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)....
Tuesday, September 8, 2009
Monday, September 7, 2009
The Labor of health care
It is Labor Day and I am using the day to catch up only to be met by the reason the nation is debating to reform our "delivery systems." My patient, a young college student was involved in a Motor Vehicle Accident over 2 days ago. She was taken to California Hospital in downtown LA where she was evaluated. Apparently an MRI of her neck was suspicious. Since that time, she has had a CT scan at the request of a neurosurgeon who has yet to evaluate her in person.
I was made aware of her admission when her father called me from Florida. I was not aware of her admission. She forgot to tell the doctors that I was her doctor. She was caught up in the frantics of the moment. Of course, no one there asked her, either.
In any event, I have had the privilege of speaking with a physicians' assistant who promised me that a Dr. Hubbard would be calling me. He is the trauma doctor on the team who is managing her care today. (everything is team based, these days making no one in charge) That was several hours ago. I was also promised that the neurosurgeon would be by to evaluate her in a matter of an hour ... that was three hours ago. No call... no visit.. no contact.
In the meantime, they finally decided to give his 20 pound young woman some clear fluids for the first time in 2 days but they will take her out of the collar that they have her in.
I will be filing the usual Marcy complaint with the medical board tomorrow and I will be talking with the CEO of the hospital. And... by the way .... she is VERY INSURED. Insurance is NOT assurance of anything in the present system. What an embarrassment.
More to come ..
Just heard from Dr. Hubbard .. he has NEVER examined my patient but will not let her leave until the neurosurgeon (who he says he cannot control) clears her to go home. Dr. Hubbard has never examined her and does not even know how long she has been in the hospital... kicked it up a notch... Nursing supervisor is on it and is going up stairs (7th floor) to get things rolling ...
More later...
it is now 5 hours since I have been involved in the "case" and I have been called by the nursing supervisor that she found the neurosurgeon. He will be seeing Nicole soon. We'll see. Hopefully, my next entry will be that she is discharged in safe condition.
The neurosurgeon saw the patient and documented that he had examined the patient and that she had no neuro deficits. He was, however, unable to discharge her. That decision would lie with the trauma team. After more phone calls than I could count on both hands, I could not get the patient discharged. But, I was successful in making sure that she had food (after 48 hours) and that her hard neck collar had been removed. She will surely go home in the am after I speak with the CEO.
What an embarrassment to the entire system. IN this case, I will not sit back but will call the medical board in the morning and will report the problem. Thank goodness, she was not hurt.
The labors of the remainder of my labor day were spent watching GREAT football. Miami vs. the Seminoles. I await the Ohio State vs USC game next weekend. I'll be sure to have my Bloody Mary prior to the game ... my Buckeyes are going to be in for a long night.
In the meantime, I await the Obama speech and I am finishing up my next op-ed. I will not stop fighting for my patients' rights. It is the right fight ... We cannot lose ...
I was made aware of her admission when her father called me from Florida. I was not aware of her admission. She forgot to tell the doctors that I was her doctor. She was caught up in the frantics of the moment. Of course, no one there asked her, either.
In any event, I have had the privilege of speaking with a physicians' assistant who promised me that a Dr. Hubbard would be calling me. He is the trauma doctor on the team who is managing her care today. (everything is team based, these days making no one in charge) That was several hours ago. I was also promised that the neurosurgeon would be by to evaluate her in a matter of an hour ... that was three hours ago. No call... no visit.. no contact.
In the meantime, they finally decided to give his 20 pound young woman some clear fluids for the first time in 2 days but they will take her out of the collar that they have her in.
I will be filing the usual Marcy complaint with the medical board tomorrow and I will be talking with the CEO of the hospital. And... by the way .... she is VERY INSURED. Insurance is NOT assurance of anything in the present system. What an embarrassment.
More to come ..
Just heard from Dr. Hubbard .. he has NEVER examined my patient but will not let her leave until the neurosurgeon (who he says he cannot control) clears her to go home. Dr. Hubbard has never examined her and does not even know how long she has been in the hospital... kicked it up a notch... Nursing supervisor is on it and is going up stairs (7th floor) to get things rolling ...
More later...
it is now 5 hours since I have been involved in the "case" and I have been called by the nursing supervisor that she found the neurosurgeon. He will be seeing Nicole soon. We'll see. Hopefully, my next entry will be that she is discharged in safe condition.
The neurosurgeon saw the patient and documented that he had examined the patient and that she had no neuro deficits. He was, however, unable to discharge her. That decision would lie with the trauma team. After more phone calls than I could count on both hands, I could not get the patient discharged. But, I was successful in making sure that she had food (after 48 hours) and that her hard neck collar had been removed. She will surely go home in the am after I speak with the CEO.
