Wednesday, December 10, 2008

A Talk With a Doc


1900 hrs. -- I'm at the hospital on a consult for a prospective hospice patient. At the nurse's station, I sit near Mrs. L's primary physician as I study her chart.

"So, what do you do over at hospice?" asks Dr. S.

"Well, my primary duty is to take care of after hours emergencies", I reply."

"HAH!", laughs the doc. "What emergencies could hospice patients possibly have?"

I keep silent. A little anger is rising up within me. There is no way to respond to his thoughtless remark without betraying my feelings. I get up and go into Mrs L.'s room.

Earlier in the day, Dr. S. had ordered a Dilaudid drip for the patient. Running at a rate of 1 mg. per hour, it clearly is inadequate for Mrs L's pain. She's in agony. Her poor husband, sitting by her side, is suffering nearly as much as she. I immediately return to the nurse's station.

"Dr. S., could you please write titration orders on the IV Dilaudid so we can get her comfortable? The hospice won't be able to get her into an inpatient unit until tomorrow and her pain isn't under control yet."

The doc's eyes widen considerably. I instinctively know that he's hesitant -- no, he's afraid to increase the rate of the drip. "Noooo... I can't do that", he finally answers and gets up from the desk and walks briskly away.

Watching him leave, I raise my voice, "Why did you order Dilaudid if you weren't going to use it for her pain?"

He disappears into the elevator. Shit.

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14 comments:

Kit Courteney said...

Outcome?

Outcome!

dethmama said...

I'm sorry, Kit. The doc left me to "twist in the wind". Thought I'd do the same to the reader. Cruel, isn't it?

papercages said...

Doctors are good at that aren't they?

Cruel indeed. You are going to fix that right?

Christian Sinclair, MD said...

Excellent post. Linked to it in a post coming up tonight. What do you think about doing a monthly Palliative Care Grand Rounds?

Jessica Knapp said...

Oh, I'm angry just reading this post. You must have been fuming! How can people go into medicine and have so little sensitivity? I know it happens, but it doesn't make it any easier to hear about.

dethmama said...

@papercages...
Et tu tricia?
Sorry the ending leaves you hanging. Since I can't take out my frustration on the doc, I might as well let the reader suffer.

I guess it's like having a bad day at work and going home to kick the poor doggie.

dethmama said...

@Christian... thanks so much. Palliative Care Grand Rounds? I think it's a great idea! Let me know how I can help.

@Jessica...it's unimaginable how many people have gone into the medical field for all the wrong reasons. We all suffer for this.

Drew Rosielle MD said...

Re: the snarky comment about how can there be hospice emergencies. That one gets me going - how can there be palliative care emergencies? You get called at night about what?? Why would you have to come in on the weekend? Etc.
It 1) devalues what we do, 2) displays an astonishing naivete and cluelessness about palliative and hospice care, particularly around the reality that many patients receiving such care are dying, and dying patients tend to be sick, real bloody sick in fact, have rapidly changing statuses, and need rapid evaluation and management even if the goals of care are 'only' being comfortable in a safe place. Drives me nuts. Things are often a wee bit more challenging than hand-holding and Roxanol.

Anyway - just recently had this conversation with someone who should have known better, and it still exasperates me. Love the blog DM.

dethmama said...

@Drew...

I've lost count how many times I've had reactions like that regarding hospice/palliative care.

Which then raises a burning question for me (and please forgive my ignorance). Just how much education does the average med student get about the dying process and its management? Any?

soulsoprano said...

Oh, cripes what a prig! I have seen so many doctors take that attitude that it makes me crazy! It reminds me of the movie "Patch Adams", how some of the doctors were in their field just for the glory and the recognition, and didn't seem to give a crud about their patients' real needs! I thank God that for the most part, our hospice deals with doctors in the area that are kind and caring, and actually understand what hospice is all about!

dethmama said...

@soulsoprano...

Yes,it would be nice if everyone entered the field because it was their "calling". But then, we'd have darn few people in medicine, wouldn't we?

Gail Rae said...

"Shit!" Extremely appropriate. I find yet another aspect of this maddening...Here's a doctor who doesn't understand that being on Hospice does not diminish the possibility of emergencies, and yet he has created what would be considered a legitimate Hospice emergency for his patient through his devil-may-care consideration of his soon-to-be-a-Hospice-patient's pain crisis and his lackadaisical use of Dilaudid. Fie on him!
I'm hoping his patient soon escapes his incompetent clutches.

dethmama said...

You've completely hit the nail on the head! This MD created what is considered a legitimate emergency in the hospice field.

Anonymous said...

This is why I always tell patient's families and friends that it is much better to get hospice involved sooner, rather than later. Unfortunately, my father received inadequate pain medication thanks to a dr who was afraid to prescribe proper pain control to him, until we got him on hospice!