Sunday, January 18, 2009

A Talk With a Doc II

1945 hrs -- Hospice consult in hospital emergency room (New Year's Eve)

Telephone Conversation

"I see from your orders that you want Mrs S. to be admitted into an inpatient hospice unit. She just doesn't qualify for that right now..."


My God, he's screaming... I hold the phone out at arm's length. He's caught me completely by surprise. It's been a very long time since I've been on the receiving end of an MD's temper tantrum.

"Well, Mrs. S. just doesn't fit any of the criteria for admission. There are no symptoms to manage. She... "


"Look", I continue, "Mrs. S. is stable. Her vital signs are good. No more respiratory distress, her O2 sats and vital signs are fine, she's coherent and in no pain whatsoever. There's no reason for her to be admitted into the unit." (What's wrong with me? Why am I allowing his abusive behavior to continue?) I forge on ahead... "With her history of COPD, I'm sure she's appropriate to receive our services in her home. Just discharge her home and we can sign her up tomorrow."

"What does her family have to say?"

"There's no family with her right now", I reply.

"Well, of COURSE NOT! They're gone because they think she's going into a hospice bed. They can't take care of her anymore. Isn't THAT a reason for hospice admission?"

A not so pretty picture is coming together in my head... The family is out partying like rock stars right now on New Year's Eve because Dr. E. told them that she's going to live in a hospice until she dies. Great.

"Actually, Dr. E., my supervisors have told me that that hasn't been an acceptable reason for admission for over a year now. Listen, she's a Medicare patient, if you're so determined to have her go inpatient, you can try calling any other hospice in the city and have them come give her a look!"

"She's NOT Medicare, she's got "Senior Perks" coverage and only YOUR hospice can TAKE her!!"

Okay... I've had enough. Reaching deep within, I manage to find the tiny, "Testicle of Intestinal Fortitude". Clutching the little guy within my sweaty palm I say:

"Dr. E., it's common knowledge that anyone that has Senior Perks insurance also has Medicare coverage. But I imagine that it's so much easier to be abusive than informed, isn't it? This conversation is over and I'm giving the phone back to the Charge Nurse."

I hand the phone over to the RN. As I write a progress note detailing why the patient is not suitable for inpatient admission, I notice that the Charge Nurse is writing an order for another hospice to come in and evaluate the patient. Ah... the next hapless victim. I hope that they're able to find their "Testicle of Intestinal Fortitude" a lot faster than I did.

Click here to get the Joint Commission's take on bullying in the workplace.


Buck said...

What a dick. Jewel and I used to tell our incoming residents that anger is the last refuge of the incompetent. To raise your voice or abuse staff is a sign that you are weak and unsure of your own knowledge and skills to deal effectively as a physician. An angry doctor is a dangerously incompetent doctor - Michael DeBakey be damned.

Kit Courteney said...

I swear, you have the patience of a saint!

soulsoprano said...

LOL Dethmama! Regarding the strangely quiet night of superstition in your last post prior to this one...guess the "other shoe" finally dropped! LOL

Barbara K. said...

"Testicle of Intestinal Fortitude" - that's brilliant. I'm trying to think of all the times I could have used a concept like that.

PAM said...

OMG! I'm just catching up on reading your blog! I KNOW this doc! LOL! "Testicle of Intestinal Fortitude" is being added to my daily vocabulary!

Peter said...

G'day! Surely there are better ways to go about getting respite care for carers under the pump. The doctor should have known this. I can only hazard a guess that all his other avenues had been exhausted just like the hard working nurses and carers within the hospice that you work in.

Take Care,

dethmama said...

@ Buck... I tend to agree. People that interact with others using anger and arrogance are hiding something... usually incompetence.

@ Kit...oh, dear no. The older I get the less of that I have.

@ soulsoprano...yes, the universe always sorts itself out.

@ Barbara and PAM.. strangely enough the phrase came to me while in bed. Which happens to be a virtual desert for male genitalia.