What an embarrassment to the entire system. IN this case, I will not sit back but will call the medical board in the morning and will report the problem. Thank goodness, she was not hurt.
The labors of the remainder of my labor day were spent watching GREAT football. Miami vs. the Seminoles. I await the Ohio State vs USC game next weekend. I'll be sure to have my Bloody Mary prior to the game ... my Buckeyes are going to be in for a long night.
In the meantime, I await the Obama speech and I am finishing up my next op-ed. I will not stop fighting for my patients' rights. It is the right fight ... We cannot lose ...
Thursday, September 3, 2009
CMA Strikes Gold
Today, the CMA BOT voted in our new CEO, Alfred Gilchrist. He is a seasoned lobbyist and manager. I am eager to work with Mr. Gilchrist and try to bring organized medicine back to life. And, to that end..... we know that President Obama will be addressing Congress and the nation on Wednesday night, 9th of September. There is HUGE debate about how to manage his message ... obviously what will the message be? Will he take a leadership position and lay out what he expects to see in a bill? Will he insist on the public option? What will happen if he does? or does not?
The core issue... of course... is the government has no business in the "business" of health care. They have no idea what they are talking about and their interference only adds cost and decreases quality to the opportunities we can offer our patients.
Again... the "product" medical care is what happens amongst doctors and patients. It should be defined by the specific patients' needs. And its value ... can be commoditized... that is so important .. it is NOT the patients or the doctors who should be the commodity .... but the product.... how to get this difficult economic premise to the public ... for another day ... I have to think on that one.
So now back to Moses...I have concluded that on the one hand, we need Moses to lead us out of the desert ... but given today's regulatory obstructions, we would probably never get past the gate into the promised land. I was commiserating with a friend that if Nancy Pelosi were alive when Moses was approaching the "gates," she would pass a law requiring photo ID's of all the tribal members and Moses would have to wait for the camera to be invented before he could finally finish his mission. One of my friends suggested he could have waited for Al Gore to invent the internet ... he could have probably consolidated those 40 years down to 2 or 3 with the right GPS system. So, I think that I am going to change the premise of this next op ed... to reflect that even Moses with the tablets and God at his back would be left in the desert wanting for something if our government were in charge of the "gate charge" in the promised land.
My ended with a lot of reflection and a long conversation with my friend Bre. Oh ... what a smart "cookie" as my mother would say. She talks a mile a minute and you have to really listen to her intently because she says lots of smart things. I think that the two of us could probably save the world ... but the question always remains .. does the world want saving? I just love smart, motivated people ..
More on Bre over the weekend... i have to go home .. talking to Javier Becerra's office in the am.. very excited..... Could be the entre into the democratic caucus... we could get some REAL movement forward.... I hope ... I hope...
Good news..Bob is better... SW does NOT have breast cancer... and the sun will shine tomorrow...
The core issue... of course... is the government has no business in the "business" of health care. They have no idea what they are talking about and their interference only adds cost and decreases quality to the opportunities we can offer our patients.
Again... the "product" medical care is what happens amongst doctors and patients. It should be defined by the specific patients' needs. And its value ... can be commoditized... that is so important .. it is NOT the patients or the doctors who should be the commodity .... but the product.... how to get this difficult economic premise to the public ... for another day ... I have to think on that one.
So now back to Moses...I have concluded that on the one hand, we need Moses to lead us out of the desert ... but given today's regulatory obstructions, we would probably never get past the gate into the promised land. I was commiserating with a friend that if Nancy Pelosi were alive when Moses was approaching the "gates," she would pass a law requiring photo ID's of all the tribal members and Moses would have to wait for the camera to be invented before he could finally finish his mission. One of my friends suggested he could have waited for Al Gore to invent the internet ... he could have probably consolidated those 40 years down to 2 or 3 with the right GPS system. So, I think that I am going to change the premise of this next op ed... to reflect that even Moses with the tablets and God at his back would be left in the desert wanting for something if our government were in charge of the "gate charge" in the promised land.
My ended with a lot of reflection and a long conversation with my friend Bre. Oh ... what a smart "cookie" as my mother would say. She talks a mile a minute and you have to really listen to her intently because she says lots of smart things. I think that the two of us could probably save the world ... but the question always remains .. does the world want saving? I just love smart, motivated people ..
More on Bre over the weekend... i have to go home .. talking to Javier Becerra's office in the am.. very excited..... Could be the entre into the democratic caucus... we could get some REAL movement forward.... I hope ... I hope...
