after her accident. I called the CEO of the hospital twice but he was too busy to call me, the head of the medical staff office couldn't find the time, either but about 7:00 pm, I did receive a call from the quality manager (I wonder why) .. I recited my story and then asked... I bet this isn't the first time you've heard this story? she paused and said hesitantly .. "No."

So, I offered her my hand and suggested that we do one of two things. 1) I would call and report the hospital to the medical board.. clearly they had real issues with "process" or 2) I help them with some educational opportunities .... I would meet with their CEO and with the Chief of staff and the Chief of Surgery ( who oversees trauma) .. the hospital will hire an agency to look at their trauma "process" and we re-work how they manage their patients. I asked them to call me back within 48 hours. She called back to be sure that she had all my contact numbers.

We'll see.. This actually could turn out to be very positive. Perhaps patients will be saved from the horrors of California Hospital ... and doctors will be given a chance to really do their job... The sad truth.. and I know this .. this is what is happening all over America. Doctors have left their calling... fallen from their profession ... into a job... and our patients are suffering...

So .. remember that thing the media has been calling the "death panel?" Well .. you and I know it does NOT exist ... of course.. but the "death" culture is creeping up on us. Today, my patient who was successfully rehabilitating at a local facility came to visit me. She came with all her orders from the facility and the first order was "DNR... No CPR" I asked my patient, EW, if she had been asked about her wishes and she explained that somewhat stopped by one day and out of the blue just asked her if she wanted to be resuscitated..... she thought "well, No not if she was going to die... "

Oh my... I explained that what had happened is that they had moved her from the "life track" to the "death track." Her daughter was shocked and not too happy.. This is happening in our hospitals every day...We admit our patients to "cure them" to "mend them" but the first question out of the nurses mouth (because they have to fill out the form) is "what shall we do about resuscitation?" Most patients don't understand that a DNR order is a change in culture status in a hospital.... Personally, I refuse to write it.... I don't admit patients into a hospital to die for heavens sake and if a tragedy overwhelms them, I should be called first.. and immediately. That does NOT preclude an advanced directive, of course.

Patients beware.. these are the subtleties that are invading our hospital culture. Most doctors understand ... but nurses often use the DNR as an excuse to do nothing... seriously ..

Anyway.... problem solved.. I wrote an order FULL CODE... Oh.. by the way .. the patient is an 87 year old woman who is on her way to Maui when she recovers from her hip fracture. She reads about a book a day ... and is the most lovely and wonderful woman in the world...

Then there was the clerk who told me that she could not approve my STAT CT scan (for suspected diverticulitis) until I answered the list of computer questions. Well, "Yes," she said.. "we are treating the computer; but Dr. Zwelling, if you want your patient to get the study answer the irrelevant questions".. so I did.... I know when I'm beat. The patient had diverticulitis.. stepped in my office unannounced, had her CT and lab work and was back home with her diagnosis, lab and CT results and taking her antibiotics and clear fluids within 2.5 hours. NO ER .. NO hospital.... That's the medical home .. YEAH ....

I talked to the CMA today .. the staff at the CMA have been working feverishly because they want to win the REC RFP (federal dollars) so that they can manage the 30-60 million dollars donated from the FEDS to educate doctors about EHR's.. Oh never mind that the board has NEVER discussed the issue... the staff thinks that they know what doctors want. It does not matter that the EHR does not decrease errors... or increase productivity and costs too much .. So what they say .. doctors should know what dance they need to dance on that pin head in order to not "violate the federal government" .. I asked.. "who said we wanted to play at all? Who said that we wanted to abrogate our patient's privacy?" Well... no one really... That issue will come up next month at the CMA HOD ... where I try to defend my patients right to privacy ...

In the battle of CalRHIO vs the local HIE's and who gets those millions of dollars... Molly Coye called. She wants me to endorse CalRHIO .. I want to endorse the HIE's .. more on that later... in the end .. and you heard it here first.. the patient owns their own record !!!! STOP THE PRESSES... I promise to explain this whole issue in the next blog.... its too darn complicated for this late hour...

I rant on and on ... but I tire of the same arguments .. and it is always the same argument... The saddest part of the story is that I truly am beginning to believe that I come from a different place. and I'll never belong ... It's not that it matters where I come from .... I just want to be able to wake up one day to a world that isn't so damn gullible ....

On to another day ... Have to finish that darn charting .. (I hate that stuff)....