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The Patient’s Wife Hates Me

July 9, 2014 Leave a comment

“You work hard all your life and when it comes time when you need help, you get tossed aside like an old rag”  That’s what the patient’s wife said to me when I told them I had to discharge them tomorrow.  My patient is dying of a terminal cancer, all his wife wants is an extra two days in the hospital.  She needs to work; they have nobody else.  It would be more convenient if he could be discharge two days later.  She could have the house cleaned and be there when he arrived from the hospital.  Sounds reasonable.  I said he couldn’t stay the extra two days.  He was medically stable for discharge.  I explained that his vitals and labs had all returned to normal.  The electrolyte disturbance he was admitted with had been corrected.  He was eating and walking more.  The therapists have all cleared him for discharge.  Hospice would be there to set up services and provide equipment for him when he got home.  All of this felt like yelling into the wind.  I could see the disappointment in her face.  The wife said, “Getting old is bad.  You work hard all your life and when your health fails, no one is there to help you.”  She felt abandoned, hurt.  She asked again if they could stay longer.  I had already done my homework.  I scoured the chart for every possible reason to keep the patient longer in the hospital.  Again, I said “no.”  I sat there in silence with both of them.  I contemplated whether to explain my position further.  I wanted to say, “Look, we’ve set up all these services for him.  We haven’t abandoned him.”  Most of all I wanted to say, “I’m sorry for failing you.”  Instead, I asked if they had any further questions.  Sensing defeat, they said “no”  I excused myself and left the room.

Oftentimes doctors and patients disagree on when they should be discharge.  Most patients want to leave ASAP but others want to stay longer.  The problem is Medicare or private insurance won’t pay for hospital days when patients are medically stable.  The patient can refuse to leave but they’ll end up paying for those extra days.  Charges will likely be in the tens of thousands of dollars.  Most families can’t afford to pay this.  The responsibility of determining medical stability is up to the physician.  I’d like to think that most docs provide compassionate care but they also can’t make up things up to keep their patients hospitalized longer.  Medicare fraud carries fines and jail time.  None of this matters to the dying patient and his wife.  He just asking for understanding and a little more time.  I have lots of the former but none of the latter for him.  What bothers me a great deal is that my patient doesn’t think I have either for him.

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Categories: Medical

Disgruntled worker

February 8, 2011 1 comment

I have a good job.  Decent pay, good schedule, and I get to help people.  Why did I travel to another state for a job interview?  The biggest reason is professional dissatisfaction.  I work for ‘The Man’.  Which is to say I am an employee of a large health system.  I am a cog in a massive health care company.  I feel more like a screw than a cog though.  Goals, deadlines, and required participation are sent down to us from administrative leadership.  Thou shall see this many patients in a year or your pay will be deducted.  Thou shall achieve high scores on patient satisfaction survey.  Thou shall attend meetings where you will be taught to be a more compassionate doctor.  As a person who spent 8 years in school, 4 years of residency training, and accumulated $200,000 in debt from schooling, I find being treated in such ways demeaning, and insulting.  My co-workers and I find being sent to learn to be more compassionate and empathetic degrading.  We have trained for years to take care of people.  Being told by a trainer who has not taken care of real patients to sit down, lean in, nod our heads while listening to a patient talk is maddening.  I’d like to say my company truly cares what patients thinks about our service, but instead it’s all about money.  Let me explain.  Part of the Affordable Care Act stipulates that health care organizations, hospitals, and doctors need to be held more accountable for the care they provide.  So Medicare payments will be linked to patient satisfaction results obtained through surveys.  I agree that patient satisfaction is important but why the sudden interest now when previous years the company had focused on decreasing length of stay (average number of days a patient is hospitalized), increasing case mix index (doing more expensive procedures, having sicker patients), and improving payer mix.  I find it hypocritical that the company is using patient satisfaction as a guise when their real motivation is improving reimbursements from Medicare.  It’s about improving the bottom line.  So I’ll trudge to training, and learn to listen more attentively so that maybe patients will give me good marks on the after hospitalization survey.  Quietly though, I’ll work to provide good care for my patients, survey or no survey.

Categories: Medical