Good news..Bob is better... SW does NOT have breast cancer... and the sun will shine tomorrow...
Tuesday, September 1, 2009
My friend Lu
My friend Lu ...
You know what happens when a friend really "gets you." It is incredibly invigorating and at the same time painfully honest. So... Lu and were talking about my future and the future of Choice Care. Am I going to continue to pursue "marcy care" or can I step back .... and allow this "thing" to grow by brining others on board to join me in a more collaborative effort. Wow... it is so hard for me to give away any control. I didn't realize what how narcissistic I am. That's painful.
So I'm thinking on this one ... If I could just step back and open up ... maybe I could make a bigger difference. More to come.
The day ended when I read a column from the Annals of Internal Medicine ... entitled "Is There a Doctor in the Home?," written by Roy C Ziegelstein, MD. I was so angry that I called husband Lance from the car, screaming all the way home.
The story ... Dr. Ziegelstein wrote a column about his patient who emailed him from his hospital bed. The patient was in the hospital for evaluation of chest pain and this Dr. "z" (note little z) is his cardiologist. Dr. "z" thought it was so cute that his patient wrote him .. and that his patient had chosen this method of communicating with him. Dr. "z" went on to comment about the 47 million uninsured without a medical home and whether doctors will ever be able to coordinate care again. What? Why didn't Dr. "z" get off his bottom and go visit his patient? Why was his patient forced to see a hospitalist? Why didn't his patient think to call his own doctor when he had chest pain? Why didn't the ER contact Dr. "z" directly when the patient arrived at the hospital? We can do this ... Doctors can do this... I do this every day .... Patient should EXPECT that we will be there. How said that Dr. "z" didn't understand that he is the problem ... He is too busy writing letters in the Annals of Internal Medicine and not busy enough talking to his own patients...
And now .. today ... what a yucky one .. I just got off the phone with Sprint and Verizon ... I cancelled my accounts with Sprint and Verizon trying to consolidate all my phones on AT&T... I cover my dad's phone... etc. Long and short ... and you need to know this.. as soon as you pay your bill in full in order to "close the account," they re-open your account and re-bill you. Oh My .. and then they send you to collection. I am reporting this to the public utility commission.... I can't believe the swindle ....
so beware....
I think maybe it is the phone service that needs reform ! I know .. ain't goin' to happen ... but I can dream....
Onward...
You know what happens when a friend really "gets you." It is incredibly invigorating and at the same time painfully honest. So... Lu and were talking about my future and the future of Choice Care. Am I going to continue to pursue "marcy care" or can I step back .... and allow this "thing" to grow by brining others on board to join me in a more collaborative effort. Wow... it is so hard for me to give away any control. I didn't realize what how narcissistic I am. That's painful.
So I'm thinking on this one ... If I could just step back and open up ... maybe I could make a bigger difference. More to come.
The day ended when I read a column from the Annals of Internal Medicine ... entitled "Is There a Doctor in the Home?," written by Roy C Ziegelstein, MD. I was so angry that I called husband Lance from the car, screaming all the way home.
The story ... Dr. Ziegelstein wrote a column about his patient who emailed him from his hospital bed. The patient was in the hospital for evaluation of chest pain and this Dr. "z" (note little z) is his cardiologist. Dr. "z" thought it was so cute that his patient wrote him .. and that his patient had chosen this method of communicating with him. Dr. "z" went on to comment about the 47 million uninsured without a medical home and whether doctors will ever be able to coordinate care again. What? Why didn't Dr. "z" get off his bottom and go visit his patient? Why was his patient forced to see a hospitalist? Why didn't his patient think to call his own doctor when he had chest pain? Why didn't the ER contact Dr. "z" directly when the patient arrived at the hospital? We can do this ... Doctors can do this... I do this every day .... Patient should EXPECT that we will be there. How said that Dr. "z" didn't understand that he is the problem ... He is too busy writing letters in the Annals of Internal Medicine and not busy enough talking to his own patients...
And now .. today ... what a yucky one .. I just got off the phone with Sprint and Verizon ... I cancelled my accounts with Sprint and Verizon trying to consolidate all my phones on AT&T... I cover my dad's phone... etc. Long and short ... and you need to know this.. as soon as you pay your bill in full in order to "close the account," they re-open your account and re-bill you. Oh My .. and then they send you to collection. I am reporting this to the public utility commission.... I can't believe the swindle ....
so beware....
I think maybe it is the phone service that needs reform ! I know .. ain't goin' to happen ... but I can dream....
Onward...
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