1945 hrs -- Hospice consult in hospital emergency room (New Year's Eve)
"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..."
"WHY NOT, WHY NOT, WHY NOT!?!!"
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... "
"THAT'S NOT AN ANSWER! Give me an ANSWER! Why? WHY?!"
"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.
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